Effects of COVID-19 Lockdown on Nutritional, Functional and Frailty Biomarkers of People Living in Nursing Homes. A Prospective Study.

BACKGROUND: Nursing home residences suffered a lockdown from the beginning of the COVID-19 pandemic. The present study prospectively evaluates the frailty, functional, and nutritional statuses of nursing home residents. METHODS: Three hundred and one residents from three nursing homes took part in the study. Frailty status was measured using the FRAIL scale. Functional status was evaluated using the Barthel Index. Additionally, Short Physical Performance Batter (SPPB), SARC-F, hand-grip strength, and gait speed were also evaluated. Nutritional status was determined using the mini nutritional assessment test (MNA) and several anthropometrical and biochemical markers. RESULTS: Mini Nutritional Assessment test scores decreased in 20% throughout the confinement (p < .001). Barthel index, SPPB and SARC-F scores also decreased, although to a lesser extent, reflecting a decrease in functional capacity. However, both anthropometric parameters, hand grip strength and gait speed, remained stable throughout confinement (p > .050 in all cases). Morning cortisol secretion significantly decreased by 40% from baseline to post-confinement. A significant reduction in daily cortisol variability was observed, which may suggest increased distress. Fifty-six residents died during the period of confinement (81.4% survival rate). Sex, FRAIL and Barthel Index scores were significant predictors of resident survival. CONCLUSION: After the first COVID-19 blockade, several alterations in residents' frailty markers were observed, which were small and potentially reversible. However, many of the residents were pre-frail after the lockdown. This fact highlights the need for preventive strategies to reduce the impact of future social and physical stressors on these vulnerable individuals.

Psychosocial changes during COVID-19 lockdown on nursing home residents, their relatives and clinical staff: a prospective observational study.

BACKGROUND: Previous works have observed an increase of depression and other psychological disorders on nursing home residents as a consequence of coronavirus disease 2019 (COVID-19) lockdown; however, there are few studies that have performed a comprehensive evaluation of all people involved in nursing homes environment. The objective of the work was to analyse the impact of lockdown on psychosocial factors of nursing home residents, relatives and clinical staff and how these variables have influenced residents' survival. METHODS: A prospective study was designed. Evaluations were performed at three different times: a) at the beginning of Spanish confinement, in March 2020; b) just before the second wave of the pandemic, with relaxation of security measures but in lockdown, and c) in January-February 2021, at the end of the second wave, when visits were already allowed. The study was conducted on three different nursing homes. Three hundred and one residents, 119 clinical staff and 51 relatives took part in the study. Anxiety and depression were evaluated in all participants. A scale on the meaning of suffering was also performed. In addition, burnout status was also determined in the clinical staff. RESULTS: All participants showed lower depression during lockdown, while at the beginning and at the end of the confinement, these values were significantly increased. In residents, these changes were dependent of cognitive status (p = 0.012). Anxiety was significantly higher in residents. The evolution of anxiety was similar than with depression, with lower values during confinement, although clinical staff showed higher anxiety levels at the beginning. The feeling of suffering was significantly lower in the clinical staff than in resident and relative groups. Residents' survival was dependent of cognitive status (p = 0.018) and voluntary confinement (p < 0.001). CONCLUSIONS: During the first COVID-19 lockdown, psychological wellbeing of residents cared in nursing homes, their relatives and staff did not seem to be seriously affected. Previous mental health in relatives and staff together with a resilient approach to the adversity might partly be protecting factors. The lack of consequences on residents' anxiety, depression and perception of social support may reflect the special attention and care they received. Finally, as in the current study only data of the first two COVID-19 waves were analysed, its findings might be partly generalized to all the pandemic.

Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study.

OBJECTIVES: The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patients awaiting surgery. DESIGN: This was an observational retrospective study. SETTINGS: A tertiary-level multicentre study of neurosurgery activity between 1 March and 30 June 2020. PARTICIPANTS: A total of 680 patients awaiting any scheduled neurosurgical procedure were enrolled. 470 patients (69.1%) were awaiting surgery because of spine degenerative disease, 86 patients (12.6%) due to functional disorders, 58 patients (8.5%) due to brain or spine tumours, 25 patients (3.7%) due to cerebrospinal fluid (CSF) disorders and 17 patients (2.5%) due to cerebrovascular disease. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was mortality due to any reason and any deterioration of the specific neurosurgical condition. Second, we analysed the rate of confirmed SARS-CoV-2 infection. RESULTS: More than one-quarter of patients experienced clinical or radiological deterioration. The rate of worsening was higher among patients with functional (39.5%) or CSF disorders (40%). Two patients died (0.4%) during the waiting period, both because of a concurrent disease. We performed a multivariate logistic regression analysis to determine independent covariates associated with maintaining the surgical indication. We found that community SARS-CoV-2 incidence (OR=1.011, p<0.001), degenerative spine (OR=0.296, p=0.027) and expedited indications (OR=6.095, p<0.001) were independent factors for being operated on during the pandemic. CONCLUSIONS: Patients awaiting neurosurgery experienced significant collateral damage even when they were considered for scheduled procedures.

Análisis de Estados Financiero, como enfoque en la toma de decisiones, en épocas de pandemia, basado en sistemas informáticos

: Analysis applied in this research aimed to analyze the commercial transactions passed by the pandemic to prevent the future, the methodology started from the positivist research paradigm, type of research, non-experimental and crosssectional field design with documentary support, research level descriptive, the population was 77,289 and the sample of 471, within which 35 industrial companies from the region 6 of the Austro were focused, controlled by the super companies, the questionnaire instrument was validated through the judgment of three experts with experience in the area of accounting, entrepreneurship and methodology, qualifying clarity, coherence and relevance. Regarding the cash conversion cycle for 2020, it was 150 days late to generate cash in the generation of money in companies, likewise the profit margin for the same year was 13.35%, this ratio Financial was lower compared to the previous years 2019 and 2018, that is to say, the profit that the company achieves after deducting the operating costs were reduced, Conclusion. Keywords: Self-sustainability, COVID-19, Industry, Financial Ratios, Financial Information. 1.Introducción El COVID-19, ha tenido un impacto devastador en el Ecuador, la pandemia y la fuerte caída de los precios del petróleo han planteado un gran desafío para la economía ecuatoriana y han generado significativas limitaciones financieras, ante esto, el gobierno nacional toma medidas decisivas para contener la propagación del virus y mitigar el impacto socioeconómico generado por la crisis de salud en los hogares y las empresas, al tiempo que prioriza financiar los sistemas de asistencia social y de salud, de ahí que la información financiera es vital en la administración y conocimiento de las empresas. Las inversiones de uso de los activos, se determinan a partir análisis del balance general, de tal manera, que se calculan las variaciones de aumentos y disminuciones de los activos, pasivos y el patrimonio de un periodo anterior;y por otra parte, los pasivos y patrimonio, que implica el financiamiento, es decir;la fuente u orígenes de recursos cuando disminuyen los activos o aumentan los pasivos y el patrimonio, así por ejemplo, recoger una inversión, el recaudo de cartera de clientes, la venta de inventarios o propiedad planta y equipo, adquirir nuevas obligaciones financieras, tener un mayor nivel de endeudamiento o emitir acciones.

Respiratory drive, inspiratory effort, and work of breathing: review of definitions and non-invasive monitoring tools for intensive care ventilators during pandemic times. / Impulso, esfuerzo y trabajo respiratorio: revisión de definiciones y herramientas no invasivas de ventiladores de cuidados intensivos durante tiempos de pandemia.

Technological advances in mechanical ventilation have been essential to increasing the survival rate in intensive care units. Usually, patients needing mechanical ventilation use controlled ventilation to override the patients respiratory muscles and favor lung protection. Weaning from mechanical ventilation implies a transition towards spontaneous breathing, mainly using assisted mechanical ventilation. In this transition, the challenge for clinicians is to avoid under and over assistance and minimize excessive respiratory effort and iatrogenic diaphragmatic and lung damage. Esophageal balloon monitoring allows objective measurements of respiratory muscle activity in real time, but there are still limitations to its routine application in intensive care unit patients using mechanical ventilation. Like the esophageal balloon, respiratory muscle electromyography and diaphragmatic ultrasound are minimally invasive tools requiring specific training that monitor respiratory muscle activity. Particularly during the coronavirus disease pandemic, non invasive tools available on mechanical ventilators to monitor respiratory drive, inspiratory effort, and work of breathing have been extended to individualize mechanical ventilation based on patients needs. This review aims to identify the conceptual definitions of respiratory drive, inspiratory effort, and work of breathing and to identify non invasive maneuvers available on intensive care ventilators to measure these parameters. The literature highlights that although respiratory drive, inspiratory effort, and work of breathing are intuitive concepts, even distinguished authors disagree on their definitions.

Los avances tecnológicos de la ventilación mecánica han sido parte esencial del aumento de la sobrevida en las unidades de cuidados intensivos. Desde la conexión a la ventilación mecánica, comúnmente se utiliza ventilación controlada sin la consecuente participación de los músculos respiratorios del paciente, con el fin de favorecer la protección pulmonar. El retiro de la ventilación mecánica implica un periodo de transición hacia la respiración espontánea, utilizando principalmente ventilación mecánica asistida. En esta transición, el desafío de los clínicos es evitar la sub y sobre asistencia ventilatoria, minimizando el esfuerzo respiratorio excesivo, daño diafragmático y pulmonar inducidos por la ventilación mecánica. La monitorización con balón esofágico permite mediciones objetivas de la actividad muscular respiratoria en tiempo real, pero aún hay limitaciones para su aplicación rutinaria en pacientes ventilados mecánicamente en la unidad de cuidados intensivos. Al igual que el balón esofágico, la electromiografía de los músculos respiratorios y la ecografía diafragmática son herramientas que permiten monitorizar la actividad muscular de la respiración, siendo mínimamente invasivas y con requerimiento de entrenamiento específico. Particularmente, durante la actual pandemia de enfermedad por coronavirus se ha extendido el uso de herramientas no invasivas disponibles en los ventiladores mecánicos para monitorizar el impulso (drive), esfuerzo y trabajo respiratorio, para promover una ventilación mecánica ajustada a las necesidades del paciente. Consecuentemente, el objetivo de esta revisión es identificar las definiciones conceptuales de impulso, esfuerzo y trabajo respiratorio utilizadas en el contexto de la unidad de cuidados intensivos, e identificar las maniobras de medición no invasivas disponibles en los ventiladores de cuidados intensivos para monitorizar impulso, esfuerzo y trabajo respiratorio. La literatura destaca que, aunque los conceptos de impulso, esfuerzo y trabajo respiratorio se perciben intuitivos, no existe una definición clara. Asimismo, destacados autores los definen como conceptos diferentes.

Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: a nationwide study in Spain.

OBJECTIVE: To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain. SETTINGS: The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied. PARTICIPANTS: This was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020. INTERVENTIONS: An exploratory factorial analysis was performed to select the most relevant variables of the sample. PRIMARY AND SECONDARY OUTCOME MEASURES: Univariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection. RESULTS: Sixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/105 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade ≥3 (OR 2.5) and preoperative GCS 3-8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/105 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated. CONCLUSIONS: Perioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/105 people/week) was a statistically independent predictor of mortality. TRIAL REGISTRATION NUMBER: CEIM 20/217.

Towards Covid-19 Literacy: Investigating the Literacy Levels of University Students in Colombia.

Covid-19 literacy, induced by the coronavirus disease (2019), is characterized as the understanding of Covid-19 as well as informed decisions based upon this understanding. This type of literacy is closely related to health literacy, scientific literacy, and scientific media literacy. It may be obvious to say that Covid-19 literacy is a key factor for governments to effectively manage the Covid-19 transition. However, lack of literature exists about Covid-19 literacy among university students. Therefore, the current study aimed to determine the Covid-19 literacy level among 4168 students from a Colombian university. The data were derived from students' responses to a 25-item anonymous online self-reporting questionnaire. We found that 21-25-year age group, graduate students, students enrolled prior to 2015, and medical students had a significantly higher mean score. Moreover, the Internet (86.8%) was the most popular source of information from which participants gained most information regarding Covid-19. Furthermore, 58.5% of the participants considered health workers as a source that can provide accurate information. Most importantly, the findings reveal the students' knowledge about (1) the role of an eventual process of vaccination, (2) the test currently used as diagnostic for Covid-19, and (3) the fatality rate, three aspects of Covid-19 literacy that deserve more attention. The findings provide a useful basis for the formulation of policies and concrete actions in improving Covid-19 literacy.

Using Historical Scientific Controversies to Promote Undergraduates' Argumentation.

The Covid-19 pandemic is the reason why humanity is paying more attention to the importance of regular and rigorous handwashing. Interestingly, in the nineteenth century, regular and rigorous handwashing was a key (and controversial) solution proposed by the Hungarian obstetrician Ignaz Philipp Semmelweis to cut drastically cases of puerperal fever. The purpose of this study was to provide evidence that the case of Semmelweis and puerperal fever-a crucial historical scientific controversy-can be used as a springboard to promote university student argumentation. Our study was inspired by the fact that the Organization for Economic and Cooperative Development (OECD) stressed that more efforts and resources should be invested in promoting argumentation as an essential component for scientifically literate citizens in twenty-first century societies. However, nowadays, argument and debate are virtually absent from university science education. The data was derived from 124 undergraduates' (64 females and 60 males, 15-30 years old) written responses and audio and video recordings in a university biology course in Colombia. The findings show that the articulation of this historical controversy with decision-making, small-group debate, and whole-class debate activities can be useful for promoting undergraduates' argumentation. This study contributes to the development of a research-based university science education that can inform the design of an argumentation curriculum for higher education.