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Background The COVID-19 pandemic has severely impacted older people. The disease and the measures to combat it have had a differential impact according to gender, with higher mortality rates in men and worse psychological and social consequences in women. The objective of this work is to analyze the changes in perceived health of older people in Europe during the first months of the pandemic and to assess the combined role of age and gender. Methods Wave 8 data of SHARE-corona (Survey of Health, Aging and Retirement in Europe) (n = 51,695, aged≥50) collected between Jun-Aug 2020 were used. Perceived health status was explored with a question on whether there has been a change compared with the health status before the COVID-19 outbreak (response options: worse, the same and better). Two-way ANOVA with interaction and Student's t-test with Bonferroni correction were used to compare the effects of gender and age group (50-59 years, 60-69 years, 70-79 years, and ≥80) in changes in perceived health. Results Differences in perceived health were observed by age, as well as by gender in participants aged ≥70 years (F = 91.94;p < 0.001). These differences were significant both by gender (F = 19.39;p < 0.001) and age (F = 191.79;p < 0.001). No interaction was detected between both factors (p = 0.170), which allowed their effect to be studied individually. Among the people who reported a worsening in their perceived health, women aged 70 to 79 years predominated (11.1%), followed by men aged 80 and over (15.3%) and women of the same age group (16.4%). Conclusions The results suggest an association between the change in perceived health during the pandemic and age. Women have a slightly worse health status than men in all age groups. Therefore, gender can be considered as an influential factor in perceived health in old age, which in turn can have a potential impact in the quality of life of older people. Funding Projects Ref. H2019/HUM-5698 and Ref. 202010E158. Key messages Older people have been severely impacted by COVID-19 pandemic. The combined effect of age and gender on the change in perceived health status during the pandemic have been analyzed.
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Purpose/Objectives: Patients with Limited English proficiency (LEP) are at greater risk for hospital admissions and representations to the emergency department (ED) in comparison to patients with English proficiency (EP). Improved communication with language services has been shown to decrease these health disparities. In our free-standing Children's Hospital yearly ED representation rates for patients with LEP (4.6%) are over 20% higher than for our patients with EP (3.7%). We aimed to decrease the 7-day representation rate for patients with LEP in the emergency department by 20% over 18 months using the Plan Do Study Act (PDSA) method for quality improvement. Design/Methods: Our first cycle was the deployment of video remote interpretation (VRI). Second and third cycles included focused teaching for Faculty, House staff and staff on VRI use. PDSA cycles were interrupted with the unexpected event of Covid-19 and issues obtaining Cerner data. We evaluated outcomes quantitatively based on data from our language service provider and electronic medical record (EMR). We also conducted an electronic survey of Faculty and Staff to evaluate quantitatively over time VRI reception and frequency of obtaining preferred language. Results: LEP representation rates initially increased followed by a decreasing trend with the Covid19 pandemic and opening of an ED observation unit but this trend was not sustained and average representation rates after PDSA cycles increased to 6.1%. EP representation rates overall remained unchanged at 3.7%. Utilization of interpretation carts increased from 0 to >250 total calls made per month over the course of 18 months. The monthly average number of identified patients with LEP decreased after changes were made to the recording system in the EMR. Monthly rates of interpretation carts used for un-identified patients with LEP were found to range from 27% to 78%, signifying significant under identification in the EMR. 75% of ED Faculty and staff reported that they only ask preferred language or offer interpretation services for medical discussions infrequently when patients appear to speak English well but is clearly not their native language. Total ED visit numbers decreased after March of 2020 to 30-50% of expected due to Covid-19 pandemic. Conclusion/Discussion: ED Patients with LEP had an unexpectedly high rate of un-identification in addition to ED faculty and staff reporting not asking preferred language if the patient seems to speak English well. This has likely led to an underestimation of our LEP representation rate and lack of representative change during our PDSA cycles. Without identifying this vulnerable population, we will always be lacking in providing care in the preferred language which is critical for improving outcomes for our patients with LEP. Our next steps are to develop interventions to increase the identification of patients with LEP to provide safe and comprehensive care for this vulnerable population.
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Those in positions of leadership are accustomed to having to deal with complex and uncertain situations. However, the on-going COVID-19 pandemic has taken this challenge to a new level of complexity. Although econometric models are being used to predict economic scenarios relating to the fall-out from the pandemic, these forecasts do not factor-in the uncertainty generated by new changes announced weekly by policymakers. The aim of the present study is therefore to apply a fuzzy approach to develop a method for providing consistent and reliable forecasting scenarios that facilitate managers’ and policymaker’s decision-making in complex and uncertain situations. The chosen context of the study is the case of the potential consequences of COVID-19 for the international tourism sector in Spain, using fuzzy cognitive maps. This semi-quantitative model can help researchers to forecast the potential impact of major events in fuzzy or uncertain environments by constructing flexible and adaptable scenarios. © 2021 Informa UK Limited, trading as Taylor & Francis Group.
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RATIONALE COVID-19 infection has affected 5 million lives, resulting in over 300,000 deaths worldwide. Those with respiratory failure requiring mechanical ventilation (MV) make up less than 10% of individuals, but account for the majority of fatalities.(1) Exploring characteristics of those extubated, strategies for treatment and resource allocation can be potentially implemented. METHODS A retrospective review of the initial 33 adult patients positive for COVID19 admitted to EHC, with respiratory failure and extubated from 3/8/2020 to 5/8/2020 was performed. Clinical characteristics were evaluated descriptively. RESULTS Successfully extubated patients averaged 56 years of age, males made up 91% of the population. Average BMI was 28.2 and hemoglobin A1C was 6.26. The mean maximum creatinine was 4.39 and max procalcitonin was 26. Mean admission and maximum D-dimer levels were 5,349 and 12,450 respectively, while mean admission CRP was 204. The mean days on nasal cannula, non-rebreather and CPAP prior to intubation were 5, 4, and 3, respectively, with overall mean time to intubation of 11.9 days and average length of stay of 20.6 days. The mean minimum PaO2 was 57.7 (most often on 100% FiO2) and max mean PEEP was 12.7. Total sedation days and total pressors days were calculated giving each pressor or sedative used the equivalence of 1 to provide an estimate of sedative and pressor requirements. The mean number of pressor days was 9.8;with a mean number of sedative days as 28. Survival after extubation at time of analyses was (21/33) 63%. CONCLUSION These results signal that these initial extubated patients were quite hypoxic and ventilated with a low PEEP strategy deviating from those suggested by surviving sepsis guidelines. They were in a hyperinflammatory state with moderate renal failure and propensity for infection, however, perhaps the BMI, low A1C scores, relatively fast decline in D dimers and ventilation with low PEEP strategy allowed them to be mechanically liberated. Classifying patient demographics and disease severity early can help identify patients likely to achieve successful extubation. The duration of preintubation oxygen support, duration of intubation, ideal vent settings, and realistic sedative requirements should be explored to optimize successful MV and extubation strategies.
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INTRODUCTION: SARS-CoV-2 was first detected in December 2019 in the Chinese city of Wuhan and has since spread across the world. At present, the virus has infected over 1.7 million people and caused over 100 000 deaths worldwide. Research is currently focused on understanding the acute infection and developing effective treatment strategies. In view of the magnitude of the epidemic, we conducted a speculative review of possible medium- and long-term neurological consequences of SARS-CoV-2 infection, with particular emphasis on neurodegenerative and neuropsychiatric diseases of neuroinflammatory origin, based on the available evidence on neurological symptoms of acute SARS-CoV-2 infection. DEVELOPMENT: We systematically reviewed the available evidence about the pathogenic mechanisms of SARS-CoV-2 infection, the immediate and lasting effects of the cytokine storm on the central nervous system, and the consequences of neuroinflammation for the central nervous system. CONCLUSIONS: SARS-CoV-2 is a neuroinvasive virus capable of triggering a cytokine storm, with persistent effects in specific populations. Although our hypothesis is highly speculative, the impact of SARS-CoV-2 infection on the onset and progression of neurodegenerative and neuropsychiatric diseases of neuroinflammatory origin should be regarded as the potential cause of a delayed pandemic that may have a major public health impact in the medium to long term. Cognitive and neuropsychological function should be closely monitored in COVID-19 survivors.