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Introduction: Mental, physical, and cognitive impairments are common after an intensive care unit (ICU) stay. It remains unknown to what extent the extraordinary increase in bed occupancy during the pandemic could be linked to the severity and frequency of patient's impairments. Objective: To determine the frequency, severity, and risk factors for mental, physical, and cognitive impairments at ICU discharge during high and low bed occupancy periods. Methods: Prospective cohort study in seven Chilean ICUs (ClinicalTrials.gov Identifier: NCT04979897). We included adults, mechanically ventilated >48 hours in the ICU who could walk independently prior to admission. Trained physiotherapists assessed the Medical Research Council Sum-Score (MRC-SS), Montreal Cognitive Assessment (MOCA-blind), Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale-Revised (IES-R), and the World Health Organization Disability Assessment Schedule (WHODAS 2.0) at ICU discharge. Pre-admission employment status, educational level, and Clinical Frailty Scale (CFS) were also collected. We compared periods of low and high bed-occupancy, defined as less or more than 90% of staffed ICU beds occupied. We used t-test for normally distributed, Mann-Whitney for those not normally distributed, and chi-square for categorical variables. We explored risk factors for mental, physical, and cognitive impairments using logistic regression adjusted for age, sex, educational level, and bed occupancy. Analyses were performed in Stata/SE 16.0. Results: We included 192 patients with COVID-19 of which 126 [66%] were admitted during a high bedoccupancy period (January to April 2021). Majority were male (137 [71%]) and worked full-time (127 [66%]). Median [P25-P75] age was 57 [47-67], length of ICU stay was 15[ 11-27] days, and duration of mechanical ventilation (MV) was 9 [6-16.5] days. Seven (4%) patients were clinically frail, 65 (34%) had ICUacquired weakness (ICU-AW), 134(70%) had cognitive impairment, 122 (64%) had post-traumatic stress symptoms (PTSS), 53 (28%) had depressive symptoms, 106 (55%) had anxiety symptoms, and 148 (77%) had severe disability. Table 1 shows the combined prevalence of physical and mental health problems. Patients admitted during the high-occupancy period were younger (mean 54, 95% confidence interval [47, 61] vs 61 [58, 64]), more likely to have a higher education qualification(HEQ) (OR 1.67 [0.9, 3.06]), and had a shorter duration of MV (8 [6-13] vs 13 [8-34];p<0.001) and ICU stay (13 [10-19] vs 21.5 [13-42];p<0.001). Mental, physical, and cognitive impairments were similar in low and high occupancy periods. Patients with a HEQ were less likely to have ICU-AW (OR 0.23 [0.11, 0.46]), cognitive impairments (OR 0.26 [0.11, 0.6]), symptoms of depression (OR 0.45 [0.22, 0.9]) or anxiety (OR 0.26 [0.13, 0.5]), and severe disability (OR 0.4 [0.18, 0.94]). Females were more likely to have ICU-AW (OR 2.4 [1.13, 4.93]). Older patients were less likely to suffer PTSS (OR 0.97 [0.94, 0.99] per year old). Conclusions: Majority of patients had at least one mental, physical or cognitive impairment being similar by bed occupancy. Having a higher education qualification was the main protective factor for impairments at ICU discharge. Preventative treatments programmes should target patients with <12 years of education.
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this article presents considerations related to the evaluation of university professors from Colombia, Mexico and Peru who participated in a training course in virtual modality, in the context of COVID 19 pandemic. This is a mixed-approach study, including information collected through a survey, validated by peers of experts, which researched aspects of the evaluation applied in an asynchronous modality virtual learning environment. An interpretative analysis was used for information processing. At a quantitative level, the reliability indicators principal component, analysis technique, was considered to determine the evaluation variables. The results indicate that traditional assessment prevails, but changes in its foundation and implementation are needed. Four variables were identified: routine assessment, crisis routine assessment, continuous and formative assessment, and evaluation with technological resources. The main conclusion is that the situation forced by the pandemic in education has challenged evaluation control, which generates a reflection to the group of teachers on this matter.
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Background/Purpose: The physical effects of clefting can obscure the psychosocial aspects of the disease. With this in mind, the idea for a unique mental health booklet arose. 9 Reasons to Smile: Family Fun Activity Booklet was developed when Smile Train international programs suspended all cleft treatment for patients at the height of the COVID-19 pandemic. Patients could not receive cleft surgery and other nonsurgical treatments, such as nutritional support, orthodontic care, dental care, psychosocial care, and speech therapy, to ensure long-term, successful rehabilitation. Suspension of cleft treatment poses significant challenges for children and families. Recognizing these challenges, Smile Train developed this booklet to raise awareness for psychosocial health as it is not readily accessible or prioritized around the world. The booklet includes art projects on self-love, engaging games to help children explore their emotions, their relationships, and their self-confidence. Methods/Description: The booklet was developed with support from Fundaci'on Cl'inica Noel, a Smile Train Partner in Colombia. It was first launched in English, French, and Spanish during the World Health Organization Walk the Talk Virtual Event on May 17, 2020. A global launch for the booklet in 10 languages took place on June 17, 2020. To further increase awareness for psychosocial health, Smile Train hosted a live, virtual celebration of 9 Reasons to Smile on July 21st and Smile Train Brazil and Mexico participated in their own local celebrations. The event convened representatives from the global health and global cleft communities to discuss art, health, clefts, and the importance of maintaining self-esteem and positivity through adversity. Results: The booklet is now available in 15+ languages and is shared through WhatsApp messaging platforms worldwide. The global virtual celebration had over 4000 views on Facebook and YouTube, and its reach continues to grow. Smile Train has received thousands of photos and stories from families and partners sharing their experiences using the booklet and its tremendous impact on their lives. The overwhelming response confirms the demand for programs and resources that focus on cleft patients and their psychosocial health needs. Conclusions: There is a need for supporting psychosocial services in global cleft care which is particularly evident during the COVID-19 pandemic. Access to these services is not always prioritized in many countries around the world and the enthusiasm for the 9 Reasons to Smile booklet indicates the positive impact such resources have on mental health. Smile Train is committed to raising awareness on the importance of psychosocial health in global cleft care and will continue to support and scale initiatives for cleft patients and their families around the globe.
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The pediatric population is a contagion fuel for SARS CoV-2, putting health care workers at risk. Exposure to respiratory droplets and aerosols are a major cause of disease transmission during airway procedures. Crying, coughing, laryngospasm, airway obstruction and hypoxia, which are more frequent in children than adults, directly or indirectly increase aerosol production and hence the risk of transmission to health workers. We present recommendations for the perioperative management of children suspected or confirmed positive for COVID-19, with the aim of reducing the risk of infection in these patients and in the healthcare team.
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Purpose/Context. According to the history of previous epidemics, and in the context of the current emergency caused by COVID-19, it is a priority to carry out research and create biobanks or biorepositories. These allow accessing samples and information to understand the disease, formulate interventions, and evaluate the safety and efficacy of examinations, diagnostic tests, treatments, vaccines, and management strategies. Although research during significant public health emergencies is essential, studies on human beings in these cases must have higher ethical guarantees than ordinary situations. Method/Approach. This review includes literature related to regulations and legislation, biobanks, sample collections, and their relevance to the context of the pandemic. Results/Findings. Accelerated sample collection and the establishment of biobanks have been typical during this pandemic, which induces the adoption of sample management guidelines with major ethical, legal, and social differences among countries. Discussion/Conclusions/Contributions. This review comprises reflections on the establishment and use of biobanks during the pandemic that is currently afflicting the world.