ABSTRACT
India has a double disease burden of chronic infectious and non-communicable diseases (NCDs) like diabetes, cardiovascular diseases, cancers, chronic renal diseases, etc. The Covid-19 pandemic is putting a huge pressure and a profound impact on healthcare systems worldwide. According to WHO rapid survey, 122 countries reported that NCD services are disrupted. To assess treatment seeking behavior of patients with chronic diseases during Covid-19 pandemic a cross-sectional study was conducted among 174 patients with chronic diseases by telephonic interview at NEIGRIHMS, a tertiary care institute in the capital city of the north-eastern state of Meghalaya, Shillong. Of the total patients, 33.3% did not come for regular health visits to the hospital. Characteristics like age (≥60 years), low income (≤15000 Rupee per month), education (illiteracy) and place of stay (outside local district) were significantly associated with irregular health visits of the patients. Education on preventive measures of Covid-19 and improving chronic illness care services by the primary level health institutions including availability of essential drugs may reduce the loss to follow up among patients. Telemedicine services in the primary level health care centers can be used for availability of follow-up services during emergency situations.
ABSTRACT
Background In the struggle with COVID-19 pandemic, Pre-Hospital Emergency Healthcare Workers(PHE-HCW) are faced with a lot of problems. It is known that people with good psychological resilience(PR) levels could successfully cope with the problems. The study was aimed to evaluate the effectiveness of the psychological resilience training program in PHE-HCW. Objectives This intervention study conducted on PHE-HCW. In the study, when type 1 error(α) was taken as 5% and type 2 error(1-β) was taken as 95% and the effect size was accepted as 0.5, it was calculated that there should be at least 47 HCW in the groups.To minimizing the differences between groups, two groups were selected as intervention(n = 51) and control(n = 49) by applying propensity score matching analysis, taking into age, gender, occupation and working time. The questionnaire included questions of sociodemographic characteristics and the PR Scale(PRS).The questionnaire was applied to the both groups before the program and after four weeks of follow-up. The PRS consists of six subdimensions(structural style, future perception, family cohesion, personal strenghts, social competence, social resources), and it was accepted that psychological resilience increased as the score increased. The intervention group received video training on PR(self-awareness, hopefulness, optimism, etc.) whereas online classical training was applied to the control group. Results There was no difference in PR score between the intervention and control groups before the intervention(p > 0.05).The mean PR score±SD increased in both groups, for the intervention group from (67.2±18.2) to (80.3±12.4) and for the control group from (64.2±19.3) to (77.7±9.5).After the follow-up, positive changes were found in all subdimensions in the intervention group and in subdimensions except structural style and social competence in the control group(p < 0.05). Conclusions Psychological resilience training is effective in PHE-HCW during the pandemic period. Key messages Pre-hospital emergency healthcare workers need psychological resilience training during the pandemic process and this training program provides a positive change in healthcare workers. Psychological resilience training programs should be developed according to the needs of healthcare workers and added to in-service training.
ABSTRACT
Background Pandemic is a major global health threat in the present and the future as in the past. As Pre-Hospital Emergency Healthcare Workers (PHE-HCW) are at the front-line of pandemic, they should be well-equipped. The study was aimed to evaluate the knowledge, attitude and skills of PHE-HCW about pandemic preparedness. Methods This cross-sectional study conducted on 202 PHE-HCW selected by random sampling in Eskisehir. Of 40.6% the study group consisted of paramedic graduates of associate degree and 59.4% of emergency medical technicians (EMT) graduated from vocational high schools. A total of 111 cases were developed using the template of events for applied and critical healthcare simulation. The green (minor injuries), yellow (non-life-threatening injuries) and red (life-threatening injuries) coded COVID-19 positive cases were used to evaluate the simulated case scores of each participant. Each scenario consists of 6 steps (infection control measures, patient history-examination, medical treatment, diagnosis, communication, and delivering the patient to the healthcare institution) and 20 questions (min:0, max:40 points). The score that could be obtained according to the number of questions in the steps was standardized. Results Of 62.4% the study group was female and the mean age (SD) was 29.2 (5.5). The mean score (SD) that the study group had from the cases was 28.5 (5.6) in a green cases, 28.9 (5.6) in yellow cases, and 25.7 (6.5) in red cases.The mean score was lower in the red cases. Male than female (p = 0.001), paramedics than EMTs (p = 0.009) and those with 2-3 years of working time than those with one year of working time scored higher (p = 0.023). None of the participants obtained a full score in any of the steps, the highest score step was infection control measures (1.56), while the lowest score was medical treatment (1.27). Conclusions PHE-HCW have deficiencies at all steps, most notably at the medical treatment step. Key messages Pre-hospital healthcare workers’ pre-graduate education and professional experiences have an positive impact on their knowledge, attitudes and skills regarding the pandemic. In order to increase the pandemic preparedness in pre-hospital healthcare workers intensive training should be given in the first year of their professional life and its continuity should be provided.
ABSTRACT
Introduction: The pandemic caused by the Coronavirus Disease 2019 (COVID-19) has caused huge economic and health crisis. It is reported to have pulmonary sequelae which can overburden the healthcare systems. Survivors needing medical attention in the form of pulmonary rehabilitation should be prioritised. Aim: To study the impact of COVID-19 infection in terms of the pulmonary and extrapulmonary sequelae. Materials and Methods: This prospective observational study was carried out at a tertiary hospital in India. Recovered COVID-19 patients who were admitted from April to July 2020 were enrolled. Participants with radiological evidence of pneumonia during hospitalisation were assessed two months post-discharge. They were evaluated for persistent symptomatology, chest radiography, Six-Minute Walk Test (6MWT). The relationship between the outcome parameters with the baseline epidemiology, laboratory and radiology were evaluated by using student t-test, Mann-Whitney U test and multivariate logistic regression analysis. Results: Thirty participants were recruited. Their mean age was 47.93 years. Males were more than females. Persistent symptoms were reported by 17 (56.66%) and four (13.33%) developed pulmonary fibrosis on Chest X-Ray (CXR). Prolonged hospitalisation (mean >20 days) strongly correlated to the fibrosis (p=0.022). A fall in the finger oxygen saturation after the 6MWT was significant (p≤0.001). Higher serum levels of lactate dehydrogenase and D-dimer were associated with a more severe disease (p=0.02 and p≤0.001, respectively). Conclusion: Convalescent phase of COVID-19 is characterised by persistent symptomatology in half of the recovered patients. Simple and inexpensive CXRs and the 6MWT can be used as the primary investigation to identify post COVID-19 patients requiring pulmonary rehabilitation in resource limited settings.