Validation of a Satisfaction Scale with a Telemedicine COVID-19 Service: Satis-COVID.

Objectives: Despite being a widespread tool, telehealth was significantly incorporated during the COVID-19 pandemic period, but it still lacks analysis methodologies, greater digital security, and satisfaction assessment instruments that are still little explored and validated. The objective is to assess user satisfaction through the validation of a satisfaction scale with a telemedicine COVID-19 service (TeleCOVID). Methods: Cross-sectional study of a cohort of confirmed COVID-19 cases evaluated and monitored by the TeleCOVID team. To study the scale's measurement qualities, a factorial analysis was performed to test the validity of the construct. Correlation between items and the global scale was assessed using Spearman's correlation coefficient, and the instrument's internal consistency was assessed using Cronbach's alpha coefficient. Results: There were 1,181 respondents evaluating the care received from the TeleCOVID project. A total of 61.6% were female, and 62.4% aged between 30 and 59 years. The correlation coefficients indicated a good correlation between the items present in the instrument. The internal consistency of the global scale was high (Cronbach's alpha = 0.903) and the item-total correlations for the scale ranged from 0.563 to 0.820. The average overall user satisfaction was 4.58, based upon a 5-point Likert scale where 5 is the highest level of satisfaction. Conclusions: The results presented here show how much telehealth can contribute to improving access, resolutibility, and quality of care to the population in general in Public Health Care. In view of the results found, it can be said that the TeleCOVID team offered excellent care and fulfilled its proposed objectives. The scale fulfills its objective of evaluating the quality of teleservice, bringing good results in terms of validity and reliability, in addition to showing high levels of user satisfaction.

Children wearing face masks to prevent communicable diseases: scoping review.

OBJECTIVE: To identify and synthesize scientific evidence that the use of face protection masks by children, in the community and at home, is a way of preventing communicable diseases. DATA SOURCE: A scoping review was made using the Joana Briggs Institute method and PRISMA-ScR. A research was carried out in five electronic databases, at the Cochrane Library and on seven websites of governmental and non-governmental institutions. The data were organized in a spreadsheet and submitted to narrative analysis. DATA SYNTHESIS: Initially, 658 productions were identified, of which 19 made up the final sample. Studies with higher levels of evidence are scarce. The types of masks identified were professional (surgical and facial respirators with filtration) and non-professional (homemade). The transmissible agents studied were influenza and SARS-CoV-2 viruses, and the evaluated environments were schools, homes and community spaces. The main discomforts reported were heat, shortness of breath, headache and maladjustment to the face. The indication and acceptability of masks change according to the age group and clinical conditions. There is no consensus on the reduction in the transmissibility of infections. CONCLUSIONS: Children older than five can benefit from the correct use of masks, as long as they are supervised, taught and educated to do so and the masks should be well adjusted to the face. The use of masks show better results when associated with other measures such as physical distancing, keeping places ventilated and frequent hand hygiene.

Synchronous teleconsultation and monitoring service targeting COVID-19: leveraging insights for post-pandemic healthcare.

BACKGROUND: Although a great number of teleconsultation services have been developed during COVID-19 pandemic, studies assessing usability and healthcare provider satisfaction are still incipient. OBJECTIVE: To describe the development, implementation and expansion of a synchronous teleconsultation service targeting patients with symptoms of COVID-19 in Brazil, as well as to assess its usability and healthcare professionals' satisfaction. METHODS: This mixed-methods study was developed in five phases: (i) identification of components, technical and functional requirements and system architecture; (ii) system and user interface development and validation; (iii) pilot testing in the city of Divinópolis; (iv) expansion in the cities of Divinópolis, Teófilo Otoni and Belo Horizonte for Universidade Federal de Minas Gerais faculty and students; (v) usability and satisfaction assessment, using Likert scale and open-ended questions. RESULTS: During pilot development, problems to contact users were solved by introducing standardized text messages (SMS) sent to them to obtain their feedback and keep track of them. Until April, 2022, the expanded system achieved 31,966 patients in 146,158 teleconsultations. Teleconsultations were initiated through chatbot in 27,69% of cases. Teleconsultation efficiency per city was 93.7% in Teófilo Otoni, 92.4% in Divinopolis, and 98.8% in Belo Horizonte (university campus), avoiding in-person assistance for the great majority of patients. 60 healthcare professionals assessed the system's usability as satisfactory, despite a few system instability problems. CONCLUSIONS: The system provided updated information about COVID-19 and enabled remote care for thousands of patients, which evidenced the critical role of telemedicine in expanding emergency services capacity during the pandemic. The dynamic nature of the current pandemic required fast planning, implementation, development and updates in the system. Usability and satisfaction assessment was key to identifying areas for improvement. The experience reported here is expected to inform telemedicine strategies to be implemented in a post-pandemic scenario.

Glycaemic control during the COVID-19 pandemic: A catastrophe or a sign of hope for the person with type 1 Diabetes Mellitus? Control glucémico en tiempos de pandemia por COVID-19: ¿Una catástrofe o un signo de esperanza para la persona con diabetes mellitus tipo 1?

Introduction In a person with type 1 diabetes, any change concerning daily routine may lead to changes in glycaemic control. This study aimed to evaluate the impact of work and lockdown on glycaemic control in adults with type 1 diabetes. Material and methods A retrospective cohort was stratified into three activity groups (g1-students/telework/laid-off;g2-unemployed/retired;g3-work without lockdown). Continuous and categorical variations (reductions ≥ 0.4%) in glycated haemoglobin were obtained in 2020 (t3:December/2019–March/2020;t4:April/2020–July/2020) and in homologous periods of 2019. Intragroup comparisons between years and intergroups in the same year were made. Regression models were developed to predict the variation of glycated haemoglobin in 2020. Results 241 participants were included, with a significant reduction between t4 and t3 (vs. t2 and t1) in g1 (p < 0.001) and g2 (p = 0.025) and in 2020 in g1 (vs. g2, p < 0.001;vs. g3, p < 0.001). Only g1 presented superiority in the reduction ≥0.4% in glycated haemoglobin in 2020 (vs. 2019, p < 0.001;vs. g2, p < 0.001;vs. g3, p < 0.001). The insulin regimens were comparable and the development of hypoglycaemia was found to be superimposed between t3 and t4, except for g1, which was higher at t3 (p = 0.029). G1 correlated with continuous reductions (vs. g2, p = 0.001;vs. g3, p < 0.001) and ≥0.4% in glycated haemoglobin in 2020 (vs. g2, OR 3.6, p < 0.001;vs. g3, OR 12.7, p < 0.001), regardless of the age and duration of type 1 diabetes. Conclusions A more stable and better glycaemic control was observed in participants who transitioned from face-to-face work to total lockdown.

CARACTERÍSTICAS CLÍNICAS DOS PACIENTES COM SINTOMAS RESPIRATÓRIOS AGUDOS ATENDIDOS PELO SISTEMA DE TELEATENDIMENTO DE DIVINÓPOLIS/MG (TELECOVID)

Introdução A pandemia de COVID-19 trouxe grandes desafios para a gestão e organização dos serviços de saúde, em decorrência de sua magnitude e potencial de disseminação. Neste sentido, novas medidas de enfrentamento à pandemia foram desenvolvidas, como ferramentas tecnológicas para assistência remota e monitoramento de casos. Este trabalho busca descrever as principais características clínicas dos pacientes com sintomas respiratórios agudos atendidos pelo Sistema de Teleatendimento (TeleCOVID) do município de Divinópolis/MG. Métodos Estudo transversal com amostra obtida por meio de registros eletrônicos de pacientes com sintomas respiratórios agudos, com idade igual ou superior a 18 anos, atendidos pelo Sistema TeleCOVID-Divinópolis, no período de um ano (05/2020 a 05/2021). As consultas foram realizadas por meio de ligação telefônica por profissionais médicos e enfermeiros, com preenchimento de questionário estruturado mediado por aplicativo de Telessaúde. Foi realizada análise descritiva da população com frequência absoluta e relativa e medidas de tendência central. Resultados No período, foram atendidos 8529 pacientes, sendo 62,2% do sexo feminino e idade média de 38,4 anos (9,5% com 60+ anos). A mediana de tempo entre o início dos sintomas e o atendimento foi de quatro dias. Os principais sintomas relatados foram tosse (30,7%), febre (26,7%), cefaleia (24,9%), coriza (23,0%), anosmia (21,1%), mialgia (19,3%) e odinofagia (11,4%). Quase metade (46,1%) dos pacientes informou contato com pessoa com COVID-19 e 39,3% informaram presença de sintomas gripais em algum familiar próximo, sendo que apenas 34,8% realizaram exame específico para COVID-19 (17,9% com resultado positivo). Dentre os pacientes atendidos, 11,1% apresentavam algum sinal de alerta, 4,2% foram encaminhados para avaliação presencial em Unidade de Urgência e 3,1% para a Unidade Básica de Saúde. Conclusão Os resultados mostram que o Sistema TeleCOVID contribuiu significativamente no enfrentamento da pandemia no município, com alta resolubilidade, incentivo à adesão às medidas preventivas e redução da sobrecarga nos serviços ambulatoriais e hospitalares. Mesmo considerando que grande parte dos pacientes atendidos apresentava sintomas leves, a proporção de testagem foi muito baixa. Ferramentas de teleatendimento são consideradas estratégias eficientes para fornecer cuidados adequados e seguros, e deveriam ser incorporadas como um suporte permanente à assistência à saúde da população.

Glycaemic control during the COVID-19 pandemic: A catastrophe or a sign of hope for the person with type 1 Diabetes Mellitus?

Introduction: In a person with type 1 diabetes, any change concerning daily routine may lead to changes in glycaemic control. This study aimed to evaluate the impact of work and lockdown on glycaemic control in adults with type 1 diabetes. Material and methods: A retrospective cohort was stratified into three activity groups (g1-students/telework/laid-off; g2-unemployed/retired; g3-work without lockdown). Continuous and categorical variations (reductions ≥ 0.4%) in glycated haemoglobin were obtained in 2020 (t3:December/2019-March/2020; t4:April/2020-July/2020) and in homologous periods of 2019. Intragroup comparisons between years and intergroups in the same year were made. Regression models were developed to predict the variation of glycated haemoglobin in 2020. Results: 241 participants were included, with a significant reduction between t4 and t3 (vs. t2 and t1) in g1 (p < 0.001) and g2 (p = 0.025) and in 2020 in g1 (vs. g2, p < 0.001; vs. g3, p < 0.001). Only g1 presented superiority in the reduction ≥0.4% in glycated haemoglobin in 2020 (vs. 2019, p < 0.001; vs. g2, p < 0.001; vs. g3, p < 0.001). The insulin regimens were comparable and the development of hypoglycaemia was found to be superimposed between t3 and t4, except for g1, which was higher at t3 (p = 0.029). G1 correlated with continuous reductions (vs. g2, p = 0.001; vs. g3, p < 0.001) and ≥0.4% in glycated haemoglobin in 2020 (vs. g2, OR 3.6, p < 0.001; vs. g3, OR 12.7, p < 0.001), regardless of the age and duration of type 1 diabetes. Conclusions: A more stable and better glycaemic control was observed in participants who transitioned from face-to-face work to total lockdown.

Introducción: En una persona con diabetes tipo 1, cualquier cambio en la rutina diaria puede provocar cambios en el control glucémico. Este estudio tuvo como objetivo evaluar el impacto del trabajo y el confinamiento en el control glucémico en adultos con diabetes tipo 1. Material y métodos: Se estratificó una cohorte retrospectiva en tres grupos de actividad (g1-estudiantes/teletrabajo/despido; g2-desempleados/jubilados; g3-trabajo sin encierro). Se obtuvieron variaciones continuas y categóricas (reducciones ≥ 0,4%) en la hemoglobina glucosilada en 2020 (t3: diciembre/2019-marzo/2020; t4: abril/2020-julio/2020) y en períodos homólogos de 2019. Se desarrollaron modelos de regresión para predecir la variación de la hemoglobina glucosilada en 2020. Resultados: Se incluyeron 241 participantes, con una reducción significativa entre t4 y t3 (vs. t2 y t1) en g1 (p < 0,001) y g2 (p = 0,025) y en 2020 en g1 (vs. g2, p < 0,001; vs. g3, p < 0,001). Solo g1 demostró superioridad en la reducción ≥ 0,4% de la hemoglobina glucosilada en 2020 (vs. 2019, p < 0,001; vs. g2, p < 0,001; vs. g3, p < 0,001). Los regímenes de terapia con insulina fueron comparables y el desarrollo de hipoglucemia fue superponible entre t3 y t4, excepto para g1, que fue mayor en t3 (p = 0,029). G1 se correlacionó con reducciones continuas (vs. g2, p = 0,001; vs. g3, p < 0,001) y ≥ 0,4% en la hemoglobina glucosilada en 2020 (vs. g2, odds ratio [OR] 3,6, p < 0,001; vs. g3, OR 12,7, p < 0,001), independientemente de la edad y la duración de la diabetes tipo 1. Conclusiones: Se observó un control glucémico más optimizado a los participantes que pasaron del trabajo presencial al confinamiento total.

Control glucémico en tiempos de pandemia por COVID-19: ¿una catástrofe o un signo de esperanza para la persona con Diabetes Mellitus tipo 1? Glycaemic control during the COVID-19 pandemic: a catastrophe or a sign of hope for the person with type 1 Diabetes Mellitus?

Introducción: En una persona con diabetes tipo 1, cualquier cambio en la rutina diaria puede provocar cambios en el control glucémico. Este estudio tuvo como objetivo evaluar el impacto del trabajo y el confinamiento en el control glucémico en adultos con diabetes tipo 1. Material y métodos: Se estratificó una cohorte retrospectiva en tres grupos de actividad (g1-estudiantes/teletrabajo/despido;g2-desempleados/jubilados;g3-trabajo sin encierro). Se obtuvieron variaciones continuas y categóricas (reducciones ≥0,4%) en la hemoglobina glucosilada en 2020 (t3: diciembre/2019-marzo/2020;t4:abril/2020-julio/2020) y en períodos homólogos de 2019. Se desarrollaron modelos de regresión para predecir la variación de la hemoglobina glucosilada en 2020. Resultados: Se incluyeron 241 participantes, con una reducción significativa entre t4 y t3 (vs. t2 y t1) en g1 (p<0,001) y g2 (p=0,025) y en 2020 en g1 (vs. g2, p<0,001;vs. g3, p<0,001). Solo g1 demostró superioridad en la reducción ≥0,4% de la hemoglobina glucosilada en 2020 (vs. 2019, p <0,001;vs. g2, p<0,001;vs. g3, p<0,001). Los regímenes de terapia con insulina fueron comparables y se encontró que el desarrollo de hipoglucemia estaba superpuesto entre t3 y t4, excepto para g1, que fue mayor en t3 (p=0,029). G1 se correlacionó con reducciones continuas (vs. g2, p=0,001;vs. g3, p<0,001) y ≥0,4% en la hemoglobina glucosilada en 2020 (vs. g2, OR 3,6, p<0,001;vs. g3, OR 12,7, p<0,001), independientemente de la edad y la duración de la diabetes tipo 1. Conclusiones: Se apuntó un control glucémico más optimizado a los participantes que pasaron del trabajo presencial al confinamiento total.

Glycemic Control in People with Type 1 Diabetes Mellitus after the First Portuguese COVID-19–Related State of Emergency

Introduction: The first Portuguese COVID-19-related state of emergency (SE) extended between March and May 2020. The relevance of achieving the glycemic target for the person with type 1 Diabetes Mellitus (T1DM) is deepened in these circumstances, given the forced changes in daily routine. Objective: To determine the influence of work activity (WA) on glycemic control (GC) of adults with T1DM after the first SE. Material and methods: A retrospective cohort study was designed to enroll adults with ≥2 years from T1DM diagnosis. Cases of pregnancy/hospitalizations in 2019/2020, factors that affect interpretation of glycated hemoglobin (HbA1c) and/or SARS-CoV-2 infections were excluded. The participants were stratified into groups of WA after the SE: g1 (telework/lay-off/students), g2 (retired/unemployed) and g3 (WA without lockdown). HbA1c were obtained from 4 periods: t3 (4/1-6/1/2020);t4 (7/1-9/1/2020);t1 and t2 (homologous periods of 2019). Differences in HbA1c were calculated in both years and compared to each other in the same group and between groups in the same year. Hypoglycemia and insulin regimens (insulin pump and multiple injections daily) were analyzed in intragroup (t3 vs. t4) and intergroup (t3 and t4) comparisons. Results: Two hundred and seven participants were included [106 (51.2%) men;median age of 35 (25;47) years]: 144 (69.6%) in g1, 44 (21.3%) in g2 and 19 (9.2%) in g3. HbA1c increased significantly between t4 and t3 (vs. t2 and t1) in g1 (p=0.001), but not in g2 (p=0.077) and g3 (p=0.744). In 2020, HbA1c raised significantly in the analysis "g1 vs. g3" (p=0.004), but not in "g1 vs. g2" (p=0.213) and "g2 vs. g3" (p=0.083). No differences were reported in 2019, along with all the comparisons involving hypoglycemia and insulin regimens. Conclusions: This study found an overall worsening of GC in participants who returned to higher levels of activity after a total lockdown. This is probably explained by the time spent on T1DM self-care during the lockdown.

The Influence of Vitamin D Status on the Severity of SARS-CoV-2 Respiratory Infection

Introduction: The high prevalence of vitamin D (vitD) deficiency in the general population is well recognized. Evidence suggests an immunomodulatory role for vitD in pro-inflammatory conditions, but doubt remains on its association with the severity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) respiratory infection (RI).