Assessment of Post-COVID Symptoms Using the C19-YRS Tool in a Cohort of Patients from the First Pandemic Wave in Northwestern Spain.

Introduction: The emergence or persistence of symptoms after acute SARS-CoV-2 infection has made it necessary to develop tools to detect them and assess their impact on patients' quality of life. One of these tools is the COVID-19 Yorkshire Rehabilitation Screening (C19-YRS) scale. We present the results of this tool in a cohort of first pandemic wave patients. Methods: A cross-sectional study of patients with confirmed SARS-CoV-2 infection from March to May 2020 in Lugo (northwestern Spain). C19-YRS was administered via phone 10 months after the acute infection to both former inpatients and outpatients. Electronic medical records were reviewed and relevant data from the acute episode were collected. The main outcome was the presence of impairment in different areas measured by the C19-YRS scale. Results: The answer rate was 63.2%. The mean age was 54 ± 16 years, 38.4% were male and 190 (42.9%) had some comorbidity. Eighty-seven patients (19.6%) required hospitalization and 10 (2.3%) required intensive care unit admission. Ten (3.5%) patients lost their job due to the pandemic. Two hundred seventy-six patients (62.3%) related any symptoms; fatigue (37.2%) and exertional dyspnea (33.4%) were the most common with significant worsening in both cases compared with the situation before the infection. Subgroup analysis showed that more symptom domains were impaired in women than men. Older patients, those with comorbidity and those who needed hospital admission, demanded more health resources after the acute infection. Discussion: C19-YRS is useful for the detection and quantification of symptoms after COVID-19 and provides relevant social, health, and occupational information.

Psychological Well-Being during the COVID-19 Lockdown: Labour Market and Gender Implications.

In the Spring of 2020, a great number of countries introduced different restrictive measures in order to cope with the COVID-19 pandemic. This article examines the labour market transitions of individuals brought about by some of those measures, and the effect of such transitions on psychological well-being. The fact that it has been possible to distinguish between unemployment transitions before the pandemic began and those resulting from the lockdowns is worth highlighting. Evidence is provided showing that unemployment due to the lockdown had a greater negative impact on psychological well-being than furloughs and teleworking. Gender differences confirm that women experienced greater adverse effects as compared to men. Specifically, women working at home exhibited greater negative effects when compared with those on furlough, probably due to a combination of work disruption and increased family obligations. Finally, on the contrary to men, women living in areas with more rigorous restrictions show a reduced probability of worse PWB when compared to those residing in areas without restrictions. This finding suggests that women are willing to sacrifice freedom of movement as long as restrictions protect their at-risk relatives.

The Effect of Being Unemployed on Mental Health: The Spanish Case.

BACKGROUND: The lack of work appeared to be linked to several symptoms related to poor mental health. Likewise, the reverse relationship, namely the influence of poor mental health on the risk of job loss, has also been analysed, i.e. distress could lead to a poorer work performance culminating in potential job loss. Thus, the bidirectional nature of the relationship between unemployment and mental health makes the accurate estimation of causal relationships a complex matter, leaving room for additional research on the subject. AIMS OF THE STUDY: The aim of this research is to analyse the influence that unemployment could have on mental health taking into account the bidirectional nature that exists between both concepts. METHODS: In order to tackle the causal effect of being unemployed on mental health, we present a biprobit model taking into account the presence of dummy endogenous regressors and we compare these results with those obtained from a standard univariate probit. Our identification strategy exploits geographical information on the unemployment rates as instrument. We use Spanish cross-sectional data from the 2006, 2011 and 2017 years. RESULTS: Based on the results, the paper concludes that unemployed persons in Spain could be subject to a 5.4% higher probability of suffering symptoms related to a common mental disorder (versus 11% obtained using a standard probit). DISCUSSION: The results obtained confirm a negative impact of unemployment situation on mental health. In other words, the probability of unemployed people suffering a mental disorder seems superior to that for individuals with a job. Moreover, the marginal effect obtained from a univariate probit model without the possibility of controlling the mental health selection effects, proves the existence of a problem of simultaneity that would have overestimated the effect of being unemployed on mental health. IMPLICATIONS FOR HEALTH CARE PROVISION: It is hoped that the conclusions obtained here prove useful in the implementation of specific mental health care provision aimed at unemployed people. In this context, the evidence obtained should result in the incorporation of health assistance as an essential part in response to the needs of this collective. IMPLICATIONS FOR HEALTH POLICIES: These special needs of unemployed people should be contemplated not only from a health care provision but also as part of a broader system that incorporates the mental health care of unemployed persons as part of more general public health policies. Finally, these results suggest that mental health-related objectives should be considered when planning, implementing, and evaluating active labour market policies for the unemployed. IMPLICATIONS FOR FURTHER RESEARCH: The length and severity of the last recession, together with the risks associated with the global crisis resulting from COVID-19, reiterate the obvious concerns about the consequences of economic crises and unemployment on personal mental health. In this context, our study could be a step forward in the study of the causal relationships between unemployment and mental health when new data are available.

Furloughs, Teleworking and Other Work Situations during the COVID-19 Lockdown: Impact on Mental Well-Being.

As a consequence of the Spring 2020 lockdown that occurred in Spain due to the COVID-19 pandemic, many people lost their jobs or had to be furloughed. The objective of this study is to analyse the influence of the latter changes in labour market status on psychological well-being. For this purpose, an ad-hoc questionnaire featuring socio-demographic and mental health criteria was created. Granted that the pandemic can be viewed as an exogenous shock, the bias caused by the bidirectional problems between the work situation and mental well-being can be tackled. Results indicate that the lockdown exerted a greater negative effect on the self-perceived well-being of unemployed and furloughed persons than on those in employment. Moreover, among those in continuous employment, teleworkers experienced a lesser degree of self-perceived well-being post lockdown as compared to those people remaining in the same work location throughout the COVID-19 crisis. Finally, the lockdown provoked worse effects on the self-perceived well-being of women as compared to men, a result that appears to be related to gender differences in household production. In conclusion, these results could be especially relevant given that the evolution of the pandemic is having ongoing effects on employment and, therefore, on the mental health of workers.

Usefulness of a Telemedicine Tool TELEA in the Management of the COVID-19 Pandemic.

Background: The usefulness of telemedicine in the management of the coronavirus disease 2019 (COVID-19) pandemic has not been evaluated. Methods: We conducted a descriptive study of the process of recruitment and follow-up of patients using a telemedicine tool (TELEA) in the management of patients at risk, in a rural environment with a dispersed population in Lugo in north western Spain. Results: A large number of patients diagnosed with COVID-19 infection (N = 545) were evaluated. Of this group, 275 had comorbidities and were enrolled in the program, with a mean age of 57.6 ± 16.3 years, 43.1% male. The risk factors were hypertension (38%), diabetes (16%), asthma (9.5%), heart disease (8.8%), and immunosuppression (5.1%). Patients were followed through the platform with daily control of symptoms and vital signs. Only 8% were admitted to the hospital, 5.1% on a scheduled basis and 2.9% through the emergency room. Conclusion: The telemedicine tool TELEA is useful for the management of high-risk patients with COVID-19.

Tracing of COVID-19 patients by telemedicine with telemonitoring

Aim To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. Methods A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least 11a day. Results 313 patients (52.4% female) with a total average age of 60.9 (DE 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions;18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. Conclusions Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way. Resumen Objetivo Evaluar si la telemedicina con telemonitorización es una herramienta clínicamente útil y segura para el seguimiento de pacientes con COVID-19. Métodos Estudio observacional prospectivo de los pacientes con diagnóstico de COVID-19 por PCR positiva y considerados de alto riesgo que se siguieron con telemedicina y telemonitorización en el Área Sanitaria de Lugo entre el 17 de marzo y el 17 de abril del 2020. Se incluyeron 2grupos de pacientes: seguimiento ambulatorio desde el inicio y tras el alta hospitalaria. Cada paciente remitió un cuestionario clínico al día con su temperatura y saturación de oxígeno 3 veces al día. El seguimiento fue proactivo, contactando con todos los pacientes al menos una vez al día. Resultados Se incluyó a 313 pacientes (52,4% mujeres) con edad media 60,9 (DE 15,9) años. Otros 2 pacientes rehusaron entrar en el programa. Desde el inicio, se siguió ambulatoriamente a 224 pacientes y a 89 pacientes tras su alta hospitalaria. Entre los primeros, 38 (16,90%) se remitieron a Urgencias en 43 ocasiones con 18 (8,03%) ingresos y 2 fallecidos. En los domicilios no hubo fallecimientos ni urgencias vitales. Incluyendo a los pacientes tras hospitalización, el seguimiento se realizó en 304 casos. Un paciente reingresó (0,32%) y otro abandonó (0,32%). El tiempo medio de seguimiento fue 11,64 (DE 3,58) días y en los 30 días del estudio 224 (73,68%) pacientes fueron dados de alta. Conclusiones Nuestros datos sugieren que la telemedicina con telemonitorización domiciliaria, utilizada de forma proactiva, permite un seguimiento clínicamente útil y seguro en pacientes con COVID-19 de alto riesgo.