Study Abroad and Student Decision Making in Times of COVID: A Mixed Methods Study

The impacts of COVID-19 on Study abroad (SA) are deep and widespread and potentially affect the factors that guide US undergraduate students' choices as they relate to SA. To investigate them, the present study relies on the MSA (Motivation to SA questionnaire: Anderson & Lawton, 2015) and adds two new groups of factors: language learning and health. To observe changes in the relative weight of factors before and during the pandemic, responses to two different versions of the MSA from 83 students who had participated in SA prior to the pandemic were compared. Results from statistical analyses show stability in the ranking of importance of factors pre- and during pandemic, except for health-related factors, which come second after world enlightenment. In addition, interviews show that while students view "immersive" SA as a significant experience for its contribution to their personal and intellectual development, they do not consider virtual SA a real SA experience.

Using latent profile analysis to understand palliative care professionals' quality of life during the COVID-19 pandemic.

Healthcare workers' professional quality of life has been increasingly under the spotlight, even more so during the COVID-19 pandemic, which has posed a genuine challenge for them. This study aims to describe the professional quality of life profiles of a sample of Spanish palliative care professionals during the COVID-19 pandemic, encompassing aspects such as work satisfaction, burnout, compassion fatigue, and compassion satisfaction; while studying the relationships between these profiles and sociodemographic variables, clinical situations experienced during the pandemic, protectors of professional quality of life, the quality of care delivered, and the professionals' wellbeing. Data from a survey of Spanish palliative care professionals were used. The variables measured were professional quality of life, sociodemographic characteristics, COVID-19-related experiences, protectors of professional quality of life, wellbeing, and quality of care. Our research included latent profile analyses, along with chi-squared and t-tests. The results suggested two profiles of professional quality of life, namely low (32.78%) and high (67.22%). The following profile displayed a higher likelihood of having a low professional quality of life: younger professionals, registered nurses, with a decrease in their teamwork, without specific training in palliative care, in coping with death and stress or emotional training and with lower levels of self-care and self-compassion, whose patients were unable to die a dignified death. Similarly, a low professional quality of life profile was associated with reduced wellbeing and poorer quality of care offered. In conclusion, providing professionals with education and training to improve their ability to handle end-of-life care and stress, maintaining cohesive teams and promoting self-care and self-compassion are pivotal to maintaining the quality of life and wellbeing of palliative care professionals and the quality of care that they provide.

Clinical characteristics and indications for blood transfusion in patients with SARS-CoV-2 infection Perfil clínico y motivo de transfusión de sangre en pacientes infectados por SARS-CoV-2

Background There are few data on the clinical characteristics of COVID-19 patients who require blood transfusion. We aimed to investigate the clinical characteristics and indication for transfusion in COVID-19 patients seen during the epidemic's first wave. Material and methods Cross-sectional study that included all consecutive COVID-19 patients admitted to the Hospital Clínic of Barcelona, Spain, from mid-March to mid-May 2020. Results A total of 80 patients received 354 RBC units, 116 plasma units, and 48 platelet units. Median age was 71 years (IQR: 62–76), and 59 (74%) were males. In total, 138 of the 261 transfusion episodes that involved RBCs (59%) were related to spontaneous (n = 94) or procedure-related (n = 44) bleeding. Spontaneous bleeding was more frequent in the retroperitoneal space and the gastrointestinal apparatus. Tracheostomy with endotracheal intubation, surgical interventions, and cannulation of femoral vessels were the main procedures behind non-spontaneous bleeding. Most patients (91%) were on anticoagulants, mostly intermediate- or full-dose heparin. Conclusion Anticoagulation-related bleeding was a leading cause of blood transfusion in COVID-19 patients during the epidemic's first-wave.

Clinical characteristics and indications for blood transfusion in patients with SARS-CoV-2 infection.

Background: There are few data on the clinical characteristics of COVID-19 patients who require blood transfusion. We aimed to investigate the clinical characteristics and indication for transfusion in COVID-19 patients seen during the epidemic's first wave. Material and methods: Cross-sectional study that included all consecutive COVID-19 patients admitted to the Hospital Clínic of Barcelona, Spain, from mid-March to mid-May 2020. Results: A total of 80 patients received 354 RBC units, 116 plasma units, and 48 platelet units. Median age was 71 years (IQR: 62-76), and 59 (74%) were males. In total, 138 of the 261 transfusion episodes that involved RBCs (59%) were related to spontaneous (n = 94) or procedure-related (n = 44) bleeding. Spontaneous bleeding was more frequent in the retroperitoneal space and the gastrointestinal apparatus. Tracheostomy with endotracheal intubation, surgical interventions, and cannulation of femoral vessels were the main procedures behind non-spontaneous bleeding. Most patients (91%) were on anticoagulants, mostly intermediate- or full-dose heparin. Conclusion: Anticoagulation-related bleeding was a leading cause of blood transfusion in COVID-19 patients during the epidemic's first-wave.

Introducción: Las características de los pacientes con COVID-19 transfundidos son poco conocidas. Nuestro objetivo fue investigar el perfil clínico y el motivo de la transfusión en los pacientes con COVID-19 vistos durante la primera ola de la epidemia. Material y métodos: Estudio transversal que incluyó a todos los pacientes con COVID-19 transfundidos en el Hospital Clínic de Barcelona entre marzo y mayo de 2020. Resultados: Ochenta pacientes recibieron 354 unidades de hematíes, 116 de plasma y 48 de plaquetas. La edad mediana fue de 71 años y 59 (74%) eran hombres. En total, 138 de los 261 episodios de transfusión de hematíes (59%) estaban relacionados con hemorragia espontánea (n = 94: principalmente retroperitoneal y gastrointestinal) o con procedimientos invasivos (n = 44: principalmente traqueostomía, cirugía, y canulación de vasos femorales). El 91% de los pacientes recibía tratamiento anticoagulante el día de la transfusión o los dos días previos, sobre todo heparina a dosis intermedia o completa. Conclusión: El sangrado relacionado con la anticoagulación fue el motivo principal de transfusión en los pacientes con COVID-19.

Psychometric Properties of the Self-Compassion Scale-Short Form: Study of Its Role as a Protector of Spanish Nurses Professional Quality of Life and Well-Being during the COVID-19 Pandemic.

Self-compassion is a multifaceted construct that represents compassion turned inward and involves approaching one's failure and inadequacy with kindness. To measure these self-compassionate behaviors, the Self-Compassion Scale-Short Form (SCS-SF) is one of the most widely used and has been recurrently employed in the healthcare arena. Specifically, self-compassion has been pointed out as essential for providing compassionate care and maintaining healthcare workers balance. AIM: The aim of this study is twofold: (1) to provide evidence of the psychometric properties of the SCS-SF in a sample of Spanish nurses and (2) to study of its role as a protector of Spanish nurses professional quality of life and well-being during the COVID-19 pandemic. METHODS: A sample of 115 Spanish nurses was studied. Mean age was 43.79 years old (SD = 10.99); 84.3% were women. The factorial structure of the SCS-SF was studied with competitive confirmatory factor analysis (CFA). Finally, a full structural equation model was tested, in which positive and negative self-compassion predicted professional quality of life, and professional quality of life, in turn, predicted well-being. RESULTS: Three a priori structures were compared: one-factor, two-factor, and six-factor model. The two-factor solution, positive and negative self-compassion, was retained as the best structure to represent the data. Regarding the predictive model, the two poles of self-compassion predicted professional quality of life prediction, and professional quality of life positively predicted well-being, showing a strong relationship. CONCLUSION: Self-compassion can be an important resource for nurses' balance, promoting adequate professional quality of life and their well-being.

Efficacy of early transfusion of convalescent plasma with high-titer SARS-CoV-2 neutralizing antibodies in hospitalized patients with COVID-19.

BACKGROUND: Despite most controlled trials have shown no measurable benefit of COVID-19 convalescent plasma (CCP) in patients with COVID-19, some studies suggest that early administration of CCP with high-titer anti-SARS-CoV-2 can be beneficial in selected patients. We investigated the efficacy of early administration of high-titer CCP to patients with COVID-19 who required hospitalization, STUDY DESIGN AND METHODS: Observational, propensity score (PS) matched case-control study of COVID-19 patients treated with CCP within 72 h of hospital admission and untreated controls from August 2020 to February 2021. All CCP donations had a Euroimmun anti-SARS-CoV-2 sample-to-cutoff ratio ≥3. PS matching was based on prognostic factors and presented features with high-standardized differences between the treated and control groups. The primary endpoint was mortality within 30 days of diagnosis. RESULTS: A total of 1604 patients were analyzed, 261 of whom received CCP, most (82%) within 24 h after admission. Median age was 67 years (interquartile range: 56-79), and 953 (60%) were men. Presenting factors independently associated with higher 30-day mortality were increased age, cardiac disease, hypoxemic respiratory failure, renal failure, and plasma d-dimer >700 ng/ml. After PS matching, transfusion of CCP was associated with a significant reduction in the 30-day mortality rate (odds ratio [OR]; 0.94, 95% confidence interval [CI]: 0.91-0.98; p = .001) that extended to the 60th day after COVID-19 diagnosis (OR: 0.95; 95% CI: 0.92-0.99; p = .01). CONCLUSION: Our results suggest that CCP can still be helpful in selected patients with COVID-19 and call for further studies before withdrawing CCP from the COVID-19 therapeutic armamentarium.

Hemorrhage Is a Major Cause of Blood Transfusion in COVID-19 Patients

INTRODUCTIONReports from China and other countries have allowed to quickly understand the clinical and biological features of COVID-19. In contrast, little has been published on the transfusion requirements of COVID-19 patients and the clinical characteristics of transfused patients.PATIENTS AND METHODSFor this cross-sectional study, we reviewed the blood bank and clinic records of 80 consecutive patients diagnosed with COVID 19, who required red blood cells (RBC) transfusion at the Hospital Clinic of Barcelona over a period of 60 days, from mid-March to mid-May 2020. COVID-13 was confirmed by at least two PCR test in nasopharyngeal swaps. Categorical data were described as frequencies and percentage and continuous variables were summarized as median and interquartile range (IQR)RESULTSMedian age was 71 years (IQR: 62-76) and 59 (74 %) patients were males. The patients' main clinical characteristics and the indications for transfusion are summarized in the table. In total, the 80 patients received 2,081 RBC units in 261 independent transfusion episodes. Number of days on transfusion support ranged from 1 to 44 (median: 5).Bleeding was the indication for transfusion in 55 patients (69%), and included either large hematomas in 22 and external hemorrhage in 31. Anemia of critical illness was the reason for transfusion in 22 (27%) patients. Most patients were on anticoagulants at the time of transfusion or the two days before (table). In total, 138 of the 261 transfusion episodes (59%) were related to spontaneous (94) or procedure-related (44) bleeding. Spontaneous bleeding was more frequent in the retroperitoneal space and the gastrointestinal apparatus. Tracheostomy with endotracheal intubation, surgical interventions, and cannulation of femoral vessels were the main procedures behind non-spontaneous bleeding.Hemorrhage was protracted and difficult to control and patients often required transfusion support for several days. Not rarely, hemorrhage recurred when the patient was restarted on anticoagulants. It was not unusual for bleeding from an anatomical location to be followed by, and overlapped with bleeding from a different location.Seventeen patients died during the period on study. None of the deaths was ascribed to hemorrhage or the blood transfusion.DISCUSSIONBleeding, mostly related to the use of anticoagulants, was the main indication for RBC transfusion in patients with COVID-19.Figure 1

Clinical characteristics and indications for blood transfusion in patients with SARS-CoV-2 infection.

BACKGROUND: There are few data on the clinical characteristics of COVID-19 patients who require blood transfusion. We aimed to investigate the clinical characteristics and indication for transfusion in COVID-19 patients seen during the epidemic's first wave. MATERIAL AND METHODS: Cross-sectional study that included all consecutive COVID-19 patients admitted to the Hospital Clínic of Barcelona, Spain, from mid-March to mid-May 2020. RESULTS: A total of 80 patients received 354 RBC units, 116 plasma units, and 48 platelet units. Median age was 71 years (IQR: 62-76), and 59 (74%) were males. In total, 138 of the 261 transfusion episodes that involved RBCs (59%) were related to spontaneous (n=94) or procedure-related (n=44) bleeding. Spontaneous bleeding was more frequent in the retroperitoneal space and the gastrointestinal apparatus. Tracheostomy with endotracheal intubation, surgical interventions, and cannulation of femoral vessels were the main procedures behind non-spontaneous bleeding. Most patients (91%) were on anticoagulants, mostly intermediate- or full-dose heparin. CONCLUSION: Anticoagulation-related bleeding was a leading cause of blood transfusion in COVID-19 patients during the epidemic's first-wave.

Neurological symptoms in Covid-19 patients in the emergency department.

BACKGROUND: Coronavirus disease 2019 (Covid-19) might present neurological symptoms. We aimed to evaluate the frequency of them at the moment of emergency department (ED) visit and their impact in the prognosis. METHODS: Retrospective cohort study including all consecutive hospitalized cases between March 8th and April 11th, 2020. Covid-19 diagnosis was confirmed by polymerase chain reaction test and/or serology. We compared, in patients with and without neurological symptoms on admission, demographic, clinical presentation, and frequency and type of abnormal laboratory values. We analyzed the variables that were associated with in-hospital all-cause mortality by Cox-regression log-rank test. RESULTS: We included 576 hospitalized patients, 250 (43.3%) female, aged 67.2 years. At the moment of ED visit, 320 (55.6%) described neurological symptoms, including anosmia (146, 25.3%), myalgia (139, 24.1%), headache (137, 23.8%), and altered mental status (98, 17.0%). Neurological symptoms started the first symptomatic day in 198 (54.2%) cases. Patients with neurological symptoms presented later to the ED (7.9 versus. 6.6 days, p = .019). Only four (0.6%) cases had no typical Covid-19 general symptoms, and only six (1.9%) had a normal laboratory results, for a sensitivity of 98.7% (95% confidence interval (CI): 96.6%-99.6%) and 98.1% (95% CI: 95.7%-99.2%), respectively. In the multivariate Cox-regression of mortality predictors, anosmia (HR: 0.358, 95%CI: 0.140-0.916) and altered mental status (HR: 1.867, 95%CI: 1.162-3.001) were significant. CONCLUSION: Neurological symptoms were the most frequent extrapulmonary symptoms. They were present in half of the Covid-19 patients at the time of the ED visit. Anosmia on admission was an independent predictor of lower in-hospital mortality and altered mental status on admission predicted in-hospital mortality.

Uses and Perceptions of Music in Times of COVID-19: A Spanish Population Survey.

Since March 14, 2020, Spanish citizens have been confined to their homes due to the impact of the COVID-19 pandemic. Participating in musical activities has been associated with reduced anxiety and increased subjective wellbeing. The aim of this study is to analyze how Spanish citizens used music during the lockdown period. We also study perceptions of the impact music has in everyday life, in particular examining the respondents' insights into the effects of listening to music in situations of isolation. The study was conducted using the MUSIVID19 questionnaire administered to a total of 1868 Spanish citizens. The results indicate that during lockdown, respondents perceived an increase in the time they devoted to musical activities such as listening, singing, dancing or playing an instrument. The participants also reported using music to cope with the lockdown, finding that it helped them to relax, escape, raise their mood or keep them company. The findings suggest an improvement in their perception of the value of music in personal and social wellbeing during the lockdown. However, the study reveals significant differences in the use and perceptions of music according to respondents' personal situations. Age and feelings of vulnerability may lead to more conservative uses of musical practice and to more moderate perceptions of the positive values of music.

Factors associated with the presence of headache in hospitalized COVID-19 patients and impact on prognosis: a retrospective cohort study.

INTRODUCTION: Headache is one of the most frequent neurologic manifestations in COVID-19. We aimed to analyze which symptoms and laboratory abnormalities were associated with the presence of headache and to evaluate if patients with headache had a higher adjusted in-hospital risk of mortality. METHODS: Retrospective cohort study. We included all consecutive patients admitted to the Hospital with confirmed SARS-CoV-2 infection between March 8th and April 11th, 2020. We collected demographic data, clinical variables and laboratory abnormalities. We used multivariate regression analysis. RESULTS: During the study period, 576 patients were included, aged 67.2 (SD: 14.7), and 250/576 (43.3%) being female. Presence of headache was described by 137 (23.7%) patients. The all-cause in-hospital mortality rate was 127/576 (20.0%). In the multivariate analysis, patients with headache had a lower risk of mortality (OR: 0.39, 95% CI: 0.17-0.88, p = 0.007). After adjusting for multiple comparisons in a multivariate analysis, variables that were independently associated with a higher odds of having headache in COVID-19 patients were anosmia, myalgia, female sex and fever; variables that were associated with a lower odds of having headache were younger age, lower score on modified Rankin scale, and, regarding laboratory variables on admission, increased C-reactive protein, abnormal platelet values, lymphopenia and increased D-dimer. CONCLUSION: Headache is a frequent symptom in COVID-19 patients and its presence is an independent predictor of lower risk of mortality in COVID-19 hospitalized patients.

Anosmia is associated with lower in-hospital mortality in COVID-19.

BACKGROUND: Anosmia is common in Coronavirus disease 2019, but its impact on prognosis is unknown. We analysed whether anosmia predicts in-hospital mortality; and if patients with anosmia have a different clinical presentation, inflammatory response, or disease severity. METHODS: Retrospective cohort study including all consecutive hospitalized patients with confirmed Covid-19 from March 8th to April 11th, 2020. We determined all-cause mortality and need of intensive care unit (ICU) admission. We registered the first and worst laboratory parameters. Statistical analysis was done by multivariate logistic and linear regression. RESULTS: We included 576 patients, 43.3% female, and aged 67.2 years in mean. Anosmia was present in 146 (25.3%) patients. Patients with anosmia were more frequently females, younger and less disabled and had less frequently hypertension, diabetes, smoking habit, cardiac and neurological comorbidities. Anosmia was independently associated with lower mortality (OR: 0.180, 95% CI: 0.069-0.472) and ICU admission (OR: 0.438, 95% CI: 0.229-0.838, p = 0.013). In the multivariate analysis, patients with anosmia had a higher frequency of cough (OR: 1.96, 95%CI: 1.18-3.28), headache (OR: 2.58, 95% CI: 1.66-4.03), and myalgia (OR: 1.74, 95% CI: 1.12-2.71). They had higher adjusted values of hemoglobin (+0.87, 95% CI: 0.40-1.34), lymphocytes (+849.24, 95% CI: 157.45-1541.04), glomerular filtration rate (+6.42, 95% CI: 2.14-10.71), and lower D-dimer (-4886.52, 95% CI: -8655.29-(-1117.75)), and C-reactive protein (-24.92, 95% CI: -47.35-(-2.48)). CONCLUSIONS: Hospitalized Covid-19 patients with anosmia had a lower adjusted mortality rate and less severe course of the disease. This could be related to a distinct clinical presentation and a different inflammatory response.

Neurological Comorbidity Is a Predictor of Death in Covid-19 Disease: A Cohort Study on 576 Patients.

Introduction: Prognosis of Coronavirus disease 2019 (Covid-19) patients with vascular risk factors, and certain comorbidities is worse. The impact of chronic neurological disorders (CND) on prognosis is unclear. We evaluated if the presence of CND in Covid-19 patients is a predictor of a higher in-hospital mortality. As secondary endpoints, we analyzed the association between CND, Covid-19 severity, and laboratory abnormalities during admission. Methods: Retrospective cohort study that included all the consecutive hospitalized patients with confirmed Covid-19 disease from March 8th to April 11th, 2020. The study setting was Hospital Clínico, tertiary academic hospital from Valladolid. CND was defined as those neurological conditions causing permanent disability. We assessed demography, clinical variables, Covid-19 severity, laboratory parameters and outcome. The primary endpoint was in-hospital all-cause mortality, evaluated by multivariate cox-regression log rank test. We analyzed the association between CND, covid-19 severity and laboratory abnormalities. Results: We included 576 patients, 43.3% female, aged 67.2 years in mean. CND were present in 105 (18.3%) patients. Patients with CND were older, more disabled, had more vascular risk factors and comorbidities and fewer clinical symptoms of Covid-19. They presented 1.43 days earlier to the emergency department. Need of ventilation support was similar. Presence of CND was an independent predictor of death (HR 2.129, 95% CI: 1.382-3.280) but not a severer Covid-19 disease (OR: 1.75, 95% CI: 0.970-3.158). Frequency of laboratory abnormalities was similar, except for procalcitonin and INR. Conclusions: The presence of CND is an independent predictor of mortality in hospitalized Covid-19 patients. That was not explained neither by a worse immune response to Covid-19 nor by differences in the level of care received by patients with CND.