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This letter discusses mental health care after the COVID-19 outbreak by presenting preliminary findings from a public general hospital in Madrid. The pandemic caused by the SARS-CoV-2 poses a major challenge for national health systems around the globe. In these situations, healthcare centers are urged to adjust their structures to the demands of the outbreak in order to protect both the users and the workers. However, this emergency has no precedent in the recent history, and entire hospitals and clinics need further adaptations for which there is no previous evidence. This affects mental healthcare teams, which deal with the unknown psychological consequences of an overwhelming, global crisis. La Paz University Hospital is a public general hospital that provides healthcare to a catchment area of more than half a million people in Madrid. So far, more than 2,700 confirmed cases of SARS-CoV-2 have been attended in this hospital, which required a complete restructuring process. A few days after the outbreak, its mental health team managed to develop a COVID-19 intervention protocol that was based on its previous experience during the 2014 Ebola crisis in Madrid and on the reports that were coming from China. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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Introduction: Spain went into lockdown in March of 2020 due to the COVID-19 outbreak. We had to stop the third randomization of our ongoing clinical trial (Mediavilla et al., 2019), pausing weekly group psychotherapy for 12 people with a first episode of psychosis. Only 5 weekly sessions had been delivered, thus many were just starting to form a therapeutic link with the group. In a public health emergency context, psychotherapeutic groups are considered avoidable gatherings. However, stopping psychological therapy abruptly can make participants more vulnerable. The intervention groups were launched in an online format because we could not let anyone go without psychological support in such a difficult time. Objective(s): Communicate how we adapted an ongoing clinical trial to an online format during the lockdown in Spain. Method(s): In light of our participants' needs and their acute deterioration the first two weeks of lockdown, we adapted our intervention. First, both arms (mindfulness-based v. psychoeducational multicomponent intervention) began online adaptations of the interventions. Second, a research assistant made weekly phone calls to provide basic psychosocial support, assure participants groups would continue, and later remind them of each online session. Third and last, the phoneline was accessible 24/7 (WhatsApp). Result(s): The third randomization concluded in December. Six participants were lost in the transition to online groups. However, adherence was comparable to the previous two randomizations (4/12 completed the intervention). Conclusion(s): Online psychotherapy may be used in emergencies such as a lockdown. However, the psychological mid- and longterm effects of a lockdown and online group therapy remain unknown.
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Introduction: Paediatric and adult psychiatric emergency department (ED) visits decreased during the initial COVID-19 pandemic outbreak. Long-term consequences of the pandemic will include increases in mental healthcare needs especially among especially vulnerable groups such as children and adolescents. Objective(s): This study examined changes in the number of overall and diagnosis-specific mental healthEDvisitsamongpatients aged<18 years following onset of the COVID-19 pandemic inMadrid, Spain. Method(s): We used electronic health records to extract the monthly numbers of total and diagnosis-specific mental health ED visits among patients aged <18 years, between October 2018 and April 2021, to La Paz University Hospital. We conducted interrupted time-series analyses and compared trends before and after the day of the first ED COVID-19 case (1st March 2020). Result(s): In March 2020, there was a marked initial decrease of -12.8 (95%CI -21.9, -7.9) less monthly mental health ED visits. After April 2020, there was a subsequent increasing trend of 3.4 (95%CI 2.6, 4.2) additional monthly mental health ED visits. Conclusion(s): After onset of the COVID-19 pandemic, there was an increase in paediatric psychiatric ED visits, especially due to suicide-related reasons. These data reinforce the crucial role of the ED in the management of acute mental health problems among youth and highlight the need for renovated efforts to enhance access to care outside of and during acute crises during the pandemic and its aftermath.
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A few elected favelas in Rio de Janeiro have become a tourist attraction. In the 2000s, the State recognized these neighbourhoods as tourist spots and encouraged the presentation and touristification of favelas in the historical, social, and economic context of mega-events attracting investments to these areas. Consultants, analysts, and technicians were hired to carry out studies on the tourist potential of favelas and train their residents to work in tourism. However, since 2016, a series of economic and political crises in Rio have unfolded and caused a sharp reduction in the number of tourists, as well as in investment in these areas. With the COVID-19 pandemic in 2020, the situation got worse and tourism projects in favelas were completely paralysed. In this context, a group of researchers based in Brazil (Rio de Janeiro) and in the United Kingdom, in partnership with favela residents, have initiated the project Lockdown Stories. The project intends to evaluate the impact of the pandemic in favela tourism and to produce virtual tours as a strategy of impact mitigation with the aim of keeping favelas within the global tourist flow, albeit virtually. In this sense, this chapter describes four virtual tours carried out in Rio’s favelas in 2020 and analyses what should be done to convert favela tourism into virtual attractions and how favelas were virtually reinvented. © 2023 selection and editorial matter, Maria Alice de Faria Nogueira;individual chapters, the contributors.
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Purpose : The main purpose of this study is to describe the fundoscopic alterations and retinal vessel caliber measurements in SARS-CoV2 positive patients admitted to a tertiary referral hospital in Madrid (Spain) and to correlate the retinal vessel caliber with the severity of the disease. Methods : A single-center cross-sectional observational study to document the retinal vascular findings in SARS-CoV2 patients admitted to a tertiary Hospital during the first wave in Madrid, Spain. Fundoscopy was performed in both eyes (when possible) with a manual retinography Zeiss Visuscout 100. All patients signed a consent form to participate in the study. Pharmacological mydriasis prior to retinography was achieved by applying one drop of tropicamide 1% in each eye. Data collected included previous medical and ophthalmic history, prescribed medical and postural treatments, and laboratory findings at the time of admission. All cases were classified according to their outcome as per the WHO clinical progression scale on a scale of 0 to 10, with being 0 the uninfected state and 10 being death. All the retinal images were analysed by two medical retina experts independently. Retinal vessel calibers were measured by a single masked grader using a validated research software with high reproducibility.The relationship between the WHO clinical progression scale and retinal vessel caliber was assessed by Kruskal-Wallis test for independent samples. Results : In total, 81 patients and 154 eyes were included in the study. The fundus retinal assessment disclosed signs of hypertensive retinopathy in 8 right eyes (OD) (8/77) and 9 left eyes (OS) (9/77);vascular tortuosity was present in 13 OD (13/77) and 13 OS (13/77);age-related macular degeneration was found in 13 OD (13/77) and 12 OS (12/77);myopic retinopathy in 3 OD (3/77) and 3 OS (3/77);finally incidental choroidal nevi were found in 4 OD (4/77) and 2 OS (2/77). The retinal microvascular caliber assessment was performed in a total of 72 eyes from 72 subjects, the right eye was used in 61 cases, left eye in the rest. There was no statistically significant difference according to vessel caliber and WHO outcome score. Conclusions : COVID-19 has been linked to an increase risk of cardiovascular events. However, we could not find a correlation among retinal vascular findings and clinical outcome in our cohort.
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Objectives: to analyze the experience of health professionals who provided first-line care to infected patients during the COVID-19 pandemic during the first wave. Material and Methods: Participants were recruited from among physicians and nurses in several hospitals and health centers in Spain. Narratives were obtained through three focus groups. Qualitative methodology was used according to exploratory, inductive, and ethnographic principles. Results: The experience of the health personnel was classified into six categories: The reaction and organization of health workers, materials and tests, emotional aspects of care, ethical conflicts, health management of the pandemic, and the social role of health workers. Conclusions: Healthcare workers took a proactive approach during the pandemic. Weaknesses and strengths in the provision of health care were.The capacity of emotional self-regulation of the health care workers is shown to be key to the ability of the health care system to continue operating. © 2022, Accion Medica S.A.. All rights reserved.
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OBJECTIVE: Rituximab-induced immunosuppression could be a risk factor for mortality from COVID-19. The aim of the study was to describe the prevalence of SARS-CoV-2 infection in patients who have received rituximab and its association with a persistent viral infection. METHODS: Retrospective observational study of patients who received rituximab in the 6 months before to the onset of the pandemic. We analyzed the presence of infection and associated them with demographic variables, pathological history related to an increased risk of developing severe COVID-19, the doses of rituximab received, the type of ventilatory support, thromboembolic events, and the treatment received. A descriptive analysis of all the variables was carried out and infected and uninfected patients were compared. RESULTS: We screened a total of 68 patients who had received rituximab (median cumulative dose: 4,161mg (2,611-8,187.5)). 54.4% men, mean age 60.8 years (15.7; 25-87)). C + was confirmed for 22 patients. Of these, 45.5% had high blood pressure, 36.4% Diabetes Mellitus, 31.8% smokers/ex-smoker, 22.7% lung disease, 13.6% heart disease and 4.5% obesity. There were no statistically significant differences between C+ and C-. Only 2 patients developed immunity. For 10 patients (45.5%) did not have a negative CRP until the end of the follow-up. There was no association with cumulative dose of rituximab. The mortality rate was 22.7% in the C+. CONCLUSIONS: We observe that the persistence of the infection leads to a worse evolution of COVID-19. The use of alternatives should be considered during the pandemic, because of patients with decreased B-cell function may have high risk of fatal progression from COVID-19.
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COVID-19 Drug Treatment , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , Rituximab/adverse effects , SARS-CoV-2ABSTRACT
A door-to-door survey was organised in Cuenca, Ecuador, to determine the prevalence of COVID-19 infection and adherence of the population to COVID-19 preventive measures. A total of 2457 persons participated in the study;584 (23.7%) reported having experienced at least one flu-like symptom since the onset of the pandemic. The maximum SARS-CoV-2 seroprevalence in Cuenca was 13.2% (CI: 12-14.6%) (IgM or IgG positive). Considering PCR confirmed infections, the prevalence was 11% (CI: 10-12.4%). There was no significant difference in seroprevalence between rural and urban areas. Participants aged 35-49 years old, living with a COVID-19 positive person, at least six people in a household, physical contact with someone outside the household, a contact with a person outside the home with flu-like symptoms, using public transport, and not having enough resources for living, significantly increased the odds for SARS-CoV-2 seropositivity. Overall, there was good adherence to COVID-19 preventive measures. Having known someone who tested positive for COVID-19, having a primary or secondary level of education, and having enough resources for living, significantly increased the odds for higher adherence. In conclusion, despite good overall adherence of the population of Cuenca with COVID-19 preventive measures, our study suggests high ongoing COVID-19 transmission in Cuenca, particularly in certain parishes. Prevention should not only focus on behavioural change, but on intensified testing strategies in demographical risk groups.
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Background: The clinical presentation of SARS-CoV-2 disease ranges from asymptomatic respiratory infection to acute respiratory distress syndrome. Risk factors upon hospital admission associated with the need for invasive mechanical ventilation are not well documented. Methods: 185 hospitalized patients with confirmed COVID-19 were enrolled in this study, and they were classified as patients who required invasive mechanical ventilation and patients who did not require it. Comorbidities such as diabetes, high blood pressure, obesity, chronic lung disease and immunodeficiency were recorded. Laboratory studies were requested upon admission such as C-reactive protein, leukocyte and lymphocyte levels, D-dimer, troponin, serum ferritin and procalcitonin. Results: Of the patients who entered the study, 65 patients (35%) required invasive mechanical ventilation (IMV), while 120 (65%) did not require advanced airway management. Of the patients with invasive mechanical ventilation, age > 65 years, male sex, obesity (BMI > 30) and high blood pressure were the most frequent characteristics, presenting the latter two in 26% and 27% respectively. Regarding laboratory studies, the parameters most associated with the requirement for mechanical ventilation were a D-dimer (> 1000) and troponin (> 1), with 26% and 18%, respectively. Conclusion: This study showed the high proportion of obesity, hypertension and advanced age among patients who required invasive mechanical ventilation associated with SARS-CoV2 infection. The presence of elevated D-dimer and troponin on admission are associated with more severe presentations and a requirement for invasive mechanical ventilation.
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INTRODUCCIÓN: En Chile, los efectos maternos y perinatales de la pandemia por SARS-CoV-2 son aún desconocidos. GESTACOVID es un estudio multicéntrico que incluye embarazadas y puérperas hasta el día 42 con COVID-19. El objetivo de este estudio es presentar un informe preliminar, describiendo el impacto de la enfermedad en las embarazadas, factores de riesgo asociados y resultados perinatales. MÉTODOS: Estudio de cohorte descriptivo que incluye 661 pacientes enroladas entre el 7 de marzo y el 6 de julio de 2020, en 23 centros hospitalarios del país. Se analizaron variables demográficas, comorbilidades, características clínicas y del diagnóstico de COVID-19 y resultado materno y perinatal. RESULTADOS: Las pacientes hospitalizadas por COVID-19 tuvieron mayor prevalencia de hipertensión arterial crónica [10% vs 3%; OR=3,1 (1,5-6,79); p=0,003] y de diabetes tipo 1 y 2 [7% vs 2%; OR=3,2 (1,3-7,7); p=0,009] que las pacientes manejadas ambulatoriamente. Un IMC >40 kg/mt2 se asoció con un riesgo dos veces mayor de requerir manejo hospitalizado [OR=2,4 (1,2 - 4,6); p=0,009]. Aproximadamente la mitad de las pacientes (54%) tuvo un parto por cesárea, y un 8% de las interrupciones del embarazo fueron por COVID-19. Hasta la fecha de esta publicación, 38% de las pacientes continuaban embarazadas. Hubo 21 PCR positivas en 316 neonatos (6,6%), la mayoría (17/21) en pacientes diagnosticadas por cribado universal. CONCLUSIONES: Las embarazadas con COVID-19 y comorbilidades como diabetes, hipertensión crónica y obesidad mórbida deben ser manejadas atentamente y deberán ser objeto de mayor investigación. La tasa de transmisión vertical requiere una mayor evaluación para diferenciar el mecanismo y tipo de infección involucrada.
INTRODUCTION: In Chile, effects of the SARS-CoV-2 infection in pregnant women are unknown. GESTACOVID is a multicenter collaborative study including pregnant women and those in the postpartum period (until 42 days) who have had COVID-19. The purpose of this study is to report our preliminary results describing the clinical impact of COVID-19 in pregnant women, the associated risk factors and perinatal results. METHODS: Descriptive cohort study including 661 patients between April 7th and July 6th, 2020, in 23 hospitals. Demographical, comorbidities, clinical and diagnostic characteristics of COVID-19 disease and maternal and perinatal outcomes were analyzed. RESULTS: Pregnant women with COVID-19 admitted to the hospital were more likely to have chronic hypertension [10% vs 3%; OR=3.1 (1.5-6.79); p=0,003] and diabetes type 1 and 2 [7% vs 2%; OR=3.2 (1.3-7.7); p=0.009] than those with outpatient management. A body mass index of >40 kg/mt2 was associated with two-fold higher risk of hospitalization [OR=2.4 (1.2-4.6); p=0.009]. Almost half of patients (54%) were delivered by cesarean section, and 8% of the medically indicated deliveries were due to COVID-19. So far, 38% of the patients are still pregnant. Among 316 newborns, there were 21 positive PCR tests (6.6%), mostly from asymptomatic mothers undergoing universal screening. CONCLUSIONS: Pregnant women with COVID-19 and comorbidities such as diabetes, chronic hypertension and morbid obesity need a close follow up and should be a matter for further research. Vertical transmission of COVID-19 should be thoroughly studied to define the mechanisms and type of infection involved.