Impact of mandatory social isolation measures due to the COVID-19 pandemic on the subjective well-being of Latin American and Caribbean dentists.

BACKGROUND: With the spread of the COVID-19 virus, containment measures such as home confinement were implemented, generating stress, anxiety, depression and aggravation of pre-existing diseases in the population, including dentists, who have also been affected due to the risk involved in practicing their profession. Objective: To determine the impact of mandatory social isolation measures on the subjective well-being of Latin American and Caribbean dentists during the community quarantine due to the COVID-19 pandemic in 2020. MATERIAL AND METHODS: A Cross-sectional study in a sample of 1195 dentists from 21 countries in Latin America and the Caribbean. The main outcome was Subjective Well-Being, evaluated through the World Health Organization Well-Being Index (WHO-5). In addition, sociodemographic characteristics, variables related to the community quarantine due to the COVID-19 pandemic and health variables were considered. A descriptive, bivariate and multivariate (multiple linear regression) analysis was performed to observe the behavior of the variables. RESULTS: A multiple linear regression analysis was performed, where all the variables included within dimensions, were distributed in a single model, observing an R2% of 9.000 (p<0.001), where the R2% change was significant (p<0.001) and a constant of 44.190; likewise, within this model, the variable follow-up of preventive measures against COVID-19 reported an unstandardized regression coefficient (b) of 2. 316 (95%CI:1.133-3.499;p<0.001), the self-perceived level of concern against COVID-19 obtained a (b) of -5.470 (95%CI:-7.509--3.430; p<0.001), the biological sex variable manifested a (b) of -5.417 (95%CI: - 1.157-1.910; p<0.001); finally, the level of economic income during compulsory social isolation presented a (b)=5.354 (CI95%:3.461- 7.247; p<0.001). CONCLUSIONS: An association was found between subjective well-being and variables related to the social impact of the COVID-19 pandemic, such as following preventive measures, concern about the pandemic and economic factors (decrease in income level), in addition to biologic sex. Follow-up strategies are required for these dental professionals, considering that social isolation measures have continued in many of the countries. Key words:Quarantine, Coronavirus infections, WHO-5, Cross-sectional studies, Latin America, Caribbean Region.

Perceived stress and subjective well-being of COVID-19 confinement in Latin American pediatric dentists and dental students: A cross sectional study

Aim: The COVID-19 pandemic, the first registered in the last 100 years, triggered fear and uncertainty, with manifestations related to stress, anxiety, and depression, mainly in health professionals. The study aimed to evaluate the psychological impact of the community quarantine, implemented due to the COVID-19 pandemic, in pediatric dentists and pediatric dentistry graduate students in Latin America. Materials and Methods: Convenience sample made up of 139 pediatric dentists and postgraduate pediatric dentistry students from different Latin American countries, who were asked to fill out a questionnaire, submitted electronically, with prior authorization of participation through an informed consent. The anonymity of the participants was protected using identification codes, and only their email address was requested for subsequent follow-up. Results: The multivariate model shows an association between the value of the PSS-14 v25 questionnaire and the different study variables;thus, the variables—quality of sleep (P ≤ 0.001), number of biosafety measures (P≤0.02), age (P = 0.04), and perception of their state of health (P = 0.03)—were statistically significant in the perceived stress and subjective well-being, caused by COVID-19 lockdown. In the same way, in the most representative demographic variables related to the affective and social support perceived by the participant, it was observed that, with increasing age, there is a decrease in perceived affective support and, consequently, in participants with mandatory quarantine and time restriction;there is a perception of not having emotional support. Conclusion: The disease caused by COVID-19 has modified the habits and quality of life of all professionals in the health field. The psychological impact that the community quarantine implemented due to the COVID-19 pandemic has produced is evident, as older and female individuals more frequently present signs of stress and anxiety, manifested by fear and uncertainty.

Perceived Stress in Dentists and Dental Students of Latin America and the Caribbean during the Mandatory Social Isolation Measures for the COVID-19 Pandemic: A Cross-Sectional Study.

This study aims to determine the impact of the COVID-19 pandemic, specifically considering the mandatory social isolation measures implemented, on the perceived stress of a sample of dentists and dental students from Latin America and the Caribbean, as well as the associated sociodemographic and pandemic-related variables. A cross-sectional survey was conducted with a sample of 2036 dentists and dental students (1433 women). For the main outcome, the 14-item Perceived Stress Scale (PSS-14) was used. The survey also questioned sociodemographic aspects, questions on the COVID-19 pandemic, health variables, and habits. Descriptive, bivariate, and multivariate analyses (linear regression) were applied to observe the factors associated with perceived stress. The PSS-14 mean score was 24.76 (±11.76). Hierarchical regression models showed significant variables associated with the PSS-14 scores: income level during mandatory social isolation, having older adults under care during mandatory social isolation, self-perceived level of concern regarding COVID-19, self-perceived health, Coffee consumption during mandatory social isolation. In general terms, the pandemic has influenced the personal, social, labor, and everyday life of dental staff and affected the mental health of this population specifically when perceived stress is considered. Public policies, strategies, and mental health surveillance systems are required for this population.

Prophylaxis against covid-19: living systematic review and network meta-analysis.

OBJECTIVE: To determine and compare the effects of drug prophylaxis on SARS-CoV-2 infection and covid-19. DESIGN: Living systematic review and network meta-analysis. DATA SOURCES: World Health Organization covid-19 database, a comprehensive multilingual source of global covid-19 literature to 25 March 2021, and six additional Chinese databases to 20 February 2021. STUDY SELECTION: Randomised trials of people at risk of covid-19 who were assigned to receive prophylaxis or no prophylaxis (standard care or placebo). Pairs of reviewers independently screened potentially eligible articles. METHODS: Random effects bayesian network meta-analysis was performed after duplicate data abstraction. Included studies were assessed for risk of bias using a modification of the Cochrane risk of bias 2.0 tool, and certainty of evidence was assessed using the grading of recommendations assessment, development, and evaluation (GRADE) approach. RESULTS: The first iteration of this living network meta-analysis includes nine randomised trials-six of hydroxychloroquine (n=6059 participants), one of ivermectin combined with iota-carrageenan (n=234), and two of ivermectin alone (n=540), all compared with standard care or placebo. Two trials (one of ramipril and one of bromhexine hydrochloride) did not meet the sample size requirements for network meta-analysis. Hydroxychloroquine has trivial to no effect on admission to hospital (risk difference 1 fewer per 1000 participants, 95% credible interval 3 fewer to 4 more; high certainty evidence) or mortality (1 fewer per 1000, 2 fewer to 3 more; high certainty). Hydroxychloroquine probably does not reduce the risk of laboratory confirmed SARS-CoV-2 infection (2 more per 1000, 18 fewer to 28 more; moderate certainty), probably increases adverse effects leading to drug discontinuation (19 more per 1000, 1 fewer to 70 more; moderate certainty), and may have trivial to no effect on suspected, probable, or laboratory confirmed SARS-CoV-2 infection (15 fewer per 1000, 64 fewer to 41 more; low certainty). Owing to serious risk of bias and very serious imprecision, and thus very low certainty of evidence, the effects of ivermectin combined with iota-carrageenan on laboratory confirmed covid-19 (52 fewer per 1000, 58 fewer to 37 fewer), ivermectin alone on laboratory confirmed infection (50 fewer per 1000, 59 fewer to 16 fewer) and suspected, probable, or laboratory confirmed infection (159 fewer per 1000, 165 fewer to 144 fewer) remain very uncertain. CONCLUSIONS: Hydroxychloroquine prophylaxis has trivial to no effect on hospital admission and mortality, probably increases adverse effects, and probably does not reduce the risk of SARS-CoV-2 infection. Because of serious risk of bias and very serious imprecision, it is highly uncertain whether ivermectin combined with iota-carrageenan and ivermectin alone reduce the risk of SARS-CoV-2 infection. SYSTEMATIC REVIEW REGISTRATION: This review was not registered. The protocol established a priori is included as a supplement. READERS' NOTE: This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.

Drug treatments for covid-19: living systematic review and network meta-analysis

OBJECTIVE: To compare the effects of treatments for coronavirus disease 2019 (covid-19). DESIGN: Living systematic review and network meta-analysis. DATA SOURCES: WHO covid-19 database, a comprehensive multilingual source of global covid-19 literature, up to 3 December 2021 and six additional Chinese databases up to 20 February 2021. Studies identified as of 1 December 2021 were included in the analysis. STUDY SELECTION: Randomised clinical trials in which people with suspected, probable, or confirmed covid-19 were randomised to drug treatment or to standard care or placebo. Pairs of reviewers independently screened potentially eligible articles. METHODS: After duplicate data abstraction, a bayesian network meta-analysis was conducted. Risk of bias of the included studies was assessed using a modification of the Cochrane risk of bias 2.0 tool, and the certainty of the evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach. For each outcome, interventions were classified in groups from the most to the least beneficial or harmful following GRADE guidance. RESULTS: 463 trials enrolling 166 581 patients were included; 267 (57.7%) trials and 89 814 (53.9%) patients are new from the previous iteration; 265 (57.2%) trials evaluating treatments with at least 100 patients or 20 events met the threshold for inclusion in the analyses. Compared with standard care, three drugs reduced mortality in patients with mostly severe disease with at least moderate certainty: systemic corticosteroids (risk difference 23 fewer per 1000 patients, 95% credible interval 40 fewer to 7 fewer, moderate certainty), interleukin-6 receptor antagonists when given with corticosteroids (23 fewer per 1000, 36 fewer to 7 fewer, moderate certainty), and Janus kinase inhibitors (44 fewer per 1000, 64 fewer to 20 fewer, high certainty). Compared with standard care, two drugs probably reduce hospital admission in patients with non-severe disease: nirmatrelvir/ritonavir (36 fewer per 1000, 41 fewer to 26 fewer, moderate certainty) and molnupiravir (19 fewer per 1000, 29 fewer to 5 fewer, moderate certainty). Remdesivir may reduce hospital admission (29 fewer per 1000, 40 fewer to 6 fewer, low certainty). Only molnupiravir had at least moderate quality evidence of a reduction in time to symptom resolution (3.3 days fewer, 4.8 fewer to 1.6 fewer, moderate certainty); several others showed a possible benefit. Several drugs may increase the risk of adverse effects leading to drug discontinuation; hydroxychloroquine probably increases the risk of mechanical ventilation (moderate certainty). CONCLUSION: Corticosteroids, interleukin-6 receptor antagonists, and Janus kinase inhibitors probably reduce mortality and confer other important benefits in patients with severe covid-19. Molnupiravir and nirmatrelvir/ritonavir probably reduce admission to hospital in patients with non-severe covid-19. SYSTEMATIC REVIEW REGISTRATION: This review was not registered. The protocol is publicly available in the supplementary material. READERS' NOTE: This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This is the fifth version of the original article published on 30 July 2020 (BMJ 2020;370:m2980), and previous versions can be found as data supplements. When citing this paper please consider adding the version number and date of access for clarity.