ABSTRACT
Background: Post-COVID syndrome (PCS) is an increasingly recognised complication of acute SARS-CoV- 2 infection, characterised by persistent fatigue, reduced exercise tolerance, chest pain, shortness of breath and cognitive slowing. Acute COVID-19 is strongly linked with increased risk of thrombosis;a prothrombotic state. Elevated Von Willebrand Factor (VWF) Antigen (Ag):ADAMTS13 ratio is associated with severity of acute COVID-19 infection. Aim(s): We hypothesised that the pro-thrombotic state is implicated in the pathogenesis of PCS. We investigated specialist coagulation parameters associated with reduced exercise capacity in patients with PCS to identify the utility of these parameters to determine ongoing disease activity. We also investigated if an association exists between elevated VWF(Ag):ADAMTS13 ratio and impaired exercise capacity in patients with PCS. Method(s): Retrospective analysis of VWF(Ag):ADAMTS13 ratio in patients with PCS at a dedicated post-COVID clinic. VWF(Ag):ADAMTS13 ratio was correlated with symptoms including exercise capacity as assessed by 1 minute sit-to- stand (STS) test and/or 6 minute walk test (6MWT). Peripheral oxygen desaturation >=3% for 6MWT and STS test, and increase in lactate>1 from baseline during 6MWT were taken as markers of impaired exercise capacity. Result(s): Elevated VWF(Ag):ADAMTS13 ratio (>=1.5) was found to be four times (OR 4.3) more likely in patients with impaired exercise capacity. 20% (56/276) had impaired exercise capacity, of which 55% (31/56) had a raised VWF(Ag):ADAMTS13 ratio >=1.5 (p < 0.0001). A higher median VWF(Ag):ADAMTS13 ratio of 1.5 (IQR 1.2-1.7) in patients with abnormal exercise testing compared to 1.1 (IQR 0.9-1.4) in patients with normal exercise testing was found (p < 0.0001). FVIII and VWF(Ag) were elevated in 26% and 18% respectively and support a hypercoagulable state in patients with PCS. Conclusion(s): These findings suggest possible ongoing microvascular/ endothelial dysfunction in the pathogenesis of PCS and highlight the potential role for prophylactic anticoagulation in the management of these patients.
ABSTRACT
Background: Cerebral palsy (CP) is a lifelong disability, where people experience complications as they age in addition to their underlying condition. Including the views of people with CP through public and patient involvement (PPI) ensures that research is relevant and meaningful in addressing their concerns. However, there is a lack of evidence on incorporating the voices of adults with CP in the research process. Further, there is no guidance on how to involve people with CP in PPI during the COVID-19 pandemic. Therefore, this paper aims to provide an overview of how adults with CP were involved in a doctoral research process during the pandemic. Methods: This paper describes the PPI process and its impact at various stages of the doctoral research process and reflects on the experiences from the perspective of the researcher and adults with CP. Results: A panel of adults with CP was established and consulted throughout the research to support development of the research question, study documentation, data collection, analysis, interpretation and dissemination of findings. The researcher and adult reflections highlighted the value of collaboration and the positive impact on research at each stage. Although meetings were adapted due to the pandemic, the values of PPI were adhered to throughout the doctoral research. Conclusion: Involving adults with CP positively impacts the research process and ensures meaningful change. Reflective findings may help other researchers involve adults with CP and adapt to remote PPI processes.
ABSTRACT
In the present study, we focus on stories about working conditions in the Swedish health care sector during the initial phase of the corona pandemic in the spring of 2020.The study is based on 33 interviews with health care professionals conducted during the first weeks of the corona pandemic. By linking interpretations of narratives to time and temporality in the analysis, we analyze how stories about working conditions relate to managing the effects of the pandemic as well as to working conditions before and after the pandemic.Narrative analysis shows that different perspectives on time are used to support the argumentation in the participants' stories. One perspective is linked to the specific situation of the first phase of the corona pandemic and the other relates to the work situation during the corona pandemic as part of an, in time, extended context.The analysis with a focus on time and temporality in the stories creates an opening to understand the corona pandemic as an event that draws attention to something more than the work situation right now, namely a critique of working conditions on a general level.