ABSTRACT
El propósito general de este estudio consiste en identificar y diagnosticar la situación familiar, las principales necesidades socioeducativas y servicios gubernamentales de apoyo y asesoría requeridos por las familias del Estado de Aguascalientes (México), a fin de orientar el proceso de análisis y rediseño de políticas públicas estatales en materia familiar, por parte del Órgano Consultivo Estratégico (OCE) del Gobierno Estatal. Para ello se realizó un estudio con diseño no experimental, de tipo trasversal y con alcance exploratorio y descriptivo, en el que una muestra de 2,488 familias contestó un instrumento diseñado para medir indicadores sociodemográficos, de cohesión social y de necesidades socioeducativas en un contexto en donde recién comenzaba el confinamiento promovido por los gobiernos estatal y federal respectivamente por la contingencia de la COVID-19. El análisis de resultados evidenció un nivel adecuado de confiabilidad en los ítems analizados para los fines de este estudio. Asimismo, se reveló que en el Estado las necesidades socioeducativas prioritarias son las relativas a adicciones a substancias, depresión y tristeza, agresión psicológica o verbal, agresión física y otras adicciones (redes sociales, videojuegos, apuestas, pornografía, entre otras). En cuanto a los servicios gubernamentales con mayor demanda se identificaron la atención psicológica familiar, el aprendizaje de procesos asertivos de comunicación con las hijas e hijos, así como la atención y prevención de violencia intrafamiliar. Los resultados anteriores son relevantes por el hecho de reflejar un diagnóstico de la situación familiar en un contexto afectado por la pandemia de la COVID-19, así como por la contribución que implican para el proceso de análisis y redefinición de políticas públicas estatales en materia familiar a raíz del trabajo del OCE y el Gobierno Estatal.Alternate :The general purpose of this study is to identify and diagnose the family situation, the main socio-educational needs and government services of support and advice required by the families of the State of Aguascalientes (Mexico), in order to guide the process of analysis and redesign of public policies in family matters, by the Strategic Consultative Body (OCE) of the State Government. For this, a study with a non-experimental design, of a transactional type and with an exploratory and descriptive scope, was carried out, in which a sample of 2,488 families answered an instrument designed to measure sociodemographic indicators, social cohesion and socio-educational needs in a context where the confinement promoted by the state and federal governments respectively due to the contingency of COVID-19 was just beginning. The analysis of the results showed an adequate level of reliability in the items analyzed for the purposes of this study. Likewise, it was revealed that in the State the priority socio-educational needs are those related to substance addictions, depression and sadness, psychological or verbal aggression, physical aggression and other addictions (social networks, video games, gambling, pornography, among others). Regarding the government services with the highest demand, family psychological care, learning assertive communication processes with children, as well as care and prevention of domestic violence were identified. The previous results are relevant for the fact of reflecting a diagnosis of the family situation in a context affected by the COVID-19 pandemic, as well as for the contribution they imply for the process of analysis and redefinition of state public policies on family matters as a result of the work of the OCE and the State Government.Alternate :O objetivo geral deste estudo é identificar e diagnosticar a situação familiar, as principais necessidades socioeducativas e os serviços governamentais de apoio e aconselhamento requeridos pelas famílias do Estado de Aguascalientes (México) para orientar o processo de análise e reformulação de políticas poder público es adual em matéria de família, pelo Conselho Consultivo Estratégico (OCE) do Governo do Estado. Para tanto, foi realizado um estudo com desenho não experimental, de tipo transversal e de escopo exploratório e descritivo, no qual uma amostra de 2,488 famílias respondeu a um instrumento destinado a medir indicadores sociodemográficos, coesão social e necessidades socioeducativas em um contexto onde O confinamento promovido pelos governos estadual e federal respectivamente devido ão contingenciamento da COVID-19 estava apenas começando. A análise dos resultados mostrou um nível adequado de confiabilidade nos itens analisados para os fins deste estudo. Da mesma forma, foi revelado que no Estado as necessidades socioeducativas prioritárias são aquelas relacionadas as dependencias de substancias, depressão e tristeza, agressão psicológica ou verbal, agressão física e outras dependencias (redes sociais, videogames, jogos de azar, pornografia, entre outras). Em relação ãos serviços governamentais de maior demanda, foram identificados o atendimento psicológico familiar, o aprendizado de processos de comunicação assertivos com as crianças, bem como o atendimento e prevenção a violencia familiar. Os resultados anteriores são relevantes pelo fato de refletirem um diagnóstico da situação familiar em um contexto afetado pela pandemia COVID-19, bem como pela contribuição que implicam para o processo de análise e redefinição das políticas públicas estaduais em matéria de família. como resultado do trabalho da OCE e do Governo do Estado.
ABSTRACT
BACKGROUND AND PURPOSE: To evaluate the results of low-dose radiation therapy (LD-RT) to lungs in the management of patients with COVID-19 pneumonia. MATERIAL AND METHODS: We conducted a prospective phase I-II trial enrolling COVID-19 patients ≥50 years-old, with bilateral lung involvement at imaging study and oxygen requirement (oxygen saturation ≤93% on room air). Patients received 1 Gy to whole lungs in a single fraction. Primary outcome was a radiological response assessed as severity and extension scores at days +3 and +7. Secondary outcomes were toxicity (CTCAE v5.0), days of hospitalization, changes in inflammatory blood parameters (ferritin, lymphocytes, C-reactive protein, d-dimer and LDH) and SatO2/FiO2 index (SAFI), at day +3 and +7. Descriptive analyses were summarized as means with standard deviation (SD) and/or medians with interquartile ranges (IQR). A Wilcoxon sign rank test for paired data was used to assess the CT scores and Chi Square was used to assess for comparison of categorical variables. RESULTS: Forty-one patients were included. Median age was 71 (IQR 60-84). Eighteen patients (44%) previously received an anti-COVID treatment (tocilizumab, lopinavir/ritonavir, remdesivir) and thirty-two patients (84%) received steroids during LD-RT. The extension score improved significantly (p = 0.02) on day +7. Mean baseline extension score was 13.7 (SD ± 4.9) with a score of 12.2 (±5.2) at day 3, and 12.4 ± 4.7 at day 7. No differences were found in the severity score. SAFI improved significantly on day +3 and +7 (p < 0.01). Median SAFI on day 0 was 147 (IQR 118-264), 230 (IQR 120-343) on day +3 and 293 (IQR 121-353) on day +7. Significant decrease was found in C-reactive protein on day +7 (p = 0.02) and in lymphocytes counts on day +3 and +7 (p = 0.02). The median number of days in hospital after RT was 11 (range 4-78). With a median follow-up of 60 days after LD-RT, 26 (63%) patients were discharged, 11 (27%) died because of COVID respiratory failure and 4 (10%) died of other causes. CONCLUSIONS: LD-RT is a feasible and well-tolerated treatment that could lead to rapid clinical improvement. Large randomized trials would be required to establish the efficacy of LD-RT to treat COVID-19 pneumonia.
Subject(s)
COVID-19 , Aged , C-Reactive Protein , COVID-19/radiotherapy , Humans , Middle Aged , Prospective Studies , SARS-CoV-2 , Treatment OutcomeABSTRACT
PURPOSE: Low-dose radiation therapy (LD-RT) has been shown to have an anti-inflammatory effect, and preliminary results suggest it is feasible to treat patients with coronavirus disease 2019 (COVID-19) pneumonia. MATERIALS AND METHODS: We conducted a prospective, single-arm, phase 1/2 clinical trial enrolling patients aged ≥50 years, who were coronavirus disease 2019 (COVID-19) positive, at phase 2 or 3 with lung involvement at imaging study and oxygen requirement. Patients received 100 cGy to total lungs in a single fraction. Primary outcome was radiologic response using severity and extension score on baseline computed tomography (CT), at days 3 and 7 after LD-RT. Secondary outcomes were toxicity using Common Terminology Criteria for Adverse Events v.5.0, duration of hospitalization, blood work evolution, and oxygen requirements using SatO2/FiO2 index (SAFI), at days 3 and 7 after LD-RT. RESULTS: Nine patients were included. Median age was 66 (interquartile range, 57-77). Severity score was stable or decreased in the third CT but was not statistically significant (P = .28); however, there were statistically significant changes in the extension score (P = .03). SAFI index significantly improved 72 hours and 1 week after LD-RT (P = .01). Inflammatory blood parameters decreased 1 week after RT compared with baseline; only lactate dehydrogenase decreased significantly (P = .04). Two patients presented grade 2 lymphopenia after RT and another (with baseline grade 3) worsened to grade 4. Overall, the median number of days of hospitalization was 59 (range, 26-151). After RT the median number of days in the hospital was 13 (range, 4-77). With a median follow-up after RT of 112 days (range, 105-150), 7 patients were discharged and 2 patients died, 1 due to sepsis and the other with severe baseline chronic obstructive pulmonary disease from COVID-19 pneumonia. CONCLUSIONS: Our preliminary results show that LD-RT was a feasible and well-tolerated treatment, with potential clinical improvement. Randomized trials are needed to establish whether LD-RT improves severe pneumonia.
Subject(s)
COVID-19/radiotherapy , Radiation Dosage , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Radiotherapy Dosage , Treatment OutcomeABSTRACT
Three cardinal manifestations of neoplasia, namely inflammation, immune dysfunction, and coagulopathy are also seen in patients with severe SARS-CoV-2 infection, providing a biological rationale for testing selected anticancer drugs for their ability to control the symptoms and/or modify the course of COVID-19.