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1.
BMC Med ; 20(1): 244, 2022 07 06.
Article in English | MEDLINE | ID: covidwho-1923545

ABSTRACT

BACKGROUND: Previous studies assessing the prevalence of COVID-19 sequelae in adults and children were performed in the absence of an agreed definition. We investigated prevalence of post-COVID-19 condition (PCC) (WHO definition), at 6- and 12-months follow-up, amongst previously hospitalised adults and children and assessed risk factors. METHODS: Prospective cohort study of children and adults with confirmed COVID-19 in Moscow, hospitalised between April and August, 2020. Two follow-up telephone interviews, using the International Severe Acute Respiratory and Emerging Infection Consortium survey, were performed at 6 and 12 months after discharge. RESULTS: One thousand thirteen of 2509 (40%) of adults and 360 of 849 (42%) of children discharged participated in both the 6- and 12-month follow-ups. PCC prevalence was 50% (95% CI 47-53) in adults and 20% (95% CI 16-24) in children at 6 months, with decline to 34% (95% CI 31-37) and 11% (95% CI 8-14), respectively, at 12 months. In adults, female sex was associated with PCC at 6- and 12-month follow-up (OR 2.04, 95% CI 1.57 to 2.65) and (OR 2.04, 1.54 to 2.69), respectively. Pre-existing hypertension (OR 1.42, 1.04 to 1.94) was associated with post-COVID-19 condition at 12 months. In children, neurological comorbidities were associated with PCC both at 6 months (OR 4.38, 1.36 to 15.67) and 12 months (OR 8.96, 2.55 to 34.82) while allergic respiratory diseases were associated at 12 months (OR 2.66, 1.04 to 6.47). CONCLUSIONS: Although prevalence of PCC declined one year after discharge, one in three adults and one in ten children experienced ongoing sequelae. In adults, females and persons with pre-existing hypertension, and in children, persons with neurological comorbidities or allergic respiratory diseases are at higher risk of PCC.


Subject(s)
COVID-19 , Hypertension , Adult , COVID-19/epidemiology , Child , Cohort Studies , Female , Hospitals , Humans , Moscow/epidemiology , Patient Discharge , Prevalence , Prospective Studies , Risk Factors
2.
Lancet Respir Med ; 10(7): 715-724, 2022 07.
Article in English | MEDLINE | ID: covidwho-1886188

ABSTRACT

Health consequences that persist beyond the acute infection phase of COVID-19, termed post-COVID-19 condition (also commonly known as long COVID), vary widely and represent a growing global health challenge. Research on post-COVID-19 condition is expanding but, at present, no agreement exists on the health outcomes that should be measured in people living with the condition. To address this gap, we conducted an international consensus study, which included a comprehensive literature review and classification of outcomes for post-COVID-19 condition that informed a two-round online modified Delphi process followed by an online consensus meeting to finalise the core outcome set (COS). 1535 participants from 71 countries were involved, with 1148 individuals participating in both Delphi rounds. Eleven outcomes achieved consensus for inclusion in the final COS: fatigue; pain; post-exertion symptoms; work or occupational and study changes; survival; and functioning, symptoms, and conditions for each of cardiovascular, respiratory, nervous system, cognitive, mental health, and physical outcomes. Recovery was included a priori because it was a relevant outcome that was part of a previously published COS on COVID-19. The next step in this COS development exercise will be to establish the instruments that are most appropriate to measure these core outcomes. This international consensus-based COS should provide a framework for standardised assessment of adults with post-COVID-19 condition, aimed at facilitating clinical care and research worldwide.


Subject(s)
COVID-19 , Adult , COVID-19/complications , Delphi Technique , Humans , Outcome Assessment, Health Care , Research Design , Treatment Outcome
3.
Z Evid Fortbild Qual Gesundhwes ; 2022 May 12.
Article in German | MEDLINE | ID: covidwho-1852259

ABSTRACT

In the context of the COVID-19 pandemic, researchers face particular challenges: as contact restrictions prevented face-to-face formats, both data collection and qualitative interpretation work (data analysis) had to be carried out in virtual space. In this article, we outline a digital option for strategically conducting joint interpretation work in qualitative health research in times of "physical distancing", which also provides inspiration for research practice in the post-pandemic future.

4.
Inquiry ; 59: 469580221081059, 2022.
Article in English | MEDLINE | ID: covidwho-1832925

ABSTRACT

Faced with the pandemic of the novel coronavirus (SARS-CoV-2), healthcare professionals (HCPs) in intensive care units (ICU) adjusted their organizational, operational, and personal procedures to ensure care for COVID-19 patients. We used grounded theory approach to explore ICU HCPs' perspectives on professional action at the beginning of the COVID-19 pandemic in Germany from March to July 2020. The study aimed to examine implicit principles on negotiating social practice and interaction of ICU HCPs in an exceptional situation, which was characterized by a high level of changes. We conducted theme-guided qualitative telephone/virtual interviews with 39 ICU HCPs from ten German federal states. The data collection followed the principles of theoretical sampling. We adpoted grounded theory approach proposed by Charmaz and discussed using Lüscher's theoretical concept of ambivalence. The analysis revealed five interconnected categories about the ICU HCPs' negotiation of social practice and interaction at the beginning of the COVID-19 pandemic in Germany. In this context, a complex field of ambivalence (key category) emerged between habits and routines of a pre-pandemic normality. Pragmatic restructuring processes were initiated, which quickly resulted in a new normality of a "daily routine of preparation". Dealing with ambivalence offers the potential for change.


Subject(s)
COVID-19 , COVID-19/epidemiology , Delivery of Health Care , Grounded Theory , Humans , Intensive Care Units , Negotiating , Pandemics , SARS-CoV-2
5.
Int J Public Health ; 67: 1604542, 2022.
Article in English | MEDLINE | ID: covidwho-1809646

ABSTRACT

Since the WHO's "Influenza Pandemic Preparedness Plan" in 1999, pandemic preparedness plans at the international and national level have been constantly adapted with the common goal to respond early to outbreaks, identify risks, and outline promising interventions for pandemic containment. Two years into the COVID-19 pandemic, public health experts have started to reflect on the extent to which previous preparations have been helpful as well as on the gaps in pandemic preparedness planning. In the present commentary, we advocate for the inclusion of social and ethical factors in future pandemic planning-factors that have been insufficiently considered so far, although social determinants of infection risk and infectious disease severity contribute to aggravated social inequalities in health.


Subject(s)
COVID-19 , Disaster Planning , Health Equity , Influenza, Human , COVID-19/epidemiology , COVID-19/prevention & control , Disease Outbreaks , Humans , Influenza, Human/epidemiology , Pandemics/prevention & control , Social Determinants of Health
6.
Dtsch Med Wochenschr ; 147(8): 485-491, 2022 04.
Article in German | MEDLINE | ID: covidwho-1805706

ABSTRACT

Hundreds of thousands of individuals who experience lasting sequelae after sepsis and infections in Germany do not receive optimal care. In this White Paper we present measures for improvement, which were developed by a multidisciplinary expect panel as part of the SEPFROK project. Improved care rests on four pillars: 1. cross-sectoral assessment of sequelae and a structured discharge and transition management, 2. interdisciplinary rehabilitation and aftercare with structural support, 3. strengthening the specific health literacy of patients and families, and 4. increased research into causes, prevention and treatment of sequelae. To achieve this, appropriate cross-sectoral care structures and legal frameworks must be created.


Subject(s)
Aftercare , Sepsis , Germany , Humans , Patient Discharge , Sepsis/diagnosis , Sepsis/therapy
7.
Int J Environ Res Public Health ; 19(5)2022 02 28.
Article in English | MEDLINE | ID: covidwho-1715364

ABSTRACT

This study aimed to compare worries related to the Coronavirus disease 2019 (COVID-19) in families with young children in two regions in Germany differently affected by the pandemic (Regensburg in Southeast Germany, Leipzig in Eastern Germany) during the first and the second waves of the COVID-19 pandemic. 720 parents participating in the KUNO Kids health study in Regensburg (n = 507) or the LIFE Child study in Leipzig (n = 213) answered questions regarding COVID-19-related worries and trust in anti-pandemic policy measures during the first wave (spring 2020) and during the second wave (winter 2020/2021) of the pandemic. Ordinal mixed-effects models were performed to assess differences depending on region and time, adjusting for education and migration background. Participants worried most about the general economic situation and their family and least about their own health or financial situation. Worries about oneself, family, friends, hometown, and country were stronger during the second than during the first wave. In regional comparisons, worries about family, friends, and hometown increased more pronouncedly from wave 1 to wave 2 in Leipzig (OR ranging from 2.67 (95% CI 1.71-4.19) to 3.01 (95% CI 1.93-4.71), all p < 0.001) than in Regensburg (OR ranging from to 1.38 (95% CI 1.08-1.78) to 1.72 (95% CI 1.33-2.21), all p < 0.05), running parallel with the increase in SARS-CoV-2 infections. Trust in anti-pandemic policy measures, in contrast, decreased significantly between wave 1 and wave 2, with a stronger decrease in Regensburg (OR = 0.30 (95% CI 0.22-0.39), p < 0.001) than in Leipzig (OR = 0.91 (95% CI 0.59-1.41), n.s.). The degree of families' COVID-19-related worries differs by region and time, which might be related to differences in infection rates and public interest. Regional differences should be taken into account when developing communication strategies and policy measures during the COVID-19 pandemic.


Subject(s)
COVID-19 , Influenza, Human , COVID-19/epidemiology , Child , Child, Preschool , Germany/epidemiology , Humans , Influenza, Human/epidemiology , Longitudinal Studies , Pandemics , SARS-CoV-2
8.
Eur Respir J ; 59(2)2022 Feb.
Article in English | MEDLINE | ID: covidwho-1690989

ABSTRACT

BACKGROUND: The long-term sequelae of coronavirus disease 2019 (COVID-19) in children remain poorly characterised. This study aimed to assess long-term outcomes in children previously hospitalised with COVID-19 and associated risk factors. METHODS: This is a prospective cohort study of children (≤18 years old) admitted to hospital with confirmed COVID-19. Children admitted between 2 April 2020 and 26 August 2020 were included. Telephone interviews used the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 Health and Wellbeing Follow-up Survey for Children. Persistent symptoms (>5 months) were further categorised by system(s) involved. RESULTS: 518 out of 853 (61%) eligible children were available for the follow-up assessment and included in the study. Median (interquartile range (IQR)) age was 10.4 (3-15.2) years and 270 (52.1%) were girls. Median (IQR) follow-up since hospital discharge was 256 (223-271) days. At the time of the follow-up interview 126 (24.3%) participants reported persistent symptoms, among which fatigue (53, 10.7%), sleep disturbance (36, 6.9%) and sensory problems (29, 5.6%) were the most common. Multiple symptoms were experienced by 44 (8.4%) participants. Risk factors for persistent symptoms were: older age "6-11 years" (OR 2.74, 95% CI 1.37-5.75) and "12-18 years" (OR 2.68, 95% CI 1.41-5.4), and a history of allergic diseases (OR 1.67, 95% CI 1.04-2.67). CONCLUSIONS: A quarter of children experienced persistent symptoms months after hospitalisation with acute COVID-19 infection, with almost one in 10 experiencing multisystem involvement. Older age and allergic diseases were associated with higher risk of persistent symptoms at follow-up.


Subject(s)
COVID-19 , Adolescent , Aged , Child , Child, Hospitalized , Female , Follow-Up Studies , Humans , Prospective Studies , Risk Factors , SARS-CoV-2
9.
BMC Med ; 20(1): 50, 2022 02 04.
Article in English | MEDLINE | ID: covidwho-1690914

ABSTRACT

BACKGROUND: A substantial portion of people with COVID-19 subsequently experience lasting symptoms including fatigue, shortness of breath, and neurological complaints such as cognitive dysfunction many months after acute infection. Emerging evidence suggests that this condition, commonly referred to as long COVID but also known as post-acute sequelae of SARS-CoV-2 infection (PASC) or post-COVID-19 condition, could become a significant global health burden. MAIN TEXT: While the number of studies investigating the post-COVID-19 condition is increasing, there is no agreement on how this new disease should be defined and diagnosed in clinical practice and what relevant outcomes to measure. There is an urgent need to optimise and standardise outcome measures for this important patient group both for clinical services and for research and to allow comparing and pooling of data. CONCLUSIONS: A Core Outcome Set for post-COVID-19 condition should be developed in the shortest time frame possible, for improvement in data quality, harmonisation, and comparability between different geographical locations. We call for a global initiative, involving all relevant partners, including, but not limited to, healthcare professionals, researchers, methodologists, patients, and caregivers. We urge coordinated actions aiming to develop a Core Outcome Set (COS) for post-COVID-19 condition in both the adult and paediatric populations.


Subject(s)
COVID-19 , Adult , COVID-19/complications , Child , Disease Progression , Humans , Outcome Assessment, Health Care , SARS-CoV-2
10.
SSRN;
Preprint in English | SSRN | ID: ppcovidwho-326233

ABSTRACT

Abstract Background: Recent data suggest that many people experience Post COVID-19 Condition (Long COVID) following the acute phase of the SaRS CoV-2 infection. At present there is no agreement on what patient health outcomes should be measured in Post COVID-19 Condition. We aimed to identify core outcomes for Post COVID-19 Condition that stakeholders considered critical to assess in all research studies and clinical practice. Methods: We conducted a multi-step study: (1) review of outcomes reported in studies of Post COVID-19 Condition to develop a list of potential core outcomes;(2) outcomes were then grouped, using the COMET taxonomy, to present in a consensus process;(3) a two-round online international modified Delphi consensus process, including 3 stakeholder groups (‘people with Post COVID-19 Condition and their carers’, ‘healthcare professionals and researchers’ and ‘healthcare professionals and researchers with Post COVID-19 Condition) to prioritise outcomes;and (4) an international online consensus meeting to finalize the core outcome set. Consensus ‘in’ was defined, a priori, as 80% or more of each stakeholder group rating an outcome as critical (‘7-9’ on a 9-point scale). Patient engagement and global outreach activities were undertaken at all stages of the project. Findings: 1535 participants from 71 countries, representing six continents, were involved in the online modified Delphi process, with 1148 participating in both rounds (75% completion rate). Eleven of 24 outcomes met consensus ‘in’ criteria after the two Delphi rounds and consensus meeting: fatigue or exhaustion;pain;post-exertion symptoms;work/occupational and study changes;survival;and “functioning, symptoms and conditions” for each of the following outcomes: cardiovascular, respiratory, nervous system, cognition, mental and physical. ‘Recovery’ outcome was added ‘a-priori’ as a part of previously published COS on COVID-19. Interpretation: This international study resulted in the development of a COS for Post COVID-19 Condition using a rigorous methodology. The generated consensus-based list of core outcomes should be assessed in clinical research and practice settings. The next step for the development of this COS will be to determine which measurement instruments best measure these outcomes. Funding Information: Funding by the National Institute for Health Research (NIHR) (Grant COV-LT2-0072) supporting the second stage of the process. Declaration of Interests: None to declare.

11.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-319863

ABSTRACT

Background: Digital interventions may be used to mitigate psychosocial consequences of the COVID-19 pandemic but evidence-based recommendations are lacking. The aim of this rapid meta-review was to investigate the theoretical base, user perspective, safety, effectiveness, and cost effectiveness of digital interventions in public mental health provision (i.e. mental health promotion, prevention of, and treatment for mental disorder). Methods: A rapid meta-review was conducted. MEDLINE, PsychINFO, and CENTRAL databases were searched on May 11, 2020. Study inclusion criteria were broad and considered systematic reviews that investigated digital tools for health promotion, prevention, or treatment of mental health conditions likely affected by the COVID-19 pandemic. Findings: We identified 813 reviews of which 82 met inclusion criteria. Overall, there is good evidence on the usability, safety, acceptance/satisfaction, and effectiveness of eHealth interventions while evidence on mHealth apps is promising, especially if social components (e.g. blended care) and strategies to promote adherence are incorporated. Although most digital interventions focus on the prevention or treatment of mental disorders, there is some evidence on mental health promotion. However, evidence on long-term clinical effects, process quality, and cost-effectiveness is very limited. Interpretation: Accumulating evidence suggests negative effects of the COVID-19 pandemic on public mental health. There is evidence that digital interventions are particularly suited to mitigating psychosocial consequences at the population level. Decision-makers should develop digital strategies for continued mental health care and the development and implementation of mental health promotion and prevention programs in times of quarantine and social distancing.

12.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-319195

ABSTRACT

Introduction: Serologic studies are crucial for clarifying the regional dynamics of the SARS-CoV-2 coronavirus pandemic as well as the success of a vaccination campaign against COVID-19. We describe a cohort study investigating the seroprevalence of antibodies against SARS-CoV-2 in Magdeburg (Saxony-Anhalt, Germany). Protocol and study design: The SeMaCo study (Serologische Untersuchungen bei Blutspendern des Großraums Magdeburg auf Antikörper gegen SARS-CoV-2) is a longitudinal, regional cohort study to assess the seroprevalence of COVID-19 in blood donors from Magdeburg (Capital of Saxony-Anhalt) and surrounding areas. We consider blood donors as a surrogate for the healthy, working-age population of Saxony-Anhalt. The study primarily aims to measure the prevalence and kinetics of IgG antibodies against SARS-CoV-2 in first time and repeat blood donors over a period of 21 months. The study explores four survey periods of three to four months each (January–April 21, July–October 21, February–April 22, July–October 22). At each visit, we will assess the attitude towards vaccination, the antibody response following vaccination, as well as undesired vaccination effects. Furthermore, we will collect data on occupational activities, housing conditions and the frequency of family and other social contacts. Discussion: The SeMaCo study extends the spectrum of seroepidemiological investigations in Germany. A longitudinal observation with repeated testing and serial interviews can provide a more accurate view on the dynamics of COVID-19 prevalence and spread than repeated cross-sectional studies. Based on interim results from similar studies, we expect a seroprevalence of SARS-CoV-2 antibodies below 5% in the first survey period. SeMaCo will influence policy decisions and preventative measures.

13.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-307285

ABSTRACT

Background: The present study aimed to compare worries related to the Coronavirus disease 2019 (COVID-19) in families with young children in two regions in Germany differently affected by the pandemic (Regensburg in Southeast Germany, Leipzig in Eastern Germany) during the first and the second wave of the COVID-19 pandemicMethods720 parents participating in the KUNO Kids health study in Regensburg (n = 507) or the LIFE Child study in Leipzig (n = 213) answered questions regarding COVID-19-related worries and trust in anti-pandemic policy measures at two time points, during the first wave (spring 2020) and during the second wave (winter 2020/2021) of the pandemic. Ordinal mixed-effects models were performed to assess differences depending on region (Regensburg versus Leipzig) and time (first versus second wave), adjusting for education and migration background. ResultsParticipants worried most about the general economic situation and their family and least about their own health or financial situation. Most COVID-19-related worries were stronger during the second than during the first wave. In regional comparisons, worries about family, friends, and hometown increased more pronouncedly from wave 1 to wave 2 in Leipzig than in Regensburg, paralleling the increase in SARS-CoV-2 infections. Trust in anti-pandemic policy measures, in contrast, decreased significantly between wave 1 and wave 2, with a stronger decrease in Regensburg. ConclusionsThe degree of families’ COVID-19-related worries differs by region and time, which might be related to differences in infection rates and public interest.

14.
Int J Environ Res Public Health ; 19(4)2022 02 09.
Article in English | MEDLINE | ID: covidwho-1674652

ABSTRACT

Individuals with chronic conditions have been faced with many additional challenges during the COVID-19 pandemic. Individual health literacy (HL) as the ability to access, understand, evaluate, and apply pandemic-related information has thus become ever more important in these populations. The purpose of this study was to develop and content-validate a comprehensive HL survey instrument for people with asthma based on an integrated framework, and on previous surveys and other instruments for use in the general population and vulnerable groups. Beside HL, assumed determinants, mediators, and health outcomes were embraced in the framework. A mixed-method design was used. A comprehensive examination of the available literature yielded an initial pool of 398 single items within 20 categories. Based on content validity indices (CVI) of expert ratings (n = 11) and the content analysis of cognitive interviews with participants (n = 9), the item pool was reduced, and individual items/scales refined or modified. The instrument showed appropriate comprehensibility (98.0%), was judged relevant, and had an acceptable CVI at scale level (S-CVI/Ave = 0.91). The final version comprises 14 categories measured by 38 questions consisting of 116 single items. In terms of content, the instrument appears a valid representation of behavioural and psychosocial constructs pertaining to a broad HL understanding and relevant to individuals with asthma during the COVID-19 pandemic. Regular monitoring of these behavioural and psychosocial constructs during the course of the pandemic can help identify needs as well as changes during the course of the pandemic, which is particularly important in chronic disease populations.


Subject(s)
Asthma , COVID-19 , Health Literacy , Asthma/epidemiology , COVID-19/epidemiology , Humans , Pandemics , Psychometrics , Reproducibility of Results , SARS-CoV-2 , Surveys and Questionnaires
15.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz ; 64(12): 1592-1602, 2021 Dec.
Article in German | MEDLINE | ID: covidwho-1565352

ABSTRACT

BACKGROUND: Wearing face masks in public is recommended under certain circumstances in order to prevent infectious diseases transmitted through droplets. AIM: The objective was to compile all German and English research results from peer-reviewed journal articles using a sensitive literature search on the effects of mask-wearing for preventing infectious diseases on the psychosocial development of children and adolescents. METHODS: A systematic review was conducted considering different study designs (search period up until 12 July 2021). The risk of bias in the studies was determined using a risk of bias procedure. A descriptive-narrative synthesis of the results was performed. RESULTS: Thirteen studies were included, and the overall risk of bias was estimated to be high in all primary studies. There are some indications from the included surveys that children, adolescents, and their teachers in (pre)schools perceived facial expression processing as impaired due to mask wearing, which were confirmed by several experimental studies. Two studies reported psychological symptoms like anxiety and stress as well as concentration and learning problems due to wearing a mask during the COVID-19 pandemic. One survey study during the 2002/2003 SARS pandemic examined oral examination performance in English as a foreign language and showed no difference between the "mask" and "no mask" conditions. DISCUSSION: Only little evidence can be derived on the effects of wearing mouth-nose protection on different developmental areas of children and adolescents based on the small number of studies. There is a lack of research data regarding the following outcomes: psychological development, language development, emotional development, social behavior, school success, and participation. Further qualitative studies and epidemiological studies are required.


Subject(s)
COVID-19 , Communicable Diseases , Adolescent , Child , Child, Preschool , Germany , Humans , Masks , Pandemics , SARS-CoV-2
16.
BMJ Open ; 11(12): e049086, 2021 12 06.
Article in English | MEDLINE | ID: covidwho-1555198

ABSTRACT

OBJECTIVES: To gain insights into the impact of the COVID-19 pandemic on ongoing health research projects, using projects from a selected funding programme in Germany as an example. DESIGN: Online survey and validation workshop. SETTING: Lockdowns and social distancing policies impact on clinical and public health research in various forms, especially if unrelated to COVID-19. Research institutions have reduced onsite activities, data are often collected remotely, and during the height of the crisis, clinical researchers were partially forced to abandon their projects in favour of front-line care. PARTICIPANTS SURVEY: 120 investigators of health research projects across Germany, performed between 15 and 25 May 2020; workshop: 32 investigators, performed on 28 May 2020. RESULTS: The response rate (78%) showed that the survey generated significant interest among investigators. 85 responses were included for analysis, and the majority of investigators (93%) reported that their projects were affected by the pandemic, with many (80%) stating that data collection was not possible as planned, and they could not carry out interventions as intended (67%). Other impacts were caused by staff being unavailable, for example, through child or elder care commitments or because of COVID-19 quarantine or illness. Investigators also reported that publications were delayed or not feasible at all (56%), and some experienced problems with PhD or Masters theses (18%). The majority of investigators had mitigation strategies in place such as adjustment of data collection methods using digital tools (46%) or of project implementation in general (46%), others made changes in research design or research questions (27%). CONCLUSIONS: The COVID-19 pandemic has severely impacted on health research projects. The main challenge is now to mitigate negative effects and to improve long-term resilience in health research. The pandemic has also acted as a driver of innovation and change, for example, by accelerating the use of digital methods.


Subject(s)
COVID-19 , Pandemics , Aged , Child , Communicable Disease Control , Germany/epidemiology , Humans , SARS-CoV-2
17.
BMC Health Serv Res ; 21(1): 1298, 2021 Dec 02.
Article in English | MEDLINE | ID: covidwho-1551207

ABSTRACT

BACKGROUND: Measures to manage the COVID-19 pandemic have led to impacts on healthcare systems and providers worldwide. Outpatient healthcare professionals (HCPs) provide the majority of patient care. Insight into their experiences during a pandemic is rare. Therefore, we explored how primary and secondary care HCPs in a rural area in Germany experienced their work during the pandemic and what health-related outcomes they perceived in their patients. In this context, we also examined the impact on access to and utilization of healthcare and working conditions. METHODS: We conducted a qualitative interview study with outpatient HCPs. We recruited by e-mail, telephone, professional networks and personal contacts. Data were collected between August 2020 and January 2021. All interviews were audio recorded, transcribed, and analysed using qualitative content analysis. RESULTS: Our sample consisted of 28 HCPs (15 family physicians, 7 cardiologists, and 6 non-physician assistants, 12 female) from Saxony-Anhalt, Germany. HCPs experienced fewer consultations as well as cancellations by hospitals and secondary care physicians, especially at the beginning of the Covid-19-pandemic, while they continued throughout to provide outpatient care. They quickly adopted changes in practice organisation and healthcare provision. There was a shift towards telephone consultations, home visits as well as unconventional consultations e.g. through the practice window. Family physicians used personal relationships to support utilization of healthcare and to avoid health-related effects. Social tension and burden seemed to interact with a perceived lack of preparedness, the pandemic-related changes in their working condition as well as access to and utilization of healthcare. Chronic disease monitoring was postponed, which could have consequences in the course of disease of patients. HCPs experienced effects on patients' psychological well-being. CONCLUSION: Our study demonstrates the impacts of Covid-19-pandemic on outpatient care in rural areas and emphasizes its importance. HCPs experienced impacts on access to and utilization of healthcare, working conditions and health-related outcomes. Health policy should create a framework for healthcare to support outpatient care in rural areas with a looming undersupply of primary and secondary care in order to maintain healthcare and reduce pandemic impacts.


Subject(s)
COVID-19 , Ambulatory Care , Delivery of Health Care , Female , Health Personnel , Humans , Pandemics , SARS-CoV-2
18.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz ; 64(12): 1592-1602, 2021 Dec.
Article in German | MEDLINE | ID: covidwho-1482187

ABSTRACT

BACKGROUND: Wearing face masks in public is recommended under certain circumstances in order to prevent infectious diseases transmitted through droplets. AIM: The objective was to compile all German and English research results from peer-reviewed journal articles using a sensitive literature search on the effects of mask-wearing for preventing infectious diseases on the psychosocial development of children and adolescents. METHODS: A systematic review was conducted considering different study designs (search period up until 12 July 2021). The risk of bias in the studies was determined using a risk of bias procedure. A descriptive-narrative synthesis of the results was performed. RESULTS: Thirteen studies were included, and the overall risk of bias was estimated to be high in all primary studies. There are some indications from the included surveys that children, adolescents, and their teachers in (pre)schools perceived facial expression processing as impaired due to mask wearing, which were confirmed by several experimental studies. Two studies reported psychological symptoms like anxiety and stress as well as concentration and learning problems due to wearing a mask during the COVID-19 pandemic. One survey study during the 2002/2003 SARS pandemic examined oral examination performance in English as a foreign language and showed no difference between the "mask" and "no mask" conditions. DISCUSSION: Only little evidence can be derived on the effects of wearing mouth-nose protection on different developmental areas of children and adolescents based on the small number of studies. There is a lack of research data regarding the following outcomes: psychological development, language development, emotional development, social behavior, school success, and participation. Further qualitative studies and epidemiological studies are required.


Subject(s)
COVID-19 , Communicable Diseases , Adolescent , Child , Child, Preschool , Germany , Humans , Masks , Pandemics , SARS-CoV-2
19.
BMJ Open ; 11(10): e048212, 2021 10 13.
Article in English | MEDLINE | ID: covidwho-1467703

ABSTRACT

INTRODUCTION: German government regulations such as physical distancing and limited group numbers, designed to curb the spread of COVID-19, have had far-reaching consequences for the very foundations of social life. They have, to name only a few, transformed greetings and goodbyes, blurred private and public worlds, and complicated basic communication with mandatory mask wearing. The ethnographic study CoronaCare investigates how these sociopolitical measures affect social health, a form of health which unfolds through and across social relations. It explores how caring as a fundamental human activity and one integral to sustaining social health is impacted when in-person and person-to-person contacts are restricted and everyone is radically redefined as at risk from others and a risk to others. It explores care relationships, relationships involving the giving or receiving of care in everyday life, institutional settings such as an assisted living facility, and informal settings, such as a housing block. Inside of the pandemic, relationships are a pivotal site at which the negotiation of caring and risk is intensified and where the consequences for social health and social life more generally are pronounced. METHODS AND ANALYSIS: This ethnographic project aims to understand the tensions that arise in the lives of individuals and communities living under the sociopolitical regulations and to analyse the tacit forms of practice that individuals and communities develop to uphold social health. Fueled by citizen science, the ethnography uses a variety of methods namely telephone and video interviews with 60-70 research participants, the collection of ethnographic material including video and audio diaries, storyboards, first-person camera footage, photographs and a survey to enrich the sample description based on the Copenhagen Psychosocial Questionnaire. The analysis will draw on elements of grounded theory and through the aid of the qualitative software MAXQDA it will rigorously document and explain how the social regulations are (re)shaping our ability to be cared for and to care for one another. The survey data will be analysed through the use of the quantitative software programme R. ETHICS AND DISSEMINATION: The ethics committee of the Brandenburg Medical School Theodor Fontane has approved the project (E-01-20200605). The dissemination strategy includes publications in medical, sociological and research methods journals, as well as a stakeholder discussion with political and civil society leaders where the research team will present its recommendations for future pandemic preparedness.


Subject(s)
COVID-19 , Pandemics , Anthropology, Cultural , Humans , SARS-CoV-2 , Surveys and Questionnaires
20.
Sci Rep ; 11(1): 19521, 2021 09 30.
Article in English | MEDLINE | ID: covidwho-1447323

ABSTRACT

School closures have a negative impact on physical and mental well-being, and education, of children and adolescents. A surveillance programme to detect asymptomatic SARS-CoV-2 infection could allow schools to remain open, while protecting the vulnerable. We assessed the feasibility of a programme employing gargle samples and pool testing of individually extracted RNA using rRT-qPCR in a primary and a secondary school in Germany, based on programme logistics and acceptance. Twice a week, five participants per class were selected to provide samples, using an algorithm weighted by a risk-based priority score to increase likelihood of case detection. The positive response rate was 54.8% (550 of 1003 pupils). Logistics evaluation revealed the rate-limiting steps: completing the regular pre-test questionnaire and handing in the samples. Acceptance questionnaire responses indicated strong support for research into developing a surveillance programme and a positive evaluation of gargle tests. Participation was voluntary. As not all pupils participated, individual reminders could lead to participant identification. School-wide implementation of the programme for infection monitoring purposes would enable reminders to be given to all school pupils to address these steps, without compromising participant anonymity. Such a programme would provide a feasible means to monitor asymptomatic respiratory tract infection in schools.


Subject(s)
COVID-19/diagnosis , COVID-19/prevention & control , Disease Outbreaks/prevention & control , Epidemiological Monitoring , Schools/statistics & numerical data , Adolescent , COVID-19/virology , COVID-19 Nucleic Acid Testing/statistics & numerical data , Child , Feasibility Studies , Germany/epidemiology , Humans , Pandemics , Saliva/virology , Students/statistics & numerical data , Surveys and Questionnaires
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