Prevalence of oropharyngeal dysphagia and risk of mortality among hospitalized COVID-19 patients: A meta-analysis.

Background: Post-extubation and neurologic complications in COVID-19 patients have been shown to cause oropharyngeal dysphagia (OD). We performed the first meta-analysis to explore and estimate the pooled prevalence of OD, risk of mortality, and associated factors among hospitalized COVID-19 patients. Methods: We searched Scopus, PubMed, Embase, CINAHL, WHO COVID-19 database, and Web of Science for literature on dysphagia in COVID-19 patients. We used the generalized linear mixed model (GLMM) to determine the prevalence estimates of OD in the R software and the DerSimonian-Lard random-effects model in the Comprehensive Meta-Analysis software to explore the risk of mortality and associated factors of OD, presented as odds ratios (ORs) and corresponding 95% confidence intervals (CIs). We used Cochran's Q, τ2, and the I2 statistic to assess heterogeneity and conducted a moderator analysis to identify moderator variables. Results: We included eighteen studies with a total of 2055 participants from the 910 studies retrieved from electronic databases. The prevalence of OD among hospitalized COVID-19 patients was estimated at 35% (95% CI = 21-52; low certainty of evidence) associated with a high risk of mortality (OR = 6.41; 95% CI = 1.48-27.7; moderate certainty of evidence). Intubation (OR = 16.3; 95% CI = 7.10-37.3; high certainty of evidence), use of tracheostomies (OR = 8.09; 95% CI = 3.05-21.5; high certainty of evidence), and proning (OR = 4.97; 95% CI = 1.34-18.5; high certainty of evidence) among hospitalized COVID-19 patients were highly associated with developing OD. The prevalence of OD was higher among hospitalized COVID-19 patients who were admitted in intensive care units (ICU), intubated, and mechanically ventilated. Conclusions: The prevalence of OD among hospitalized COVID-19 patients is estimated at 35% associated with a high risk of mortality. OD assessment among hospitalized COVID-19 patients who are managed in an ICU, prone position, intubated, and mechanical ventilated deserves more attention. Registration: PROSPERO CRD42022337597.

Prevalence of depression, anxiety, and stress among first responders for medical emergencies during COVID-19 pandemic: A meta-analysis.

Background: The COVID-19 pandemic has been shown to cause enormous psychological burden among health care workers, including first responders. However, psychological well-being of first responders, essential in the fight against COVID-19 pandemic, has often been ignored. We performed the first meta-analysis to explore the prevalence of 1) depression, 2) anxiety, and 3) stress among first responders for medical emergencies during the COVID-19 pandemic. Methods: A comprehensive search was conducted in Embase, CINAHL, Web of Science, PsychInfo, PubMed, and the WHO COVID-19 database from 2020. The Freeman-Tukey double-arcsine transformation model in R-software determined the pooled prevalence and Comprehensive Meta-Analysis for associated factors of depression, anxiety, and stress with corresponding 95% confidence intervals (CI). The Cochrane Q, τ2, and I2 statistics were used to examine heterogeneity. Sub-group analysis was conducted to identify moderator variables. Results: We identified 765 records, from which 17 studies were included with 8096 first responders. The pooled prevalence was 31% (95% CI = 21%-41%) for depression; 67% (95% CI = 64%-70%) for mild depression, 24% (95% CI = 17%-31%) for moderate depression, and 16% (95% CI = 4%-34%) for severe depression. The pooled prevalence for anxiety was 32% (95% CI = 20%-44%); 60% (95% CI = 46%-73%) for mild anxiety, 27% (95% CI = 14%-42%) for moderate anxiety, and 14% (95% CI = 7%-22%) for severe anxiety. The pooled prevalence for stress was 17% (95% CI = 4%-34%); 58% (95% CI = 38%-77%) for mild stress, 22% (95% CI = 5%-44%) for moderate stress, and 19% (95% CI = 5%-37%) for severe stress. The prevalence of depression was 37% (95% CI = 25%-52%) for paramedics, 28% (95% CI = 12%-54%) for EMS personnel and 22% (95% CI = 13%-33%) for police. Similarly, the prevalence of anxiety was 38% (95% CI = 20%-60%) for paramedics, 28% (95% CI = 11%-53%) for EMS personnel, and 19% (95% CI = 10%-32%) for police. Married responders were likely at risk for depression (1.50, 95% CI = 1.26-1.78) and anxiety (1.94, 95% CI = 1.62-2.33), while unmarried responders were less likely at risk for depression (0.67, 95% CI = 0.56-0.79) and anxiety (0.50, 95% CI = 0.43-0.63). Conclusions: High prevalence of depression, anxiety, and stress during the COVID-19 pandemic among first responders for medical emergencies emphasizes the need for monitoring their psychological well-being. Early assessment and management of mild depression, anxiety, and stress among first responders are crucial in preventing progression into moderate and severe types.