ABSTRACT
Authors are analysing the extent of acceptance of rule on mandatory presence of two witnesses during a home search in national criminal proceedings in EU Member States. While some police powers in Croatia are regulated using modern forms of protection of suspects' rights, some other investigative actions are regulated using rules that are uncommon in EU. Home search has a historic model of obligatory presence of two witnesses. These witnesses are often randomly selected among citizens, they are not legal professionals. A suspect has no right to reject witnesses if he considers that they could violate his privacy or health rights. Besides that, the Two-witness Rule has a peculiar impact on the evidence law. Items found during home search cannot be legally used if only one witness was present. According to such consequence, this rule actually requires a certain number of witnesses to prove a fact. Such requirements on number of witnesses have been abandoned in modern evidence law. The results of the analysis of the EU Member States show that the rule on the mandatory presence of two witnesses is widespread only in some post-communist systems. When it comes to EU criminal procedure codes (CPCs), the mandatory presence of witnesses exists in Croatian, Slovenian and Bulgarian CPC. The study is showing influence of former Russian CPC in post-Soviet era as well as the influence of former Yugoslav CPC. Regarded as the relic of the past, these procedural guarantees of home inviolability in the cases of home search should be reassessed and improved. In the context of COVID crisis, mandatory presence of witnesses presents challenge for the protection of suspect's and witnesses' health. Observed from the suspect's right to protect his health or the witnesses' right not to expose themselves to potentially health endangered situations, finding witnesses presents even more complexed mission. If the suspect is in COVID quarantine and the search must be conducted, can witnesses be forced to enter such premises? In case that suspect requires fully vaccinated witnesses who can present valid COVID Certificate or negative PCR test, how could his requirement be fulfilled? The possible solution for both evidence law and health reasons could be the use of modern technologies such as video recording that could replace mandatory witnesses presence. Finally, it would be more appropriate to respect the suspect's choice on protection of his rights or to use modern technical means or defence lawyer, as in other investigative actions in criminal procedure.
ABSTRACT
Introduction. The COVID-19 pandemic has had a dramatic impact on the health and social care landscape, both in terms of service provision and citizen need. Responsive, evidence-based research is essential to develop and implement appropriate policies and practices that manage both the pandemic itself, and the impact COVID-19 has on other health and social care issues. To address this, the Wales COVID-19 Evidence Centre (WCEC) was launched in 2021 with the aim of providing the best available, up-to-date, and relevant evidence to inform health and care decision making across Wales. Methods. Funded by the Welsh Government, the WCEC comprises of a core team and several collaborating partner organizations, including Health Technology Wales, Wales Centre for Evidence- Based Care, Specialist Unit for Review Evidence Centre, SAIL Databank, Public Health Wales, Bangor Institute for Health & Medical Research in conjunction with Health and Care Economics Cymru, and the Public Health Wales Observatory. Over the last year, WCEC has developed its rapid review processes and methodology informed by best international practice and aims to provide around 50 reviews each year. WCEC works alongside various stakeholder groups from health and social care across Wales, and they form an integral part of the review process, from scoping to knowledge mobilization. Results. To date, the WCEC has produced reviews on a diverse range of COVID-19 topics, including transmission, vaccination uptake (barriers, facilitators and interventions), mental health and wellbeing, as well as face coverings and other preventative interventions. The topics have also covered a wide range of populations, from general public, to healthcare workers, to children. These reviews have been used to inform policy and decision-making, including the Welsh Government's Chief Medical Officer 21-day COVID-19 reviews. Conclusions. The WCEC has brought together multiple specialist centers with a diverse range of skills to produce timely reviews of the most up-to-date research to support decision makers across health and social care. These reviews have informed policy and decisionmaking across Wales.
ABSTRACT
Background: High-grade glioma patients and their caregivers often suffer from psychological distress.1 Nevertheless, supportive services are lacking. This study investigates whether a mindfulness-based yoga intervention is feasible and affects anxiety, depression, quality of life, and stress-associated physiological parameters. Method(s): A monocentric on-site pilot study to test feasibility was started in 2020 and then adapted to an online format due to the COVID-19 pandemic. Participants were randomly assigned to immediate intervention and 8-weeks wait-list control groups. At randomization, immediately before and after the end of the 8-week intervention (1 h/week), which was performed by trained yoga teachers in a synchronous format, as well as another 3 months later, validated questionnaires were filled by participants and serum plus saliva samples were taken. In addition, participants were asked to rate their satisfaction with various course features. Result(s): A total of 43 participants with 27 donating biological samples and a drop-out of 14 were included. No significant changes in subjective criteria and physiological stress parameters were detected. Known disadvantages of online interventions were reported, e.g. technical difficulties. Overall course-satisfaction, with teachers guidance most positively rated, was reported. Discussion(s): High-grade glioma patients are very vulnerable due to their rapidly changing health status. Caregivers often have very limited time due to the care they provide. Therefore, recruitment is difficult and leads to dropouts. Validity of the results may be limited due to the small sample size and comparability of stress parameters due to circadian fluctuations in salivary cortisol. Conclusion(s): The online yoga course is feasible. Despite of lacking personal contact, supervision of participants is possible and satisfactory. To measure cortisol, more reliable hair samples will be taken in the upcoming multicenter study, starting in fall 2021.
ABSTRACT
Background: Vaccine against COVID-19 is an effective preventive measure;however, systemic lupus erythematosus (SLE) patients were excluded from the vaccine trials, which leads to questions regarding vaccine safety and efficacy, giving rise to vaccine hesitancy. We aim to study the prevalence of vaccine hesitancy among SLE patients and study the factors affecting it. Method(s): The study is a cross-sectional telephone-based survey done on SLE patients. The questionnaire included a series of 15 questions pertaining to their baseline characteristics, COVID-19 infection and vaccination details, and their perceptions regarding the COVID-19 vaccine. Nonvaccinated individuals were defined as 'willing' and 'hesitant' based on their intent to get vaccinated. Result(s): Among 418 (93% women) participants, about 8% had contracted COVID-19 infection in the past. Nearly half had been vaccinated against COVID-19, and 83% had experienced one or more side effects which were largely mild. Out of the 215 nonvaccinated participants, 84% were 'willing' and 16% were 'hesitant.' Among the reasons for hesitancy, hasty vaccine production, fear of SLE flares, general vaccine refusal and limited transport facilities were significant. On the whole, 65.1% had a positive attitude toward the vaccine. Conclusion(s): Despite a low-hesitancy rate, the number of SLE patients with a negative attitude toward the COVID-19 vaccine is reasonably high, with more than half of the patients yet to be vaccinated. This highlights that the mistrust and negative perceptions of the vaccine still persists. The role of health-care providers in vaccine acceptance in SLE patients is crucial. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
BACKGROUND: School-aged children are recommended to complete at least one hour of moderate to vigorous intensity physical activity per day. North American data has shown that due to COVID-19 restrictions placed on in person schooling and extracurricular activities, children were not meeting recommended levels of physical activity. Additional barriers to activity during the first wave of the COVID-19 pandemic included lack of access to public facilities including community centers, parks, and outdoor recreation. Decreased physical activity in children has been shown to have a negative impact on both physical and mental health, and childhood development. However, there is a paucity of literature on parents' perceptions of the association between physical activity and physical and mental health. OBJECTIVE(S): The objective of this study was to gain a better understanding of the implications of the COVID-19 pandemic on levels of physical activity and parents' perceptions surrounding physical activity and physical and mental health. DESIGN/METHODS: An online survey was distributed to parents of school-aged children aged 4-13 in Ontario. The survey included questions regarding demographics, children's physical activity prior to and during the first wave of the COVID-19 pandemic, and parental perceptions regarding the pandemic's impact on mental and physical health. This study received ethics approval, was hosted on the REDCapTM platform, and distributed from February-June 2021 through a local school board, the Pediatrics section of the Ontario Medical Association, and through social media. RESULT(S): Of 361 participants, 90.4% strongly agreed that physical activity was important for mental health, and 92.2% strongly agreed that physical activity was important for physical health. There was a statistically significant decrease in the overall mean number of hours of physical activity per week between pre-COVID and the first wave of COVID (mean difference = 9.34 hours, SD = 10.06, p<0.001). Additionally, parents of children with decreased physical activity reported a statistically significant negative impact on physical and mental health as compared to parents whose children had no change in amount of physical activity. Decreased energy, poor sleep, increased anxiety, mood disturbances, and disruptive behaviour were noted by over 50% of respondents. CONCLUSION(S): This survey highlights that parents themselves perceived a significant negative impact on children's mental and physical well-being with decreased physical activity during the COVID-19 pandemic. This emphasizes the importance of retaining access to recreational facilities and extracurricular activities. Future research includes identifying ways to re-engage parents and children with physical activity during times of decreased access.
ABSTRACT
Background. During the coronavirus disease 2019 (COVID-19) pandemic, healthcare facilities (HCFs) were overwhelmed with increasing patient volumes and limited resources. Reports of disruptions in routine practices at HCFs have emerged. We evaluated changes in policies, practices, and programs for antimicrobial stewardship (AMS), infection prevention and control (IPC), and clinical microbiology across six HCF in South America following the onset of the COVID-19 pandemic. Methods. We conducted a survey in 6 HCFs in Argentina, Brazil, and Chile;2 HCFs in each country. Data on 5 components (facility characteristics, antibiotic procurement and distribution, AMS activities, IPC activities, and clinical microbiology) were collected from designated specialists within each HCF from March 2018 - February 2021. We compared observations within these 5 components pre-pandemic (March 2018 - February 2020) to during pandemic (March 2020 - February 2021.) Results. During the pandemic, the number of ICU beds increased across all the 6 HCFs by 57-633%, and the number of ventilators increased by 15-317% in 5 out of the 6 HCFs. Healthcare personnel shortages were observed in all 6 HCFs, notably common for nurses and laboratory personnel (Table 1). Extended use of N95 respirators was reported across all 6 HCFs with 2 doing extended use of gowns and medical masks. The only PPE reused was N95 respirators in 2 HCFs. Difficulties in cohorting patients with multi-drug resistance organism (MDRO) was reported by one of the HCFs. Three HCFs reported shortages in drugs with coverage for MRSA, gramnegative bacteria, and fungal pathogens despite no reports of interruption in AMS activities in these HCFs. Two hospitals reported delays on microbiology results. Facility characteristics and reported changes during COVID-19 pandemic (March 2020-February 2021) Conclusion. The COVID-19 pandemic led to substantial increases in ICU beds, number of ventilators, and extended use of PPE suggesting increases in admission of severe patients and suboptimal IPC practices in HCFs in South America. It is unclear if shortages in agents commonly used to treat MDRO was related to overuse or access difficulties. Additional evaluation is needed to determine the impact of these findings on antimicrobial resistance and antimicrobial use.
ABSTRACT
Background. The COVID-19 pandemic has strained healthcare systems worldwide and is now a leading cause of death. Remdesivir is the first antiviral shown to decrease time to recovery in a randomized placebo-controlled trial. Other studies have conflicting results and the World Helath Organization does not recommend the routine use of Remdesivir in hospitalized patients. The herogeneity of these studies and their populations makes interpretation of the available data difficult, with standard of care in different countries as the main confounding factor. Thus, it is imperative for low and middle income countries to study the role of remdesivir within their healthcare systems. We seek to further understand the impact of COVID-19 in a cohort in the Dominican Republic. Methods. This is a retrospective review of patients admitted for COVID-19 to a tertiary center in the DR between August 2020 to March. 2021. Patients with clinical findings consistent with COVID-19 pneumonia and a positive molecular test for SARS-CoV-2 were included in the study. Results. A total of 59 cases were reviewed, of which 40 were treated with remdesivir and 19 with remdesivir plus tocilizumab. Patients were more commonly male (69.5%) and ages ranged from 71-80 years (34.5%), 61-70 (20.7%), 51-60 (20.7%), 41-50 (10%), >81 (8.6%) and 18-30 (1.7%). Hypertension was the most common comorbidity (Figure 1). The average length of stay was 16.5 days, and 2.1 days. Mechanical ventilation was needed in 33.9%. Tocilizumab was administered in 32%. Mortality for the cohort was 29% (Figure 2). Mortality in patients treated with remdesivir alone was 22%, compared to 6.8% in those receiving tocilizumab and remdesivir. Comorbidities Mortality by length of stay Conclusion. In our cohort, the use of remdesivir was associated with higher mortality than remdesivir in combination with tocilizumab. The mortality in our cohort was high (29%) compared to the 11.9% reported in in the placebo group of the ACTT-1 study. Furthermore, studies have consistently shown benefit earlier in the disease course and with lower oxygen needs. Our cohort had high rates of mechanical ventilation. Thus, the modest benefit seen in developed countries may be harder to show in resource limited settings and the number needed to treat is likely much higher. Remdesivir did not appear to have an impact in our cohort.
ABSTRACT
BACKGROUND-AIM Although more than two years have passed since the beginning of the SARS-CoV-2 pandemic, the interest of Public Health in the development and administration of effective anti-COVID-19 vaccines continues.We aimed to test the antibody response to SARS-CoV-2 vaccination in patients with and without previous infection. METHODS From June 2021 to November 2021, we recruited 203 patients who were going to receive vaccination against SARS-CoV-2: 123 women (60.6%) with a median age of 44 years (IQR: 33-56) and 80 men (39.4%) with a median age of 43 years (IQR 32-53);78 patients reported previous SARS-CoV-2 infection (41 women, 37 men). 74 out of 203 were healthy subjects, 84 reported mild to medium allergic history and 45 other diseases. 97.4% of subjects received BioNTech/Pfizer vaccination and, according to Ministerial Dispositions, patients with previous SARS-CoV-2 infection received a single dose (group 1), other patients received two (group 2). After 3 months, 98 subjects received a third dose (57 BioNTech/Pfizer and 41 half a dose of Spikevax-Moderna).The antibody response to vaccination was measured on blood samples collected before vaccination (T0), 10 days after the first dose of vaccination (T10), 15 (T15), 90 (T90) and 180 (T180) days after the second or only vaccination. Samples were tested using Access SARS-CoV-2 IgG (1st IS) on Access UniCelDxI 800 (Beckman Coulter s.r.l.). RESULTS The comparison between median concentrations in our groups showed a statistically significant difference (p<0.001) at T0, T15 and T90, but not at T180 (p=0.713). At T0 and T90 the SARS-CoV-2 IgG concentration was higher in group 1, while at T15 it was higher in group 2. At T90 the antibody titer dropped in all patients, but the decrease was higher in group 1. 77 SARS-CoV-2 infections occurred after vaccination (4.2% between T15 and T90, 95.7% between T90 and T180). CONCLUSIONS We confirm that the antibody titer is significantly associated with a having had previous SARSCoV-2 infection, but not with age and sex. The probability of contracting the infection after vaccination increases after three months from primary vaccination, confirming the efficacy of vaccination as a preventive measure against SARS-CoV-2 infections and the need of booster administrations.
ABSTRACT
Nowadays, the new narrative is the transformation of a zoonotic virus into an international predicament called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection which is affecting millions. In this pandemic situation, universal migration has had an adverse impact on the world healthcare scenario. As Kerala is a source destination for international migration and destination for internal and return migration, this paper aims to investigate the transmission dynamics of Corona Virus Disease 2019 (COVID-19) in Kerala in the light of migration. The study was conducted after creating a crowd-sourced dashboard on the details of the COVID-19 outbreak in Kerala which is available in the public domain (https://doi.org/10.5281/zenodo.3818096). The data of the COVID-19 situation in Kerala, which is crowdsourced, curated, and scientifically presented using the open data standards, formed the basis of this study. The study demonstrates that, even before community spread, return and internal migration has increased the spread of the infection in Kerala, particularly in the second phase of the disease outbreak. The largest number of COVID-19 positive cases in Kerala have been reported among migrants from the Middle East countries. The study shows an exponential growth in positive cases from July 2020, when flights continued to come in to Kerala with returning migrants. This study draws attention of the authorities and policy makers to the consequences of migration to healthcare systems, transit areas and destination areas in health emergencies.
ABSTRACT
Introduction: The COVID-19 pandemic has caused a significant impact on the mental health of health workers that has brought many hospitals to launch immediate preventive mental health programs. Objective(s): (1) To adapt and enhance a smartphone app (PRESTOapp) for health workers with mental health symptoms related to the COVID-19, and (2) to demonstrate its potential effectiveness in significantly reducing anxiety-depressive and PTSD symptoms in this population. We aim to incorporate Natural Language Processing (NLP)-based techniques in a chatbot userinterface that will enable a more personalized and accurate monitoring and intervention. Method(s): An 18-months study with a 6-months preliminary phase to adapt PRESTOapp to health workers, enhance it with NLP-based techniques and chatbot user-interface, and evaluate its feasibility, and effectiveness in 12-months. Result(s): PRESTOapp has the potential to provide a prompt, personalized and integral response to the mental health demand due to the COVID-19. It will help by providing an innovative digital platform, that will allow remote monitoring of the symptoms course, provide brief psychotherapeutic interventions, and detect urgent situations. If the preliminary results of this study point to a potential effectiveness of the intervention, PRESTOapp may be easily adapted to the general population. Conclusion(s): PRESTOapp may be one of the key digital platforms that may help preventing and treating potentially severe mental health consequences. Considering the unresolved problem of burnout in health workers even before the COVID-19, this project will develop the necessary technology for implementing cost-effective mental health solutions, not only during the pandemic.
ABSTRACT
Introduction: A 21-year-old woman diagnosed with bipolar disorder was hospitalized in the Mental Health Day Hospital of Salamanca during the Covid pandemic. The patient engaged with 4 different jobs and a master's degree, beginning with verbose speech, dysphoria, global insomnia, grandiose delusions, extremely high energy and thinking she has the vaccine. She works the following objectives: illness insight, risk factors, psychopathological stabilization, social skills, slowing down of activities and taking responsibilities. Objective(s): The objective is do a follow-up of the patient during her hospitalization in the Mental Health Day Hospital and to carry out a structured search in PubMed and Up-to-Date about psychotherapy and bipolar disorder. Method(s): 3-month follow-up of a 21-year-old woman diagnosed with bipolar disorder during her hospitalization in the Mental Health Day Hospital in Salamanca and a structured search in PubMed and Up-to-Date in April 2021 in English, French and Spanish, including the last 10 years with the keywords "psychotherapy", "psychotherapies" and "bipolar disorder ".77 studies were analyzed: 12 included, 65 excluded. Result(s): Several randomized trials highlight the efficacy of group psychoeducation and cognitive-behavioural therapy in relapse prevention, improving illness insight, medical adherence and less hospitalizations. Therapeutic alliance plays a significant role in the process. Our patient improved her knowledge of her illness and treatment, her social skills and reconnected with her relatives and slowed down her activity. She then was referred to her community mental heath center psychiatrist. Conclusion(s): The insight in bipolar disorder plays an important role in medical adherence and prevention of relapses. Therapeutic alliance improves their insight, their functionality in their daily life and enables close monitoring. Medical treatment should be accompanied by psychotherapy for a complete approach of the treatment.
ABSTRACT
Objectives: Cytokine release syndrome (CRS) is believed to be responsible for death in COVID-19. Tocilizumab is an interleukin (IL)-6 receptor antagonist, IL-6 being identified as a major component of the CRS cascade. The objective of the study was to determine if tocilizumab can prevent mortality and morbidity in moderate-to-severe COVID-19 pneumonia. Method(s): Patients admitted to the ICU between the time period of June 2020-August 2020 were included in this retrospective and cohort study conducted at GCS medical college, hospital and research center. Patients had to be more than 18 years of age and were required to have a positive reverse transcription polymerase chain reaction report for COVID-19. After applying the inclusion/exclusion criteria, 119 patients were considered for final analysis. Tocilizumab was administered as a single dose of 8 mg/kg in 22 patients. Rest of the patients received standard of care regime. The primary outcome was either discharge or death of the patients and the requirement of invasive mechanical ventilation during their hospital stay. The secondary outcome was the length of hospital stay. Appropriate demographic, clinical, and laboratory data were documented. Statistical analysis was done with appropriate clinical tests with significance set at p<0.05. Result(s): Tocilizumab significantly reduced deaths in patients as well as the need for mechanical ventilation with NNT=3 and 5, respectively. The same held true even when the data were adjusted for age, gender, and number of comorbidities. Number of comorbidities had a negative association with mortality and need for mechanical ventilation irrespective of administration of tocilizumab as evidenced by multivariable logistic regression. There was no effect of tocilizumab in shortening the hospital stay in patients. Conclusion(s): Tocilizumab seems to be a promising agent for the treatment of moderate to severe COVID-19 pneumonia and similar agents hold promise for any similar future emerging infections. Copyright © 2022 The Authors.
ABSTRACT
Background: Post-traumatic stress disorder (PTSD) has been reported in up to 15% ofgeneral population during and after the first wave of the COVID-19 pandemic. The pandemic has acted as a catalyst for the application of telemedicine in neurology. Objective(s): to evaluate the presence of PTSD symptoms as effect of the lockdown measures in people with MS (PwMS) using an e-health application specifically built for remote management of PwMS, SMcare2.0 application. Method(s): Between March 4, 2020 and July 5, 2020 (T0) PwMS who were using (n=290) the app were asked to fill in the Impact of Event Scale - Revised (IES-R) questionnaire to evaluate the presence of PTSD symptoms. The IES-R has 3 subscales: intrusion, hyperarousal, avoidance. The total IES-R score ranges from 0 to 88. A cut-off value of 33 of the total score was used to define the presence of PTSD symptoms (PTSD+). Only those PwMS who filled-in the questionnaire the first time were asked to answer again it when the lockdown measures were abolished (T1). Clinical and demographic data were extracted from the Italian MS register application and linked to the IES-R results. Baseline clinical characteristics of PwMS (classified on the basis of IES-R score) and the proportion of PTSD+, the subscales and the total score at T0 and T1 were compared. Result(s): During the lockdown 90 PwMS (31% response rate) completed the IES-R (62 F;mean (SD) age 40.1(1.0) years;median (IQR) EDSS score 2.3 (1-8);mean disease duration (SD) 10.7 (0.7)). Mean (SD) baseline subscales values were: intrusion 15.9 (7.1), hyperarousal 10.7 (5.0), avoidance 15.4 (6.7). Mean (SD) total IES-R score was 42.0 (17.0), 63 (70%) patients scored above 33 and were identified as having recently developed PTSD symptoms. No significant difference were found between PTSD+ and PTSD- patients in terms of age, EDSS and disease duration. At T1, when the lockdown measures were removed, the IES-R scores were significantly reduced in comparison to T0 scores (intrusion 8.6 (8.9), hyperarousal 6.0 (5.8), avoidance 8.4 (8.5), total score 4.8 (1.9), p<0.0001). The number of patients classified as PTSD+ was significantly reduced in comparison to T0 (16 (17.8%), p<0.0001). Conclusion(s): Our study demonstrated that PwMS during and after lockdown manifested post-traumatic stress symptoms. Furthermore, our results show how e-data collected can be useful in remotely monitoring patients and can be easily linked to clinical data collected by disease registries.
ABSTRACT
Introduction: Most CYP present with symptoms of T1D for the first time to primary care. Delayed diagnosis is common and associated with risk of life threatening diabetic ketoacidosis (DKA). In Cardiff, we had a pre-pandemic QI project to improve early diagnosis. As the pandemic changed delivery of healthcare, we introduced systems to facilitate early diagnosis of T1D. Objective(s): To facilitate early diagnosis of T1D via effective pathways during the pandemic. The primary objective is to reduce the incidence of DKA at diagnosis. Method(s): We worked with partners in primary care to identify barriers and develop initiatives at the start of the pandemic. This included an updated referral pathway, training for triage staff, revising online algorithms, and raising public awareness. Retrospective case note analysis of all newly diagnosed CYP covering prepandemic (1/4/2018-31/3/2020) and pandemic (1/4/2020- 31/3/2022). Key points included delayed diagnosis, presentation, appropriate testing, and prompt referral. Result(s): Pre-pandemic, 6/7 with delayed diagnosis had delayed triage and 1 had fasting blood glucose (BG). 25/28 had POC BG testing and 2 had a urine test. During the pandemic, 2/4 with delayed diagnosis had delayed triage. 46/49 had POC BG test and 3 a urine test. The 4 in severe DKA had delayed presentation but promptly diagnosed, of which 2 were presumed to have COVID. During the pandemic 91% had POC testing and prompt referral to secondary care compared with 75% pre pandemic. There was no increase in the DKA rates during the pandemic despite a significant increase in the number newly diagnosed. Conclusion(s): During the pandemic, we demonstrated an improvement in prompt diagnosis following the QI initiatives between primary and secondary care. Delayed presentation has resulted in severe DKA despite public awareness campaigns. Data analysis, feedback, training and public awareness campaigns across other health boards is planned.
ABSTRACT
Study Objective: Concerns over emerging infectious diseases spread via airborne or respiratory droplet transmission have highlighted the importance of respiratory protection for health care workers. During the current COVID-19 pandemic, widespread use of N95 masks by health care workers helped to prevent transmission and contraction of SARS-CoV2. It is not clear if prolonged continuous use of an N-95 during clinical duties results in any detrimental physiological effects and clinical features from increased carbon dioxide. The primary objective of the study was to evaluate for carbon dioxide retention and/or clinically significant changes in pH with prolonged use of N-95 masks. Secondary objective assessed for changes in vital signs and any unexpected subjective symptoms experienced by the study participants. Methods: 10 healthy emergency medicine residents between the ages of 27 and 31 years old provided written consent. All subjects denied history of structural lung disease (asthma, COPD, interstitial lung disease) and had been previously fit-tested for the correct size of N-95 mask. Each participant was provided a new N-95 mask and instructed to don as if they were about to enter a clinical scenario that would require this degree of respiratory protection. All subjects remained in a seated position and asked to refrain from speaking in order maximize fit of the mask. Venous blood gas samples were obtained prior to donning their mask followed by three additional intervals at, 20, 40, and 60 minutes. In addition, vital signs (heart rate, pulse oximetry, blood pressure and respiratory rate) were recorded at each of those four intervals and subjects were ask to self-record any symptoms they experienced prior to each blood draw. Each sample collected consisted of acquiring 2 ml of venous blood, which were analyzed within 30 minutes at the University of Nebraska Medical Center’s core lab. PCO2 and pH was assessed at each of the time intervals and fit with a linear mixed effect model to determine if statistically significant change over time for these measurements. Mean and standard deviations were used to describe the values at each time point. Pairwise comparisons between time points were adjusted using Tukey’s method. All analysis was done using SAS, Version 9.4 and a p-value < 0.05 was considered statistically significant. Results: The mean carbon dioxide levels at time 0 and 60 minutes were 48.9 (CI, 49.0-56.0) and 48.5 (CI 39.0- 57.0) and there was no statistically significant change across any of the time intervals (p=0.20). There was a small significant increase in the mean pH between the 20-minute assessment and baseline [(7.367, CI 7.350- 7.400) vs (7.381, CI 7.350-7.410) p=0.019], which was not clinically significant. In addition, there were no significant changes in vital signs or report of unexpected clinical symptoms by any the subjects. Conclusion: In this small cohort of subjects, there was no evidence of carbon dioxide retention or clinically significant changes in pH with prolonged use of N-95 masks. [Formula presented]
ABSTRACT
Aim: The coronavirus disease 2019 (COVID-19) pandemic has abruptly changed the life of millions as travel and social contacts have been severely restricted. We assessed the psychological impact of COVID-19 on adults and children, with special attention to health care workers (HCWs). Methods: A self-rated online survey, including the Impact of Event Scale-Revised (IES-R) for adults and the Children Revised Impact of Event Scale-Revised-13 items (CRIES-13) for their 8-18-year-old offspring, was conducted in Italy on March 20-26, 2020. Linear mixed-effects models were applied to the data, accounting for age, sex, education, and other demographic characteristics. Results: Data were available from 2,419 adults (78.4% females, mean age 38.1 ± SD 13.1 years; 15.7% HCW) and 786 children (50.1% male, mean age 12.3 ± 3.2 years). Median (IQR) IES-R score was 30.0 (21.0-40.0), corresponding to mild psychological impact, with 33.2% reporting severe psychological impact. IES-R was lower in HCWs (29.0) than non-HCWs (31.0), but HCWs directly involved in COVID-19 care had higher scores [33.0 (26.0-43.2)] than uninvolved HCWs [28.0 (19.0-36.0)]. Median CRIES-13 score was [21.0 (11.0-32.0)], with 30.9% of the children at high risk for post-traumatic stress disorder. Parent and child scores were correlated. Conclusions: Up to 30% of adult and children in the pandemic area are at high risk for post-traumatic stress disturbances. The risk is greater for HCWs directly involved in COVID-19 care and for their children.