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Background: The overarching aim of the study was to (1) investigate how working with COVID-19 patients has impacted work environment, and (2) to identify how factors in the work environment impact adverse health outcomes among hospital personnel (HP), throughout the four waves of the pandemic. Material(s) and Method(s): In a web-based survey altogether 2472 HP participated from four large university hospitals in Norway, whereof N = 680 in April-June 2020 (T1), N = 1073 in December-January 2020/2021 (T2), N = 818 in April-May 2021 (T3), and N = 972 in December 2021-February 2022 (T4). At each time point participants reported on pandemic related work tasks, work environment and adverse health outcomes. Somatic symptoms, psychological distress, posttraumatic stress symptoms and burnout served as outcomes of multivariable linear regression models. The percentage of responders involved in ICU treatment of COVID-19 patients varied between 21% and 40% from T1-T4. Result(s): Reported stressors altered in strength during the 4 waves. Preliminary results indicate that exposure to patients with COVID-19 was associated with more frequent experience of work environmental factors. Compared to colleagues not working with patients with COVID-19 HP reported challenges related to professional competency and training, predictability in teams and work environment, manageable workload, adequate help and support for work stress management, user-friendliness of Personal Protection Equipment and infection protection safety. Furthermore, these environmental factors were associated with symptoms of psychological unhealth on at least one timepoint. Conclusion(s): The results may help guide organizational efforts to maintain professional competency and to reduce stress more efficiently among hospital personnel at different stages in response to long-term crises.
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Introduction: Automatic drug dispensers are now widely used in critical care.1-2 They can provide information about dispensed drugs. Good practice in sedation restricts the use of sedatives and titrates doses to defined responses.3-4 Objectives: To extract drug dispenser issuing records for sedatives and link these to patient records to evaluate sedative use. Method(s): in October 2019, we introduced two Omnicell XT automated dispensing cabinets (Omnicell inc. CA, USA) into a 42 bedded general/neurological unit. ICNARC (Intensive care national audit and research centre) and CCMDS (Critical care minimum data set) data was collected using the Ward Watcher program. Dispenser issuing records for alfentanil, propofol and midazolam were obtained as Excel files for 13 months from January 2020. Output time stamps were converted to dates and times. Outputs were linked to outputs of the ICNARC and CCMDS records for the patients that the drugs were issued to. All the outputs had patients identified by their unique hospital numbers. These were used in Excel "power queries" to produce a spread sheet with a single row per patient. Multiple admissions used the first diagnosis, the final outcome and the total length of stay. The total dose of sedatives was calculated from ampoule dose and number. The duration of treatment was calculated from the first and last issues of the drug. ICNARC codes were used to identify the primary system in the admission diagnostic code and those patients admitted for COVID-19. Variables were compared using Chi Squared, Mann-Whitney U and Kruskal Wallis Tests. The significance of associations was established using Spearman's Rho. Linear regression was used to define relationships more clearly. Result(s): Table one summarises the patient characteristics with respect to all admissions during the study period and for patients who had had the studied drugs issued to them. Midazolam was used in fewer patients, they were more likely to be male, heavier (p>0001) and to die than patients receiving Propofol or Alfentanil (p>0.001). With respect to diagnostic groups, all the sedatives, particularly Midazolam (p<0.001), were more likely to be used in patients with COVID-19. The relationship between the dose of sedative drugs and patient age and weight was explored using the dose per advanced respiratory day. All three drugs had a significant but weak negative relationship with age, lower doses being given to older people (Propofol r2 = 0.02, p=0.01. Alfentanil r2 = 0.04, p=0.00. Midazolam r2 = 0.07, p=0.00.). There was also a weak but significant relationship between increasing dose of Propofol with patient weight (r2 = 0.02, p=0.01), but there was no relation between weight and doses of the other drugs. Conclusion(s): Information from automatic drug dispensers can be interpreted and combined with other datasets to produce clinically relevant information. The limited weak relationships between drug dose and age and weight suggests that sedative drugs could have been better titrated to response.
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Objectives: To limit the risk of contracting the coronavirus, it is crucial for individuals to attain accurate COVID-19 related information. Once they are equipped with such information, they can engage in risk preventive behaviors. This study aimed to examine the sociopsychological factors predisposing individuals' information-seeking intentions. Method(s): Based on the risk information seeking and processing (RISP) model, we hypothesized that individuals perceiving the risk of COVID-19 were likely to seek risk-related information through increased affective response (i.e., anxiety and fear) and information insufficiency. We considered perceived information gathering capacity as a moderator in the prediction of information-seeking intention. Using an online survey platform, study participants were recruited from US adults. Multivariate linear regressions were conducted in a hierarchical fashion while controlling for numerous covariates. Result(s): A total of 510 responses were included in our analyses. Respondents' mean age was 46.6+/-17.8 years;about half (53.3%) were females. Results showed that respondents' perceived risk provoked affective responses (regression coefficient (b) = 0.8417, 95% CI [0.7408, 0.9426]), which then increased self-perceived information insufficiency (b = 0.1857, 95% CI [0.0859, 0.2855]). This finding indicated that after perceiving the risk of coronavirus, individuals experienced worry and fear associated with the risk. Such affective responses made them realize that their current COVID-19 related knowledge was insufficient. Also, respondents who acknowledged information insufficiency were motivated to seek information about the coronavirus (b = 0.1099, 95% CI [0.0198, 0.1999]). The relation between information insufficiency and information-seeking intentions was moderated by perceived information gathering capacity (b = 0.0070, 95% CI [0.0001, 0.0151]), indicating that individuals with a higher capacity of gathering information were more likely to intend information seeking. Conclusion(s): Study findings suggest the importance of interventions to promote information seeking for individuals with a low information gathering capacity. Policy makers and clinicians assist the public in obtaining accurate information from reliable sources.Copyright © 2023
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Background: Since the beginning of the SARS-CoV2 pandemic medical practices have implemented diverse protective measures to contain the pandemic, practice organization and structures were adapted. In order to get information about patients' perception of their doctors' visit during the pandemic, we conducted a patient survey in medical practices. Method(s): Cross-sectional study of 58 patients, who were interviewed in four medical practices (family physicians and specialists) in the South West of Munich from 02.04.-17.04.2020 on the following topics: "personal risk assessment", "sense of security and perception of protection measures in the practice setting", "importance of the doctor's visit" and "change of medication, nicotine consumption". By means of a questionnaire with 24 items, data were collected anonymously. Results are presented descriptively and via ANOVA as well as via linear regression. Result(s): The personal risk assessments for COVID-19-disease and for a severe course of COVID-19 were rated low moderate, independent of sex or age. Around 8% of the surveyed patients discussed their personal risk with their doctors. The sense of security in the practice setting was rated high. The rating of the protection equipment was good as well, and closely met expectations. The personal importance of the visit varied. Only 6% had considered cancelling their visit beforehand. A change of medication due to SARS-CoV-2 pandemic was not observed. Conclusion(s): The patient survey provides a snapshot of the outpatient setting from the patient's perspective in a hyperdynamic pandemic situation. Yet, due to the small study population, the results have to be interpreted with caution.Copyright © 2021, Deutscher Arzteverlag.
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Aims: Gestational diabetes has been attributed to maternal obesity and suboptimal maternal diet but the relative contribution of maternal eating behaviour is unknown. We compared eating behaviour in women with gestational diabetes and non-pregnant adults, and assessed which eating behaviour traits were most strongly associated with BMI in women with gestational diabetes. Method(s): Participants (total n = 448) including men (n = 67), non-pregnant women (n = 181) and women with gestational diabetes during a singleton pregnancy (n = 200;29 weeks' gestation;NICE / Covid-19 criteria) were recruited prospectively and completed a three-factor eating questionnaire (TFEQ-R18). Associations between BMI and uncontrolled eating (UE), emotional eating (EE) and cognitive restraint (CR) were assessed using linear regression. Result(s): Women with gestational diabetes had significantly lower UE scores compared to men (53% vs 63%;p < 0.001) and non-pregnant women (53% vs 65%;p < 0.001), and lower EE scores compared to non-pregnant women (60% vs 70%;p < 0.001). In men, BMI showed positive associations with UE (Coeff 25.2;95% CI 10.8-39.6;p = 0.001) and EE scores (Coeff 11.9;95% CI 3.3-20.6;p = 0.007) while CR had no significant association. In non-pregnant women, BMI showed positive associations with UE (Coeff 20.7 95% CI 11.4-30.0), p < 0.001) and EE scores (Coeff 7.7;95% CI 1.8-13.6;p = 0.010) and negative associations with CR (Coef-10.6;95% CI -21.1 to -0.1;p = 0.049). In women with gestational diabetes, only EE scores were significantly associated with BMI (Coeff 7.8;95% CI 3.9-11.7;p < 0.001). Conclusion(s): Women with gestational diabetes have favourable eating behaviour compared to men and non-pregnant women. Addressing EE may provide new translational opportunities to reduce BMI in gestational diabetes.
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Objectives: To examine the relative effectiveness of vaccination and non-pharmaceutical interventions (NPIs) on COVID-19 infection, reproduction rate, and deaths in the US. Method(s): Retrospective national-level US data were obtained from the Oxford COVID-19 Government Response Tracker (OxCGRT dataset). We performed time-trend analyses from December 2020 to December 2022 to observe how the values of policy variables and the number of COVID-19 new cases and deaths changed over time. The policy variables included (1) the number of people fully vaccinated per 100 of the total population (referred to as vaccination rate) and (2) the stringency index (a proxy for NPIs since it is a composite measure based on nine response indicators including school closures, workplace closures, stay-at-home requirements, and travel bans). We also performed multivariable linear regression to examine the associations between the policy variables and the COVID-19 reproduction rate. Result(s): Based on the time-trend analyses, the number of people vaccinated started to rise since March 2021, while the stringency index had steadily declined since early January 2021. A decrease in new COVID-19 cases and deaths was also observed during these three months (January to March 2021). However, despite a higher vaccination rate than in early 2021, new COVID-19 cases and deaths peaked in late 2021 and early 2022, suggesting that some NPIs might still be needed. The multivariable linear regression analysis showed that the reproduction rate of COVID-19 was negatively associated with the stringency index (coefficient = -0.010, 95% CI -0.013 to -0.005) and vaccination rate (coefficient = -0.005, 95% CI -0.009 to -0.001), after controlling for time covariates. Conclusion(s): The study highlighted the importance of NPIs in reducing new COVID-19 cases and deaths even when vaccination was in progress. Further research accounting for other factors is needed to disentangle the effects of NPIs and other measures from vaccination campaigns.Copyright © 2023
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One of the leading causes of the increase in the intensity of dengue fever transmission is thought to be climate change. Examining panel data from January 2000 to December 2021, this study discovered the nonlinear relationship between climate variables and dengue fever cases in Bangladesh. To determine this relationship, in this study, the monthly total rainfall in different years has been divided into two thresholds: (90 to 360 mm) and (<90 or >360 mm), and the daily average temperature in different months of the different years has been divided into four thresholds: (16degreeC to <=20degreeC), (>20degreeC to <=25degreeC), (>25degreeC to <=28degreeC), and (>28degreeC to <=30degreeC). Then, quasi-Poisson and zero-inflated Poisson regression models were applied to assess the relationship. This study found a positive correlation between temperature and dengue incidence and furthermore discovered that, among those four average temperature thresholds, the total number of dengue cases is maximum if the average temperature falls into the threshold (>28degreeC to <=30degreeC) and minimum if the average temperature falls into the threshold (16degreeC to <=20degreeC). This study also discovered that between the two thresholds of monthly total rainfall, the risk of a dengue fever outbreak is approximately two times higher when the monthly total rainfall falls into the thresholds (90 mm to 360 mm) compared to the other threshold. This study concluded that dengue fever incidence rates would be significantly more affected by climate change in regions with warmer temperatures. The number of dengue cases rises rapidly when the temperature rises in the context of moderate to low rainfall. This study highlights the significance of establishing potential temperature and rainfall thresholds for using risk prediction and public health programs to prevent and control dengue fever.Copyright © 2023 Shamima Hossain.
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Objectives: To determine the impact of a pharmacy-based, clinical decision support (CDS) tool on herpes zoster (HZ) vaccine series completion during the initial months of the COVID-19 pandemic across the US. Method(s): In partnership with Kroger Health, a pharmacy CDS tool alerted staff of patients due for their second HZ vaccine dose, which had been accompanied previously by a timed text message. Once operations changed due to COVID-19, the system limited outreach to only patients visiting the pharmacy. Primary outcomes included the proportion of patients receiving both doses within a Kroger-owned pharmacy (n=2,293) and the number of days between doses, both within and across two 32-week periods before and after the pandemic hit the US. Generalized estimating equation-based (GEE) logistic and linear regression models determined differences in completion rates and time to completion. Result(s): During the observation period, 38,937 adults received at least one HZ vaccine dose, with 77.2% receiving both doses. Patients engaged by the CDS tool achieved 80.5% dose completion, versus 65.4% of those not intervened (p<0.0001), which was lower than in the period immediately before the pandemic (85.8%, p<0.0001). The dosing window averaged 119.4 days (SD: 26.91), which was the longest timeframe between doses since the HZ vaccine was launched and nearly one month longer than before the pandemic (93.0 days [SD: 28.02], p<0.0001). The odds of dose completion increased in areas of higher health literacy (OR: 1.01;95% CI: 1.007-1.014), but decreased in areas of higher poverty (OR: 0.992;95% CI: 0.988-0.995). Time to completion was slightly shorter (B=-0.04, p<0.05) in areas of higher health literacy. Conclusion(s): Despite changes in clinical processes, a nationwide community pharmacy was successful in completing HZ vaccine dose series for adults during the pandemic, suggesting that processes in community pharmacies can protect staff while remaining committed to providing preventive health services during public health crises.Copyright © 2023
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Orthostatic intolerance (OI) is common in Long Covid. Physical counterpressure manoeuvres (PCM) may improve OI in other disorders. We characterised the blood pressure-rising effect of PCM using surface electromyography (sEMG) and investigated its association with fatigue in adults with Long Covid. Participants performed an active stand with beat-to-beat hemodynamic monitoring and sEMG of both thighs, including PCM at 3-minutes post-stand. Multivariable linear regression investigated the association between change in systolic blood pressure (SBP) and change in normalised root mean square (RMS) of sEMG amplitude, controlling for confounders including the Chalder Fatigue Scale (CFQ). In 90 participants (mean age 46), mean SBP rise with PCM was 13.7 (SD 9.0) mmHg. In regression, SBP change was significantly, directly associated with change in RMS sEMG ( 0.25 , 95% CI 0.07-0.43, P = 0.007);however, CFQ was not significant. PCM measured by sEMG augmented SBP without the influence of fatigue. Copyright © 2013 IEEE.
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Introduction: The COVID-19 pandemic has had a significant impact on pregnant persons' mental health. Prepandemic data reports an impact of depression, anxiety, and stress on the emotional and behavioral development of the child. Objective(s): We aimed to evaluate the impact of gestational maternal depression, anxiety, and stress during the COVID-19 pandemic on the child's cognitive development at 18 months. Method(s): The CONCEPTION study is a prospective mother-child cohort, established since June 23, 2020, during the COVID-19 pandemic. Depression and anxiety were assessed during pregnancy using validated tools in French and English (Edinburgh Postnatal Depression Scale [EPDS] and General Anxiety Disorder-7 [GAD-7]) as well as stress and antidepressant consumption. The child's cognitive development was reported by the mother using the third edition of Ages and stages questionnaires (ASQ-3) at 18 months of age. Data on other covariates were collected electronically. Multivariate linear regression models were built to assess the association between prenatal maternal depression, anxiety, stress, and child development across domains: communication, gross motor, fine motor, problem solving, and personal-social domains while adjusting for covariates. In addition, sensitivity analyses have been added like COVID-19 diagnosis. Result(s): Overall, 445 mother-child dyads were included in analyses (mean gestational age at delivery 39.2 weeks +/-1.8). Mean gestational scores were, for depression (EDPS, 7.8+/-5.4), anxiety (GAD-7, 4.4+/-4.0), and stress (4.3+/-2.1). Adjusting for potential confounders, as well as for maternal depression and anxiety during pregnancy, maternal prenatal stress was associated with communication skills (adjusted beta = 1.5, CI 95 % (0.34, 2.7)) and fine motor skills (adjusted beta = 1.06, CI 95 % (0.02, 2.6)) at 18 months age. Gestational depression, anxiety, and antidepressants use were not associated with any of the ASQ-3's domains. In addition, no significant association was found in stratified analysis for COVID-19 diagnosis. Conclusion(s): During the COVID-19 pandemic, gestational maternal stress was associated with some aspects of childhood cognitive problems, including communication and fine motor skills. Our results highlight the need to continue following-up on children until kindergarten to better understand the impact of maternal mental health during pregnancy on the child's cognitive development in the era of COVID-19.
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Background/Aims: The global pandemic of COVID-19 has caused tremendous loss of human life since 2019. Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is one of the best policies to control the pandemic. The vaccination efficacy in Taiwanese patients with different comorbidities is elusive and to be explored. Method(s): Uninfected subjects who received 3-doses of mRNA vaccines (Moderna, BioNTech), non-replicating viral vector-based vaccines (AstraZeneca, AZ) or protein subunit vaccines (Medigen COVID-19 vaccine, MVC) were prospectively enrolled. SARSCoV2- IgG spike antibody level was determined (Abbott [SARS-CoV- 2 IgG II]) within 3 months after the last dose of vaccination. Charlson Comorbidity Index (CCI) was applied to disclose the association of vaccine titer and underlying comorbidities. Result(s): A total of 824 subjects were enrolled in the current study. The mean age was 58.9 years and males accounted for 48.7% of the population. The proportion of CCI with 0-1, 2-3 and>4 was 52.8% (n = 435), 31.3% (n = 258) and 15.9% (n = 131), respectively. The most commonly used vaccination combination was AZ-AZ-Moderna (39.2%), followed by Moderna-Moderna-Moderna (27.8%) and AZAZ- BioNTech (14.7%), respectively. The mean vaccination titer was 3.11 log BAU/mL after a median 48 days of the 3rd dose. Subjects of male gender, lower body mass index, chronic kidney disease, higher CCI, and receiving AZ-AZ based vaccination were likely to have a lower titer of antibody. There was a decreasing trend of antibody titer with the increase of CCT (trend P<0.001). Linear regression analysis revealed that AZ-AZ-based vaccination (beta: 0.341, 95% confidence intervals [CI]: 0.144, 0.21, P<0.001) and higher CCI (beta: - 0.055, CI: - 0.096, - 0.014, P = 0.009) independently correlated with low IgG spike antibody levels. Conclusion(s): Patients with more comorbidities had a poor response to 3 doses of COVID-19 vaccination. Further studies are warranted to clarify the efficacy of booster vaccination in the population. The vaccine titer did not differ between patient with or without chronic liver disease.
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Background: As of December 2022, SARS-CoV-2 coronavirus resulted in over 6 million deaths worldwide.[1] It was realized early into the pandemic, that COVID-19 significantly impacts the Cardiovascular system. [2] Patients with pre-existing cardiovascular comorbidities were particularly at higher risk of adverse outcomes during their hospitalizations. [3] Similarly, it can be safe to assume patients with adult congenital heart disease (ACHD) should considered a high-risk population for the development of severe COVID infection with increased rates of significant cardiovascular complications. Objective(s): Based on this reasoning and the paucity of data available on this topic using a large database, we sought to investigate the outcomes of patients with ACHD who were admitted to the hospital with COVID-19. Method(s): The National Inpatient Sample database for 2020 was queried to identify adult hospitalizations with a primary diagnosis of COVID-19 and a secondary diagnosis of ACHD using International Classification of Diseases - 10 Clinical Modification (ICD-10-CM) codes. The primary outcome studied was inpatient mortality, while secondary outcomes included inpatient complications, mean length of stay (LOS), and total hospital charge (THC). Multivariate logistic and linear regression analyses were used to adjust for possible confounders and analyze the variables. Result(s): Out of 1,050,045 COVID-19 hospitalizations registered, 2,425 (0.23%) had ACHD as a secondary diagnosis. Encounters with ACHD who were hospitalized with COVID-19 had significantly higher adjusted odds of inpatient mortality (Adjusted Odds Ratio [aOR]: 1.4, [95% CI: 1.05-1.88], p=0.022), Longer LOS (Mean 2.4 days, [95% CI: 1.35-3.40], p <0.001), and higher Total Hospital Charges (Mean $53,000, [95% CI: 20811-85190], p <0.001). A Forrest plot (Figure 1) demonstrates a graphical representation of the multivariate analysis of the significant in-hospital complications when adjusted for patient demographics, comorbidities, and hospital characteristics. Conclusion(s): Among COVID-19 hospitalizations, those with a history of congenital heart diseases had significantly worse outcomes in terms of in-hospital mortality, sepsis;the need for endotracheal intubation, mechanical ventilation, and vasopressors;developing acute kidney injury and pulmonary embolism, in addition to the longer length of stay, and higher total hospital charges. [Formula presented]Copyright © 2023
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BACKGROUND: The coronavirus disease-19 (COVID-19) pandemic in Indonesia forced the local community to live in a New Normal era with several rules and health protocols that control the community's behavior on COVID-19 prevention and control. This policy enabled several districts in Indonesia to reopen their travel and tourism sectors including Banyuwangi. Although the Banyuwangi Government already taking action in the implementation of the New Normal in the travel and tourism sectors, the COVID-19 trend in Banyuwangi was significantly increased. This suggest that the violation to health protocols and new normal policy could exist in Banyuwangi. AIM: This study aimed to identify the predisposition, enabling, and reinforcing factors in the COVID-19 prevention and control behavior and analyze factors that associated with the COVID-19 prevention and control behavior in Banyuwangi district local community. MATERIALS AND METHODS: A cross-sectional study design was conducted. The data were obtained through online survey that was disseminated to Banyuwangi district local community. A descriptive, linear regression, and logistic regression analysis was applied. RESULT(S): The knowledge and attitude on COVID-19 preventive behavior of the 352 respondents in this study were poor and adequate, respectively. The predisposition factors associated with the COVID-19 prevention and control behavior in this study were sex (p = 0.005), level of education (p = 0.028), knowledge (p = 0.015), and attitude (p <= 0.01). The reinforcing factor associated with the behavior was support from family (p <= 0.01), key opinion leader (p = 0.02), and health worker (p = 0.05). Health facility and infrastructure were also found to be associated with the behavior (p <= 0.01). CONCLUSION(S): Several approaches and commitments from the policymakers to strengthen those factors are required to improve the behavior on COVID-19 prevention and control.Copyright © 2023 Ernawaty Ernawaty, Nabilla Belqys Dherindri.
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Introduction: The COVID-19 pandemic disrupted health care delivery, particularly for high-volume procedural areas. To improve productivity in the Los Angeles County 1 University of Southern California Medical Center (LAC + USC) Endoscopy Unit, we initiated an iterative rapid cycle quality improvement process to identify inefficiencies and implement changes to our workflow. Method(s): A time-motion analysis of patient flow through the LAC + USC Endoscopy Unit was used to construct a time-tracked flow sheet to track individual patients as they moved through the Unit. Data were collected weekly over 3 9-10 week phases, and intervening plan-do-study-act (PDSA) cycles were conducted to direct interventions for subsequent phases. Following phase 1 (9/1/21 to 11/9/21) we implemented targeted interventions at the start of phase 2 (12/1/21 to 2/1/22) and phase 3 (3/15/22 to 5/31/22). Phase 2 was focused on our anesthesia supported endoscopy room which requires greater resource coordination. Metrics were compared to published benchmarks. Linear regression was used to compare outcome parameters for the lean process flow improvement project. Result(s): Our phase 1 analysis showed operational delays in room turnover time for all procedures and pre-operative assessment and first-case on time start percentage for procedures supported by anesthesia, when compared to published benchmarks (Table 1). In phase 2 we implemented an intervention of combining pre-anesthesia visits with endoscopy teaching visits for patients designated to have anesthesia support. This significantly improved both turnover time and throughput for the anesthesia room (Table 1). In phase 3 we initiated a policy of preparing the first patient of the day in the procedure room which dramatically increased first-case on time start percentage. We further streamlined inter-procedure processes by simultaneously consenting, placingmonitoring equipment and documenting in the time between procedures, leading to a greater than 20% increase in total procedure volume (Table 1). Procedure throughput for the anesthesia supported procedure room increased from 4.5 to 7 to 9 procedures per room per day for phases 1, 2, and 3 respectively (Table 1). EndoscopyUnit staffing remained unchanged throughout the study period. Conclusion(s): Time-motion analysis of patient flow may be used to perform targeted interventions with significant improvements in Endoscopy Unit efficiency. This may be achieved without costly interventions such as hiring additional support staff or faculty. (Table Presented).
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The World Health Organization (WHO) has declared the novel coronavirus as global pandemic on 11 March 2020. It was known to originate from Wuhan, China and its spread is unstoppable due to no proper medication and vaccine. The developed forecasting models predict the number of cases and its fatality rate for coronavirus disease 2019 (COVID-19), which is highly impulsive. This paper provides intrinsic algorithms namely - linear regression and long short-term memory (LSTM) using deep learning for time series-based prediction. It also uses the ReLU activation function and Adam optimiser. This paper also reports a comparative study on existing models for COVID-19 cases from different continents in the world. It also provides an extensive model that shows a brief prediction about the number of cases and time for recovered, active and deaths rate till January 2021.Copyright © 2023 Inderscience Enterprises Ltd.
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Purpose: To identify cognitive impairments in patients (pts) with long COVID using the Cambridge Brain Sciences (CBS) computerized cognitive test (CCT) commonly used to evaluate cognitive function after concussions and traumatic brain injuries. Method(s): Retrospective review from May 2021-Sept 2022 of 16 (4 male, 12 female) patients with long COVID, ages 13- 66 (avg 46), with average of 10 months from COVID infection to time of evaluation. Cognitive (cog) performance and concussion profile symptom scores were assessed with CBS CCT and the Concussion Clinical Profiles screening tool (CP screen) respectively. Result(s): The total CP symptom score average was 34/89 (ranging 7-68) in the cohort. The predominant profile was cog fatigue scoring (1.8/3) on average. CBS CCT tested cog impairment (CI) and was divided into 5 categories (0-4): no CI, borderline (scores between the 21st-30th percentile), mild (1 test < / = 20th percentile), moderate (2-3 tests < / = 20th percentile), and severe CI (>3 tests,/520th percentile). Data showed 2/16 (13%) patients had no CI, 5/16 (31%) had borderline CI, 5/16 (31%) had mild CI, 3/16 (19%) had moderate CI, and 1/16 (6%) pts had severe CI. Although not significant, there was a positive correlation between CI and cog profile score (P = 0.3149) when performing a linear regression test. Deficits were most common in the CBS CTT composites of grammatical reasoning/verbal processing and attention, with 4/16 patients scoring < 20th percentile for each test. The lowest average percentile scores for the cohort were in visuospatial processing and verbal short-term memory. Conclusion(s): Most long COVID patients assessed with CCT demonstrated signs of CI, in particular in verbal processing and memory, followed by visual processing. In addition to the CCT results illustrating CI, the top CP profile of cognitive fatigue in this cohort suggests that the brain fog experienced by long COVID patients may be quantified. Significance: CCT may be a useful tool in assessing and quantifying those with Long COVID with chronic symptoms of cognitive fog, fatigue, or impairment. Targeted interventions aimed at specific deficits can aid in treatment and recovery.
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Background/Aims Since the outbreak of COVID-19, clinicians adapted by switching from face-to-face to remote consultations in order to limit transmission and continue delivering high-quality outpatient services. We aimed to investigate patient- and clinician-related factors which may affect outcomes in follow-up telephone consultations. Methods Patients who attended follow-up clinic appointments via telephone consultations in the month of March 2022 were retrospectively evaluated. Data collected were demographics, main active diagnosis, current treatment and the clinicians' grade. Factors associated with categorical outcomes i.e. decision to request a subsequent face-toface appointment, investigations, referrals to other specialties, and to discharge a patient, were assessed using univariate logistic regression analysis. Univariate linear regression analysis was performed to identify factors associated with the length of follow-up intervals. Results 314 patients were included;218 (69%) female, median (IQR) age 63 (53- 72) years. The most common diagnosis was rheumatoid arthritis (39%). 66% of patients were on DMARDs and 16% were on steroids. There were 48 (15.3%) requests for a subsequent face-to-face appointment and 28 (8.9%) discharges. There were more investigations (20.4%) requested compared to referrals (4.5%). Specialist nurses (SpNs) were the single largest group who conducted the telephone consultations (46%). SpNs were more likely to request face-to-face appointments [odds ratio (OR) 2.16 95%CI (1.16, 4.12) P=0.017] and investigations [OR 1.77 (1.02, 3.11) P=0.043] compared to other clinicians. In contrast, consultants were less likely to request investigations [OR 0.34 (0.16, 0.66) P=0.002]. Other factors associated with a subsequent face-to-face appointment were steroid [OR 3.00 (1.45, 6.02) P=0.002] and conventional DMARD therapy [OR 2.90 (1.50, 5.92) P=0.002]. In terms of discharges, consultants were more likely to discharge a patient [OR 4.05 (1.83, 9.46) P<0.001]. Patients with a diagnosis of inflammatory arthritis [OR 0.01 (0.00, 0.06) P<0.001] and on conventional DMARDs [OR 0.03 (0.00, 0.14) P<0.001] have a lower probability of being discharged. In terms of specialty referrals, there were no significant factors identified. An analysis of 197 clinic letters which specified follow-up intervals found that consultants were more likely to request longer follow-up intervals [beta coefficient 0.32 (0.13, 0.50) P<0.001] whereas SpNs were more likely to request shorter follow-up intervals [beta coefficient -0.52 (-0.65, -0.39), P<0.001]. Conclusion These findings suggest that clinicians' experiences and roles may influence the decisions made following a telephone clinic consultation. For example, SpNs are usually involved in drugmonitoring and therefore, have a higher likelihood to request face-to-face reviews, shorter followup intervals and investigations. The consultant's level of experience may explain the higher probability of discharging patients and the lower probability of requesting investigations. Further studies over a longer duration are needed to determine other factors which may affect the clinical decisions made from telephone clinic consultations.
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Purpose: Since early 2022, the COVID-19 vaccination rate in Bulgaria has remained low, with large regional differences. This study examines the association between the availability of vaccination sites and the number of administered doses, and the extent to which district-level variation is attributable to differences in vaccination services provision. Material(s) and Method(s): Data on COVID-19 vaccine doses administered by districts were used. This data set was combined with district-level information on available vaccination sites, such as general practitioners and temporary vaccination points. The district-level differences in vaccination coverage and service provision were illustrated through country heat maps, and the association between the variables was explored using two linear regression models. Result(s): According to the first regression model, the number of general practitioners and temporary vaccination points accounted for only 3.8% of the district-level variation in administrated doses. As covariates in the second model, sociodemographic and economic data were included. The combined influence of these factors explained 42.2% of the variance across districts. According to the findings, the average annual gross wage is a significant determinant of the district-level differences in the number of administrated doses. Conclusion(s): There is no statistically significant association between administered doses and vaccination sites by districts, which does not correspond to the findings of other international studies. District-level variation in vaccination rates is associated with some sociodemographic and economic differences. The paucity of district-level data impedes further analyses of the vaccine coverage differences and their underlying determinants.Copyright © 2023, Peytchinski, Gospodin Iliev ET. All rights reserved.
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[Background] The epidemic of coronavirus disease 2019 (COVID-19) seriously affects the psychological status of medical staff who directly face the risk of the disease. [Objective] This study investigates the prevalence and related factors of depression, anxiety, and insomnia among medical staff during the COVID-19 pandemic. [Methods] From February 13 to March 1, 2020, a network questionnaire survey was conducted among 482 medical staff selected by convenience sampling. A self-designed questionnaire was used to investigate the basic demographic information and COVID-19-related questions. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Insomnia Severity Index (ISI) were used to estimate the prevalence of depression, anxiety, and insomnia among the medical staff. Stepwise multiple linear regression analysis was performed with PHQ-9 score, GAD-7 score, and ISI score as dependent variables. Multivariate logistic regression analysis (forward-conditional method) on depression, anxiety, and insomnia as dependent variables was performed with basic demographic information and COVID-19-related questions as independent variables. [Results] Among the surveyed medical staff, the prevalence rates of depression, anxiety, and insomnia were 14.3%, 11.2%, and 23.2%, respectively. There were no significant differences in the prevalence rates among different age, gender, local risk level, and occupation groups and those aiding Hubei Province or not. The medical staff who directly contacted fever or diagnosed patients had more serious depression (b=1.73, 95%CI: 0.79-2.66) and insomnia (b=2.43, 95%CI: 1.48-3.39) and a higher risk of insomnia (OR=1.89, 95%CI: 1.21-2.96). The medical staff whose current protective measures cannot prevent infection had more serious depression (b=1.72, 95% CI: 0.65-2.80), anxiety (b=1.75, 95% CI: 0.76-2.75), and insomnia (b=1.73, 95% CI: 0.63-2.82), and had a higher risk of depression (OR=1.97, 95% CI: 1.11-3.49), anxiety (OR=3.00, 95%CI: 1.64-5.46), and insomnia (OR=1.79, 95%CI: 1.08-2.96). [Conclusion] During the COVID-19 epidemic, the risks of depression, anxiety, and insomnia among selected medical staff are increased compared with the non-epidemic period. Occupational exposure to high-risk groups and protective measures would significantly affect mental health of medical staff.Copyright © 2021, Shanghai Municipal Center for Disease Control and Prevention. All rights reserved.
ABSTRACT
Background: A significant portion of individuals experience persistent symptoms months after SARS-CoV-2 infection, broadly referred to as Long COVID (LC). Although the frequencies of subsets of SARS-CoV-2-specific T cells have been shown to differ in individuals with LC relative to those with complete recovery, a deep dive into phenotypic and functional features of total and SARSCoV- 2-specific T cells from individuals with LC has yet to be performed. Method(s): Here, we used CyTOF to characterize the phenotypes and effector functions of T cells from LIINC cohort. The median age was 46, the cohort was 55.8% female, and 9/43 had been hospitalized. Participants were reported a median of 7 LC symptoms at 8 months. SARS-CoV-2-specific total antibody levels were also measured in concurrent sera. Manual gating was used to define T cell subsets, SPICE analyses for polyfunctionality, T cell clustering for phenotypic features, and linear regression for correlation. Permutation tests, Student's t tests, and Welch's t test were used for statistical analysis. Result(s): SARS-CoV-2 total antibody responses were elevated in the LC group (p=0.043), and correlated with frequencies of SARS-CoV-2-specific T cells in those without LC (r=0.776, p< 0.001) but not those with LC. While the frequencies of total SARS-CoV-2-specific CD4+ and CD8+ T cells were similar between individuals with and without LC, those from individuals without LC tended to be more polyfunctional (co-expressing IFNgamma, TNFalpha, IL2, and/or MIP1beta). CD4+ T cells from individuals with LC harbored higher frequencies of Tcm (p=0.003), Tfh (p=0.037), and Treg subsets (p=0.0412), and preferentially expressed a variety of tissue homing receptors including CXCR4 and CXCR5 (p=0.037). SARS-CoV-2-specific CD4+ T cells producing IL6, albeit rare, were observed exclusively among those with LC (p=0.016). In addition, participants with LC harbored significantly higher frequencies of SARS-CoV-2-specific CD8+ T cells co-expressing exhaustion markers PD1 and CTLA4 (p=0.018). Conclusion(s): Long COVID is characterized by global phenotypic differences in the CD4+ T cell compartment in ways suggesting preferential migration of these cells to inflamed mucosal tissues. Individuals with LC also harbor higher numbers of exhausted SARS-CoV-2-specific CD8+ T cells, potentially implicating viral persistence. Finally, our data additionally suggest that individuals with LC may uniquely exhibit an uncoordinated T cell and antibody response during COVID-19 convalescence.