[Unknown mortality of the population in long-term care homes in Spain]. / La desconocida mortalidad de la población en las residencias de personas mayores de España.

It seems necessary to assess the mortality of older people living in long-term care homes to examine its determinants, including the structural and organizational characteristics of these centers and their relationship with the use of health and social services. Attempting to investigate the mortality of the population over 65 years of age living in long-term care homes during COVID-19, we were not able to identify those who died at their long-term care home and, consequently, to know their number of deaths and their causes. In this field note, we describe this anomalous situation and propose a solution: compliance with the law that obliges all citizens to register at their usual address, which should be required in the process of admission to a residence. This would ensure the availability of the necessary data to know the mortality of the population residing in a residence.

Exploring experiences of loneliness among Canadian long-term care residents during the COVID-19 pandemic: A qualitative study.

BACKGROUND: The COVID-19 pandemic has significant impact on long-term care (LTC) residents' health and well-being. OBJECTIVES: This study investigated resident experiences of loneliness during the COVID-19 pandemic in Canadian LTC homes to offer lessons learned and implications. METHODS: 15 residents and 16 staff members were recruited from two large urban Canadian LTC homes with large outbreaks and fatalities. We used a telepresence robot to conduct one-on-one semi-structured interviews with participants remotely. We applied the Collaborative Action Research (CAR) methodology and report the early phase of CAR focused on collecting data and reporting findings to inform actions for change. Thematic analysis was performed to identify themes. RESULTS: Four themes were identified. The first two themes characterise what commonly generated feelings of loneliness amongst residents, including (1) social isolation and missing their family and friends and (2) feeling hopeless and grieving for lives lost. The second two themes describe what helped residents alleviate loneliness, including (3) social support and (4) creating opportunities for recreation and promoting positivity. CONCLUSIONS: Residents living in LTC experienced significant social isolation and grief during the pandemic that resulted in loneliness and other negative health consequences. IMPLICATIONS FOR PRACTICE: Promoting meaningful connection, safe recreational activities and a positive atmosphere in LTC homes during the pandemic may help mitigate residents' experiences of loneliness due to social isolation and/or grief and enhance their quality of life.

Prevalence, causes, and consequences of moral distress in healthcare providers caring for people living with dementia in long-term care during a pandemic.

Healthcare providers caring for people living with dementia may experience moral distress when faced with ethically challenging situations, such as the inability to provide care that is consistent with their values. The COVID-19 pandemic produced conditions in long-term care homes (hereafter referred to as 'care homes') that could potentially contribute to moral distress. We conducted an online survey to examine changes in moral distress during the pandemic, its contributing factors and correlates, and its impact on the well-being of care home staff. Survey participants (n = 227) working in care homes across Ontario, Canada were recruited through provincial care home organizations. Using a Bayesian approach, we examined the association between moral distress and staff demographics and roles, and characteristics of the long-term care home. We performed a qualitative analysis of the survey's free-text responses. More than 80% of care home healthcare providers working with people with dementia reported an increase in moral distress since the start of the pandemic. There was no difference in the severity of distress by age, sex, role, or years of experience. The most common factors associated with moral distress were lack of activities and family visits, insufficient staffing and high turnover, and having to follow policies and procedures that were perceived to harm residents with dementia. At least two-thirds of respondents reported feelings of physical exhaustion, sadness/anxiety, frustration, powerlessness, and guilt due to the moral distress experienced during the pandemic. Respondents working in not-for-profit or municipal homes reported less sadness/anxiety and feelings of not wanting to go to work than those in for-profit homes. Front-line staff were more likely to report not wanting to work than those in management or administrative positions. Overall, we found that increases in moral distress during the pandemic negatively affected the well-being of healthcare providers in care homes, with preliminary evidence suggesting that individual and systemic factors may intensify the negative effect.

Community Reintegration of Long-Stay Hospitalised Mental Health Consumers During COVID-19 Pandemic

Mandatory restrictions on social activities and access to services during the COVID-19 pandemic prevented discharge into the community of consumers from an extended-stay, hospital-based rehabilitation program. This article describes a revised discharge process that overcame the pandemic-related restrictions by replacing the graded and slow discharge process with a one-stage, full-time transition that facilitated the discharge of 16 adult consumers. No adverse mental health outcomes occurred during the process. The change of practice with its positive results reflected therapeutic risk-taking. The COVID-19 pandemic provided scope for creativity and innovation in mental health care and psychiatric rehabilitation. IMPLICATIONS Innovation and collaboration by service providers can promote consumers' positive risk-taking to return to a life in mainstream society after a prolonged stay in an inpatient rehabilitation unit. Community reintegration of consumers with enduring severe mental illness can occur under adverse public health and social situations like the COVID-19 pandemic with innovative hospital discharge planning.

A critique on the UK's net zero strategy

Before the Covid-19 pandemic UK passed net-zero emission law legislation to become the first major economy in the world to end its contribution to global warming by 2050. Following the UK's legislation to reach net-zero emissions, a long-term strategy for transition to a net-zero target was published in 2021. The strategy is a technology-led and with a top-down approach. The intention is to reach the target over the next three decades. The document targets seven sectors to reduce emissions and include a wide range of policies and innovations for decarbonization. This paper aims to accomplish a much needed review of the strategy in heat and buildings part and cover the key related areas in future buildings standard, heat pumps and use of hydrogen as elaborated in the strategy. For that purpose, this research reviews key themes in the policy, challenges, recent advancement and future possibilities. It provides an insight on the overall development toward sustainability and decarbonization of built environment in the UK by 2050. A foresight model, Future Wheels is also used to visualize the findings from the review and provide a clear picture of the potential impact of the policy. © 2023

Sharing Lessons From Successes: Long-term Care Facilities That Weathered the Storm of COVID-19 and Staffing Crises

Purpose: To identify leadership styles and staffing strategies in Missouri long-term care (LTC) facilities that stood out among their peers as "positive deviants" with regard to COVID-19 infections and staffing shortages. Methods: Statewide survey of all LTC facilities to identify exemplar facilities with stable staffing and low rates of COVID-19. Interviews with senior leaders were conducted in 10 facilities in the state to understand the strategies employed that led to these "positive outliers." A result-based educational program was designed to describe their actions and staff reactions. Results: Exemplar leaders used transformational leadership style. Top reasons for their success were as follows: (1) trusting and supportive staff relationships;(2) positive presence and communication;and (3) use of consistent staffing assignments. Strong statewide participation was noted in the educational programs.

Risk spillovers in global financial markets: Evidence from the COVID-19 crisis

This paper aims to comprehensively investigate the dynamics of short-, medium- and long-term risk spillovers across the major financial markets in the context of COVID-19. Our main empirical findings are as follows. First, we find that the deterioration of the COVID-19 pandemic raised the risk of stock, bond, crude oil, and foreign exchange markets sequentially in the short term. Second, from the perspective of the medium and long term, the COVID-19 pandemic triggered substantial risk spillovers across financial markets, which is also highly correlated with the degree of investor panic. Third, we show that different markets played different roles in terms of risk transmission during the pandemic. Specifically, the stock and crude oil markets acted more as risk senders, the gold and foreign exchange markets acted more as risk receivers, and the bond market served as a transfer station of risk. Finally, we find that containment and health responses can effectively mitigate risk spillovers across markets in the short term, while expansionary fiscal policy can reduce them more effectively in the medium and long term. Our findings have important implications for policymakers and investors who aim to mitigate the adverse impact of the COVID-19 pandemic on financial markets. © 2022 Elsevier Inc.

Nearly five-year continuous atmospheric measurements of black carbon over a suburban area in central France

Atmospheric black carbon (BC) concentration over a nearly 5 year period (mid-2017–2021) was continuously monitored over a suburban area of Orléans city (France). Annual mean atmospheric BC concentration were 0.75 ± 0.65, 0.58 ± 0.44, 0.54 ± 0.64, 0.48 ± 0.46 and 0.50 ± 0.72 μg m−3, respectively, for the year of 2017, 2018, 2019, 2020 and 2021. Seasonal pattern was also observed with maximum concentration (0.70 ± 0.18 μg m−3) in winter and minimum concentration (0.38 ± 0.04 μg m−3) in summer. We found a different diurnal pattern between cold (winter and fall) and warm (spring and summer) seasons. Further, fossil fuel burning contributed >90 % of atmospheric BC in the summer and biomass burning had a contribution equivalent to that of the fossil fuel in the winter. Significant week days effect on BC concentrations was observed, indicating the important role of local emissions such as car exhaust in BC level at this site. The behavior of atmospheric BC level with COVID-19 lockdown was also analyzed. We found that during the lockdown in warm season (first lockdown: 27 March–10 May 2020 and third lockdown 17 March–3 May 2021) BC concentration were lower than in cold season (second lockdown: 29 October–15 December 2020), which could be mainly related to the BC emission from biomass burning for heating. This study provides a long-term BC measurement database input for air quality and climate models. The analysis of especially weekend and lockdown effect showed implications on future policymaking toward improving local and regional air quality as well. © 2022 Elsevier B.V.

The PPE spotter role: Supporting best practice in acute and long-term care

Healthcare workers are at high risk of contracting infections including COVID-19 due to close and frequent contact with patients. To promote appropriate use of personal protective equipment (PPE) and to enhance protection of healthcare workers during the COVID-19 pandemic, we trained a team of registered nurses to serve as "PPE Spotters”. This team offered in-person observation, support, feedback, and on-the-spot teaching about proper PPE use and hand hygiene practices. Evaluation showed staff and leaders felt the Spotters effectively promoted best practices for PPE and hand hygiene, and 86% recommended the program continue. PPE Spotters now serve a formal role in the organization, supporting both acute and long-term care.

Long-term support referrals to enhance food security and well-being in older adults: Texas physicians and nurses on what works.

Aim: Senior participation in the congregate meal programs (CMPs) has alarmingly declined over the past decade in Texas as elsewhere in the nation. The purpose of this survey study was to identify the possible reasons for this decline from the viewpoint of the Texas physicians and nurses who are key in coordinating care and ensuring food security for the vulnerable older Texans by referring them to community-based long-term support services (LTSS). Subject and methods: The methodology adopted was an online panel survey of physicians and nurses from rural and urban Texas counties. Structured multiple-choice and open-ended questions primarily focused on provider referral processes, reasons for connecting older clients to CMPs, perceptions about various aspects of these programs, possible reasons for the decline in participation, suggestions to make the programs an integral part of the community-based LTSS referral system, and how to address the COVID-19 pandemic constraints on the programs. Results: As a majority of the healthcare providers surveyed were unaware of the CMPs in their communities, the study spotlighted an urgent need for a better-coordinated referral process centered on strategic marketing and awareness-building about the CMPs, including an extensive healthcare provider education component as well as an overall improvement in meal quality and variety. Conclusion: The study highlights a need for additional research so decision-makers better understand how to best disseminate information to healthcare providers to improve the referral mechanisms, increase the referrals, and enhance the overall CMP program quality to benefit the vulnerable food-insecure older adults.

Estimating long-term and short-term impact of COVID-19 activity restriction on regional highway traffic demand: A case study in Zhejiang Province, China.

Since the outbreak of COVID-19 in China in late 2019, government administrators have implemented traffic restriction policies to prevent the spread of COVID-19. However, highway traffic volumes obtained from ETC data in some provinces did not return to the levels of previous years after the end of the traffic restriction policy, suggesting that traffic restriction policy may have long-term effects. This paper proposed a method that analyzes traffic restriction policies' long-term and short-term impact on highway traffic volume under COVID-19. This method first analyzes the long-term and short-term impacts of traffic restriction policies on the highway traffic volume using the Prophet model combined with the concept of traffic volume loss. It further investigates the relationship between COVID-19 cases and the long-term and short-term impacts of the traffic restriction policy using Granger causality and the impulse response function of the Bayesian vector autoregressive (BVAR) model. The results showed that during the COVID-19 pandemic, highway traffic in Zhejiang Province decreased by about 95.5%, and the short-term impact of COVID-19 cases was most pronounced on the second day. However, the long-term effects were relatively small when the traffic restriction policy ended and was verified by data from other provinces. These results will provide decision support for traffic management and provide recommendations for future traffic impact assessments in the event of similar epidemics.

Review of SARS-COV-2 Systemic Impact: Building the Case for Sepsis via Virus in the Circulatory System.

SARS-COV-2 can contribute to long term consequences associated with sepsis and circulatory dysfunction. In this insightful paper, we highlight the emerging pathophysiology utilizing two case examples. Both systemic and organ specific features are discussed. In addition, a novel laboratory assay is presented that identified SARS-COV-2 in the circulation using conserved SARS ion channels rather than the spike protein. The presentation is linked to the pathophysiology with the emphasis for early recognition and continued research. This paper will serve as a catalyst for continued discovery.

Protecting Older Adult Residents in Care Facilities Against Influenza and COVID-19 Using the Influenza Communication, Advice and Reporting (FluCARE) App: Prospective Cohort Mixed Methods Study.

BACKGROUND: Early detection and response to influenza and COVID-19 outbreaks in aged care facilities (ACFs) are critical to minimizing health impacts. The Sydney Local Health District (SLHD) Public Health Unit (PHU) has developed and implemented a novel web-based app with integrated functions for online line listings, detection algorithms, and automatic notifications to responders, to assist ACFs in outbreak response. The goal of the Influenza Outbreak Communication, Advice and Reporting (FluCARE) app is to reduce time delays to notifications, which we hope will reduce the spread, duration, and health impacts of an influenza or COVID-19 outbreak, as well as ease workload burdens on ACF staff. OBJECTIVE: The specific aims of the study were to (1) evaluate the acceptability and user satisfaction of the implementation and use of FluCARE in helping ACFs recognize, notify, and manage influenza and COVID-19 outbreaks in their facility; (2) identify the safety of FluCARE and any potential adverse outcomes of using the app; and (3) identify any perceived barriers or facilitators to the implementation and use of FluCARE from the ACF user perspective. METHODS: The FluCARE app was piloted from September 2019 to December 2020 in the SLHD. Associated implementation included promotion and engagement, user training, and operational policies. Participating ACF staff were invited to complete a posttraining survey. Staff were also invited to complete a postpilot evaluation survey that included the user Mobile Application Rating Scale (uMARS) measuring app acceptance, utility, and barriers and facilitators to use. An issues log was also prospectively maintained to assess safety. Survey data were analyzed descriptively or via content analysis where appropriate. RESULTS: Surveys were completed by 31 consenting users from 27 ACFs. FluCARE was rated 3.91 of 5 overall on the uMARS. Of the 31 users, 25 (80%) would definitely use FluCARE for future outbreaks, and all users agreed that the app was useful for identifying influenza and COVID-19 outbreaks at their facilities. There were no reported critical issues with incorrect or missed outbreak detection. User training, particularly online training modules, and technical support were identified as key facilitators to FluCARE use. CONCLUSIONS: FluCARE is an acceptable, useful, and safe app to assist ACF staff with early detection and response to influenza and COVID-19 outbreaks. This study supports feasibility for ongoing implementation and efficacy evaluation, followed by scale-up into other health districts in New South Wales.

COVID-19 in German Nursing Homes: The Impact of Facilities' Structures on the Morbidity and Mortality of Residents-An Analysis of Two Cross-Sectional Surveys.

The COVID-19 pandemic constitutes an exceptional risk to people living and working in nursing homes (NHs). There were numerous cases and deaths among NH residents, especially at the beginning of the pandemic when no vaccines had yet been developed. Besides regional differences, individual NHs showed vast differences in the number of cases and deaths: while in some, nobody was affected, in others, many people were infected or died. We examine the relationship between facility structures and their effect on infections and deaths of NH residents and infections of staff, while considering the influence of COVID-19 prevalence among the general population on the incidence of infection in NHs. Two nationwide German surveys were conducted during the first and second pandemic waves, comprising responses from n = 1067 NHs. Different hurdle models, with an assumed Bernoulli distribution for zero density and a negative binomial distribution for the count density, were fitted. It can be shown that the probability of an outbreak, and the number of cases/deaths among residents and staff, increased with an increasing number of staff and the general spread of the virus. Therefore, reverse isolation of NH residents was an inadequate form of protection, especially at the beginning of the pandemic.

Pfizer-BioNTech Coronavirus Disease 2019 Vaccine Effectiveness Against Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Long-term Care Facility Staff With and Without Prior Infection in New York City, January-June 2021.

BACKGROUND: Evidence is accumulating of coronavirus disease 2019 (COVID-19) vaccine effectiveness among persons with prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: We evaluated the effect against incident SARS-CoV-2 infection of (1) prior infection without vaccination, (2) vaccination (2 doses of Pfizer-BioNTech COVID-19 vaccine) without prior infection, and (3) vaccination after prior infection, all compared with unvaccinated persons without prior infection. We included long-term care facility staff in New York City aged <65 years with weekly SARS-CoV-2 testing from 21 January to 5 June 2021. Test results were obtained from state-mandated laboratory reporting. Vaccination status was obtained from the Citywide Immunization Registry. Cox proportional hazards models adjusted for confounding with inverse probability of treatment weights. RESULTS: Compared with unvaccinated persons without prior infection, incident SARS-CoV-2 infection risk was lower in all groups: 54.6% (95% confidence interval, 38.0%-66.8%) lower among unvaccinated, previously infected persons; 80.0% (67.6%-87.7%) lower among fully vaccinated persons without prior infection; and 82.4% (70.8%-89.3%) lower among persons fully vaccinated after prior infection. CONCLUSIONS: Two doses of Pfizer-BioNTech COVID-19 vaccine reduced SARS-CoV-2 infection risk by ≥80% and, for those with prior infection, increased protection from prior infection alone. These findings support recommendations that all eligible persons, regardless of prior infection, be vaccinated against COVID-19.

Evolution and long­term respiratory sequelae after severe COVID-19 pneumonia: nitric oxide diffusion measurement value.

INTRODUCTION: There are no published studies assessing the evolution of combined determination of the lung diffusing capacity for both nitric oxide and carbon monoxide (DLNO and DLCO) 12 months after the discharge of patients with COVID-19 pneumonia. METHODS: Prospective cohort study which included patients who were assessed both 3 and 12 months after an episode of SARS-CoV-2 pneumonia. Their clinical status, health condition, lung function testings (LFTs) results (spirometry, DLNO-DLCO analysis, and six-minute walk test), and chest X-ray/computed tomography scan images were compared. RESULTS: 194 patients, age 62 years (P25-75, 51.5-71), 59% men, completed the study. 17% required admission to the intensive care unit. An improvement in the patients' exercise tolerance, the extent of the areas of ground-glass opacity, and the LFTs between 3 and 12 months following their hospital discharge were found, but without a decrease in their degree of dyspnea or their self-perceived health condition. DLNO was the most significantly altered parameter at 12 months (19.3%). The improvement in DLNO-DLCO mainly occurred at the expense of the recovery of alveolar units and their vascular component, with the membrane factor only improving in patients with more severe infections. CONCLUSIONS: The combined measurement of DLNO-DLCO is the most sensitive LFT for the detection of the long-term sequelae of COVID-19 pneumonia and it explain better their pathophysiology.