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1.
J Holist Nurs ; 40(1): 58-63, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1770118

ABSTRACT

The purpose of this manuscript is to invite a revisiting of the concept of the "discipline" of Nursing, with attention to the spiritual consciousness of "Nurse" within the sacred concept of self-caring and caring-healing consciousness. The notion of including the spiritual, evolving consciousness of "Nurse," in harmony with evolution of Professional Nursing, is congruent with a mature disciplinary matrix of caring science as sacred science. This congruence between Nurse/Nursing contributes to the evolution of Nursing, Holistic Practices and Era III unitary transformative disciplinary thinking.


Subject(s)
Consciousness , Nurse-Patient Relations , Empathy , Humans
3.
Neurocrit Care ; 36(2): 341-343, 2022 04.
Article in English | MEDLINE | ID: covidwho-1453885
4.
Neurocrit Care ; 36(2): 357-371, 2022 04.
Article in English | MEDLINE | ID: covidwho-1453884

ABSTRACT

BACKGROUND: Early neurorehabilitation improves outcomes in patients with disorders of consciousness (DoC) after brain injury, but its applicability in COVID-19 is unknown. We describe our experience implementing an early neurorehabilitation protocol for patients with COVID-19-associated DoC in the intensive care unit (ICU) and evaluate factors associated with recovery. METHODS: During the initial COVID-19 surge in New York City between March 10 and May 20, 2020, faced with a disproportionately high number of ICU patients with prolonged unresponsiveness, we developed and implemented an early neurorehabilitation protocol, applying standard practices from brain injury rehabilitation care to the ICU setting. Twenty-one patients with delayed recovery of consciousness after severe COVID-19 participated in a pilot early neurorehabilitation program that included serial Coma Recovery Scale-Revised (CRS-R) assessments, multimodal treatment, and access to clinicians specializing in brain injury medicine. We retrospectively compared clinical features of patients who did and did not recover to the minimally conscious state (MCS) or better, defined as a CRS-R total score (TS) ≥ 8, before discharge. We additionally examined factors associated with best CRS-R TS, last CRS-R TS, hospital length of stay, and time on mechanical ventilation. RESULTS: Patients underwent CRS-R assessments a median of six (interquartile range [IQR] 3-10) times before discharge, beginning a median of 48 days (IQR 40-55) from admission. Twelve (57%) patients recovered to MCS after a median of 8 days (IQR 2-14) off continuous sedation; they had lower body mass index (p = 0.009), lower peak serum C-reactive protein levels (p = 0.023), higher minimum arterial partial pressure of oxygen (p = 0.028), and earlier fentanyl discontinuation (p = 0.018). CRS-R scores fluctuated over time, and the best CRS-R TS was significantly higher than the last CRS-R TS (median 8 [IQR 5-23] vs. 5 [IQR 3-18], p = 0.002). Earlier fentanyl (p = 0.001) and neuromuscular blockade (p = 0.015) discontinuation correlated with a higher last CRS-R TS. CONCLUSIONS: More than half of our cohort of patients with prolonged unresponsiveness following severe COVID-19 recovered to MCS or better before hospital discharge, achieving a clinical benchmark known to have relatively favorable long-term prognostic implications in DoC of other etiologies. Hypoxia, systemic inflammation, sedation, and neuromuscular blockade may impact diagnostic assessment and prognosis, and fluctuations in level of consciousness make serial assessments essential. Early neurorehabilitation of these patients in the ICU can be accomplished but is associated with unique challenges. Further research should evaluate factors associated with longer-term neurologic recovery and benefits of early rehabilitation in patients with severe COVID-19.


Subject(s)
COVID-19 , Neurological Rehabilitation , COVID-19/complications , Consciousness , Consciousness Disorders/etiology , Humans , Recovery of Function , Retrospective Studies , Treatment Outcome
5.
Brain Inj ; 35(10): 1134-1142, 2021 08 24.
Article in English | MEDLINE | ID: covidwho-1397992

ABSTRACT

Purpose: The coronavirus disease 2019 (COVID-19) pandemic forced hospitals to adopt tighter restrictions, the most impacting is no access to visitors. Disorder of consciousness (DOC) due to severe acquired brain injury is a condition needing neurorehabilitation and the role of relatives is essential, hence besides physical "disconnection" digital "re-connection" is crucial. We aimed to assess whether digital communication benefits in patients with DOC, considering the sensorial and emotional deprivation due to the COVID-19 emergency lock-down.Methods: For eleven consecutive patients with DOC admitted to our Intensive Neurorehabilitation Care (mean age: 45; females: 9), two observers registered neurobehavioral changes during a video-calls with their relatives. Heart-rate variability was measured before and during the calls. The video-call was performed by using two displays of different sizes: tablet (T-video-call) and large screen (LS-Video-call).Results: The video-calls impacted on the patients' vigilance and in the relationship with relatives. Moreover, positively impacted on their relatives. The current results showed significant greater impact on patients during the LS-video-call than when they are exposed to T-video-call.Conclusions: During the COVID-19 pandemic, besides the physical disconnection to stop the contagion spread, a "digital re-connection" is needed for all and especially for fragile population groups as patients with DOC.


Subject(s)
COVID-19 , Consciousness , Communicable Disease Control , Consciousness Disorders/etiology , Female , Heart Rate , Hospitals , Humans , Middle Aged , Pandemics , SARS-CoV-2
6.
Brain Inj ; 35(12-13): 1647-1648, 2021 11 10.
Article in English | MEDLINE | ID: covidwho-1393020

ABSTRACT

We recently published in this journal (Caronni and colleagues, Brain Injury, 2021-04-16) the first description of the spread of the SARS-CoV-2 infection in a cohort of brain injured patients with a disorder of consciousness (DOC). Surprisingly enough we showed that, in these patients, the COVID was moderate and did not result in fatalities. The pathogenesis of the COVID is characterized by the profound dysregulation of the immune system. To explain our findings, we speculated that the immunosuppression due to the brain injury could be protective against the development of the COVID in patients with DOC. More recently, a second group of authors (Marino and colleagues, PLoSOne, 2021-06-30) described the course of the COVID in an independent cohort of patients with DOC. Since our results were quite unexpected, we have been very comforted by the data reported by Marino and colleagues. Moreover, these data also offer a unique opportunity to further evaluate our theory regarding the COVID pathogenesis in patients with DOC. In the current Letter to the Editor it is shown that the independent data presented by Marino and colleagues do support our theory. Waiting for larger cohorts to further test it (and in case falsify it), our interpretation seems to remain valid.


Subject(s)
Brain Injuries , COVID-19 , Brain Injuries/complications , Consciousness , Consciousness Disorders/etiology , Humans , SARS-CoV-2
7.
J Community Psychol ; 50(2): 760-777, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1340265

ABSTRACT

Critical consciousness (CC) may promote well-being, particularly during the COVID-19 pandemic. In a national survey of 707 college students conducted in April 2020, we first validated the Short Critical Consciousness Scale (ShoCCS) among youth groups not often specifically examined in CC measurement (i.e., Asian, immigrant-origin, LGBQ+, and women youth). Next, we examined associations between ShoCCS subscales and validated measures of both anxiety (Generalized Anxiety Disorder-7) and hopefulness (The Individual-Differences Measure in Hopefulness). The ShoCCS achieved measurement invariance across racial/ethnic groups and immigrant-origin status, and partial invariance among LGBQ+ and women-identifying youth. We found critical reflection and action associated with anxiety for the full sample, but no evidence of moderation by sociodemographic factors. ShoCCS subscales were differentially associated with hopefulness for Asian youth and LGBQ+ youth. This study contributes to the evolution of CC measurement and extends the field by identifying well-being associations during the onset of the COVID-19 pandemic.


Subject(s)
COVID-19 , Consciousness , Adolescent , Female , Humans , Pandemics , SARS-CoV-2 , Students
8.
J Couns Psychol ; 69(2): 146-156, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1331369

ABSTRACT

U.S. society has witnessed and experienced the impact and suffering caused by the racial pandemic within the COVID-19 viral pandemic. In response to anti-Blackness, a multigenerational and multiracial movement of people is rising and demanding justice for Black lives. Using testimonio research and Liberation Psychology as a theoretical framework, the authors describe their current understanding of what it means to practice a more responsible resistance to racist power structures as non-Black Latinas in the field of psychology. Braun and Clarke's (2016) thematic analysis (TA) was used to search for patterns of meaning within the authors' testimonios. Results revealed four themes: (a) to "hold the line" means to struggle for Black liberation, (b) confront anti-Blackness and colonial mentality in the self and community, (c) challenge anti-Blackness within the field of psychology, and (d) collective struggle. The third theme was divided into two subthemes: (a) tear down and (b) center Black lives. The testimonios emphasize that practicing allyship involves being a dissenter who questions and challenges colonial mentality and anti-Blackness, who fights for the abolition of racist policies and power systems, and who moves beyond the hegemonic values that exist in the field of psychology. This study presents the use of testimonio research and Liberation Psychology as suitable tools for psychologists to increase their racial consciousness. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Subject(s)
COVID-19 , Consciousness , Humans , Psychology , Social Justice
9.
Respir Med ; 187: 106550, 2021 10.
Article in English | MEDLINE | ID: covidwho-1331211

ABSTRACT

INTRODUCTION: In COVID-19 associated hypoxemic acute respiratory failure (ARF) without mandatory indication for urgent endotracheal intubation, a trial of CPAP may be considered. We aimed to evaluate HACOR (heart rate, acidosis, consciousness, oxygenation, respiratory rate) score performance in these patients as predictor of CPAP failure. METHODS: Prospective observational multicentric study (three centers in different countries), including adult patients with SARS-CoV-2 pneumonia admitted to a respiratory intermediate care unit, presenting PaO2/FiO2 < 300 and PaCO2 < 45 mmHg, who received CPAP. One hour after starting CPAP, HACOR was calculated. RESULTS: We enrolled 128 patients, mean age 61,7 years. Mean HACOR at 1 h after starting CPAP was 3,27 ± 3,84 and mean PaO2/FiO2 was 203,30 ± 92,21 mmHg; 35 patients (27,3 %) presented CPAP failure: 29 underwent oro-tracheal intubation and 6 died due to COVID-19 (all having a do-not-intubate order). HACOR accuracy for predicting CPAP failure was 82,03 %, while PaO2/FiO2 accuracy was 81,25 %. CONCLUSION: Although HACOR score had a good diagnostic performance in predicting CPAP failure in COVID-19-related ARF, PaO2/FiO2 has also shown to be a good predictor of failure.


Subject(s)
COVID-19/complications , COVID-19/therapy , Continuous Positive Airway Pressure , Respiratory Insufficiency/therapy , Respiratory Insufficiency/virology , Acidosis , Aged , Blood Gas Analysis , COVID-19/physiopathology , Consciousness , Female , Heart Rate , Humans , Intubation, Intratracheal , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , ROC Curve , Respiratory Insufficiency/diagnosis , Respiratory Rate , Treatment Failure
10.
Nihon Koshu Eisei Zasshi ; 68(9): 618-630, 2021 Sep 07.
Article in Japanese | MEDLINE | ID: covidwho-1323450

ABSTRACT

Objectives This study aims to develop a dietary consciousness scale and examine its reliability and validity, as well as investigate the changes in psychological aspects that influence diet among Japanese adults during the COVID-19 pandemic and clarify its related factors.Methods An online survey was conducted from July 1, 2020 to July 3, 2020. Participants were adults aged between 20 and 69 years selected from 13 prefectures where the government declared the state of emergency from April to May 2020. All selected participants were shopping or cooking foods for more than 2 days a week at the time of the survey. A total of 2,299 participants were included in the analysis. Dietary consciousness was measured using 12 items, and the construct was examined using factor analysis. Cronbach's alpha was examined as an indicator of internal validity, and the criterion-referenced validity was confirmed using the Kruskal-Wallis test. To determine changes in dietary consciousness, we calculated total scores based on changes in each item of the Dietary Consciousness Scale as follows: no change (0 points), improved (+1 point), and worsening (-1 point). The associations between the changes in dietary consciousness and characteristics or socioeconomic factors of the participants were examined using the chi-squared test and residual analysis.Results Exploratory and confirmatory factor analyses demonstrated that a model consisting of two factors fitted the data (GFI = 0.958, AGFI = 0.938, CFI = 0.931, RMSEA = 0.066). Cronbach's alpha of the first factor (importance of diet) was 0.838 and 0.734 for the second factor (precedence of diet), and the reliability was confirmed at 0.828 for the entire scale. In the examination of criterion-related validity, the higher the stage of change, the higher the total score of the scale, and a significant difference was observed (P<0.001). The percentage of participants whose precedence worsened was higher than the importance. Significant differences were observed regarding gender, age group, marital status, employment status, household annual income, and income change during the COVID-19 pandemic considering changes in both the importance and precedence of diet. Those who were in the "worsening tendency" group in both the importance and precedence were men, 20-29 years old, unmarried, full-time employees, with a household income of 4-6 million yen during the past year.Conclusion During the COVID-19 pandemic, the precedence of diet worsened, compared to its importance, and men, young, or unmarried persons show a worsening of dietary consciousness.


Subject(s)
/psychology , COVID-19/psychology , Consciousness , Diet/psychology , Eating/psychology , Feeding Behavior/psychology , Adult , Aged , COVID-19/economics , Diet/economics , Family Characteristics , Female , Humans , Income/statistics & numerical data , Male , Middle Aged , Socioeconomic Factors , Young Adult
11.
Neurocrit Care ; 36(1): 89-96, 2022 02.
Article in English | MEDLINE | ID: covidwho-1286190

ABSTRACT

BACKGROUND: Prevalence and etiology of unconsciousness are uncertain in hospitalized patients with coronavirus disease 2019 (COVID-19). We tested the hypothesis that increased inflammation in COVID-19 precedes coma, independent of medications, hypotension, and hypoxia. METHODS: We retrospectively assessed 3203 hospitalized patients with COVID-19 from March 2 through July 30, 2020, in New York City with the Glasgow Coma Scale and systemic inflammatory response syndrome (SIRS) scores. We applied hazard ratio (HR) modeling and mediation analysis to determine the risk of SIRS score elevation to precede coma, accounting for confounders. RESULTS: We obtained behavioral assessments in 3203 of 10,797 patients admitted to the hospital who tested positive for SARS-CoV-2. Of those patients, 1054 (32.9%) were comatose, which first developed on median hospital day 2 (interquartile range [IQR] 1-9). During their hospital stay, 1538 (48%) had a SIRS score of 2 or above at least once, and the median maximum SIRS score was 2 (IQR 1-2). A fivefold increased risk of coma (HR 5.05, 95% confidence interval 4.27-5.98) was seen for each day that patients with COVID-19 had elevated SIRS scores, independent of medication effects, hypotension, and hypoxia. The overall mortality in this population was 13.8% (n = 441). Coma was associated with death (odds ratio 7.77, 95% confidence interval 6.29-9.65) and increased length of stay (13 days [IQR 11.9-14.1] vs. 11 [IQR 9.6-12.4]), accounting for demographics. CONCLUSIONS: Disorders of consciousness are common in hospitalized patients with severe COVID-19 and are associated with increased mortality and length of hospitalization. The underlying etiology of disorders of consciousness in this population is uncertain but, in addition to medication effects, may in part be linked to systemic inflammation.


Subject(s)
COVID-19 , Consciousness , Hospitalization , Humans , Retrospective Studies , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/epidemiology
13.
Int J Environ Res Public Health ; 18(11)2021 06 04.
Article in English | MEDLINE | ID: covidwho-1266736

ABSTRACT

The objective of this study was the translation and validation of a health consciousness scale in order to provide an economically and empirically confirmed measurement of health consciousness, which is associated with health-related behavior. We evaluated this translation on the basis of psychometric testing in a German convenience sample. A cross-sectional online survey (n = 470) was carried out using a translated version of the health consciousness scale, oriented on the basis of international guidelines. As previous studies have not consistently confirmed the factorial structure of the health consciousness scale, we conducted a Confirmatory Factor Analysis to verify its factorial structure. Furthermore, we cross-validated the questionnaire with other scales in order to verify convergent and discriminant validity. The results indicated a two-factor solution for the Health Consciousness Scale-German (HCS-G). The criterion validity was confirmed on the basis of a significantly positive correlation between the HCS-G and health literacy. Furthermore, strict measurement invariance was able to be verified, indicating that the HCS-G is an applicable measurement, regardless of gender. In practical research, this questionnaire can help to assess health consciousness and its influence on health-related constructs. Future studies should consider possible mediating variables between health consciousness and health outcomes.


Subject(s)
Consciousness , Translations , Cross-Sectional Studies , Psychometrics , Reproducibility of Results , Surveys and Questionnaires
14.
Acta Neurol Scand ; 144(3): 251-259, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1240998

ABSTRACT

BACKGROUND: To investigate the association between impairment of consciousness and risk of death in people with COVID-19. METHODS: In this multicentre retrospective study, we enrolled people with confirmed COVID-19 from 44 hospitals in Wuhan and Sichuan, China, between 18 January and 30 March 2020. We extracted demographics, clinical, laboratory data and consciousness level (as measured by the Glasgow Coma Scale (GCS) score) from medical records. We used Cox proportional hazards regression, structural equation modelling and survival time analysis to compare people with different progressions of impaired consciousness. RESULTS: We enrolled 1,143 people (average age 51.3 ± standard deviation 17.1-year-old; 50.3% males), of whom 76 died. Increased mortality risk was identified in people with GCS score between 9 and 14 (hazard ratio (HR) 46.76, p < .001) and below 9 (HR 65.86, p < .001). Pathway analysis suggested a significant direct association between consciousness level and death. Other factors, including age, oxygen saturation level and pH, had indirect associations with death mediated by GCS scores. People who developed impaired consciousness more rapidly either from symptoms onset (<10 days vs. 10-19 days, p = .025, <10 days vs. ≥20 days and 10-19 days vs. ≥20 days, <.001) or deterioration of oxygen saturation (≤2 days vs.>2 days, p = .028) had shorter survival times. CONCLUSION: Altered consciousness and its progression had a direct link with death in COVID-19. Interactions with age, oxygen saturation level and pH suggest possible pathophysiology. Further work to confirm these findings explore prevention strategies and interventions to decrease mortality is warranted.


Subject(s)
COVID-19/mortality , COVID-19/physiopathology , Consciousness , Disease Progression , COVID-19/virology , Female , Glasgow Coma Scale , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/pathogenicity , Time Factors
15.
AJOB Neurosci ; 12(2-3): 154-156, 2021.
Article in English | MEDLINE | ID: covidwho-1219362
16.
Int J Mol Sci ; 22(5)2021 Mar 03.
Article in English | MEDLINE | ID: covidwho-1129731

ABSTRACT

Cells emerged at the very beginning of life on Earth and, in fact, are coterminous with life. They are enclosed within an excitable plasma membrane, which defines the outside and inside domains via their specific biophysical properties. Unicellular organisms, such as diverse protists and algae, still live a cellular life. However, fungi, plants, and animals evolved a multicellular existence. Recently, we have developed the cellular basis of consciousness (CBC) model, which proposes that all biological awareness, sentience and consciousness are grounded in general cell biology. Here we discuss the biomolecular structures and processes that allow for and maintain this cellular consciousness from an evolutionary perspective.


Subject(s)
Cell Membrane/physiology , Consciousness/physiology , Animals , Biological Evolution , Cell Biology
17.
Explore (NY) ; 16(6): 345-347, 2020.
Article in English | MEDLINE | ID: covidwho-734559
18.
Eur J Clin Nutr ; 75(1): 209-211, 2021 01.
Article in English | MEDLINE | ID: covidwho-734445

ABSTRACT

In a pilot study, we wanted to influence the food selection of employees in a pediatric clinic bistro aiming to increase the sale of "healthy" grain buns (number and proportion of all sold buns). During basic assessment, the mean weekly sale of grain buns was 98 (52.3%) and in the second week of highlighting them on a green napkin under a transparent hood (intervention 1) reached 124 (54.6%). However, just when starting intervention 2 (position in front of the display), the bistro was closed due to the Coronavirus pandemic. Thus, necessary public health measures stopped our interventional public health experiment.


Subject(s)
Consciousness , Diet , Environment , Food Preferences , Health Promotion/methods , Social Marketing , Whole Grains , Ambulatory Care Facilities , COVID-19 , Commerce , Communicable Disease Control , Communication , Feasibility Studies , Food Preferences/psychology , Food Service, Hospital , Germany , Humans , Pandemics , Personnel, Hospital , Pilot Projects , Public Health , Research Design
19.
Nature ; 586(7831): 658-661, 2020 10.
Article in English | MEDLINE | ID: covidwho-1019753

Subject(s)
Consciousness , Organoids , Brain , Humans
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