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2.
Crit Care Clin ; 38(3): 553-570, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1878086

ABSTRACT

Neurologic complications can be seen in mild to severe COVID-19 with a higher risk in patients with severe COVID-19. These can occur as a direct consequence of viral infection or consequences of treatments. The spectrum ranges from non-life-threatening, like headache, fatigue, malaise, anosmia, dysgeusia, to life-threatening complications, like stroke, encephalitis, coma, Guillain-Barre syndrome. A high index of suspicion can aid in early recognition and treatment. Outcomes depend on severity of underlying COVID-19, patient age, comorbidities, and severity of the complication. Postacute sequelae of COVID-19 range from fatigue, headache, dysosmia, brain fog, anxiety, depression to an overlap with postintensive care syndrome.


Subject(s)
COVID-19 , Nervous System Diseases , Stroke , COVID-19/complications , Disease Progression , Fatigue/complications , Headache/complications , Humans , Nervous System Diseases/etiology , Nervous System Diseases/therapy
3.
Eur Rev Med Pharmacol Sci ; 26(10): 3771-3786, 2022 May.
Article in English | MEDLINE | ID: covidwho-1876426

ABSTRACT

OBJECTIVE: The two-year long epidemic situation around the world has resulted in an increasing number of people experiencing "pandemic fatigue". The aim of this study was to examine the correlation between a sense of self-efficacy and fatigue experienced in everyday life by nursing students in Poland, Spain and Slovakia during the COVID-19 pandemic. PATIENTS AND METHODS: The study was conducted by the diagnostic survey method on a group of 756 nursing students of the first-cycle degree program, from 20 March to 15 May 2021, in the University of Warmia and Mazury in Olsztyn, Pomeranian Medical University in Szczecin (Poland), as well as in Murcia University (Spain) and in the Catholic University in Ruzomberok (Slovakia). RESULTS: The sense of self-efficacy was significantly lower among the students in Poland than in those in Spain (p < 0.0001) and in Slovakia (p < 0.0001). Students in Slovakia showed symptoms of general, physical, cognitive and psychosocial fatigue much less frequently than those in Poland (p < 0.001) and Spain (p < 0.001). Especially students in Spain acutely felt physical health issues as a result of COVID-19 pandemic-imposed restrictions. CONCLUSIONS: A high level of a generalized sense of self-efficacy among the nursing students participating in the study was identified. However, it was significantly differentiated with respect to the country of residence. The fatigue severity experienced by the students during the COVID-19 pandemic was determined by a sense of self-efficacy.


Subject(s)
COVID-19 , Students, Nursing , COVID-19/epidemiology , Fatigue/epidemiology , Humans , Pandemics , Poland/epidemiology , Self Efficacy , Slovakia/epidemiology , Spain/epidemiology , Students, Nursing/psychology
4.
Biomed Res Int ; 2022: 3755460, 2022.
Article in English | MEDLINE | ID: covidwho-1874896

ABSTRACT

This study analyzed the research hotspots and frontiers of exercise rehabilitation among cancer patients via CiteSpace. Relevant literature published in the core collection of the Web of Science (WoS) database from January 1, 2000, to February 6, 2022, was searched. Further, we used CiteSpace5.8R1 to generate a network map and identified top authors, institutions, countries, keywords, and research trends. A total of 2706 related literature were retrieved. The most prolific writer was found to be Kathryn H Schmitz (21 articles). The University of Toronto (64 articles) was found to be the leading institution, with the United States being the leading country. Further, "rehabilitation," "exercise," "quality of life," "cancer," and "physical activity" were the top 5 keywords based on frequency; next, "disability," "survival," "fatigue," "cancer," and "rehabilitation" were the top 5 keywords based on centrality. The keyword "fatigue" was ranked at the top of the most cited list. Finally, "rehabilitation medicine," "activities of daily living," "lung neoplasm," "implementation," "hospice," "exercise oncology," "mental health," "telemedicine," and "multidisciplinary" are potential topics for future research. Our results show that the research hotspots have changed from "quality of life," "survival," "rehabilitation," "exercise," "cancer," "physical therapy," "fatigue," and "breast cancer" to "exercise oncology," "COVID-19," "rehabilitation medicine," "inpatient rehabilitation," "implementation," "telemedicine," "lung neoplasm," "telehealth," "multidisciplinary," "psycho-oncology," "hospice," "adapted physical activity," "cancer-related symptom," "cognitive function," and "behavior maintenance." Future research should explore the recommended dosage and intensity of exercise in cancer patients. Further, following promotion of the concept of multidisciplinary cooperation and the rapid development of Internet medical care, a large amount of patient data has been accumulated; thus, how to effectively use this data to generate results of high clinical value is a question for future researchers.


Subject(s)
COVID-19 , Lung Neoplasms , Activities of Daily Living , Bibliometrics , COVID-19/epidemiology , Fatigue , Humans , Pattern Recognition, Automated , Quality of Life , United States
5.
Nutrients ; 14(11)2022 May 31.
Article in English | MEDLINE | ID: covidwho-1869725

ABSTRACT

OBJECTIVE: The purpose of the present study was to assess the effect of a specific oral nutritional supplement among patients recovered from COVID-19 but suffering symptoms of fatigue. METHODS: This is an observational case-control study involving a sample of 66 COVID-19 survivors divided in two groups, 33 subjects in the intervention group who received the nutritional supplement and 33 subjects in the control group. The nutritional supplement received by subjects in the active group was based on amino acids; vitamin B6 and B1; and malic, succinic and citric acids. After an 8-week follow-up, the main outcomes considered were skeletal muscle index (measured by bioelectrical impedance analysis), physical performance measures (handgrip strength, one-minute chair-stand test, six-minute walking test), and quality of life (using EuroQol visual analogue scale). RESULTS: All the considered areas increased significantly in the subjects receiving the active treatment with oral nutritional supplement in comparison with the baseline values. After adjusting for age, gender, and baseline values, skeletal muscle index, handgrip strength test, the one-minute chair-stand test, and six-minute walking test values were higher among participants in the treatment group compared with subjects in control group. The oral nutritional supplement significantly improved the handgrip strength; similarly, participants in the active group showed a higher improvement in skeletal muscle index, the one-minute chair-stand test, the six-minute walking test, and in quality of life. CONCLUSION: The nutritional supplement containing nine essential amino acids plus cysteine; vitamin B6 and B1; and malic, succinic and citric acids had a positive effect on nutritional status, functional recovery, and quality of life in COVID-19 survivors still suffering from fatigue. Additional controlled clinical trials are required to corroborate these results.


Subject(s)
COVID-19 , Hand Strength , Case-Control Studies , Dietary Supplements , Fatigue , Humans , Muscle Strength , Muscle, Skeletal , Physical Functional Performance , Quality of Life , Vitamin B 6/pharmacology
6.
PLoS Biol ; 20(5): e3001643, 2022 05.
Article in English | MEDLINE | ID: covidwho-1869144

ABSTRACT

Ensuring high vaccination and even booster vaccination coverage is critical in preventing severe Coronavirus Disease 2019 (COVID-19). Among the various COVID-19 vaccines currently in use, the mRNA vaccines have shown remarkable effectiveness. However, systemic adverse events (AEs), such as postvaccination fatigue, are prevalent following mRNA vaccination, and the underpinnings of which are not understood. Herein, we found that higher baseline expression of genes related to T and NK cell exhaustion and suppression were positively correlated with the development of moderately severe fatigue after Pfizer-BioNTech BNT162b2 vaccination; increased expression of genes associated with T and NK cell exhaustion and suppression reacted to vaccination were associated with greater levels of innate immune activation at 1 day postvaccination. We further found, in a mouse model, that altering the route of vaccination from intramuscular (i.m.) to subcutaneous (s.c.) could lessen the pro-inflammatory response and correspondingly the extent of systemic AEs; the humoral immune response to BNT162b2 vaccination was not compromised. Instead, it is possible that the s.c. route could improve cytotoxic CD8 T-cell responses to BNT162b2 vaccination. Our findings thus provide a glimpse of the molecular basis of postvaccination fatigue from mRNA vaccination and suggest a readily translatable solution to minimize systemic AEs.


Subject(s)
COVID-19 , Animals , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Fatigue/etiology , Humans , Killer Cells, Natural , Mice , RNA, Messenger/genetics , Vaccination/adverse effects
7.
Stud Health Technol Inform ; 293: 47-51, 2022 May 16.
Article in English | MEDLINE | ID: covidwho-1862566

ABSTRACT

BACKGROUND: Many patients suffering from post-acute COVID-19 syndrome must deal with fatigue. They need physical and psychological support, strengthening, and adaption of their individual lifestyle. The use of apps can foster fatigue management. OBJECTIVES: The aim of this study was to analyse experiences of patients with fatigue caused by post-acute COVID-19 syndrome after using Untire for more than two weeks. METHODS: A qualitative research design was chosen to identify user-experience after using the app. Seven semi-structured interviews were conducted and qualitative content analysis according to Mayring was applied. RESULTS: The Untire App was generally perceived as being easy to use. Patients judged the Untire App as supportive in most of the features, especially in energy measurement and relaxation exercises. CONCLUSION: Thus, though developed for cancer patients, this mobile health (mHealth) application is with some restrictions also suitable for patients with post-acute COVID-19 syndrome.


Subject(s)
COVID-19 , Mobile Applications , Telemedicine , COVID-19/complications , Fatigue/etiology , Fatigue/therapy , Humans
8.
Int J Environ Res Public Health ; 19(10)2022 05 16.
Article in English | MEDLINE | ID: covidwho-1855633

ABSTRACT

Practicing regular physical activity in green spaces has been invocated as a promising strategy for improving wellbeing in urban settings. The aim of the study was to assess the effect of a structured park-based physical activity intervention, the "Moving Parks" project, on citizens' wellbeing at the time of COVID-19. The intervention was carried out in six public parks in Bologna (Italy) and administered by qualified instructors (from May 2021 to September 2021). The Psychological General Well Being Index short form questionnaire was administered before and after the three months of outdoor activities. A total of 328 participants completed the questionnaire at the beginning and at the end of the project. In September 2021, all psychosocial domains of the questionnaire (anxiety, depressed mood, self-control, positive well-being, vitality energy, and vitality-tiredness) significantly improved in the female sample (p value < 0.01) and only the last two in the male sample (p value < 0.05). The "Moving Parks" project seems to be able to improve citizens' psychological wellbeing, particularly in women.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Exercise , Fatigue , Female , Humans , Male , Parks, Recreational , Surveys and Questionnaires
9.
Dtsch Arztebl Int ; 119(10): 167-174, 2022 Mar 11.
Article in English | MEDLINE | ID: covidwho-1855307

ABSTRACT

BACKGROUND: After recovering from coronavirus disease 2019 (COVID-19), a considerable number of patients report long-term sequelae. The epidemiologic data vary widely in the studies published to date, depending on the study design and the patient cohorts analyzed. Using a population-based approach, we report symptoms and clinical characteristics following COVID-19 (long COVID), focusing on symptoms ≥ 12 weeks (post-COVID-19). METHODS: In three German administrative districts, all adult patients with a diagnosis of COVID-19 confirmed by polymerase chain reaction (PCR) between March and September 2020 (n = 4632) were invited to complete a questionnaire. Predictors for post-COVID-19 were identified by multiple ordinal regression analysis. Study registration: DRKS00023069. RESULTS: A total of 1459 patients were included in the study, 175 (12%) of whom had been hospitalized for treatment of the acute phase of COVID-19. The prevalence of post-COVID-19 was 72.6% (n = 127) and 46.2% (n = 588) for hospitalized and non-hospitalized patients, respectively. The most frequently occurring long-term symptoms were fatigue (41.5% of all symptoms ≥ 12 weeks, n = 297), physical exhaustion (40.8%, n = 292), difficulty in concentrating (30.6%, n = 219), and loss of the senses of taste (25.9%, n = 185) and smell (25.5%, n = 182). Quality of life was significantly impaired in patients with post-COVID-19. The strongest risk factors for post-COVID-19 were female sex, overall severity of comorbidities, and severity of acute COVID-19. CONCLUSION: Patients who are not hospitalized also frequently experience continued symptoms following COVID-19. The heterogeneity of symptoms calls for a multi - disciplinary stepped-care approach, for which identification of patients at risk is crucial. A limitation of the study is the lack of a control group.


Subject(s)
COVID-19 , Adult , COVID-19/complications , COVID-19/epidemiology , Fatigue/epidemiology , Fatigue/etiology , Female , Hospitalization , Humans , Male , Quality of Life , SARS-CoV-2
10.
Infect Disord Drug Targets ; 22(1): e100821195494, 2022.
Article in English | MEDLINE | ID: covidwho-1855232

ABSTRACT

INTRODUCTION: With the increasing rate of COVID-19, particularly in developing countries such as Iran, a high number of frontline service providers, including doctors and nurses, have died, making frontline healthcare workers (HCWs) more vulnerable to psychological disorders and fear and anxiety of secondary transmission to others, especially their family members. In this study, we aimed to report the incidence of COVID-19 infection among HCWs in an Iranian referral pediatrics hospital between April 2020 and July 2020. MATERIALS AND METHODS: In this retrospective cross-sectional study, HCWs and hospital staff working at Children's Medical Center, Tehran, Iran, with positive SARS-CoV-2 real-time polymerase chain reaction (RT-PCR) test results were evaluated between April 2020 and July 2020. RESULTS: Sixty-one out of the 1085 personnel (5.6%) including 14 pediatricians (23%), 24 nurses (39%), 9 paramedics (15%), and 14 HCWs without direct patient contact (23%) had a nasopharyngeal specimen positive SARS-CoV-2 RT-PCR test. The mean age was 39.8±10.6 years. Eleven cases (18%) had underlying diseases such as hypertension and asthma. The most common symptoms were fatigue (67%, n=41), dry cough (61%, n=37), fever (52%, n=32), headache (46%, n=28), dyspnea (43%, n=24), anosmia (28%, n=17), chills (26%, n=16), sore throat (26%, n=16), gastrointestinal symptoms (23%, n=14), and productive cough (3%, n=2). Eleven cases (18%) showed lung involvement in their chest X-rays and/or CT scans. Eighteen cases (29.5%) had lymphopenia, and 20 individuals (33%) had a high level of C-reactive protein. CONCLUSION: In conclusion, in the early phase of the COVID-19 outbreak, a substantial proportion of HCWs with fever, respiratory, and other prevalent symptoms including fatigue and headache were infected with SARS-CoV-2. Therefore, implementation of infection prevention measures, isolation of confirmed HCWs, disinfection of the environment, and regular COVID-19 prevention training for HCWs are strongly recommended for the wellbeing of health workers and minimizing the spread of infection.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , COVID-19/diagnosis , COVID-19/epidemiology , Child , Cough , Cross-Sectional Studies , Fatigue , Fever , Headache , Health Personnel , Humans , Iran/epidemiology , Middle Aged , Retrospective Studies
11.
BMC Musculoskelet Disord ; 23(1): 471, 2022 May 19.
Article in English | MEDLINE | ID: covidwho-1854793

ABSTRACT

OBJECTIVES: To determine the prevalence and characteristics of post-COVID-19 (PC) in fibromyalgia (FM) patients. METHODS: Retrospective, multi-centric, observational study, comparing a group of FM patients (FM group) with another group of patients with other rheumatic diseases (RD group). COVID-19 diagnosis was established by positive polymerase chain reaction or antigen during acute infection or by positive antibodies thereafter. We considered PC diagnosis when symptoms remain after COVID-19. We collected the principal characteristics of COVID-19, the severity of fatigue, waking unrefreshed and cognitive impairment, and persistent symptoms. The American College of Rheumatology (ACR) criteria and the Combined Index of Severity in Fibromyalgia (ICAF) were collected in the FM group. RESULTS: RD group (n = 56) had more pneumonia (p = 0.001) and hospital admissions (p = 0.002), but the FM group (n = 78) had a higher number of symptoms (p = 0.002). The percentage of patients with PC was similar between groups (FM group 79.5%; RD group 66.1%, p = 0.081). FM group had more PC symptoms (p = 0.001), more impairment after COVID-19 (p = 0.002) and higher severity of fatigue, waking unrefreshed and cognitive impairment (p <  0.0001). Only loss of smell was more frequent in the FM group (p = 0.005). The FM group with PC (n = 29) showed more severity of the Combined Index of Severity in Fibromyalgia (ICAF) total score and physical factor after COVID-19, while emotional, coping factors and the ACR criteria did not change. CONCLUSIONS: The prevalence of PC in FM patients is similar to RD patients. In FM patients, the presence of PC does not appear to impact the severity of FM.


Subject(s)
Autoimmune Diseases , COVID-19 , Fibromyalgia , Rheumatic Diseases , COVID-19/epidemiology , COVID-19 Testing , Fatigue/diagnosis , Fatigue/epidemiology , Fibromyalgia/diagnosis , Fibromyalgia/epidemiology , Fibromyalgia/psychology , Humans , Prevalence , Retrospective Studies , Rheumatic Diseases/diagnosis , Rheumatic Diseases/epidemiology , Severity of Illness Index , Surveys and Questionnaires
12.
BMJ Open ; 12(5): e055308, 2022 05 18.
Article in English | MEDLINE | ID: covidwho-1854342

ABSTRACT

OBJECTIVES: COVID-19 can result in persistent symptoms leaving potential rehabilitation needs unmet. This study aims to describe persistent symptoms and health status of individuals hospitalised for COVID-19 according to the International Classification of Functioning, Disability and Health domains of impairments, limitations in activity, and participation restrictions. DESIGN: Cross-sectional study consisting in a telephone interview 3 months after hospital discharge. SETTING: This study was conducted during the first peak of the COVID-19 pandemic by the Local Health Authority of Reggio Emilia (Italy). PARTICIPANTS: Adult individuals discharged from hospital between April and June 2020 after COVID-19. EXCLUSION CRITERIA: hospitalisation for reasons other than COVID-19, inability to participate in the study, concomitant acute or chronic conditions causing disability. PRIMARY AND SECONDARY OUTCOME MEASURES: We assessed: dyspnoea (Medical Research Council), fatigue (Fatigue Severity Scale), mood disturbances (Hospital Anxiety and Depression Scale), limitations in activity (Barthel Index) and participation restrictions (Reintegration to Normal Living Index). We also collected data on sociodemographic characteristics, health status prior to COVID-19, COVID-related clinical manifestations and hospital care pathway up to discharge, rehabilitation interventions, accidental falls and emergency room access. RESULTS: 149 participants (men, 62%; average age 62 (±11) years) were enrolled, 35 of which (23%) were admitted to the intensive care unit (ICU) while hospitalised. Three months after hospital discharge, nearly half of the participants still suffered from dyspnoea (44%) or fatigue (39%). Almost all individuals (91.2%) recovered a good level of independence in activity of daily living, but 76% still suffered participation restrictions. Female sex was significantly associated with worse outcomes for all symptoms. CONCLUSIONS: Individuals who had moderate or severe COVID-19 may perceive persistent symptoms which may result in reduced social participation. Sex differences should be monitored, as women may recover more slowly than men. TRIAL REGISTRATION NUMBER: NCT04438239.


Subject(s)
COVID-19 , Adult , COVID-19/epidemiology , Cross-Sectional Studies , Dyspnea/epidemiology , Fatigue/epidemiology , Female , Hospitals , Humans , Male , Middle Aged , Pandemics , Patient Discharge , Sex Characteristics , Treatment Outcome
13.
Support Care Cancer ; 30(6): 4813-4821, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1850339

ABSTRACT

PURPOSE: To investigate cancer patients' knowledge and attitudes regarding fatigue and the potential benefits and acceptability of a brief information booklet. METHODS: The CARPE DIEM study assessed knowledge and attitudes regarding fatigue in a diverse group of 50 cancer patients before (T0) and about one (T1) and four months (T2) after reading the booklet. At T1, participants additionally rated its usefulness. RESULTS: At baseline, 37.5% of respondents did not know the term "fatigue" or what it meant. Those who already knew something about fatigue mainly had obtained their information from booklets, books, or articles (63.3%) and/or the internet (46.7%). Overall, knowledge gaps existed, particularly about potential fatigue treatment options and whether fatigue is an indicator of cancer progression. Furthermore, 56.4% felt poorly informed, and 46.1% reported feeling helpless in the face of fatigue. Lower knowledge at baseline was significantly associated with lower education and older age. At T1 and T2, there were significant improvements in several knowledge questions and attitudes. Patient-reported benefits included getting new information about fatigue (91.1%), awareness of not being alone with their problems (89.7%), taking appropriate actions (72.9%), and encouragement to talk about their fatigue with family/friends (55.3%) or with a health professional (52.7%). CONCLUSIONS: Specific gaps were identified in the provision of information and education for cancer patients about fatigue. A low-cost intervention asking to read a brief information booklet was associated with improved knowledge. This could be considered as a first step offered as part of a bundle of further efforts to improve knowledge and care of fatigue.


Subject(s)
Neoplasms , Pamphlets , Fatigue/etiology , Fatigue/therapy , Humans , Knowledge , Neoplasms/complications , Neoplasms/therapy
14.
Cochrane Database Syst Rev ; 5: CD013665, 2022 05 20.
Article in English | MEDLINE | ID: covidwho-1849971

ABSTRACT

BACKGROUND: COVID-19 illness is highly variable, ranging from infection with no symptoms through to pneumonia and life-threatening consequences. Symptoms such as fever, cough, or loss of sense of smell (anosmia) or taste (ageusia), can help flag early on if the disease is present. Such information could be used either to rule out COVID-19 disease, or to identify people who need to go for COVID-19 diagnostic tests. This is the second update of this review, which was first published in 2020. OBJECTIVES: To assess the diagnostic accuracy of signs and symptoms to determine if a person presenting in primary care or to hospital outpatient settings, such as the emergency department or dedicated COVID-19 clinics, has COVID-19. SEARCH METHODS: We undertook electronic searches up to 10 June 2021 in the University of Bern living search database. In addition, we checked repositories of COVID-19 publications. We used artificial intelligence text analysis to conduct an initial classification of documents. We did not apply any language restrictions. SELECTION CRITERIA: Studies were eligible if they included people with clinically suspected COVID-19, or recruited known cases with COVID-19 and also controls without COVID-19 from a single-gate cohort. Studies were eligible when they recruited people presenting to primary care or hospital outpatient settings. Studies that included people who contracted SARS-CoV-2 infection while admitted to hospital were not eligible. The minimum eligible sample size of studies was 10 participants. All signs and symptoms were eligible for this review, including individual signs and symptoms or combinations. We accepted a range of reference standards. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently selected all studies, at both title and abstract, and full-text stage. They resolved any disagreements by discussion with a third review author. Two review authors independently extracted data and assessed risk of bias using the QUADAS-2 checklist, and resolved disagreements by discussion with a third review author. Analyses were restricted to prospective studies only. We presented sensitivity and specificity in paired forest plots, in receiver operating characteristic (ROC) space and in dumbbell plots. We estimated summary parameters using a bivariate random-effects meta-analysis whenever five or more primary prospective studies were available, and whenever heterogeneity across studies was deemed acceptable. MAIN RESULTS: We identified 90 studies; for this update we focused on the results of 42 prospective studies with 52,608 participants. Prevalence of COVID-19 disease varied from 3.7% to 60.6% with a median of 27.4%. Thirty-five studies were set in emergency departments or outpatient test centres (46,878 participants), three in primary care settings (1230 participants), two in a mixed population of in- and outpatients in a paediatric hospital setting (493 participants), and two overlapping studies in nursing homes (4007 participants). The studies did not clearly distinguish mild COVID-19 disease from COVID-19 pneumonia, so we present the results for both conditions together. Twelve studies had a high risk of bias for selection of participants because they used a high level of preselection to decide whether reverse transcription polymerase chain reaction (RT-PCR) testing was needed, or because they enrolled a non-consecutive sample, or because they excluded individuals while they were part of the study base. We rated 36 of the 42 studies as high risk of bias for the index tests because there was little or no detail on how, by whom and when, the symptoms were measured. For most studies, eligibility for testing was dependent on the local case definition and testing criteria that were in effect at the time of the study, meaning most people who were included in studies had already been referred to health services based on the symptoms that we are evaluating in this review. The applicability of the results of this review iteration improved in comparison with the previous reviews. This version has more studies of people presenting to ambulatory settings, which is where the majority of assessments for COVID-19 take place. Only three studies presented any data on children separately, and only one focused specifically on older adults. We found data on 96 symptoms or combinations of signs and symptoms. Evidence on individual signs as diagnostic tests was rarely reported, so this review reports mainly on the diagnostic value of symptoms. Results were highly variable across studies. Most had very low sensitivity and high specificity. RT-PCR was the most often used reference standard (40/42 studies). Only cough (11 studies) had a summary sensitivity above 50% (62.4%, 95% CI 50.6% to 72.9%)); its specificity was low (45.4%, 95% CI 33.5% to 57.9%)). Presence of fever had a sensitivity of 37.6% (95% CI 23.4% to 54.3%) and a specificity of 75.2% (95% CI 56.3% to 87.8%). The summary positive likelihood ratio of cough was 1.14 (95% CI 1.04 to 1.25) and that of fever 1.52 (95% CI 1.10 to 2.10). Sore throat had a summary positive likelihood ratio of 0.814 (95% CI 0.714 to 0.929), which means that its presence increases the probability of having an infectious disease other than COVID-19. Dyspnoea (12 studies) and fatigue (8 studies) had a sensitivity of 23.3% (95% CI 16.4% to 31.9%) and 40.2% (95% CI 19.4% to 65.1%) respectively. Their specificity was 75.7% (95% CI 65.2% to 83.9%) and 73.6% (95% CI 48.4% to 89.3%). The summary positive likelihood ratio of dyspnoea was 0.96 (95% CI 0.83 to 1.11) and that of fatigue 1.52 (95% CI 1.21 to 1.91), which means that the presence of fatigue slightly increases the probability of having COVID-19. Anosmia alone (7 studies), ageusia alone (5 studies), and anosmia or ageusia (6 studies) had summary sensitivities below 50% but summary specificities over 90%. Anosmia had a summary sensitivity of 26.4% (95% CI 13.8% to 44.6%) and a specificity of 94.2% (95% CI 90.6% to 96.5%). Ageusia had a summary sensitivity of 23.2% (95% CI 10.6% to 43.3%) and a specificity of 92.6% (95% CI 83.1% to 97.0%). Anosmia or ageusia had a summary sensitivity of 39.2% (95% CI 26.5% to 53.6%) and a specificity of 92.1% (95% CI 84.5% to 96.2%). The summary positive likelihood ratios of anosmia alone and anosmia or ageusia were 4.55 (95% CI 3.46 to 5.97) and 4.99 (95% CI 3.22 to 7.75) respectively, which is just below our arbitrary definition of a 'red flag', that is, a positive likelihood ratio of at least 5. The summary positive likelihood ratio of ageusia alone was 3.14 (95% CI 1.79 to 5.51). Twenty-four studies assessed combinations of different signs and symptoms, mostly combining olfactory symptoms. By combining symptoms with other information such as contact or travel history, age, gender, and a local recent case detection rate, some multivariable prediction scores reached a sensitivity as high as 90%. AUTHORS' CONCLUSIONS: Most individual symptoms included in this review have poor diagnostic accuracy. Neither absence nor presence of symptoms are accurate enough to rule in or rule out the disease. The presence of anosmia or ageusia may be useful as a red flag for the presence of COVID-19. The presence of cough also supports further testing. There is currently no evidence to support further testing with PCR in any individuals presenting only with upper respiratory symptoms such as sore throat, coryza or rhinorrhoea. Combinations of symptoms with other readily available information such as contact or travel history, or the local recent case detection rate may prove more useful and should be further investigated in an unselected population presenting to primary care or hospital outpatient settings. The diagnostic accuracy of symptoms for COVID-19 is moderate to low and any testing strategy using symptoms as selection mechanism will result in both large numbers of missed cases and large numbers of people requiring testing. Which one of these is minimised, is determined by the goal of COVID-19 testing strategies, that is, controlling the epidemic by isolating every possible case versus identifying those with clinically important disease so that they can be monitored or treated to optimise their prognosis. The former will require a testing strategy that uses very few symptoms as entry criterion for testing, the latter could focus on more specific symptoms such as fever and anosmia.


Subject(s)
Ageusia , COVID-19 , Pharyngitis , Aged , Ageusia/complications , Anosmia/diagnosis , Anosmia/etiology , Artificial Intelligence , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Testing , Child , Cough/etiology , Dyspnea , Fatigue/etiology , Fever/diagnosis , Fever/etiology , Hospitals , Humans , Outpatients , Primary Health Care , Prospective Studies , SARS-CoV-2 , Sensitivity and Specificity
15.
Aerosp Med Hum Perform ; 93(5): 433-441, 2022 May 01.
Article in English | MEDLINE | ID: covidwho-1847145

ABSTRACT

INTRODUCTION: COVID-19 has had a significant impact on the aviation industry. While reduced flying capacity may intuitively translate to reduced fatigue risk by way of fewer flights and duty hours, the actual impact of the pandemic on pilot fatigue is unknown.METHODS: We surveyed U.S. commercial airline pilots in late 2020 (N = 669) and early 2021 (N = 156) to assess the impact of COVID-19 on schedules and fatigue during the pandemic.RESULTS: Overall, pilots reported reduced flight and duty hours compared to prepandemic. Average sleep on workdays was slightly shorter in late 2020 (6.87 ± 1.14 h) and recovered to prepandemic levels in early 2021 (6.95 ± 1.11 h). Similarly, the frequency of sleepiness on days off and in-flight increased in late 2020, with 54% of pilots reporting an increase in in-flight sleepiness, then returned to prepandemic levels in early 2021. The use of in-flight sleepiness countermeasures remained the same across assessed time points. Pilots highlighted several factors which impacted their sleep and job performance, including limited access to nutritional food during duty days and layovers, reduced access to exercise facilities during layovers, increased stress due to job insecurity and health concerns, increased distractions and workload, and changes to scheduling.DISCUSSION: Despite a reduction in flights and duty days, COVID-19 led to increased sleepiness on days off and in flight, potentially due to the negative impact of lack of access to essential needs and heightened stress on sleep. Operators need to monitor the change in these COVID-19 related risks as the industry returns to full service.Hilditch CJ, Flynn-Evans EE. Fatigue, schedules, sleep, and sleepiness in U.S. commercial pilots during COVID-19. Aerosp Med Hum Perform. 2022; 93(5):433-441.


Subject(s)
COVID-19 , Pilots , COVID-19/epidemiology , Fatigue/epidemiology , Humans , Sleep , Sleepiness , Work Schedule Tolerance
16.
Przegl Epidemiol ; 75(4): 463-470, 2021.
Article in English | MEDLINE | ID: covidwho-1841824

ABSTRACT

BACKGROUND AND AIM: The aim of this study was to investigate the status of anxiety, quality of work life, and fatigue of healthe care providers in six educational and medical centers of Shahrekord University of Medical Sciences in the southwest of Iran in the Covid-19 pandemic. MATERIALS AND METHODS: The present study was a cross-sectional study and included the statistical population of healthcare providers in six educational and medical centers of Shahrekord University of Medical Sciences in the southwest of Iran. Using random sampling method, 181 people who had direct involvement with patients with Covid-19 were selected and compared with 261 staff in other wards who had no direct contact with patients with Covid-19. For data collection, demographic information (demographic characteristics questionnaire), Covid-19 Anxiety Questionnaire, quality of work life and Rhoten fatigue questionnaires were used by self-administered online questionnaires. RESULTS: The results showed that the quality of life in both groups decreased and fatigue and anxiety caused by Covid-19 increased, but there was no statistically significant difference between anxiety derived fatigues of personnel involved with Covid-19 with personnel of other wards which were no directly faced Covid-19 patients. Regarding the quality of work life, no significant difference was observed in other components except in the component of human resource development. The results also showed that there was a statistically significant relationship between the level of anxiety caused by Covid-19 with quality of work life and fatigue. CONCLUSION: According to the results of the present study, Covid-19 had a negative effect on physical, mental and various aspects of quality of life of health care staff and led to increased fatigue.


Subject(s)
COVID-19 , Anxiety/epidemiology , Cross-Sectional Studies , Delivery of Health Care , Depression/epidemiology , Fatigue/epidemiology , Health Personnel , Humans , Iran/epidemiology , Pandemics , Poland , Quality of Life , Surveys and Questionnaires
17.
BMJ Open ; 12(4): e057863, 2022 04 29.
Article in English | MEDLINE | ID: covidwho-1832458

ABSTRACT

OBJECTIVE: To investigate if the physical activity (PA) prior to infection is associated with the severity of the disease in patients positively tested for COVID-19, as well as with the most common symptoms. DESIGN: A cross-sectional study using baseline data from a prospective, hybrid cohort study (Predi-COVID) in Luxembourg. Data were collected from May 2020 to June 2021. SETTING: Real-life setting (at home) and hospitalised patients. PARTICIPANTS: All volunteers aged >18 years with confirmed SARS-CoV-2 infection, as determined by reverse transcription-PCR, and having completed the PA questionnaire (n=452). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was disease severity (asymptomatic, mild illness and moderate illness). The secondary outcomes were self-reported symptoms. RESULTS: From the 452 patients included, 216 (48%) were female, the median (IQR) age was 42 (31-51) years, 59 (13%) were classified as asymptomatic, 287 (63%) as mild illness and 106 (24%) as moderate illness. The most prevalent symptoms were fatigue (n=294; 65%), headache (n=281; 62%) and dry cough (n=241; 53%). After adjustment, the highest PA level was associated with a lower risk of moderate illness (OR 0.37; 95% CI 0.14 to 0.98, p=0.045), fatigue (OR 0.54; 95% CI 0.30 to 0.97, p=0.040), dry cough (OR 0.55; 95% CI 0.32 to 0.96, p=0.034) and chest pain (OR 0.32; 95% CI 0.14 to 0.77, p=0.010). CONCLUSIONS: PA before COVID-19 infection was associated with a reduced risk of moderate illness severity and a reduced risk of experiencing fatigue, dry cough and chest pain, suggesting that engaging in PA may be an effective approach to minimise the severity of COVID-19. TRIAL REGISTRATION NUMBER: NCT04380987.


Subject(s)
COVID-19 , Exercise , Adult , COVID-19/epidemiology , Chest Pain/virology , Cohort Studies , Cough/virology , Cross-Sectional Studies , Fatigue/virology , Female , Humans , Luxembourg/epidemiology , Male , Middle Aged , Prospective Studies , SARS-CoV-2 , Severity of Illness Index
18.
Rheumatol Int ; 42(5): 783-790, 2022 05.
Article in English | MEDLINE | ID: covidwho-1826438

ABSTRACT

As a result of the pandemic, many patients with an inflammatory rheumatic disease (IRD) have isolated themselves. The lack of disease management together with fear of infection could lead to changes in physical- and mental health. The aim of this study was to evaluate the social- and health behaviour in patients with an IRD compared with the behaviour of healthy individuals during the COVID-19 pandemic. The study was a questionnaire survey answered by patients with an IRD and healthy individuals (HI). The questionnaire contained seven sections with questions regarding COVID-19 and quality of life including SF-36, EQ-5D-5L, and visual analogue scale (VAS) pain, fatigue and global health. Of 1663 invited participants, 661 patients with IRD and 266 HI were included in the analyses. Patients with an IRD felt more isolated during the COVID-19 pandemic compared with HI (IRD: 9.5% (61/644), HI: 3.1% (8/259), p-value = 0.001). More HI (5.4%) had been infected with COVID-19 than patients with an IRD (1.7%). Among patients with an IRD those with worse self-reported disease activity outcomes (VAS pain, fatigue and global health, all p-value < 0.001), worse social functioning and emotional well-being were more isolated than individuals with low disease activity. Patients with an IRD feel more isolated during the COVID-19 pandemic compared to HI. Isolation seems to be most pronounced in patients with worse disease related patient-reported outcomes and lower quality of life.


Subject(s)
COVID-19 , Rheumatic Diseases , COVID-19/epidemiology , Fatigue/epidemiology , Humans , Pain , Pandemics , Quality of Life , Rheumatic Diseases/epidemiology , Rheumatic Diseases/psychology , Surveys and Questionnaires
19.
Respir Res ; 23(1): 115, 2022 May 04.
Article in English | MEDLINE | ID: covidwho-1822194

ABSTRACT

BACKGROUND: Published studies suggest physical recovery from the COVID-19 is complex, with many individuals experiencing persistent symptoms. There is a paucity of data investigating the longer-term trajectory of physical recovery from COVID-19. METHODS: A prospective longitudinal design was utilised to investigate the impact COVID-19 has on physical functioning at 10-weeks (T1), 6-months (T2) and 1-year (T3) post-hospital discharge. Objective measures of recovery included 6-Minute Walk Test Distance (6MWTD), frailty (Clinical Frailty Scale), quantification of falls following hospital-discharge, return to work status and exercise levels. Subjective markers included symptoms (COVID-19-Specific Patient Concerns Assessment), fatigue (Chalder Fatigue Score) and health-related quality of life (HrQOL) [Short-Form-36 Health Survey Questionnaire (SF-36-II)]. Univariate analysis was performed using t-test, Wilcoxon rank-sum, and Chi-squared test, paired analysis using one-way analysis of variance and Krustal Wallis testing and correlation analysis with Spearman correlation tests. RESULTS: Sixty-one subjects participated. Assessments were conducted at a median of 55 days(T1), 242 days(T2), and 430 days(T3) following hospital-discharge. 6MWTD improved significantly overtime (F = 10.3, p < 0.001) from 365(209)m at T1 to 447(85)m at T3, however remained below population norms and with no associated improvement in perceived exertion. Approximately half (n = 27(51%)) had returned to pre-diagnosis exercise levels at T3. At least one concern/symptom was reported by 74%, 59% and 64% participants at T1, T2 and T3 respectively. Fatigue was the most frequently reported symptom at T1(40%) and T2(49%), while issues with memory/concentration was the most frequently reported at T3(49%). SF-36 scores did not change in any domain over the study period, and scores remained lower than population norms in the domains of physical functioning, energy/vitality, role limitations due to physical problems and general health. Return-to-work rates are low, with 55% of participants returning to work in some capacity, and 31% of participants don't feel back to full-health at 1-year following infection. CONCLUSION: Hospitalised COVID-19 survivors report persistent symptoms, particularly fatigue and breathlessness, low HrQOL scores, sub-optimal exercise levels and continued work absenteeism 1-year following infection, despite some objective recovery of physical functioning. Further research is warranted to explore rehabilitation goals and strategies to optimise patient outcomes during recovery from COVID-19. CLINICAL MESSAGE: Hospitalised COVID-19 survivors report significant ongoing rehabilitation concerns 1-year following infection, despite objective recovery of physical functioning. Our findings suggest those who returned to exercise within 1-year may have less fatigue and breathlessness. The impact of exercise, and other rehabilitative strategies on physical functioning outcomes following COVID-19 should be investigated in future research.


Subject(s)
COVID-19 , Frailty , Cohort Studies , Dyspnea , Fatigue/diagnosis , Fatigue/epidemiology , Humans , Longitudinal Studies , Prospective Studies , Quality of Life
20.
BMC Emerg Med ; 22(1): 82, 2022 05 08.
Article in English | MEDLINE | ID: covidwho-1822164

ABSTRACT

BACKGROUND: The resuscitation guidelines provided for the COVID-19 pandemic strongly recommended wearing personal protective equipment. The current study aimed to evaluate and compare the effectiveness of chest compressions and the level of fatigue while wearing two different types of mask (surgical vs. cloth). METHODS: A randomized, non-inferiority, simulation study was conducted. Participants were randomised into two groups: surgical mask group (n = 108) and cloth mask group (n = 108). The effectiveness (depth and rate) of chest compressions was measured within a 2-min continuous chest-compression-only CPR session. Data were collected through an AMBU CPR Software, a questionnaire, recording vital parameters, and using Borg-scale related to fatigue (before and after the simulation). For further analysis the 2-min session was segmented into 30-s intervals. RESULTS: Two hundred sixteen first-year health care students participated in our study. No significant difference was measured between the surgical mask and cloth mask groups in chest compression depth (44.49 ± 10.03 mm vs. 45.77 ± 10.77 mm), rate (113.34 ± 17.76/min vs. 111.23 ± 17.51/min), and the level of fatigue (5.72 ± 1.69 vs. 5.56 ± 1.67) (p > 0.05 in every cases). Significant decrease was found in chest compression depth between the first 30-s interval and the second, third, and fourth intervals (p < 0.01). CONCLUSION: The effectiveness of chest compressions (depth and rate) was non-inferior when wearing cloth mask compared to wearing surgical mask. However, the effectiveness of chest compressions decreased significantly in both groups during the 2-min chest-compression-only CPR session and did not reach the appropriate chest compression depth range recommended by the ERC.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , COVID-19/epidemiology , Cardiopulmonary Resuscitation/education , Delivery of Health Care , Fatigue , Humans , Manikins , Pandemics , Students
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