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2.
Rev Colomb Psiquiatr (Engl Ed) ; 50(3): 225-231, 2021.
Article in English, Spanish | MEDLINE | ID: covidwho-1401810

ABSTRACT

INTRODUCTION: The crisis situation generated by COVID-19 and the measures adopted have generated social changes in the normal dynamics of the general population and especially for health workers, who find themselves caring for patients with suspected or confirmed infection. Recent studies have detected in them depression and anxiety symptoms and burnout syndrome, with personal and social conditions impacting their response capacity during the health emergency. Our aim was to generate recommendations for the promotion and protection of the mental health of health workers and teams in the first line of care in the health emergency due to COVID-19. METHODS: A rapid literature search was carried out in PubMed and Google Scholar, and an iterative expert consensus and through electronic consultation, with 13 participants from the areas of psychology, psychiatry and medicine; the grading of its strength and directionality was carried out according to the international standards of the Joanna Briggs Institute. RESULTS: Thirty-one recommendations were generated on self-care of health workers, community care among health teams, screening for alarm signs in mental health and for health institutions. CONCLUSIONS: The promotion and protection activities in mental health to face the health emergency generated by COVID-19 worldwide can include coordinated actions between workers, health teams and health institutions as part of a comprehensive, community care, co-responsible and sustained over time.


Subject(s)
COVID-19/psychology , Health Personnel/psychology , Mental Disorders/diagnosis , Mental Disorders/therapy , Occupational Diseases/diagnosis , Occupational Diseases/therapy , Occupational Health Services/methods , Humans , Mass Screening/methods , Mass Screening/standards , Mental Disorders/etiology , Mental Disorders/psychology , Occupational Diseases/etiology , Occupational Diseases/psychology , Occupational Health Services/standards , Preventive Health Services/methods , Preventive Health Services/standards , Self Care/methods , Self Care/standards
3.
Rev Colomb Psiquiatr (Engl Ed) ; 50(3): 199-213, 2021.
Article in English, Spanish | MEDLINE | ID: covidwho-1347802

ABSTRACT

BACKGROUND: The aim of the study is to compare the emotional effects of COVID-19 among three different groups, namely: health personnel, medical students, and a sample of the general population. METHODS: 375 participants were recruited for this study, of which 125 were medical students (preclinical studies, 59; clinical studies, 66), 125 were health personnel (COVID-19 frontline personnel, 59; personnel not related with COVID-19, 66), and 125 belonged to the general population. The PHQ-9, GAD-7, and CPDI scales were used to assess the emotional impact. A multinomial logistic regression was performed to measure differences between groups, considering potential confounding factors. RESULTS: Regarding CPDI values, all other groups showed reduced values compared to COVID-19 frontline personnel. However, the general population, preclinical and clinical medical students showed increased PHQ-9 values compared to COVID-19 frontline personnel. Finally, confounding factors, gender and age correlated negatively with higher CPDI and PHQ-9 scores. CONCLUSIONS: Being frontline personnel is associated with increased COVID-19-related stress. Depression is associated, however, with other groups not directly involved with the treatment of COVID-19 patients. Female gender and younger age correlated with COVID-19-related depression and stress.


Subject(s)
COVID-19/psychology , Mental Disorders/therapy , Mental Health Services , Preventive Health Services/methods , Student Health Services/methods , Students/psychology , Teaching/psychology , COVID-19/prevention & control , Health Promotion/methods , Health Promotion/organization & administration , Humans , Mental Disorders/diagnosis , Mental Disorders/etiology , Mental Health , Mental Health Services/organization & administration , Preventive Health Services/organization & administration , Student Health Services/organization & administration , Universities , Young Adult
4.
CMAJ Open ; 9(2): E693-E702, 2021.
Article in English | MEDLINE | ID: covidwho-1278708

ABSTRACT

BACKGROUND: Identification of therapies to prevent severe COVID-19 remains a priority. We sought to determine whether hydroxychloroquine treatment for outpatients with SARS-CoV-2 infection could prevent hospitalization, mechanical ventilation or death. METHODS: This randomized controlled trial was conducted in Alberta during the first wave of the COVID-19 pandemic without direct contact with participants. Community-dwelling individuals with confirmed SARS-CoV-2 infection (by reverse transcription polymerase chain reaction [RT-PCR] viral ribonucleic acid test) within the previous 4 days, and symptom onset within the previous 12 days, were randomly assigned to oral hydroxychloroquine or matching placebo for 5 days. Enrolment began Apr. 15, 2020. The primary outcome was the composite of hospitalization, invasive mechanical ventilation or death within 30 days. Secondary outcomes included symptom duration and disposition at 30 days. Safety outcomes, such as serious adverse events and mortality, were also ascertained. Outcomes were determined by telephone follow-up and administrative data. RESULTS: Among 4919 individuals with a positive RT-PCR test, 148 (10.2% of a planned 1446 patients) were randomly assigned, 111 to hydroxychloroquine and 37 to placebo. Of the 148 participants, 24 (16.2%) did not start the study drug. Four participants in the hydroxychloroquine group met the primary outcome (4 hospitalizations, 0 mechanical ventilation, 4 survived to 30 days) and none in the placebo group. Hydroxychloroquine did not reduce symptom duration (hazard ratio 0.77, 95% confidence interval 0.49-1.21). Recruitment was paused on May 22, 2020, when a since-retracted publication raised concerns about the safety of hydroxychloroquine for hospitalized patients with COVID-19. Although we had not identified concerns in a safety review, enrolment was slower than expected among those eligible for the study, and cases within the community were decreasing. Recruitment goals were deemed to be unattainable and the trial was not resumed, resulting in a study underpowered to assess the effect of treatment with hydroxychloroquine and safety. INTERPRETATION: There was no evidence that hydroxychloroquine reduced symptom duration or prevented severe outcomes among outpatients with proven COVID-19, but the early termination of our study meant that it was underpowered. TRIAL REGISTRATION: ClinicalTrials.gov, no. NCT04329611.


Subject(s)
Ambulatory Care , COVID-19 , Hospitalization/statistics & numerical data , Hydroxychloroquine , Respiration, Artificial/statistics & numerical data , Ambulatory Care/methods , Ambulatory Care/statistics & numerical data , Antiviral Agents/administration & dosage , Antiviral Agents/adverse effects , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/mortality , Early Termination of Clinical Trials , Female , Humans , Hydroxychloroquine/administration & dosage , Hydroxychloroquine/adverse effects , Independent Living/statistics & numerical data , Male , Middle Aged , Mortality , Outcome Assessment, Health Care , Preventive Health Services/methods , SARS-CoV-2/isolation & purification , Severity of Illness Index
6.
Eur Heart J Qual Care Clin Outcomes ; 7(4): 330-339, 2021 07 21.
Article in English | MEDLINE | ID: covidwho-1262139

ABSTRACT

AIMS: To consolidate evidence to determine (i) the association between cardiovascular risk factors and health outcomes with coronavirus 2019 (COVID-19); and (ii) the impact of COVID-19 on cardiovascular health. METHODS AND RESULTS: An umbrella review of systematic reviews was conducted. Fourteen medical databases and pre-print servers were searched from 1 January 2020 to 5 November 2020. The review focused on reviews rated as moderate or high-quality using the AMSTAR 2 tool. Eighty-four reviews were identified; 31 reviews were assessed as moderate quality and one was high-quality. The following risk factors were associated with higher mortality and severe COVID-19: renal disease [odds ratio (OR) (95% confidence interval) for mortality 3.07 (2.43-3.88)], diabetes mellitus [OR 2.09 (1.80-2.42)], hypertension [OR 2.50 (2.02-3.11)], smoking history [risk ratio (RR) 1.26 (1.20-1.32)], cerebrovascular disease [RR 2.75 (1.54-4.89)], and cardiovascular disease [OR 2.65 (1.86-3.78)]. Liver disease was associated with higher odds of mortality [OR 2.81 (1.31-6.01)], but not severe COVID-19. Current smoking was associated with a higher risk of severe COVID-19 [RR 1.80 (1.14-2.85)], but not mortality. Obesity associated with higher odds of mortality [OR 2.18 (1.10-4.34)], but there was an absence of evidence for severe COVID-19. In patients hospitalized with COVID-19, the following incident cardiovascular complications were identified: acute heart failure (2%), myocardial infarction (4%), deep vein thrombosis (7%), myocardial injury (10%), angina (10%), arrhythmias (18%), pulmonary embolism (19%), and venous thromboembolism (25%). CONCLUSION: Many of the risk factors identified as associated with adverse outcomes with COVID-19 are potentially modifiable. Primary and secondary prevention strategies that target cardiovascular risk factors may improve outcomes for people following COVID-19.


Subject(s)
COVID-19 , Cardiovascular Diseases , COVID-19/epidemiology , COVID-19/prevention & control , Cardiovascular Diseases/classification , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Heart Disease Risk Factors , Humans , Preventive Health Services/methods , Preventive Health Services/statistics & numerical data , SARS-CoV-2 , Systematic Reviews as Topic
8.
BMJ Open ; 10(12): e044197, 2020 12 29.
Article in English | MEDLINE | ID: covidwho-1083582

ABSTRACT

AIM: To explore indigenous communities' responses to the COVID-19 pandemic and its consequences for maternal and neonatal health (MNH) care in the Peruvian Amazon. METHODS: Mamás del Río is a community-based, MNH programme with comprehensive supervision covering monthly meetings with community health workers (CHW), community leaders and health facilities. With the onset of the lockdown, supervisors made telephone calls to discuss measures against COVID-19, governmental support, CHW activities in communities and provision of MNH care and COVID-19 preparedness at facilities. As part of the programme's ongoing mixed methods evaluation, we analysed written summaries of supervisor calls collected during the first 2 months of Peru's lockdown. RESULTS: Between March and May 2020, supervisors held two rounds of calls with CHWs and leaders of 68 communities and staff from 17 facilities. Most communities banned entry of foreigners, but about half tolerated residents travelling to regional towns for trade and social support. While social events were forbidden, strict home isolation was only practised in a third of communities as conflicting with daily routine. By the end of April, first clusters of suspected cases were reported in communities. COVID-19 test kits, training and medical face masks were not available in most rural facilities. Six out of seven facilities suspended routine antenatal and postnatal consultations while two-thirds of CHWs resumed home visits to pregnant women and newborns. CONCLUSIONS: Home isolation was hardly feasible in the rural Amazon context and community isolation was undermined by lack of external supplies and social support. With sustained community transmission, promotion of basic hygiene and mask use becomes essential. To avoid devastating effects on MNH, routine services at facilities need to be urgently re-established alongside COVID-19 preparedness plans. Community-based MNH programmes could offset detrimental indirect effects of the pandemic and provide an opportunity for local COVID-19 prevention and containment.


Subject(s)
COVID-19 , Communicable Disease Control , Community Health Services , Infant Health , Maternal Health , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/organization & administration , Communicable Disease Control/standards , Community Health Services/methods , Community Health Services/organization & administration , Community Health Services/standards , Disease Transmission, Infectious/prevention & control , Female , Health Knowledge, Attitudes, Practice , Health Services Needs and Demand , Health Services, Indigenous/trends , Humans , Infant Health/statistics & numerical data , Infant Health/trends , Infant, Newborn , Male , Maternal Health/statistics & numerical data , Maternal Health/trends , Peru/epidemiology , Pregnancy , Preventive Health Services/methods , SARS-CoV-2
12.
In Vivo ; 35(1): 635-639, 2021.
Article in English | MEDLINE | ID: covidwho-1011856

ABSTRACT

BACKGROUND/AIM: The perspective validation of a selective approach in patients undergoing breast cancer surgery was performed in order to assess whether patients as well as Health Care Workers (HCWs) were exposed to any undue risk of COVD-19 infection. PATIENTS AND METHODS: From March 9th to June 9th 2020, 207 patients were phone-triaged by a dedicated Breast Care Nurse; a patient-tailored program was adopted with the aim of avoiding hospitalization of SARS-CoV-2 symptomatic patients, with a careful prioritization of surgical procedures according to specific disease features. RESULTS: Two hundred and three out of 207 patients underwent operation; seven patients were temporarily excluded because they tested positive at phone triage (n=3), or in-hospital triage (n=3); another asymptomatic patient with negative NP swab tested IgM Ab-positive so that surgery was re-scheduled two weeks later. Four patients had no surgery; one of them was reconsidered for neoadjuvant chemotherapy (NAC) after testing positive at phone triage; three patients were excluded because they were already hospitalized for COVID-19. Overall, mean in-hospital stay was 2.2 days (±SD, 0.7) and, after hospital discharge, no patient required readmission. CONCLUSION: This preventive program avoided any COVID-19 infection among patients and HCWs, so that an elective breast cancer surgical procedure can be safely and timely pursued without affecting the oncologic outcome.


Subject(s)
Breast Neoplasms/surgery , COVID-19/prevention & control , Health Personnel/statistics & numerical data , Mastectomy/methods , Preventive Health Services/methods , SARS-CoV-2/isolation & purification , Adult , Breast Neoplasms/therapy , COVID-19/epidemiology , COVID-19/virology , Female , Humans , Length of Stay/statistics & numerical data , Medical Oncology/methods , Middle Aged , Pandemics , Reproducibility of Results , SARS-CoV-2/physiology , Triage/methods
13.
J Natl Med Assoc ; 112(6): 681-687, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-950877

ABSTRACT

Influenza is a contagious respiratory virus that causes a significant annual health burden in the United States (US). In spite of effective yearly vaccinations to protect individuals against influenza-related health complications, especially with certain chronic co-morbid illnesses, persistent racial/ethnic disparities exist in influenza immunization. African Americans continue to experience low vaccination uptake, stemming, at least in part, from years of bias in and mistrust of orthodox medicine, safety concerns, and environmental barriers to vaccine access. The novel respiratory coronavirus, SARS-CoV2, causes COVID-19, leading to a pandemic that in the U.S. has exerted severe physical, psychological, and economic tolls on the African Americans and other disadvantaged communities. These two respiratory-borne virus' cause disparate effects in the black community, unmasking persistent disparities in healthcare. Unfortunately, suboptimal influenza immunization acceptance exacerbates flu-related adverse health outcomes, similar to difficulties from the effects of the COVID-19 pandemic. In consideration of the impending influenza-COVID-19 "twindemic", robust educational campaigns, policy initiatives, and novel approaches to influenza immunization must be considered for the African American community to build trust in the health benefits of the influenza vaccination and, ultimately, to trust in the health benefits of potential SARS-CoV2 vaccines, when available for the general public.


Subject(s)
African Americans , COVID-19 Vaccines/therapeutic use , COVID-19 , Influenza Vaccines/therapeutic use , Influenza, Human , Preventive Health Services , Quality Improvement/organization & administration , COVID-19/epidemiology , COVID-19/prevention & control , Healthcare Disparities , Humans , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Pandemics/prevention & control , Patient Acceptance of Health Care/ethnology , Preventive Health Services/methods , Preventive Health Services/standards , SARS-CoV-2 , United States/epidemiology , Vaccination
15.
BMJ Open ; 10(10): e041514, 2020 10 23.
Article in English | MEDLINE | ID: covidwho-889900

ABSTRACT

OBJECTIVE: The COVID-19 pandemic is having major implications for stroke care with a documented significant fall in hospital acute stroke admissions. We investigated whether COVID-19 has resulted in a decreased number of referrals to the transient ischaemic attack (TIA) clinics across the North West London region. SETTING AND DESIGN: All the TIA clinical leads of the North West London region received an invitation by email to participate in an online survey in May 2020. The survey questionnaire aimed to assess the number of patients with suspected TIA consecutively referred to each of the TIA clinics of the North West London region between 1 March and 30 April 2020, the COVID-19 period, and between 1 March and 30 April 2019. RESULTS: We had a response rate of 100%. During the COVID-19 period, the TIA clinics of the North West London region received 440 referrals compared with 616 referrals received between 1 March and 30 April 2019 with a fall in the number of the referrals by 28.6%. In April 2020 compared with April 2019, the number of the referrals declined by 40.1%. CONCLUSIONS: This multicentre analysis documented a significant reduction in the number of patients referred with suspected TIA to the specialised rapid access outpatient clinics in the North West London region during the COVID-19 pandemic. Future studies are needed to confirm our findings and to better characterise the incidence of cerebrovascular disease during the COVID-19 pandemic.


Subject(s)
Coronavirus Infections/epidemiology , Ischemic Attack, Transient , Pneumonia, Viral/epidemiology , Referral and Consultation/statistics & numerical data , Ambulatory Care Facilities/statistics & numerical data , Betacoronavirus , COVID-19 , Cross-Sectional Studies , Hospitalization , Humans , Incidence , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/epidemiology , London/epidemiology , Pandemics , Preventive Health Services/methods , Preventive Health Services/statistics & numerical data , Quality of Health Care , SARS-CoV-2
16.
J Appl Psychol ; 105(12): 1397-1407, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-889147

ABSTRACT

In order to combat the spread of the novel coronavirus, the Centers for Disease Control and Prevention (CDC) has developed a list of recommended preventative health behaviors for Americans to enact, including social distancing, frequent handwashing, and limiting nonessential trips from home. Drawing upon scarcity theory, the purpose of this study was to examine whether the economic stressors of perceived job insecurity and perceived financial insecurity are related to employee self-reports of enacting such behaviors. Moreover, we tested propositions regarding the impact of two state-level contextual variables that may moderate those relationships: the generosity of unemployment insurance benefits and extensiveness of statewide COVID-19-related restrictions. Using a multilevel data set of N = 745 currently employed U.S. workers nested within 43 states, we found that both job insecurity and financial insecurity were negatively related to the enactment of the CDC-recommended guidelines. However, the state-level variables acted as cross-level moderators, such that the negative relationship between job insecurity and compliance with the CDC guidelines was attenuated within states that have a more robust unemployment system. However, working in a state with more extensive COVID-19 restrictions seemed to primarily benefit more financially secure workers. When statewide policies were more restrictive, employees reporting more financial security were more likely to enact the CDC-recommended guidelines compared to their financially insecure counterparts. We discuss these findings in light of the continuing need to develop policies to address the public health crisis while also protecting employees facing economic stressors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Subject(s)
COVID-19/economics , COVID-19/prevention & control , Centers for Disease Control and Prevention, U.S./legislation & jurisprudence , Financial Stress/psychology , Preventive Health Services/legislation & jurisprudence , State Government , Adult , COVID-19/psychology , Centers for Disease Control and Prevention, U.S./economics , Female , Financial Stress/economics , Humans , Male , Pandemics , Preventive Health Services/economics , Preventive Health Services/methods , Unemployment/psychology , Unemployment/statistics & numerical data , United States
19.
Age Ageing ; 50(1): 49-54, 2021 01 08.
Article in English | MEDLINE | ID: covidwho-799418

ABSTRACT

BACKGROUND: SARS-CoV-2 has disproportionately affected nursing homes (NH). In Ireland, the first NH case COVID-19 occurred on 16 March 2020. A national point-prevalence testing programme of all NH residents and staff took place (18 April 2020 to 5 May 2020). AIMS: to examine characteristics of NHs across three Irish Community Health Organisations, proportions with COVID-19 outbreaks, staff and resident infection rates symptom profile and resident case fatality. METHODS: in total, 45 NHs surveyed, requesting details on occupancy, size, COVID-19 outbreak, outbreak timing, total symptomatic/asymptomatic cases and outcomes for residents from 29 February 2020 to 22 May 2020. RESULTS: surveys were returned from 62.2% (28/45) of NHs (2,043 residents, 2,303 beds). Three-quarters (21/28) had COVID-19 outbreaks (1,741 residents, 1,972 beds). Median time from first COVID-19 case in Ireland to first case in these NHs was 27.0 days. Resident incidence was 43.9% (764/1,741)-40.8% (710/1,741) laboratory confirmed, with 27.2% (193/710) asymptomatic and 3.1% (54/1,741) clinically suspected. Resident case fatality was 27.6% (211/764) for combined laboratory-confirmed/clinically suspected COVID-19. Similar proportions of residents in NHs with 'early-stage' (<28 days) versus 'later-stage' outbreaks developed COVID-19. Lower proportions of residents in 'early' outbreak NHs had recovered compared with those with 'late' outbreaks (37.4 versus 61.7%; χ2 = 56.9, P < 0.001). Of 395 NH staff across 12 sites with confirmed COVID-19, 24.7% (99/398) were asymptomatic. There was a significant correlation between the proportion of staff with symptomatic COVID-19 and resident numbers with confirmed/suspected COVID-19 (Spearman's rho = 0.81, P < 0.001). CONCLUSION: this study demonstrates the significant impact of COVID-19 on the NH sector. Systematic point-prevalence testing is necessary to reduce risk of transmission from asymptomatic carriers and manage outbreaks in this setting.


Subject(s)
Asymptomatic Infections/mortality , COVID-19 Testing/methods , COVID-19 , Carrier State/diagnosis , Homes for the Aged/statistics & numerical data , Nursing Homes/statistics & numerical data , Aged , COVID-19/diagnosis , COVID-19/mortality , Disease Transmission, Infectious/prevention & control , Female , Humans , Ireland/epidemiology , Male , Preventive Health Services/methods , Risk Management/methods , Risk Management/organization & administration , SARS-CoV-2/isolation & purification , Symptom Assessment/statistics & numerical data
20.
Expert Rev Anti Infect Ther ; 19(3): 323-329, 2021 03.
Article in English | MEDLINE | ID: covidwho-752315

ABSTRACT

INTRODUCTION: The HIV epidemic continues to disproportionately impact sexual and gender minority Latinxs (SGML). Several syndemic conditions have been linked with HIV acquisition and transmission among SGML including immigration, discrimination, environmental racism, substance use, and mental health. AREAS COVERED: We provide a summary of biomedical, behavioral, and social/structural interventions to reduce risks for acquiring HIV and improve outcomes along the HIV care continuum among SGML. We also discuss intervention approaches and opportunities that respond at the intersection of HIV and COVID-19 prevention and treatment. EXPERT OPINION: There is a dire need for the combination of biomedical, behavioral, and social/structural interventions to reduce risks for acquiring HIV and improve outcomes along the HIV care continuum. Interventions and combination approaches should be driven by community-based participatory action research. The inclusion of community members in all stages of the research process can assure successful implementation of program activities and deliverables, including the provision of culturally and linguistically appropriate services. Given the current COVID-19 pandemic, which is disproportionately impacting individuals living with HIV and other comorbidities, the elderly, and under-resourced communities with a ferocity not seen in other communities, intervention approaches that respond at the intersection of HIV and COVID-19 prevention and treatment are also urgently needed.


Subject(s)
Biobehavioral Sciences , COVID-19 , HIV Infections , Preventive Health Services , Sexual and Gender Minorities/psychology , COVID-19/epidemiology , COVID-19/prevention & control , HIV Infections/epidemiology , HIV Infections/prevention & control , HIV Infections/therapy , Humans , Mental Health , Preventive Health Services/methods , Preventive Health Services/organization & administration , Preventive Health Services/trends , SARS-CoV-2
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