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1.
PLoS One ; 16(2): e0247414, 2021.
Article in English | MEDLINE | ID: covidwho-1388900

ABSTRACT

BACKGROUND: Facemasks are recommended to reduce the spread of SARS-CoV-2, but concern about inadequate gas exchange is an often cited reason for non-compliance. RESEARCH QUESTION: Among adult volunteers, do either cloth masks or surgical masks impair oxygenation or ventilation either at rest or during physical activity? STUDY DESIGN AND METHODS: With IRB approval and informed consent, we measured heart rate (HR), transcutaneous carbon dioxide (CO2) tension and oxygen levels (SpO2) at the conclusion of six 10-minute phases: sitting quietly and walking briskly without a mask, sitting quietly and walking briskly while wearing a cloth mask, and sitting quietly and walking briskly while wearing a surgical mask. Brisk walking required at least a 10bpm increase in heart rate. Occurrences of hypoxemia (decrease in SpO2 of ≥3% from baseline to a value of ≤94%) and hypercarbia (increase in CO2 tension of ≥5 mmHg from baseline to a value of ≥46 mmHg) in individual subjects were collected. Wilcoxon signed-rank was used for pairwise comparisons among values for the whole cohort (e.g. walking without a mask versus walking with a cloth mask). RESULTS: Among 50 adult volunteers (median age 33 years; 32% with a co-morbidity), there were no episodes of hypoxemia or hypercarbia (0%; 95% confidence interval 0-1.9%). In paired comparisons, there were no statistically significant differences in either CO2 or SpO2 between baseline measurements without a mask and those while wearing either kind of mask mask, both at rest and after walking briskly for ten minutes. INTERPRETATION: The risk of pathologic gas exchange impairment with cloth masks and surgical masks is near-zero in the general adult population.


Subject(s)
COVID-19/prevention & control , Masks , Oxygen/metabolism , Pulmonary Ventilation/physiology , Adult , COVID-19/psychology , COVID-19/transmission , Carbon Dioxide/metabolism , Exercise/physiology , Female , Heart Rate/physiology , Humans , Hypoxia/etiology , Hypoxia/metabolism , Male , Masks/adverse effects , N95 Respirators/adverse effects , Rest/physiology , SARS-CoV-2/isolation & purification , Walking/physiology
3.
Sci Rep ; 10(1): 13066, 2020 08 03.
Article in English | MEDLINE | ID: covidwho-1242030

ABSTRACT

As prosociality is key to facing many of our societies' global challenges (such as fighting a global pandemic), we need to better understand why some individuals are more prosocial than others. The present study takes a neural trait approach, examining whether the temporal dynamics of resting EEG networks are associated with inter-individual differences in prosociality. In two experimental sessions, we collected 55 healthy males' resting EEG, their self-reported prosocial concern and values, and their incentivized prosocial behavior across different reward domains (money, time) and social contexts (collective, individual). By means of EEG microstate analysis we identified the temporal coverage of four canonical resting networks (microstates A, B, C, and D) and their mutual communication in order to examine their association with an aggregated index of prosociality. Participants with a higher coverage of microstate A and more transitions from microstate C to A were more prosocial. Our study demonstrates that temporal dynamics of intrinsic brain networks can be linked to complex social behavior. On the basis of previous findings on links of microstate A with sensory processing, our findings suggest that participants with a tendency to engage in bottom-up processing during rest behave more prosocially than others.


Subject(s)
Electroencephalography , Rest/physiology , Social Behavior , Adult , Humans , Male , Time Factors , Young Adult
4.
J Orthop Sports Phys Ther ; 51(5): 197-200, 2021 05.
Article in English | MEDLINE | ID: covidwho-1209238

ABSTRACT

SYNOPSIS: The term long COVID was coined by patients to describe the long-term consequences of COVID-19. One year into the pandemic, it was clear that all patients-those hospitalized with COVID-19 and those who lived with the disease in the community-were at risk of developing debilitating sequelae that would impact their quality of life. Patients with long COVID asked for rehabilitation. Many of them, including previously healthy and fit clinicians, tried to fight postviral fatigue with exercise-based rehabilitation. We observed a growing number of patients with long COVID who experienced adverse effects from exercise therapy and symptoms strikingly similar to those of myalgic encephalomyelitis (ME). Community-based physical therapists, including those in private practice, unaware of safety issues, are preparing to help an influx of patients with long COVID. In this editorial, we expose growing concerns about long COVID and ME. We issue safety recommendations for rehabilitation and share resources to improve care for those with postviral illnesses. J Orthop Sports Phys Ther 2021;51(5):197-200. doi:10.2519/jospt.2021.0106.


Subject(s)
COVID-19/complications , Fatigue Syndrome, Chronic/etiology , Fatigue Syndrome, Chronic/therapy , Fatigue/etiology , Fatigue/therapy , Exercise Therapy/adverse effects , Humans , Quality of Life , Rest
5.
Clin Nutr ESPEN ; 43: 383-389, 2021 06.
Article in English | MEDLINE | ID: covidwho-1163553

ABSTRACT

BACKGROUND & AIMS: Different metabolic phases can be distinguished in critical illness, which influences nutritional treatment. Achieving optimal nutritional treatment during these phases in critically ill patients is challenging. COVID-19 patients seem particularly difficult to feed due to gastrointestinal problems. Our aim was to describe measured resting energy expenditure (mREE) and feeding practices and tolerance during the acute and late phases of critical illness in COVID-19 patients. METHODS: Observational study including critically ill mechanically ventilated adult COVID-19 patients. Indirect calorimetry (Q-NRG+, Cosmed) was used to determine mREE during the acute (day 0-7) and late phase (>day 7) of critical illness. Data on nutritional intake, feeding tolerance and urinary nitrogen loss were collected simultaneously. A paired sample t-test was performed for mREE in both phases. RESULTS: We enrolled 21 patients with a median age of 59 years [44-66], 67% male and median BMI of 31.5 kg/m2 [25.7-37.8]. Patients were predominantly fed with EN in both phases. No significant difference in mREE was observed between phases (p = 0.529). Sixty-five percent of the patients were hypermetabolic in both phases. Median delivery of energy as percentage of mREE was higher in the late phase (94%) compared to the acute phase (70%) (p = 0.001). Urinary nitrogen losses were significant higher in the late phase (p = 0.003). CONCLUSION: In both the acute and late phase, the majority of the patients were hypermetabolic and fed enterally. In the acute phase patients were fed hypocaloric whereas in the late phase this was almost normocaloric, conform ESPEN guidelines. No significant difference in mREE was observed between phases. Hypermetabolism in both phases in conjunction with an increasing loss of urinary nitrogen may indicate that COVID-19 patients remain in a prolonged acute, catabolic phase.


Subject(s)
COVID-19/metabolism , Critical Illness , Energy Metabolism , Enteral Nutrition , Nutritional Requirements , Adult , Basal Metabolism , Body Mass Index , COVID-19/complications , COVID-19/therapy , Critical Care , Critical Illness/therapy , Disease Progression , Energy Intake , Female , Gastrointestinal Diseases/etiology , Humans , Male , Middle Aged , Nitrogen/urine , Parenteral Nutrition , Respiration, Artificial , Rest , SARS-CoV-2
6.
Mayo Clin Proc ; 96(1): 156-164, 2021 01.
Article in English | MEDLINE | ID: covidwho-1065442

ABSTRACT

Behavioral lifestyle factors are associated with cardiometabolic disease and obesity, which are risk factors for coronavirus disease 2019 (COVID-19). We aimed to investigate whether physical activity, and the timing and balance of physical activity and sleep/rest, were associated with SARS-CoV-2 positivity and COVID-19 severity. Data from 91,248 UK Biobank participants with accelerometer data and complete covariate and linked COVID-19 data to July 19, 2020, were included. The risk of SARS-CoV-2 positivity and COVID-19 severity-in relation to overall physical activity, moderate-to-vigorous physical activity (MVPA), balance between activity and sleep/rest, and variability in timing of sleep/rest-was assessed with adjusted logistic regression. Of 207 individuals with a positive test result, 124 were classified as having a severe infection. Overall physical activity and MVPA were not associated with severe COVID-19, whereas a poor balance between activity and sleep/rest was (odds ratio [OR] per standard deviation: 0.71; 95% confidence interval [CI], 0.62 to 0.81]). This finding was related to higher daytime activity being associated with lower risk (OR, 0.75; 95% CI, 0.61 to 0.93) but higher movement during sleep/rest being associated with higher risk (OR, 1.26; 95% CI, 1.12 to 1.42) of severe infection. Greater variability in timing of sleep/rest was also associated with increased risk (OR, 1.21; 95% CI, 1.08 to 1.35). Results for testing positive were broadly consistent. In conclusion, these results highlight the importance of not just physical activity, but also quality sleep/rest and regular sleep/rest patterns, on risk of COVID-19. Our findings indicate the risk of COVID-19 was consistently approximately 1.2-fold greater per approximately 40-minute increase in variability in timing of proxy measures of sleep, indicative of irregular sleeping patterns.


Subject(s)
COVID-19/epidemiology , Exercise , Rest , Sleep , Accelerometry , Aged , Biological Specimen Banks , Female , Humans , Male , Prospective Studies , Risk Factors , SARS-CoV-2 , Severity of Illness Index , United Kingdom/epidemiology
7.
BMJ Open ; 11(1): e042591, 2021 01 28.
Article in English | MEDLINE | ID: covidwho-1054682

ABSTRACT

OBJECTIVES: To measure work-related burnout in all groups of health service staff during the COVID-19 pandemic and to identify factors associated with work-related burnout. DESIGN: Cross-sectional staff survey. SETTING: All staff grades and types across primary and secondary care in a single National Health Service organisation. PARTICIPANTS: 257 staff members completed the survey, 251 had a work-related burnout score and 239 records were used in the regression analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Work-related burnout as measured by the Copenhagen Burnout Inventory; (2) factors associated with work-related burnout identified through a multiple linear regression model; and (3) factors associated with work-related burnout identified through thematic analysis of free text responses. RESULTS: After adjusting for other covariates (including age, sex, job, being able to take breaks and COVID-19 knowledge), we observed meaningful changes in work-related burnout associated with having different COVID-19 roles (p=0.03), differences in the ability to rest and recover during breaks (p<0.01) and having personal protective equipment concerns (p=0.04). Thematic analysis of the free text comments also linked burnout to changes in workload and responsibility and to a lack of control through redeployment and working patterns. Reduction in non-COVID-19 services has resulted in some members of staff feeling underutilised, with feelings of inequality in workload. CONCLUSIONS: Our analyses support anecdotal reports of staff struggling with the additional pressures brought on by COVID-19. All three of the factors we found to be associated with work-related burnout are modifiable and hence their effects can be mitigated. When we next find ourselves in extraordinary times the ordinary considerations of rest and protection and monitoring of the impact of new roles will be more important than ever.


Subject(s)
Burnout, Professional/epidemiology , COVID-19 , Health Personnel/psychology , Professional Role/psychology , Workload/psychology , Adolescent , Adult , COVID-19/epidemiology , Cross-Sectional Studies , Female , Health Workforce/organization & administration , Humans , Male , Middle Aged , Personal Protective Equipment/supply & distribution , Psychiatric Status Rating Scales , Rest/psychology , SARS-CoV-2 , State Medicine , United Kingdom/epidemiology , Young Adult
8.
J Cardiopulm Rehabil Prev ; 41(1): 1-5, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-990862

ABSTRACT

PURPOSE: Masking has been employed as a strategy for reducing transmission of a variety of communicable diseases. With the outbreak of SARS-CoV-2, many countries have implemented mandatory public masking. However, the perceived impact of mask use on pulmonary function has been a deterrent to public compliance with recommendations. COVID-19 has shed light on the impact that comorbid cardiac and pulmonary conditions may have on disease severity. This knowledge has led to increased primary and secondary prevention efforts for which exercise and rehabilitation are central. The importance of safe methods of exercise while mitigating risk of viral transmission is paramount to global recovery from the pandemic and prevention of future outbreaks. METHODS: We constructed a focused literature review of the impact of various masks on pulmonary function at rest and with exercise. This was then incorporated into recommendations for the integration of masks with exercise and rehabilitation in the COVID-19 era. RESULTS: While there is a paucity of evidence, we identified the physiological effects of masking at rest and during exercise to be negligible. The perceived impact appears to be far greater than the measured impact, and increased frequency of mask use leads to a physiological and psychological adaptive response. CONCLUSIONS: Masking during daily activities, exercise, and rehabilitation is safe in both healthy individuals and those with underlying cardiopulmonary disease. Rehabilitation participants should be reassured that the benefits of masking during COVID-19 far outweigh the risks, and increased frequency of mask use invokes adaptive responses that make long-term masking tolerable.


Subject(s)
COVID-19/prevention & control , Lung/physiology , Masks , Activities of Daily Living , Exercise/physiology , Humans , Masks/adverse effects , Rehabilitation , Rest/physiology , SARS-CoV-2
9.
Clin Nutr ESPEN ; 41: 443-446, 2021 02.
Article in English | MEDLINE | ID: covidwho-917265

ABSTRACT

BACKGROUND & AIMS: During the coronavirus disease 2019 (COVID-19) pandemic the use of Indirect calorimetry (IC) during nutritional rehabilitation program requires special precautions due to possible contagions for patients and health professionals. We evaluated in a sample of healthy subjects the agreement between oxygen consumption (VO2 mL/min), carbon dioxide production (VCO2 mL/min), respiratory quotient (RQ) and resting energy expenditure (REE kcal/24 h/day) measured by IC with and without a filtering facepiece mask. MATERIALS: 10 subjects with a mean (SD) age of 43 (10) years and a body mass index of 25.2 (5.8) kg/m2 underwent indirect calorimetry both with and without a class 2 filtering facepiece mask (FFP2), in random order. The limits of agreement (LOA) and the concordance correlation coefficient (CCC) were used to evaluate the interchangeability of the measurement conditions. RESULTS: The LOA between REE measured with and without FFP2 (-111 to 189 kcal/day) were comparable to those for repeated IC tests without wearing masks and CCC (0.95) showed substantial agreement. CONCLUSIONS: We observed high agreement between REE measured by IC with and without FFP2 mask. These procedures are interchangeable in clinical practice.


Subject(s)
Basal Metabolism , COVID-19 , Calorimetry, Indirect/methods , Carbon Dioxide/metabolism , Masks , Oxygen Consumption , Pandemics , Adult , Body Mass Index , Female , Humans , Male , Masks/adverse effects , Middle Aged , Personal Protective Equipment , Pilot Projects , Respiration , Rest , SARS-CoV-2
10.
Intensive Crit Care Nurs ; 62: 102966, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-893915

ABSTRACT

BACKGROUND: The COVID-19 pandemic is a public health challenge that puts health systems in a highly vulnerable situation. Nurses in critical care units (CCUs) and hospital emergency services (HESs) have provided care to patients with COVID-19 under pressure and uncertainty. OBJECTIVE: To identify needs related to safety, organisation, decision-making, communication and psycho-socio-emotional needs perceived by critical care and emergency nurses in the region of Madrid, Spain, during the acute phase of the epidemic crisis. METHODS: This is a cross-sectional study (the first phase of a mixed methods study) with critical care and emergency nurses from 26 public hospitals in Madrid using an online questionnaire. RESULTS: The response rate was 557, with 37.5% reporting working with the fear of becoming infected and its consequences, 28.2% reported elevated workloads, high patient-nurse ratios and shifts that did not allow them to disconnect or rest, while taking on more responsibilities when managing patients with COVID-19 (23.9%). They also reported deficiencies in communication with middle management (21.2%), inability to provide psycho-social care to patients and families and being emotionally exhausted (53.5%), with difficulty in venting emotions (44.9%). CONCLUSIONS: Critical care and emegency nurses may be categorised as a vulnerable population. It is thus necessary to delve deeper into further aspects of their experiences of the pandemic.


Subject(s)
Attitude of Health Personnel , Burnout, Professional/psychology , COVID-19/nursing , Critical Care Nursing , Emergency Nursing , Nurses , Workload , Adult , Communication , Critical Care , Cross-Sectional Studies , Delivery of Health Care , Emergency Service, Hospital , Family , Female , Hospital Administrators , Hospitals, Public , Humans , Intensive Care Units , Male , Middle Aged , Needs Assessment , Nurse Administrators , Nurses/psychology , Personnel Management , Rest/psychology , SARS-CoV-2 , Spain , Young Adult
11.
JPEN J Parenter Enteral Nutr ; 44(7): 1234-1236, 2020 09.
Article in English | MEDLINE | ID: covidwho-806590

ABSTRACT

BACKGROUND: Hypermetabolism has been described in stress states such as trauma, sepsis, acute respiratory distress syndrome, and severe burn injuries. We hypothesize that patients with Coronavirus disease 2019 (COVID-19) may develop a hypermetabolic state, which may be a major contributing factor to the extraordinary ventilatory and oxygenation demands in patients with COVID-19. METHOD: Resting energy expenditure (REE), carbon dioxide production (VCO2 ), and oxygen consumption (VO2 ) were measured by indirect calorimetry on 7 critically ill patients with COVID-19. RESULTS: The median measured REE was 4044 kcal/d, which was 235.7% ± 51.7% of predicted. The median VCO2 was 452 mL/min (range, 295-582 mL/min), and the median VO2 was 585 mL/min (range, 416-798 mL/min). CONCLUSION: Critically ill patients with COVID-19 are in an extreme hypermetabolic state. This may explain the high failure rates for mechanical ventilation for these patients and highlights the potential need for increased nutrition requirements for such patients.


Subject(s)
Basal Metabolism , COVID-19/metabolism , Carbon Dioxide/metabolism , Critical Illness , Oxygen Consumption , Rest , Adult , COVID-19/virology , Calorimetry, Indirect/methods , Energy Metabolism , Humans , Nutritional Requirements , Respiration, Artificial , Respiratory Distress Syndrome , SARS-CoV-2
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