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1.
Medicine (Baltimore) ; 100(43): e27634, 2021 Oct 29.
Article in English | MEDLINE | ID: covidwho-1597449

ABSTRACT

ABSTRACT: Acute sstroke is the most common time-dependent disease attended in the emergency medical service (EMS) of Madrid (SUMMA 112). Community of Madrid has been one of the most affected regions in Spain by the coronavirus disease 2019 (COVID-19) pandemic. A significant reduction in acute sstroke hospital admissions has been reported during the COVID-19 pandemic compared to the same period 1 year before. As international clinical practice guidelines support those patients with suspected acute stroke should be accessed via EMS, it is important to know whether the pandemic has jeopardized urgent pre-hospital stroke care, the first medical contact for most patients. We aimed to examine the impact of the COVID-19 in stroke codes (SC) in our EMS among 3 periods of time: the COVID-19 period, the same period the year before, and the 2019-2020 seasonal influenza period.We compared the SC frequency among the periods with high cumulative infection rate (above the median of the series) of the first wave of COVID-19, seasonal influenza, and also with the same period of the year before.One thousand one hundred thirty SC were attended during the 3 periods. No significant reduction in SC was found during the COVID-19 pandemic. The reduction of hospital admissions might be attributable to patients attending the hospital by their means. The maximum SC workload seen during seasonal influenza has not been reached during the pandemic. We detected a nonsignificant deviation from the SC protocol, with a slight increase in hospitals' transfers to hospitals without stroke units.


Subject(s)
COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Stroke/epidemiology , Age Distribution , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Sex Distribution , Spain/epidemiology
2.
Int J Environ Res Public Health ; 19(1)2021 Dec 22.
Article in English | MEDLINE | ID: covidwho-1580854

ABSTRACT

Health care personnel constitutes the most vulnerable group of professionals, as they are employed in a work context with higher exposure to SARS-CoV-2 infection. This study aims to estimate the prevalence of SARS-CoV-2 infection in health personnel (n = 2858) of two health departments in the Valencian community between March 2020 and April 2021, as well as the sociodemographic and work variables predicting higher infection prevalence in this group. A cross-sectional descriptive study was performed on health workers from the health departments of Torrevieja and Elche-Crevillente of the Valencian Community (Spain). After obtaining the samples, the cases were identified through an active infection diagnostic test (AIDT). The analyzed variables were: sex, age (18-34/35-49/>50 years), professional category, health care, risk service, and AIDT. A total of 2858 staff members were studied. Of them, 55.4% (1582) underwent an AIDT, with 9.7% (277) of positive cases. Infection predominated in the age group of 18 to 34 years, 12.6% (OR = 1.98, 95% CI [1.26, 3.11]); nurses, 12.1% (OR = 1.5, 95% CI [1.00, 2.23]); and at-risk services, 11.4% (OR = 1.3, 95% CI [1.06, 1.81]). A very low positivity rate was identified in the health personnel linked to the health departments analyzed during the 14 months of the study period. Based on our results, prevention strategies could focus more intensively on the most at-risk groups, specifically young nurses who work in at-risk services, mainly in emergency and internal medicine.


Subject(s)
COVID-19 , Adolescent , Adult , Cross-Sectional Studies , Health Personnel , Humans , Middle Aged , Prevalence , SARS-CoV-2 , Spain/epidemiology , Young Adult
3.
Int J Environ Res Public Health ; 19(1)2021 Dec 23.
Article in English | MEDLINE | ID: covidwho-1580839

ABSTRACT

INTRODUCTION: Evidence on sexual behaviour and COVID-19 shows a change in sexual habits; however, there is no research on the association between mental health and sexual activity. AIM: To examine the relationship between mental health and sexual activity during the quarantine in Spanish adults. METHODS: A sample of 305 adults filled out an online questionnaire. Sexual activity was assessed with one question. Anxiety and depression symptoms were assessed using the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI), respectively. To check associations between levels of both anxiety and depressive symptoms (exposure) and weekly prevalence of sexual activity (outcome), we conducted multiple logistic regression adjusted for control variables (marital status, employment, average household annual income, place of living, pre-COVID-19 sexual activity, current smoking, current alcohol consumption, chronic physical conditions, chronic psychiatric conditions, physical symptoms, and days of confinement). RESULTS: Higher depression level was associated with lower weekly sexual activity in a dose-response fashion in the three implemented models. Participants with higher levels of depression were associated with significantly lower sexual activity in the fully adjusted model (OR: 0.09, 95% CI 0.01-0.61). Mild anxiety-level participants consistently presented significantly lower ORs for lower sexual activity than their minimal-anxiety category counterparts. Particularly, the fully adjusted model showed the lower values (OR: 0.40, 95% CI 0.19-0.84). CONCLUSION: The results of this study support existing evidence stressing the association between mental health and sexual activity in quarantined adults.


Subject(s)
COVID-19 , Quarantine , Adult , Anxiety/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Humans , SARS-CoV-2 , Sexual Behavior , Spain/epidemiology
4.
Biomed Environ Sci ; 34(11): 871-880, 2021 Nov 20.
Article in English | MEDLINE | ID: covidwho-1580280

ABSTRACT

Objective: Previous studies have shown that meteorological factors may increase COVID-19 mortality, likely due to the increased transmission of the virus. However, this could also be related to an increased infection fatality rate (IFR). We investigated the association between meteorological factors (temperature, humidity, solar irradiance, pressure, wind, precipitation, cloud coverage) and IFR across Spanish provinces ( n = 52) during the first wave of the pandemic (weeks 10-16 of 2020). Methods: We estimated IFR as excess deaths (the gap between observed and expected deaths, considering COVID-19-unrelated deaths prevented by lockdown measures) divided by the number of infections (SARS-CoV-2 seropositive individuals plus excess deaths) and conducted Spearman correlations between meteorological factors and IFR across the provinces. Results: We estimated 2,418,250 infections and 43,237 deaths. The IFR was 0.03% in < 50-year-old, 0.22% in 50-59-year-old, 0.9% in 60-69-year-old, 3.3% in 70-79-year-old, 12.6% in 80-89-year-old, and 26.5% in ≥ 90-year-old. We did not find statistically significant relationships between meteorological factors and adjusted IFR. However, we found strong relationships between low temperature and unadjusted IFR, likely due to Spain's colder provinces' aging population. Conclusion: The association between meteorological factors and adjusted COVID-19 IFR is unclear. Neglecting age differences or ignoring COVID-19-unrelated deaths may severely bias COVID-19 epidemiological analyses.


Subject(s)
COVID-19/epidemiology , Pandemics/statistics & numerical data , Weather , Adult , Aged , Aged, 80 and over , COVID-19/virology , Humans , Meteorological Concepts , Middle Aged , SARS-CoV-2/physiology , Spain/epidemiology , Young Adult
5.
Sci Rep ; 11(1): 24400, 2021 12 22.
Article in English | MEDLINE | ID: covidwho-1585787

ABSTRACT

Coping style represents the cognitive and behavioral patterns to manage particular demands appraised as taxing the resources of individuals. Studies report associations between certain coping styles and levels of adjustment of anxious symptomatology and emotional distress. The main objective of this study was to analyze behavioral co-occurrent patterns and relationships in the coping strategies used to deal with psychological distress displayed by the Spanish adult population during the first State of Emergency and lockdown of the COVID-19 pandemic. This is a cross-sectional study that uses selective methodology complemented with an indirect observational methodology, with a nomothetic/punctual/unidimensional design. We collected 996 surveys from 19 out of the 22 autonomous regions in Spain. We focused the analysis on sociodemographic variables, cumulative incidence of the COVID-19 disease and psychological distress variables. We performed two different inferential analyses: Lag sequential analysis to define the participant coping patterns, and polar coordinate analysis to study the interrelationship of the focal behavior with conditioned behaviors. We found behavioral co-occurrent patterns of coping strategies with problem avoidance being found as the coping strategy most frequently engaged by participants. Interestingly, the problem avoidance strategy was not associated with lower anxious symptomatology. By contrast, emotion-focused strategies such as express emotions and social support were associated with higher anxious symptomatology. Our findings underscore the importance of furthering our understanding of coping as a way to aid psychological distress during global public health emergencies.


Subject(s)
Adaptation, Psychological , COVID-19/epidemiology , Psychological Distress , Adolescent , Adult , Aged , COVID-19/virology , Emotions , Female , Humans , Male , Mental Health , Middle Aged , Pandemics , Quarantine , SARS-CoV-2/isolation & purification , Social Support , Spain/epidemiology , Surveys and Questionnaires , Young Adult
6.
BMJ Open ; 11(12): e051572, 2021 12 20.
Article in English | MEDLINE | ID: covidwho-1583102

ABSTRACT

OBJECTIVE: COVID-19 disease has affected more than a hundred countries worldwide and has exposed the population to an increase in mental health problems. The objective of this study was to assess the emotional impact of the pandemic from a gender perspective, as well as to study the modulating variables of that impact. DESIGN: A descriptive and cross-sectional study through the General Health Questionnaire scale and the Sense of Coherence (SOC) scale is developed. SETTING: General population of Spain was the target of this study PARTICIPANTS: The sample consisted of 3801 adult subjects living in Spain, without diagnosis for Sars-Cov-2 virus infection during confinement. INTERVENTION: Data collection was carried out using an online questionnaire, from 26 March 2020 to 26 April 2020. PRIMARY AND SECONDARY OUTCOMES MEASURES: A sample profile description was obtained, regarding to the study variables. Later, a regression model was implemented in order to test the relationship between these variables, and to achieve a predictive model of psychological discomfort controlling the gender variable. RESULTS: The results showed that women, as compared with men, had increased psychological discomfort during confinement (t=-12.877; p<0.001; d=0.470). In contrast, significantly higher scores were observed on the SOC scale (t=6.336; p<0.001; d=0.231) in men, as compared with those obtained by women. CONCLUSIONS: Women have higher levels of psychological discomfort, increased concern about getting infected with COVID-19 and infecting others, as well as a lower level of SOC and perceived health. In addition, low levels of SOC predict greater concern about contagion and increased psychological discomfort.


Subject(s)
COVID-19 , Adult , Cross-Sectional Studies , Female , Humans , Male , Pandemics , SARS-CoV-2 , Spain/epidemiology , Stress, Psychological/epidemiology , Surveys and Questionnaires
7.
Nutrients ; 13(2)2021 Jan 21.
Article in English | MEDLINE | ID: covidwho-1575293

ABSTRACT

BACKGROUND: Lockdown due to COVID-19 influenced food habits and lifestyles with potential negative health impact. This study aims to identify patterns of change in eating habits and physical activity during COVID-19 lockdown in Spain and to identify associations with sociodemographic factors and usual habits. METHODS: This cross-sectional study included 1155 adults recruited online to answer a 10-section questionnaire. The protocol assessed usual diet by means of a semi-quantitative food frequency questionnaire, usual physical activity (PA) and supplement use, dietary changes, sedentary time, PA, exposure to sunlight, sleep quality, and smoking during confinement. Patterns of dietary change were identified by factor analysis. Factor scores were included in cluster analysis together with change in PA. RESULTS: Six patterns of dietary change were identified that together with PA changes during lockdown defined three clusters of lifestyle change: a cluster less active, a more active cluster, and a third cluster as active as usual. People who were usually less active were more likely to be classified in the cluster that increased physical activity in confinement. Scores of the Healthy Mediterranean-Style dietary pattern were higher in this group. Conclusions: Different patterns of change in lifestyles in confinement suggest the need to tailor support and advice to different population groups.


Subject(s)
COVID-19/epidemiology , Exercise , Feeding Behavior , Quarantine/psychology , Adult , Aged , COVID-19/psychology , Female , Humans , Male , Middle Aged , Spain/epidemiology , Young Adult
8.
PLoS One ; 16(3): e0247251, 2021.
Article in English | MEDLINE | ID: covidwho-1574883

ABSTRACT

In the context of COVID-19 pandemic, we aimed to analyze the epidemiology, clinical characteristics, risk factors for mortality and impact of COVID-19 on outcomes of solid organ transplant (SOT) recipients compared to a cohort of non transplant patients, evaluating if transplantation could be considered a risk factor for mortality. From March to May 2020, 261 hospitalized patients with COVID-19 pneumonia were evaluated, including 41 SOT recipients. Of these, thirty-two were kidney recipients, 4 liver, 3 heart and 2 combined kidney-liver transplants. Median time from transplantation to COVID-19 diagnosis was 6 years. Thirteen SOT recipients (32%) required Intensive Care Unit (ICU) admission and 5 patients died (12%). Using a propensity score match analysis, we found no significant differences between SOT recipients and non-transplant patients. Older age (OR 1.142; 95% [CI 1.08-1.197]) higher levels of C-reactive protein (OR 3.068; 95% [CI 1.22-7.71]) and levels of serum creatinine on admission (OR 3.048 95% [CI 1.22-7.57]) were associated with higher mortality. The clinical outcomes of SARS-CoV-2 infection in our cohort of SOT recipients appear to be similar to that observed in the non-transplant population. Older age, higher levels of C-reactive protein and serum creatinine were associated with higher mortality, whereas SOT was not associated with worse outcomes.


Subject(s)
COVID-19/complications , Organ Transplantation/mortality , Adult , Aged , Aged, 80 and over , Allografts/physiology , Allografts/virology , COVID-19/epidemiology , COVID-19 Testing , Cohort Studies , Female , Hospitalization , Humans , Intensive Care Units , Male , Middle Aged , Organ Transplantation/adverse effects , Organ Transplantation/methods , Pandemics , Propensity Score , Risk Factors , SARS-CoV-2/pathogenicity , Spain/epidemiology , Transplant Recipients/statistics & numerical data , Treatment Outcome
9.
PLoS One ; 16(3): e0248029, 2021.
Article in English | MEDLINE | ID: covidwho-1574593

ABSTRACT

Many countries have seen a two-wave pattern in reported cases of coronavirus disease-19 during the 2020 pandemic, with a first wave during spring followed by the current second wave in late summer and autumn. Empirical data show that the characteristics of the effects of the virus do vary between the two periods. Differences in age range and severity of the disease have been reported, although the comparative characteristics of the two waves still remain largely unknown. Those characteristics are compared in this study using data from two equal periods of 3 and a half months. The first period, between 15th March and 30th June, corresponding to the entire first wave, and the second, between 1st July and 15th October, corresponding to part of the second wave, still present at the time of writing this article. Two hundred and four patients were hospitalized during the first period, and 264 during the second period. Patients in the second wave were younger and the duration of hospitalization and case fatality rate were lower than those in the first wave. In the second wave, there were more children, and pregnant and post-partum women. The most frequent signs and symptoms in both waves were fever, dyspnea, pneumonia, and cough, and the most relevant comorbidities were cardiovascular diseases, type 2 diabetes mellitus, and chronic neurological diseases. Patients from the second wave more frequently presented renal and gastrointestinal symptoms, were more often treated with non-invasive mechanical ventilation and corticoids, and less often with invasive mechanical ventilation, conventional oxygen therapy and anticoagulants. Several differences in mortality risk factors were also observed. These results might help to understand the characteristics of the second wave and the behaviour and danger of SARS-CoV-2 in the Mediterranean area and in Western Europe. Further studies are needed to confirm our findings.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Hospitalization/statistics & numerical data , Aged , Comorbidity , Female , Humans , Male , Middle Aged , Pandemics , Spain/epidemiology , Treatment Outcome
10.
Eur J Psychotraumatol ; 12(1): 2001192, 2021.
Article in English | MEDLINE | ID: covidwho-1559108

ABSTRACT

This systematic review aims to summarize the prevalence of anxiety, depression, and insomnia in the general adult population and healthcare workers (HCWs) in several key regions worldwide during the first year of the COVID pandemic. Several literature databases were systemically searched for meta-analyses published by 22 September 2021 on the prevalence rates of mental health symptoms worldwide. The prevalence rates of mental health symptoms were summarized based on 388 empirical studies with a total of 1,067,021 participants from six regions and four countries. Comparatively, Africa and South Asia had the worse overall mental health symptoms, followed by Latin America. The research effort on mental health during COVID-19 has been highly skewed in terms of the scope of countries and mental health outcomes. The mental health symptoms are highly prevalent yet differ across regions, and such evidence helps to enable prioritization of mental health assistance efforts to allocate attention and resources based on the regional differences in mental health.


El objetivo de esa revisión sistemática es el de resumir la prevalencia de la ansiedad, la depresión y el insomnio, tanto en la población general adulta como en los trabajadores de salud de diferentes regiones clave alrededor del mundo durante el primer año de la pandemia por la COVID-19. Se revisaron de manera sistemática diversas bases de datos científicas buscando metaanálisis sobre la prevalencia de síntomas en salud mental alrededor del mundo, publicados hasta el 22 de setiembre del 2021. Se resumió la prevalencia de los síntomas de salud mental sobre la base de 388 estudios empíricos, comprendiendo a 1.067.021 participantes de cuatro países y de seis regiones. África y Asia meridional tuvieron, de manera general, los peores síntomas de salud mental, seguidas por Latinoamérica. El esfuerzo por realizar investigación en salud mental durante la pandemia por la COVID-19 ha estado altamente sesgado en torno a la envergadura de los países y de las medidas de resultado empleadas en salud mental. Los síntomas de salud mental son altamente prevalentes; no obstante, difieren a lo largo de diferentes regiones. Esta evidencia ayuda a permitir la priorización de los esfuerzos de atención en salud mental asignando la atención y recursos basados sobre las diferencias regionales en salud mental.


Subject(s)
COVID-19/psychology , Global Health/statistics & numerical data , Mental Disorders/epidemiology , Pandemics , Adult , Africa/epidemiology , Asia/epidemiology , Asia, Southeastern/epidemiology , COVID-19/epidemiology , China/epidemiology , Europe, Eastern/epidemiology , Health Personnel/psychology , Humans , Latin America/epidemiology , Prevalence , Spain/epidemiology
11.
Lancet HIV ; 8(11): e701-e710, 2021 11.
Article in English | MEDLINE | ID: covidwho-1541051

ABSTRACT

BACKGROUND: Factors affecting outcomes of SARS-CoV-2 infection in people living with HIV are unclear. We assessed the factors associated with SARS-CoV-2 diagnosis and severe outcomes among people living with HIV. METHODS: We did a retrospective cohort study using data from the PISCIS cohort of people with HIV in Catalonia (Spain) between March 1 and Dec 15, 2020. We linked PISCIS data with integrated health-care, clinical, and surveillance registries through the Public Data Analysis for Health Research and Innovation Program of Catalonia (PADRIS) to obtain data on SARS-CoV-2 diagnosis, chronic comorbidities, as well as clinical and mortality outcomes. Participants were aged at least 16 years in care at 16 hospitals in Catalonia. Factors associated with SARS-CoV-2 diagnoses and severe outcomes were assessed using univariable and multivariable Cox regression models. We estimated the effect of immunosuppression on severe outcomes (hospital admission for >24 h with dyspnoea, tachypnoea, hypoxaemia, asphyxia, or hyperventilation; or death) using Kaplan-Meier survival analysis. FINDINGS: We linked 20 847 (72·8%) of 28 666 participants in the PISCIS cohort with PADRIS data; 13 142 people had HIV. 749 (5·7%) people with HIV were diagnosed with SARS-CoV-2: their median age was 43·5 years (IQR 37·0-52·7), 131 (17·5%) were female, and 618 (82·5%) were male. 103 people with HIV (13·8%) were hospitalised, seven (0·9%) admitted to intensive care, and 13 (1·7%) died. SARS-CoV-2 diagnosis was more common among migrants (adjusted hazard ratio 1·55, 95% CI 1·31-1·83), men who have sex with men (1·42, 1·09-1·86), and those with four or more chronic comorbidities (1·46, 1·09-1·97). Age at least 75 years (5·2, 1·8-15·3), non-Spanish origin (2·1, 1·3-3·4), and neuropsychiatric (1·69, 1·07-2·69), autoimmune disease (1·92, 1·14-3·23), respiratory disease (1·84, 1·09-3·09), and metabolic disease (2·59, 1·59-4·23) chronic comorbidities were associated with increased risk of severe outcomes. A Kaplan-Meier estimator showed differences in the risk of severe outcomes according to CD4 cell count in patients with detectable HIV RNA (p=0·039) but no differences were observed in patients with undetectable HIV RNA (p=0·15). INTERPRETATION: People living with HIV with detectable HIV viraemia, chronic comorbidities, and some subpopulations could be at increased risk of severe outcomes from COVID-19. These groups should be prioritised in clinical management and SARS-CoV-2 vaccination programmes. FUNDING: Fundació "la Caixa". TRANSLATIONS: For the Catalan, Spanish and Russian translations of the Summary see Supplementary Materials section.


Subject(s)
COVID-19/immunology , COVID-19/mortality , HIV Infections/complications , HIV Infections/immunology , Immunoglobulin G/blood , SARS-CoV-2/immunology , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/epidemiology , COVID-19 Testing , COVID-19 Vaccines , Cohort Studies , Female , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Immunologic Factors , Male , Middle Aged , Retrospective Studies , Severity of Illness Index , Socioeconomic Factors , Spain/epidemiology
12.
BMC Ophthalmol ; 21(1): 408, 2021 Nov 27.
Article in English | MEDLINE | ID: covidwho-1538064

ABSTRACT

PURPOSE: To evaluate ophthalmological emergencies (OE) during the COVID-19 pandemic comparing them with the same period of the previous year. METHODS: Retrospective observational study of all OE visits in four tertiary hospitals in Spain comparing data from March 16th to April 30th, 2020 (COVID-19 period) and the same period of 2019 (pre-COVID-19 period). Severity of the conditions was assessed following Channa et al. publication. Data on demographics, diagnosis and treatments were collected from Electronic Medical Records. RESULTS: During lockdown, OE significantly declined by 75.18%, from 7,730 registered in the pre-COVID-19 period to 1,928 attended during the COVID-19 period (p < 0.001). In 2019, 23.86% of visits were classified as emergent, 59.50% as non-emergent, and 16.65% could not be determined. In 2020, the percentage of emergent visits increased up to 29.77%, non-emergent visits significantly decreased to 52.92% (p < 0.001), and 17.31% of the visits were classified as "could not determine". During the pandemic, people aged between 45 and 65 years old represented the largest attending group (37.89%), compared to 2019, where patients over 65 years were the majority (39.80%). In 2019, most frequent diagnosis was unspecified acute conjunctivitis (11.59%), followed by vitreous degeneration (6.47%), and punctate keratitis (5.86%). During the COVID-19 period, vitreous degeneration was the first cause for consultation (9.28%), followed by unspecified acute conjunctivitis (5.63%) and punctate keratitis (5.85%). CONCLUSIONS: OE visits dropped significantly during the pandemic in Spain (75.18%), although more than half were classified as non-urgent conditions, indicating a lack of understanding of the really emergent ocular pathologies among population.


Subject(s)
COVID-19 , Pandemics , Aged , Communicable Disease Control , Emergencies , Humans , Middle Aged , Retrospective Studies , SARS-CoV-2 , Spain/epidemiology
13.
Environ Health Perspect ; 129(11): 117003, 2021 11.
Article in English | MEDLINE | ID: covidwho-1523382

ABSTRACT

BACKGROUND: Emerging evidence links ambient air pollution with coronavirus 2019 (COVID-19) disease, an association that is methodologically challenging to investigate. OBJECTIVES: We examined the association between long-term exposure to air pollution with SARS-CoV-2 infection measured through antibody response, level of antibody response among those infected, and COVID-19 disease. METHODS: We contacted 9,605 adult participants from a population-based cohort study in Catalonia between June and November 2020; most participants were between 40 and 65 years of age. We drew blood samples from 4,103 participants and measured immunoglobulin M (IgM), IgA, and IgG antibodies against five viral target antigens to establish infection to the virus and levels of antibody response among those infected. We defined COVID-19 disease using self-reported hospital admission, prior positive diagnostic test, or more than three self-reported COVID-19 symptoms after contact with a COVID-19 case. We estimated prepandemic (2018-2019) exposure to fine particulate matter [PM with an aerodynamic diameter of ≤2.5µm (PM2.5)], nitrogen dioxide (NO2), black carbon (BC), and ozone (O3) at the residential address using hybrid land-use regression models. We calculated log-binomial risk ratios (RRs), adjusting for individual- and area-level covariates. RESULTS: Among those tested for SARS-CoV-2 antibodies, 743 (18.1%) were seropositive. Air pollution levels were not statistically significantly associated with SARS-CoV-2 infection: Adjusted RRs per interquartile range were 1.07 (95% CI: 0.97, 1.18) for NO2, 1.04 (95% CI: 0.94, 1.14) for PM2.5, 1.00 (95% CI: 0.92, 1.09) for BC, and 0.97 (95% CI: 0.89, 1.06) for O3. Among infected participants, exposure to NO2 and PM2.5 were positively associated with IgG levels for all viral target antigens. Among all participants, 481 (5.0%) had COVID-19 disease. Air pollution levels were associated with COVID-19 disease: adjusted RRs=1.14 (95% CI: 1.00, 1.29) for NO2 and 1.17 (95% CI: 1.03, 1.32) for PM2.5. Exposure to O3 was associated with a slightly decreased risk (RR=0.92; 95% CI: 0.83, 1.03). Associations of air pollution with COVID-19 disease were more pronounced for severe COVID-19, with RRs=1.26 (95% CI: 0.89, 1.79) for NO2 and 1.51 (95% CI: 1.06, 2.16) for PM2.5. DISCUSSION: Exposure to air pollution was associated with a higher risk of COVID-19 disease and level of antibody response among infected but not with SARS-CoV-2 infection. https://doi.org/10.1289/EHP9726.


Subject(s)
Air Pollutants , Air Pollution , COVID-19 , Adult , Aged , Air Pollutants/adverse effects , Air Pollutants/analysis , Air Pollution/analysis , Antibody Formation , Cohort Studies , Environmental Exposure/analysis , Humans , Middle Aged , Nitrogen Dioxide/analysis , Particulate Matter/adverse effects , Particulate Matter/analysis , SARS-CoV-2 , Spain/epidemiology
14.
J Clin Microbiol ; 59(12): e0173621, 2021 11 18.
Article in English | MEDLINE | ID: covidwho-1522907

ABSTRACT

With the emergence of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and the acquisition of novel mutations in existing lineages, the need to implement methods capable of monitoring viral dynamics arises. We report the emergence and spread of a new SARS-CoV-2 variant within the B.1.575 lineage, containing the E484K mutation in the spike protein (named B.1.575.2), in a region in northern Spain in May and June 2021. SARS-CoV-2-positive samples with cycle threshold values of ≤30 were selected to screen for presumptive variants using the TaqPath coronavirus disease 2019 (COVID-19) reverse transcription (RT)-PCR kit and the TaqMan SARS-CoV-2 mutation panel. Confirmation of variants was performed by whole-genome sequencing. Of the 200 samples belonging to the B.1.575 lineage, 194 (97%) corresponded to the B.1.575.2 sublineage, which was related to the presence of the E484K mutation. Of 197 cases registered in the Global Initiative on Sharing Avian Influenza Data (GISAID) EpiCoV database as lineage B.1.575.2, 194 (99.5%) were identified in Pamplona, Spain. This report emphasizes the importance of complementing surveillance of SARS-CoV-2 with sequencing for the rapid control of emerging viral variants.


Subject(s)
COVID-19 , SARS-CoV-2 , Animals , Humans , Mutation , Spain/epidemiology , Spike Glycoprotein, Coronavirus/genetics
15.
An Pediatr (Engl Ed) ; 95(5): 345-353, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1517028

ABSTRACT

INTRODUCTION: Non-pharmaceutical interventions that have been implemented in southern hemisphere countries because of COVID-19 pandemic declaration in March 2020, have evidenced some unexpected changes in the way of spreading of many other viruses. This study as a part of ECEALHBA's Project, reports the consequences of COVID-19 pandemic over 2020-2021 bronchiolitis epidemic period in the Central and Eastern regions of Spain. METHOD: Multicenter, observational, descriptive and ambispective study of admitted infants with the diagnosis of bronchiolitis in 16 Spanish hospitals involved in the investigation project. Five epidemic periods previous to COVID-19 pandemic, from 2015 to 2020, were compared with the current one, 2020-2021, in both a qualitative and quantitative manner. RESULTS: Total of 4643 infants were admitted to the participating hospitals along the study period. Pandemic season hospital admissions for bronchiolitis were 94.1% lower than in pre-pandemic period. December and January were peak months for bronchiolitis admissions during pre-pandemic period, but September was the peak month during pandemic year. There was a progressive decrease of admissions from this moment until the end of the follow-up, in April 2021. Rhinovirus has been the commonest etiology for bronchiolitis in 2020-2021 epidemic period of bronchiolitis. CONCLUSIONS: Some of the non-pharmaceutical interventions initiated because of COVID-19 pandemic are probably related to the dramatic decrease of bronchiolitis cases in 2020-2021 season. It would be rewarding to purpose novel research to clarify how these simple interventions can be useful, close to vaccines and antiviral drugs, to achieve the goal of avoiding the spread of respiratory viruses in pediatric population.


Subject(s)
Bronchiolitis , COVID-19 , Bronchiolitis/epidemiology , Child , Hospitalization , Humans , Infant , Pandemics , SARS-CoV-2 , Spain/epidemiology
16.
Rev Neurol ; 73(10): 345-350, 2021 Nov 16.
Article in Spanish | MEDLINE | ID: covidwho-1513474

ABSTRACT

INTRODUCTION: The health pandemic brought about by SARS-CoV-2 (COVID-19) has limited access to neurorehabilitation programmes for many patients who have suffered stroke, traumatic brain injury or acquired brain damage due to some other cause. As telerehabilitation allows for the provision of care in situations of social distancing, it may mitigate the negative effects of confinement. The aim of this study was to determine the efficacy, adherence and usability of a teleneurorehabilitation intervention for patients with acquired brain injury. PATIENTS AND METHODS: All patients included in a face-to-face neurorehabilitation programme at the time of the declaration of the state of alarm in Spain due to COVID-19 and who agreed to participate in the study were included in a teleneurorehabilitation programme. The effectiveness of the programme, understood as an improvement in independence, was quantified with the Barthel index. Adherence to the programme and usability of the tool were explored through questionnaires. RESULTS: Altogether, 46 patients, accounting for 70.6% of the total, participated in the study. Participants significantly improved their independence and showed an improvement in the Barthel index between the start (77.3 ± 28.6) and the end of the programme (82.3 ± 26). Adherence to the intervention was very high (8.1 ± 2.2 out of 10) and the online sessions were the most highly rated content. The tool used showed a high usability (50.1 ± 9.9 out of 60) and could be used without assistance by more than half the participants. CONCLUSION: The teleneurorehabilitation intervention was found to be effective in improving patients' independence, and promoted a high degree of adherence and usability.


Efectividad, adhesión y usabilidad de un programa de teleneurorrehabilitación para garantizar la continuidad de cuidados en pacientes con daño cerebral adquirido durante la pandemia originada por la COVID-19.Introducción. La pandemia sanitaria originada por el SARS-CoV-2 (COVID-19) ha limitado el acceso a programas de neurorrehabilitación de muchos pacientes que han sufrido ictus, traumatismos craneoencefálicos o un daño cerebral adquirido por otra causa. Dado que la telerrehabilitación permite la provisión de cuidados en situaciones de distanciamiento social, podría atenuar los efectos negativos del confinamiento. El objetivo de este estudio fue determinar la eficacia, la adhesión y la usabilidad de una intervención de teleneurorrehabilitación dirigida a pacientes con daño cerebral adquirido. Pacientes y métodos. Todos los pacientes incluidos en un programa de neurorrehabilitación presencial en el momento de la declaración del estado de alarma en España con motivo de la COVID-19 y que aceptaron participar en el estudio fueron incluidos en un programa de teleneurorrehabilitación. La eficacia del programa, entendida como una mejora en la independencia, se cuantificó con el índice de Barthel. La adhesión al programa y la usabilidad de la herramienta se investigaron mediante cuestionarios. Resultados. Un total de 146 pacientes, el 70,6% del total, participó en el estudio. Los participantes mejoraron significativamente su independencia y mostraron una mejoría en el índice de Barthel entre el inicio (77,3 ± 28,6) y el fin del programa (82,3 ± 26). La intervención tuvo una gran adhesión (8,1 ± 2,2 sobre 10) y las sesiones en línea fueron el contenido mejor valorado. La herramienta utilizada mostró una elevada usabilidad (50,1 ± 9,9 sobre 60) y pudo ser utilizada sin ayuda por más de la mitad de los participantes. Conclusión. La intervención de teleneurorrehabilitación resultó ser eficaz para mejorar la independencia de los pacientes, y promovió una elevada adhesión y usabilidad.


Subject(s)
Brain Injuries/complications , Brain Injuries/rehabilitation , COVID-19/complications , Continuity of Patient Care/organization & administration , Telerehabilitation/organization & administration , Adult , Aged , Female , Humans , Male , Middle Aged , Pandemics , Patient Compliance , Patient Satisfaction , Physical Distancing , Program Evaluation , Spain/epidemiology , Surveys and Questionnaires/standards , Virtual Reality
17.
PLoS One ; 16(11): e0259822, 2021.
Article in English | MEDLINE | ID: covidwho-1511833

ABSTRACT

BACKGROUND: Clinical outcomes among COVID-19 patients vary greatly with age and underlying comorbidities. We aimed to determine the demographic and clinical factors, particularly baseline chronic conditions, associated with an increased risk of severity in COVID-19 patients from a population-based perspective and using data from electronic health records (EHR). METHODS: Retrospective, observational study in an open cohort analyzing all 68,913 individuals (mean age 44.4 years, 53.2% women) with SARS-CoV-2 infection between 15 June and 19 December 2020 using exhaustive electronic health registries. Patients were followed for 30 days from inclusion or until the date of death within that period. We performed multivariate logistic regression to analyze the association between each chronic disease and severe infection, based on hospitalization and all-cause mortality. RESULTS: 5885 (8.5%) individuals showed severe infection and old age was the most influencing factor. Congestive heart failure (odds ratio -OR- men: 1.28, OR women: 1.39), diabetes (1.37, 1.24), chronic renal failure (1.31, 1.22) and obesity (1.21, 1.26) increased the likelihood of severe infection in both sexes. Chronic skin ulcers (1.32), acute cerebrovascular disease (1.34), chronic obstructive pulmonary disease (1.21), urinary incontinence (1.17) and neoplasms (1.26) in men, and infertility (1.87), obstructive sleep apnea (1.43), hepatic steatosis (1.43), rheumatoid arthritis (1.39) and menstrual disorders (1.18) in women were also associated with more severe outcomes. CONCLUSIONS: Age and specific cardiovascular and metabolic diseases increased the risk of severe SARS-CoV-2 infections in men and women, whereas the effects of certain comorbidities are sex specific. Future studies in different settings are encouraged to analyze which profiles of chronic patients are at higher risk of poor prognosis and should therefore be the targets of prevention and shielding strategies.


Subject(s)
COVID-19/epidemiology , Chronic Disease/mortality , Pulmonary Disease, Chronic Obstructive/epidemiology , SARS-CoV-2/pathogenicity , Adult , Aged , COVID-19/complications , COVID-19/pathology , COVID-19/virology , Cohort Studies , Comorbidity , Female , Hospitalization/statistics & numerical data , Humans , Logistic Models , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/pathology , Risk Factors , Spain/epidemiology
18.
Lancet Infect Dis ; 21(5): 629-636, 2021 05.
Article in English | MEDLINE | ID: covidwho-1510471

ABSTRACT

BACKGROUND: Scarce data are available on what variables affect the risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the development of symptomatic COVID-19, and, particularly, the relationship with viral load. We aimed to analyse data from linked index cases of COVID-19 and their contacts to explore factors associated with transmission of SARS-CoV-2. METHODS: In this cohort study, patients were recruited as part of a randomised controlled trial done between March 17 and April 28, 2020, that aimed to assess if hydroxychloroquine reduced transmission of SARS-CoV-2. Patients with COVID-19 and their contacts were identified by use of the electronic registry of the Epidemiological Surveillance Emergency Service of Catalonia (Spain). Patients with COVID-19 included in our analysis were aged 18 years or older, not hospitalised, had quantitative PCR results available at baseline, had mild symptom onset within 5 days before enrolment, and had no reported symptoms of SARS-CoV-2 infections in their accommodation or workplace within the 14 days before enrolment. Contacts included were adults with a recent history of exposure and absence of COVID-19-like symptoms within the 7 days preceding enrolment. Viral load of contacts, measured by quantitative PCR from a nasopharyngeal swab, was assessed at enrolment, at day 14, and whenever the participant reported COVID-19-like symptoms. We assessed risk of transmission and developing symptomatic disease and incubation dynamics using regression analysis. We assessed the relationship of viral load and characteristics of cases (age, sex, number of days from reported symptom onset, and presence or absence of fever, cough, dyspnoea, rhinitis, and anosmia) and associations between risk of transmission and characteristics of the index case and contacts. FINDINGS: We identified 314 patients with COVID-19, with 282 (90%) having at least one contact (753 contacts in total), resulting in 282 clusters. 90 (32%) of 282 clusters had at least one transmission event. The secondary attack rate was 17% (125 of 753 contacts), with a variation from 12% when the index case had a viral load lower than 1 × 106 copies per mL to 24% when the index case had a viral load of 1 × 1010 copies per mL or higher (adjusted odds ratio per log10 increase in viral load 1·3, 95% CI 1·1-1·5). Increased risk of transmission was also associated with household contact (3·0, 1·59-5·65) and age of the contact (per year: 1·02, 1·01-1·04). 449 contacts had a positive PCR result at baseline. 28 (6%) of 449 contacts had symptoms at the first visit. Of 421 contacts who were asymptomatic at the first visit, 181 (43%) developed symptomatic COVID-19, with a variation from approximately 38% in contacts with an initial viral load lower than 1 × 107 copies per mL to greater than 66% for those with an initial viral load of 1 × 1010 copies per mL or higher (hazard ratio per log10 increase in viral load 1·12, 95% CI 1·05-1·20; p=0·0006). Time to onset of symptomatic disease decreased from a median of 7 days (IQR 5-10) for individuals with an initial viral load lower than 1 × 107 copies per mL to 6 days (4-8) for those with an initial viral load between 1 × 107 and 1 × 109 copies per mL, and 5 days (3-8) for those with an initial viral load higher than 1 × 109 copies per mL. INTERPRETATION: In our study, the viral load of index cases was a leading driver of SARS-CoV-2 transmission. The risk of symptomatic COVID-19 was strongly associated with the viral load of contacts at baseline and shortened the incubation time of COVID-19 in a dose-dependent manner. FUNDING: YoMeCorono, Generalitat de Catalunya. TRANSLATIONS: For the Catalan translation of the abstract see Supplementary Materials section.


Subject(s)
COVID-19/transmission , SARS-CoV-2 , Adult , COVID-19/epidemiology , Cohort Studies , Female , Humans , Incidence , Male , Middle Aged , Spain/epidemiology , Viral Load
19.
Reumatol Clin (Engl Ed) ; 17(9): 491-493, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1510266

ABSTRACT

SARS-COV-2 infection has spread worldwide since it originated in December 2019, in Wuhan, China. The pandemic has largely demonstrated the resilience of the world's health systems and is the greatest health emergency since World War II. There is no single therapeutic approach to the treatment of COVID-19 and the associated immune disorder. The lack of randomised clinical trials (RCTs) has led different countries to tackle the disease based on case series, or from results of observational studies with off-label drugs. We as rheumatologists in general, and specifically rheumatology fellows, have been on the front line of the pandemic, modifying our activities and altering our training itinerary. We have attended patients, we have learned about the management of the disease and from our previous experience with drugs for arthritis and giant cell arteritis, we have used these drugs to treat COVID-19.


Subject(s)
Antiviral Agents/therapeutic use , Biological Factors/therapeutic use , COVID-19/drug therapy , Immunosuppressive Agents/therapeutic use , Physician's Role , Rheumatologists , Autoimmune Diseases/complications , Autoimmune Diseases/drug therapy , Autoimmune Diseases/immunology , COVID-19/complications , COVID-19/epidemiology , COVID-19/immunology , Drug Therapy, Combination , Education, Medical, Graduate , Fellowships and Scholarships , Global Health , Humans , Immunocompromised Host , Opportunistic Infections/complications , Opportunistic Infections/drug therapy , Opportunistic Infections/immunology , Patient Care Team/organization & administration , Practice Patterns, Physicians' , Rheumatic Diseases/complications , Rheumatic Diseases/drug therapy , Rheumatic Diseases/immunology , Rheumatologists/education , Rheumatologists/organization & administration , Rheumatology/education , Rheumatology/methods , Rheumatology/organization & administration , Spain/epidemiology
20.
Crit Care ; 25(1): 381, 2021 11 08.
Article in English | MEDLINE | ID: covidwho-1506432

ABSTRACT

BACKGROUND: COVID-19 is primarily a respiratory disease; however, there is also evidence that it causes endothelial damage in the microvasculature of several organs. The aim of the present study is to characterize in vivo the microvascular reactivity in peripheral skeletal muscle of severe COVID-19 patients. METHODS: This is a prospective observational study carried out in Spain, Mexico and Brazil. Healthy subjects and severe COVID-19 patients admitted to the intermediate respiratory (IRCU) and intensive care units (ICU) due to hypoxemia were studied. Local tissue/blood oxygen saturation (StO2) and local hemoglobin concentration (THC) were non-invasively measured on the forearm by near-infrared spectroscopy (NIRS). A vascular occlusion test (VOT), a three-minute induced ischemia, was performed in order to obtain dynamic StO2 parameters: deoxygenation rate (DeO2), reoxygenation rate (ReO2), and hyperemic response (HAUC). In COVID-19 patients, the severity of ARDS was evaluated by the ratio between peripheral arterial oxygen saturation (SpO2) and the fraction of inspired oxygen (FiO2) (SF ratio). RESULTS: Healthy controls (32) and COVID-19 patients (73) were studied. Baseline StO2 and THC did not differ between the two groups. Dynamic VOT-derived parameters were significantly impaired in COVID-19 patients showing lower metabolic rate (DeO2) and diminished endothelial reactivity. At enrollment, most COVID-19 patients were receiving invasive mechanical ventilation (MV) (53%) or high-flow nasal cannula support (32%). Patients on MV were also receiving sedative agents (100%) and vasopressors (29%). Baseline StO2 and DeO2 negatively correlated with SF ratio, while ReO2 showed a positive correlation with SF ratio. There were significant differences in baseline StO2 and ReO2 among the different ARDS groups according to SF ratio, but not among different respiratory support therapies. CONCLUSION: Patients with severe COVID-19 show systemic microcirculatory alterations suggestive of endothelial dysfunction, and these alterations are associated with the severity of ARDS. Further evaluation is needed to determine whether these observations have prognostic implications. These results represent interim findings of the ongoing HEMOCOVID-19 trial. Trial registration ClinicalTrials.gov NCT04689477 . Retrospectively registered 30 December 2020.


Subject(s)
COVID-19/physiopathology , Intensive Care Units/trends , Microvessels/physiopathology , Respiratory Care Units/trends , Respiratory Distress Syndrome/physiopathology , Severity of Illness Index , Adult , Aged , Brazil/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology , Female , Humans , Male , Mexico/epidemiology , Microcirculation/physiology , Middle Aged , Muscle, Skeletal/blood supply , Muscle, Skeletal/physiopathology , Prospective Studies , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/epidemiology , Spain/epidemiology
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