The effects of parents' vaccine hesitancy and COVID-19 vaccine literacy on attitudes toward vaccinating their children during the pandemic

Purpose The study was conducted to examine the effects of parents' vaccine hesitancy and COVID-19 vaccine literacy on their attitudes toward vaccinating their children during the COVID-19 pandemic. Design and methods The study was descriptive, cross-sectional, and comparative. The data were collected from 199 parents with children aged 0–18 using a Google Form on social media. In the study, the Parent Introductory Information Form, the Vaccine Hesitancy Scale in Pandemics, and the COVID-19 Vaccine Literacy Scale were used. In the analysis of the data, numbers, percentages, and means were calculated, and the significance test of the difference between the two means and the logistic regression analysis were used. Results Parents' vaccination hesitancy scale sub-dimensions and COVID-19 vaccine literacy scale sub-dimensions together explain 25.4% of their attitudes toward having their children vaccinated against COVID-19. When the variables were examined individually, it was determined that the sub-dimensions of the Vaccine Hesitancy Scale in Pandemics alone significantly affected their attitudes during the pandemic period (p < 0.001). Conclusions Parents are hesitant about getting their children vaccinated against COVID-19. Improving vaccine literacy can increase vaccination rates in special groups to overcome vaccine hesitancy.

Criteria for Hyperinflammation Developing in COVID-19: Analysis of 2 Cohorts From Different Periods of the Pandemic.

OBJECTIVE: Hyperinflammation (HI) that develops in week 2 of COVID-19 contributes to a worse outcome. Because week 2 laboratory findings can be relatively mild, the available criteria for classification of hemophagocytic lymphohistiocytosis or macrophage activation syndrome are not helpful. METHODS: Our study included a discovery cohort of patients from Turkey with symptomatic COVID-19 who were followed up while hospitalized during the initial wave and a replication cohort of hospitalized patients from a later period, all of whom required oxygen support and received glucocorticoids. Diagnosis of HI was made by an expert panel; most patients with COVID-19-associated HI (HIC) received tocilizumab or anakinra. Clinical and laboratory data from start day of treatment with tocilizumab or anakinra in HIC patients were compared with the data from day 5-6 in patients without HIC. Values maximizing the sensitivity and specificity of each parameter were calculated to determine criteria items. RESULTS: The discovery cohort included 685 patients, and the replication cohort included 156 patients, with 150 and 61 patients receiving treatment for HI, respectively. Mortality rate in HI patients in the discovery cohort (23.3%) was higher than the rate in patients without HI (3.7%) and the rate in patients in the overall replication cohort (10.3%). The 12-item criteria that we developed for HIC showed that a score of 35 provided 85.3% sensitivity and 81.7% specificity for identification of HIC. In the replication cohort, the same criteria resulted in 90.0% sensitivity for HIC; however, lower specificity values were observed because of the inclusion of milder cases of HIC responding only to glucocorticoids. CONCLUSION: The use of the 12-item criteria for HIC can better define patients with HIC with reasonable sensitivity and specificity and enables an earlier treatment start.

A case of systemic lupus erythematosus presenting with intestinal lymphangiectasia-associated protein-losing enteropathy accompanying hyperinflammation.

Systemic lupus erythematosus (SLE) has the potential to affect virtually every organ; however, gastrointestinal system manifestations are relatively rare compared to other autoimmune diseases such as systemic sclerosis and inflammatory bowel disease. A 29-year-old female patient attended to the emergency room with abdominal distention, acute onset abdominal pain and constipation. She had watery chronic diarrhea (4-5 times/d) and weight loss (6 kg, 12%) for 4 months. While there was increased intestinal wall thickness, air-liquid levels were shown on abdomen computed tomography scan. The patient underwent abdominal surgery due to diagnosis of ileus. Ileocecal resection was performed and pathologic evaluation revealed intestinal lymphangiectasia. Autoimmune serology was performed with the following resulats: anti-nuclear antibody 1/3200 with homogenous pattern, anti-DNA antibody and anti-Sm/ribonucleoprotein antibodies were positive in addition to low complement levels (C3: 0.28 [0.9-1.8 g/L], C4: 0.06 [0.1-0.4 g/L]) indicating diagnosis of SLE. Development of intestinal involvement in SLE (lupus enteritis) is mainly grouped into 3 headings such as mesenteric vasculitis, pseudo-obstruction, and protein-losing enteropathy. Although the pathogenesis of intestinal lymphangiectasia remains unknown, it has been reported that immune complex-mediated visceral vasculitis may result in bowel wall and mucosal edema. To our knowledge this is the first case report accompanying hyperinflammatory response in addition to intestinal lymphangiectasia in SLE. On the other hand, clinicians should be alert for other reasons for hyperinflammatory syndromes rather than COVID-19, even during the pandemic.

Effects of digital game addiction on cardiovascular health behavior on secondary school students during the COVID-19 pandemic.

PURPOSE: This study aimed to investigate factors affecting digital game addiction in secondary school students during the COVID-19 pandemic and the effects of digital game addiction on cardiovascular health behavior. DESIGN AND METHODS: This descriptive, correlational, and cross-sectional study was conducted with 619 secondary school students aged 10-14 years. Study data were analyzed using World Health Organization AnthroPlus and SPSS programs. Simple linear regression and multiple linear regression methods were used in the analysis process. RESULTS: Findings showed that 43.6% of the students played digital games for more than two hours a day. Descriptive characteristics (gender, age, basal metabolic rate, educational status of parent, income status, etc.) and digital gaming habits of the students accounted for 37.0% of the variance in digital game addiction. Digital game addiction adversely affected cardiovascular health behavior and all its sub-dimensions. CONCLUSION: The first factor that predicted digital game addiction, in order of significance, was daily digital game playing time. Digital game addiction negatively affected the sedentary lifestyle sub-dimension of cardiovascular health behavior most. Digital game addiction may trigger an increase in the incidence of diseases such as diabetes, cancer, and especially cardiovascular diseases, at later ages. PRACTICE IMPLICATIONS: Nurses, schools, and parents have critical responsibilities in preventing digital game addiction. Results of this research will make a remarkable contribution to the development of preventive services by revealing risk factors for digital game addiction and the effects of digital game addiction on cardiovascular health behavior.

High-dose intravenous anakinra treatment is safe and effective in severe and critical COVID-19 patients: a propensity score-matched study in a single center.

BACKGROUND: In COVID-19, severe disease course such as need of intensive care unit (ICU) as well as development of mortality is mainly due to cytokine storm. In this study, we aimed to evaluate the high-dose intravenous anakinra treatment response and outcome in patients with severe and critically ill COVID-19 compared to standard of care. METHODS: This retrospective observational study was carried out at a tertiary referral center. The study population consisted of two groups as follows: the patients receiving high-dose intravenous anakinra (anakinra group) between 01.09.2021 and 01.02.2022 and the patients treated with standard of care (SoC, control group) as historical control group who were hospitalized between 01.07.2021 and 01.09.2021. RESULTS: After the propensity score 1:1 matching, 79 patients in anakinra and 79 patients in SoC matched and were included into the analysis. Mean ± SD patient age was 67.4 ± 16.7 and 67.1 ± 16.3 years in anakinra and SoC groups, respectively (p = 0.9). Male gender was 38 (48.7%) in anakinra and 36 (46.2%) in SoC (p = 0.8). Overall, ICU admission was in 14.1% (n = 11) and 30.8% (n = 24) (p = 0.013; OR 6.2), intubation in 12.8% (n = 10) and 16.7% (n = 13) patients (p = 0.5), and 14.1% (n = 11) and 32.1% (n = 25) patients died in anakinra and control groups, respectively (p = 0.008; OR 7.1). CONCLUSION: In our study, mortality was lower in patients receiving anakinra compared to SoC. Intravenous high-dose anakinra is safe and effective treatment in patients with severe and critical COVID-19.

Impact of the coronavirus disease 2019 pandemic on obesity, internet addiction, and sleep quality in adolescents.

PURPOSE: This descriptive cross-sectional study aimed to examine the effects of the coronavirus disease-19 (COVID-19) pandemic on obesity, Internet addiction, and sleep quality in adolescents. METHODS: In this study, data were collected from 395 healthy adolescents using a sociodemographic form, an Internet addiction scale, and a sleep quality scale. Descriptive statistics were analyzed as numbers, percentages, and mean values. The Wilcoxon test was performed to compare the mean body mass index (BMI), Internet addiction, and sleep quality scores of the participants before and after the COVID-19 pandemic. The differences were significant at a p value of <0.05. RESULTS: The mean age of the participants was 15.04 ± 1.81 years, and 53% of them were female. The difference between the mean BMI scores of adolescents before and after the COVID-19 pandemic was significant (p < 0.01). The difference between the mean Internet addiction scale scores of the participants before and after the COVID-19 pandemic was significant (p < 0.01). The difference between the mean sleep quality scale scores before and after the COVID-19 pandemic was also significant (p < 0.01). Approximately 27.1% and 34.9% of the participants were obese before and after COVID-19, respectively. CONCLUSION: The obesity rate, BMI, and Internet addiction levels of children increased, whereas their sleep quality decreased after the COVID-19 pandemic. PRACTICAL IMPLICATIONS: During the pandemic period, online trainings for parents should be organized on planning physical activities during closure periods, regulating the adolescents' sleep and eating habits.

Antineutrophil Cytoplasmic Antibody-Associated Vasculitis and COVID-19: The Clinical Course and Prognosis of 15 Patients From a Tertiary Care Center.

OBJECTIVE: The aim of this study was to evaluate incidence rates, prognoses, and disease-related factors associated with poor outcomes in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) who had coronavirus disease (COVID-19). METHODS: Patients with AAV were questioned for a history of COVID-19 in the outpatient setting. Cumulative clinical findings and treatment history were obtained from the patients' medical records. The clinical, laboratory, and imaging findings of inpatients with COVID-19 were recorded. The data of patients who developed symptomatic COVID-19 and/or died of the disease were used for comparison. RESULTS: Eighty-nine patients (47.2% female; mean age, 56 ± 12.5 years) were included. The diagnosis was granulomatosis with polyangiitis in 56 patients (62.9%) and microscopic polyangiitis in 33 (37.1%). Sixty-one (68.2%) and 21 patients (23.6%) had renal and peripheral nerve involvement, respectively. Ten patients had a history of diffuse alveolar hemorrhage. Fifteen patients (16.9%) had COVID-19, including 9 (60%) with severe pneumonia. Twelve patients (85.7%) were hospitalized, 6 (42.9%) were admitted to the intensive care unit, and 5 (35.7%) died. All deceased patients had hypogammaglobulinemia (IgG levels <700 mg/dL) during hospital admission. Symptomatic COVID-19 was associated with higher disease activity, glucocorticoid and rituximab treatments, and glomerular filtration rate <30 mL/min. A history of peripheral nerve involvement, higher organ damage scores, and hypogammaglobulinemia was associated with mortality. CONCLUSIONS: The prognosis was poor in our patients with AAV who had COVID-19, especially those with severe multisystem involvement. Hypogammaglobulinemia was associated with mortality. Serum IgG level monitoring in patients with AAV would be beneficial during the COVID-19 pandemic.

Frequency and severity of COVID-19 in patients with various rheumatic diseases treated regularly with colchicine or hydroxychloroquine.

This study aimed to investigate whether patients regularly using colchicine or hydroxychloroquine (HCQ) have an advantage of protection from coronavirus disease 2019 (COVID-19) or developing less severe disease. Patients who were taking colchicine or HCQ regularly for a rheumatic disease including Familial Mediterranean Fever, Behçet's syndrome, Systemic Lupus Erythematosus, Rheumatoid Arthritis, and Sjogren's syndrome, as well as their healthy household contacts as the control group, were included in the study. The clinical data regarding COVID-19 were collected using a standard form, and serum samples were analyzed for anti-severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) nucleocapsid immunoglobulin G (IgG). A total of 635 regular colchicine users with their 643 household contacts and 317 regular HCQ users with their 333 household contacts were analyzed. Anti-SARS-COV-2 IgG was positive in 43 (6.8%) regular colchicine users and 35 (5.4%) household contacts (odds ratio [OR] = 1.3; 95% confidence interval [CI]:0.8-2; p = 0.3). COVID-19-related symptoms were described by 29 (67.4%) of the patients and 17 (48.6%) household contacts (OR = 2.2; 95% CI :0.9-5.5; p = 0.09), and hospital admission was observed in five (11.6%) and one (2.9%) of these subjects (OR = 4.5; 95% CI: 0.5-40.2; p = 0.1), respectively. Seropositive subjects were observed in 22 (6.9%) regular HCQ users and 24 (7.2%) household contacts (OR = 1.1; 95% CI: 0.6-1.9; p = 0.8). COVID-19-related symptoms occurred in 16 (72.7%) of the 22 patients and 12 (50%) of 24 household contacts (OR = 2.7; 95% CI: 0.8-9.1; p = 0.1). Three patients (13.6%) were admitted to hospital, while one household contact (4.2%) was hospitalized (OR = 3.6; 95% CI: 0.3-37.8; p = 0.2). Being on a regular treatment of colchicine or HCQ did not result in the prevention of COVID-19 or amelioration of its manifestations.

Protracted or recurrent COVID-19 associated cytokine storm in a patient with chronic lymphocytic leukemia receiving rituximab-based chemotherapy.

A 52-year-old male patient who was diagnosed with chronic lymphocytic leukemia two years ago; admitted to our hospital with complaints of fever (>38C), shortness of breath, and fatigue. He was receiving fludarabine, cyclophosphamide, and rituximab (FCR) regimen for one year after two courses of cyclophosphamide, vincristine, and prednisolone (CVP) regimen. The patient was diagnosed with COVID-19 associated cytokine storm and tocilizumab 800 mg was administered in addition to corticosteroids. Significant improvement was observed in both clinical and laboratory parameters and his hypoxemia resolved. The patient whose complaints recurred on the 13 th day of discharge was admitted to the hospital again with severe hypoxemia (oxygen saturation < 90) and fever (>38C). Pulse steroid (250 mg methylprednisolone for three days, followed by 40 mg/day) and anakinra 400 mg/day intravenously were started. Despite the treatment, the patient progressed to respiratory failure and died on the sixth day of second hospitalization.

Undergraduate nursing students' experiences of distance education during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has led to significant changes in the field of education, including not least of all the adoption of distance education, which nursing students have had limited experience with in Turkey. PURPOSE: This study aimed to determine the factors affecting nursing students' success in distance education and to evaluate their experiences during this process. METHODS: The study was designed as a descriptive, cross-sectional study and involved the participation of 454 nursing who were members of the Student Nurses Association in Turkey. An evaluation form for assessing students' sociodemographic and distance education-related characteristics and the Distance Education Assessment Questionnaire for Nursing Students (DEAQNS) were used for data collection. RESULTS: The students further reported that the main factors affecting the success of distance education were provision of preliminary information, proficiency level of technological software use, economic status, proficiency level of use of technological devices, and asynchronous learning. CONCLUSIONS: In order to increase the success of distance education, students need information on the protection of personal data and use of technological software and devices in the nursing curriculum.

A single center survey study of systemic vasculitis and COVID-19 during the first months of pandemic

Introduction: COVID-19 pandemic created concerns among patients receiving immunosuppressive therapy. Frequency of COVID-19 and impact of lockdown on treatment compliance in patients with vasculitis are largely unknown. Patients and method: Patients with ANCA-associated and large vessel vasculitis that have been followed-up in our clinic were contacted by phone and a questionnaire containing home isolation status, treatment adherence and history of COVID -19 between March 1st and June 30th, 2020 was applied. Results: The survey was applied to 103 patients (F/M: 59/44, mean age: 53.2±12.5). Thirty-three (32%) patients didn?t attend at least one appointment; 98(95.1%) noted that they spent 3 months in home isolation. Five patients (4.8%) received immunosuppressives irregularly and 3(2.9%) developed symptoms due to undertreatment. Four (3.9%) patients admitted to hospital with a suspicion of COVID-19, but none of them had positive PCR or suggestive findings by imaging. COVID-19 diagnosed in a patient with granulomatosis with polyangiitis during hospitalization for disease flare and she died despite treatment. Discussion: Frequency of COVID-19 was low in patients with vasculitis in our single center cohort. Although outpatient appointments were postponed in one-third of our patients, high compliance with treatment and isolation rules ensured patients with vasculitis overcome this period with minimal morbidity and mortality.

Development of the parental attitude scale-protecting children during COVID-19 and the relationship between parental attitudes and fear of COVID-19.

BACKGROUND: During the COVID-19 pandemic, parents and children have experienced stress and fear, and the attitudes of parents toward COVID-19 need to be explored. PURPOSE: This study aimed to develop the Parental Attitude Scale-Protecting Children during COVID-19 (PAS-CV19S) and assess its psychometric properties. This study also aimed to determine the relationship between parental attitudes about COVID-19 and fear of COVID-19. DESIGN AND METHODS: In this methodological and correlational study, parents of children ages 6 to 18 years old were included (N = 402). The PAS-CV19S was developed for this study. The study collected data using an online sociodemographic form, a fear of COVID-19 scale, and the PAS-CV19S. The Cronbach alpha coefficient, confirmatory factor analysis, and explanatory factor analysis were used to assess the validity and reliability of PAS-CV19S. Pearson correlation analysis was used to examine the relationship between the fear of COVID-19 scale and the PAS-CV19S. RESULTS: The PAS-CV19S is a valid and reliable scale consisting of three factors (general health, mental health, and preventive behaviors) as subdimensions. The Cronbach alpha of the PAS-CV19S overall was 0.90; the Cronbach alphas for the general health, mental health, and preventive behaviors subdimensions were 0.78, 0.80, and 0.92, respectively. There was a significant negative correlation between fear of COVID-19 and the mental health subdimension. CONCLUSION AND PRACTICE IMPLICATIONS: This study sheds light on parental attitudes about protecting their children from COVID-19. The fear of COVID-19 of parents did not affect attitudes other than mental health. Parental concerns and attitudes about COVID-19 need to be discussed to protect children.

Tocilizumab treatment in severe COVID-19: a multicenter retrospective study with matched controls.

Coronavirus disease-2019 (COVID-19) associated pneumonia may progress into acute respiratory distress syndrome (ARDS). Some patients develop features of macrophage activation syndrome (MAS). Elevated levels of IL-6 were reported to be associated with severe disease, and anti-IL-6R tocilizumab has been shown to be effective in some patients. This retrospective multicenter case-control study aimed to evaluate the efficacy of tocilizumab in hospitalized COVID-19 patients, who received standard of care with or without tocilizumab. Primary outcome was the progression to intubation or death. PSMATCH (SAS) procedure was used to achieve exact propensity score (PS) matching. Data from 1289 patients were collected, and study population was reduced to 1073 based on inclusion-exclusion criteria. The composite outcome was observed more frequently in tocilizumab-users, but there was a significant imbalance between arms in all critical parameters. Primary analyses were carried out in 348 patients (174 in each arm) after exact PS matching according to gender, ferritin, and procalcitonin. Logistic regression models revealed that tocilizumab significantly reduced the intubation or death (OR 0.40, p = 0.0017). When intubation is considered alone, tocilizumab-users had > 60% reduction in odds of intubation. Multiple imputation approach, which increased the size of the matched patients up to 506, provided no significant difference between arms despite a similar trend for intubation alone group. Analysis of this retrospective cohort showed more frequent intubation or death in tocilizumab-users, but PS-matched analyses revealed significant results for supporting tocilizumab use overall in a subset of patients matched according to gender, ferritin and procalcitonin levels.