Developing and delivering a hybrid Cardiac Rehabilitation Phase II exercise program during the COVID-19 pandemic: a quality improvement program.

The COVID-19 pandemic resulted in the cessation of approximately 75% of cardiac rehabilitation (CR) programmes worldwide. In March 2020, CR phase II (CRP2) services were stopped in Qatar. Multiple studies had shown safety, effectiveness, reduced cost of delivery and improved participation with hybrid CR. A multidisciplinary team reviewed various alternative models for delivery and decided to implement a hybrid CRP2 exercise programme (HCRP2-EP) to ensure continuation of our patient care. Our aim was to enrol in the HCRP2-EP 70% of all eligible patients by 30 September 2020. Institute for Health Care Improvement's collaborative model was adopted. Multiple plan-do-study-act cycles were used to test change ideas. The outcomes of the project were analysed using standard run chart rules to detect the changes in outcomes over time. This project was implemented from March 2020, and the male patients enrolled between August 2020 and April 2021, with sustained monthly median enrolment above target of 70% throughout. As for our secondary outcome, 75.8% of the male patients who completed HCRP2-EP showed a meaningful change in peak exercise capacity of ≥10% (mean change 17%±6%). There were no major adverse events reported, and the median Patient Satisfaction Score was 96% well above the institutional target of 90%. This shows a well-designed quality improvement programme is an appropriate strategy for implementing HCRP2-EP in a clinical setting, and HCRP2-EP is a feasible, effective and safe intervention in eligible male patients with cardiovascular disease.

[Corticoid treatment and SARS-CoV-2 variants: two independent factors associated with COVID-19 mortality in a Spanish regional hospital].

BACKGROUND: Pandemic inter-wave hospital admissions and COVID-19-related mortality rates vary greatly. Some of the factors that may be playing part in this are the profile of the patients, viral variants, pharmacological treatments, or preventive measures. This work aimed to analyze the factors associated with mortality in COVID-19 patients admitted to hospital during 2020-2021. METHODS: Retrospective cohort study with COVID-19 patients admitted to Hospital de Barbastro (Spain) during 2020-2021. Data were collected from the Spanish Conjunto Mínimo Básico de Datos and microbiology and electronic prescription records. RESULTS: During the study period, 908 patients were consecutively admitted for COVID-19 (median age 70 years, 57.2% males); 162 (17.8%) patients died. We identified seven successive epidemiological waves. The following variables significantly associated to higher mortality: age, arterial hypertension, chronic renal failure, dementia, chronic obstructive pulmonary disease, heart failure, prior stroke, Charlson index, and wave 2; wave 4 was associated to greater survival. The multivariate analysis showed that age (OR=1.11; 95% CI: 1.09-1.14), chronic obstructive pulmonary disease (OR=2.33; 95% CI: 1.18-4.57), wave 2 (OR=2.57; 95% CI: 1.10-6.00), and wave 3 (OR=2.94; 95% CI: 1.17-7.38) associated with higher mortality. Glucocorticoid treatment was the only protective factor (OR=0.29; 95%CI: 0.14-0.62). CONCLUSIONS: This study confirms the therapeutic utility of glucocorticoids to reduce in-hospital mortality due to COVID-19. Heterogeneous mortality rates between the different COVID-19 waves suggest a direct role of viral variants as determinants of lethality, regardless of the patient's history.

Psychological impact of coronavirus‐related social isolation in Colombia after a year of lockdown

Several repercussions of the COVID‐19 pandemic and its subsequent isolation period have been reported worldwide. In this paper, we analyze the behavioral and emotional effects of 1 year of coronavirus‐related lockdown in Colombia. A cross‐sectional correlational design was used on a sample of 1853 participants from different regions, and with different levels of education, income, and employment situations. We applied the fear of coronavirus scale, the use of preventive behaviors scale, and a scale to measure pleasant and unpleasant emotions based on the circumplex model of affect. Our data shows that women, participants who were unemployed during the lockdown, and participants that study or work in legal, computational, or related fields, have been more affected in terms of unpleasant emotions. In addition, we observed a trend towards a relation between higher income and educational levels with lower degrees of fear, higher degrees of pleasant emotions, and a greater use of preventive behaviors related to the pandemic. [ FROM AUTHOR] Copyright of Social & Personality Psychology Compass is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Aumento del síndrome de burnout en los adjuntos de Medicina Interna durante la pandemia de COVID-19 Burnout syndrome increase during COVID-19 pandemic in attending Internal Medicine physicians

Introducción: El burnout es un síndrome psicosocial causado por situaciones estresantes en el ámbito laboral. Afecta al 30-60% de los profesionales médicos. El objetivo de este estudio es realizar un análisis comparativo de su frecuencia antes y después del brote de la COVID-19 en los médicos adjuntos de Medicina Interna españoles. Métodos: Se enviaron encuestas por correo electrónico y redes sociales integradas con el Maslach Burnout Inventory a los miembros de la Sociedad Española de Medicina Interna en 2019 y 2020. Resultados y conclusiones: Se ha observado un aumento no significativo de burnout (38,0% vs. 34,4%). Sin embargo, sí se constata un aumento en la baja realización personal (66,4% vs. 33,6%;p = 0,002), dimensión asociada a la prevención de la morbilidad psiquiátrica, además de otras dos: la fatiga emocional y la despersonalización, que pueden afectar negativamente a la atención del paciente. Por ello, es esencial abordar este síndrome Individual e institucionalmente.

Cambios en hábitos saludables relacionados con actividad física y sedentarismo durante un confinamiento nacional por covid-19 (Changes in healthy habits regarding physical activity and sedentary lifestyle during a national lockdown due to covid-19)

The aim of this study was to analyze the effect of a lockdown in Spain due to COVID-19 on the levels of physical activity, exercise and sedentary lifestyle. After declaring state of alarm in Spain, a questionnaire was distributed via social networks with demographic questions, academic and/or employment status, physical activity and sedentary lifestyle. Subsequently, another questionnaire was sent by email in relation to the new lockdown measures. 474 participants replied to both questionnaires. An increase in weight and body mass index was recorded during lockdown (p <0.001). The number of days in which physical activity was practiced during leisure time increased (p <0.001), but the total time of weekly practice stayed the same. The time of physical activity during academic and the time spent walking was reduced, as well as was the time spent walking (p <0.001). Longer sleep, naps and sitting time was also recorded (p <0.01). The present study shows the need to create effective strategies aimed to increase the practice of physical activity and promote a healthy lifestyle during the current humanitarian crisis and possible future ones. Alternate : El presente estudio analizó el efecto del confinamiento en España derivado de la COVID-19 en niveles de actividad física diaria, ejercicio físico y comportamientos sedentarios. Tras la declaración del estado de alarma, se difundió un cuestionario por redes sociales con preguntas sociodemográficas, actividad física y comportamientos sedentarios. Posteriormente, se envió por correo electrónico otro cuestionario en relación con la nueva situación de confinamiento. Respondieron a ambos cuestionarios 474 participantes. Se registró un aumento del peso e índice de masa corporal durante el confinamiento (p < .001). Aumentó el número de días en los que se realizaba ejercicio físico en tiempo de ocio (p < .001), pero no el tiempo de práctica semanal total. Se redujo el tiempo de actividad física durante actividades académicas y/o profesionales y el tiempo destinado a desplazamientos (p < .001). Se registró un mayor tiempo de sueño, siestas y sedestación (p < .01). El presente estudio evidencia la necesidad de crear estrategias eficaces encaminadas a aumentar la práctica actividad física y promover los hábitos de vida saludables, especialmente durante la actual crisis humanitaria y posibles futuras.Alternate :O presente estudo analisou o efeito do confinamento na Espanha derivado do COVID-19 sobre os níveis de atividade física diária, exercício físico e comportamentos sedentários. Após a declaração do estado de alarme, foi divulgado nas redes sociais um questionário com questões sociodemográficas, atividade física e comportamentos sedentários. Posteriormente, outro questionário foi enviado por e-mail sobre a nova situação de confinamento. 474 participantes responderam a ambos os questionários. Um aumento no peso e no índice de massa corporal foi registrado durante o confinamento (p <0,001). O número de dias em que o exercício físico foi realizado no lazer aumentou (p <0,001), mas não o tempo total de prática semanal. O tempo de atividade física durante as atividades acadêmicas e / ou profissionais e o tempo despendido em viagens foram reduzidos (p <0,001). Maior tempo de sono, cochilo e tempo sentado foram registrados (p <0,01). Este estudo mostra a necessidade de criar estratégias eficazes que visem aumentar a prática de atividade física e promover estilos de vida saudáveis, especialmente durante a atual crise humanitária e possíveis futuras.

Handball Training and Competition With Facemasks in Galicia: The FISICOVID-DXTGALEGO Protocols Experience.

Objective: COVID-19 caused a complete stop in non-professional sports. The use of face masks for team sports is not a widely used measure in non-professional sports. The study aimed to evaluate the perception about using the mask and the adaptation difficulties related to training and competition in team sports following the FISICOVID-DXTGALEGO protocol. Methods: Seven hundred eighty-seven handball players from the Galician Handball Federation were followed during their return to participation after months of confinement through an electronic questionnaire of perception and experience on the use of a mask. Results: There is an excellent adaptation to the mask in training and competition with medium and high correlations. The 86,41% of players reported an adaptation to the mask in 3 weeks with a three times a week training frequency. The negative opinion on the mask was drastically reduced (-66.86%) after use. The 80,44% of players considered the use of a mask as an essential measure to resume competitions. Conclusions: It is very feasible to adapt to training and compete with a mask (hygienic or surgical) in a short period. The use of a mask following these protocols changed previous opinions on the disadvantages of the mask during training and competition.

Comparison of different prognostic scores for patients with cirrhosis hospitalized with SARS-CoV-2 infection.

INTRODUCTION AND OBJECTIVES: Viral infections have been described to increase the risk of decompensation in patients with cirrhosis. We aimed to determine the effect of SARS-CoV-2 infection on outcome of hospitalized patients with cirrhosis and to compare the performance of different prognostic models for predicting mortality. PATIENTS: We performed a prospective cohort study including 2211 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through October 1, 2020 in 38 Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters of patients with and without cirrhosis. All patients were followed until discharge or death. We evaluated the prognostic performance of different scoring systems to predict mortality in patients with cirrhosis using ROC curves. RESULTS: Overall, 4.6% (CI 3.7-5.6) subjects had cirrhosis (n = 96). Baseline Child-Turcotte-Pugh (CTP) class was assessed: CTP-A (23%), CTP-B (45%) and CTP-C (32%); median MELD-Na score was 19 (IQR 14-25). Mortality was 47% in patients with cirrhosis and 16% in patients without cirrhosis (P < .0001). Cirrhosis was independently associated with death [OR 3.1 (CI 1.9-4.8); P < .0001], adjusted by age, gender, and body mass index >30. The areas under the ROC curves for performance evaluation in predicting 28-days mortality for Chronic Liver Failure Consortium (CLIF-C), North American Consortium for the Study of End-Stage Liver Disease (NACSELD), CTP score and MELD-Na were 0.85, 0.75, 0.69, 0.67; respectively (P < .0001). CONCLUSIONS: SARS-CoV-2 infection is associated with elevated mortality in patients with cirrhosis. CLIF-C had better performance in predicting mortality than NACSELD, CTP and MELD-Na in patients with cirrhosis and SARS-CoV-2 infection. Clinicaltrials.gov:NCT04358380.

Perception of the Sports Social Environment After the Development and Implementation of an Identification Tool for Contagious Risk Situations in Sports During the COVID-19 Pandemic.

This study details the methodological process for creating a tool for the identification of COVID-19 potential contagion situations in sports and physical education before, during, and after practice and competition. It is a tool that implies an educational and methodological process with all the agents of the sports system. This tool identifies the large number of interactions occurring through sports action and everything that surrounds it in training, competition, and organization. The aim is to prepare contingency protocols based on an exhaustive analysis, risk detection, and proposal of contingency measures trying to reduce the residual risk to a minimum. In the second part, the results of the implementation of this tool in the sports system of Galicia (Spain) are shown. The technicians have changed their perceptions about the coronavirus transmission in sports. They highlight the problem for returning to sports participation for athletes under 18 years in the pandemic context.

University Teaching Planning in Times of COVID-19: Analysis of the Catalan Context and Proposal for a Future Model from ESIC Business and Marketing School Experience

On 14 March 2020, Spain came to a standstill and the movement of people was restricted with the publication of Royal Decree (RD) 463/2020 and the education sector had to reinvent itself with new rules and procedures. The purpose of this paper is to analyse the impact of the different government regulations and their effect on university teaching planning. Since the approval of RD 555/2020, educational competences were returned to the autonomous communities and each of them implemented different public policies. We will analyse the specific impact on teaching planning and models applied in Catalonia and their development, which vary according to the evolution of the number of COVID-19 infections and which has been marking the political, economic and social agenda since the beginning of the pandemic. The university has moved from teaching in a face-to-face environment to a virtual or semi-virtual or blended learning environment. This change implies a paradigmatic transformation in communication, education, organisation, evaluation and planning, among others. At ESIC Business &Marketing School (ESIC) these pedagogical paradigm shifts have contributed to transform the learning processes in a context of pedagogical innovation.

Burn-out syndrome in Spanish internists during the COVID-19 outbreak and associated factors: a cross-sectional survey.

OBJECTIVES: The objective of this study is to evaluate the impact of the COVID-19 outbreak on mental health and burn-out syndrome in Spanish internists and the factors that could be related to its appearance. DESIGN: We performed an observational, cross-sectional, descriptive study for which we designed a survey that was distributed in May 2020. SETTING: We included internists who worked in Spain during the COVID-19 outbreak. PARTICIPANTS: A total of 1015 internists responded to the survey. Of those 62.9% were women. RESULTS: Of 1015 people, 58.3% presented with high emotional exhaustion, 61.5% had a high level of depersonalisation and 67.6% reported low personal fulfilment. 40.1% presented with the 3 criteria described, and therefore burn-out syndrome.Burn-out syndrome was independently related to the management of patients with SARS-CoV-2 (HR: 2.26; 95% CI 1.15 to 4.45), the lack of availability of personal protective equipment (HR: 1.41; 95% CI 1.05 to 1.91), increased responsibility (HR: 2.13; 95% CI 1.51 to 3.01), not having received financial compensation for overtime work (HR: 0.43; 95% CI 0.31 to 0.62), not having rested after 24-hour shifts (HR: 1.61; 95% CI 1.09 to 2.38), not having had holidays in the previous 6 months (HR: 1.36; 95% CI 1.01 to 1.84), consumption of sleeping pills (HR: 1.83; 95% CI 1.28 to 2.63) and higher alcohol intake (HR: 1.95; 95% CI 1.39 to 2.73). CONCLUSIONS: During the COVID-19 outbreak, 40.1% of Internal Medicine physicians in Spain presented with burn-out syndrome, which was independently related to the assistance of patients with SARS-CoV-2, overworking without any compensation and the fear of being contagious to their relatives. Therefore, it is imperative to initiate programmes to prevent and treat burn-out in front-line physicians during the COVID-19 outbreak.

Prospective Latin American cohort evaluating outcomes of patients with COVID-19 and abnormal liver tests on admission.

INTRODUCTION & OBJECTIVES: The independent effect of liver biochemistries as a prognostic factor in patients with COVID-19 has not been completely addressed. We aimed to evaluate the prognostic value of abnormal liver tests on admission of hospitalized patients with COVID-19. MATERIALS & METHODS: We performed a prospective cohort study including 1611 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through July 31, 2020 in 38 different Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters, including liver function tests, on admission and during hospitalization. All patients were followed until discharge or death. We fit multivariable logistic regression models, further post-estimation effect through margins and inverse probability weighting. RESULTS: Overall, 57.8% of the patients were male with a mean age of 52.3 years, 8.5% had chronic liver disease and 3.4% had cirrhosis. Abnormal liver tests on admission were present on 45.2% (CI 42.7-47.7) of the cohort (n = 726). Overall, 15.1% (CI 13.4-16.9) of patients died (n = 244). Patients with abnormal liver tests on admission presented higher mortality 18.7% (CI 15.9-21.7), compared to those with normal liver biochemistries 12.2% (CI 10.1-14.6); P < .0001). After excluding patients with history of chronic liver disease, abnormal liver tests on admission were independently associated with death [OR 1.5 (CI 1.1-2.0); P = 0.01], and severe COVID-19 (2.6 [2.0-3.3], P < .0001), both adjusted by age, gender, diabetes, pneumonia and body mass index >30. CONCLUSIONS: The presence of abnormal liver tests on admission is independently associated with mortality and severe COVID-19 in hospitalized patients with COVID-19 infection and may be used as surrogate marker of inflammation. CLINICALTRIALS.GOV: NCT04358380.

Perception of the Sports Social Environment After the Development and Implementation of an Identification Tool for Contagious Risk Situations in Sports During the COVID-19 Pandemic.

The present work details the methodological process for creating a tool for the identification of COVID-19 potential contagion situations in sport and physical education before, during, and after practice and competition. It is a tool that implies an educational and methodological process with all the agents of the sports system. This tool identifies the large number of interactions occurring through sports action and everything that surrounds it in training, competition, and its organization. The aim is to prepare contingency protocols based on an exhaustive analysis, risk detection, and proposal of contingency measures trying to reduce the residual risk to a minimum. In a second part, the results of the implementation of this tool in the sports system of Galicia (Spain) are shown revealing the change in perception about the coronavirus transmission in sport of the technicians and the problem for returning to sport for athletes under 18 years.