Changes in psychological and cognitive variables as well as cortisol levels in recovered Covid-19 patients: a longitudinal study.

BACKGROUND: Decreased psychological and cognitive functioning is one of the complications of Covid-19 disease. We aimed to evaluate mental health, cognitive functioning, and salivary cortisol levels in Covid-19 patients with different disease severities in three 45-day intervals after recovery. METHODS: 258 Covid-19 patients were assigned into three groups based on their disease severity: 112 patients in mild group, 67 patients in moderate group and 79 patients in severe group. The participants underwent psychological evaluations (including Depression, Anxiety and Stress Scale questionnaire, Beck Depression Inventory, SpeilBerger State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Inventory), cognitive assessments (The Paced Auditory Serial Addition Test) and salivary cortisol level evaluation in three 45-day periods. Non-parametric statistical methods were applied for psychological and cognitive indicators, while two-way mixed model ANOVA was used to evaluate the cortisol concentration in three replications. RESULTS: The group of mild patients became more anxious and the group of moderate patients became more anxious and depressed. But all three groups of patients developed severe sleep disorders over time. For cognitive functioning, although the results showed a decrease in the correct response rate, a significant increase in the correct response rate was observed in all three groups in all three measurements. However, the response speed not only did not increase, but also decreased in severe group. Cortisol level had a markedly increasing trend in all three groups. CONCLUSION: Improvement of cognitive functioning was in line with the increase in cortisol. Besides, the decrease in mental health had no effect on the cognitive functioning.

The Relationship between the Severity of the COVID-19 Disease, Temperament and Psychological Factors.

Objective: The coronavirus (COVID-19) pandemic negatively affects public mental health around the world. Individuals' reactions to COVID-19 vary depending on their temperament, individual differences, and personality traits. Therefore, the current study is conducted to assess the association of demographical features, Persian temperament, and psychological characteristics with the severity of COVID-19. Method: An online survey was sent to COVID-19 patients to collect their demographic information, COVID-19 symptoms, and clinical data. The Depression, Anxiety and Stress Scale (DAAS-21) questionnaire, Beck Depression Inventory (BDI-II), Spiel Berger State-Trait Anxiety Inventory (STAI) , Pittsburgh Sleep Quality Inventory (PSQI), and Persian general and brain temperament Questionnaire were also completed by 258 participants (127 men and 131 women) 45 days after recovery from COVID-19. Non-parametric analysis was used for statistical analysis. Results: Results showed the significant relationship of demographic factors such as weight, age and gender with the severity of the COVID-19 (P < 0.05). Mean scores of brain temperament (warm/cold) in the severe group were significantly lower than the moderate and mild groups (P < 0.05). There was a significant increase in the dry/wet temperament of the brain in the severe and moderate groups compared to the mild group (P < 0.05). The results of DASS-21 showed a significantly higher anxiety in patients with severe COVID-19 compared with moderate and mild groups (P < 0.05). The severe group was found to be significantly different compared to moderate group in the results of BDI-II (P < 0.05). The result of STAI (state and trait) showed a significant difference between the severe group and the mild and moderate groups. The score of PSQI between the moderate and mild groups was significant (P < 0.05). Conclusion: These results indicate the relationship between demographic factors such as weight, age and gender, brain temperament, as well as some psychological factors such as sleep quality and anxiety with the severity of the COVID-19 disease.

Evaluation of Appropriateness Admission and Hospital Stay at Educational Hospital.

BACKGROUND: Appropriate admissions and patients' length of stay are two of the most important indicators of efficient health care delivery in hospitals. Paying due attention to these indicators may lead to optimal use of hospital resources as well as provision of ambulatory services to a larger population of patients. The purpose of the current study is to quantify the rate of inappropriate hospital admissions and days of hospital stay to identify factors affecting them. METHODS: Data were collected regarding admissions and length of stay of 1815 patients admitted to an educational hospital in Tehran, Iran, with a total 12,629 days of hospitalization using the Appropriateness Evaluation Protocol. A qualitative study was conducted using content analysis method by analyzing data from interviews with the hospital personnel about the factors affecting patients' length of stay. RESULTS: The results indicated that the average length of stay in medical and surgical wards was 9.4 to 6.3 days, and 8.5% of admissions and 3.4% of stays were inappropriate. The necessity to receive nursing care and/or to receive medical services and/or the patients' conditions accounted for 57.6% of total hospitalization days, followed by the need to receive nursing care alone (36.6%). Planning/Procedures/ Personnel factors were responsible for 77.3% of inappropriate stays. The qualitative study revealed that in addition to sound in house policy setting, abundance of suitable equipment and facilities at the hospital site had positively affected the appropriateness of hospital stay while incoordination of health care delivery groups, rotation of residents and other wards personnel and lack of a proper complementary patient follow-up system, had a negative impact on the same indicator. CONCLUSION: Inappropriate admissions and inappropriate stays are influenced by numerous factors, both inside and outside of the hospitals; the results of the current study indicate that structural factors such as techniques adopted in the studied hospital, contributed significantly to decreasing inappropriate stays. Improving and upgrading these techniques will make optimal use of hospital beds possible.

Organ yield from deceased donors: initial experience of an organ procurement unit in Iran.

To promote organ transplantation in Iran, organ procurement from deceased donors should be supported. For this policy, some organ procurement units have been established in university hospitals. Further researches in these activities are warranted to better elucidate the role of cadaveric organ transplantation in Iran.We retrospectively studied deceased organ donation from June 2005 through December 2007 in Organ Procurement Unit of Shariati Hospital in Tehran. We analyzed a total of 141 organs that were retrieved from 46 brain-dead organ donors.The median age of all donors was 29 years (min: six, max: 63). Two third of them were males. The average of harvested organs was 3.06 per donor and four organs per month. The main cause of brain death was head trauma (n=33, 72%). Organ yield per donor was correlated to the time of the organ procurement unit activity and increased during the three years (r=0.261, P=0.017). Other variables were not changed during this period. Donor characteristics such as age, sex, blood group, and causes of brain death impacted on the organ yield. This study showed that organ procurement units can improve organ yield and both experience and donor characteristics influence on the number of harvested organs.