COVID-19 pandemic on coronary artery and cerebrovascular diseases in Southern Spain: interrupted time series analysis.

OBJECTIVE: Healthcare systems have been put under intense pressure by the COVID-19 pandemic, although some studies have shown a decline in hospital admissions for cardiovascular and cerebrovascular diseases during the first and second wave of the pandemic. In addition, studies analyzing gender and procedural differences are scarce. The present study aimed to determine the impact of the pandemic on hospital admissions for acute myocardial infarction (AMI) and cerebrovascular disease (CVD) in Andalusia (Spain) and analyzed differences by gender and by percutaneous coronary interventions performed. PATIENTS AND METHODS: An interrupted time series analysis of AMI and CVD hospital admissions in Andalusia (Spain) was carried out to measure the impact of the COVID-19 outbreak. AMI and CVD cases admitted daily in public hospitals of Andalusia between January 2018 and December 2020 were included. RESULTS: During the pandemic, significant reductions in AMI [-19%; 95% confidence interval (CI): (-29%, -9%), p<0.001] and CVD [-17%; 95% CI: (-26%, -9%); p<0.01] in daily hospital admissions were observed. Differences were also produced according to the diagnosis (ST-Elevation Myocardial Infarction, Non-ST-Elevation Myocardial Infarction, other AMI and stroke), with a greater reduction in females for AMI and in males for CVD. Although there were more percutaneous coronary interventions during the pandemic, no significant reductions were observed. CONCLUSIONS: A decline in AMI and CVD daily hospital admissions during the first and second wave of COVID-19 pandemic was noted. Gender differences were observed, but no clear impact was observed in percutaneous interventions.

Vaginal birth after caesarean section before and during COVID-19 pandemic. Factors associated with successful vaginal birth.

BACKGROUND: The ratio of caesarean has been increasing considerably in many countries. Planning a vaginal birth after a previous caesarean is considered an important option for women in a subsequent pregnancy. AIMS: To analyse obstetric and neonatal outcomes in women in labour after caesarean section before and during the COVID-19 pandemic, and to determine factors associated with successful vaginal birth after caesarean (VBAC). METHODS: Observational cohort study of women in labour with history of caesarean section who gave birth between March 2019 and December 2020 in a tertiary hospital in southern Spain. Consecutive sampling was performed using the maternal birth database and a descriptive and inferential analysis of the study variables was carried out. Socio-demographic, obstetric and neonatal variables were compared between the pre-pandemic and pandemic periods. Multiple logistic regression analysis was performed to determine variables associated with VBAC success. FINDINGS: The VBAC success rate was 67.4%. The caesarean section rate was significantly higher during the COVID-19 pandemic period. Factors associated with VBAC success were: birth before the pandemic (OR 0.32) and at night (OR 0.45), use of epidural analgesia (OR 2.14), and having had a previous vaginal birth (OR 1.98). CONCLUSIONS: The success rate of VBAC was lower during the pandemic. Knowledge of the factors related to VBAC success is critical for practitioners when supporting women in decision-making about mode of birth after a previous caesarean section.

Comparison across 12 countries on knowledge, attitude, and behavior scores about medication errors in Intensive Care Units: an international study.

OBJECTIVE: The aim of the study was to explore the degree of agreement of intensive care unit nurses working on a set of medication error preventive strategies and to examine possible predictors of nurses' knowledge, attitude and behavior. MATERIALS AND METHODS: Observational, international, and cross-sectional study. Iran, Malta, Spain, Pakistan, Nepal, Qatar, Ecuador, Australia, Finland, Italy, Egypt, and Jordan were the countries included in this survey. To collect data, the Knowledge, Attitude and Behavior in Medication Errors questionnaire was used. A descriptive statistical analysis was performed for the socio-demographic characteristics of the sample and three multiple logistic regressions were performed. RESULTS: The international sample consists of 1383 nurses, of whom 478 (34.6%) were men and 900 (65.1%) were women and their mean age was 35.61 years with a range of 19-61. Descriptive statistics conducted on the international sample show a medium to high degree of agreement among participants concerning some preventive strategies of medication error. In addition, the results of the present study show a strong relationship between positive nurses' attitudes and correct behaviors and/or adequate knowledge, as well as between adequate knowledge and correct behaviors (p< 0.01). CONCLUSIONS: Further studies are needed to explore the issue of medication error concerning nurses' cultural backgrounds, as well as to assess similarities and disparities among international nurses.

Nurses, sleep disturbances, desynchronization of circadian rhythms, and performance: a dangerous liaison? A narrative mini-review.

OBJECTIVE: Nursing is a high-stress occupation, and recent research of circadian rhythm desynchronization has focused on its consequences for nurses' health. Moreover, shiftwork, sleep disturbances, nightmares, and health issues are closely related to individual circadian preferences ('chronotype'). The aim of this narrative mini-review was to check the available literature to collect findings on the interrelationships among these aspects, as well as to determine the possible consequences for performance. MATERIALS AND METHODS: We explored the PubMed, EMBASE and Google Scholar electronic databases using the search terms 'Nursing', 'Stress', 'Sleep disturbances', 'Nightmares', 'Circadian rhythm', 'Desynchronization', 'Chronotype', 'Performance', and 'Sex/Gender'. Due to the wide heterogeneity of studies, with most including only some of these terms, we proceeded to single data extractions after analyzing the studies case by case and decided to conduct a narrative mini-review. RESULTS: Shift work, due to the regular alterations of the daily light profile, disrupts the normal circadian sleep-wake cycle and is associated with impaired health among rotational shift workers, with nurses on the frontline. Circadian desynchronization may be associated with adverse effects on nurses' health and may be a risk factor for stress, metabolic disorders, and sleep disturbances, including nightmares, and stress operates in a bidirectional fashion. Chronotype plays a crucial role as well, since the asynchrony between one's chronotype and social working hours (social jetlag) may generate problems, since the time-of-day and optimal performance are strongly connected. CONCLUSIONS: Circadian rhythms, chronotype, sleep, health, and working performance are strongly connected. The assessment of chronotype could represent a tool to identify health care personnel at higher risk of circadian disruption, allowing for mitigation of work-related stress and sleep disturbances, and reducing the risk of making working errors.

Ventilatory therapies and Intensive Care admissions for patients with COVID-19: a systematic review.

OBJECTIVE: The aim of the study was to synthesize and analyze the scientific publications related to ventilatory therapies used in patients with COVID-19 in Intensive Care Units (ICUs), the parameters of invasive mechanical ventilation prescribed for these patients, and the clinical characteristics of patients admitted to the ICU. MATERIALS AND METHODS: A systematic review was carried out through the PubMed, Embase, Web of Science and Cochrane Library databases. Studies published up to 31/05/2020 were included if they made reference to ventilatory therapies used in ICU patients with COVID-19. RESULTS: Qualitative analysis was performed on 30 included studies. A total sample of 48,743 patients was analyzed, of which 17.66% were admitted to ICUs, and 6.4% of these patients died. Of the patients analyzed, 44.4% required some type of respiratory support. Specifically, 12.8% of patients received invasive mechanical ventilation, while 9.7% received non-invasive mechanical ventilation, and 29.7% received high-flow nasal oxygen. CONCLUSIONS: COVID-19 has led to a high number of ICU admissions and a challenge for ICUs is to provide the best ventilatory therapy available to patients admitted. It has been observed that the available figures for ICU admissions and the use of ventilatory therapies are similar across continents. However, the data suggest that geographic areas with higher rates of ICU admission have lower mortality rates. The lack of information in some of the clinical records limits the ability to obtain more conclusive results.

Mortality and critical conditions in COVID-19 patients at private hospitals: weekend effect?

OBJECTIVE: The aim of the study was to find factors associated with the mortality of admission to the intensive care unit (ICU) in patients with COVID-19. MATERIALS AND METHODS: Retrospective observational study with a database of 1987 patients with COVID-19 who had attended the emergency department of a private hospital network between February 2020 and April 2020 were analyzed. Clinical variables and some laboratory parameters were studied. The Charlson and Elixhauser comorbidity indices were calculated. The dependent variables were mortality and admission to the ICU. A descriptive and correlational analysis was performed. Logistic regression models and Kaplan-Meier survival curves were established. RESULTS: Positive correlations were observed between age, creatinine, and D-dimer levels, as well as with the scores obtained with the Charlson and Elixhauser indices. Differences in the levels of these parameters were also observed when analyzing variables such as mortality, sex or admission to the ICU. Mortality was associated with high creatinine and D-dimer levels and advanced age. Survival curves indicated longer survival in patients not admitted to the ICU, admitted to the hospital during the week, and in those with lower creatinine and D-dimer levels. CONCLUSIONS: Mortality in Spanish patients with COVID-19 admitted to private hospitals was associated with high creatinine and D-dimer levels and advanced age. Longer survival was obtained on weekdays. This study provides valuable information on the management and nursing care of these patients in order to optimize resources in pandemic situations.

Sleep, dreams, nightmares, and sex-related differences: a narrative review.

OBJECTIVE: The aim of this study was to review the available findings on sex-related differences for sleep disorders, dreams and nightmares. MATERIALS AND METHODS: We explored the PubMed, EMBASE and Google Scholar electronic databases, with regards to the searching terms 'sleep', 'dreams', and 'nightmares' associated with 'sex' and/or 'gender'. Moreover, other supplementary terms for the searching strategy were 'chronobiology', and 'circadian rhythm'. Due to the relative paucity of studies including separate analysis by sex, and especially to their wide heterogeneity, we decided to proceed with a narrative review, highlighting the sex-related findings of each topic into apposite boxes. RESULTS: On one hand, sleep disorders seem to be more frequent in women. On the other hand, sex-related differences exist for either dreams or nightmares. As for the former, differences make reference to dream content (men: physical aggression, women family themes), self-reported perspective (men dream in third person, women in first person), dream sharing (more frequent in women), lucid dreaming (women more realistic, men more controlled), and daydreaming (young men more frequently have sexual themes). Nightmares are more frequent in women too, and they are often associated with sleep disorders and even with psychiatric disorders, such as depression and/or anxiety. In women, a strong association has been shown between nightmares and evening circadian preference. CONCLUSIONS: For many years, and for many reasons, laboratory experiments have been conducted mainly, if not exclusively, on male animals. Thus, a novel effort towards a new governance of scientific and research activities with a gender-specific perspective has been claimed for all areas of medicine, and more research on sex-differences is strongly needed also on this topic.

Twenty-four-hour, weekly and annual patterns in serious falls of non-institutionalized independent Spanish seniors.

OBJECTIVE: The study aimed to explore clock hour, day-of-week, and month-of-year patterns of serious falls experienced by non-institutionalized Spanish seniors (age ≥65 years) in relation to associated conventional intrinsic and extrinsic factors. PATIENTS AND METHODS: Intake emergency department records from January 1 to December 31, 2013 of a tertiary hospital of southern Spain were abstracted for particulars of falls, including the time of occurrence, experienced specifically by non-institutionalized seniors. Chi-squares and Single and Multiple-Component Cosinor (time series) Analyses were applied to determine the statistical significance of observed 24-hour, 7-day, and annual variation. RESULTS: Falls were ~2.5-fold more numerous in older women than older men and ~7-fold more frequent between 12:00 and 14:00 hours than ~02:00 hours, respectively, the time spans corresponding to the absolute peak and trough of the 24-hour pattern in falls. The midday/early afternoon peak primarily represented incidents of women ≥75 years of age that occurred inside the home while walking, standing, or moving on stairs. A late evening less prominent excess of mostly inside-the-home incidents of women ≥75 years of age, largely due to fragility, slipping, stumbling, or tripping, was additionally detected. Cosinor Analysis substantiates statistical significance of the 24-hour patterning of falls of men and women (both p<0.001). Day-of-week differences, with prominent Thursday peak and Sunday minimum, were additionally detected, but only for falls of women occurring outside the home (Cosinor Analysis: p=0.007). Day-of-week discrepancy in female/male sex ratio (SR) of fallers was demonstrated, arising from day-of-week disparity in the SR of inside-the-home incidents, with ~4.5-fold more elderly women than elderly men falling Thursday than any other day of the week (p=0.005). Non-statistically significant month-of-year difference in falls, lowest in autumn and highest (~60% more) in winter, was observed and explained by prominent seasonal difference in incidents by elderly women. CONCLUSIONS: Serious falls of non-institutionalized independent seniors are characterized according to intrinsic and extrinsic factors by prominent 24-hour and 7-day patterning. These findings complement the understanding of the epidemiology of falls of the elderly and further inform fall prevention programs.

Sociodemographic factors associated with preterm birth and low birth weight: A cross-sectional study.

BACKGROUND: Preterm birth and low birth weight are two public health problems worldwide associated with higher morbidity and perinatal death risk. AIMS: To determine the incidence and socio-demographic factors associated with preterm birth and low birth weight in Spanish women. METHODS: Cross-sectional study with data from women who gave birth in Spain during 2015 extracted from the Statistical Bulletin of births (National Institute Statistics). Records analysed were 331,449. Single births from 22 weeks gestation and fetuses with weight ≥ 500 g were included. Unadjusted and adjusted odd ratios with 95% confidence interval in a multiple logistic regression model were calculated. Variables associated with both health problems were considered dependent variables. FINDINGS: Preterm birth rate in Spain was 6.7% and low birth weight rate was 7.3%. Socio-demographic variables associated with preterm birth were maternal age ≤19 years, immigrant mothers, educational level ≤ secondary studies, and women living in large cities. Low birth weight was related to maternal age ≤19 years and ≥35 years, educational level ≤ secondary studies, and single mothers. Not having previous children and caesarean births were associated with both risks. CONCLUSIONS: The rates of both risks decreased in Spain, one of the countries in Europe where maternal age at having the first child has increased the most and with the lowest birth rate in the world. Maternal age, educational level, maternal nationality, marital status and population size were associated with one or both risks, so the results of this study could be especially relevant to the clinical practice.

Hospital readmissions to internal medicine departments: a higher risk for females?

OBJECTIVE: Readmissions to hospital after discharge are considered adverse, serious and costly outcomes. In the last years, two new scores have been proposed to identify patients at high risk of hospital readmission, the HOSPITAL and the Elders Risk Assessment (ERA) indexes. The aim of this study was to evaluate these two scores and the risk of death among internal medicine readmitted patients. PATIENTS AND METHODS: During a 30-month period, we identified 613 readmitted patients out of 13,237 admissions. Age, sex, length-of-hospital stay (LOS), and deaths were retrospectively analyzed. Readmissions with diagnosis coincident with the index hospitalization were classified as avoidable, whilst those with a different diagnosis were defined as non-avoidable. HOSPITAL score for 30-day potentially avoidable readmission and ERA indexes were calculated. RESULTS: Readmitted patients (56.6% women), were aged 79±10.4 years. The incidence of 30-day readmission was 20.4 patients/month. Re-hospitalization could be classified as avoidable in 286 cases (46.7%), and death at the end of follow-up was recorded in 366 (59.7%). HOSPITAL score ≥ 7 and ERA score ≥ 16, both able to identify high risk patients for readmission, were present in 108 (17.6%) and 385 (64.4%) of cases, respectively. Patients with non-avoidable readmissions were older, more frequently female, diabetic, and had higher ERA score than subjects with avoidable readmission. Multivariate logistic regression analysis showed that non-avoidable readmissions were independently associated with female gender (OR 1.410 [95% CI 1.012-1.964], p=0.042), and age (OR 1.025 [95% CI 1.006-1.043], p=0.01), while only age (OR 1.034 [95% CI 1.015-1.054], p<0.001) and ERA score (OR 1.047 [95% CI 1.001-1.095], p=0.047) were independently associated with death at the end of follow-up. CONCLUSIONS: Although re-hospitalization represents frequent phenomenon related to age, non-avoidable readmissions mainly involve female patients. ERA score appears to be an useful practical tool, able to identify high risk patients.