Risultati per: Approfondimenti sulla terapia domiciliare del COVID‑19

Le raccomandazioni in un post su X dopo l’aumento dei casi

Objectives
While it is widely accepted that COVID-19 has disrupted routine vaccination globally, the long-term impact of COVID-19 on parental vaccination intentions is uncertain. This study aims to estimate whether COVID-19 impacted parental intentions for self-paid vaccines, and provides suggestions for local vaccination policy and intervention strategies accordingly.

Methods
A questionnaire-based cross-sectional survey was conducted among 2212 caregivers in Zhejiang province between 22 March and 30 June 2023. The following information was collected: sociodemographic characteristics, self-paid vaccination related intentions and behaviours, and vaccine hesitancy measured by the Vaccine Hesitancy Scale. Multiple multinomial logistic regression models were used to analyse the factors influencing the change in vaccination intentions.

Results
In total, 19.32% (n=390) of respondents increased their intention to immunise their children with self-paid vaccines after the COVID-19 epidemic, 9.16% (n=185) decreased their intention, and 71.52% (n=1444) of respondents indicated that the COVID-19 epidemic did not affect their intention. The major reason for increased intentions was ‘Vaccines are effective in preventing diseases’ (83.89%) and for decreased intentions was ‘Worried about the side effects of vaccines’ (65.95%). A higher hesitancy degree (OR=2.208, p=0.0001), reduced trust in vaccines after COVID-19 (OR=16.650, p1, all p

Background
Inequities in palliative and end-of-life care access exist, with evidence of lower uptake of these services among people from the British Muslim community. Little research exists exploring the experiences of British Muslims with palliative care needs and their families during the pandemic or before.

Aim
To coproduce peer research exploring the experiences of British Muslims with palliative care needs and their families during the COVID-19 pandemic.

Design
A collaborative peer research interview study. Peer researchers were recruited and trained to undertake qualitative interviewing. Data were analysed using reflective thematic analysis.

Setting/participants
3 peer researchers conducted 11 telephone interviews (10 in English and 1 in Urdu) between August and September 2021 with 12 participants (5 people with palliative care needs and 7 family carers).

Results
Four themes were identified: (1) issues in accessing healthcare exacerbated by the COVID-19 pandemic, (2) the impact on family carers, (3) variation in support from community groups and (4) social and information exclusion. The COVID-19 pandemic exacerbated existing challenges to accessing healthcare services for British Muslims with palliative care needs. Family members experienced the cumulative impact of supporting people with palliative needs while also advocating for and supporting them to access the care they required. Language barriers, digital exclusion and uncertainly about how to access information, in addition to the apparent lack of consideration of important festivals in the Muslim calendar in the implementation of policies around lockdowns, culminated in a sense of exclusion from COVID-19-related policies and messaging for this population.

Conclusions
These findings support the need to involve people from diverse backgrounds in the design and delivery of healthcare services and policies. Learning from this unique time in our histories should be used to shape future delivery of culturally aware and inclusive care.

Objectives
A range of interventions to support psychological resilience among healthcare workers were provided in hospitals during the COVID-19 pandemic. Most research has focused on the content and experience of these interventions, but less is known about their implementation. The aim of this study was to increase understanding of the development, implementation and perceived usefulness of an intervention to support psychological resilience among healthcare workers at a Swedish hospital during the pandemic.

Design
This study employs interviews and documents to explore the development and implementation of support activities and a survey to assess the usefulness of the activities (on a scale from 1 to 5). Qualitative content analysis was used to analyse the interview data and documents. Descriptive statistics were used to analyse the survey data.

Settings
A tertiary hospital in the outskirts of Region Stockholm.

Participants
Eight individual interviews were conducted with actors involved in developing the intervention. 286 healthcare workers answered the survey.

Results
Support activities were developed and implemented by an internal multidisciplinary group who continuously identified and adapted activities to the needs of staff. The strategy of involving existing resources to jointly develop and continuously adapt staff support activities was beneficial for the implementation and longevity of the intervention. Scheduling difficulties were one of the challenges. The mean ratings of the activities ranged from 2.27 for one-on-one counselling to 3.25 for physical activity. Licensed practical nurses generally valued the activities higher than other professional groups.

Conclusions
The provision of activities to support psychological resilience in a crisis is facilitated by the ability of an organisation to use current resources in the face of a crisis, which is a sign of organisational resilience. Leaders who act quickly and create the conditions to test and learn under uncertainty can contribute to developing effective responses to a crisis.

Introduction
Older adults in care homes experienced some of the highest rates of mortality from SARS-CoV-2 globally and were subjected to strict and lengthy non-pharmaceutical interventions, which severely impacted their daily lives. The VIVALDI ASCOT and Ethnography Study aims to assess the impact of respiratory outbreaks on care home residents’ quality of life, psychological well-being, loneliness, functional ability and use of space. This study is linked to the VIVALDI-CT, a randomised controlled trial of staff’s asymptomatic testing and sickness payment support in care homes (ISRCTN13296529).

Methods and analysis
This is a mixed-methods, longitudinal study of care home residents (65+) in Southeast England. Group 1—exposed includes residents from care homes with a recent COVID-19 or other respiratory infection outbreak. Group 2—non-exposed includes residents from care homes without a recent outbreak. The study has two components: (a) a mixed-methods longitudinal face-to-face interviews with 100 residents (n=50 from group 1 and n=50 from group 2) to assess the impact of outbreaks on residents’ quality of life, psychological well-being, loneliness, functional ability and use of space at time 1 (study baseline) and time 2 (at 3–4 weeks after the first visit); (b) ethnographic observations in communal spaces of up to 10 care homes to understand how outbreaks and related restrictions to the use of space and social activities impact residents’ well-being. The study will interview only care home residents who have the mental capacity to consent. Data will be compared and integrated to gain a more comprehensive understanding of the impact of outbreaks on residents’ quality of life and well-being.

Ethics and dissemination
The VIVALDI ASCOT and Ethnography Study obtained ethical approval from the Health Research Authority (HRA) Social Care REC (24/IEC08/0001). Only residents with the capacity to consent will be included in the study. Findings will be published in scientific journals.

Analisi degli esperti sui ricoveri, 3 casi su 4 sfuggono al monitoraggio

Objective
There are established inequities in the monitoring and management of hypertension in England. The COVID-19 pandemic had a major impact on primary care management of long-term conditions such as hypertension. This study investigated the possible disproportionate impact of the pandemic across patient groups.

Design
Open cohort of people with diagnosed hypertension.

Settings
North East London primary care practices from January 2019 to October 2022.

Participants
All 224 329 adults with hypertension registered in 193 primary care practices.

Outcomes
Monitoring and management of hypertension were assessed using two indicators: (i) blood pressure recorded within 1 year of the index date and (ii) blood pressure control to national clinical practice guidelines.

Results
The proportion of patients with a contemporaneous blood pressure recording fell from a 91% pre-pandemic peak to 62% at the end of the pandemic lockdown and improved to 77% by the end of the study. This was paralleled by the proportion of individuals with controlled hypertension which fell from a 73% pre-pandemic peak to 50% at the end of the pandemic lockdown and improved to 60% by the end of the study. However, when excluding patients without a recent blood pressure recording, the proportions of patients with controlled hypertension increased to 81%, 80% and 78% respectively.
Throughout the study, in comparison to the White ethnic group, the Black ethnic group was less likely to achieve adequate blood pressure control (ORs 0.81 (95% CI 0.78 to 0.85, p

Objectives
We conducted a rapid review to determine the extent that immunisation services in low-income and middle-income countries (LMICs) were disrupted by the COVID-19 pandemic and synthesised the factors that can be used to build resilience in future.

Design
Rapid review reported in accordance with the Preferred reporting for Systematic reviews and Meta-Analyses (PRISMA) guidelines.

Data sources
PubMed and Web of Science were searched through 6 October 2023.

Eligibility criteria for selecting studies
We included studies that focused on disruption to immunisation activities due to the COVID-19 pandemic in LMICs. Outcomes included routine vaccine coverage, supplementary immunisation activities, vaccine doses, timing of vaccination, supply chain changes, and factors contributing to disruption or resilience.

Data extraction and synthesis
Two independent reviewers used standardised methods to search, screen and code studies. Quality assessment was performed using a modified version of the Critical Appraisal Skills Programme for qualitative research. Findings were summarised qualitatively.

Results
Of 4978 identified studies, 85 met the eligibility criteria. Included studies showed declines in immunisation activities across LMICs related to the COVID-19 pandemic. These included reductions in achieved routine coverage, cancellation or postponement of campaigns and underimmunised cohorts. Immunisation was most disrupted in the early months of the pandemic; however, recovery varied by country, age-group and vaccine. Though many countries observed partial recovery in 2020, disruption in many countries continued into 2021. It has also been noted that clinician staff shortages and vaccine stock-outs caused by supply chain disruptions contributed to immunisation delays, but that concern over COVID-19 transmission was a leading factor. Key resiliency factors included community outreach and healthcare worker support.

Conclusions
There is limited information on whether reductions in vaccination coverage or delays have persisted beyond 2021. Further research is needed to assess ongoing disruptions and identify missed vaccine cohorts.

This Medical News story discusses the makeup of this fall’s updated COVID-19 vaccines.

People who experienced such symptoms as chills, tiredness, headaches, and feeling unwell after receiving a SARS-CoV-2 messenger RNA vaccine had higher blood levels of neutralizing antibodies, which might play a role in protecting people from COVID-19 infection, according to data published in the Annals of Internal Medicine. The data were based on a prospective cohort study of 363 participants in the US who were vaccinated in 2021 and self-reported their symptoms.

Objectives
To explore the experiences and perspectives of community pharmacists regarding their roles during the closure stage (ie, March to May 2020) of the COVID-19 pandemic in Newfoundland and Labrador (NL), Canada.

Design
This qualitative case study included a document analysis and semistructured interviews with community pharmacists who provided direct patient care during the COVID-19 pandemic. The document analysis was used to develop a chronology that informed the interviews. Themes from qualitative interviews were developed through iterative cycles of data review and analysis using applied thematic analysis. Findings are presented specifically for the time period between March and May 2020, defined as the ‘Closure Stage’.

Setting
Community pharmacies in NL, Canada.

Results
12 community pharmacists participated in the interviews. Four themes were developed including (1) pharmacists’ leadership in continuity of care, (2) pharmacists as medication stewards, (3) pharmacists as a source of COVID-19 health information and (4) the impact of COVID-19 on pharmacists’ mental health and well-being. The first three themes described the key roles played by community pharmacists during the early days of the COVID-19 pandemic, including coordinating care, prescribing for common ailments, delivering medications and supplies, providing information on COVID-19 symptoms and their management, renewing chronic medications and protecting the medication supply. Unclear guidance on scope of practice, limited scope of practice, inadequate staffing and limited support from government bodies were identified as barriers to these roles. Facilitators included access to a delivery service, swift regulatory changes, reimbursement and support from colleagues and other healthcare professionals. The fourth theme is presented independently, emphasising the impact of working within the primary healthcare (PHC) system during the COVID-19 pandemic on pharmacists’ mental health and well-being.

Conclusion
Pharmacists played a critical role in the delivery of PHC services during the closure stage of the COVID-19 pandemic. The findings of this research highlight the essential elements of a strong PHC pandemic preparedness plan that is inclusive of community pharmacists, including improved communication strategies, mental health support and access to resources.

Objectives
The COVID-19 pandemic and related lockdown measures disrupted global healthcare provision, including opioid prescribing. In North America, opioid sales declined while opioid-related deaths increased. In Europe, the effect of the pandemic on prescribing is not yet known. Given the ongoing increase in opioid-related harm and mortality, it is crucial to analyse the impact of the COVID-19 crisis and lockdown measures on opioid prescribing. Therefore, the objective of this study was to characterise opioid prescribing in the Netherlands during the COVID-19 pandemic.

Design
A nationwide register-based study characterising opioid prescribing using aggregated insurance reimbursement data.

Setting
Dutch healthcare during the first 2 years of the COVID lockdown.

Participants
The whole Dutch population.

Primary and secondary outcome measures
Comparing the number of opioid prescriptions during the pandemic with a prepandemic period using a risk ratio (RR), with separate analysis on the prescription type (first-time or repeat prescription), patients’ sex, age and socioeconomic status. We also explored lockdown effects.

Results
During the first lockdown, the total number of new opioid prescriptions and prescriptions to young patients (briefly) decreased (RR 0.88, 95% CI 0.88 to 0.89 and RR 0.73, 95% CI 0.70 to 0.75, respectively), but the overall number of opioid prescriptions remained stable throughout the pandemic compared with prepandemic. Women, older patients and patients living in lower socioeconomic areas received more opioids per capita, but the pandemic did not amplify these differences.

Conclusions
The pandemic appears to have had a limited impact on opioid prescribing in the Netherlands. Yet, chronic use of opioids remains an important public health issue.

Maggi: “L’aumento dei casi è un fenomeno previsto”

Monitoraggio Iss-ministero Salute, indice Rt sempre sopra 1

Objective
This meta-analysis aimed to estimate the national prevalence of postpartum depression (PPD) in Uganda and identify predictors in both pre-COVID-19 and post-COVID-19 eras.

Design
Used a systematic review and meta-analysis methodology.

Data sources
Reviewed papers were sourced from Medline/PubMed, PsycINFO, CINAHL/EBSCOhost, Google Scholar, ScienceDirect and African Journals Online.

Eligibility criteria for selected studies
The review encompassed observational studies published on PPD in Uganda from 1 January 2000 to 30 November 2023.

Results
11 studies (involving 7564 participants) published from 1 January 2000 to 30 November 2023 were reviewed. The pooled prevalence of PPD in Uganda was 29% (95% CI 21% to 37%, I2=98.32%). Subgroup analysis indicated a similar prevalence before (29%, 95% CI 20% to 39%) and during (28%, 95% CI 22% to 32%) the COVID-19 period. Special groups exhibited a higher prevalence (32%, 95% CI 16% to 47%) than general postpartum women (28%, 95% CI 19% to 37%). Factors associated with PPD included poor social support (OR 1.19, 95% CI 1.17 to 1.22, I2=96.8%), maternal illness (OR 1.22, 95% CI 1.19 to 1.26, I2=96.9%), poor socioeconomic status (OR 1.43, 95% CI 1.40 to 1.46, I2=99.5%) and undergoing caesarean section (OR 1.15, 95% CI 1.12 to 1.17, I2=80.6%). Surprisingly, there was a marginal decrease in PPD during the COVID-19 period. Subgroup analysis highlighted a higher prevalence among mothers with HIV.

Conclusion
This study underscores the significant prevalence of PPD in Uganda, with sociodemographic factors increasing risk. Despite a slight decrease during the COVID-19 period, the importance of prioritising maternal mental health is emphasised, considering sociodemographic factors and pandemic challenges, to improve maternal and child health outcomes and overall well-being.

This survey study reports the proportions of and reasons for Medicaid coverage loss among racially and ethnically minoritized individuals.