Risultati per: COVID-19, nuova guida per gastroenterologi

Objectives
As part of a randomised controlled trial, this qualitative study aimed to identify experiences and challenges of hospitalised patients with COVID-19 during illness and treatment (objective 1: COVID-19-related perspectives; objective 2: trial participation-related perspectives).

Design
Semistructured interviews following a prespecified interview guide, transcribed verbatim and analysed in accordance with the grounded theory process. Investigator triangulation served to ensure rigour of the analysis.

Setting
Interviews were embedded in a multicentre, randomised, active-controlled, open-label platform trial testing efficacy and safety of experimental therapeutics for patients with COVID-19 (Austrian Corona Virus Adaptive Clinical Trial).

Participants
20 patients (60±15 years) providing 21 interviews from 8 June 2020 to 25 April 2021.

Results
Qualitative data analysis revealed four central themes with subthemes. Theme 1, ‘A Severe Disease’, related to objective 1, was characterised by subthemes ‘symptom burden’, ‘unpredictability of the disease course’, ‘fear of death’ and ‘long-term aftermaths with lifestyle consequences’. Theme 2, ‘Saved and Burdened by Hospitalization’, related to objective 1, comprised patients describing their in-hospital experience as ‘safe haven’ versus ‘place of fear’, highlighting the influence of ‘isolation’. Theme 3, ‘Managing One’s Own Health’, related to objective 1, showed how patients relied on ‘self-management’ and ‘coping’ strategies. Theme 4, ‘Belief in Medical Research’, related to objective 2, captured patients’ ‘motivation for study participation’, many expressing ‘information gaps’ and ‘situational helplessness’ in response to study inclusion, while fewer mentioned ‘therapy side-effects’ and provided ‘study reflection’. Investigator triangulation with an expert focus group of three doctors who worked at the study centre confirmed the plausibility of these results.

Conclusions
Several of the identified themes (2, 3, 4) are modifiable and open for interventions to improve care of patients with COVID-19. Patient-specific communication and information is of utmost importance during clinical trial participation, and was criticised by participants of the present study. Disease self-management should be actively encouraged.

Trial registration number
NCT04351724.

Annals of Internal Medicine, Volume 175, Issue 12, Page 1693-1706, December 2022.

Annals of Internal Medicine, Ahead of Print.

This study examines the incidence of cognitive decline among long-term care residents in Ontario before and during the COVID-19 pandemic.

Life expectancy dropped by 3 years for US men and 2.3 years for US women between 2019 and 2021, according to provisional life expectancy data from the National Center for Health Statistics.

COVID-19 vaccines are considered to have prevented an estimated tens of millions of SARS-CoV-2 infections and tens of thousands of COVID-19–related deaths in the US. However, the combination of reduced vaccine effectiveness against infection in the setting of Omicron sublineages and increased vaccination coverage has resulted in an increasing number of cases among vaccinated individuals. Designing and interpreting postauthorization, observational COVID-19 vaccine effectiveness studies have also become increasingly complex due to effects of prior infection on the risk and severity of repeat infections, emergence of variants that evade vaccine-induced immunity, waning immunity, more vaccine products and dosing schedules, and heterogeneity in outcomes measured within and across studies. The proper design and interpretation of vaccine effectiveness studies have consequences for vaccine research and policy decisions and for the public’s perception and trust of vaccines.

This retrospective cohort study assesses incidence of breakthrough COVID-19 and hospitalization with COVID-19 pneumonia or death among adults who received a vaccination series plus 1 booster against SARS-CoV-2.

This study uses data from March 2020 to June 2022 to examine the association of the primary and booster COVID-19 vaccines with SARS-CoV-2 infection, hospitalization, and death.

Objectives
We aimed to describe access to food and symptoms of depression among patients with chronic diseases or their caregivers, and assess associated factors during the COVID-19 lockdown in rural Rwanda.

Design
A cross-sectional study.

Setting and participants
A stratified random sampling technique was used to recruit 220 patients enrolled in the HIV, non-communicable diseases, mental health, paediatric development clinic and oncology programmes in three rural districts of Rwanda.

Outcome measures
Telephone-based interviews were conducted to collect data on the number of daily meals before and during the COVID-19, and depression was assessed using the Patient Health Questionnaire-9. We used logistic regression analysis to investigate factors associated with households reporting a reduction in daily meals and with the survey respondent reporting symptoms of depression.

Results
Of the participants, 19.1% reported a reduction in daily number of meals for either adults or children in their households during lockdown and 24.6% had depression. Reporting a reduction in daily meals was associated with the district of residence and estimated household’s monthly income. Self-reported depression was significantly associated with negative experiences during lockdown, including reporting feeling depressed or fear (AOR 4.82; 95% CI 2.08 to 11.21), loneliness (AOR 4.33; 95% CI 1.32 to 14.13), reduction in daily meals (AOR 4.15; 95% CI 1.56 to 11.00) and lack of access to healthcare (OR 3.29; 95% CI 1.32 to 8.23).

Conclusions
Our findings suggest that significant reduction in access to food affected rural Rwandans with chronic diseases during COVID-19 lockdown, and the lockdown effect varied by household’s pre-pandemic level of vulnerability to food insecurity. Reduction in household meals, as well as other self-reported effects of the lockdown, were associated with worse psychological status of survey respondents. Economic and food support should be considered by governments and non-governmental organisations to protect those most vulnerable including patients with chronic diseases against the effects of pandemics and their associated containment measures.

Objectives
This study aimed to examine whether and how the COVID-19 pandemic has affected the postponement or cancellation of elective surgeries in Japan.

Design and setting
A cross-sectional, web-based, self-administered survey was conducted nationwide from August 25 to September 30 2020. We used data from the Japan ‘COVID-19 and Society’ Internet Survey collected by a large internet research agency, Rakuten Insight, which had approximately 2.2 million qualified panellists in 2019.

Participants
From a volunteer sample of 28 000 participants, we extracted data from 3678 participants with planned elective surgeries on any postponement or cancellation of elective surgeries.

Outcome measures
The main outcome measure was any postponement or cancelltion of elective surgeries. In addition, for all respondents, we extracted data on sociodemographic, health-related characteristics, psychological characteristics and prefectural-level residential areas. We used weighted logistic regression approaches to fulfil the study objectives, minimising potential bias relating to web-based surveys.

Results
Of the 3678 participants, 431 (11.72%) reported experiencing postponement or cancellation of their elective surgeries. Notably, the participants living in prefectures where the declaration of the state of emergency was made on 7 April 2020 were significantly more likely to experience postponement or cancellation of elective surgeries than those residing in prefectures with the state of emergency beginning on 16 April 2020 (174 (26.02%) vs 153 (12.15%)).

Conclusions
The proportion of patients whose elective surgery had been postponed was limited during Japan’s first wave of the COVID-19 pandemic, although the declaration of a state of emergency increased the likelihood of postponement. It is imperative to increase awareness of the secondary health effects related to policy intervention in pandemics and other health crises and to use appropriate countermeasures such as standard infectious control measures and triage of surgical patients.

Per l’Ufficio parlamentare di bilancio nelle 72 strutture ospedaliere osservate con la pandemia i ricavi sono diminuiti del 5% e i costi aumentati del 5,7%

La svolta sulla strategia per gestire la pandemia dipenderà molto dalla scelta del nuovo ministro della Salute che dovrà prendere il posto di Roberto Speranza

Objectives
To develop a computer-based decision support tool (DST) for key decision makers to safely explore the impact on chronic obstructive pulmonary disease (COPD) care of service changes driven by restrictions to prevent the spread of COVID-19.

Design
The DST is powered by discrete event simulation which captures the entire patient pathway. To estimate the number of COPD admissions under different scenario settings, a regression model was developed and embedded into the tool. The tool can generate a wide range of patient-related and service-related outputs. Thus, the likely impact of possible changes (eg, COVID-19 restrictions and pandemic scenarios) on patients with COPD and care can be estimated.

Setting
COPD services (including outpatient and inpatient departments) at a major provider in central London.

Results
Four different scenarios (reflecting the UK government’s Plan A, Plan B and Plan C in addition to a benchmark scenario) were run for 1 year. 856, 616 and 484 face-to-face appointments (among 1226 clinic visits) are expected in Plans A, B and C, respectively. Clinic visit quality in Plan A is found to be marginally better than in Plans B and C. Under coronavirus restrictions, lung function tests decreased more than 80% in Plan C as compared with Plan A. Fewer COPD exacerbation-related admissions were seen (284.1 Plan C vs 395.1 in the benchmark) associated with stricter restrictions. Although the results indicate that fewer quality-adjusted life years (in terms of COPD management) would be lost during more severe restrictions, the wider impact on physical and mental health must also be established.

Conclusions
This DST will enable COPD services to examine how the latest developments in care delivery and management might impact their service during and beyond the COVID-19 pandemic, and in the event of future pandemics.

Knowledge on SARS-CoV-2 infection and its resultant COVID-19 in liver diseases has rapidly increased during the pandemic. Hereby, we review COVID-19 liver manifestations and pathophysiological aspects related to SARS-CoV-2 infection in patients without liver disease as well as the impact of COVID-19 in patients with chronic liver disease (CLD), particularly cirrhosis and liver transplantation (LT). SARS-CoV-2 infection has been associated with overt proinflammatory cytokine profile, which probably contributes substantially to the observed early and late liver abnormalities. CLD, particularly decompensated cirrhosis, should be regarded as a risk factor for severe COVID-19 and death. LT was impacted during the pandemic, mainly due to concerns regarding donation and infection in recipients. However, LT did not represent a risk factor per se of worse outcome. Even though scarce, data regarding COVID-19 specific therapy in special populations such as LT recipients seem promising. COVID-19 vaccine-induced immunity seems impaired in CLD and LT recipients, advocating for a revised schedule of vaccine administration in this population.

Objective
This study aimed to assess factors associated with poor medication adherence during the COVID-19 pandemic among hypertensive patients visiting public hospitals in Eastern Ethiopia.

Setting
Hospital-based cross-sectional study was conducted in Harari regional state and Dire Dawa Administration from 1 January to 30 February 2022. Both settings are found in Eastern Ethiopia.

Participants
A total of 402 adult hypertensive patients who visited the chronic diseases clinic for follow-up were included in the study.

Main outcome measures
The main outcome measure was poor medication adherence during the COVID-19 pandemic.

Results
The level of poor antihypetensive medication adherence was 63% (95% CI 48.1 to 67.9). Patients who had no formal education (adjusted OR (AOR)=1.56, 95% CI 1.03 to 4.30), existing comorbid conditions (AOR=1.98, 95% CI 1.35 to 4.35), self-funded for medication cost (AOR=2.05, 95% CI 1.34 to 4.73), poor knowledge about hypertension (HTN) and its treatment (AOR=2.67, 95% CI 1.45 to 3.99), poor patient–physician relationship (AOR=1.22, 95% CI 1.02 to 4.34) and unavailability of medication (AOR=5.05, 95% CI 2.78 to 12.04) showed significant association with poor medication adherence during the pandemic of COVID-19.

Conclusion
The level of poor antihypertensive medication adherence was high in this study. No formal education, comorbidity, self-funded medication cost, poor knowledge about HTN and its treatment, poor patient–physician relationship, and unavailability of medication during the COVID-19 pandemic were factors significantly associated with poor adherence to antihypertensive medication. All stakeholders should take into account and create strategies to reduce the impact of the COVID-19 pandemic on medication adherence of chronic diseases.

Introduction
WHO has generated standardised clinical and epidemiological research protocols to address key public health questions for SARS-CoV-2 (COVID-19) pandemic. We present a standardised protocol with the aim to fill a gap in understanding the needs, attitudes and practices related to sexual and reproductive health in the context of COVID-19 pandemic, focusing on pregnancy, pregnancy prevention and abortion.

Methods and analysis plan
This protocol is a prospective qualitative research, using semi-structured interviews with at least 15 pregnant women at different gestational ages and after delivery, 6 months apart from the first interview. At least 10 partners, 10 non-pregnant women and 5 healthcare professionals will be interviewed once during the course of the research. Higher number of subjects may be needed if a saturation is not achieved with these numbers. Data collection will be performed in a standardised way by skilled trained interviewers using written notes or audio-record of the interview. The data will be explored using the thematic content analysis and the researchers will look for broad patterns, generalisations or theories from these categories.

Ethics and dissemination
The current protocol was first technically assessed and approved by the WHO scientific committee and then approved by its ethics review committee as a guidance document. It is expected that each country/setting implementing such a generic protocol adapted to their conditions also obtain local ethical approval. Comments for the user’s consideration are provided the document, as the user may need to modify methods slightly because of the local context in which this study will be carried out.