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Stratil JM, Biallas RL, Burns J, Arnold L, Geffert K, Kunzler AM, Monsef I, Stadelmaier J, Wabnitz K, Litwin T, Kreutz C, Boger AH, Lindner S, Verboom B, Voss S, Movsisyan A. Non-pharmacological measures implemented in the setting of long-term care facilities to prevent SARS-CoV-2 infections and their consequences: a rapid review. Cochrane Database Syst Rev 2021; 9:CD015085. [PMID: 34523727 PMCID: PMC8442144 DOI: 10.1002/14651858.cd015085.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Starting in late 2019, COVID-19, caused by the novel coronavirus SARS-CoV-2, spread around the world. Long-term care facilities are at particularly high risk of outbreaks, and the burden of morbidity and mortality is very high among residents living in these facilities. OBJECTIVES To assess the effects of non-pharmacological measures implemented in long-term care facilities to prevent or reduce the transmission of SARS-CoV-2 infection among residents, staff, and visitors. SEARCH METHODS On 22 January 2021, we searched the Cochrane COVID-19 Study Register, WHO COVID-19 Global literature on coronavirus disease, Web of Science, and CINAHL. We also conducted backward citation searches of existing reviews. SELECTION CRITERIA We considered experimental, quasi-experimental, observational and modelling studies that assessed the effects of the measures implemented in long-term care facilities to protect residents and staff against SARS-CoV-2 infection. Primary outcomes were infections, hospitalisations and deaths due to COVID-19, contaminations of and outbreaks in long-term care facilities, and adverse health effects. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and full texts. One review author performed data extractions, risk of bias assessments and quality appraisals, and at least one other author checked their accuracy. Risk of bias and quality assessments were conducted using the ROBINS-I tool for cohort and interrupted-time-series studies, the Joanna Briggs Institute (JBI) checklist for case-control studies, and a bespoke tool for modelling studies. We synthesised findings narratively, focusing on the direction of effect. One review author assessed certainty of evidence with GRADE, with the author team critically discussing the ratings. MAIN RESULTS We included 11 observational studies and 11 modelling studies in the analysis. All studies were conducted in high-income countries. Most studies compared outcomes in long-term care facilities that implemented the measures with predicted or observed control scenarios without the measure (but often with baseline infection control measures also in place). Several modelling studies assessed additional comparator scenarios, such as comparing higher with lower rates of testing. There were serious concerns regarding risk of bias in almost all observational studies and major or critical concerns regarding the quality of many modelling studies. Most observational studies did not adequately control for confounding. Many modelling studies used inappropriate assumptions about the structure and input parameters of the models, and failed to adequately assess uncertainty. Overall, we identified five intervention domains, each including a number of specific measures. Entry regulation measures (4 observational studies; 4 modelling studies) Self-confinement of staff with residents may reduce the number of infections, probability of facility contamination, and number of deaths. Quarantine for new admissions may reduce the number of infections. Testing of new admissions and intensified testing of residents and of staff after holidays may reduce the number of infections, but the evidence is very uncertain. The evidence is very uncertain regarding whether restricting admissions of new residents reduces the number of infections, but the measure may reduce the probability of facility contamination. Visiting restrictions may reduce the number of infections and deaths. Furthermore, it may increase the probability of facility contamination, but the evidence is very uncertain. It is very uncertain how visiting restrictions may adversely affect the mental health of residents. Contact-regulating and transmission-reducing measures (6 observational studies; 2 modelling studies) Barrier nursing may increase the number of infections and the probability of outbreaks, but the evidence is very uncertain. Multicomponent cleaning and environmental hygiene measures may reduce the number of infections, but the evidence is very uncertain. It is unclear how contact reduction measures affect the probability of outbreaks. These measures may reduce the number of infections, but the evidence is very uncertain. Personal hygiene measures may reduce the probability of outbreaks, but the evidence is very uncertain. Mask and personal protective equipment usage may reduce the number of infections, the probability of outbreaks, and the number of deaths, but the evidence is very uncertain. Cohorting residents and staff may reduce the number of infections, although evidence is very uncertain. Multicomponent contact -regulating and transmission -reducing measures may reduce the probability of outbreaks, but the evidence is very uncertain. Surveillance measures (2 observational studies; 6 modelling studies) Routine testing of residents and staff independent of symptoms may reduce the number of infections. It may reduce the probability of outbreaks, but the evidence is very uncertain. Evidence from one observational study suggests that the measure may reduce, while the evidence from one modelling study suggests that it probably reduces hospitalisations. The measure may reduce the number of deaths among residents, but the evidence on deaths among staff is unclear. Symptom-based surveillance testing may reduce the number of infections and the probability of outbreaks, but the evidence is very uncertain. Outbreak control measures (4 observational studies; 3 modelling studies) Separating infected and non-infected residents or staff caring for them may reduce the number of infections. The measure may reduce the probability of outbreaks and may reduce the number of deaths, but the evidence for the latter is very uncertain. Isolation of cases may reduce the number of infections and the probability of outbreaks, but the evidence is very uncertain. Multicomponent measures (2 observational studies; 1 modelling study) A combination of multiple infection-control measures, including various combinations of the above categories, may reduce the number of infections and may reduce the number of deaths, but the evidence for the latter is very uncertain. AUTHORS' CONCLUSIONS This review provides a comprehensive framework and synthesis of a range of non-pharmacological measures implemented in long-term care facilities. These may prevent SARS-CoV-2 infections and their consequences. However, the certainty of evidence is predominantly low to very low, due to the limited availability of evidence and the design and quality of available studies. Therefore, true effects may be substantially different from those reported here. Overall, more studies producing stronger evidence on the effects of non-pharmacological measures are needed, especially in low- and middle-income countries and on possible unintended consequences of these measures. Future research should explore the reasons behind the paucity of evidence to guide pandemic research priority setting in the future.
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Affiliation(s)
- Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Renke L Biallas
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Laura Arnold
- Academy of Public Health Services, Duesseldorf, Germany
| | - Karin Geffert
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Angela M Kunzler
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Wabnitz
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Tim Litwin
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Clemens Kreutz
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Anna Helen Boger
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Saskia Lindner
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ben Verboom
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Resciniti NV, Fuller M, Sellner J, Lohman MC. COVID-19 Incidence and Mortality Among Long-Term Care Facility Residents and Staff in South Carolina. J Am Med Dir Assoc 2021; 22:2026-2031.e1. [PMID: 34481792 PMCID: PMC8364806 DOI: 10.1016/j.jamda.2021.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022]
Abstract
Objectives This study explored differences in COVID-19 incidence, mortality, and timing among long-term care facility (LTCF) residents and staff with those living in the community in South Carolina (SC). Design Longitudinal secondary data analysis. Setting and Participants Adults age ≥18 in SC with confirmed COVID-19 diagnosis from 3/15/2020 and 1/2/2021 (n = 307,891). Methods COVID-19 data came from the SC Department of Health and Environmental Control (SCDHEC). We included all COVID-19 cases, hospitalizations, and deaths among adult residents. Residence and employment in LTCF were confirmed by SCDHEC. Descriptive statistics and trends for cases, hospitalizations, and deaths were calculated. We used Cox proportional hazards to compare COVID-19 mortality in LTCF residents and staff to community dwelling older adults and adults not employed in LTCF, respectively, controlling for age, gender, race, and pre-existing chronic health conditions. Results LTC residents experienced greater incidence of cases throughout the study period until the week ending on 1/2/21. LTCF residents with COVID-19 were more likely to be hospitalized compared to older adults in the community and 74% more likely to die (HR: 1.74, 95% CI: 1.59-1.90), after adjusting. LTC staff experienced greater incidence of cases compared to adults not employed in LTCF until the week ending on 12/26/2020, while experiencing similar incidence of death compared to the similar community members. After adjusting, LTC staff had 0.58 (HR = 0.58; CI: 0.39-0.88) times lower hazard of death compared to community members that did not work in a LTCF. Conclusions and Implications Narrowing of the gap between LTCF and community-wide infection and mortality rates over the study period suggests that early detection of COVID-19 in LTCFs could serve as a first indicator of disease spread in the greater community. Results also indicate that policies and regulations addressing staff testing and protection may help to slow or prevent spread within facilities.
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Affiliation(s)
- Nicholas V Resciniti
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Morgan Fuller
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Joshua Sellner
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Spacey A, Porter S, Board M, Scammell J. Impact of the COVID-19 pandemic on end of life care delivery in care homes: A mixed method systematic review. Palliat Med 2021; 35:1468-1479. [PMID: 34328031 DOI: 10.1177/02692163211029806] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Current evidence suggests that COVID-19 is having a negative impact on the delivery of end of life care in care homes around the world. There is a need to collate current evidence to provide a comprehensive overview to assess extent of the problem. AIM To describe and evaluate the impact of the COVID-19 pandemic on end of life care delivery in care homes. DESIGN Systematic review and narrative synthesis of studies reporting qualitative and quantitative data. DATA SOURCES The databases MEDLINE, psycINFO, SCOPUS and CINAHL were searched between December 2019 and March 2021. RESULTS Nine studies were included. For care home staff, challenges included significant increases in responsibility and exposure to death, both of which have taken an emotional toll. Results indicate that staff tended not to be offered adequate emotional support or afforded the time to grieve. For those receiving end of life care, results indicate that the end of life care that they tended to receive, especially in the form of advance planning, was disrupted by the pandemic. CONCLUSION The effect of the pandemic has been to exacerbate existing problems in the provision of end of life care in care homes for both service providers and users, making that which was previously opaque starkly visible. Future research is needed to explore the effects of the pandemic and its management on those receiving end of life care in care homes and their significant others.
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Affiliation(s)
- Adam Spacey
- School of Health and Society, University of Salford, Salford, UK
| | - Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, Bournemouth, UK
| | - Michele Board
- Department of Nursing Science, Bournemouth University, Poole, UK
| | - Janet Scammell
- Department of Nursing Science, Bournemouth University, Poole, UK
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Dykgraaf SH, Matenge S, Desborough J, Sturgiss E, Dut G, Roberts L, McMillan A, Kidd M. Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence. J Am Med Dir Assoc 2021; 22:1969-1988. [PMID: 34428466 PMCID: PMC8328566 DOI: 10.1016/j.jamda.2021.07.027] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long-term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision making. DESIGN Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long-term care. SETTING AND PARTICIPANTS Residents and staff in care settings such as nursing homes and long-term care facilities. METHODS PubMed/Medline, Cochrane Library, and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (eg, commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesized narratively using tabulated data extracts and summary tables. RESULTS Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational, with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control measures. Symptom- or temperature-based screening and single point-prevalence testing were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications, and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher-performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, intersectoral collaboration, and policy that facilitated access to critical resources were all significant enablers of success. CONCLUSIONS AND IMPLICATIONS High-quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though it continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long-term care residents from COVID-19 and other infectious diseases. This rapid review summarizes current evidence regarding strategies that may be effective.
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Affiliation(s)
- Sally Hall Dykgraaf
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia.
| | - Sethunya Matenge
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Jane Desborough
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Elizabeth Sturgiss
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Garang Dut
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Leslee Roberts
- Medical Advisory Unit, Primary Care Division, Australian Government Department of Health, Canberra ACT, Australia
| | - Alison McMillan
- Australian Government Department of Health, Canberra ACT, Australia
| | - Michael Kidd
- Australian Government Department of Health, Canberra ACT, Australia
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Risk Factors Associated with Nursing Home COVID-19 Outbreaks: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168434. [PMID: 34444183 PMCID: PMC8394924 DOI: 10.3390/ijerph18168434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 12/12/2022]
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic had a devastating impact on nursing homes/long-term care facilities. This study examined the relationship between geography, size, design, organizational characteristics, and implementation of infection prevention and control (IPC) measures and the extent of COVID-19 outbreaks in nursing homes in the Autonomous Province of Trento (Italy) during the time frame of March-May 2020. Methods: The analysis included 57 nursing homes (5145 beds). The association between median cumulative incidence of COVID-19 cases among residents and characteristics of nursing homes was assessed by Mann–Whitney U test, Kruskal–Wallis test or Spearman rho. To evaluate the potential confounding of geographical area, a 2-level random intercept logistic model was fitted, with level 1 units (patients in nursing homes) nested into level 2 units (nursing homes), and “being a COVID-19 case” as the dependent variable. Results: Median cumulative incidence was not significantly associated with any of the variables, except for geographical region (p = 0.002). COVID-19 cases clustered in the part of the province bordering the Italian region most affected by the pandemic (Lombardy) (45.2% median cumulative incidence). Conclusions: Structural/organizational factors and standard IPC measures may not predict the epidemiology of COVID-19 outbreaks and be sufficient alone to protect nursing homes against them.
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Dellazizzo L, Léveillé N, Landry C, Dumais A. Systematic Review on the Mental Health and Treatment Impacts of COVID-19 on Neurocognitive Disorders. J Pers Med 2021; 11:jpm11080746. [PMID: 34442390 PMCID: PMC8401453 DOI: 10.3390/jpm11080746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 01/10/2023] Open
Abstract
Objectives. The COVID-19 pandemic has had many public health impacts, especially on vulnerable individuals including adults with neurocognitive disorders (NCD). With increasing literature, this systematic literature review aimed to address the mental health effects of COVID-19 on people with NCD in addition to examine the impact of the pandemic on treatments/resources for NCD. Methods. A literature search was conducted in the electronic databases of PubMed, PsycINFO, Web of Science and Google Scholar. Studies were included so long as they assessed the mental health or therapeutic effects of COVID-19 on NCD. Results. Among the retrieved articles, 59 met eligibility criteria. First, the pandemic and resulting self-isolation led to many detrimental effects on psychological well-being. Exacerbation and relapses of neurocognitive and behavioral symptoms were observed, as well as emergences of new psychological symptoms (i.e., depression, anxiety). Second, therapeutic and community services for individuals suffering from NCD, such as social support services and outpatient clinics, were disrupted or reduced leading to postponed appointments and evaluations, as well as reduced access to medications. These issues were somewhat palliated with the growth of telemedicine. Conclusions. This systematic review highlights the extent of the effects of the pandemic, and the topics addressed should be taken into consideration by healthcare practitioners, institutions, and policymakers to ensure that proper measures are employed to protect this population from additional harm.
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Affiliation(s)
- Laura Dellazizzo
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, QC H1N 3V2, Canada; (L.D.); (N.L.); (C.L.)
- Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada
| | - Nayla Léveillé
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, QC H1N 3V2, Canada; (L.D.); (N.L.); (C.L.)
- Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada
| | - Clara Landry
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, QC H1N 3V2, Canada; (L.D.); (N.L.); (C.L.)
- Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada
| | - Alexandre Dumais
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, QC H1N 3V2, Canada; (L.D.); (N.L.); (C.L.)
- Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, 10905 Blvd Henri-Bourassa E, Montreal, QC H1C 1H1, Canada
- Correspondence:
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Brito Fernandes Ó, Lobo Julião P, Klazinga N, Kringos D, Marques N. COVID-19 Preparedness and Perceived Safety in Nursing Homes in Southern Portugal: A Cross-Sectional Survey-Based Study in the Initial Phases of the Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157983. [PMID: 34360296 PMCID: PMC8345424 DOI: 10.3390/ijerph18157983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 12/03/2022]
Abstract
(1) Background: Nursing homes’ preparedness in managing a public health emergency has been poor, with effects on safety culture. The objective of this study was to assess nursing homes’ COVID-19 preparedness in southern Portugal, including staff’s work experiences during the pandemic. (2) Methods: We used a COVID-19 preparedness checklist to be completed by management teams, followed by follow-up calls to nursing homes. Thereafter, a survey of staff was applied. Data analysis included descriptive statistics, exploratory factor analysis, and thematic analysis of open-end questions. (3) Results: In total, 71% (138/195) of eligible nursing homes returned the preparedness checklist. We conducted 83 follow-up calls and received 720 replies to the staff survey. On average, 25% of nursing homes did not have an adequate decision-making structure to respond to the pandemic. Outbreak capacity and training were areas for improvement among nursing homes’ contingency plans. We identified teamwork as an area of strength for safety culture, whereas compliance with procedures and nonpunitive response to mistakes need improvement. (4) Conclusions: To strengthen how nursing homes cope with upcoming phases of the COVID-19 pandemic or future public health emergencies, nursing homes’ preparedness and safety culture should be fostered and closely monitored.
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Affiliation(s)
- Óscar Brito Fernandes
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093 Budapest, Hungary
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.K.); (D.K.)
- Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal
- Algarve Biomedical Center, Campus Gambelas, University of Algarve, 8005-139 Faro, Portugal; (P.L.J.); (N.M.)
- Correspondence:
| | - Pedro Lobo Julião
- Algarve Biomedical Center, Campus Gambelas, University of Algarve, 8005-139 Faro, Portugal; (P.L.J.); (N.M.)
- Faculty of Medicine and Biomedical Sciences, Campus Gambelas, University of Algarve, 8005-139 Faro, Portugal
| | - Niek Klazinga
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.K.); (D.K.)
| | - Dionne Kringos
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.K.); (D.K.)
| | - Nuno Marques
- Algarve Biomedical Center, Campus Gambelas, University of Algarve, 8005-139 Faro, Portugal; (P.L.J.); (N.M.)
- Faculty of Medicine and Biomedical Sciences, Campus Gambelas, University of Algarve, 8005-139 Faro, Portugal
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Candel FJ, Barreiro P, San Román J, Carretero MM, Sanz JC, Perez-Abeledo M, Ramos B, Viñuela-Prieto JM, Canora J, Martínez-Peromingo FJ, Barba R, Zapatero A. The demography and characteristics of SARS-CoV-2 seropositive residents and staff of nursing homes for older adults in the Community of Madrid: the SeroSOS study. Age Ageing 2021; 50:1038-1047. [PMID: 33945607 PMCID: PMC8135991 DOI: 10.1093/ageing/afab096] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Nursing homes for older adults have concentrated large numbers of severe cases and deaths for COVID-19. Methods: Point seroprevalence study of nursing homes to describe the demography and characteristic of SARS-CoV-2 IgG-positive residents and staff. Results: Clinical information and blood samples were available for 9,332 residents (mean age 86.7 ± 8.1 years, 76.4% women) and 10,614 staff (mean age 45.6 ± 11.5, 86.2% women). Up to 84.4% of residents had frailty, 84.9% co-morbidity and 69.3% cognitive impairment; 65.2% of workers were health-aides. COVID-19 seroprevalence was 55.4% (95% CI, 54.4–56.4) for older adults and 31.5% (30.6–32.4) for staff. In multivariable analysis frailty of residents was related with seropositivity (OR: 1.19, p = 0.02). In the case of staff, age > 50 years (2.10, p < 0.001), obesity (1.19, p = 0.01), being a health-aide (1.94, p < 0.001), working in a center with high seroprevalence in residents (3.49, p < 0.001), and contact with external cases of COVID-19 (1.52, p < 0.001) were factors associated with seropositivity. Past symptoms of COVID-19 were good predictors of seropositivity for residents (5.41, p < 0.001) and staff (2.52, p < 0.001). Conclusions: Level of dependency influences risk of COVID-19 among residents. Individual and work factors, and contacts outside the nursing home are associated with COVID-19 exposure in staff members. It is key to strengthen control measures to prevent the introduction of COVID-19 into care facilities from the community.
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Affiliation(s)
- F J Candel
- Clinical Microbiology and Infectious Diseases, IdISSC and IML Health Institutes, Hospital Universitario San Carlos, Madrid
- Regional Public Health Laboratory, Community of Madrid
| | - P Barreiro
- Address correspondence to: Pablo Barreiro, MD PhD, Infectious Diseases. Internal Medicine. Hospital General Universitario La Paz. Madrid. Spain, E-mail:
| | - J San Román
- Department of Medical Specialties and Public Health, Rey Juan Carlos University, Madrid
- Regional Public Health Laboratory, Community of Madrid
| | - M M Carretero
- Regional Public Health Laboratory, Community of Madrid
| | - J C Sanz
- Regional Public Health Laboratory, Community of Madrid
| | | | - B Ramos
- Regional Public Health Laboratory, Community of Madrid
| | - J M Viñuela-Prieto
- Department of Neurosurgery, Hospital General Universitario La Paz, Madrid
| | - J Canora
- Assistant to the Vice-counselor of Public Health, Community of Madrid
| | | | - R Barba
- Medical Manager, Hospital Universitario Rey Juan Carlos, Madrid
| | - A Zapatero
- Vice-counselor of Public Health, Community of Madrid
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Savio A, Calza S, Guerrini G, Romano V, Marchina E. Rapid Point-Of-Care Serology and Clinical History Assessment Increase Protection Provided by RT-PCR Screening: A Pilot Study Involving Three Nursing Homes in Brescia, a Hotspot of Lombardy. Front Public Health 2021; 9:649524. [PMID: 34249831 PMCID: PMC8264443 DOI: 10.3389/fpubh.2021.649524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/27/2021] [Indexed: 12/21/2022] Open
Abstract
Background: COVID-19 outbursts have been registered worldwide within care homes with asymptomatic transmission combined with shortage/inaccuracy of diagnostic tests undermining the efforts at containment of the disease. Nursing facilities in Lombardy (Italy) were left with no, or limited, access to testing for 8 weeks after the outbreak of COVID-19. Methods: This study includes 246 residents and 286 workers of three different nursing homes in Brescia-Lombardy. Clinical questionnaires and rapid serology tests were devised to integrate the data of the first available RT-PCR screening. Follow-up serology after 60-days was performed on 67 of 86 workers with positive serology or clinically suspicious. Findings: Thirty-seven residents and 18 workers had previous positive RT-PCR. Thorough screening disclosed two additional RT-PCR-positive workers. Serology screening revealed antibodies in 59 residents and 48 workers, including 32/37 residents and all workers previously positive at RT-PCR. Follow up serology disclosed antibodies in two additional workers with recent symptoms at the time of screening. The professionals in close contact with residents had more infections (47/226–20.79% vs. 1/60–1.66%; p = 0.00013 Fisher exact-test). A suspicious clinical score was present in 44/64 residents and in 41/50 workers who tested positive with either method with totally asymptomatic disease more frequent among residents 28.1 vs. 10.0% (p = 0.019 Fisher exact-test). Interpretation: Based on the available RT-PCR ± results at the time of symptoms/contacts, our integrated clinical and serological screening demonstrated sensitivity 89% and specificity 87%. This multimodal assessment proved extremely useful in understanding the viral spread in nursing homes, in defining its stage and in implementing protective measures. Rapid serology tests demonstrated efficient and particularly suited for older people less able to move/cooperate.
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Affiliation(s)
- Antonella Savio
- Histopathology Department, The Royal Marsden Hospital, London, United Kingdom
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | | | | | - Eleonora Marchina
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
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110
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Ballin M, Bergman J, Kivipelto M, Nordström A, Nordström P. Excess Mortality After COVID-19 in Swedish Long-Term Care Facilities. J Am Med Dir Assoc 2021; 22:1574-1580.e8. [PMID: 34174196 PMCID: PMC8223135 DOI: 10.1016/j.jamda.2021.06.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/25/2021] [Accepted: 06/11/2021] [Indexed: 12/12/2022]
Abstract
Objective To compare 30-day mortality in long-term care facility (LTCF) residents with and without COVID-19 and to investigate the impact of 31 potential risk factors for mortality in COVID-19 cases. Design Retrospective cohort study. Setting and Participants All residents of LTCFs registered in Senior Alert, a Swedish national database of health examinations in older adults, during 2019-2020. Methods We selected residents with confirmed COVID-19 until September 15, 2020, along with time-dependent propensity score–matched controls without COVID-19. Exposures were COVID-19, age, sex, comorbidities, medications, and other patient characteristics. The outcome was all-cause 30-day mortality. Results A total of 3731 residents (median age 87 years, 64.5% female) with COVID-19 were matched to 3731 controls without COVID-19. Thirty-day mortality was 39.9% in COVID-19 cases and 5.7% in controls [relative risk 7.05, 95% confidence interval (CI) 6.10-8.14]. In COVID-19 cases, the odds ratio (OR) for 30-day mortality was 2.44 (95% CI 1.57-3.81) in cases aged 80-84 years, 2.99 (95% CI 1.93-4.65) in cases aged 85-89 years, and 3.28 (95% CI 2.11-5.10) in cases aged ≥90 years, as compared with cases aged <70 years. Other risk factors for mortality among COVID-19 cases included male sex (OR, 2.60, 95% CI 2.22-3.05), neuropsychological conditions (OR, 2.18; 95% CI 1.76-2.71), impaired walking ability (OR, 1.45, 95% CI 1.17-1.78), urinary and bowel incontinence (OR 1.51, 95% CI 1.22-1.85), diabetes (OR 1.36, 95% CI 1.14-1.62), chronic kidney disease (OR 1.37, 95% CI 1.11-1.68) and previous pneumonia (OR 1.57, 95% CI 1.32-1.85). Nutritional factors, cardiovascular diseases, and antihypertensive medications were not significantly associated with mortality. Conclusions and Implications In Swedish LTCFs, COVID-19 was associated with a large excess in mortality after controlling for an extensive number of risk factors. Beyond older age and male sex, several prevalent clinical risk factors independently contributed to higher mortality. These findings suggest that reducing transmission of COVID-19 in LTCFs will likely prevent a considerable number of deaths.
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Affiliation(s)
- Marcel Ballin
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden; Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Jonathan Bergman
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Medical Unit Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Nordström
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden; School of Sport Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden.
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111
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Olson NL, Albensi BC. Dementia-Friendly "Design": Impact on COVID-19 Death Rates in Long-Term Care Facilities Around the World. J Alzheimers Dis 2021; 81:427-450. [PMID: 33814449 DOI: 10.3233/jad-210017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Persons with dementia (PWD) make up a large portion of the long-term care (LTC) population the world over. Before a global pandemic swept the world, governments and healthcare providers struggled with how to best care for this unique population. One of the greatest challenges is a PWD's tendency to "walk with purpose" and exhibit unsafe wayfinding and elopement, which places them at risk of falls and injury. Past solutions included increased use of restraints and pharmacological interventions, but these have fallen out of favor over the years and are not optimal. These challenges put enormous strain on staff and caregivers, who are often poorly trained in dementia care, underpaid, overworked, and overstressed. PWD are impacted by these stresses, and unmet needs in LTC places an even greater stress on them and increases their risks of morbidity and mortality. The physical design of their environments contributes to the problem. Old, institutionalized buildings have poor lighting, poor ventilation, long dead-end hallways, poor visual cues, lack of home-like décor, shared bedrooms and bathrooms, and are often dense and overcrowded. These design elements contribute to the four 'A's' of dementia: apathy, anxiety, agitation, and aggression, and they also contributed to the rapid spread of COVID-19 in these facilities the world over. In this review, we present current "dementia friendly" design models in the home, community, and LTC, and argue how they could have saved lives during the pandemic and reduced the stresses on both the dementia resident and the caregiver/staff.
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Affiliation(s)
- Nancy L Olson
- Division of Neurodegenerative Disorders, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada
| | - Benedict C Albensi
- Division of Neurodegenerative Disorders, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada.,Department of Pharmacology & Therapeutics, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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112
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Usher K, Durkin J, Gyamfi N, Warsini S, Jackson D. Preparedness for viral respiratory infection pandemic in residential aged care facilities: A review of the literature to inform post-COVID-19 response. J Clin Nurs 2021:10.1111/jocn.15863. [PMID: 34021650 PMCID: PMC8242770 DOI: 10.1111/jocn.15863] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/12/2021] [Accepted: 05/04/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To examine what was known about disaster preparedness in residential care and to consider this in the light of the current COVID-19 pandemic. BACKGROUND Care homes provide long-term care to vulnerable, frail older people, as well as to young people with profound disabilities. The COVID-19 pandemic has shown that the residential care sector has been seriously affected in many parts of the world and has exposed major flaws and vulnerabilities in infection control and other processes that have resulted in considerable loss of life of residents of these facilities. DESIGN Discursive paper informed by a systematic literature. Review was carried out in line with PRISMA reporting guidelines. The review protocol was registered with PROSPERO on 2020 [CRD42020211847]. RESULTS The review identified six papers meeting inclusion criteria across care residential facilities in different countries. Several prevention and mitigation strategies were identified to manage and reduce the spread and severity of viral respiratory infection pandemics. These strategies include isolation, restriction of movement, personal protective and hygienic measures, health education and information sharing, monitoring and coordination, and screening and treatment. Preparedness strategies identified were contingency planning such as reporting/communication, leadership, human resource, insurance, occupational health and resource availability. The prevention/mitigation and preparedness strategies helped to achieve decline in disease severity, reduced prevalence, reduced spread of the disease, improved readiness criteria, resource usefulness and increased intervention acceptability. This paper presents a conceptual framework exploring the interconnectedness of preparedness and prevention/ mitigation strategies and associated outcomes. We discuss areas of concern in the context of workforce employment patterns in the sector. Concerns related to the unintended consequences of strategies placed on aged care facilities, which may worsen mental health outcomes for residents, are discussed. CONCLUSIONS Persons in residential care settings are at greater risk of infection during a pandemic, and therefore, strict measures to protect their safety are warranted. However, they are also a group who already experience social isolation and so any measures involving restrictions to visiting and social interaction, particularly over the longer term, must be accompanied by strategies to mitigate potential loneliness and mental health sequelae arising from long-term pandemic restrictions. RELEVANCE TO CLINICAL PRACTICE Though there was evidence of activity in preparedness for disasters within the residential care sector, various contextual factors affecting the sector were clearly not adequately considered or addressed in pre-pandemic disaster planning, particularly in the areas of staff movements between care homes and the length of time that social isolation and restriction measures would need to be in place. Future pandemic planning should consider the nature of the workforce model in the care home sector, and factor in strategies to better support the mobile and highly casualised workforce.
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Affiliation(s)
- Kim Usher
- School of HealthUniversity of New EnglandArmidaleNSWAustralia
| | - Joanne Durkin
- School of HealthUniversity of New EnglandArmidaleNSWAustralia
| | - Naomi Gyamfi
- School of HealthUniversity of New EnglandArmidaleNSWAustralia
| | | | - Debra Jackson
- Susan Wakil School of NursingUniversity of SydneySydneyNSWAustralia
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113
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Wang MX, Gwee SXW, Pang J. Micronutrients Deficiency, Supplementation and Novel Coronavirus Infections-A Systematic Review and Meta-Analysis. Nutrients 2021; 13:1589. [PMID: 34068656 PMCID: PMC8151981 DOI: 10.3390/nu13051589] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Micronutrients play roles in strengthening and maintaining immune function, but their supplementation and/or deficiency effects on respiratory tract infections are inconclusive. This review aims to systematically assess the associations between micronutrient supplementation or deficiency, with novel coronavirus incidence and disease severity. METHODS Systematic literature searches conducted in five electronic databases identified 751 unique studies, of which 33 studies (five supplementation studies, one supplementation and deficiency study, and 27 deficiency studies) were eventually included in this review. Proportions of incidence and severity outcomes in each group, and adjusted summary statistics with their relevant 95% confidence intervaIs (CI) were extracted. Data from 19 studies were pooled in meta-analysis using the generic inverse variance method. FINDINGS A total of 360,346 patients across 16 countries, with a mean age between 32 and 87.7 years, were involved across 33 studies. All studies were on COVID-19 infections. In individuals without micronutrient deficiency, there was a significant reduction on odds of COVID-19 incidence (pooled OR: 0.37, 95% CI: 0.18, 0.78), and ICU admissions or severe/critical disease onset when combined as a severity outcome (pooled OR: 0.26, 95% CI: 0.08, 0.89). Insignificant protective effects were observed on other outcome measures, namely mortality, ICU admission, progression to respiratory-related complications, severe/critical disease onset or requiring respiratory support and hospitalization rate. CONCLUSION The absence of micronutrient deficiency significantly reduced COVID-19 incidence and clinical deterioration in hospitalized patients. Usage of micronutrients as prophylaxis and complementary supplement in therapeutic management of COVID-19 patients may be a promising and cost-effective approach warranting in-depth investigation.
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Affiliation(s)
- Min Xian Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; (M.X.W.); (S.X.W.G.)
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore 117549, Singapore
| | - Sylvia Xiao Wei Gwee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; (M.X.W.); (S.X.W.G.)
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore 117549, Singapore
| | - Junxiong Pang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; (M.X.W.); (S.X.W.G.)
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore 117549, Singapore
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114
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Hower KI, Pfaff H, Pförtner TK. Is time a healer? Course of demands during the COVID-19 pandemic in long-term care: a repeated cross-sectional survey in Germany. J Public Health (Oxf) 2021; 43:e435-e437. [PMID: 33963412 PMCID: PMC8136012 DOI: 10.1093/pubmed/fdab144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 12/04/2022] Open
Abstract
In the course of the coronavirus disease 2019 pandemic, long-term nursing care facilities are faced with general and pandemic-specific demands. In our study, we examined their burden from the perspective of managers in long-term nursing care facilities and how it differed in outpatient and inpatient settings. A cross-sectional online survey of long-term care managers was conducted in April 2020 (n = 503) and December 2020/January 2021 (n = 294). Burdens have increased over the course of the pandemic especially for outpatient facilities and in terms of general demands referring to staff (e.g. (staff shortages and overload) and work organization (e.g. compliance with regulations on working hours or staffing ratio). Concerns about infections of people in need of care and of employees remain the highest burden in the course of the pandemic. This knowledge helps us to draw implications from the pandemic and to prepare for future crises.
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Affiliation(s)
- Kira Isabel Hower
- Faculty of Human Sciences, IMVR, University of Cologne, Cologne, Germany.,Faculty of Medicine, IMVR, University Hospital Cologne, Cologne, Germany
| | - Holger Pfaff
- Faculty of Human Sciences, IMVR, University of Cologne, Cologne, Germany.,Faculty of Medicine, IMVR, University Hospital Cologne, Cologne, Germany
| | - Timo-Kolja Pförtner
- Faculty of Human Sciences, IMVR, University of Cologne, Cologne, Germany.,Faculty of Medicine, IMVR, University Hospital Cologne, Cologne, Germany
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115
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Shaw Stewart PD, Bach JL. Temperature dependent viral tropism: understanding viral seasonality and pathogenicity as applied to the avoidance and treatment of endemic viral respiratory illnesses. Rev Med Virol 2021; 32:e2241. [PMID: 33942417 PMCID: PMC8209954 DOI: 10.1002/rmv.2241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 12/29/2022]
Abstract
This review seeks to explain three features of viral respiratory illnesses that have perplexed generations of virologists: (1) the seasonal timing of respiratory illness and the rapid response of outbreaks to weather, specifically temperature; (2) the common viruses causing respiratory illness worldwide, including year‐round disease in the Tropics; (3) the rapid arrival and termination of epidemics caused by influenza and other viruses. The inadequacy of the popular explanations of seasonality is discussed, and a simple hypothesis is proposed, called temperature dependent viral tropism (TDVT), that is compatible with the above features of respiratory illness. TDVT notes that viruses can spread more effectively if they moderate their pathogenicity (thereby maintaining host mobility) and suggests that endemic respiratory viruses accomplish this by developing thermal sensitivity within a range that supports organ‐specific viral tropism within the human body, whereby they replicate most rapidly at temperatures below body temperature. This can confine them to the upper respiratory tract and allow them to avoid infecting the lungs, heart, gut etc. Biochemical and tissue‐culture studies show that ‘wild’ respiratory viruses show such natural thermal sensitivity. The typical early autumn surge of colds and the occurrence of respiratory illness in the Tropics year‐round at intermediate levels are explained by the tendency for strains to adapt their thermal sensitivity to their local climate and season. TDVT has important practical implications for preventing and treating respiratory illness including Covid‐19. It is testable with many options for experiments to increase our understanding of viral seasonality and pathogenicity.
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116
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Davidsen AH, Petersen MS. The Impact of COVID-19 Restrictions on Mental Well-Being and Working Life among Faroese Employees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4775. [PMID: 33947133 PMCID: PMC8125278 DOI: 10.3390/ijerph18094775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/08/2021] [Accepted: 04/24/2021] [Indexed: 12/24/2022]
Abstract
The societal changes caused by COVID-19 have been far-reaching, causing challenges for employees around the world. The aim of this study was to assess the effect of the COVID-19 restrictions on mental well-being, working life, family life and social life among Faroese employees within a broad range of professions. A total of 1328 Faroese employees answered an anonymous self-report survey from 13 April to 4 May 2020. Employee mental well-being was only modestly affected by the restrictions and the respondents had a mean score of 50.7 on the Warwick-Edinburgh Mental Wellbeing Scale where a score between 41-44 is found to correspond with possible depression. Work commitment, work and family life, work satisfaction and work ability were all rated significantly worse after the COVID-19 outbreak than before (all p values < 0.005). Contrary to previous research, employees in health services assessed their work ability significantly higher than employees in teaching, and child and youth care (p < 0.05). Working parents had higher levels of stress and assessed their work ability significantly lower than employees without children (p < 0.05), and women tended to be more worried than men because of the pandemic. In conclusion, the overall mental well-being of Faroese employees was on an average level during lock-down in April and May 2020. Their working life seemed, however, to be worse than usual.
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Affiliation(s)
- Annika H. Davidsen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, 100 Torshavn, Faroe Islands;
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117
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Jain V, Schwarz L, Lorgelly P. A Rapid Review of COVID-19 Vaccine Prioritization in the U.S.: Alignment between Federal Guidance and State Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3483. [PMID: 33801651 PMCID: PMC8036633 DOI: 10.3390/ijerph18073483] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Population groups to be prioritized for COVID-19 vaccinations in the U.S. have been determined at the Federal level, but there is variation in how States have implemented guidance. This review examines how the position of population groups in vaccine priority lists varies between Federal guidance and State practice. METHODS An online search of State vaccination prioritization plans was conducted. Data were extracted on each population group included and their relative position. A standardized ranking method was applied to provide a directional measure of variability in prioritization between State and Federal guidance, for each population group. RESULTS Healthcare workers and those in long-term care facilities were largely prioritized in line with Federal guidance. Aside from early education staff, essential workers were often excluded at State level. Almost all States included the 65-74 year age group and most assigned them to a higher position than recommended in Federal guidance. Those with underlying medical conditions were similarly highly prioritized, although there was more variability across States. Some socially vulnerable groups (not included in Federal guidance) were highly prioritized by many States. CONCLUSIONS The prioritization of groups for COVID-19 vaccination has been highly variable despite clear Federal guidance. Future guidance must be relevant to local needs, values, and constraints, to minimize any unwarranted heterogeneity in vaccine access across populations.
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Affiliation(s)
- Vageesh Jain
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | - Lara Schwarz
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA 92093, USA;
| | - Paula Lorgelly
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK;
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