[Consequences of the COVID-19 lockdown in patients with chronic diseases in Andalusia]

Impact of the COVID-19 pandemic on the self-care and health condition of the older adults. CUIDAMOS+75. A mixed methods study protocol

Aims

To assess the impact of the COVID-19 pandemic on the health condition of people ≥75 years of age and on their family caregivers in Spain.

Design

Multicentric, mixed method concurrent study.

Methods

This work, which will be conducted within the primary care setting in 11 administrative regions of Spain, will include three coordinated studies with different methodologies. The first is a population-based cohort study that will use real-life data to analyze the rates and evolution of health needs, care provision, and services utilization before, during, and after the pandemic. The second is a prospective cohort study with 18 months of follow-up that will evaluate the impact of COVID-19 disease on mortality, frailty, functional and cognitive capacity, and quality of life of the participants. Finally, the third will be a qualitative study with a critical social approach to understand and interpret the social, political, and economic dimensions associated with the use of health services during the pandemic. We have followed the SPIRIT Checklist to address trial protocol and related documents. This research is being funded by the Instituto de Salud Carlos III since 2021 and was approved by its ethics committee (June 2022).

Discussion

The study findings will reveal the long-term impact of the COVID-19 pandemic on the older adults and their caregivers. This information will serve policymakers to adapt health policies to the needs of this population in situations of maximum stress, such as that produced by the COVID-19 pandemic.

Trial Registration

Identifier: NCT05249868 [ClinicalTrials.gov].

Health Outcomes for Older Patients with Chronic Diseases During the First Pandemic Year

Background

Worldwide, chronic diseases are prevalent among the older adults, significantly affecting their health and healthcare system. The COVID-19 pandemic exacerbated these challenges, disrupting healthcare services. Our study assesses the impact on older individuals with chronic diseases who were not infected with COVID-19, analyzing comorbidities, medication use, mortality rates, and resource utilization using real data from Aragon, Spain.

Methods

A retrospective observational study, conducted in Aragon, Spain, focused on individuals aged 75 and older with at least one chronic disease, who were not infected of COVID-19. The research used actual data collected during three distinct periods: the first covered the six months prior to the pandemic, the second the six months after the lockdown, and the third the period between six and twelve months. Key variables included socio-demographics, comorbidities, clinical parameters, medication use, and health services utilization.

Results

We included 128.130 older adults. Mean age was 82.88 years, with 60.3% being women. The most common chronic diseases were hypertension (73.2%), dyslipidemia (52.5%), and dorsopathies (31.5%). More than 90% had more than 2 conditions. A notable decline in new chronic disease diagnoses was observed, particularly pronounced in the six to twelve months period after lockdown. Although statistically significant differences were observed in all clinical variables analyzed, they were considered clinically irrelevant. Furthermore, a decrease in healthcare services utilization and medication prescriptions was reported.

Conclusion

Our study highlights a decrease in new chronic disease diagnoses, ongoing reductions in healthcare utilization, and medication prescriptions for older adults with pre-existing chronic conditions, unaffected by COVID-19.

Etiopathogenic theories about long COVID

The main etiopathogenic theories of long coronavirus disease (COVID) are listed and a conjunction of them is carried out with the objective of deciphering the pathophysiology of the entity, finally the main lines of treatment existing in real life are discussed (Paxlovid, use of antibiotics in dysbiosis, triple anticoagulant therapy, temelimab).

[Impact of the COVID-19 pandemic above a universal electronic consultation program (e-consultation) between general practitioners and cardiologists]

Blackground and objective

Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are not data of models between clinicians. Our objective is to analyse the impact of the COVID-19 pandemic on the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our area.

Methods

Patients with at least one e-consultation between 2018 and 2021 were selected. We analysed the impact of the COVID-19 pandemic on activity and waiting time for care, hospitalizations and mortality, taking as a reference the consultations carried out during 2018.

Results

We analysed 25,121 patients. Through logistic regression analysis, it was observed that a shorter delay in care and resolution of the e-consultation without the need for face-to-face care were associated with a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated with worse health outcomes compared to 2018.

Conclusions

The results of our study show a significant reduction in e-consult referrals during the first year of the COVID-19 pandemic with a subsequent recovery in the demand for care without the pandemic periods being associated with worse outcomes. The reduction in the time elapsed for solving the e-consult and no need for in-person visit were associated with better outcomes.

Bridging the educational gap in terms of digital competences between healthcare institutions' demands and professionals' needs

BACKGROUND

Healthcare professionals with insufficient digital competence can be detrimental to patient safety and increase the incidence of errors. In order to guarantee proper care, healthcare organizations should provide opportunities to learn how to use technology, especially for those professionals who have not received training about this topic during their undergraduate studies.

OBJECTIVE

This exploratory study aimed to conduct surveys among Spanish healthcare professionals to determine whether their organisations had trained them in the use of healthcare technology and the areas where most emphasis was placed.

METHODS

1624 Spanish healthcare professionals responded to an ad hoc online survey 7 questions related to the digital skill training offered by the healthcare organisations they work for.

RESULTS

Nurses were the most widely represented group, making up 58.29% of the total, followed by physicians namely 26.49%. Only 20% of the nurses surveyed had received some training from their institution related to healthcare technology. According to the participants' responses, physicians received significantly more training in this area than nurses. Training related to database searching for research purposes or computer management followed the same trend. Nurses also received less training than physicians in this area. 32% of physicians and nurses paid for their own training if they did not receive any training from institutions.

CONCLUSIONS

Nurses receive less training, on topics such as database searching or management, from the healthcare centres and hospitals where they work. Moreover, they also have fewer research and digital skills. Both of these factors may lead to deficits in their care activities, and have adverse effects on patients. Not to mention fewer opportunities for professional progress.

Repeatability, Reproducibility, and Concurrent Validity of a Stethoscope and Health App System for the Quantification of Breath Rate in Healthy Adults: Repeatability and Validity Study

BACKGROUND

Apps for smartphones that can measure the breathing rate easily can be downloaded.

OBJECTIVE

The aim of this study was to demonstrate agreement in measuring breath rates between the stethoscope and Breath Counter health app.

METHODS

We performed a repeatability study with 56 healthy volunteers. The patient's demographic data and breathing rates per minute were collected. Breathing rates were measured via two methods: (1) using a stethoscope placed in the upper area of the right lung and (2) a Breath Counter app developed by Vadion on a Samsung Fold smartphone.

RESULTS

This study demonstrated high repeatability and validity with respect to the breathing rate parameter of healthy adults using the aforementioned 2 systems. Intrasession repeatability measure using the intraclass correlation coefficient was >0.962, indicating excellent repeatability. Moreover, the intraclass correlation coefficient between methods was 0.793, indicating good repeatability, and coefficients of variation of method errors values were 1.83% with very low values in terms of other repeatability parameters. We found significant correlation coefficients and no systematic differences between the app and stethoscope methods.

CONCLUSIONS

The app method may be attractive to individuals who require repeatability in a recreational setting.

[Diagnostic delay in rare diseases: between fear and resilience]

OBJECTIVE

To describe the impact of diagnosis delay in rare diseases and analyze psychosocial needs related to this delay in patients.

METHOD

The qualitative approach has been used by conducting online group interviews with patients and family members in the Valencian Region (Spain) and a content analysis has been carried out. Two categories were differentiated: with diagnostic delay of 1 year or more and without diagnostic delay. Five interviews were conducted with a total of 25 participants.

RESULTS

The content analysis showed unequal aspects vs. common aspects, in persons with or without diagnostic delay. People with delay expressed the need to feel supported in order to live with continuous uncertainty. People without delay verbalized the importance of adequate communication between patients and professionals. The problems by the COVID-19 were common in both groups; the participants expressed that they did not feel unattended in their disease by the health services.

CONCLUSIONS

High resilience and coping capacity has been identified in people with rare disease, regardless of whether they have suffered diagnostic delay or not. The professional psychosocial support during the diagnostic process of these rare diseases is essential.

The Mental Health of the Peruvian Older Adult during the COVID-19 Pandemic

During the pandemic, the elderly population was the most exposed to disease and changes in their daily lives. The objective was to determine the association between demographic factors, access to health services, sources of information, and physical symptoms in the mental health of the elderly during the COVID-19 pandemic-a study with 3828 older adults residing in nine cities in Peru. The data was collected using a web-based survey, and the instruments of demographic data; exposure to information (radio, television, and internet); and presence of physical symptoms, anxiety, and perceived stress were used. Descriptive and analytical analysis was performed. Female sex, those aged between 60 and 79 years old, those with secondary education, those in their own home, those residing in an urban area, and those using public services of health predominated in this study. Likewise, 62.9% presented depressive symptoms; on the stress scale, an average of 27.81 (SD = 8.71), and on the anxiety scale, an average of 27.24 (SD = 6.04). Moreover, 65.1% reported fatigue, 62.2% had a headache, and 61.2% lack of energy. There is an association between demographic variables and the physical and psychological symptoms of stress, anxiety, and depressive symptoms in the elderly during the pandemic.

[What have we missed because of COVID-19? Missed diagnoses and delayed follow-ups. SESPAS Report 2022]

La pandemia de COVID-19 y la emergencia de salud pública asociada han afectado a los/las pacientes y a los servicios de salud en lo que respecta a las patologías no relacionadas con la COVID-19. Diversos estudios han evidenciado su desvinculación con los servicios sanitarios, con disminución de las consultas a los servicios de urgencias, de los ingresos hospitalarios de patologías no COVID-19, así como de la incidencia semanal notificada de enfermedades agudas y nuevos diagnósticos en atención primaria. Paralelamente, la pandemia ha tenido efectos directos e indirectos en las personas con enfermedades crónicas; las dificultades de acceso a los servicios sanitarios, la interrupción de la atención, la saturación del propio sistema y su reorientación hacia formatos no presenciales ha reducido la capacidad de prevenir o controlar las enfermedades crónicas, impactando además en los diferentes ámbitos de la vida de las personas, creando nuevas dificultades sociales y económicas, o agravando las preexistentes antes de la pandemia. Todas estas circunstancias se han ido modificando con cada una de las olas epidémicas. Se presenta una revisión de los estudios más relevantes que han ido analizando este problema y se incorporan como estudio de caso los resultados de un estudio observacional retrospectivo realizado en atención primaria en Madrid, que da cobertura sanitaria a una población de más de 6 millones de personas, y cuyo objetivo ha sido analizar la pérdida de nuevos diagnósticos en las patologías más prevalentes, como los problemas comunes de salud mental, enfermedades cardiovasculares y cerebrovasculares, diabetes tipo 2, enfermedad pulmonar obstructiva crónica y tumores de mama y de colon, en la primera y la segunda olas. Se calcularon las tasas de incidencia anual con su intervalo de confianza para cada patología y se comparó la frecuencia mensual de los nuevos códigos registrados entre el 1 de enero y el 31 de diciembre de 2020 con la media mensual de los recuentos observados para los mismos meses en 2016-2019. La tasa de incidencia anual para todos los procesos estudiados disminuyó en 2020, excepto para los trastornos de ansiedad. En relación con la recuperación de los diagnósticos perdidos, la insuficiencia cardiaca es el único diagnóstico que presenta una recuperación por encima de la media después de la primera ola. Para volver a los niveles prepandémicos de diagnóstico y seguimiento de la patología no COVID-19, el sistema sanitario debe reorganizarse y contemplar acciones específicas para los grupos de mayor riesgo.

Fibromialgia en la nueva era de la infección por SARS-CoV-2 y el síndrome post-COVID-19: una revisión exploratoria

Introducción

La fibromialgia es un síndrome caracterizado por dolor crónico generalizado, rigidez articular, trastornos del sueño, fatiga, ansiedad y episodios depresivos, cuyas manifestaciones clínicas comienzan después de un trauma físico o emocional. Pese a ello, son escasas las publicaciones que describen el impacto clínico de la COVID-19 en los síntomas de fibromialgia.

Objetivo

Mapear la evidencia médica disponible sobre el impacto de la COVID-19 y el síndrome post-COVID en pacientes con y sin diagnóstico de fibromialgia previo a la infección.

Materiales y métodos

Revisión sistemática exploratoria en PubMed y Scopus, considerando artículos en inglés y en español, con datos sobre la fibromialgia en población sobreviviente a la infección por SARS-CoV-2. Se revisaron los registros de ensayos clínicos de las bases de datos de la Organización Mundial de la Salud.

Resultados

Se incluyeron 12 artículos publicados: estudios retrospectivos (n = 4), transversales (n = 2), casos y controles (n = 2), estudios cualitativos (n = 2), cohorte prospectiva (n = 1) y corte longitudinal (n = 1). La población total fue de 3.060 pacientes. Además, se incluyeron registros de un ensayo clínico controlado aleatorizado, un estudio observacional tipo transversal y uno de casos y controles. La suma total de la población estudiada fue de 173 participantes.

Conclusión

Los pacientes sobrevivientes a la COVID-19 con o sin diagnóstico previo de fibromialgia pueden presentar un aumento del dolor crónico, insomnio, rigidez articular y deterioro en la calidad de vida. La población con antecedente de fibromialgia puede verse más afectada por estrés psicológico, lesión tisular a estructuras neuromusculares e inflamación por la infección por SARS-CoV-2.

Self-care of patients with multiple chronic conditions and their caregivers during the COVID-19 pandemic: A qualitative descriptive study

AIMS

Explore the self-care experiences of patients with multiple chronic conditions (MCCs) and caregivers' contributions to patient self-care during COVID-19 pandemic.

DESIGN

A descriptive qualitative design was used. The COREQ checklist was used for study reporting.

METHODS

Individual semi-structured interviews were used to collect data from patients with MCCs and caregivers selected from the dataset of an ongoing longitudinal study. Data analysis was performed through deductive thematic analysis. The middle-range theory of self-care of chronic illness, which entails the three dimensions of self-care maintenance, monitoring and management, was used as a theoretical framework to guide data collection and analysis.

RESULTS

A total of 16 patients and 25 caregivers were interviewed from May to June 2020. The participants were mainly women, with a mean age for patients of 76.25 years and caregivers of 45.76 years; the caregivers were mainly the patients' children (72%). During the pandemic, some patients reported remaining unchanged in their self-care maintenance, monitoring and management behaviours, others intensified their behaviours, and others decreased them. Caregivers played an important role in protecting patients from the risk of contagion COVID-19 and in ensuring patients' self-care of chronic diseases through direct and indirect interventions.

CONCLUSIONS

Critical events can modify the self-care experiences of chronically ill patients and caregivers' contributions, leading to maintenance, increase or decrease of self-care and contributions to self-care behaviours.

IMPACT

Patients with MCCs and their caregivers can react in different ways in their performances of self-care and contribution to patients' self-care behaviours when ordinary daily life is disrupted; therefore, nurses should assess such performances during critical events to identify the individuals at risk of reduced self-care and promote the most suitable healthcare services (e.g. eHealth) to implement individualised interventions.

Effects of the COVID-19 Pandemic on Physical Activity in Chronic Diseases: A Systematic Review and Meta-Analysis

The management of chronic diseases (CD) includes physical activity (PA). It is necessary to determine the effects of COVID-19 restrictions in CD. The aim was to review the research related to PA levels before and during the COVID-19 pandemic in people with CD. This review was designed according to PRISMA guidelines and registered in PROSPERO: CRD42020218825. The search was performed in CINAHL, Medline, Scopus, and Web of Science up to January 2021. The PICOS recommendations were applied. The search was conducted by two reviewers, who completed the data extraction of included articles. Methodological quality was assessed using the STROBE checklist, and a meta-analysis was conducted. The literature search strategy identified 227 articles. Five studies remained and were included. Only three studies were included in the meta-analysis. Two articles used accelerometers to objectively compare PA levels before and during the pandemic. Three studies made this comparison using an online survey. All articles showed a decrease in PA levels during the COVID-19 pandemic. The meta-analysis showed a significant reduction in PA levels during pandemic. PA levels during the COVID-19 pandemic have been reduced with respect to previous levels of PA in patients with CD.