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Jokela-Pansini M, Greenhough B, Cousins O, Dainow J. When you can't find the words: Using body mapping to communicate patients' experiences of Long Covid. Health Place 2024; 89:103302. [PMID: 38991485 DOI: 10.1016/j.healthplace.2024.103302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 07/13/2024]
Abstract
The aim of this paper is to reflect on the value of body mapping in supporting patients to communicate their everyday experiences of Long Covid. Body maps are life-sized drawings of bodies and body mapping is used to discuss experiences through guided questions and answering those questions using colours, images and other prompts. This short paper focuses on the first of four body mapping workshops of this study, which was conducted in June 2023 in London with 4 participants in collaboration with Long Covid Support. Our preliminary results suggest i) body mapping can offer novel insights into patients' experiences of Long Covid, ii) the method may be effectively applied as a tool for patients to communicate their symptoms and overall experiences to practitioners, friends, and family members, and iii) body mapping may be adapted to offer peer support as part of Long Covid advocacy. This has significant potential application as a resource for healthcare professionals and patient-led peer support and Long Covid advocacy work.
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Affiliation(s)
- Maaret Jokela-Pansini
- School of Geography and the Environment, University of Oxford, South Parks Road, Oxford, OX1 3QY, United Kingdom.
| | - Beth Greenhough
- School of Geography and the Environment, University of Oxford, South Parks Road, Oxford, OX1 3QY, United Kingdom
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Elneima O, Hurst JR, Echevarria C, Quint JK, Walker S, Siddiqui S, Novotny P, Pfeffer PE, Brown JS, Shankar-Hari M, McAuley HJ, Leavy OC, Shikotra A, Singapuri A, Sereno M, Richardson M, Saunders RM, Harris VC, Houchen-Wolloff L, Greening NJ, Harrison EM, Docherty AB, Lone NI, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Evans RA, Wain LV, Sheikh A, Brightling CE, De Soyza A, Heaney LG. Long-term impact of COVID-19 hospitalisation among individuals with pre-existing airway diseases in the UK: a multicentre, longitudinal cohort study - PHOSP-COVID. ERJ Open Res 2024; 10:00982-2023. [PMID: 39010888 PMCID: PMC11247371 DOI: 10.1183/23120541.00982-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/06/2024] [Indexed: 07/17/2024] Open
Abstract
Background The long-term outcomes of COVID-19 hospitalisation in individuals with pre-existing airway diseases are unknown. Methods Adult participants hospitalised for confirmed or clinically suspected COVID-19 and discharged between 5 March 2020 and 31 March 2021 were recruited to the Post-hospitalisation COVID-19 (PHOSP-COVID) study. Participants attended research visits at 5 months and 1 year post discharge. Clinical characteristics, perceived recovery, burden of symptoms and health-related quality of life (HRQoL) of individuals with pre-existing airway disease (i.e., asthma, COPD or bronchiectasis) were compared to the non-airways group. Results A total of 615 out of 2697 (22.8%) participants had a history of pre-existing airway diseases (72.0% diagnosed with asthma, 22.9% COPD and 5.1% bronchiectasis). At 1 year, the airways group participants were less likely to feel fully recovered (20.4% versus 33.2%, p<0.001), had higher burden of anxiety (29.1% versus 22.0%, p=0.002), depression (31.2% versus 24.7%, p=0.006), higher percentage of impaired mobility using short physical performance battery ≤10 (57.4% versus 45.2%, p<0.001) and 27% had a new disability (assessed by the Washington Group Short Set on Functioning) versus 16.6%, p=0.014. HRQoL assessed using EQ-5D-5L Utility Index was lower in the airways group (mean±SD 0.64±0.27 versus 0.73±0.25, p<0.001). Burden of breathlessness, fatigue and cough measured using a study-specific tool was higher in the airways group. Conclusion Individuals with pre-existing airway diseases hospitalised due to COVID-19 were less likely to feel fully recovered, had lower physiological performance measurements, more burden of symptoms and reduced HRQoL up to 1 year post-hospital discharge.
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Affiliation(s)
- Omer Elneima
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - John R. Hurst
- UCL Respiratory, Department of Medicine, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Carlos Echevarria
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | | | | | - Salman Siddiqui
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Petr Novotny
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Paul E. Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jeremy S. Brown
- UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Manu Shankar-Hari
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Hamish J.C. McAuley
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Olivia C. Leavy
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Aarti Shikotra
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Marco Sereno
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Matthew Richardson
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Ruth M. Saunders
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Victoria C. Harris
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Linzy Houchen-Wolloff
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University of Leicester, Leicester, UK
| | - Neil J. Greening
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Ewen M. Harrison
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Annemarie B. Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nazir I. Lone
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - James D. Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Ling-Pei Ho
- MRC Translational Discovery Immunology Unit, University of Oxford, Oxford, UK
- NIHR Oxford BRC, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alex Horsley
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
| | | | - Betty Raman
- NIHR Oxford BRC, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rachael A. Evans
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Louise V. Wain
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Chris E. Brightling
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
- Joint senior authors
| | - Anthony De Soyza
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- Joint senior authors
| | - Liam G. Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, Belfast, UK
- Belfast Health and Social Care Trust, Belfast, UK
- Joint senior authors
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Burton A, Bone JK, Lawrence-Lunniss K, Philip KE. Acceptability and feasibility of a theatre-based wellness programme to support people living with long COVID: a single-arm feasibility study. BMJ Open 2024; 14:e083224. [PMID: 38951002 PMCID: PMC11218014 DOI: 10.1136/bmjopen-2023-083224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/12/2024] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVES To determine acceptability and feasibility of a theatre-based wellness programme to support the health and well-being of people with long COVID. DESIGN Single-group, repeated-measures feasibility study. SETTING Community centre and online. PARTICIPANTS Adults with diagnosed long COVID experiencing breathlessness, pain and/or loneliness. INTERVENTION Six-week participatory creative programme delivered to one online and one in-person group facilitated by movement, voice and drama consultants using breathing, visualisation, singing, poetry, storytelling and movement exercises. PRIMARY OUTCOME MEASURES Programme acceptability and feasibility measured via uptake, reasons for non-attendance and barriers to engagement. SECONDARY OUTCOME MEASURES Feasibility of recruitment and data collection procedures measured through proportion of missing data and follow-up rates, mechanisms of action of the programme identified through qualitative interviews, changes in mental health, well-being, quality of life, loneliness, social support, fatigue, breathlessness and post-COVID-19 functional status at 8-week follow-up. RESULTS 21 people expressed interest in participating, 20 people took part in the programme, 19 completed baseline and 16 completed follow-up assessments. Participants attended an average of 4.8 of 6 sessions (SD=1.5, range 2-6). Exploratory analyses demonstrated significant improvements in self-rated health (t-test mean difference=0.12, 95% CI=0.00, 0.23, p=0.04) and chronic fatigue symptoms (mean difference=-3.50, 95% CI=-6.97, -0.03, p=0.05) at 8 weeks. Key mechanisms of action that supported health and well-being included: increased sense of community, illness acceptance, experiencing joy, increased confidence in managing everyday life, increased ability to relax and reconnection with previous identity. Barriers to engagement included: activities being outside of the participant's comfort zone, ongoing long COVID symptoms, emotional consequences of sharing experiences and connectivity and connecting online. CONCLUSIONS A 6-week theatre-based programme was perceived as acceptable to most participants and resulted in some positive psychosocial impacts. The findings provide a rationale for supporting the ongoing development and scale-up of this and related arts programmes to support people living with long COVID.
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Affiliation(s)
- Alexandra Burton
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Jessica K Bone
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | | | - Keir Ej Philip
- National Heart and Lung Institute, Imperial College London, UK; and NIHR Imperial Biomedical Research Centre, London, UK
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Reuschke D, Houston D, Sissons P. Impacts of Long COVID on workers: A longitudinal study of employment exit, work hours and mental health in the UK. PLoS One 2024; 19:e0306122. [PMID: 38924025 PMCID: PMC11207153 DOI: 10.1371/journal.pone.0306122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has had enormous implications for the world of work. However, there has been relatively little focus on the employment and workforce challenges of the virus in relation to workforce health, beyond the immediate management of the spread of the disease. There is an important gap in understanding the ongoing workforce issues created by the significant incidence of Long COVID in the population. AIM This paper examines the effects of Long COVID on employment and workers' mental health to contribute to understanding of work-limiting health conditions and to offer policy implications for COVID-19 and similar health conditions on employment and the workforce. METHODS A large national panel study for the UK is used to estimate the likelihood of exiting employment as well as on changes in working hours and general mental health and happiness of those who remain in work. The sample includes individuals 16 years and older who were in employment in January/February 2020 and followed during the pandemic 2020-2021. Long COVID is self-reported in the data. Informed by conceptual consideration of employment protection in the UK, two groups of individuals with Long COVID are defined based on the duration of symptoms. Group 1 has Long COVID 5-28 weeks after an infection with COVID-19, which is up to the maximum length of Statutory Sick Pay in the UK. Group 2 has symptoms for 29+ weeks, which is beyond the statutory entitlement to sickness pay. Panel regression models are fitted both with fixed-effects and random-effects. Individual and job characteristics are used as controls Those with no COVID-19 symptoms are the reference group. RESULTS In between-person comparison, Group 2 is at higher risk of exiting employment compared to those with no COVID-19 symptoms. Between-person estimates of mental health and well-being show negative effects of Long COVID for both groups but these are greatest in Group 2. Within-person estimates suggest that factors associated with earnings mediate the negative Long COVID effects on mental health in Group 1 and that Group 2 adapts to working with Long COVID. Group 1 is at risk of working zero hours (i.e. being on sick leave) but neither Group 1 nor Group 2 have a higher probability of working fewer hours compared to those with no COVID-19 symptoms. The negative impact of Long COVID on working hours stems primarily from working zero hours (sickness leave) rather than working fewer hours, suggesting a lack of accommodation by employers of Long COVID at work. POLICY IMPLICATIONS The extension of Statutory Sickness Pay and greater flexibility to manage partial (returns to) work would help preserve employment and mental health. Those with Long COVID for 12 months are likely to meet the definition of disability and so have a right to receive reasonable workplace adjustments.
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Affiliation(s)
- Darja Reuschke
- Birmingham Business School, City-Region Economic Development Institute, University of Birmingham, Birmingham, United Kingdom
| | - Donald Houston
- Birmingham Business School, City-Region Economic Development Institute, University of Birmingham, Birmingham, United Kingdom
| | - Paul Sissons
- Keele Business School, Keele University, Staffordshire, United Kingdom
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Rhead R, Wels J, Moltrecht B, Shaw RJ, Silverwood R, Zhu J, Hughes A, Chaturvedi N, Demou E, Katikireddi SV, Ploubidis G. Long COVID and financial outcomes: evidence from four longitudinal population surveys. J Epidemiol Community Health 2024; 78:458-465. [PMID: 38508701 PMCID: PMC11187380 DOI: 10.1136/jech-2023-221059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/22/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Long-term sequelae of COVID-19 (long COVID) include muscle weakness, fatigue, breathing difficulties and sleep disturbance over weeks or months. Using UK longitudinal data, we assessed the relationship between long COVID and financial disruption. METHODS We estimated associations between long COVID (derived using self-reported length of COVID-19 symptoms) and measures of financial disruption (subjective financial well-being, new benefit claims, changes in household income) by analysing data from four longitudinal population studies, gathered during the first year of the pandemic. We employed modified Poisson regression in a pooled analysis of the four cohorts adjusting for a range of potential confounders, including pre-pandemic (pre-long COVID) factors. RESULTS Among the 20 112 observations across four population surveys, 13% reported having COVID-19 with symptoms that impeded their ability to function normally-10.7% had such symptoms for <4 weeks (acute COVID-19), 1.2% had such symptoms for 4-12 weeks (ongoing symptomatic COVID-19) and 0.6% had such symptoms for >12 weeks (post-COVID-19 syndrome). We found that post-COVID-19 syndrome was associated with worse subjective financial well-being (adjusted relative risk ratios (aRRRs)=1.57, 95% CI=1.25, 1.96) and new benefit claims (aRRR=1.79, CI=1.27, 2.53). Associations were broadly similar across sexes and education levels. These results were not meaningfully altered when scaled to represent the population by age. CONCLUSIONS Long COVID was associated with financial disruption in the UK. If our findings reflect causal effects, extending employment protection and financial support to people with long COVID may be warranted.
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Affiliation(s)
- Rebecca Rhead
- Department of Psychological Medicine, King's College London, London, UK
- University College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Jacques Wels
- University College London, London, UK
- BE, Washington, District of Columbia, USA
| | | | - Richard John Shaw
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Jingmin Zhu
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Alun Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, UCL, London, UK
| | | | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - George Ploubidis
- Centre of Longitudinal Studies, University College London, London, UK
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Emıroglu C, Gorpelıoglu S, Ozagar SD, Demır P, Aypak C. Prevalence and risk factors of psychological symptoms and quality of life in COVID-19 survivors: A cross-sectional study of three different populations. Int J Nurs Pract 2024; 30:e13202. [PMID: 37771143 DOI: 10.1111/ijn.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/30/2023]
Abstract
AIM Studies of the effects of COVID-19, especially post-acute COVID-19 syndrome, on psychological health in non-severe cases are limited. We aimed to evaluate the prevalence and associated risk factors of psychological symptoms, and quality-of-life in three groups of outpatients, hospitalized and intensive care patients. METHODS A total 276 patients, previously confirmed with SARS-CoV-2 infection, attending the COVID-19 follow-up outpatient clinic from December 2020 to July 2021 were interviewed face-to-face. In this cross-sectional, retrospective study, all participants were asked our self-designed demographic and screening questions to assess their psychological symptoms and administered the WHQOOL-BREF survey to evaluate quality of life. RESULTS In screening questions, major depressive disorder symptoms were detected at a rate of 20.3%, generalized anxiety disorder symptoms at a rate of 16.7%, panic attack symptoms at a rate of 10.9%, post-traumatic stress disorder symptoms at a rate of 28.6% and obsessive-compulsive disorder symptoms at a rate of 18.1%. The outpatient group with COVID-19 infection had a higher risk of developing psychological symptoms and decreased quality of life. CONCLUSION COVID-19 infection was found to have a considerable psychological impact on those treated as outpatients despite the less severe course of their illness.
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Affiliation(s)
- Canan Emıroglu
- Department of Family Medicine, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ziraat Mahallesi, Dışkapı Altındağ Ankara, Turkey
| | - Süleyman Gorpelıoglu
- Department of Family Medicine, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ziraat Mahallesi, Dışkapı Altındağ Ankara, Turkey
| | - Serap Demirelli Ozagar
- Department of Family Medicine, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ziraat Mahallesi, Dışkapı Altındağ Ankara, Turkey
| | - Pervin Demır
- Department of Statistics, University of Ankara Yıldırım Beyazıt, Ankara, Turkey
| | - Cenk Aypak
- Department of Family Medicine, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ziraat Mahallesi, Dışkapı Altındağ Ankara, Turkey
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Williams PJ, Buttery SC, Laverty AA, Hopkinson NS. Lung Disease and Social Justice: Chronic Obstructive Pulmonary Disease as a Manifestation of Structural Violence. Am J Respir Crit Care Med 2024; 209:938-946. [PMID: 38300144 DOI: 10.1164/rccm.202309-1650ci] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/01/2024] [Indexed: 02/02/2024] Open
Abstract
Lung health, the development of lung disease, and how well a person with lung disease is able to live all depend on a wide range of societal factors. These systemic factors that adversely affect people and cause injustice can be thought of as "structural violence." To make the causal processes relating to chronic obstructive pulmonary disease (COPD) more apparent, and the responsibility to interrupt or alleviate them clearer, we have developed a taxonomy to describe this. It contains five domains: 1) avoidable lung harms (processes impacting lung development, processes that disadvantage lung health in particular groups across the life course), 2) diagnostic delay (healthcare factors; norms and attitudes that mean COPD is not diagnosed in a timely way, denying people with COPD effective treatment), 3) inadequate COPD care (ways in which the provision of care for people with COPD falls short of what is needed to ensure they are able to enjoy the best possible health, considered as healthcare resource allocation and norms and attitudes influencing clinical practice), 4) low status of COPD (ways COPD as a condition and people with COPD are held in less regard and considered less of a priority than other comparable health problems), and 5) lack of support (factors that make living with COPD more difficult than it should be, i.e., socioenvironmental factors and factors that promote social isolation). This model has relevance for policymakers, healthcare professionals, and the public as an educational resource to change clinical practices and priorities and stimulate advocacy and activism with the goal of the elimination of COPD.
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Affiliation(s)
| | | | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
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Clutterbuck D, Ramasawmy M, Pantelic M, Hayer J, Begum F, Faghy M, Nasir N, Causer B, Heightman M, Allsopp G, Wootton D, Khan MA, Hastie C, Jackson M, Rayner C, Brown D, Parrett E, Jones G, Clarke R, Mcfarland S, Gabbay M, Banerjee A, Alwan NA. Barriers to healthcare access and experiences of stigma: Findings from a coproduced Long Covid case-finding study. Health Expect 2024; 27:e14037. [PMID: 38634418 PMCID: PMC11024953 DOI: 10.1111/hex.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND AND AIM Long Covid is often stigmatised, particularly in people who are disadvantaged within society. This may prevent them from seeking help and could lead to widening health inequalities. This coproduced study with a Community Advisory Board (CAB) of people with Long Covid aimed to understand healthcare and wider barriers and stigma experienced by people with probable Long Covid. METHODS An active case finding approach was employed to find adults with probable, but not yet clinically diagnosed, Long Covid in two localities in London (Camden and Merton) and Derbyshire, England. Interviews explored the barriers to care and the stigma faced by participants and were analysed thematically. This study forms part of the STIMULATE-ICP Collaboration. FINDINGS Twenty-three interviews were completed. Participants reported limited awareness of what Long Covid is and the available pathways to management. There was considerable self-doubt among participants, sometimes reinforced by interactions with healthcare professionals (HCPs). Participants questioned their deservedness in seeking healthcare support for their symptoms. Hesitancy to engage with healthcare services was motivated by fear of needing more investigation and concerns regarding judgement about the ability to carry out caregiving responsibilities. It was also motivated by the complexity of the clinical presentation and fear of all symptoms being attributed to poor mental health. Participants also reported trying to avoid overburdening the health system. These difficulties were compounded by experiences of stigma and discrimination. The emerging themes reaffirmed a framework of epistemic injustice in relation to Long Covid, where creating, interpreting and conveying knowledge has varied credibility based on the teller's identity characteristics and/or the level of their interpretive resources. CONCLUSION We have codeveloped recommendations based on the findings. These include early signposting to services, dedicating protected time to listening to people with Long Covid, providing a holistic approach in care pathways, and working to mitigate stigma. Regardless of the diagnosis, people experiencing new symptoms must be encouraged to seek timely medical help. Clear public health messaging is needed among communities already disadvantaged by epistemic injustice to raise awareness of Long Covid, and to share stories that encourage seeking care and to illustrate the adverse effects of stigma. PATIENT OR PUBLIC CONTRIBUTION This study was coproduced with a CAB made up of 23 members including HCPs, people with lived experience of Long Covid and other stakeholders.
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Affiliation(s)
- Donna Clutterbuck
- School of Primary CarePopulation Sciences and Medical EducationUniversity of SouthamptonSouthamptonUK
| | - Mel Ramasawmy
- Institute of Health InformaticsUniversity College LondonLondonUK
| | - Marija Pantelic
- Brighton and Sussex Medical SchoolUniversity of SussexFalmerUK
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Jasmine Hayer
- PPIE Co‐applicant for STIMULATE‐ICPLondonUK
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Fauzia Begum
- University Hospitals of Derby and Burton NHS Foundation TrustDerbyshireUK
| | - Mark Faghy
- Clinical Exercise and Rehabilitation Research CentreUniversity of DerbyDerbyUK
| | - Nayab Nasir
- Department of Health and Social CareOffice for Health Improvement and DisparitiesUK
| | | | | | | | - Dan Wootton
- Clinical Infection Microbiology and ImmunologyUniversity of LiverpoolLiverpoolUK
- Liverpool University Hospitals NHS Foundation TrustLiverpoolUK
| | - M. Asad Khan
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Claire Hastie
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Long Covid Support CharityLondonUK
| | - Monique Jackson
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Clare Rayner
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Darren Brown
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Chelsea and Westminster Hospital NHS Foundation TrustLondonUK
| | - Emily Parrett
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Geraint Jones
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Rowan Clarke
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Sammie Mcfarland
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Long Covid Kids CharitySalisburyUK
| | - Mark Gabbay
- NIHR Applied Research Collaboration North West CoastLiverpoolUK
- Department of Primary Care and Mental HealthUniversity of LiverpoolLiverpoolUK
| | - Amitava Banerjee
- Institute of Health InformaticsUniversity College LondonLondonUK
| | - Nisreen A. Alwan
- School of Primary CarePopulation Sciences and Medical EducationUniversity of SouthamptonSouthamptonUK
- University Hospital Southampton NHS Foundation TrustSouthamptonUK
- NIHR Applied Research Collaboration WessexSouthamptonUK
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Oatis D, Herman H, Balta C, Ciceu A, Simon-Repolski E, Mihu AG, Lepre CC, Russo M, Trotta MC, Gravina AG, D’Amico M, Hermenean A. Dynamic shifts in lung cytokine patterns in post-COVID-19 interstitial lung disease patients: a pilot study. Ther Adv Chronic Dis 2024; 15:20406223241236257. [PMID: 38560720 PMCID: PMC10981850 DOI: 10.1177/20406223241236257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/14/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction The pathogenesis of post-COVID interstitial lung disease, marked by lung tissue scarring and functional decline, remains largely unknown. Objectives We aimed to elucidate the temporal cytokine/chemokine changes in bronchoalveolar lavage (BAL) from patients with post-COVID interstitial lung disease to uncover potential immune drivers of pulmonary complications. Design We evaluated 16 females diagnosed with post-COVID interstitial lung disease, originating from moderate to severe cases during the second epidemic wave in the Autumn of 2020, treated at the Pneumology Department of the Arad County Clinical Hospital, Romania. Their inflammatory response over time was compared to a control group. Methods A total of 48 BAL samples were collected over three intervals (1, 3, and 6 months) and underwent cytology, gene, and protein expression analyses for pro/anti-inflammatory lung cytokines and chemokines using reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay. Results One month after infection, there were significant increases in the levels of IL-6 and IL-8. These levels decreased gradually over the course of 6 months but were still higher than those seen in control. Interferon-gamma and tumor necrosis factor alpha exhibited similar patterns. Persistent elevations were found in IL-10, IL-13, and pro-fibrotic M2 macrophages' chemokines (CCL13 and CCL18) for 6 months. Furthermore, pronounced neutrophilia was observed at 1 month post-COVID, highlighting persistent inflammation and lung damage. Neutrophil efferocytosis, aiding inflammation resolution and tissue repair, was evident at the 1-month time interval. A notable time-dependent reduction in CD28 was also noticed. Conclusion Our research provides insight into the immunological processes that may lead to the fibrotic changes noted in the lungs following COVID-19.
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Affiliation(s)
- Daniela Oatis
- Department of Infectious Disease, Faculty of Medicine, “Vasile Goldis” Western University of Arad, Arad, Romania
- Multidisciplinary Doctoral School, “Vasile Goldis” Western University of Arad, Arad, Romania
| | - Hildegard Herman
- “Aurel Ardelean” Institute of Life Sciences, “Vasile Goldis” Western University of Arad, Arad, Romania
| | - Cornel Balta
- “Aurel Ardelean” Institute of Life Sciences, “Vasile Goldis” Western University of Arad, Arad, Romania
| | - Alina Ciceu
- “Aurel Ardelean” Institute of Life Sciences, “Vasile Goldis” Western University of Arad, Arad, Romania
| | - Erika Simon-Repolski
- Department of Pneumology, Faculty of Medicine, “Vasile Goldis” Western University of Arad, Arad, Romania
- Department of Pneumology, Arad Clinical Emergency Hospital, Arad, Romania
| | - Alin Gabriel Mihu
- “Aurel Ardelean” Institute of Life Sciences, “Vasile Goldis” Western University of Arad, Arad, Romania
| | - Caterina Claudia Lepre
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marina Russo
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Maria Consiglia Trotta
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonietta Gerarda Gravina
- Department of Precision Medicine and Complex Operative Unit of Hepatogastroenterology and Digestive Endoscopy, University Hospital, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Michele D’Amico
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Anca Hermenean
- Department of Histology, Faculty of Medicine, “Vasile Goldis” Western University of Arad, 94-96 Revolutiei Av., Arad 310025, Romania
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10
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Kim M, Hwang J, Grist JT, Abueid G, Yoon SH, Grau V, Fraser E, Gleeson FV. Functional Impairment in Small Airways Associated With the Breathlessness Symptoms in Long-Coronavirus Disease. J Thorac Imaging 2024; 39:79-85. [PMID: 37889567 DOI: 10.1097/rti.0000000000000748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE This study aimed to determine the association between functional impairment in small airways and symptoms of dyspnea in patients with Long-coronavirus disease (COVID), using imaging and computational modeling analysis. PATIENTS AND METHODS Thirty-four patients with Long-COVID underwent thoracic computed tomography and hyperpolarized Xenon-129 magnetic resonance imaging (HP Xe MRI) scans. Twenty-two answered dyspnea-12 questionnaires. We used a computed tomography-based full-scale airway network (FAN) flow model to simulate pulmonary ventilation. The ventilation distribution projected on a coronal plane and the percentage lobar ventilation modeled in the FAN model were compared with the HP Xe MRI data. To assess the ventilation heterogeneity in small airways, we calculated the fractal dimensions of the impaired ventilation regions in the HP Xe MRI and FAN models. RESULTS The ventilation distribution projected on a coronal plane showed an excellent resemblance between HP Xe MRI scans and FAN models (structure similarity index: 0.87 ± 0.04). In both the image and the model, the existence of large clustered ventilation defects was not identifiable regardless of dyspnea severity. The percentage lobar ventilation of the HP Xe MRI and FAN model showed a strong correlation (ρ = 0.63, P < 0.001). The difference in the fractal dimension of impaired ventilation zones between the low and high dyspnea-12 score groups was significant (HP Xe MRI: 1.97 [1.89 to 2.04] and 2.08 [2.06 to 2.14], P = 0.005; FAN: 2.60 [2.59 to 2.64] and 2.64 [2.63 to 2.65], P = 0.056). CONCLUSIONS This study has identified a potential association of small airway functional impairment with breathlessness in Long-COVID, using fractal analysis of HP Xe MRI scans and FAN models.
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Affiliation(s)
- Minsuok Kim
- School of Mechanical, Electrical, and Manufacturing Engineering, Loughborough University, Loughborough
| | - Jeongeun Hwang
- Department of Engineering Science, Institute of Biomedical Engineering, Oxford e-Research Centre
- Department of Medical IT Engineering, Soonchunhyang University, Chungcheonnam-do
| | - James T Grist
- Department of Physiology, Anatomy, and Genetics
- Department of Radiology
- Oxford Centre for Clinical MR Research, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Vicente Grau
- Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine
| | - Emily Fraser
- Oxford Interstitial Lung Disease Service, The Churchill Hospital
| | - Fergus V Gleeson
- Department of Oncology, University of Oxford
- Department of Radiology
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11
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Álvarez-Santacruz C, Tyrkalska SD, Candel S. The Microbiota in Long COVID. Int J Mol Sci 2024; 25:1330. [PMID: 38279329 PMCID: PMC10816132 DOI: 10.3390/ijms25021330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 01/28/2024] Open
Abstract
Interest in the coronavirus disease 2019 (COVID-19) has progressively decreased lately, mainly due to the great effectivity of vaccines. Furthermore, no new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants able to circumvent the protection of these vaccines, while presenting high transmissibility and/or lethality, have appeared. However, long COVID has emerged as a huge threat to human health and economy globally. The human microbiota plays an important role in health and disease, participating in the modulation of innate and adaptive immune responses. Thus, multiple studies have found that the nasopharyngeal microbiota is altered in COVID-19 patients, with these changes associated with the onset and/or severity of the disease. Nevertheless, although dysbiosis has also been reported in long COVID patients, mainly in the gut, little is known about the possible involvement of the microbiota in the development of this disease. Therefore, in this work, we aim to fill this gap in the knowledge by discussing and comparing the most relevant studies that have been published in this field up to this point. Hence, we discuss that the relevance of long COVID has probably been underestimated, and that the available data suggest that the microbiota could be playing a pivotal role on the pathogenesis of the disease. Further research to elucidate the involvement of the microbiota in long COVID will be essential to explore new therapeutic strategies based on manipulation of the microbiota.
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Affiliation(s)
| | - Sylwia D. Tyrkalska
- Departamento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain;
- Instituto Murciano de Investigación Biosanitaria (IMIB)-Pascual Parrilla, 30120 Murcia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Sergio Candel
- Departamento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain;
- Instituto Murciano de Investigación Biosanitaria (IMIB)-Pascual Parrilla, 30120 Murcia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, 28029 Madrid, Spain
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12
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Fotinos K, Sansone A, Greifenberger A, Katzman MA, Jannini TB, Reisman Y, Limoncin E, Jannini EA. Pornography and sexual function in the post-pandemic period: a narrative review from psychological, psychiatric, and sexological perspectives. Int J Impot Res 2024:10.1038/s41443-023-00812-3. [PMID: 38184709 DOI: 10.1038/s41443-023-00812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 01/08/2024]
Abstract
The COVID-19 pandemic and lockdowns had significant impacts on sexual functioning and behavior. Partnered sexual activity decreased overall, while solo sex activities such as masturbation and pornography consumption increased exponentially. Given the ongoing debate about the effects of pornography on sexual function, it was prudent to consider how the increase in porn consumption during the pandemic might have impacted sexual function in the post-pandemic period. Results indicated that despite the increased rates of use during lockdowns, there remains no evidence supporting the relationship between sexual dysfunction and porn use during and following the pandemic period. On the contrary, pornography consumption and solo sex activities offered an alternative to conventional sexual behavior during a highly stressful period and were found to have positive effects of relieving psychosocial stress otherwise induced by the pandemic. Specifically, those who maintained an active sexual life experienced less anxiety and depression, and greater relational health than those who were not sexually active. It is important to consider factors including frequency, context, and type of consumption when analyzing the impact of pornography on sexual function. While excessive use can have negative effects, moderate use can be a natural and healthy part of life.
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Affiliation(s)
- Kathryn Fotinos
- Course of Clinical Psychosexology, Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
- Stress Trauma Anxiety Rehabilitation Treatment (S.T.A.R.T.) Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Andrea Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Alexandria Greifenberger
- Stress Trauma Anxiety Rehabilitation Treatment (S.T.A.R.T.) Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Martin A Katzman
- Stress Trauma Anxiety Rehabilitation Treatment (S.T.A.R.T.) Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
- Adler Graduate Professional School, Toronto, ON, Canada
- Northern Ontario School of Medicine, Lakehead University, Thunder Bay, ON, Canada
| | - Tommaso B Jannini
- School of Psychiatry, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | | | - Erika Limoncin
- Course of Clinical Psychosexology, Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Emmanuele A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.
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13
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Mohammed Y, Tran K, Carlsten C, Ryerson C, Wong A, Lee T, Cheng MP, Vinh DC, Lee TC, Winston BW, Sweet D, Boyd JH, Walley KR, Haljan G, McGeer A, Lamontagne F, Fowler R, Maslove D, Singer J, Patrick DM, Marshall JC, Murthy S, Jain F, Borchers CH, Goodlett DR, Levin A, Russell JA. Proteomic Evolution from Acute to Post-COVID-19 Conditions. J Proteome Res 2024; 23:52-70. [PMID: 38048423 PMCID: PMC10775146 DOI: 10.1021/acs.jproteome.3c00324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023]
Abstract
Many COVID-19 survivors have post-COVID-19 conditions, and females are at a higher risk. We sought to determine (1) how protein levels change from acute to post-COVID-19 conditions, (2) whether females have a plasma protein signature different from that of males, and (3) which biological pathways are associated with COVID-19 when compared to restrictive lung disease. We measured protein levels in 74 patients on the day of admission and at 3 and 6 months after diagnosis. We determined protein concentrations by multiple reaction monitoring (MRM) using a panel of 269 heavy-labeled peptides. The predicted forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO) were measured by routine pulmonary function testing. Proteins associated with six key lipid-related pathways increased from admission to 3 and 6 months; conversely, proteins related to innate immune responses and vasoconstriction-related proteins decreased. Multiple biological functions were regulated differentially between females and males. Concentrations of eight proteins were associated with FVC, %, and they together had c-statistics of 0.751 (CI:0.732-0.779); similarly, concentrations of five proteins had c-statistics of 0.707 (CI:0.676-0.737) for DLCO, %. Lipid biology may drive evolution from acute to post-COVID-19 conditions, while activation of innate immunity and vascular regulation pathways decreased over that period. (ProteomeXchange identifiers: PXD041762, PXD029437).
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Affiliation(s)
- Yassene Mohammed
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center, Leiden 2333 ZA, The Netherlands
- UVic-Genome
BC Proteomics Centre, University of Victoria, Victoria V8Z 5N3, BC Canada
- Gerald
Bronfman Department of Oncology, McGill
University, Montreal, QC H3A 0G4, Canada
| | - Karen Tran
- Division
of General Internal Medicine, Vancouver
General Hospital and University of British Columbia, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - Chris Carlsten
- Division
of Respiratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Christopher Ryerson
- Division
of Respiratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Alyson Wong
- Division
of Respiratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Terry Lee
- Centre for
Health Evaluation and Outcome Science (CHEOS), St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Matthew P. Cheng
- Division
of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, PQ H4A 3J1, Canada
| | - Donald C. Vinh
- Division
of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, PQ H4A 3J1, Canada
| | - Todd C. Lee
- Division
of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, PQ H4A 3J1, Canada
| | - Brent W. Winston
- Departments
of Critical Care Medicine, Medicine and Biochemistry and Molecular
Biology, Foothills Medical Centre and University
of Calgary, 1403 29 Street
NW, Calgary, Alberta T2N 4N1, Canada
| | - David Sweet
- Division
of Critical Care Medicine, Vancouver General
Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - John H. Boyd
- Centre
for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British
Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Keith R. Walley
- Centre
for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British
Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Greg Haljan
- Department of Medicine, Surrey Memorial
Hospital, 13750 96th
Avenue, Surrey, BC V3V 1Z2, Canada
| | - Allison McGeer
- Mt. Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada
| | | | - Robert Fowler
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
| | - David Maslove
- Department
of Critical Care, Kingston General Hospital
and Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7, Canada
| | - Joel Singer
- Centre for
Health Evaluation and Outcome Science (CHEOS), St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - David M. Patrick
- British Columbia Centre for Disease Control
(BCCDC) and University
of British Columbia, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - John C. Marshall
- Department of Surgery, St. Michael’s
Hospital, 30 Bond Street, Toronto, ON M5B
1W8, Canada
| | - Srinivas Murthy
- BC Children’s Hospital and University of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Fagun Jain
- Black Tusk Research Group, Vancouver, BC V6Z 2C7, Canada
| | - Christoph H. Borchers
- Segal Cancer Proteomics, Centre, Lady Davis
Institute
for Medical Research, McGill University, Montreal, QC H3T 1E2, Canada
- Gerald Bronfman Department of Oncology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Division of Experimental Medicine, McGill
University, Montreal, QC H3T 1E2, Canada
- Department of Pathology, McGill
University, Montreal, QC H3T 1E2, Canada
| | - David R. Goodlett
- UVic-Genome
BC Proteomics Centre, University of Victoria, Victoria V8Z 5N3, BC Canada
| | - Adeera Levin
- Division of Nephrology, St.
Paul’s Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - James A. Russell
- Centre
for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British
Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - ARBs CORONA I Consortium
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center, Leiden 2333 ZA, The Netherlands
- UVic-Genome
BC Proteomics Centre, University of Victoria, Victoria V8Z 5N3, BC Canada
- Gerald
Bronfman Department of Oncology, McGill
University, Montreal, QC H3A 0G4, Canada
- Division
of General Internal Medicine, Vancouver
General Hospital and University of British Columbia, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
- Division
of Respiratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Centre for
Health Evaluation and Outcome Science (CHEOS), St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division
of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, PQ H4A 3J1, Canada
- Departments
of Critical Care Medicine, Medicine and Biochemistry and Molecular
Biology, Foothills Medical Centre and University
of Calgary, 1403 29 Street
NW, Calgary, Alberta T2N 4N1, Canada
- Division
of Critical Care Medicine, Vancouver General
Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
- Centre
for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British
Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Department of Medicine, Surrey Memorial
Hospital, 13750 96th
Avenue, Surrey, BC V3V 1Z2, Canada
- Mt. Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada
- University of Sherbrooke, Sherbrooke, PQ J1K 2R1, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
- Department
of Critical Care, Kingston General Hospital
and Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7, Canada
- British Columbia Centre for Disease Control
(BCCDC) and University
of British Columbia, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
- Department of Surgery, St. Michael’s
Hospital, 30 Bond Street, Toronto, ON M5B
1W8, Canada
- BC Children’s Hospital and University of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
- Black Tusk Research Group, Vancouver, BC V6Z 2C7, Canada
- Segal Cancer Proteomics, Centre, Lady Davis
Institute
for Medical Research, McGill University, Montreal, QC H3T 1E2, Canada
- Gerald Bronfman Department of Oncology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Division of Experimental Medicine, McGill
University, Montreal, QC H3T 1E2, Canada
- Department of Pathology, McGill
University, Montreal, QC H3T 1E2, Canada
- Division of Nephrology, St.
Paul’s Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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14
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Williams Z, Hull JH. Respiratory complications following COVID-19 in athletic populations: A narrative review. Scand J Med Sci Sports 2024; 34:e14275. [PMID: 36539388 PMCID: PMC9880648 DOI: 10.1111/sms.14275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/04/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022]
Abstract
Athletes typically experience a mild-to-moderate, self-limiting illness following infection with the novel severe acute respiratory syndrome coronavirus 2. Some athletes, however, can develop prolonged symptoms, with breathlessness, cough, and chest tightness impacting return to training and competition. In athletes with persistent cardiopulmonary symptoms following COVID-19, focus is usually placed on the identification and characterization of cardiac complications, such as myocarditis. In this review, we focus on summarizing the literature assessing pulmonary complications and physiological consequences associated with COVID-19 illness in athletes. The review also provides recommendations for clinical assessment of the athlete with pulmonary issues following COVID-19 and directions for future research.
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Affiliation(s)
- Zander Williams
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK
| | - James H. Hull
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK
- Institute of Sport, Exercise and Health (ISEH), Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
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15
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Duncan E, Alexander L, Cowie J, Love A, Morris JH, Moss R, Ormerod J, Preston J, Shim J, Stage E, Tooman T, Cooper K. Investigating Scottish Long COVID community rehabilitation service models from the perspectives of people living with Long COVID and healthcare professionals: a qualitative descriptive study. BMJ Open 2023; 13:e078740. [PMID: 38101833 PMCID: PMC10729197 DOI: 10.1136/bmjopen-2023-078740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES This study aimed to explore the perceptions and experiences of barriers and facilitators to accessing Long COVID community rehabilitation. DESIGN We used a qualitative descriptive design over two rounds of data collection with three participant groups: (1) people with experience of rehabilitation for Long COVID (PwLC); (2) National Health Service (NHS) staff delivering and/or managing community rehabilitation services (allied health professionals (AHPs)) and (3) NHS staff involved in strategic planning around Long COVID in their health board (Long COVID leads). SETTING Four NHS Scotland territorial health boards. PARTICIPANTS 51 interviews: eight Long COVID leads (11 interviews); 15 AHPs (25 interviews) and 15 PwLC (15 interviews). RESULTS Three key themes were identified: (1) accessing care for PwLC, (2) understanding Long COVID and its management and (3) strengths and limitations of existing Long COVID rehabilitation services. CONCLUSIONS Organisational delivery of Long COVID community rehabilitation is complex and presents multiple challenges. In addition, access to Long COVID community rehabilitation can be challenging. When accessed, these services are valued by PwLC but require adequate planning, publicity and resource. The findings presented here can be used by those developing and delivering services for people with Long COVID.
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Affiliation(s)
| | - Lyndsay Alexander
- Scottish Centre for Evidence-Based Multi-Professional Practice, Aberdeen, UK
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Julie Cowie
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Rachel Moss
- Healthcare Improvement Scotland, Edinburgh, UK
| | | | - Jenny Preston
- Douglas Grant Rehabilitation Centre, Ayrshire Central Hospital, Irvine, UK
| | - Joanna Shim
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Emma Stage
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | | | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
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16
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Buttery SC. Getting the best from pulmonary rehabilitation. Thorax 2023; 78:951-952. [PMID: 37380355 DOI: 10.1136/thorax-2023-220411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Sara C Buttery
- National Heart and Lung Institute, Imperial College, London, UK
- Royal Brompton and Harefield Hopsitals, London, UK
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17
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Pouliopoulou DV, Macdermid JC, Saunders E, Peters S, Brunton L, Miller E, Quinn KL, Pereira TV, Bobos P. Rehabilitation Interventions for Physical Capacity and Quality of Life in Adults With Post-COVID-19 Condition: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2333838. [PMID: 37725376 PMCID: PMC10509723 DOI: 10.1001/jamanetworkopen.2023.33838] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/08/2023] [Indexed: 09/21/2023] Open
Abstract
Importance Current rehabilitation guidelines for patients with post-COVID-19 condition (PCC) are primarily based on expert opinions and observational data, and there is an urgent need for evidence-based rehabilitation interventions to support patients with PCC. Objective To synthesize the findings of existing studies that report on physical capacity (including functional exercise capacity, muscle function, dyspnea, and respiratory function) and quality of life outcomes following rehabilitation interventions in patients with PCC. Data Sources A systematic electronic search was performed from January 2020 until February 2023, in MEDLINE, Scopus, CINAHL, and the Clinical Trials Registry. Key terms that were used to identify potentially relevant studies included long-covid, post-covid, sequelae, exercise therapy, rehabilitation, physical activity, physical therapy, and randomized controlled trial. Study Selection This study included randomized clinical trials that compared respiratory training and exercise-based rehabilitation interventions with either placebo, usual care, waiting list, or control in patients with PCC. Data Extraction and Synthesis This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A pairwise bayesian random-effects meta-analysis was performed using vague prior distributions. Risk of bias was assessed using the Cochrane risk of bias tool version 2, and the certainty of evidence was evaluated using the GRADE system by 2 independent researchers. Main Outcomes and Measures The primary outcome was functional exercise capacity, measured at the closest postintervention time point by the 6-minute walking test. Secondary outcomes were fatigue, lower limb muscle function, dyspnea, respiratory function, and quality of life. All outcomes were defined a priori. Continuous outcomes were reported as standardized mean differences (SMDs) with 95% credible intervals (CrIs) and binary outcomes were summarized as odds ratios with 95% CrIs. The between-trial heterogeneity was quantified using the between-study variance, τ2, and 95% CrIs. Results Of 1834 identified records, 1193 were screened, and 14 trials (1244 patients; 45% female participants; median [IQR] age, 50 [47 to 56] years) were included in the analyses. Rehabilitation interventions were associated with improvements in functional exercise capacity (SMD, -0.56; 95% CrI, -0.87 to -0.22) with moderate certainty in 7 trials (389 participants). These improvements had a 99% posterior probability of superiority when compared with current standard care. The value of τ2 (0.04; 95% CrI, 0.00 to 0.60) indicated low statistical heterogeneity. However, there was significant uncertainty and imprecision regarding the probability of experiencing exercise-induced adverse events (odds ratio, 1.68; 95% CrI, 0.32 to 9.94). Conclusions and Relevance The findings of this systematic review and meta-analysis suggest that rehabilitation interventions are associated with improvements in functional exercise capacity, dyspnea, and quality of life, with a high probability of improvement compared with the current standard care; the certainty of evidence was moderate for functional exercise capacity and quality of life and low for other outcomes. Given the uncertainty surrounding the safety outcomes, additional trials with enhanced monitoring of adverse events are necessary.
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Affiliation(s)
- Dimitra V. Pouliopoulou
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, St Joseph’s Hospital, London, Ontario, Canada
| | - Joy C. Macdermid
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, St Joseph’s Hospital, London, Ontario, Canada
| | - Emily Saunders
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
| | - Sue Peters
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
| | - Laura Brunton
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
| | - Erin Miller
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
| | - Kieran L. Quinn
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tiago V. Pereira
- Health Technology Assessment Unit, Department of Pharmaceutical Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Pavlos Bobos
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, St Joseph’s Hospital, London, Ontario, Canada
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18
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Alwan NA, Clutterbuck D, Pantelic M, Hayer J, Fisher L, Hishmeh L, Heightman M, Allsopp G, Wootton D, Khan A, Hastie C, Jackson M, Rayner C, Brown D, Parrett E, Jones G, Smith K, Clarke R, Mcfarland S, Gabbay M, Banerjee A. Long Covid active case finding study protocol: A co-produced community-based pilot within the STIMULATE-ICP study (Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways). PLoS One 2023; 18:e0284297. [PMID: 37471432 PMCID: PMC10358953 DOI: 10.1371/journal.pone.0284297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/28/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND AND AIM Long Covid is a significant public health concern with potentially negative implications for health inequalities. We know that those who are already socially disadvantaged in society are more exposed to COVID-19, experience the worst health outcomes and are more likely to suffer economically. We also know that these groups are more likely to experience stigma and have negative healthcare experiences even before the pandemic. However, little is known about disadvantaged groups' experiences of Long Covid, and preliminary evidence suggests they may be under-represented in those who access formal care. We will conduct a pilot study in a defined geographical area in London, United Kingdom to test the feasibility of a community-based approach of identifying Long Covid cases that have not been clinically diagnosed and have not been referred to Long Covid specialist services. We will explore the barriers to accessing recognition, care, and support, as well as experiences of stigma and perceived discrimination. METHODS This protocol and study materials were co-produced with a Community Advisory Board (CAB) made up primarily of people living with Long Covid. Working with voluntary organisations, a study leaflet will be distributed in the local community to highlight Long Covid symptoms and invite those experiencing them to participate in the study if they are not formally diagnosed. Potential participants will be assessed according to the study's inclusion criteria and offered the opportunity to participate if they fit them. Awareness of Long Covid and associated symptoms, experiences of trying to access care, as well as stigma and discrimination will be explored through qualitative interviews with participants. Upon completion of the interviews, participants will be offered a referral to the local social prescribing team to receive support that is personalised to them potentially including, but not restricted to, liaising with their primary care provider and the regional Long Covid clinic.
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Affiliation(s)
- Nisreen A. Alwan
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
| | - Donna Clutterbuck
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Marija Pantelic
- Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Jasmine Hayer
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Lere Fisher
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Lyth Hishmeh
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Melissa Heightman
- University College London Hospitals NHS Trust, London, United Kingdom
| | - Gail Allsopp
- Royal College of General Practitioners, London, United Kingdom
| | - Dan Wootton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Asad Khan
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
- Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Claire Hastie
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
- Long Covid Support Charity, https://www.longcovid.org/, London, United Kingdom
| | - Monique Jackson
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Clare Rayner
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Darren Brown
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
- Long COVID Physio, https://longcovid.physio/, London, United Kingdom
| | - Emily Parrett
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Geraint Jones
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Kerry Smith
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Rowan Clarke
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Sammie Mcfarland
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
- Long Covid Kids Charity, https://www.longcovidkids.org/, Salisbury, United Kingdom
| | - Mark Gabbay
- NIHR Applied Research Collaboration North West Coast, Liverpool, United Kingdom
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom
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19
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Houchen-Wolloff L, Overton C, Ibbetson A, Walters A, Hastie C, Gill R, Armstrong N, Singh S, Little P, Evans K, Pimm J, Marks M, Poinasamy K, Walker S, Briggs A, Evans RA. A typology of healthcare pathways after hospital discharge for adults with COVID-19: the evolution of UK services during pandemic conditions. ERJ Open Res 2023; 9:00565-2022. [PMID: 37583962 PMCID: PMC10423987 DOI: 10.1183/23120541.00565-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/30/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Over half of post-COVID-hospitalisation adults have persistent symptoms 2 years after discharge, providing a challenge for individuals and healthcare systems. We therefore aimed to describe a typology of UK healthcare pathways post-hospital discharge as a first step towards understanding clinical effectiveness and cost-effectiveness of different healthcare pathways. Methods In 2021, we surveyed hospital sites taking part in the UK Post-hospital COVID-19 (PHOSP-COVID) study. The online survey explored the availability of proactive follow-up, patient selection, involvement of multidisciplinary teams, investigations, assessment and access to mental health and rehabilitation interventions. The typology was defined by a three-stage process: 1) using the survey results to develop a bespoke algorithm to inform a draft classification, 2) a stakeholder event for refinement and 3) finalisation between the Project Advisory Group and research team. The bespoke algorithm was used to map each site onto the classification with further mapping by level of mental health and rehabilitation provision. Results 70% of hospital sites (45 out of 64) responded to the survey. 82% (37 out of 45) reported delivering a follow-up service after hospital discharge during the first few months of the pandemic. Only 13 out of 37 services (35%) were delivered by permanent staff. The final typology of five categories included no proactive follow-up, and a matrix of four groups based on patient selection (prespecified subgroup/all patients) and complexity of assessment (low/high). The complexity of assessment, rehabilitation and mental health interventions was variable within sites. Discussion We describe the first typology of post-hospitalisation COVID-19 healthcare pathways to enable modelling of clinical effectiveness and cost-effectiveness to inform future policy. Our results highlight the heterogeneity and vulnerability of healthcare services after COVID-19 hospitalisation.
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Affiliation(s)
- Linzy Houchen-Wolloff
- Leicester NIHR Biomedical Research Centre – Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Charlotte Overton
- SAPPHIRE, Department of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Andrew Ibbetson
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Archie Walters
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Rhyan Gill
- Leicester NIHR Biomedical Research Centre- Respiratory Patient and Public Involvement Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Natalie Armstrong
- SAPPHIRE, Department of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Sally Singh
- Leicester NIHR Biomedical Research Centre – Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Paul Little
- Department of Medicine, University of Southampton, Southampton, UK
| | - Kirby Evans
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - John Pimm
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College Hospital London, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | | | | | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachael A. Evans
- Leicester NIHR Biomedical Research Centre – Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
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20
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Huerne K, Filion KB, Grad R, Ernst P, Gershon AS, Eisenberg MJ. Epidemiological and clinical perspectives of long COVID syndrome. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 9:100033. [PMID: 36685609 PMCID: PMC9846887 DOI: 10.1016/j.ajmo.2023.100033] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/02/2023] [Accepted: 01/07/2023] [Indexed: 01/19/2023]
Abstract
Long COVID, or post-acute COVID-19 syndrome, is characterized by multi-organ symptoms lasting 2+ months after initial COVID-19 virus infection. This review presents the current state of evidence for long COVID syndrome, including the global public health context, incidence, prevalence, cardiopulmonary sequelae, physical and mental symptoms, recovery time, prognosis, risk factors, rehospitalization rates, and the impact of vaccination on long COVID outcomes. Results are presented by clinically relevant subgroups. Overall, 10-35% of COVID survivors develop long COVID, with common symptoms including fatigue, dyspnea, chest pain, cough, depression, anxiety, post-traumatic stress disorder, memory loss, and difficulty concentrating. Delineating these issues will be crucial to inform appropriate post-pandemic health policy and protect the health of COVID-19 survivors, including potentially vulnerable or underrepresented groups. Directed to policymakers, health practitioners, and the general public, we provide recommendations and suggest avenues for future research with the larger goal of reducing harms associated with long COVID syndrome.
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Affiliation(s)
- Katherine Huerne
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Medicine, Division of Experimental Medicine, and Biomedical Ethics Unit, McGill University, Montreal, QC, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Kristian B. Filion
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Departments of Medicine and of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Roland Grad
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department Family Medicine, McGill University, Montreal, QC, Canada
| | - Pierre Ernst
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Andrea S. Gershon
- Sunnybrook Health Sciences Centre and Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mark J. Eisenberg
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Departments of Medicine and of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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21
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Agergaard J, Yamin Ali Khan B, Engell-Sørensen T, Schiøttz-Christensen B, Østergaard L, Hejbøl EK, Schrøder HD, Andersen H, Blicher JU, Holm Pedersen T, Harbo T, Tankisi H. Myopathy as a cause of Long COVID fatigue: Evidence from quantitative and single fiber EMG and muscle histopathology. Clin Neurophysiol 2023; 148:65-75. [PMID: 36804609 DOI: 10.1016/j.clinph.2023.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe neurophysiological abnormalities in Long COVID and correlate quantitative electromyography (qEMG) and single fiber EMG (sfEMG) results to clinical scores and histopathology. METHODS 84 patients with non-improving musculoskeletal Long COVID symptoms were examined with qEMG and sfEMG. Muscle biopsies were taken in a subgroup. RESULTS Mean motor unit potential (MUP) duration was decreased in ≥ 1 muscles in 52 % of the patients. Mean jitter was increased in 17 % of the patients in tibialis anterior and 25 % in extensor digitorum communis. Increased jitter was seen with or without myopathic qEMG. Low quality of life score correlated with higher jitter values but not with qEMG measures. In addition to our previously published mitochondrial changes, inflammation, and capillary injury, we show now in muscle biopsies damage of terminal nerves and motor endplate with abundant basal lamina material. At the endplate, axons were present but no vesicle containing terminals. The post-synaptic cleft in areas appeared atrophic with short clefts and coarse crests. CONCLUSIONS Myopathic changes are common in Long COVID. sfEMG abnormality is less common but may correlate with clinical scores. sfEMG changes may be due to motor endplate pathology. SIGNIFICANCE These findings may indicate a muscle pathophysiology behind fatigue in Long COVID.
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Affiliation(s)
- Jane Agergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Benjamin Yamin Ali Khan
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Eva K Hejbøl
- Department of Pathology, Odense University Hospital, Odense, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Henrik D Schrøder
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Henning Andersen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
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22
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Hossain MM, Das J, Rahman F, Nesa F, Hossain P, Islam AMK, Tasnim S, Faizah F, Mazumder H, Purohit N, Ramirez G. Living with "long COVID": A systematic review and meta-synthesis of qualitative evidence. PLoS One 2023; 18:e0281884. [PMID: 36795701 PMCID: PMC9934341 DOI: 10.1371/journal.pone.0281884] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES Long-term health consequences of coronavirus disease (COVID-19), also known as "long COVID," has become a global health concern. In this systematic review, we aimed to synthesize the qualitative evidence on lived experiences of people living with long COVID that may inform health policymaking and practice. METHODS We searched six major databases and additional sources and systematically retrieved relevant qualitative studies and conducted a meta-synthesis of key findings using the Joanna Briggs Institute (JBI) guidelines and reporting standards of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. RESULTS We found 15 articles representing 12 studies out of 619 citations from different sources. These studies provided 133 findings that were categorized into 55 categories. All categories were aggregated to the following synthesized findings: living with complex physical health problems, psychosocial crises of long COVID, slow recovery and rehabilitation, digital resources and information management, changes in social support, and experiences with healthcare providers, services, and systems. Ten studies were from the UK, and others were from Denmark and Italy, which highlights a critical lack of evidence from other countries. CONCLUSIONS More representative research is needed to understand long COVID-related experiences from diverse communities and populations. The available evidence informs a high burden of biopsychosocial challenges among people with long COVID that would require multilevel interventions such as strengthening health and social policies and services, engaging patients and caregivers in making decisions and developing resources, and addressing health and socioeconomic disparities associated with long COVID through evidence-based practice.
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Affiliation(s)
- M. Mahbub Hossain
- Department of Decision and Information Sciences, C.T. Bauer College of Business, University of Houston, Houston, Texas, United States of America
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, Texas, United States of America
- * E-mail:
| | - Jyoti Das
- Research Initiative for Health Equity, Khulna, Bangladesh
| | | | - Fazilatun Nesa
- Research Initiative for Health Equity, Khulna, Bangladesh
| | - Puspita Hossain
- McMaster University, Hamilton, Ontario, Canada
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - A. M. Khairul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Samia Tasnim
- School of Public Health, Texas A&M University, College Station, Texas, United States of America
| | - Farah Faizah
- School of Public Health, University of Memphis, Memphis, Tennessee, United States of America
| | - Hoimonty Mazumder
- School of Public Health, University of Memphis, Memphis, Tennessee, United States of America
| | | | - Gilbert Ramirez
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, United States of America
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23
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Squillace N, Cogliandro V, Rossi E, Bellelli G, Pozzi M, Luppi F, Lettino M, Strepparava MG, Ferrarese C, Pollastri E, Ricci E, Bonfanti P. A multidisciplinary approach to screen the post-COVID-19 conditions. BMC Infect Dis 2023; 23:54. [PMID: 36694110 PMCID: PMC9872735 DOI: 10.1186/s12879-023-08006-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Post-COronaVIrus Disease 2019 (COVID-19) conditions (PCC) include multiple symptoms afflicting different organs and systems. To evaluate the frequency and type of them, we described our multidisciplinary approach with preliminary results of the first enrolled patients. METHODS We included patients aged ≥ 18 years with hospital admission for confirmed SARS-CoV-2 infection. Symptoms were grouped in five macro groups hereafter referred to as "Symptoms Category" (SC): respiratory SC (dyspnoea or cough), neurological SC (peripheral neuropathies, headache, impaired mobility, behavioural disorders), psychological SC (sleep disorders, mood disorders), muscular SC (arthromyalgia, asthenia), other SC (fever, alopecia, diarrhoea, weight loss, smell and taste alterations, sexual dysfunctions). SC were evaluated at discharge and at follow-up. Association between patients' characteristics and presence of SC at follow up was estimated by a logistic multivariable regression model. RESULTS From June 2020 to July 2021, we followed up 361 patients: 128 (35.5%) who were previously admitted to Intensive Care Unit (ICU) and 233 patients to ordinary department. The median length of hospital stay was 20 days (Inter-Quartile-Range 13-32). Most patients (317/361, 87.8%) were still symptomatic at discharge, with one third referring three or more SC. At follow up, 67.3% (243/361) of patients still complained at least one SC. Moreover, 159 patients (44%) developed at least one new involved SC during follow up: 116 (72.9%) one SC, 39 (24.5%) two SC, 4 (2.5%) three or more SC. At follow up visit 130 of 361 (36%) were still with SC developed during follow up. At multivariable analysis presence of any SC at follow-up was associated with male gender (Odds Ratio [OR] 3.23, Confidence Interval [CI] 95% 1.46-7.15), ICU admission (OR 2.78, CI 95% 1.29-5.96) and presence of SC at discharge (OR 14.39, CI 95% 6.41-32.32). CONCLUSIONS In our sample of patients with severe COVID-19, we found that PCC are highly variable and fluctuating over time; in particular, in about 50% of our patients new SC appear during follow up. Moreover, presence of PCC also in patients without SC at discharge and the variability of symptoms underlining the advisability of our multidisciplinary approach. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT04424992, registered on 28 February 2020 https://www. CLINICALTRIALS gov/ct2/results?recrs=ab&cond=&term=NCT04424992&cntry=&state=&city=&dist The current version of protocol is version 1.0 enrolling since June 2020. The enrollment is still ongoing.
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Affiliation(s)
- Nicola Squillace
- grid.415025.70000 0004 1756 8604Infectious Disease Unit, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi, 33, Monza, Italy
| | - Viola Cogliandro
- grid.415025.70000 0004 1756 8604Infectious Disease Unit, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi, 33, Monza, Italy
| | - Emanuela Rossi
- grid.7563.70000 0001 2174 1754Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, University of Milano-Bicocca, Monza, Italy
| | - Giuseppe Bellelli
- grid.415025.70000 0004 1756 8604Acute Geriatric Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy ,grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Matteo Pozzi
- grid.415025.70000 0004 1756 8604Anesthesia and Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Fabrizio Luppi
- grid.415025.70000 0004 1756 8604Respiratory Disease Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy ,grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maddalena Lettino
- grid.415025.70000 0004 1756 8604Cardiology Division, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Maria Grazia Strepparava
- grid.415025.70000 0004 1756 8604Clinical Psychology Unit, Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy ,grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Carlo Ferrarese
- grid.415025.70000 0004 1756 8604Neurology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy ,grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ester Pollastri
- grid.415025.70000 0004 1756 8604Infectious Disease Unit, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi, 33, Monza, Italy
| | | | - Paolo Bonfanti
- grid.415025.70000 0004 1756 8604Infectious Disease Unit, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi, 33, Monza, Italy ,grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Parisi S, Lehner N, Schrader H, Kierer L, Fleischer A, Miljukov O, Borgulya G, Rüter G, Viniol A, Gágyor I. Experiencing COVID-19, home isolation and primary health care: A mixed-methods study. Front Public Health 2023; 10:1023431. [PMID: 36703817 PMCID: PMC9872200 DOI: 10.3389/fpubh.2022.1023431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023] Open
Abstract
Objectives Although the vast majority of COVID-19 cases are treated in primary care, patients' experiences during home isolation have been little studied. This study aimed to explore the experiences of patients with acute COVID-19 and to identify challenges after the initial adaptation of the German health system to the pandemic (after first infection wave from February to June 2020). Methods A mixed-method convergent design was used to gain a holistic insight into patients experience. The study consisted of a cross-sectional survey, open survey answers and semi-structured telephone interviews. Descriptive analysis was performed on quantitative survey answers. Between group differences were calculated to explore changes after the first infection wave. Qualitative thematic analysis was conducted on open survey answers and interviews. The results were then compared within a triangulation protocol. Results A total of 1100 participants from all German states were recruited by 145 general practitioners from August 2020 to April 2021, 42 additionally took part in qualitative interviews. Disease onset varied from February 2020 to April 2021. After the first infection wave, more participants were tested positive during the acute disease (88.8%; 95.2%; P < 0.001). Waiting times for tests (mean 4.5 days, SD 4.1; 2.7days, SD 2.6, P < 0.001) and test results (mean 2.4 days, SD 1.9; 1.8 days, SD 1.3, P < 0.001) decreased. Qualitative results indicated that the availability of repeated testing and antigen tests reduced insecurities, transmission and related guilt. Although personal consultations at general practices increased (6.8%; 15.5%, P < 0.001), telephone consultation remained the main mode of consultation (78.5%) and video remained insignificant (1.9%). The course of disease, the living situation and social surroundings during isolation, access to health care, personal resilience, spirituality and feelings of guilt and worries emerged as themes influencing the illness experience. Challenges were contact management and adequate provision of care during home isolation. A constant contact person within the health system helped against feelings of care deprivation, uncertainty and fear. Conclusions Our study highlights that home isolation of individuals with COVID-19 requires a holistic approach that considers all aspects of patient care and effective coordination between different care providers.
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Affiliation(s)
- Sandra Parisi
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Nina Lehner
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Hanna Schrader
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Leonard Kierer
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Anna Fleischer
- Division of Medical Psychosomatics, University Hospital Würzburg, Würzburg, Germany
| | - Olga Miljukov
- Institute of Clinical Epidemiology and Biometry, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Gabor Borgulya
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Gernot Rüter
- Academic Teaching Practice, Mentoring Team of the Competence-Based Continuing Education Baden-Württemberg Kompetenzzentrum Weiterbildung Baden-Württemberg (KWBW), University of Tübingen, Tübingen, Germany
| | - Annika Viniol
- Department of General Practice, University of Marburg, Marburg, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
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25
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Psychiatric and neurological complications of long COVID. J Psychiatr Res 2022; 156:349-360. [PMID: 36326545 PMCID: PMC9582925 DOI: 10.1016/j.jpsychires.2022.10.045] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/23/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
COVID-19 was primarily considered a pulmonary disease with extrapulmonary manifestations. As the pandemic spread, there has been growing evidence that the disease affects various organs/systems, including the central and peripheral nervous systems. Accumulation of clinical data demonstrates that in a large population of survivors impairments in the function of one or more organs may persist for a long time, a phenomenon commonly known as post COVID or long COVID. Fatigue and cognitive dysfunction, such as concentration problems, short-term memory deficits, general memory loss, a specific decline in attention, language and praxis abilities, encoding and verbal fluency, impairment of executive functions, and psychomotor coordination, are amongst the most common and debilitating features of neuropsychatric symptoms of post COVID syndrome. Several patients also suffer from compromised sleep, depression, anxiety and post-traumatic stress disorder. Patients with long COVID may demonstrate brain hypometabolism, hypoperfusion of the cerebral cortex and changes in the brain structure and functional connectivity. Children and adolescents represent a minority of COVID-19 cases, so not surprisingly data on the long-term sequelae after SARS-CoV-2 infections in these age groups are scarce. Although the pathogenesis, clinical characteristics, epidemiology, and risk factors of the acute phase of COVID-19 have been largely explained, these areas are yet to be explored in long COVID. This review aims to provide an update on what is currently known about long COVID effects on mental health.
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26
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Ghossein-Doha C, Wintjens MSJN, Janssen EBNJ, Klein D, Heemskerk SCM, Asselbergs FW, Birnie E, Bonsel GJ, van Bussel BCT, Cals JWL, Ten Cate H, Haagsma J, Hemmen B, van der Horst ICC, Kietselaer BLJH, Klok FA, de Kruif MD, Linschoten M, van Santen S, Vernooy K, Willems LH, Westerborg R, Warle M, van Kuijk SMJ. Prevalence, pathophysiology, prediction and health-related quality of life of long COVID: study protocol of the longitudinal multiple cohort CORona Follow Up (CORFU) study. BMJ Open 2022; 12:e065142. [PMID: 36446465 PMCID: PMC9709810 DOI: 10.1136/bmjopen-2022-065142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The variety, time patterns and long-term prognosis of persistent COVID-19 symptoms (long COVID-19) in patients who suffered from mild to severe acute COVID-19 are incompletely understood. Cohort studies will be combined to describe the prevalence of long COVID-19 symptoms, and to explore the pathophysiological mechanisms and impact on health-related quality of life. A prediction model for long COVID-19 will be developed and internally validated to guide care in future patients. METHODS AND ANALYSIS Data from seven COVID-19 cohorts will be aggregated in the longitudinal multiple cohort CORona Follow Up (CORFU) study. CORFU includes Dutch patients who suffered from COVID-19 at home, were hospitalised without or with intensive care unit treatment, needed inpatient or outpatient rehabilitation and controls who did not suffer from COVID-19. Individual cohort study designs were aligned and follow-up has been synchronised. Cohort participants will be followed up for a maximum of 24 months after acute infection. Next to the clinical characteristics measured in individual cohorts, the CORFU questionnaire on long COVID-19 outcomes and determinants will be administered digitally at 3, 6, 12, 18 and 24 months after the infection. The primary outcome is the prevalence of long COVID-19 symptoms up to 2 years after acute infection. Secondary outcomes are health-related quality of life (eg, EQ-5D), physical functioning, and the prevalence of thromboembolic complications, respiratory complications, cardiovascular diseases and endothelial dysfunction. A prediction model and a patient platform prototype will be developed. ETHICS AND DISSEMINATION Approval was obtained from the medical research ethics committee of Maastricht University Medical Center+ and Maastricht University (METC 2021-2990) and local committees of the participating cohorts. The project is supported by ZonMW and EuroQol Research Foundation. Results will be published in open access peer-reviewed scientific journals and presented at (inter)national conferences. TRIAL REGISTRATION NUMBER NCT05240742.
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Affiliation(s)
- Chahinda Ghossein-Doha
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Marieke S J N Wintjens
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht UMC+, Maastricht, The Netherlands
- Intensive Care Medicine, Maastricht UMC+, Maastricht, The Netherlands
| | - Emma B N J Janssen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Obstetrics and Gynaecology, Maastricht UMC+, Maastricht, The Netherlands
| | - Dorthe Klein
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht UMC+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Stella C M Heemskerk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht UMC+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Erwin Birnie
- Scientific Department, EuroQol Research Foundation, Rotterdam, The Netherlands
- Department of Genetics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gouke J Bonsel
- Scientific Department, EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Bas C T van Bussel
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Intensive Care, Maastricht UMC+, Maastricht, The Netherlands
| | - Jochen W L Cals
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
- Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Hugo Ten Cate
- Department of Biochemistry, Department of Internal Medicine, Thrombosis Expert Centre, Maastricht, The Netherlands
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Juanita Haagsma
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Bena Hemmen
- Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation, Maastricht University, Maastricht, The Netherlands
| | - Iwan C C van der Horst
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Bastiaan L J H Kietselaer
- Department of Cardiology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Martijn D de Kruif
- Department of Pulmonology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Marijke Linschoten
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Susanne van Santen
- Department of Intensive Care, Maastricht UMC+, Maastricht, The Netherlands
- Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Loes H Willems
- Department of Surgery, Radboudumc Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Rosa Westerborg
- Department of Pulmonology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Michiel Warle
- Department of Surgery, Radboudumc Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht UMC+, Maastricht, The Netherlands
- Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Baránková M, Greškovičová K, Strnádelová B, Krizova K, Halamová J. Let Us Take It into Our Own Hands: Patient Experience during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14150. [PMID: 36361026 PMCID: PMC9655667 DOI: 10.3390/ijerph192114150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic introduced new health situations for patients and health professionals alike and, with them, opportunities to study these new patient experiences, gain insights into changed healthcare practices, and propose potential new healthcare solutions. The aim of our study was to explore how people coped with their health issues during the pandemic. We utilized a consensual qualitative analysis. The convenience sample that was gathered online through social media comprised 1683 participants with a mean age of 31.02 years (SD = 11.99). The 50 participants from the convenience sample who scored the highest on subscales of the COPE inventory were selected for in-depth interviews. In-depth interviews with 27 participants from the convenience sample who reported a health issue were analyzed. The final sample in our study therefore comprised 17 women (63%) and 10 men (37%) with a mean age of 28.35 years (SD = 9.31). The results showed that behavioral coping with health problems was mentioned across all participants' accounts. However, participants facing a health issue during the COVID-19 pandemic mostly relied on their own self-help instead of on healthcare services. They utilized healthcare services only when absolutely necessary. Furthermore, the participants had two main sources of resilience: themselves and other people.
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Schaap G, Wensink M, Doggen CJM, van der Palen J, Vonkeman HE, Bode C. "It Really Is an Elusive Illness"-Post-COVID-19 Illness Perceptions and Recovery Strategies: A Thematic Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13003. [PMID: 36293582 PMCID: PMC9602798 DOI: 10.3390/ijerph192013003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
A substantial number of patients report persisting symptoms after a COVID-19 infection: so-called post-COVID-19 syndrome. There is limited research on patients' perspectives on post-COVID-19 symptoms and ways to recover. This qualitative study explored the illness perceptions and recovery strategies of patients who had been hospitalised for COVID-19. Differences between recovered and non-recovered patients were investigated. Semi-structured in-depth interviews were held with 24 participating patients (8 recovered and 16 non-recovered) 7 to 12 months after hospital discharge. Data were interpreted using reflexive thematic analysis. Four overarching themes were identified: (I) symptoms after hospital discharge; (II) impact of COVID-19 on daily life and self-identity; (III) uncertainty about COVID-19; and (IV) dealing with COVID-19. Formerly hospitalised post-COVID-19 patients seem to have difficulties with making sense of their illness and gaining control over their recovery. The majority of non-recovered participants continue to suffer mostly from weakness or fatigue, dyspnoea and cognitive dysfunction. No notable differences in illness beliefs were observed between recovered and non-recovered participants.
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Affiliation(s)
- Gerko Schaap
- Department of Psychology, Health and Technology, University of Twente, 7522 NB Enschede, The Netherlands
| | - Marleen Wensink
- Department of Psychology, Health and Technology, University of Twente, 7522 NB Enschede, The Netherlands
| | - Carine J. M. Doggen
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands
- Clinical Research Centre, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands
- Section Cognition, Data and Education, University of Twente, 7522 NB Enschede, The Netherlands
| | - Harald E. Vonkeman
- Department of Psychology, Health and Technology, University of Twente, 7522 NB Enschede, The Netherlands
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands
| | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, 7522 NB Enschede, The Netherlands
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Adler L, Gazit S, Pinto Y, Perez G, Mizrahi Reuveni M, Yehoshua I, Hoffman R, Azuri J, Patalon T. Long-COVID in patients with a history of mild or asymptomatic SARS-CoV-2 infection: a Nationwide Cohort Study. Scand J Prim Health Care 2022; 40:342-349. [PMID: 36314555 PMCID: PMC9848375 DOI: 10.1080/02813432.2022.2139480] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Evaluating the prevalence of long-COVID symptoms in patients with a history of mild or asymptomatic infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the factors associated with developing long-COVID. DESIGN A nationwide cohort study. Using a centralized database, we have identified patients with and without a history of SARS-CoV-2 infection 1-6 months before data collection. Patients were asked to fill out an online questionnaire through text messages. SETTING Israeli general practice. SUBJECTS 2755 persons participated in the study in September 2021 (a response rate of 7.5%): 819 with and, 936 without a history of SARS-CoV-2 infection. MAIN OUTCOME MEASURES We asked patients to provide details about their demographic status, medical history, COVID-related variables and the presence of long-COVID symptoms. RESULTS Most prevalent long-COVID symptoms were decreased smell sensation (35.1% vs. 4.3%, p < 0.001), decreased taste sensation (25.2% vs. 3.2%, p < 0.001), memory disturbances (36.9% vs. 14.4%, p < 0.001), dyspnea (24.2% vs. 10.7%, p < 0.001) and arthralgia (33% vs. 16.3%, p < 0.001). Risk factors associated with long-COVID included female gender, symptomatic COVID-19, overweight or obesity and the presence of dyslipidemia. About 34.6% of participants reported not returning to their baseline health condition after the acute illness. CONCLUSION Long-COVID is frequently seen following a mild symptomatic COVID-19 infection and, to a lesser extent, following an asymptomatic SARS-CoV-2 infection. Primary care physicians should be aware of these symptoms and consider this option in their differential diagnosis. Health policymakers should expect a significant impact of this syndrome on public health.Key PointsLong-COVID has emerged as a significant health problem with a serious impact on normal daily function• Long-COVID symptoms were evident in patients with mild symptomatic disease and in asymptomatic patients to a lesser extent.• Risk factors for having Long-COVID symptoms include female gender, symptomatic disease, increased BMI, and the presence of dyslipidemia.• Fatigue, dyspnea, weakness, decreased libido, weight changes, memory, and sleep disturbances were associated with not returning to the baseline health state.
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Affiliation(s)
- Limor Adler
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- CONTACT Limor Adler Health Division, Maccabi Healthcare Services, Hamered 27 st, Tel Aviv, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Yuval Pinto
- Family Medicine Residency Program, Meritus Medical Center, Hagerstwon, MD, USA
| | - Galit Perez
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Ilan Yehoshua
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Family Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Robert Hoffman
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Azuri
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
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Lewis A, Kal E, Nolan CM, Cave P, Grillo L, Conway J, Jones M. Pilot study of physiotherapist-led versus music therapist-led breathing control exercises for young adults living with breathing pattern disorder: a randomised controlled trial protocol. BMJ Open Respir Res 2022; 9:9/1/e001414. [PMID: 36104105 PMCID: PMC9476152 DOI: 10.1136/bmjresp-2022-001414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Breathing pattern disorder (BPD) is an abnormal breathing pattern associated with biochemical, biomechanical and psychophysiological changes. While physiotherapy is often offered, limited evidence-based therapies for BPD are available. Music therapy-based singing exercises have been shown to improve quality of life for individuals with respiratory conditions and may also be beneficial for individuals living with BPD. No study has previously compared these participatory interventions in the treatment of people living with BPD. Methods and analysis This is a study protocol for an assessor blinded 1:1 randomised controlled trial and qualitative interview study. Forty participants aged 18–40 years who score at least 19 on the Nijmegen Questionnaire (NQ) and do not have any underlying respiratory conditions will be recruited. Participants will be randomised to receive either physiotherapy-led or music therapy-led breathing exercises for 6 weeks. The primary outcome will be between-group difference in NQ post-intervention. Semistructured interviews with a purposive sample of participants will be performed. Qualitative data will be analysed using thematic analysis to better understand participants’ intervention and trial experiences. Ethics and dissemination This study has received ethical approval by Brunel University London College of Health, Medicine and Life Science’s Research Ethics Committee (32483-MHR-Mar/2022-38624-3). The anonymised completed dataset will be made available as an open-access file via Brunel University London Figshare and the manuscript containing anonymised patient data will be published in an open-access journal. Trial registration number This trial is registered on the Open Science Framework Registry (https://osf.io/u3ncw).
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Affiliation(s)
- Adam Lewis
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Elmar Kal
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Claire Marie Nolan
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK.,Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, London, UK
| | - Phoene Cave
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Lizzie Grillo
- National Heart and Lung Institute, Imperial College London, London, UK.,Physiotherapy Department, Royal Brompton and Harefield Hospitals, London, UK
| | - Joy Conway
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Mandy Jones
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
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Choudhury A, Tariq R, Jena A, Vesely EK, Singh S, Khanna S, Sharma V. Gastrointestinal manifestations of long COVID: A systematic review and meta-analysis. Therap Adv Gastroenterol 2022; 15:17562848221118403. [PMID: 36004306 PMCID: PMC9393939 DOI: 10.1177/17562848221118403] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Prolonged symptoms after COVID-19 are an important concern due to the large numbers affected by the pandemic. OBJECTIVES To ascertain the frequency of gastrointestinal (GI) manifestations as part of long GI COVID. DESIGN A systematic review and meta-analysis of studies reporting GI manifestations in long COVID was performed. DATA SOURCES AND METHODS Electronic databases (Medline, Scopus, Embase, Cochrane Central Register of Controlled Trials, and Web of Science) were searched till 21 December 2021 to identify studies reporting frequency of GI symptoms in long COVID. We included studies reporting overall GI manifestations or individual GI symptoms as part of long COVID. We excluded pediatric studies and those not providing relevant information. We calculated the pooled frequency of various symptoms in all patients with COVID-19 and also in those with long COVID using the inverse variance approach. All analysis was done using R version 4.1.1 using packages 'meta' and 'metafor'. RESULTS A total of 50 studies were included. The frequencies of GI symptoms were 0.12 [95% confidence interval (CI), 0.06-0.22, I 2 = 99%] and 0.22 (95% CI, 0.10-0.41, I 2 = 97%) in patients with COVID-19 and those with long COVID, respectively. The frequencies of abdominal pain, nausea/vomiting, loss of appetite, and loss of taste were 0.14 (95% CI, 0.04-0.38, I 2 = 96%), 0.06 (95% CI, 0.03-0.11, I 2 = 98%), 0.20 (95% CI, 0.08-0.43, I 2 = 98%), and 0.17 (95% CI, 0.10-0.27, I 2 = 95%), respectively, after COVID-19. The frequencies of diarrhea, dyspepsia, and irritable bowel syndrome were 0.10 (95% CI, 0.04-0.23, I 2 = 98%), 0.20 (95% CI, 0.06-0.50, I 2 = 97%), and 0.17 (95% CI, 0.06-0.37, I 2 = 96%), respectively. CONCLUSION GI symptoms in patients were seen in 12% after COVID-19 and 22% as part of long COVID. Loss of appetite, dyspepsia, irritable bowel syndrome, loss of taste, and abdominal pain were the five most common GI symptoms of long COVID. Significant heterogeneity and small number of studies for some of the analyses are limitations of the systematic review.
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Affiliation(s)
- Arup Choudhury
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raseen Tariq
- Division of Gastroenterology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anuraag Jena
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Siddharth Singh
- Division of Gastroenterology and Biomedical Informatics, University of California San Diego, La Jolla, CA, USA
| | - Sahil Khanna
- Division of Gastroenterology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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32
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Goldstein Ferber S, Shoval G, Zalsman G, Weller A. Does COVID-19 related symptomatology indicate a transdiagnostic neuropsychiatric disorder? - Multidisciplinary implications. World J Psychiatry 2022; 12:1004-1015. [PMID: 36158308 PMCID: PMC9476837 DOI: 10.5498/wjp.v12.i8.1004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/28/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
The clinical presentation that emerges from the extensive coronavirus disease 2019 (COVID-19) mental health literature suggests high correlations among many conventional psychiatric diagnoses. Arguments against the use of multiple comorbidities for a single patient have been published long before the pandemic. Concurrently, diagnostic recommendations for use of transdiagnostic considerations for improved treatment have been also published in recent years. In this review, we pose the question of whether a transdiagnostic mental health disease, including psychiatric and neuropsychiatric symptomology, has emerged since the onset of the pandemic. There are many attempts to identify a syndrome related to the pandemic, but none of the validated scales is able to capture the entire psychiatric and neuropsychiatric clinical presentation in infected and non-infected individuals. These scales also only marginally touch the issue of etiology and prevalence. We suggest a working hypothesis termed Complex Stress Reaction Syndrome (CSRS) representing a global psychiatric reaction to the pandemic situation in the general population (Type A) and a neuropsychiatric reaction in infected individuals (Type B) which relates to neurocognitive and psychiatric features which are part (excluding systemic and metabolic dysfunctions) of the syndrome termed in the literature as long COVID. We base our propositions on multidisciplinary scientific data regarding mental health during the global pandemic situation and the effects of viral infection reviewed from Google Scholar and PubMed between February 1, 2022 and March 10, 2022. Search in-clusion criteria were “mental health”, “COVID-19” and “Long COVID”, English language and human studies only. We suggest that this more comprehensive way of understanding COVID-19 complex mental health reactions may promote better prevention and treatment and serve to guide implementation of recommended administrative regulations that were recently published by the World Psychiatric Association. This review may serve as a call for an international investigation of our working hypothesis.
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Affiliation(s)
- Sari Goldstein Ferber
- Department of Psychology and Gonda Brain Research Center, Bar Ilan University, Ramat Gan 5317000, Israel
| | - Gal Shoval
- Department of Psychiatry, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Neuroscience, Princeton University, Princeton, NJ 08544, United States
| | - Gil Zalsman
- Department of Psychiatry, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Psychiatry, Columbia University, New York, NY 10032, United States
| | - Aron Weller
- Department of Psychology and Gonda Brain Research Center, Bar Ilan University, Ramat Gan 5317000, Israel
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Gyöngyösi M, Alcaide P, Asselbergs FW, Brundel BJJM, Camici GG, da Costa Martins P, Ferdinandy P, Fontana M, Girao H, Gnecchi M, Gollmann-Tepeköylü C, Kleinbongard P, Krieg T, Madonna R, Paillard M, Pantazis A, Perrino C, Pesce M, Schiattarella GG, Sluijter JPG, Steffens S, Tschöpe C, Van Linthout S, Davidson SM. Long COVID and the cardiovascular system - elucidating causes and cellular mechanisms in order to develop targeted diagnostic and therapeutic strategies: A joint Scientific Statement of the ESC Working Groups on Cellular Biology of the Heart and Myocardial & Pericardial Diseases. Cardiovasc Res 2022; 119:336-356. [PMID: 35875883 PMCID: PMC9384470 DOI: 10.1093/cvr/cvac115] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 02/07/2023] Open
Abstract
Long COVID has become a world-wide, non-communicable epidemic, caused by long-lasting multi-organ symptoms that endure for weeks or months after SARS-CoV-2 infection has already subsided. This scientific document aims to provide insight into the possible causes and therapeutic options available for the cardiovascular manifestations of long COVID. In addition to chronic fatigue, which is a common symptom of long COVID, patients may present with chest pain, ECG abnormalities, postural orthostatic tachycardia, or newly developed supraventricular or ventricular arrhythmias. Imaging of the heart and vessels has provided evidence of chronic, post-infectious peri-myocarditis with consequent left or right ventricular failure, arterial wall inflammation or micro-thrombosis in certain patient populations. Better understanding of the underlying cellular and molecular mechanisms of long COVID will aid in the development of effective treatment strategies for its cardiovascular manifestations. A number of mechanisms have been proposed, including those involving direct effects on the myocardium, micro-thrombotic damage to vessels or endothelium, or persistent inflammation. Unfortunately, existing circulating biomarkers, coagulation and inflammatory markers, are not highly predictive for either the presence or outcome of long COVID when measured 3 months after SARS-CoV-2 infection. Further studies are needed to understand underlying mechanisms, identify specific biomarkers and guide future preventive strategies or treatments to address long COVID and its cardiovascular sequelae.
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Affiliation(s)
- Mariann Gyöngyösi
- Corresponding Author: Mariann Gyöngyösi Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria Tel.: +43-1-40400-46140 , Fax: +43-1-40400-42160
| | - Pilar Alcaide
- Department of Immunology, Tufts University School of Medicine, Boston, MA, USA
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,Health Data Research UK and Institute of Health Informatics, University College London, London, United Kingdom
| | - Bianca J J M Brundel
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland,University Heart Center, Department of Cardiology, University Hospital, Zurich, Switzerland
| | - Paula da Costa Martins
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands,Department of Molecular Genetics, Faculty of Sciences and Engineering, Maastricht University, Maastricht, The Netherlands
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary,Pharmahungary Group, Szeged, Hungary
| | - Marianna Fontana
- Royal Free Hospital London, Division of Medicine, University College London, London, UK
| | - Henrique Girao
- Center for Innovative Biomedicine and Biotechnology (CIBB), Clinical Academic Centre of Coimbra (CACC), Faculty of Medicine, Univ Coimbra, Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal
| | - Massimiliano Gnecchi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia,Unit of Translational Cardiology, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Petra Kleinbongard
- Institut für Pathophysiologie, Westdeutsches Herz- und Gefäßzentrum, Universitätsklinikum Essen, Essen, Germany
| | - Thomas Krieg
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Rosalinda Madonna
- Department of Pathology, Institute of Cardiology, University of Pisa, Pisa, Italy
| | - Melanie Paillard
- Laboratoire CarMeN-équipe IRIS, INSERM, INRA, Université Claude Bernard Lyon-1, INSA-Lyon, Univ-Lyon, 69500 Bron, France
| | - Antonis Pantazis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Cinzia Perrino
- Department of Advanced Biomedical Sciences, Federico II University, Via Pansini 5, 80131 Naples
| | - Maurizio Pesce
- Unità di Ingegneria Tissutale cardiovascolare, Centro Cardiologico Monzino, IRCCS
| | - Gabriele G Schiattarella
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy,Center for Cardiovascular Research (CCR), Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany,Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Joost P G Sluijter
- Laboratory of Experimental Cardiology, Cardiology, UMC Utrecht Regenerative Medicine Center,Circulatory Health Laboratory, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sabine Steffens
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-Universität, Munich,Germany and Munich Heart Alliance, DZHK partner site Munich, Germany
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH) at Charité, - Universitätmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), German Center for Cardiovascular Research (DZHK), Partner site Berlin and Dept Cardiology (CVK), Charité, Berlin; Germany
| | - Sophie Van Linthout
- Berlin Institute of Health (BIH) at Charité, - Universitätmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), German Center for Cardiovascular Research (DZHK), Partner site Berlin and Dept Cardiology (CVK), Charité, Berlin; Germany
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, WC1E 6HX, London, United Kingdom
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Ireson J, Taylor A, Richardson E, Greenfield B, Jones G. Exploring invisibility and epistemic injustice in Long Covid-A citizen science qualitative analysis of patient stories from an online Covid community. Health Expect 2022; 25:1753-1765. [PMID: 35557480 PMCID: PMC9327841 DOI: 10.1111/hex.13518] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 02/01/2023] Open
Abstract
Background In 2020, the long‐lasting effects of the Covid‐19 virus were not included in public messages of risks to public health. Long Covid emerged as a novel and enigmatic illness with a serious and life‐changing impact. Long Covid is poorly explained by objective medical tests, leading to widespread disbelief and stigma associated with the condition. The aim of this organic research is to explore the physical and epistemic challenges of living with Long Covid. Methods Unlike any previous pandemic in history, online Covid communities and ‘citizen science’ have played a leading role in advancing our understanding of Long Covid. As patient‐led research of this grassroots Covid community, a team approach to thematic analysis was undertaken of 66 patient stories submitted online to covid19‐recovery.org at the beginning of the Covid‐19 pandemic between April and September 2020. Results The overriding theme of the analysis highlights the complexities and challenges of living with Long Covid. Our distinct themes were identified: the life‐changing impact of the condition, the importance of validation and how, for many, seeking alternatives was felt to be their only option. Conclusions Long Covid does not easily fit into the dominant evidence‐based practice and the biomedical model of health, which rely on objective indicators of the disease process. Patient testimonies are vital to understanding and treating Long Covid, yet patients are frequently disbelieved, and their testimonies are not taken seriously leading to stigma and epistemic injustice, which introduces a lack of trust into the therapeutic relationship. Patient Contribution The research was undertaken in partnership with our consumer representative(s) and all findings and subsequent recommendations have been coproduced.
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Affiliation(s)
- Jane Ireson
- Centre for Psyhcological Research, Leeds Beckett University, Leeds, UK.,Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Amy Taylor
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Medical Imaging, University of Exeter, Exeter, UK
| | | | | | - Georgina Jones
- Centre for Psyhcological Research, Leeds Beckett University, Leeds, UK
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35
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Burton A, Aughterson H, Fancourt D, Philip KEJ. Factors shaping the mental health and well-being of people experiencing persistent COVID-19 symptoms or 'long COVID': qualitative study. BJPsych Open 2022; 8:e72. [PMID: 35307048 PMCID: PMC8987646 DOI: 10.1192/bjo.2022.38] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/20/2022] [Accepted: 02/25/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Around one in ten people who contract COVID-19 report persistent symptoms or 'long COVID'. Impaired mental health and well-being is commonly reported, including anxiety, depression and reduced quality of life. However, there is limited in-depth research exploring why mental health and well-being are affected in people experiencing long COVID. AIMS To explore factors affecting mental health and well-being from the perspective of people with long COVID. METHOD Semi-structured qualitative interviews were audio-recorded and transcribed. Data were analysed using reflexive thematic analysis. Twenty-one people with long COVID participated in the study. Participants were eligible if they self-reported a positive swab test/antibody test or one or more commonly reported COVID-19 symptoms at illness onset. and experiences of one or more long COVID symptoms ≥3 weeks following illness onset. RESULTS Five themes were identified across participant accounts regarding factors affecting mental health and well-being, including symptoms causing severe disruption to daily life, lack of service and treatment options, uncertainty of illness trajectories, experiences of care and understanding from others and changes to identity. CONCLUSIONS People with long COVID experience a range of factors that negatively affect their mental health and well-being. Providing patient-centred health services that integrate rapidly evolving research in this area is important, as are peer support groups and supported approaches to self-management.
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Affiliation(s)
- Alexandra Burton
- Department of Behavioural Science and Health, University College London, UK
| | - Henry Aughterson
- Department of Behavioural Science and Health, University College London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, UK
| | - Keir E. J. Philip
- National Heart and Lung Institute, Imperial College London, UK; and NIHR Imperial Biomedical Research Centre, UK
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36
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Philip KEJ, Buttery S, Williams P, Vijayakumar B, Tonkin J, Cumella A, Renwick L, Ogden L, Quint JK, Johnston SL, Polkey MI, Hopkinson NS. Impact of COVID-19 on people with asthma: a mixed methods analysis from a UK wide survey. BMJ Open Respir Res 2022; 9:9/1/e001056. [PMID: 35027428 PMCID: PMC8762134 DOI: 10.1136/bmjresp-2021-001056] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/24/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The impact of acute COVID-19 on people with asthma appears complex, being moderated by multiple interacting disease-specific, demographic and environmental factors. Research regarding longer-term effects in this group is limited. We aimed to assess impacts of COVID-19 and predictors of persistent symptoms, in people with asthma. METHODS Using data from an online UK-wide survey of 4500 people with asthma (median age 50-59 years, 81% female), conducted in October 2020, we undertook a mixed methods analysis of the characteristics and experience of those reporting having had COVID-19. RESULTS The COVID-19 group (n=471, 10.5%) reported increased inhaler use and worse asthma management, compared with those not reporting COVID-19, but did not differ by gender, ethnicity or household income. Among the COVID-19 group, 56.1% reported having long COVID, 20.2% were 'unsure'. Those with long COVID were more likely than those without long COVID to describe: their breathing as worse or much worse after their initial illness (73.7% vs 34.8%, p<0.001), increased inhaler use (67.8% vs 34.8%, p<0.001) and worse or much worse asthma management (59.6% vs 25.6%, p<0.001). Having long COVID was not associated with age, gender, ethnicity, UK nation or household income.Analysis of free text survey responses identified three key themes: (1) variable COVID-19 severity, duration and recovery; (2) symptom overlap and interaction between COVID-19 and asthma; (3) barriers to accessing healthcare. CONCLUSIONS Persisting symptoms are common in people with asthma following COVID-19. Measures are needed to ensure appropriate healthcare access including clinical evaluation and investigation, to distinguish between COVID-19 symptoms and asthma.
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Affiliation(s)
- Keir Elmslie James Philip
- National Heart and Lung Institute, Imperial College London, London, UK .,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Sara Buttery
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Parris Williams
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Bavithra Vijayakumar
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - James Tonkin
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Andrew Cumella
- Asthma UK and British Lung Foundation Partnership, London, UK
| | | | - Lizzie Ogden
- Asthma UK and British Lung Foundation Partnership, London, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK.,Respiratory Epidemiology, Occupational Medicine and Public Health, Imperial College London, London, UK
| | - Sebastian L Johnston
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK
| | - Michael I Polkey
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Biomedical Research Unit, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
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37
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Kang YR, Oh JY, Lee JH, Small PM, Chung KF, Song WJ. Long-COVID severe refractory cough: discussion of a case with 6-week longitudinal cough characterization. Asia Pac Allergy 2022; 12:e19. [PMID: 35571551 PMCID: PMC9066079 DOI: 10.5415/apallergy.2022.12.e19] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 11/21/2022] Open
Abstract
Long coronavirus disease (COVID) refers to an array of variable and fluctuating symptoms experienced after acute illness, with signs and symptoms that persist for 8–12 weeks and are not otherwise explicable. Cough is the most common symptom of acute COVID-19, but cough may persist in some individuals for weeks or months after recovery from acute phase. Long-COVID cough patients may get stigmatised because of the public fear of contagion and reinfection. However, clinical characteristics and longitudinal course of long-COVID cough have not been reported in detail, and evidence-based treatment is also lacking. In this paper, we describe a case of long-COVID severe refractory cough with features of laryngeal hypersensitivity and dysfunction. We characterized cough using patient-reported outcomes and engaged in continuous cough frequency monitoring. Through the case study, we discuss potential mechanisms, managements, and clinical implications of long-COVID refractory cough problems.
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Affiliation(s)
- Yu Ri Kang
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Yoon Oh
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Peter M. Small
- Hyfe, Inc and University of Washington, Department of Global Health, Seattle, WA, USA
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chaaban T, Achkar M, Jamal O. Post-COVID lung disease(s). Ann Thorac Med 2022; 17:137-144. [PMID: 35968401 PMCID: PMC9374125 DOI: 10.4103/atm.atm_103_22] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/28/2022] [Indexed: 11/04/2022] Open
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Algamdi MM. Assessment of Post-COVID-19 Quality of Life Using the Quality of Life Index. Patient Prefer Adherence 2021; 15:2587-2596. [PMID: 34824527 PMCID: PMC8610760 DOI: 10.2147/ppa.s340868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/13/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COVID-19 has impacted many aspects of peoples' quality of life (QOL). AIM To assess the QOL of post-COVID-19 cases and determine their associated sociodemographic attributes. METHODS A cross-sectional community-based study targeted recovered COVID-19 cases using an online questionnaire. An Arabic version of the Quality of Life Index (QLI) was evaluated for reliability and validity using Cronbach's alpha and Spearman's product moment tests, respectively. Descriptive analysis, Mann-Whitney U, Kruskal-Wallis H, and Spearman correlation tests were used to investigate the relationships between QOL and study independent variables, including sociodemographic characteristics, time since infection, intention for vaccination, perception of the influence of COVID-19 on general health, history of hospitalization, and history of chronic illness. Subgroups were compared using a Student's t-test for normally distributed data and the Wilcoxon rank-sum test or the Kruskal-Wallis test for non-normally distributed data. RESULTS In a sample of 449 respondents, the total QLI score was 22.64 ± 4.36; for subscales, it ranged from 20.86 ± 5.04 to 24.99 ± 4.74. Males had significantly higher health and functioning subscale (HFSUB) scores compared to females (p = 0.033). Employed cases had significantly higher social and economic subscale (SOCSUB) scores than unemployed cases (p = 0.000). Married people reported significantly higher family subscale (FAMSUB) scores (p = 0.000) than unmarried people. People who believe that their general health was affected by COVID-19 had significantly lower HFSUB and psychological and spiritual subscale (PSPSUB) scores (p = 0.000 and p = 0.021, respectively). Individuals with a history of hospital admissions scored lower on PSPSUB (p = 0.000). Age was significantly associated with both SOCSUB (p = 0.006) and FAMSUB (p = 0.040). CONCLUSION Sociodemographic attributes of people with a history of COVID-19 revealed significant differences in some QOL domains, as measured by the Arabic version of the generic QLI. History of hospitalization and beliefs about COVID-19's impact on general health negatively influenced individual's HFSUB and PSPSUB.
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Affiliation(s)
- Maaidah M Algamdi
- Department of Nursing, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
- Correspondence: Maaidah M Algamdi Department of Nursing, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi ArabiaTel +966560091866 Email
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