The Impact of the SARS-CoV-2 Outbreak on the Psychological Flexibility and Behaviour of Cancelling Medical Appointments of Italian Patients with Pre-Existing Medical Condition: The "ImpACT-COVID-19 for Patients" Multi-Centre Observational Study

The emotional states and associated behavioral responses (flexible-adaptive behaviors vs. inflexible-maladaptive behaviors) of cancer patients during the SARS-CoV-2 outbreak: A multi-center cross-sectional study in Italy

OBJECTIVE

Distress during SARS-CoV-2 outbreak affected also cancer patients' well-being. Aim of this study was to investigate patient' reactions and behavior (flexible-adaptive vs. inflexible-maladaptive) during the SARS-CoV-2 outbreak.

METHODS

A cross-sectional survey was designed with a self-report questionnaire, "the ImpACT questionnaire," developed for the study. Regression analysis was performed on data.

RESULTS

Four hundred and forty five cancer patients from 17 Italian regions participated in the study. 79.8% of participants were female (mean age of 58 years). 92.6% of participants reported feeling vulnerable to COVID-19 contagion; 75.6% reported helpless, 62.7% sad, 60.4% anxious, and 52.0% anger. Avoidance of thinking about coronavirus is the principal maladaptive behavior that emerged. Participants who reported feeling anxious were more likely to have fear of staff being infected with COVID-19 (OR = 3.01; 95% CI = 1.49-6.30) and to have disrupted sleep due to worry (OR = 2.42; 95% CI = 1.23-4.83). Younger participants reported more anxiety (OR = 0.97; 95% CI = 0.94-1.00); men reported feeling calm more than women (OR = 2.60; 95% CI = 1.27-5.43).

CONCLUSIONS

Majority of cancer patients reported serious concerns regarding SARS-CoV-2 infection; reliable information and psychological support must be offers to respond to these needs.

Missed Healthcare Visits During the COVID-19 Pandemic: A Longitudinal Study

INTRODUCTION

Missed visits have been estimated to cost the U.S. healthcare system $50 billion annually and have been linked to healthcare inefficiency, higher rates of emergency department visits, and worse outcomes. COVID-19 disrupted existing outpatient healthcare utilization patterns. In our study, we sought to examine the frequency of missed outpatient visits over the course of the COVID-19 pandemic and to examine patient-level characteristics associated with non-attendance.

METHODS

This study utilized data from a longitudinal cohort study (the Chicago COVID-19 Comorbidities (C3) study). C3 participants were enrollees in 1 of 4 active, "parent" studies; they were rapidly enrolled in C3 at the onset of the pandemic. Multiple waves of telephone-based interviews were conducted to collect experiences with the pandemic, as well as socio-demographic and health characteristics, health literacy, patient activation, and depressive and anxiety symptoms. For the current analysis, data from waves 3 to 8 (05/01/20-05/19/22) were analyzed. Participants included 845 English or Spanish-speaking adults with 1 or more chronic conditions.

RESULTS

The percentage of participants reporting missed visits due to COVID-19 across study waves ranged from 3.1 to 22.4%. Overall, there was a decline in missed visits over time. No participant sociodemographic or health characteristic was consistently associated with missed visits across the study waves. In bivariate and multivariate analysis, only patient-reported anxiety was significantly associated with missed visits across all study waves.

CONCLUSION

Findings reveal that anxiety was consistently associated with missed visits during the COVID-19 pandemic, but not sociodemographic or health characteristics. Results can inform future public health initiatives to reduce absenteeism by considering patients' emotional state during times of uncertainty.

The Impact of COVID-19 on Members of the Saudi Community: Perceptions and Expectations From the Pandemic

Background and purpose Community individuals and sectors worldwide, including health, security, economy, education, and occupation, are being challenged to confront the coronavirus disease 2019 (COVID-19) pandemic. The deadly virus originated in Wuhan city in China and spread globally to other countries on account of its rapid mode of transmission. Solidarity and cooperation were vital elements in mitigating the COVID-19 pandemic all around the globe. Actions of solidarity among countries included gathering the world's leading experts to discuss the latest research and innovation while working to promote knowledge and empowerment across the communities. The purpose of this study was to explore the influence of the COVID-19 pandemic on different aspects of the Saudi community, including health, education, finance, lifestyle, and others. We also wanted to identify the perceptions of the general Saudi population regarding the impact of the pandemic and its long-term effects. Methodology This cross-sectional study was conducted from March 2020 to February 2021 among individuals across the Kingdom of Saudi Arabia. The online self-developed survey was disseminated to thousands of individuals in the Saudi community and yielded 920 responses. Results Roughly 49% of the studied participants postponed their dental and cosmetic center appointments, and 31% reported delayed periodic health appointments in hospitals and primary healthcare centers. Around 64% reported missing hearing "Tarawih/Qiyam" Islamic prayers. Furthermore, 38% of the study respondents reported being anxious and stressed, 23% reported having sleeping disorders, and 16% wanted to be isolated from the community. On the other hand, the COVID-19 pandemic helped approximately 65% of the studied participants to abstain from ordering from restaurants and cafes. Additionally, 63% of them reported gaining new skills or behaviors during the pandemic. Many participants (54%) thought that after the curfew recession, they will face financial challenges while 44% assumed that life will not return to what it used to be. Conclusion The COVID-19 pandemic has had a multidimensional impact on Saudi society, which has affected both individuals and the community as a whole. Some of the short-term perceived impacts involved interruption in the provision of health care, poor mental well-being, financial hardship, challenges related to homeschooling and working from home, and the inability to fulfill spiritual needs. On the bright side, community individuals demonstrated the ability to learn and develop during the pandemic by striving to acquire knowledge and new skills.

Mental Health Problems During COVID-19 and Attitudes Toward Digital Therapeutics

OBJECTIVE

We aimed to elucidate public mental health problems and associated factors during the coronavirus disease-2019 (COVID-19). Furthermore, we evaluated people's attitudes toward digital therapeutics during the pandemic.

METHODS

Data was collected online from participants, aged between 20-50 without any history of mental illness, from June 1st to June 30th 2021. The survey consisted of questions regarding demographics, changes during pandemic and attitude towards digital therapeutics, and mental health measures.

RESULTS

Among the total of 445 participants, 49.2% reported significant level of stress and 13.5% and 7.0% met the screening criteria for major depressive disorder and generalized anxiety disorder, respectively. Significant predictive factors for mental health problems were-younger age group, female sex, currently being treated for medical or surgical disease, change in the amount of time spent on mobile device or computer after pandemic, change in household income, and change in work environment due to pandemic. Furthermore, 35.1% of participants, considered psychiatric consultation, at least slightly, but were hesitant to receive it due to the fear of contacting COVID-19 at the clinics. Instead, 54.4% of them preferred using digital therapeutics as an alternative to visiting offline clinics.

CONCLUSION

We demonstrated that COVID-19 increased mental health problems along with access problems and identified their predictive factors. Digital therapeutics emerged as a viable solution to mental health problems and it was well-received by those in need of psychiatric consultation. Therefore, development and implementation of digital therapeutics should be considered to improve the mental health of people.

Post-pandemic stress of COVID-19 among high-risk groups: A systematic review and meta-analysis

BACKGROUND

Post-Traumatic Stress Disorder (PTSD) is considered as a prevalent outcome of the COVID-19 pandemic. This study aimed to present a global picture of the prevalence of PTSD in high-risk groups for COVID-19 (HRGs-COVID19) and determine its risk factors.

METHODS

Cross-sectional studies published between March 11, 2020, and October 11, 2021, in English, were searched in seven databases on the prevalence of PTSD in HRGs-COVID19. After screening the retrieved records, their quality was assessed, and the required data were extracted. R-4.1.3 software and random effect model with 95 % confidence interval (CI) were used to synthesize and analyze the data.

RESULTS

The pooled prevalence of PTSD in HRGs-COVID19 was 30 % (95 % CI: 21-39 %). The pooled prevalence of PTSD was significantly different in terms of the variables of data collection during the lockdown, gender, and data collection season (P < 0.05). Subgroup analyses could not identify sources of heterogeneity.

LIMITATIONS

The included studies did not cover all HRGs-COVID19 such as smokers and the elderly.

CONCLUSION

Considering the higher pooled prevalence of PTSD in HRGs-COVID19 than the general population, COVID-19 patients, and health care workers, prioritizing this subgroup for prevention and treatment of psychological outcomes is highly recommended. Predicting and implementing psychological interventions early in the pandemic is more critical when applying restrictive measures and among HRGs-COVID19 women.

Psychological impact on healthcare workers, general population and affected individuals of SARS and COVID-19: A systematic review and meta-analysis

Background

Any infectious disease outbreak may lead to a negative detrimental psychological impact on individuals and the community at large, however; there was no systematic review nor meta-analysis that examined the relationship between the psychological/mental health impact of SARS and COVID-19 outbreak in Asia.

Methods and design

A systematic search was conducted using PubMed, EMBASE, Medline, PsycINFO, and CINAHL databases from 1/1/2000 to 1/6/2020. In this systematic review and meta-analysis, we analyzed the psychological impact on confirmed/suspected cases, healthcare workers and the general public during the Severe Acute Respiratory Syndrome (SARS) outbreak and Coronavirus disease (COVID-19) epidemics. Primary outcomes included prevalence of depression, anxiety, stress, post-traumatic stress disorder, aggression, sleeping problems and psychological symptoms.

Result

Twenty-three eligible studies (N = 27,325) were included. Random effect model was used to analyze the data using STATA. Of these studies, 11 were related to the SARS outbreak and 12 related to COVID-19 outbreaks. The overall prevalence rate of anxiety during SARS and COVID-19 was 37.8% (95% CI: 21.1-54.5, P < 0.001, I2 = 96.9%) and 34.8% (95% CI: 29.1-40.4), respectively. For depression, the overall prevalence rate during SARS and COVID-19 was 30.9% (95% CI: 18.6-43.1, P < 0.001, I2 = 97.3%) and 32.4% (95% CI: 19.8-45.0, P < 0.001, I2 = 99.8%), respectively. The overall prevalence rate of stress was 9.4% (95% CI: -0.4 -19.2, P = 0.015, I2 = 83.3%) and 54.1% (95% CI: 35.7-72.6, P < 0.001, I2 = 98.8%) during SARS and COVID-19, respectively. The overall prevalence of PTSD was 15.1% (95% CI: 8.2-22.0, P < 0.001) during SARS epidemic, calculated by random-effects model (P < 0.05), with significant between-study heterogeneity (I2 = 93.5%).

Conclusion

The SARS and COVID-19 epidemics have brought about high levels of psychological distress to individuals. Psychological interventions and contingent digital mental health platform should be promptly established nationwide for continuous surveillance of the increasing prevalence of negative psychological symptoms. Health policymakers and mental health experts should jointly collaborate to provide timely, contingent mental health treatment and psychological support to those in need to reduce the global disease burden.

Systematic review registration

CRD42020182787, identifier PROSPER.

Impact of SARS-CoV-2 infection on tuberculosis outcome and follow-up in Italy during the first COVID-19 pandemic wave: a nationwide online survey

BACKGROUND

SARS-CoV-2 pandemic affected tuberculosis (TB) management. This Italian nationwide survey assessed COVID-19 impact on TB care and outcomes.

MATERIALS AND METHODS

Twenty-one hospitals or referral centres fulfilled an online survey. Primary objective was to describe clinical features, outcomes and retention in care in subjects with latent TB infection (LTBI) or disease over the first wave of COVID-19 pandemic. Secondary objectives were the assessment of risk factors, co-morbidities, diagnostics, radiological findings, and outcomes of COVID-19 in the study population.

RESULTS

254 patients with LTBI or active TB were included. In co-infected (SARS-CoV-2, LTBI/TB) patients, recovery occurred in 29/32 (90.6%) cases, death in one case. High retention in care was preserved.

CONCLUSION

in our cohort, outcomes did not seem to be adversely conditioned by incident COVID-19.

A Physiotherapy Treatment Plan for Post-COVID-19 Patients That Improves the FEV1, FVC, and 6-Min Walk Values, and Reduces the Sequelae in 12 Sessions

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causal agent of Coronavirus disease 2019 (COVID-19), a pandemic disease declared in 2020. The clinical manifestations of this pathology are heterogeneous including fever, cough, dyspnea, anosmia, headache, fatigue, taste dysfunction, among others. Survivors of COVID-19 have demonstrated several persistent symptoms derived from its multisystemic physiopathology. These symptoms can be fatigue, dyspnea, chest pain, dry and productive cough, respiratory insufficiency, and psychoemotional disturbance. To reduce and recover from the post-COVID-19 sequelae is fundamental an early and multifactorial medical treatment. Integral post-COVID-19 physiotherapy is a tool to reduce dyspnea, improve lung capacity, decrease psychoemotional alterations, as well as increase the muscle strength affected by this disease. Thus, the aim of this study was to establish a novel physiotherapeutic plan for post-COVID-19 patients, evaluating the effect of this treatment in the reduction of the sequelae in terms of lung capacity, cardio-respiratory, and muscular strength improvements. This was a cross-sectional study in which a protocol of 12 sessions in 4 weeks of physiotherapy was implemented in the patients enrolled. We conducted a medical assessment, an interview, a DASS-21 test, a spirometry, a 6-min walk test, and a hand dynamometer test to evaluate the post-COVID condition of patients before and after the sessions. A total of 42 patients participated in the program. Results of this work showed a decrease of around 50% of post-COVID-19 sequelae and an improvement in the psychoemotional status of patients. Also, we observed an increase of 7.16% in the FEV1 value and 7.56% for FVC. In addition, the maximal functional capacity increased by 0.577 METs, the 6-min walk test performance increased by 13%, and the SpO2 improved by 1.40%. Finally, the handgrip strength test showed an improvement in the left hand and right hand of 2.90 and 2.24 Kg, respectively. We developed this study to propose a novel methodology to provide information for a better treatment and management of post-COVID-19 patients.

[Medical conditions, symptoms of anxiety, and depression during the COVID-19 pandemic in a population sample of Lima, Peru]

Introduction: This study aims to determine differences between the number of underlying medical conditions, depression, and anxiety, when controlling for the covariates of age, sex, and completed education.Methods: Participants (n=484) indicated the number of medical conditions present during the survey, also including the PHQ-9 and GAD-7, to assess depression and anxiety, respectively.Results: Differences were found between groups of medical conditions and the combined values of PHQ-9 and GAD-7 after controlling for the covariates mentioned above (F4,954=5.78; Wilks' Λ=0.95; P<0.0005). The univariate tests showed differences for PHQ-9 (F2,478=8.70; P<0.0005) and GAD-7 (F2,478=11.16; P<0.0005) between the 3 groups. Finally, post-hoc analysis showed differences between participants with one medical condition and with no medical condition (PHQ-9: MD=1.82; 95%CI, 0.25-3.40; GAD-7: MD=1.73; 95%CI, 0.55-2.91), and between participants with more than one medical condition and participants with no medical condition (PHQ-9: MD=3.10; 95%CI, 1.11-5.10; GAD-7: MD=2.46; 95%CI, 0.97-3.95).Conclusions: Our results suggest that people who had a medical condition during the COVID-19 pandemic were more prone to developing severe symptoms of anxiety and depression.

Teachers’ emotional well-being during the SARS-CoV-2 pandemic with long school closures: A large-scale cross-sectional survey in Northern Italy

Objectives

This study aimed to evaluate the magnitude of emotional burden on teaching staff during the SARS-CoV-2 pandemic in a significantly impacted region. In addition, the correlates of emotional burden were analysed to enable the design of targeted interventions.

Study design

This study was a cross-sectional survey.

Methods

An electronic survey was administered to the teaching staff at public schools and kindergartens in a specific geographical area. Cross-sectional assessments of pandemic-specific variables were performed using the Pandemic Fatigue Scale, the Depression Anxiety Stress Scale (DASS)-21, the Satisfaction with Life Scale, and the Resilient Coping Scale. DASS-21 results were compared with results from a parallel survey that was representative of the local general population.

Results

In total, 3251 teaching staff members participated in the survey. Teachers showed a higher emotional burden for depression, anxiety and stress than the general population during the pandemic. According to a linear regression model, this burden is correlated with the language in which the questionnaires were answered, mistrust towards institutions, specific SARS-CoV-2 anxiety, past infection with SARS-CoV-2, avoidance of information about the pandemic and pandemic fatigue; emotional burden was negatively correlated with measures for life satisfaction, resilience and team atmosphere. Some independent variables were shown to contribute differentially to the variance of depression, anxiety or stress.

Conclusions

Emotional distress during the pandemic among teachers is higher than in the general population and correlates with variables that could, at least in principle, be targeted for specific interventions.

The Impact of the COVID-19 Pandemic on Avoidance of Health Care, Symptom Severity, and Mental Well-Being in Patients With Coronary Artery Disease

The COVID-19 pandemic affected regular health care for patients with chronic diseases. However, the impact of the pandemic on primary care for patients with coronary artery disease (CAD) who are enrolled in a structured disease management program (DMP) in Germany is not clear. We investigated whether the pandemic affected primary care and health outcomes of DMP-CAD patients (n = 750) by using a questionnaire assessing patients' utilization of medical care, CAD symptoms, as well as health behavior and mental health since March 2020. We found that out of concern about getting infected with COVID-19, 9.1% of the patients did not consult a medical practitioner despite having CAD symptoms. Perceived own influence on infection risk was lower and anxiety was higher in these patients compared to symptomatic CAD patients who consulted a physician. Among the patients who reported chest pain lasting longer than 30 min, one third did not consult a medical practitioner subsequently. These patients were generally more worried about COVID-19. Patients with at least one worsening CAD symptom (chest pain, dyspnea, perspiration, or nausea without apparent reason) since the pandemic showed more depressive symptoms, higher anxiety scores, and were less likely to consult a doctor despite having CAD symptoms out of fear of infection. Our results provide evidence that the majority of patients received sufficient medical care during the COVID-19 pandemic in Germany. However, one in ten patients could be considered particularly at risk for medical undersupply and adverse health outcomes. The perceived infection risk with COVID-19 might have facilitated the decision not to consult a medical doctor.

A National Representative, Cross-Sectional Study by the Hellenic Academy of NeuroImmunology (HEL.A.NI.) on COVID-19 and Multiple Sclerosis: Overall Impact and Willingness Toward Vaccination

Background: In the context of the coronavirus disease 2019 (COVID-19) pandemic, the constant needs of people with multiple sclerosis (PwMS) and their caregivers were urgently highlighted.

Aim: The present study aims to capture the effects of the COVID-19 pandemic in several aspects of the quality of life of PwMS, in perception and behavior to COVID-19 and multiple sclerosis (MS), as well as concerning healthcare, working conditions, and the willingness toward COVID-19 vaccination.

Methods: This study is an initiative of the Hellenic Academy of Neuroimmunology (HEL.A.NI.) and it has been included in the MS Data Alliance (MSDA) Catalog, which can be accessed after creating an account on https://msda.emif-catalogue.eu/login. Two online questionnaires were administered: (i) impact of the COVID-19 pandemic on the quality of life, behavior, and healthcare of PwMS (Questionnaire A) and (ii) vaccination against COVID-19 (Questionnaire B). People with MS were invited to participate by the Hellenic Federation of Persons with Multiple Sclerosis (HFoPwMS).

Results: Three-hundred-ninety PwMS responded to Questionnaire A, whereas 176 PwMS provided answers for Questionnaire B. Older age, longer disease duration, and higher MS-related disability were associated with the increased perceived sensitivity toward severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as well as the increased perceived severity of COVID-19 upon potential infection. A significant proportion of PwMS experienced restricted access to MS-related health professionals, disease-modifying therapy (DMT) prescription, and/or to MS-related laboratory examination due to the pandemic. Subgroups of PwMS reported exacerbated symptoms (i.e., chronic MS-related symptoms, fatigue and/or worsening of pre-existing fatigue, and sexual dysfunction and or/worsening of pre-existing sexual dysfunction). Overall, the majority of the participants reported either a strong willingness to get vaccinated against COVID-19 or a likeliness to undergo vaccination. Being aware of the HEL.A.NI. recommendations regarding COVID-19 vaccination for PwMS were reported to increase the willingness of the participants to receive the vaccine.

Conclusions: Our results highlight the necessity of scientific and patient organizations in taking joint action to increase awareness on health-related issues during the pandemic and to provide accurate and up-to-date guidance for PwMS. Online information and communications technology (ICT) tools for polling public belief and behavior may prove valuable as means of retaining active routes of communication between stakeholders.

The Impact of COVID-19 pandemic on a tertiary referral proctology center: no one should be left behind

BACKGROUND

Coronavirus disease 2019 (COVID-19) has disrupted healthcare delivery. We aimed to describe a novel strategy to mitigate the impact of COVID-19 pandemic on a tertiary referral proctology center during the first wave of infection in Italy.

METHODS

All patients booked appointments at the Proctology Unit between March 9th and May 4th 2020 were identified. Patients booked for a first visit underwent a structured remote consultation. Patients with perianal or sacrococcygeal abscesses, major anorectal bleeding, incoercible anal pain and red flags for malignancy were labelled as 'non-deferrable'. A flowchart was designed to comply with adequate assistance of proctologic patients. Demographics, clinical data and outcomes of in-office procedures were collected.

RESULTS

On a total of 548 booked visits, 198 (36.1%) were cancelled before remote consultation. Of the remaining 350, 112 (32.0%) attended a follow-up visit. Among 238 (68.0%) patients undergoing remote consultation, 88 (25.1%) were deemed 'deferrable' and 148 (42.3%) 'nondeferrable'. 2 (0.6%) were hospitalized for COVID-19 while waiting for an outpatient visit. 25/88 (28.4%) deferrable patients cancelled their appointment as felt no longer necessary. A total of 45/148 (30.4%) non deferrable patients (mean age, 46 years; 31% females) underwent in-office procedures, most often related to anal abscess and/or fistula (48.9%). Final diagnosis of malignancy occurred in 4 cases. A 55% increase in the number of in-office procedures was noted compared to the previous year. None of the attending patients nor staff members resulted COVID-19 positive during the study period.

CONCLUSIONS

Despite the uncertainties accompanying the use of remote consultations in proctology, the results of this study may inform the development of strategies for restructuring activities in response to future emergencies of this magnitude.

Economic Impact of COVID-19 Lockdown on Italian NHS: Focus on Diabetes Mellitus

Background

In Italy, the adoption of a total lockdown has generated almost total suspension of outpatient visits except for emergencies. Even after lockdown, the pandemic fear created additional barriers to access the health services. The aim of our study is to evaluate the economic impact of the lockdown for COVID-19 on public health in Italy, focusing on its effects on diabetic population.

Materials and Methods

We analyzed the impact of the lockdown on excess mortality and morbidity in the Italian diabetic population during 2020. The analysis was divided into several steps: a quantification of specialist visit reduction, the calculation of excess mortality in the diabetic population, the economic evaluation of the slowdown in the use of innovative diabetic therapies. Furthermore, the impact of the lockdown on the reduction of procedures and follow-up visits in diabetic population was evaluated. The overall impact of the pandemic and lockdown effects on costs and quality of life was then calculated.

Results

During 2020, a drop of 28% in patient access has been observed. Diabetic patients recorded a twice higher mortality value compared to general population (20.4% vs 10.2%). The analysis of market data revealed a slowdown in consumption of new antidiabetic therapies (−14%, 27% vs 41%). We estimated an expense of €26.6 million for NHS and a loss of 257 utilities in diabetic population due to the missed benefits related to slowdown in innovative antidiabetic drugs use and non-optimal follow-up and control of diabetes complications. In simulation scenarios, we also estimated an overall expenditure ranging from €38.7 to 94.0 million and a loss of 294–836 utilities.

Conclusion

Diabetic population paid a high tribute to pandemic and lockdown, both in terms of number of deaths and burden of diabetic complications, together with an overall deterioration of quality of life.