Psychological and functional impacts associated with restrictions in long-term care facilities (LTCF) due to the COVID-19 pandemic: A multicentre study

Objectives: To analyze the impacts of the restrictions implemented in LTCF during the COVID-19 pandemic on the psychological and functional status of older adults. Design: A retrospective multicentre study is designed. We hypothesize that the negative effects of the restrictions will lead to a higher rate of decline between the measures taken immediately before and after the lockdown than between the two measures taken before the lockdown. Setting and participants: 365 participants recruited in four Spanish LTCFs in Galicia and Valencia.Methods: Impacts of restrictions on cognitive (MMSE), affective (GDS) and functional status (Barthel index, Tinetti) were analyzed by Linear Mixed Models with random intercepts, random slopes, and personal and contextual factors as covariates.Results: Social measures covaried significantly with the cognitive and functional status but did not predict longitudinal change. MMSE, Barthel index and Tinetti scores decreased significantly across pre- and post-lockdown measurement times, but only the Tinetti scores showed a specific impact of the restrictions.Conclusions: Only performance-based functional measures showed the real impact of restrictions. The findings highlight the importance of having data from several pre-lockdown measurements to enable identification of changes that can be causally attributed to the restrictions. The findings also support the resilience of older adults in mitigating the effect of the restrictions.

Low resilience as risk factor of mental disorders during COVID-19 pandemic: A cohort study

Background

To analyze whether people with low resilience are at higher risk of mental health problems during the COVID-19 pandemic in Spanish adults.

Methods

A longitudinal cohort study was carried out. Resilience was measured pre/post-pandemic with the CD-RISC. Mental health problems assessed were: Major Depressive Episode (MDE), Generalized Anxiety Disorder (GAD), Suicidal Thoughts and Behaviors (STB), and Posttraumatic Stress Disorder (PTSD) symptoms.

Results

We found statistically significant differences between groups and resilience scores in MDE [F (3;48.40)=19.55], GAD [F(3;19.63)=6.45] and STB [F(3;111.74)=31.94]. Multivariable analyses showed individuals with very low resilience were at a 5-fold risk of Incidence of MDE and a 4-fold risk of STB. Persistent group presented a 21-fold risk of MDE and 54-fold risk of STB, respectively. No evidence of higher risk was found for GAD. Individuals with low resilience and exposed to COVID-19 did not have a significantly higher risk. Individuals with low resilience were at higher risk of PTSD in general population [β(95%CI)= -3.25(-3.969 to -2.54)], but not for individuals with COVID-19.

Conclusions

In the general population, having low or very low resilience increases the risk of suffering MDE, STB, and PTSD, but not GAD during the COVID-19 pandemic, but not in the population with COVID-19.

Key messages

• Resilience was a buffer of mental health problems in general population, but not in those exposed to COVID-19.

• Those with low resilience were at 21-fold risk of mental health problems before and during the first year of pandemic.

Safety and Efficacy of Ultrasound-Guided Radiofrequency Ablation of Recurrent Colorectal Cancer Liver Metastases after Hepatectomy

INTRODUCTION

To assess the results and outcome of radiofrequency ablation in the treatment of recurrent colorectal liver metastases.

PATIENTS AND METHODS

Between January 2005 and September 2012, we treated 59 patients with recurrent colorectal metastases not amenable to surgery with 77 radiofrequency ablation procedures. Radiofrequency was indicated if oncologic resection was technically not possible or the patient was not fit for major surgery. A total of 91 lesions were treated. The mean number of liver tumors per patient was 1.5, and the mean tumor diameter was 2.3 cm. In 37.5% of the cases, lesions had a subcapsular location, and 34% were close to a vascular structure.

RESULTS

The morbidity rate was 18.7%, and there were no post-procedural deaths. Distant extrahepatic recurrence appeared in 50% of the patients. Local recurrence at the site of ablation appeared in 18% of the lesions. Local recurrence rate was 6% in lesions less than 3 cm and 52% in lesions larger than 3 cm. The size of the lesions (more than 3 cm) was an independent risk factor for local recurrence (p < 0.05). Survival rates at 1, 3, and 5 years were 94.5%, 65.3%, and 21.7%, respectively.

DISCUSSION

Radiofrequency ablation is a safe procedure and allows local tumor control in lesions less than 30 mm (local recurrence of 6%) and provides survival benefits in patients with recurrent colorectal liver metastases.

Multiple response optimization of vegetable oils fatty acid composition to improve biodiesel physical properties

The effect of fatty acids chain length (LC) and its interaction with unsaturation degree (UD) on important biodiesel quality parameters was studied. Low calorific value, kinematic viscosity, flash point, cetane number and cold filter plugging point of biodiesel blends covering a wide range of fatty acids were analyzed. Analytical results were processed with statistical regression to obtain a prediction model for each property, combining LC and UD. Due to the antagonistic effects of the chemical composition over quality properties, the Derringer desirability function was proposed to allow the most suitable fatty acid composition. This target was achieved considering an average of 1.26 double bounds and 17 carbon atoms. A set of combinations of LC and UD values that provides a biodiesel that fits the European standard EN 14214 was proposed. It was found that a reduction of FAME LC allows a lower UD while keeping biodiesel specifications under the standard limits.