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Documents  COVID-19 | enregistrements trouvés : 102

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Impact of COVID-19 on Pediatric Mental and Behavioral Health Visits to the Emergency Department | Août 2022 H Nouveau

Article | Veille Urgence et soins intensifs (Urgence et soins intensifs)

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Objectives: This study aimed to describe changes in pediatric emergency department (ED) mental and behavioral health (MBH) visits before and during the early COVID-19 pandemic.

Methods: We retrospectively reviewed medical records of patients aged from 5 to 17 years presenting to the pediatric ED of a major tertiary care hospital with MBH-related concerns from March 2017 to September 2020. We evaluated trends in MBH ED visits over the study period, specifically comparing patient demographics, diagnosis categories, and ED disposition between the pre-COVID (2019) and COVID (2020) periods using pairwise Pearson [chi]2 analyses with reported odds ratios (ORs) in SAS statistical software version 9.4 (SAS Institute Inc, Cary, NC).

Results: Of 8093 MBH-related visits, 58.5% were females, 85.4% were adolescents, and 62.7% self-identified as non-Hispanic. The proportion of MBH-related ED visits increased from 3.8% to 7.5% over the study period (P < 0.0001). Although total MBH visits decreased by 17.3% from 2019 to 2020, there was a proportionate increase in MBH-to-total-ED visits, representing a 42.8% increase through 2019. Compared with 2019, there was a proportionate increase in MBH-related ED visits by females (10.6%, P < 0.0001), older adolescents (18.2%, P < 0.0001), and non-Hispanic patients (6.1%, P = 0.017) in 2020. The MBH visits in 2020 were more likely related to suicidality/self-harm (OR, 1.2; confidence interval [CI], 1.1-1.4) or substance use (OR, 1.4; CI, 1.1-1.9). Compared with 2019, there were significantly higher odds of admission (OR, 1.6; CI, 1.3-2.1) or transfer for inpatient psychiatric care (OR, 1.8; CI, 1.6-2.1) in 2020.

Conclusions: Our data suggest that the early COVID-19 pandemic had a significant impact on MBH-related ED visits. Compared with 2019, we observed a significant increase in the proportion of MBH-to-total-ED visits primarily affecting older adolescent, non-Hispanic girls with suicidality/self-harm and substance-related disorders in 2020, despite an overall decrease in the number of MBH visits during this period. There was also an increase in the proportion of visits resulting in admission or transfer for inpatient psychiatric care in 2020.
Objectives: This study aimed to describe changes in pediatric emergency department (ED) mental and behavioral health (MBH) visits before and during the early COVID-19 pandemic.

Methods: We retrospectively reviewed medical records of patients aged from 5 to 17 years presenting to the pediatric ED of a major tertiary care hospital with MBH-related concerns from March 2017 to September 2020. We evaluated trends in MBH ED visits over the study ...

COVID-19 ; Médecine d'urgence ; Hôpitaux - Services des urgences ; Enfants - Santé mentale

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Neurologic Outcomes of Survivors of COVID-19-Associated Acute Respiratory Distress Syndrome Requiring Intubation | Août 2022 H Nouveau

Article | Veille Urgence et soins intensifs (Urgence et soins intensifs)

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OBJECTIVES: To describe 3-6-month neurologic outcomes of survivors of COVID-19-associated acute respiratory distress syndrome, invasively ventilated in the ICU.

DESIGN: A bicentric prospective study during the two first waves of the pandemic (March to May and September to December, 2020).

SETTING: Two academic hospital ICUs, Paris, France.

PATIENTS: Adult COVID-19-associated acute respiratory distress syndrome survivors, invasively ventilated in the ICU, were eligible for a neurologic consultation between 3 and 6 months post ICU discharge.

INTERVENTIONS: Follow-up by face-to-face neurologic consultation.

MEASURES AND MAIN RESULTS: The primary endpoint was favorable functional outcome defined by a modified Rankin scale score less than 2, indicating survival with no significant disability. Secondary endpoints included mild cognitive impairment (Montreal Cognitive Assessment score < 26), ICU-acquired weakness (Medical Research Council score < 48), anxiety and depression (Hospital Anxiety and Depression score > 7), and posttraumatic stress disorder (posttraumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders 5 score > 30). Of 54 eligible survivors, four non-French-speaking patients were excluded, eight patients were lost-to-follow-up, and one died during follow-up. Forty-one patients were included. Time between ICU discharge and neurologic consultation was 3.8 months (3.6-5.9 mo). A favorable functional outcome was observed in 16 patients (39%) and mild cognitive impairment in 17 of 33 patients tested (52%). ICU-acquired weakness, depression or anxiety, and posttraumatic stress disorder were reported in six of 37 cases (16%), eight of 31 cases (26%), and two of 27 cases (7%), respectively. Twenty-nine patients (74%) required rehabilitation (motor, cognitive, or psychologic). ICU and hospital lengths of stay, tracheostomy, and corticosteroids were negatively associated with favorable outcome. By contrast, use of alpha-2 agonists during ICU stay was associated with favorable outcome.

CONCLUSIONS: COVID-19-associated acute respiratory distress syndrome requiring intubation led to slight-to-severe functional disability in about 60% of survivors 4 months after ICU discharge. Cognitive impairment, muscle weakness, and psychologic symptoms were frequent. A large multicenter study is warranted to allow identification of modifiable factors for improving long-term outcome.
OBJECTIVES: To describe 3-6-month neurologic outcomes of survivors of COVID-19-associated acute respiratory distress syndrome, invasively ventilated in the ICU.

DESIGN: A bicentric prospective study during the two first waves of the pandemic (March to May and September to December, 2020).

SETTING: Two academic hospital ICUs, Paris, France.

PATIENTS: Adult COVID-19-associated acute respiratory distress syndrome survivors, invasively ventilated ...

Appareil respiratoire - Maladies ; COVID-19 ; Cognition

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COVID-19 Vaccines in Older Adults: Challenges in Vaccine Development and Policy Making | Août 2022 H

Article | Veille Gériatrie-gérontologie (Gériatrie - gérontologie)

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Older adults are a vulnerable group with a high need for coronavirus disease 2019 (COVID-19) vaccines, but these individuals are also more prone to the development of vaccine-related adverse events.

Older adults with frailty, disability, dementia or living in long-term care facilities need special attention in COVID-19 vaccination programs because supporting evidence for the safety and efficacy of COVID-19 vaccines in these individuals is limited.

The active involvement of geriatricians in vaccine development and related public-policy development is important for the success of adult vaccination strategies against COVID-19 and other communicable and noncommunicable diseases.

The completion of a primary series of COVID-19 vaccines with a heterologous booster dose remains the best strategy to reduce the impact of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections and transmission.
Older adults are a vulnerable group with a high need for coronavirus disease 2019 (COVID-19) vaccines, but these individuals are also more prone to the development of vaccine-related adverse events.

Older adults with frailty, disability, dementia or living in long-term care facilities need special attention in COVID-19 vaccination programs because supporting evidence for the safety and efficacy of COVID-19 vaccines in these individuals is ...

COVID-19 ; Coronavirus ; Vaccination ; Personnes âgées

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Some COVID-19 patients experience dyspnea without objective impairment of pulmonary or cardiac function. This study determined diaphragm function and its central voluntary activation as a potential correlate w...CorrespondenceFri, 15 Jul 2022 00:00:00 GMT

COVID-19

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Caring for older adults during the COVID-19 pandemic | Juin 2022 H

Article | Veille Gériatrie-gérontologie (Gériatrie - gérontologie)

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Background
Elderly patients represent a high-risk group with increased risk of death from COVID-19. Despite the number of published studies, several unmet needs in care for older adults exist.
Objectives
To discuss unmet needs of COVID-19 in this special population.
Sources
A literature review for studies on COVID-19 in elderly patients published between December 2019 and November 2021 was performed. Clinical questions were formulated to guide the literature search. The search was conducted in the MEDLINE database, combining specific search terms. Two reviewers independently conducted the search and selected the studies according to the prespecified clinical questions.
Content
Elderly patients with COVID-19 have peculiar characteristics. They may have atypical clinical presentation, with no fever and with delirium or neurological manifestations as the most common signs, with potential delayed diagnosis and increased risk of death. The reported fatality rates among elderly patients with COVID-19 are extremely high. Several factors, including comorbidities, atypical presentation, and exclusion from intensive care unit care, contribute to this excess of mortality. Age alone is frequently used as a key factor to exclude the elderly from intensive care, but there is evidence that frailty rather than age better predicts the risk of poor outcome in this category. Durability of vaccine efficacy in the elderly remains debated, and the need for a third booster dose is becoming increasingly evident. Finally, efforts to care for elderly patients who have survived after acute COVID-19 should be implemented, considering the high rates of long COVID sequelae and the risk of longitudinal functional and cognitive decline.
Implications
We highlight peculiar aspects of COVID-19 in elderly patients and factors contributing to high risk of poor outcome in this category. We also illuminated gaps in current evidence, suggesting future research directions and underlining the need for further studies on the optimal management of elderly patients with COVID-19.
Background
Elderly patients represent a high-risk group with increased risk of death from COVID-19. Despite the number of published studies, several unmet needs in care for older adults exist.
Objectives
To discuss unmet needs of COVID-19 in this special population.
Sources
A literature review for studies on COVID-19 in elderly patients published between December 2019 and November 2021 was performed. Clinical questions were formulated to guide ...

COVID-19 ; Coronavirus ; Personnes âgées

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The aim of this study was to investigate if and how disordered gaming, loneliness, and family relations have changed throughout the COVID-19 pandemic (from 2019 to 2021), and whether there were any changes in the association between these variables across three samples of gamers (for each respective year). Samples from 2019, 2020, and 2021 were matched by using propensity score matching across socio-demographic characteristics. The total effective sample comprised 897 gamers (N = 299 per year). These samples were compared in terms of disordered gaming – separately as Gaming Disorder (GD; WHO framework) and Internet Gaming Disorder (IGD; APA framework), loneliness, and family harmony scores with analyses of covariance (ANCOVAs), with age and gender as covariates. Steiger tests were used for correlation differences testing. ANCOVAs showed that while GD and IGD scores have increased significantly during the pandemic years, loneliness and family harmony did not change significantly. Furthermore, the correlation differences tests indicated that the correlations between both IGD and GD with loneliness as well as poorer family harmony have increased during the pandemic years. This study provides empirical evidence that the well-being of gamers might have been negatively affected during the COVID-19 pandemic. While loneliness and family harmony did not increase, the stronger correlations between Gaming Disorder and other variables might suggest that gaming may have been used to cope with loneliness and poorer family harmony.
The aim of this study was to investigate if and how disordered gaming, loneliness, and family relations have changed throughout the COVID-19 pandemic (from 2019 to 2021), and whether there were any changes in the association between these variables across three samples of gamers (for each respective year). Samples from 2019, 2020, and 2021 were matched by using propensity score matching across socio-demographic characteristics. The total ...

Pandémies ; Joueurs de jeux vidéo ; Solitude ; Familles - Aspect social ; COVID-19 ; Dépendance (Psychologie)

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Objective: This study investigated the relationship between intimate partner violence (IPV) experienced
both before and during the COVID-19 pandemic and increased economic insecurity in food, phone/internet
services, health care, and housing. We also assessed sociodemographic differences associated with
increased economic insecurity among women and transgender/nonbinary adults since the start of the
COVID-19 pandemic. Method: An online, cross-sectional survey was administered to a general population
sample of women and transgender individuals in one Midwestern state (N = 1,169). Results: IPV
victimization during stay-at-home orders was associated with approximately three times higher odds of
housing insecurity (adjusted odds ratio [AOR] = 3.06, p < .001) and increased health care insecurity
(AOR = 2.95, p < .001) than those without victimization during stay-at-home orders, even after adjusting
for IPV immediately prior to the pandemic. Multiracial, pregnant, and sexual minority (defined as lesbian,
gay, bisexual, queer, or other sexual orientation [LGBQ+]) women and transgender/nonbinary individuals
were at elevated risk for specific forms of increased insecurity. Conclusions: Findings highlight the need for
continued COVID-19 legislation that enhances housing and rental support for populations most in need of
safe and stable housing, particularly survivors of IPV. Reduced access to health care limits IPV
opportunities for intervention and treatment. Expanding accessible and affordable health care options
during the COVID-19 pandemic can enhance the safety and well-being of survivors and increase
opportunities for providers to screen for IPV.
Objective: This study investigated the relationship between intimate partner violence (IPV) experienced
both before and during the COVID-19 pandemic and increased economic insecurity in food, phone/internet
services, health care, and housing. We also assessed sociodemographic differences associated with
increased economic insecurity among women and transgender/nonbinary adults since the start of the
COVID-19 pandemic. Method: An online, ...

COVID-19 ; Violence entre conjoints ; Insécurité ; Finances personnelles ; Identité de genre

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Long-term cardiovascular adverse events in very elderly COVID-19 patients | Mai-juin 2022 H

Article | Veille Gériatrie-gérontologie (Gériatrie - gérontologie)

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The number of deaths owing to coronavirus disease 2019 (COVID-19) is escalating. Apart from the known clinical presentation of respiratory failure precipitated by COVID-19, the cardiovascular complications induced by this viral infection have raised essential concerns. A retrospective study reported that the cardiovascular system was the most sensitive tissue after the respiratory tract in COVID-19 (Sandoval et al., 2020). As in other viral infections, it is well-known that cardiovascular complications can increase the severity of COVID-19, leading to the aggravation of clinical conditions (Clerkin et al., 2020). The National Health Commission of China informed that almost 12% of patients had a myocardial injury in hospitalization (Zheng et al., 2020). A retrospective study of 138 hospitalized COVID-19 patients reported 10% acute cardiac injury and 16% arrhythmia (Wang et al., 2020). In addition, coagulopathy is another life-threatening problem causing arterial and venous thromboembolism in COVID-19 patients (Bikdeli et al., 2020).

It is well established that aged patients with COVID-19 are more likely to progress to severe disease (Liu et al., 2020, Li et al., 2020, Sun, 2020). A large study conducted with 4021 COVID-19 participants showed that patients over 60 years old had a significantly higher mortality rate than patients under 60 years (Yang et al., 2020). Another study stated robust relationships between older age and acute respiratory distress syndrome and death (Wu et al., 2020). The studies mentioned above have been performed during hospitalization, and data on post-discharge results are limited. Moreover, there is no data about long-term cardiovascular outcomes in very elderly (≥80 years) COVID-19 patients. Therefore, the primary goal of this research was to describe the long-term (>6 months) cardiovascular outcomes in very elderly COVID-19.
The number of deaths owing to coronavirus disease 2019 (COVID-19) is escalating. Apart from the known clinical presentation of respiratory failure precipitated by COVID-19, the cardiovascular complications induced by this viral infection have raised essential concerns. A retrospective study reported that the cardiovascular system was the most sensitive tissue after the respiratory tract in COVID-19 (Sandoval et al., 2020). As in other viral ...

COVID-19 ; Coronavirus ; Personnes âgées ; Accidents vasculaires cérébraux

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Background
The COVID-19 pandemic has posed an unprecedented threat to global mental health. Children and adolescents may be more susceptible to mental health impacts related to their vulnerable developmental stage, fear of infection, home confinement, suspension of regular school and extracurricular activities, physical distancing mandates, and larger scale threats such as global financial recessions and associated impacts. Our objective was to review existing evidence of the COVID-19 pandemic’s global impact on the mental health of children and adolescents <19 years of age and to identify personal and contextual factors that may enhance risk or confer protection in relation to mental health outcomes.

Methods
We conducted a search of peer-reviewed and preprint research published in English from January 1, 2020, to February 22, 2021. We included studies collecting primary data on COVID-19-related mental health impacts on children and adolescents. We graded the strength of included articles using the Oxford Centre for Evidence-Based Medicine rating scheme.

Results
Our search and review yielded 116 articles presenting data on a total of 127,923 children and adolescents; 50,984 child and adolescent proxy reports (e.g., parents, healthcare practitioners); and >3,000 chart reviews. A high prevalence of COVID-19-related fear was noted among children and adolescents, as well as more depressive and anxious symptoms compared with prepandemic estimates. Older adolescents, girls, and children and adolescents living with neurodiversities and/or chronic physical conditions were more likely to experience negative mental health outcomes. Many studies reported mental health deterioration among children and adolescents due to COVID-19 pandemic control measures. Physical exercise, access to entertainment, positive familial relationships, and social support were associated with better mental health outcomes.

Conclusions
This review highlights the urgent need for practitioners and policymakers to attend to and collaborate with children and adolescents, especially those in higher risk subgroups, to mitigate short- and long-term pandemic-associated mental health effects.
Background
The COVID-19 pandemic has posed an unprecedented threat to global mental health. Children and adolescents may be more susceptible to mental health impacts related to their vulnerable developmental stage, fear of infection, home confinement, suspension of regular school and extracurricular activities, physical distancing mandates, and larger scale threats such as global financial recessions and associated impacts. Our objective was to ...

Adolescents - Santé mentale ; Enfants - Santé mentale ; COVID-19 ; Pandémies ; Coronavirus

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Effective Holistic Approaches to Reducing Nurse Stress and Burnout During COVID-19 | Mai 2022 H

Article (Soins infirmiers généraux)

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Background: Prolonged exposure to work-related stress can lead to nurse burnout, potentiating clinical and medication errors and low-quality patient care. Holistic approaches (such as mindfulness training, "zen rooms," and massage chairs, among others) have been shown to reduce nurses' anxiety, stress, and burnout.

Purpose: To evaluate the use of "serenity lounges" (dedicated rooms where nurses can take workday breaks for the purposes of relaxation and rejuvenation) and massage chairs on nurses' anxiety, stress, and burnout.

Methods: This quality improvement project analyzed 67 paired responses to surveys filled out by nurses before and after their use of serenity lounges at a medical center in Los Angeles between November 2020 and May 2021. Following successful implementation of a serenity lounge on a pilot unit, this project was expanded to a total of 10 units, including COVID-19 cohort units. As part of this expansion, massage chairs were added to 10 serenity lounges, along with items such as wipes, gloves, and shoe covers to enable nurses to adhere to infection control protocols.

Results: Analysis of the 67 paired responses to pre- and post-lounge-use surveys revealed a significant reduction in feelings of emotional exhaustion, burnout, frustration, being worn out, stress, and anxiety after use of the serenity lounge. Improvements in feelings of emotional exhaustion, being worn out, and being anxious were also noted after using the massage chair for at least 10 to 20 minutes.

Conclusions: These results highlight the importance of providing a holistic approach, including a serene space, massage equipment, and other amenities, to help nurses reduce feelings of anxiety, stress, and burnout, particularly during challenging times such as the COVID-19 pandemic.
Background: Prolonged exposure to work-related stress can lead to nurse burnout, potentiating clinical and medication errors and low-quality patient care. Holistic approaches (such as mindfulness training, "zen rooms," and massage chairs, among others) have been shown to reduce nurses' anxiety, stress, and burnout.

Purpose: To evaluate the use of "serenity lounges" (dedicated rooms where nurses can take workday breaks for the purposes of ...

Anxiété ; Épuisement professionnel ; COVID-19 ; SOINS INFIRMIERS ; Stress

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Association between urbanization and internet addiction | Mai 2022 H

Article (Psychiatrie)

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Purpose of review: Understanding the association between urbanization and Internet addiction is essential to the design and implementation of Internet addiction prevention measures in urban areas. This epidemiological review explores the urbanization-Internet addiction association and its potential underlying factors.

Recent findings: Nine studies have reported that Internet addiction prevalence is higher in urban areas, but three studies have noted the opposite. Psychiatric disorders and stress are the most commonly mentioned factors underlying the association. The effects of urbanization on Internet availability, Internet cafes, online gaming, outdoor or interactive activities, and family regulation and monitoring have been suggested to lead to higher Internet addiction risk. The ongoing COVID-19 pandemic, obesity, sleep problems, and the migration of parents to urban areas in search of work have strengthened the effect of urbanization on Internet addiction.

Summary: Early assessment and treatment provided by mental health services are crucial for mitigating the effect of urbanization on Internet addiction risk. Cities should be designed to provide adequate space for physical and interactive activities. To promote outdoor activities, air pollution, traffic congestion, and crime should be controlled. Prospective face-to-face studies involving analysis of data on pollution, traffic, and Internet addiction could provide evidence to elucidate the urbanization- Internet addiction association.
Purpose of review: Understanding the association between urbanization and Internet addiction is essential to the design and implementation of Internet addiction prevention measures in urban areas. This epidemiological review explores the urbanization-Internet addiction association and its potential underlying factors.

Recent findings: Nine studies have reported that Internet addiction prevalence is higher in urban areas, but three studies have ...

COVID-19 ; Jeux vidéo - Aspect psychologique ; Dépendance (Psychologie) ; Internet

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Purpose of review: The COVID-19 pandemic has had a severe and widespread global impact but particularly for those with psychosis. This review summarizes recent evidence on the relationship between the COVID-19 pandemic and psychotic disorders, highlighting the risks faced by these individuals including the negative impacts on treatment services, complications from contracting COVID-19, and the acceptability of digital interventions.

Recent findings: Mortality, morbidity, and infection outcomes are among the worst for individuals with psychotic disorders. Presentation rates for psychotic disorders are elevated at emergency departments compared with before the COVID-19 pandemic; demand for inpatient services has increased, and there have been complications in access because of pandemic restrictions. COVID-19 related stressors have led to the exacerbation and incidence of psychotic symptoms among individuals with and without preexisting psychotic diagnoses. Digital interventions may be an acceptable method for maintaining patient contact and treatment during extended isolation.

Summary: More data is needed on the longitudinal trajectory for psychotic symptoms post-COVID-19 infection and pandemic restrictions to better support individuals with psychotic disorders. Development of a long-term pandemic management plan is needed to monitor and support psychiatric health across the population.
Purpose of review: The COVID-19 pandemic has had a severe and widespread global impact but particularly for those with psychosis. This review summarizes recent evidence on the relationship between the COVID-19 pandemic and psychotic disorders, highlighting the risks faced by these individuals including the negative impacts on treatment services, complications from contracting COVID-19, and the acceptability of digital interventions.

Recent ...

Psychoses ; COVID-19 ; Pandémies ; Vaccination ; Coronavirus ; Services de santé - Accessibilité

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Background
Multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) superspreading events suggest that aerosols play an important role in driving the coronavirus disease 2019 (COVID-19) pandemic. To better understand how airborne SARS-CoV-2 transmission occurs, we sought to determine viral loads within coarse (>5 μm) and fine (≤5 μm) respiratory aerosols produced when breathing, talking, and singing.

Methods
Using a G-II exhaled breath collector, we measured viral RNA in coarse and fine respiratory aerosols emitted by COVID-19 patients during 30 minutes of breathing, 15 minutes of talking, and 15 minutes of singing.

Results
Thirteen participants (59%) emitted detectable levels of SARS-CoV-2 RNA in respiratory aerosols, including 3 asymptomatic and 1 presymptomatic patient. Viral loads ranged from 63–5821 N gene copies per expiratory activity per participant, with high person-to-person variation. Patients earlier in illness were more likely to emit detectable RNA. Two participants, sampled on day 3 of illness, accounted for 52% of total viral load. Overall, 94% of SARS-CoV-2 RNA copies were emitted by talking and singing. Interestingly, 7 participants emitted more virus from talking than singing. Overall, fine aerosols constituted 85% of the viral load detected in our study. Virus cultures were negative.

Conclusions
Fine aerosols produced by talking and singing contain more SARS-CoV-2 copies than coarse aerosols and may play a significant role in SARS-CoV-2 transmission. Exposure to fine aerosols, especially indoors, should be mitigated. Isolating viable SARS-CoV-2 from respiratory aerosol samples remains challenging; whether this can be more easily accomplished for emerging SARS-CoV-2 variants is an urgent enquiry necessitating larger-scale studies.
Background
Multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) superspreading events suggest that aerosols play an important role in driving the coronavirus disease 2019 (COVID-19) pandemic. To better understand how airborne SARS-CoV-2 transmission occurs, we sought to determine viral loads within coarse (>5 μm) and fine (≤5 μm) respiratory aerosols produced when breathing, talking, and singing.

Methods
Using a G-II exhaled ...

COVID-19 ; Coronavirus ; Infection ; Appareil respiratoire - Infections ; Aérosols - Transmission

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Background
Our objective is to describe the presentation and complications, including relapses, of coronavirus disease 2019 (COVID-19) in patients under anti-CD20 treatments. In addition, to describe viral clearance and determine the safety of reintroducing anti-CD20 treatment.

Methods
Retrospective cohort study of 422 patients under anti-CD20 treatment that was administered from 1 January 2019 to 31 December 2020.

Results
Fifty-seven patients were diagnosed with COVID-19 (13.5%). Twenty-five patients (43.9%) required hospital admission. Five patients died (8.8%), and 10 developed severe COVID-19 and acute respiratory distress syndrome. Mortality rate was higher among patients infected during the first 3 months following the last dose of anti-CD20 (14.7% vs 0%, P = .046). The median time of persistence of positive reverse transcription polymerase chain reaction (RT-PCR) was 22 days (IQR 13–40).

Nine out of 52 survivors (17.3%) presented relapses. All of them received the last dose of anti-CD20 less than 6 months before the COVID-19 episode. Clinical presentation was fever (n = 8; 88.9%), dyspnea (n = 7; 77.8%), cough (n = 7; 77.8%), worsening of previous infiltrates (n = 5; 55.6%) and new pulmonary infiltrates (n = 8; 88.9%). An increase in lymphocytes with CD4/CD8 ratio inversion was observed in all cases. Among the 25 patients who resumed anti-CD20 drug, 4 (16.0%) presented relapses vs 5/28 among those who did not (17.9%), (P = .857).

Conclusions
Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the 6 months after anti-CD20 administration had a worse outcome and a higher mortality rate. The duration of infectivity may be longer. Relapses of COVID-19 occurred in more than 15% and were associated with viral replication. Once the infection is resolved, it is safe to restart treatment with anti-CD20.
Background
Our objective is to describe the presentation and complications, including relapses, of coronavirus disease 2019 (COVID-19) in patients under anti-CD20 treatments. In addition, to describe viral clearance and determine the safety of reintroducing anti-CD20 treatment.

Methods
Retrospective cohort study of 422 patients under anti-CD20 treatment that was administered from 1 January 2019 to 31 December 2020.

Results
Fifty-seven patients ...

Appareil respiratoire - Infections ; COVID-19 ; Coronavirus ; Infection ; Anticorps

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Background
There is limited information on the risk of hospital-acquired coronavirus disease 2019 (COVID-19) among high-risk hospitalized patients after exposure to an infected patient or healthcare worker (HCW) in a nonoutbreak setting.

Methods
This study was conducted at a tertiary care cancer center in New York City from 10 March 2020 until 28 February 2021. In early April 2020, the study institution implemented universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing at admission and retesting every 3 days through the hospital stay. Contact tracing records were reviewed for all exposures to SARS-CoV-2 positive patients and HCWs.

Results
From 10 March 2020 to 28 February 2021, 11 348 unique patients who were SARS-CoV-2 polymerase chain reaction (PCR) negative at the time of admission underwent 31 662 postadmission tests during their hospitalization, and 112 tested positive (0.98%). Among these, 49 patients housed in semiprivate rooms during admission resulted in 74 close contacts and 14 secondary infections within 14 days, for an overall attack rate of 18.9%. Among those exposed to a roommate undergoing an aerosol-generating procedure (AGP), the attack rate was 35.7%. Whole genome sequencing (WGS) corroborated transmission in 6/8 evaluated pairs. In addition, three transmission events occurred in 214 patients with significant exposure to 105 COVID-19 positive healthcare workers (1.4%).

Conclusions
The overall risk of hospital-acquired COVID-19 is low for hospitalized cancer patients, even during periods of high community prevalence. However, shared occupancy with an unrecognized case is associated with a high secondary attack rate in exposed roommates.
Background
There is limited information on the risk of hospital-acquired coronavirus disease 2019 (COVID-19) among high-risk hospitalized patients after exposure to an infected patient or healthcare worker (HCW) in a nonoutbreak setting.

Methods
This study was conducted at a tertiary care cancer center in New York City from 10 March 2020 until 28 February 2021. In early April 2020, the study institution implemented universal severe acute ...

Coronavirus ; COVID-19 ; Cancer - Prévention ; Cancer ; Appareil respiratoire - Maladies

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Background: Early reports on COVID-19 patient outcomes showed a marked fatality rate among patients requiring invasive mechanical ventilation (IMV).

Objective: Our aim was to compare case fatality rate (CFR) outcomes for patients requiring IMV due to severe acute respiratory syndrome (SARS)-associated coronavirus 2 (COVID-19), SARS-associated coronavirus 1, Middle East respiratory syndrome (MERS), and influenza (H1N1).

Materials and Methods: We searched PubMed, EMBASE, MEDLINE, Google Scholar, and Cochrane Library for relevant studies published between December 2019 and April 2021 for COVID-19, between January 2002 and December 2008 for SARS, between January 2012 and December 2019 for MERS, and between January 2009 and December 2016 for influenza (H1N1).

Results: Overall, this study included 81 peer-reviewed studies, pertaining to 65,058 patients requiring IMV: 61 studies including 62,809 COVID-19 patients, 4 studies including 148 SARS patients, 9 studies including 875 MERS patients, and 7 studies including 1226 influenza (H1N1) patients. The CFR for COVID-19 patients requiring IMV was not significantly different from the CFR for SARS and influenza (H1N1) patients (45.5% [95% confidence interval (CI), 38.5%-52.8%] vs. 48.1% [95% CI, 39.2%-57.2%] and 39.7% [95% CI, 29.3%-51.3%], respectively). However, CFR for COVID-19 patients was significantly lower compared with that for MERS patients (CFR, 70.6%; 95% CI, 60.9%-78.8%).

Conclusions: COVID-19 patients requiring IMV show a similar CFR compared with SARS and H1N1 influenza patients but a lower CFR compared with MERS patients. To improve survival in future pandemics, we recommend examining the pros and cons of the liberal use of endotracheal intubation and considering drafting guidelines for the selection of patients to intubate and the timing of intubation.
Background: Early reports on COVID-19 patient outcomes showed a marked fatality rate among patients requiring invasive mechanical ventilation (IMV).

Objective: Our aim was to compare case fatality rate (CFR) outcomes for patients requiring IMV due to severe acute respiratory syndrome (SARS)-associated coronavirus 2 (COVID-19), SARS-associated coronavirus 1, Middle East respiratory syndrome (MERS), and influenza (H1N1).

Materials and Methods: ...

COVID-19 ; Maladies infectieuses ; Influenza

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OBJECTIVE: To describe trends and risk factors for pressure injuries (PIs) in adult critical care patients proned to alleviate acute respiratory distress syndrome secondary to COVID-19 and examine the effectiveness of products and strategies used to mitigate PIs.

METHODS: The authors conducted a retrospective chart review between April 9 and June 8, 2020. Demographic data were analyzed using descriptive statistics. Differences between groups with and without PIs were analyzed.

RESULTS: Among 147 patients, significant PI risk factors included male sex (P = .019), high body mass index (>40 kg/m2; P = .020), low Braden Scale score (<12; P = .018), and low-dose vasopressor therapy (P = .020). Taping endotracheal tubes (ETTs) caused significantly fewer facial PIs than commercial ETT holders (P < .0001). Maximum prone duration/session was a significant risk factor for anterior PIs (P = .016), which dropped 71% with newer pressure redistribution products. D-Dimer greater than 3,200 [mu]g/mL (P = .042) was a significant risk factor for sacrococcygeal PIs while supine. Mortality was 30%; significant risk factors included age older than 60 years (P = .005), Sequential Organ Failure Assessment score greater than 11 (P = .003), and comorbid congestive heart failure (P = .016).

CONCLUSIONS: Taping the ETT, limiting the maximum duration of prone positioning to less than 32 hours, and frequent repositioning while supine may reduce the number of modifiable risk factors for PIs. Standardized methods for testing products for PI prevention will inform individualized patient care.
OBJECTIVE: To describe trends and risk factors for pressure injuries (PIs) in adult critical care patients proned to alleviate acute respiratory distress syndrome secondary to COVID-19 and examine the effectiveness of products and strategies used to mitigate PIs.

METHODS: The authors conducted a retrospective chart review between April 9 and June 8, 2020. Demographic data were analyzed using descriptive statistics. Differences between groups ...

Appareil respiratoire - Maladies ; Coronavirus ; COVID-19

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To prevent deterioration in physical and mental health and cognitive function that could prejudice the autonomy and independence of persons 65 and older, it is important for them to adopt a physically active lifestyle.

To mitigate the impact of public health measures on physical activity, additional strategies are proposed for the public health network, its partners, and municipalities.

For the public health network and its partners:
Raise awareness of the importance of being active at home and promote regular physical activity to foster wellness and quality of life and help maintain independence (1–7) and good mental health (8) (e.g., targeted campaigns promoting physical activity, promotion of physical activities all year long).
Encourage the reduction of extended sedentary behaviours and of their total duration (e.g., active breaks, walking, housekeeping activities).
Support the regular practice of simple, safe, and pleasant exercise (e.g., exercise in the home).
For municipalities:
Promote active travel by seniors by providing more pedestrian-friendly spaces.
Encourage physical activity by seniors in parks and green spaces by providing universal access to attractive infrastructure, in keeping with public health guidelines.
Offer an activity program tailored to seniors and to pandemic conditions in collaboration with sports and recreation organizations
To prevent deterioration in physical and mental health and cognitive function that could prejudice the autonomy and independence of persons 65 and older, it is important for them to adopt a physically active lifestyle.

To mitigate the impact of public health measures on physical activity, additional strategies are proposed for the public health network, its partners, and municipalities.

For the public health network and its partners:
Raise ...

Comportement sédentaire ; Personnes âgées - Loisirs ; COVID-19 ; Pandémies

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Question
How effective and safe is telerehabilitation for people with COVID-19 and post-COVID-19 conditions?

Design
Systematic review of randomised trials.

Participants
People with COVID-19 and post-COVID-19 conditions.

Intervention
Any type of telerehabilitation.

Outcome measures
Satisfaction, quality of life, adverse events, adherence to telerehabilitation, dyspnoea, functional performance, readmissions, mortality, pulmonary function and level of independence.

Results
Database searches retrieved 2,962 records, of which six trials with 323 participants were included in the review. Breathing exercises delivered via telerehabilitation improved 6-minute walk distance (MD 101 m, 95% CI 61 to 141; two studies), 30-second sit-to-stand test performance (MD 2.2 repetitions, 95% CI 1.5 to 2.8; two studies), Multidimensional Dyspnoea-12 questionnaire scores (MD –6, 95% CI –7 to –5; two studies) and perceived effort on the 0-to-10 Borg scale (MD –2.8, 95% CI –3.3 to –2.3; two studies), with low certainty of evidence. Exercise delivered via telerehabilitation improved 6-minute walk distance (MD 62 m, 95% CI 42 to 82, four studies), 30-second sit-to-stand test performance (MD 2.0 repetitions, 95% CI 1.3 to 2.7; two studies) and Multidimensional Dyspnoea-12 scores (MD –1.8, 95% CI –2.5 to –1.1; one study), with low certainty of evidence. Adverse events were almost all mild or moderate and occurred with similar frequency in the telerehabilitation group (median 0 per participant, IQR 0 to 2.75) as in the control group (median 0 per participant, IQR 0 to 2); Hodges-Lehmann median difference 0 (95% CI 0 to 0), with low certainty of evidence.

Conclusion
Telerehabilitation may improve functional capacity, dyspnoea, performance and physical components of quality of life and does not substantially increase adverse events.
Question
How effective and safe is telerehabilitation for people with COVID-19 and post-COVID-19 conditions?

Design
Systematic review of randomised trials.

Participants
People with COVID-19 and post-COVID-19 conditions.

Intervention
Any type of telerehabilitation.

Outcome measures
Satisfaction, quality of life, adverse events, adherence to telerehabilitation, dyspnoea, functional performance, readmissions, mortality, pulmonary function and ...

COVID-19 ; Coronavirus ; Physiothérapie ; Dyspnée

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Objective
To analyze the psychological and functional sequelae of the COVID-19 pandemic among older adults living in long term care facilities (LTCFs).
Design
Cohort longitudinal study
Setting ant participants
A total of 215 residents ≥ 65 years without moderate-to-severe cognitive impairment, living in five LTCFs in Albacete (Spain).
Measurements
Baseline on-site data were collected between March - June 2020 and three-month follow-up between June to September 2020. Symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), and sleep disturbances were measured as psychological variables. Disability in basic activities of daily living (BADL), ambulation and frailty were assessed as functional variables. Differences were analyzed in relation to level of comorbidity and test positivity for COVID-19.
Results
At baseline, residents with COVID-19 presented worse functionality, higher frailty levels and malnutrition risk compared to non-COVID-19 residents. At three-month follow-up, higher rates of clinically significant depressive symptoms (57.7%), anxiety symptoms (29.3%), PTSD symptoms (19.1%) and sleep disturbances (93.0%) were found among residents regardless of COVID status. Thus, among 215 residents, 101 (47%) experienced a decline in BADL from baseline to the 3-month follow-up (median functional loss = 5 points in Barthel Index). In multivariate analyses, COVID-19 status did not explain either the functional or the ambulation loss. By contrast, residents with low comorbidity and COVID-19 presented higher PTSD symptoms (effect 2.58; 95% CI 0.93 to 4.23) and anxiety symptoms (effect 2.10; 95% CI 0.48 to 3.73) compared to the low comorbidity/non-COVID19 group.
Conclusion
COVID-19 pandemic was associated, after three-months, with high psychological impact in older adults in LTCFs., specifically with higher post-traumatic stress and anxiety symptoms. Functional decline did not differ in relation to COVID-19 status but could be related to isolation strategies used for pandemic control.
Objective
To analyze the psychological and functional sequelae of the COVID-19 pandemic among older adults living in long term care facilities (LTCFs).
Design
Cohort longitudinal study
Setting ant participants
A total of 215 residents ≥ 65 years without moderate-to-severe cognitive impairment, living in five LTCFs in Albacete (Spain).
Measurements
Baseline on-site data were collected between March - June 2020 and three-month follow-up between ...

Personnes âgées ; Coronavirus ; COVID-19

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Type
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Descripteurs

COVID-19 [102]

Coronavirus [57]

Personnes âgées [14]

Physiothérapie [14]

Pandémies [12]

Pneumologie [9]

Rehabilitation [9]

Vaccination [8]

Appareil respiratoire - Maladies [6]

Télémédecine [5]

Dépendance (Psychologie) [4]

Santé mentale [4]

Cancer [3]

Enfants - Santé mentale [3]

Épuisement professionnel [3]

Infection [3]

Soins de santé primaires [3]

Stress [3]

Anticorps [2]

Anxiété [2]

Appareil respiratoire - Infections [2]

Gériatrie [2]

Gestion de crise [2]

Isolation [2]

Pneumonie [2]

Santé publique [2]

Sciences [2]

SCIENCES DE LA SANTÉ [2]

Services de santé - Accessibilité [2]

SOINS INFIRMIERS [2]

Toxicomanie [2]

Violence entre conjoints [2]

Accidents vasculaires cérébraux [1]

Adolescents - Santé mentale [1]

Aérosols - Transmission [1]

Angoisse [1]

Anticoagulants [1]

Asthme [1]

Autochtones - Santé mentale [1]

Bien - Aspect psychologique [1]

Biotechnologie [1]

Cancer - Prévention [1]

Cerveau - Lésions et blessures [1]

Chirurgie [1]

Coeur - Maladies [1]

Cognition [1]

Communication non-verbale [1]

Comportement sédentaire [1]

Confinement (Politique sanitaire) - Aspect psychologique [1]

Démence [1]

Dysphasie [1]

Dyspnée [1]

Éducation sanitaire [1]

État de stress post-traumatique [1]

Éthique [1]

Exercices pour personnes âgées [1]

Familles - Aspect social [1]

Femmes enceintes [1]

Finances personnelles [1]

Fractures [1]

Grossesse [1]

Hanche [1]

Hôpitaux - Services des urgences [1]

Hyperphagie [1]

Hypertension artérielle [1]

Identité de genre [1]

Immunologie [1]

Infection - Prévention [1]

Infirmières - Rôle professionnel [1]

Influenza [1]

Insécurité [1]

Interdisciplinarité [1]

Internet [1]

Jeux vidéo - Aspect psychologique [1]

Joueurs de jeux vidéo [1]

Maladies infectieuses [1]

Médecine d'urgence [1]

Médecins - Responsabilité professionnelle [1]

Médicaments [1]

Médicaments - Usage [1]

Motivation en éducation [1]

Nutrition [1]

Oncologie [1]

Opioïdes [1]

PARENTS [1]

Parents d'enfants autistes [1]

Parents et enfants [1]

Pédiatrie [1]

Personnel médical - Responsabilité professionnelle [1]

Personnes âgées - Loisirs [1]

Personnes âgées - Santé mentale [1]

Promotion de la santé [1]

PSYCHIATRIE [1]

Psychomotricité [1]

Psychoses [1]

Qualité de la vie [1]

Résilience [1]

Rôle parental [1]

Santé publique - Enquêtes [1]

Sciences de l'information [1]

Service social [1]

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