Research

Open AccessArticle

Relative Risk of Death in Bulgarian Cancer Patients during the Initial Waves of the COVID-19 Pandemic

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Velizar Shivarov

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Denitsa Grigorova

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Angel Yordanov

Healthcare 2023, 11(18), 2594; https://doi.org/10.3390/healthcare11182594 - 20 Sep 2023

Viewed by 468

Abstract

Background: The COVID-19 pandemic has led to millions of documented deaths worldwide, with diverse distribution among countries. Surprisingly, Bulgaria, a middle-income European Union member state, ranked highest in COVID-19 mortality. This study aims to assess whether Bulgarian cancer patients experienced a higher relative [...] Read more.

Background: The COVID-19 pandemic has led to millions of documented deaths worldwide, with diverse distribution among countries. Surprisingly, Bulgaria, a middle-income European Union member state, ranked highest in COVID-19 mortality. This study aims to assess whether Bulgarian cancer patients experienced a higher relative risk (RR) of death compared to the general Bulgarian population during the pandemic. Materials and Methods: Data from the Bulgarian National Statistical Institute and the Bulgarian National Cancer Registry were analyzed to estimate monthly RR of death in cancer patients compared to the general population before and during the first two years of the pandemic. The impact of the COVID-19 waves and predominant SARS-CoV-2 variants on RR was evaluated on various cancer types and age groups using a multiple linear regression approach. Results: During the COVID-19 waves, both the general population and cancer patients experienced a significant increase in mortality rates. Surprisingly, the RR of death in cancer patients was lower during pandemic waves. The results from the statistical modeling revealed a significant association between the COVID-19 waves and reduced RR for all cancer patients. Notably, the effect was more pronounced during waves associated with the Alpha and Delta variants. The results also showed varying impacts of the COVID-19 waves on RR when we analyzed subsamples of data grouped depending on the cancer type, age and sex. Conclusions: Despite increased overall mortality in Bulgarian cancer patients during the pandemic, the RR of death was lower compared to the Bulgarian general population, indicating that protective measures were relatively effective in this vulnerable group. This study underscores the importance of implementing and encouraging preventive measures, especially in cancer patients, to mitigate the impact of future viral pandemics and reduce excess mortality. Full article

(This article belongs to the Special Issue The Impact of the COVID-19 Pandemic on Health: Time to Take a Longer-Term Perspective)

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Open AccessArticle

Impact of COVID-19 on Quality of Life in Long-Term Advanced Rectal Cancer Survivors

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Luitpold Valentin Distel

Healthcare 2023, 11(14), 1981; https://doi.org/10.3390/healthcare11141981 - 08 Jul 2023

Viewed by 569

Abstract

Colorectal cancer remains one of the most commonly diagnosed cancers. Advanced rectal cancer patients receive neoadjuvant radiochemotherapy as well as surgery and suffer from reduced health-related quality of life due to various side effects. We were interested in the role of the COVID-19 [...] Read more.

Colorectal cancer remains one of the most commonly diagnosed cancers. Advanced rectal cancer patients receive neoadjuvant radiochemotherapy as well as surgery and suffer from reduced health-related quality of life due to various side effects. We were interested in the role of the COVID-19 pandemic and how it affected those patients’ quality of life. A total of 489 advanced rectal cancer patients from the University Hospital Erlangen in Germany were surveyed between May 2010 and March 2022 and asked to fill out the EORTC QLQ-C30 and QLQ-CR38 questionnaires over eight different time points: at the beginning, during and after radiochemotherapy, right before surgery, and in yearly intervals after surgery for up to four years. Answers were converted to scores to compare the COVID-19 period to the time before March 2020, focusing on the follow-ups, the developments over time—including by sex and age—and the influence of the TNM cT-stage. Overall, a trend of impaired functional and symptom scores was found across all surveys with few significances (body image −10.6 percentage points (pp) after one year; defecation problems +13.5 pp, insomnia +10.2 pp and weight loss +9.8 pp after three years; defecation problems +11.3 pp after four years). cT4-stage patients lost significantly more weight than their cT1-3-stage counterparts (+10.7 to 13.7 pp). Further studies should be conducted to find possible causes and develop countermeasures for future major infectious diseases. Full article

(This article belongs to the Special Issue The Impact of the COVID-19 Pandemic on Health: Time to Take a Longer-Term Perspective)

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Open AccessArticle

A Cross-Sectional Assessment of Parental Concerns in the Pediatric Surgery Department during the COVID-19 Pandemic

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Ada Claudia Silvana Gruescu

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Calin Popoiu

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Mihaela Codrina Levai

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Raluca Tudor

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Roxana Manuela Fericean

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Mircea Rivis

Healthcare 2023, 11(9), 1330; https://doi.org/10.3390/healthcare11091330 - 05 May 2023

Viewed by 762

Abstract

The COVID-19 pandemic has impacted various aspects of healthcare, including pediatric surgery. This study aimed to assess parental concerns and stress levels in pediatric surgery during the COVID-19 pandemic, identify factors associated with increased parental anxiety or concern, and provide recommendations for healthcare [...] Read more.

The COVID-19 pandemic has impacted various aspects of healthcare, including pediatric surgery. This study aimed to assess parental concerns and stress levels in pediatric surgery during the COVID-19 pandemic, identify factors associated with increased parental anxiety or concern, and provide recommendations for healthcare providers. A cross-sectional study was conducted in a tertiary pediatric hospital in Timisoara, Romania, involving 174 parents of pediatric patients requiring elective or emergency surgery, with a mean age of 37.6 (25–47) years, out of which 89.1% of respondents were women. Parental concerns were assessed using the Parental Concerns Questionnaire (PCQ), the Hospital Anxiety and Depression Scale (HADS), and the Perceived Stress Scale (PSS-10). Parents of children undergoing emergency surgery (n = 108) reported higher levels on the practical impact domain of the PCQ scale (3.4 vs. 2.2, p < 0.001), emotional impact (2.7 vs. 2.2, p = 0.002), and total PCQ score (9.5 vs. 7.7, p < 0.001) compared to parents of children undergoing elective surgery (n = 66). Parents in the emergent surgery group also reported higher anxiety scores on the HADS questionnaire (7.9 vs. 6.5, p = 0.009) and higher perceived stress and total score on the PSS-10 survey (7.8 vs. 5.6, p = 0.046) (10.5 vs. 9.1, p = 0.047), respectively. A significantly higher proportion of parents in the emergent surgery group were concerned about restricted visitation policies (p = 0.013) and reported delaying or considering delaying their child’s surgery due to the pandemic (p = 0.036). The results demonstrate heightened concerns, anxiety, and stress among parents of children undergoing emergency surgery during the COVID-19 pandemic. Healthcare providers should address parental concerns, provide clear communication, and ensure adequate support for families. Recommendations include enhancing information about COVID-19 precautions, reassuring parents about personal protective equipment availability, and facilitating family support within visitation restrictions. Full article

(This article belongs to the Special Issue The Impact of the COVID-19 Pandemic on Health: Time to Take a Longer-Term Perspective)

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Open AccessArticle

Successive Waves of the COVID-19 Pandemic Had an Increasing Impact on Chronic Cardiovascular Patients in a Western Region of Romania

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Healthcare 2023, 11(8), 1183; https://doi.org/10.3390/healthcare11081183 - 20 Apr 2023

Viewed by 1325

Abstract

Three years since the COVID-19 pandemic started, there is still little information about patients with chronic medical conditions, such as cardiovascular diseases (CVDs), who become infected with SARS-CoV-2. A retrospective analysis was performed to evaluate the impact of the COVID-19 pandemic on patients [...] Read more.

Three years since the COVID-19 pandemic started, there is still little information about patients with chronic medical conditions, such as cardiovascular diseases (CVDs), who become infected with SARS-CoV-2. A retrospective analysis was performed to evaluate the impact of the COVID-19 pandemic on patients with cardiovascular comorbidities hospitalized with positive RT-PCR results for SARS-CoV-2 during the highest peaks of the first three pandemic waves: April 2020, October 2020, and November 2021. The primary outcome was in-hospital mortality; the secondary outcomes were length of hospitalization and required mechanical ventilation to assess the disease severity. Data were extracted from the hospital electronic database system: 680 eligible cases were identified out of 2919 patients. Mortality was the highest in wave 3 (31.9%) compared to the previous waves (13.6% and 25.8%). Hospitalization was also significantly longer in wave 3 (11.58 ± 5.34 vs. 8.94 ± 4.74 and 10.19 ± 5.06; p < 0.001), and so was the need for mechanical ventilation (21.7% vs. 8.2% and 9%; p < 0.001). Older age and male gender were confirmed as highly significant predictors of unfavorable outcomes. Ischemic heart disease worsened the odds of patients’ survival irrespective of the three pandemic waves (Breslow–Day test, p = 0.387), with a marginally significant Mantel–Haenszel common estimate for risk: OR = 1.604, 95% (0.996; 2.586). The significantly worse outcomes in wave 3 could have been influenced by a combination of factors: the low percentage of vaccinations in Romanian population, the more virulent delta strain, and pandemic attrition in the care provided to these patients with chronic CVDs. Full article

(This article belongs to the Special Issue The Impact of the COVID-19 Pandemic on Health: Time to Take a Longer-Term Perspective)

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Open AccessArticle

Child and Adolescent Mental Health during the COVID-19 Pandemic: Challenges of Psychiatric Outpatient Clinics

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Mariela Mosheva

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Yael Barzilai

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Nimrod Hertz-Palmor

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Ehud Mekori-Domachevsky

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Healthcare 2023, 11(5), 765; https://doi.org/10.3390/healthcare11050765 - 06 Mar 2023

Cited by 1 | Viewed by 1124

Abstract

Background: Worldwide national surveys show a rising mental health burden among children and adolescents (C&A) during COVID-19. The objective of the current study is to verify the expected rise in visits to psychiatric outpatient clinics of C&A, especially of new patients. Methods: a [...] Read more.

Background: Worldwide national surveys show a rising mental health burden among children and adolescents (C&A) during COVID-19. The objective of the current study is to verify the expected rise in visits to psychiatric outpatient clinics of C&A, especially of new patients. Methods: a cross-sectional study focusing on visits as recorded in electronic medical records of eight heterogeneous C&A psychiatric outpatient clinics. The assessment was based on visits held from March to December of 2019 (before the pandemic) in comparison to visits held in 2020 (during the pandemic). Results: The number of visits was similar for both periods. However, in 2020, 17% of the visits used telepsychiatry (N = 9885). Excluding telepsychiatry reveals a monthly decrease in traditional in-person activities between 2020 and 2019 (691.6 ± 370.8 in 2020 vs. 809.1 ± 422.8 in 2019, mean difference = −117.5, t (69) = −4.07, p = 0.0002, Cohen’s d = −0.30). Acceptation of new patients declined during 2020, compared to 2019 (50.0 ± 38.2 in 2020 vs. 62.8 ± 42.9 in 2019; Z = −3.12, p = 0.002, r = 0.44). Telepsychiatry was not used for new patients. Conclusions: The activity of C&A psychiatric outpatient clinics did not rise but was guarded due to the use of telepsychiatry. The decline in visits of new patients was explained by the lack of use of telepsychiatry for these patients. This calls for expanding the use of telepsychiatry, especially for new patients. Full article

(This article belongs to the Special Issue The Impact of the COVID-19 Pandemic on Health: Time to Take a Longer-Term Perspective)

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Open AccessArticle

Toward a Positive Life beyond COVID-19: Problem-Solving Appraisal as a Resistance Resource in the Relationship between Stress and Well-Being in Students

by

Tyrone B. Pretorius

and

Anita Padmanabhanunni

Healthcare 2023, 11(3), 350; https://doi.org/10.3390/healthcare11030350 - 25 Jan 2023

Viewed by 767

Abstract

The COVID-19 pandemic is a major global stressor that has been associated with elevated risk of negative mental health symptoms. As a helping profession, our main task should be identifying factors that may shield individuals from the negative consequences of stress, rather than [...] Read more.

The COVID-19 pandemic is a major global stressor that has been associated with elevated risk of negative mental health symptoms. As a helping profession, our main task should be identifying factors that may shield individuals from the negative consequences of stress, rather than only focusing on the causes and symptoms of stress. One such factor, identified in the literature, is an individual’s perception of their problem-solving skills. In this study we investigate the role of problem-solving appraisal in the association between perceived stress and psychological well-being. Participants were students (n = 322) who completed the Problem Solving Inventory, the Perceived Stress Scale, the short forms of the trait scale of the State-Trait Anxiety Inventory, and the Beck Hopelessness Scale. The results demonstrate the health-sustaining benefits of problem-solving appraisal, as all dimensions of problem-solving appraisal (problem-solving confidence, approach-avoidance style, and problem-solving control) were directly associated with hopelessness and anxiety. The stress-buffering role of problem-solving appraisal with respect to hopelessness was demonstrated through the interaction between perceived stress and problem-solving appraisal. However, problem-solving appraisal did not buffer the effects of stress on anxiety. The findings indicate that problem-solving appraisal may be an important protective resource that could be beneficial for coping with other negative events and experiences beyond COVID-19. The implications of these findings for interventions are discussed. Full article

(This article belongs to the Special Issue The Impact of the COVID-19 Pandemic on Health: Time to Take a Longer-Term Perspective)

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Open AccessArticle

Clinical Characteristics in the Acute Phase of COVID-19 That Predict Long COVID: Tachycardia, Myalgias, Severity, and Use of Antibiotics as Main Risk Factors, While Education and Blood Group B Are Protective

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Jose Guzman-Esquivel

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Martha A. Mendoza-Hernandez

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Hannah P. Guzman-Solorzano

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Karla A. Sarmiento-Hernandez

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Iram P. Rodriguez-Sanchez

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Margarita L. Martinez-Fierro

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Jorge E. Plata-Florenzano

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Marina Delgado-Machuca

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Ivan Delgado-Enciso

Healthcare 2023, 11(2), 197; https://doi.org/10.3390/healthcare11020197 - 09 Jan 2023

Cited by 2 | Viewed by 1860

Abstract

Background: Risk factors for developing long COVID are not clearly established. The present study was designed to determine if any sign, symptom, or treatment of the acute phase, or personal characteristics of the patient, is associated with the development of long COVID. Methods: [...] Read more.

Background: Risk factors for developing long COVID are not clearly established. The present study was designed to determine if any sign, symptom, or treatment of the acute phase, or personal characteristics of the patient, is associated with the development of long COVID. Methods: A cohort study was carried out, randomly selecting symptomatic COVID-19 patients and not vaccinated. The severity of the acute illness was assessed through the number of compatible COVID-19 symptoms, hospitalizations, and the symptom severity score using a 10-point visual analog scale. Results: After multivariate analysis, a severity score ≥8 (RR 2.0, 95%CI 1.1–3.5, p = 0.022), hospitalization (RR 2.1, 95%CI 1.0–4.4, p = 0.039), myalgia (RR 1.9, 95%CI 1.08–3.6, p = 0.027), tachycardia (RR 10.4, 95%CI 2.2–47.7, p = 0.003), and use of antibiotics (RR 2.0, 95%CI 1.1–3.5, p = 0.022), was positively associated with the risk of having long COVID. Higher levels of education (RR 0.6, 95%CI 0.4–0.9, p = 0.029) and type positive B blood group (B + AB, RR 0.44, 95%CI 0.2–0.9, p = 0.044) were protective factors. The most important population attributable fractions (PAFs) for long COVID were myalgia (37%), severity score ≥8 (31%), and use of antibiotics (27%). Conclusions: Further studies in diverse populations over time are needed to expand the knowledge that could lead us to prevent and/or treat long COVID. Full article

(This article belongs to the Special Issue The Impact of the COVID-19 Pandemic on Health: Time to Take a Longer-Term Perspective)

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Open AccessArticle

Exploration of COVID-19 Pandemic Prevention Behaviors among Healthcare Workers

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Healthcare 2023, 11(2), 153; https://doi.org/10.3390/healthcare11020153 - 04 Jan 2023

Viewed by 1241

Abstract

Since the outbreak of COVID-19, the pandemic has become an important topic of global public health. To reduce the rapid spread of the pandemic, compliance with preventive behaviors has become one of the important guidelines from the World Health Organization (WHO). Healthcare workers [...] Read more.

Since the outbreak of COVID-19, the pandemic has become an important topic of global public health. To reduce the rapid spread of the pandemic, compliance with preventive behaviors has become one of the important guidelines from the World Health Organization (WHO). Healthcare workers stand on the frontline for pandemic prevention, and preventive behaviors are essential measures to protect their health and safety. The purpose of this study was to propose an integrative model that explained and predicted COVID-19 preventive behaviors among healthcare workers. The study integrated workplace safety climate and the health belief model (HBM) to verify the impact of workplace safety climate and health belief factors on the safety attitude, safety compliance, and safety satisfaction of healthcare workers performing COVID-19 pandemic prevention behaviors. A cross-sectional study was conducted from March to August 2021 with a self-administered online questionnaire. The sample of the study was drawn from healthcare workers of a famous medical institution in Taipei City as research subjects. After collecting 273 valid questionnaires and verifying them through the analysis of structural equation modeling (SEM), the findings revealed that workplace safety climate had an impact on health belief factors, and then health belief factors had impacts on safety attitudes. In addition, safety attitude affected safety compliance, while safety compliance further affected safety satisfaction. The study showed that workplace safety climate can strengthen healthcare workers’ health beliefs and further affect their safety attitudes, safety compliance, and safety satisfaction. The study attempted to propose a model of healthcare workers’ pandemic prevention behaviors as a reference for medical facility administrators in real practice. Full article

(This article belongs to the Special Issue The Impact of the COVID-19 Pandemic on Health: Time to Take a Longer-Term Perspective)

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Open AccessArticle

The Risk of SARS-CoV-2 Infection in Pregnant Women: An Observational Cohort Study Using the BIFAP Database

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Mercedes Mota

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Consuelo Huerta-Álvarez

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Ana Llorente

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Lucia Cea-Soriano

Healthcare 2022, 10(12), 2429; https://doi.org/10.3390/healthcare10122429 - 02 Dec 2022

Viewed by 1187

Abstract

Background: It has been suggested that women experiencing during pregnancy several physiological and immunological changes that might increase the risk of any infection including the SARS-CoV-2. Objective: We aimed to quantify the risk of SARS-CoV-2 infection during pregnancy compared with women with no [...] Read more.

Background: It has been suggested that women experiencing during pregnancy several physiological and immunological changes that might increase the risk of any infection including the SARS-CoV-2. Objective: We aimed to quantify the risk of SARS-CoV-2 infection during pregnancy compared with women with no pregnancies. Methods: We used data from the BIFAP database and a published algorithm to identify all pregnancies during 2020. Pregnancies were matched (1:4) by age region, and length of pregnancy with a cohort of women of childbearing age. All women with SARS-CoV-2 infection before entering the study were discarded. We estimated incidence rates of SARS-CoV-2 with 95% confidence intervals (CIs) expressed by 1000 person-months as well as Kaplan–Meier figures overall and also stratified according to pregnancy period: during pregnancy, at puerperium (from end of pregnancy up to 42 days) and after pregnancy. (from 43 days after pregnancy up to end pf study period (i.e., June 2021). We conducted a Cox regression to assess risk factors for SARS-COV infection. The incidence rate of SARS-CoV-2 infection expressed by 1000 person-months were. Results: There was a total of 103,185 pregnancies and 412,740 matched women at childbearing, with a mean age of 32.3 years. The corresponding incidence rates of SARS-CoV-2 infection according to cohorts were: 2.44 cases per 1000 person-months (confidence interval (CI) 95%: 2.40–2.50) and 4.29 (95% CI: 4.15–4.43) for comparison cohort. The incidence rate ratio (IRR) of SARS-CoV-2 was 1.76 (95% CI: 1.69–1.83). When analyzing according to pregnancy period, the IRRs were 1.30 (95% CI: 11.20–1.41) during the puerperium and 1.19 (95% CI: 41.15–1.23) after pregnancy. In addition to pregnancy itself, other important risk factors were obesity (1.33 (95% CI: 1.23–1.44)) and diabetes (1.23 (95% CI: 11.00–1.50). Conclusion: Pregnant women are at increased risk of SARS-CoV-2 infection compared with women of childbearing age not pregnant. Nevertheless, there is a trend towards reverting during puerperium and after pregnancy. Full article

(This article belongs to the Special Issue The Impact of the COVID-19 Pandemic on Health: Time to Take a Longer-Term Perspective)

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