"DORMIR MEJOR" PROJECT: Promoting the importance of quality sleep and sleep care

Treball Final de Grau en Psicologia. Codi: PS1048. Curs: 2022/2023Un buen hábito de sueño influye en nuestra salud física y mental. De hecho, un mal descanso se ha asociado al aumento del riesgo de padecer ciertas enfermedades. Dada la importancia del sueño, el objetivo de este proyecto era comprobar cómo era la calidad de sueño de la población española y crear un tratamiento para mejorarla. En el primer estudio participaron 593 personas, con una edad media de 48 años (DT= 14,65) siendo el 69,31% mujeres. La medida utilizada fue el Índice de calidad de sueño de Pittsburgh (PSQI) para población española administrada mediante la plataforma Qualtrics. La encuesta se publicó en diferentes redes sociales y se utilizó la técnica de bola de nieve para aumentar la muestra. La puntuación total del PSQI fue de 8,29 (DT = 3,86) y un 83,46% presentaba problemas de sueño. En conclusión, este estudio encontró que los problemas del sueño son prevalentes entre la población española y que, por tanto, era necesario trabajar en la concienciación y el abordaje de este problema. En el segundo estudio se creó un tratamiento virtual autoadministrado en la Plataforma Psicología y Tecnología, formado por 2 módulos: Felices Sueños, para población general (18-64 años); y Sueño con Valores, para población mayor (>65 años). Los Módulos de Aprendizaje se diseñaron para concienciar de la importancia de la calidad del sueño y para enseñar estrategias para mejorarla. Además, se pasó el cuestionario CSQ-I sobre viabilidad, aceptabilidad y satisfacción sobre la experiencia tras el uso de los módulos. Los resultados indicaron que las personas que utilizaron los módulos manifestaron una muy buena aceptabilidad y satisfacción (un 92% consideraba los módulos como satisfactorios o muy satisfactorios). Por tanto, los módulos online pueden ser una herramienta muy útil para aumentar la accesibilidad de intervenciones para el sueño a distintas poblaciones.A good sleep habit influences our physical and mental health. In fact, poor sleep has been associated with an increased risk of certain diseases. Given the importance of sleep, the aim of this project was to check the quality of sleep in the Spanish population and create a treatment to improve it. The first study involved 593 people, with an average age of 48 years (SD= 14.65), 69.31% of whom were women. The measure used was the Pittsburgh Sleep Quality Index (PSQI) for the Spanish population, administered using the Qualtrics platform. The survey was published in different social networks and the snowball technique was used to increase the sample. The PSQI total score was 8.29 (SD = 3.86) and 83.46% had sleep problems. In conclusion, this study found that sleep problems are prevalent in the Spanish population and that it was therefore necessary to work on raising awareness and addressing this problem. In the second study, a self-administered virtual treatment was created on the Psychology and Technology Platform, consisting of 2 modules: Happy Dreams, for the general population (18-64 years old); and Sleep with Values, for the elderly population (>65 years old). The Learning Modules were designed to raise awareness of the importance of sleep quality and to teach strategies to improve it. In addition, the CSQ-I questionnaire on feasibility, acceptability and satisfaction with the experience after using the modules was administered. The results indicated that those who used the modules reported very good acceptability and satisfaction (92% considered the modules as satisfactory or very satisfactory). Therefore, online modules can be a very useful tool to increase the accessibility of sleep interventions to different populations

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Risk of recurrence after discontinuing anticoagulation in patients with COVID-19- associated venous thromboembolism: a prospective multicentre cohort studyResearch in context

Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain

Risk of recurrence after discontinuing anticoagulation in patients with COVID-19- associated venous thromboembolism: a prospective multicentre cohort studyResearch in context

Summary: Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain