Resiliência do cuidador domiciliar da pessoa idosa durante a pandemia da COVID-19

Objective: This study aims to identify the resilience level in formal and informal in-home caregivers of older adults in Ibagué during the COVID-19 pandemic. Methods: Quantitative, descriptive, cross-sectional study with a convenience sample of 49 formal and informal in-home caregivers of older adults. We administered the Brief Resilient Coping Scale (BRCS), an instrument consisting of four items, to these caregivers. The questionnaire was self-completed and, in some cases, answered by telephone. The data were collected in April 2020. Results: 35 women and 14 men participated in this study. The formal (69.4 %) and informal caregivers, mostly family (30.6 %), were between 18 and 30 years old (65.30 %). Their resilience levels were high (16.3 %), moderate (61.3 %), and low (22.4 %). There was a significant association between caregiver type and resilience level (p ≤ 0.05). Other studied covariates did not show a significant association. Conclusions: Due to stressful situations caused by care during social isolation and the risk of death of the elderly by COVID-19, strategies to improve resilience related to emotional, cognitive, and sociocultural interventions in the caregiver should be considered.Objetivo: este estudio tiene como objetivo identificar el nivel de resiliencia en cuidadores formales e informales de adultos mayores en el hogar en Ibagué durante la pandemia del COVID-19. Métodos: estudio cuantitativo, descriptivo y transversal con una muestra de conveniencia de 49 cuidadores formales e informales de adultos mayores en el hogar. Aplicamos la Escala Breve de Afrontamiento Resiliente (BRCS), un instrumento que consta de cuatro puntos, para estos cuidadores. Ellos mismos completaron el cuestionario y, en algunos casos, lo respondieron por teléfono. Los datos se recopilaron en abril de 2020. Resultados: 35 mujeres y catorce hombres participaron en este estudio. Los cuidadores formales (69,4 %) y los cuidadores informales, en su mayoría familiares (30,6 %), tenían entre 18 y 30 años (65,30 %). Sus niveles de resiliencia fueron altos (16,3 %), moderados (61,3 %) y bajos (22,4 %). Hubo una asociación significativa entre el tipo de cuidador y el nivel de resiliencia (p≤ 0,05). Otras covariables estudiadas no mostraron una asociación significativa. Conclusiones: debido a las situaciones de estrés causadas por la atención durante el aislamiento social y el riesgo de muerte de los adultos mayores por COVID-19, se deben considerar estrategias para mejorar la resiliencia mediante intervenciones emocionales, cognitivas y socioculturales en el cuidador.Objetivo: o objetivo deste estudo é identificar o nível de resiliência de cuidadores domiciliares formais e informais de idosos maiores no lar em Ibagué, Colômbia, durante a pandemia ocasionada pela COVID-19. Métodos: estudo quantitativo, descritivo e transversal, com uma amostra de conveniência de 49 cuidadores domiciliares formais e informais de idosos. Aplicamos a Escala Breve de Enfrentamento Resiliente, um instrumento que consta de quatro artigos, para esses cuidadores. O questionário foi respondido por eles mesmos e, em alguns casos, por telefone. Os dados foram coletados em abril de 2020. Resultados: 35 mulheres e 14 homens participaram deste estudo. Cuidadores formais (69,4 %) e cuidadores informais, em sua maioria familiares (30,6 %), tinham entre 18 e 30 anos (65,30 %). Seus níveis de resiliência foram altos (16,3 %), moderados (61,3 %) e baixos (22,4 %). Houve uma associação significativa entre o tipo de cuidador e o nível de resiliência (p ≤ 0,05). Outras covariáveis estudadas não apresentaram uma associação significativa. Conclusões: devido às situações de estresse causadas pelo atendimento durante o isolamento social e ao risco de morte de idosos por causa da COVID-19, devem ser consideradas estratégias para melhorar a resiliência com relação às intervenções emocionais, cognitivas e socioculturais no cuidador

Towards precision medicine: defining and characterizing adipose tissue dysfunction to identify early immunometabolic risk in symptom-free adults from the GEMM family study

Interactions between macrophages and adipocytes are early molecular factors influencing adipose tissue (AT) dysfunction, resulting in high leptin, low adiponectin circulating levels and low-grade metaflammation, leading to insulin resistance (IR) with increased cardiovascular risk. We report the characterization of AT dysfunction through measurements of the adiponectin/leptin ratio (ALR), the adipo-insulin resistance index (Adipo-IRi), fasting/postprandial (F/P) immunometabolic phenotyping and direct F/P differential gene expression in AT biopsies obtained from symptom-free adults from the GEMM family study. AT dysfunction was evaluated through associations of the ALR with F/P insulin-glucose axis, lipid-lipoprotein metabolism, and inflammatory markers. A relevant pattern of negative associations between decreased ALR and markers of systemic low-grade metaflammation, HOMA, and postprandial cardiovascular risk hyperinsulinemic, triglyceride and GLP-1 curves was found. We also analysed their plasma non-coding microRNAs and shotgun lipidomics profiles finding trends that may reflect a pattern of adipose tissue dysfunction in the fed and fasted state. Direct gene differential expression data showed initial patterns of AT molecular signatures of key immunometabolic genes involved in AT expansion, angiogenic remodelling and immune cell migration. These data reinforce the central, early role of AT dysfunction at the molecular and systemic level in the pathogenesis of IR and immunometabolic disorders

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Resiliência do cuidador domiciliar da pessoa idosa durante a pandemia da COVID-19

Objective: This study aims to identify the resilience level in formal and informal in-home caregivers of older adults in Ibagué during the COVID-19 pandemic. Methods: Quantitative, descriptive, cross-sectional study with a convenience sample of 49 formal and informal in-home caregivers of older adults. We administered the Brief Resilient Coping Scale (BRCS), an instrument consisting of four items, to these caregivers. The questionnaire was self-completed and, in some cases, answered by telephone. The data were collected in April 2020. Results: 35 women and 14 men participated in this study. The formal (69.4 %) and informal caregivers, mostly family (30.6 %), were between 18 and 30 years old (65.30 %). Their resilience levels were high (16.3 %), moderate (61.3 %), and low (22.4 %). There was a significant association between caregiver type and resilience level (p ≤ 0.05). Other studied covariates did not show a significant association. Conclusions: Due to stressful situations caused by care during social isolation and the risk of death of the elderly by COVID-19, strategies to improve resilience related to emotional, cognitive, and sociocultural interventions in the caregiver should be considered.Objetivo: este estudio tiene como objetivo identificar el nivel de resiliencia en cuidadores formales e informales de adultos mayores en el hogar en Ibagué durante la pandemia del COVID-19. Métodos: estudio cuantitativo, descriptivo y transversal con una muestra de conveniencia de 49 cuidadores formales e informales de adultos mayores en el hogar. Aplicamos la Escala Breve de Afrontamiento Resiliente (BRCS), un instrumento que consta de cuatro puntos, para estos cuidadores. Ellos mismos completaron el cuestionario y, en algunos casos, lo respondieron por teléfono. Los datos se recopilaron en abril de 2020. Resultados: 35 mujeres y catorce hombres participaron en este estudio. Los cuidadores formales (69,4 %) y los cuidadores informales, en su mayoría familiares (30,6 %), tenían entre 18 y 30 años (65,30 %). Sus niveles de resiliencia fueron altos (16,3 %), moderados (61,3 %) y bajos (22,4 %). Hubo una asociación significativa entre el tipo de cuidador y el nivel de resiliencia (p≤ 0,05). Otras covariables estudiadas no mostraron una asociación significativa. Conclusiones: debido a las situaciones de estrés causadas por la atención durante el aislamiento social y el riesgo de muerte de los adultos mayores por COVID-19, se deben considerar estrategias para mejorar la resiliencia mediante intervenciones emocionales, cognitivas y socioculturales en el cuidador.Objetivo: o objetivo deste estudo é identificar o nível de resiliência de cuidadores domiciliares formais e informais de idosos maiores no lar em Ibagué, Colômbia, durante a pandemia ocasionada pela COVID-19. Métodos: estudo quantitativo, descritivo e transversal, com uma amostra de conveniência de 49 cuidadores domiciliares formais e informais de idosos. Aplicamos a Escala Breve de Enfrentamento Resiliente, um instrumento que consta de quatro artigos, para esses cuidadores. O questionário foi respondido por eles mesmos e, em alguns casos, por telefone. Os dados foram coletados em abril de 2020. Resultados: 35 mulheres e 14 homens participaram deste estudo. Cuidadores formais (69,4 %) e cuidadores informais, em sua maioria familiares (30,6 %), tinham entre 18 e 30 anos (65,30 %). Seus níveis de resiliência foram altos (16,3 %), moderados (61,3 %) e baixos (22,4 %). Houve uma associação significativa entre o tipo de cuidador e o nível de resiliência (p ≤ 0,05). Outras covariáveis estudadas não apresentaram uma associação significativa. Conclusões: devido às situações de estresse causadas pelo atendimento durante o isolamento social e ao risco de morte de idosos por causa da COVID-19, devem ser consideradas estratégias para melhorar a resiliência com relação às intervenções emocionais, cognitivas e socioculturais no cuidador

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care