[COVID-19 pandemic: Now what?]

[Challenges and strategies to recover and dynamize primary care: SWOT-CAME analysis in a Health Department]

OBJECTIVE

To identify strengths, obstacles, changes in the environment, and capabilities of primary care teams and support units, with the aim of providing high-quality care in an integrated healthcare area.

DESIGN

Mixed methods study based on the SWOT matrix and CAME analysis.

LOCATION

Primary care, Valencian community.

PARTICIPANTS

A total of 271 professionals from different collectives and patient association representatives participated. 99 in the idea generation phase, 154 in the SWOT matrix development phase, and 18 in the CAME analysis development phase.

INTERVENTIONS

A SWOT-CAME analysis was conducted, from which action lines were established. Information capture was carried out through nominal groups, and the consensus phase involved integrating all professionals through Delphi and consensus conference techniques.

MAIN MEASUREMENTS

Prioritization of proposals to maintain strengths, address threats, exploit opportunities, and correct weaknesses within the framework of an integrated healthcare area action plan.

RESULTS

A total of 82 different ideas were proposed (20 strengths; 40 weaknesses; 4 threats; 12 opportunities; 6 threats-opportunities), which, once prioritized, were translated into 7 lines and 33 prioritized actions/interventions (CAME analysis).

CONCLUSIONS

Integrated care, seeking collaborative approaches between care levels, redefining roles, digital solutions, staff training, and improvements in equipment and support processes, along with measures to address the aging population and the needs of socio-sanitary centers, constitute the challenges to be addressed.

[Healthcare workers in intensive care units as second victims of SARS-CoV-2: results of a survey]

Introducción

La epidemia por el virus SARS-CoV-2 ha generado una situación extraordinaria en la asistencia sanitaria de nuestro país. La enorme sobrecarga de trabajo a la que han estado expuestos los profesionales sanitarios, la importante carga emocional, las situaciones estresantes y el miedo al contagio propio y de sus familiares, entre otros aspectos, han podido tener consecuencias en los profesionales, convirtiéndolos en segundas víctimas. El objetivo de este estudio es conocer la sobrecarga emocional de los trabajadores de áreas de pacientes críticos por SARS-CoV-2 en un hospital terciario de la Comunidad de Madrid.

Materiales y métodos

Estudio descriptivo transversal, realizado mediante la cumplimentación voluntaria por parte de los profesionales de áreas de cuidados críticos de un cuestionario adaptado a partir de la Escala de Estrés Agudo «EASE COVID-19», consistente en 10 preguntas cerradas tipo Likert a las que se añadieron cuatro preguntas: sexo, categoría profesional, si trabajan habitualmente en áreas de críticos y el sacrificio en sus rutinas. Los datos se recogieron en julio de 2020, para evaluar el impacto de la primera ola. Se realizó una descripción de los datos y se analizó la asociación entre las variables y la respuesta emocional.

Resultados

Un 54% de los encuestados mostró buen ajuste emocional. Lo que más preocupó a los participantes fue la posibilidad de contagiar a sus familiares. Los colectivos con puntuaciones medias más altas fueron los enfermeros, técnicos en cuidados auxiliares de enfermería (TCAE) y celadores, mostrando ajuste emocional el 100% de los médicos, sin encontrarse diferencias por sexo. El 60% de los participantes modificó su rutina familiar, siendo los médicos internos residentes (MIR) los que presentaron mayor porcentaje.

Conclusiones

La crisis sanitaria vivida ha convertido a los profesionales sanitarios en segundas víctimas del SARS-CoV-2. Su detección es fundamental para ofrecerles los recursos y ayuda necesaria para garantizar su bienestar emocional, eliminando barreras y ayudándoles a salir reforzados.

Teacher Teleworking during the COVID-19 Pandemic: Association between Work Hours, Work-Family Balance and Quality of Life

BACKGROUND

Teachers worldwide had to reinvent their work routine according to teleworking during the COVID-19 pandemic, a work format that negatively impacts individuals' physical and mental health. This study evaluates the association between work hours, work-family balance and quality of life (QoL) among teachers during the Chilean health emergency of the COVID-19 pandemic. Teachers from across Chile were contacted via email and social media to answer an online survey. QoL was evaluated via the SF-36 questionnaire, work hours and work-family balance in the pandemic. A total of 336 teachers from across Chile participated in this study. Teachers had a low QoL score, associated with age (p < 0.05). Teachers who were ≤44 showed lower deterioration risks in the Physical Component Summary (OR: 0.54) than the ≥45-year-old age group; simultaneously, the younger group (≤44 years) had a greater risk (OR: 2.46) of deterioration in the Mental Component Summary than teachers over 45 years. A total of 78.7% of teachers reported having increased their work hours during the COVID-19 pandemic due to teleworking and 86% indicated negative effects on their work-family balance. Pandemic work hours and negative work-family balance increase the risk of reducing the Mental Component Summary (OR: 1.902; OR: 3.996, respectively). Teachers presented low median QoL scores, especially in the Mental Component Summary, suggesting that it would be beneficial to promote a better workload distribution for teachers in emergency contexts, considering the adverse effects of teleworking.

[Impact of the COVID-19 pandemic: The point of view of patient associations]

Antecedentes y objetivo

La pandemia por COVID-19 está produciendo un gran impacto social y sanitario. Ante esta situación, los pacientes han de participar en la detección de sus nuevas necesidades. El objetivo de este estudio fue valorar la percepción de las organizaciones asociadas al Foro Español de Pacientes (FEP) sobre la pandemia.

Materiales y métodos

Estudio descriptivo transversal mediante encuesta online. Participaron las organizaciones asociadas al FEP durante la segunda quincena de mayo de 2020. Se realizó la valoración previa del cuestionario por profesionales y pacientes. Los ámbitos temáticos fueron: afectación general a causa de la pandemia, impacto, papel de las asociaciones de pacientes, limitaciones y retos. Se realizó un análisis descriptivo de las variables cuantitativas y un análisis de contenido de la información cualitativa.

Resultados

El porcentaje de participación fue del 88,7%. Los participantes destacaron el impacto de la pandemia en la calidad de vida y bienestar de pacientes y familiares. También refirieron la afectación de la enfermedad de base y el atraso de tratamientos y pruebas. La pandemia ha afectado también a las asociaciones de pacientes.

Conclusiones

El impacto de la pandemia se ha producido a nivel sanitario y en otras esferas de la sociedad. Los pacientes se han visto afectados en su salud, calidad de vida y utilización de los servicios sanitarios.

Se destaca la necesidad de contar con los pacientes, sus familiares y sus representantes legítimos en la búsqueda de soluciones que se adapten a las necesidades actuales de estos colectivos.

Postoperative complications and mortality following emergency digestive surgery during the COVID-19 pandemic: A multicenter collaborative retrospective cohort study protocol (COVID-CIR)

ABSTRACT

Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients.A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the "pandemic" cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the "control" cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients.The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).

"INSIDE" Project on Sexual Health in Spain: Sexual Life During the Lockdown Caused by COVID-19

INTRODUCTION

The COVID-19 pandemic is becoming a major hazard to public health worldwide. This is causing a significant impact on life and physical health, as well as on the psychological well-being of the general population. Since the emotional distress and the social restrictions caused by this epidemic, it must be expected that its impact will also extend to sexual health. The purpose of this study, the first including a large sample of the Spanish general population, was to analyze sexual behavior during the 99 days of confinement in Spain (INSIDE Project).

METHOD

One thousand four hundred forty-eight Spanish people, between 18 and 60 years old, were evaluated through an online survey during April 2020. The variables analyzed were the physical and social environment during confinement, sexual desire, type of sexual activity, masturbation, sexual intercourse, online sexual activity, general sexual frequency, sexual fantasies, degree of self-control over sexual drive, sexual abuse, general impact of confinement on sexuality, and emotional mood.

RESULTS

Confinement has affected the sexual life of half of the Spanish population (47.7%), especially women. Those who reported a worsening of their sexual life are almost three times more (37.9%) than those who reported an improvement (14.4%).

CONCLUSIONS

Different factors have been significant predictors of the positive or negative evaluation about the impact of this confinement on sexual life, such as gender, couple life, privacy, stress level, and the perception of confinement as unbearable.

POLICY IMPLICATIONS

These results have important implications for the public health and more especially sexual health of the Spanish population.

Confinement and the Hatred of Sound in Times of COVID-19: A Molotov Cocktail for People With Misophonia

Forced strict confinement to hamper the COVID-19 pandemic seriously affected people suffering from misophonia (M+) and those living with them. Misophonia is a complex neurophysiological and behavioral disorder of multifactorial origin, characterized by an intense physiological and emotional response produced by intolerance to auditory stimuli of the same pattern, regardless of physical properties. The present work studied the secondary impact that strict confinement caused in 342 adults (224 women: 118 men) regularly attending a medical psychological center in Barcelona. Misophonia, usually underdiagnosed, showed a prevalence of 35%, the same for women (37%) than men (31%). A retrospective analysis using a physical-psychological-social inventory of 10 variables evaluated the number of individuals that during confinement and self-confinement (March 11 - June 29, 2020) canceled (mostly M-) and/or requested a therapeutic intervention, the reasons for their request, and the strategies they used to self-manage the situation. Ten main variables indicated that the confinement exponentially increased the effects of misophonia compared with results from the same individuals during the last quarter of 2019. Most people diagnosed with misophonia continued with tele-assistance during the confinement because of this impact's self-concern. Besides the impacts as part of the general population, M+ also developed different symptoms causing significant personal, social, and job/occupational imbalance, as compared to M-. Health, fears, conflicts with neighbors, study-related difficulties were outstanding reasons for consultations. The LSB-50 test for 'Psychological and Psychosomatic Symptoms' applied to M+ revealed the increase of 8 of 9 items of this psychopathological test. Sleep disorders (coronasomnia), hostility, depression, and somatization were more severe than in previous assessments. Women presented the worst psychological and psychosomatic states (eight out of nine, as compared to one out of nine in males). The study unveiled the complex physical-psychological-social burden, the need for dissemination and a gender perspective to understand the secondary impact of COVID-19 pandemic on the mental health of the population with misophonia. The results also show that in this new COVID era people suffering from misophonia need to develop coping strategies addressing modifiable risk and protective factors. They deserve familial/social comprehension, stronger clinical support and a gender medicine perspective.

"INSIDE" Project on Sexual Health in Spain: Sexual Life During the Lockdown Caused by COVID-19

INTRODUCTION

The COVID-19 pandemic is becoming a major hazard to public health worldwide. This is causing a significant impact on life and physical health, as well as on the psychological well-being of the general population. Since the emotional distress and the social restrictions caused by this epidemic, it must be expected that its impact will also extend to sexual health. The purpose of this study, the first including a large sample of the Spanish general population, was to analyze sexual behavior during the 99 days of confinement in Spain (INSIDE Project).

METHOD

One thousand four hundred forty-eight Spanish people, between 18 and 60 years old, were evaluated through an online survey during April 2020. The variables analyzed were the physical and social environment during confinement, sexual desire, type of sexual activity, masturbation, sexual intercourse, online sexual activity, general sexual frequency, sexual fantasies, degree of self-control over sexual drive, sexual abuse, general impact of confinement on sexuality, and emotional mood.

RESULTS

Confinement has affected the sexual life of half of the Spanish population (47.7%), especially women. Those who reported a worsening of their sexual life are almost three times more (37.9%) than those who reported an improvement (14.4%).

CONCLUSIONS

Different factors have been significant predictors of the positive or negative evaluation about the impact of this confinement on sexual life, such as gender, couple life, privacy, stress level, and the perception of confinement as unbearable.

POLICY IMPLICATIONS

These results have important implications for the public health and more especially sexual health of the Spanish population.

[Proposals by the Spanish Society of Quality in Healthcare (SECA) for the recovery of the National Health Service after the COVID-19 pandemic]

Justificación

La pandemia por SARS-CoV-2 ha exigido respuestas para las que el Sistema Nacional de Salud (SNS) no estaba preparado. La Sociedad Española de Calidad Asistencial (SECA) tiene la misión de impulsar la calidad en el ámbito sanitario y de contribuir a su adecuado funcionamiento.

Objetivo

Presentar recomendaciones de la SECA para asegurar la calidad y la seguridad de los pacientes en la recuperación del SNS tras el impacto de la pandemia por SARS-CoV-2 y ante la posibilidad de un rebrote.

Método

Estudio cualitativo de búsqueda de consenso con participación de 49 representantes de los diferentes grupos de interés (pacientes, directivos, profesionales, académicos e investigadores). Las áreas a explorar fueron: lecciones aprendidas, gestión de nuevas demandas asistenciales de pacientes COVID-19, recomposición de plantillas, fortalecimiento de la resiliencia de los profesionales, nuevo rol del paciente y planes de contingencia.

Resultados

Se aportaron 428 recomendaciones. Una vez eliminadas las duplicidades y unificado similitudes se redujeron a 120. De estas, se priorizaron 60 recomendaciones que fueron agrupadas en 2 bloques: 1) para la recuperación del SNS (equidad, accesibilidad, efectividad, eficiencia, seguridad, experiencia de pacientes y moral laboral) y 2) para afrontar posibles rebrotes.

Conclusión

La SECA responde a su compromiso con la sociedad con recomendaciones para asegurar la calidad y seguridad de pacientes en la era COVID-19.