Coping Strategies and Stress Related Disorders in Patients with COVID-19

A Three-Year Cross-Sectional Analysis of Depression, Anxiety, and Quality of Life in Patients with Post-COVID-19 Syndrome

Background

This study explores the longitudinal psychosocial impact of Long-COVID syndrome, also known as Post-COVID-19 syndrome, characterized by enduring symptoms after coronavirus disease (COVID-19) infection, over the years 2020, 2021, and 2022. It aimed to examine the variations in depression, anxiety, and quality of life among Post-COVID-19 patients during these years, hypothesizing significant inter-year differences reflecting the pandemic's evolving influence.

Methods

Conducted at Victor Babes Hospital for Infectious Diseases and Pulmonology, Romania, this cross-sectional research involved 324 patients diagnosed with mild to moderate COVID-19, assessed six months post-hospitalization. Standardized instruments, namely Short Form (SF-36) for quality of life, Generalised Anxiety Disorder Assessment (GAD-7) for anxiety, and Patient Health Questionnaire (PHQ-9) for depression, were utilized.

Results

The study observed a consistent average patient age of around 55 years across the years. A notable increase in COVID-19 vaccination rates was recorded, rising from 20.9% in 2020 to over 70% in 2022 (p<0.001). Trends in key post-COVID symptoms like fatigue and cognitive issues varied over the years. Importantly, there was a consistent decrease in feelings of sadness or depression, with scores declining from 7.3 in 2020 to 4.8 in 2022 (p<0.001). The SF-36 survey indicated a steady improvement in overall health, reaching 55.8±7.1 in 2022 (p=0.035). Both GAD-7 and PHQ-9 scores showed significant reductions in anxiety and depression over the years, with p-values of 0.030 and 0.031, respectively. Factors such as smoking status, substance use, and the initial severity of COVID-19 infection were significantly associated with depression levels.

Conclusion

The findings suggest that despite persistent physical symptoms, Long-COVID patients experienced enhancements in mental well-being and quality of life over the studied period. The increasing vaccination rates might have contributed to this improvement. Addressing modifiable risk factors like smoking and substance use could further optimize post-COVID care and mental health outcomes.

Pandemic Stressors and Adaptive Responses: A Longitudinal Analysis of the Quality of Life and Psychosocial Dynamics among Urothelial Cancer Patients

The 2019 coronavirus disease (COVID-19) pandemic has had a profound influence on different sectors of society, including health. This study hypothesized a significant impact of the pandemic on the quality of life and psychosocial well-being of urothelial cancer patients, specifically anticipating a decrease in anxiety and depression scores as the pandemic progressed. The primary objectives were to assess longitudinal changes in quality of life indexes, evaluate Healthcare Anxiety and Depression Scale (HADS) score trends over three years (2020-2022), and identify any correlational patterns between the progression of the pandemic and anxiety, depression, and stress levels among this cohort. A cross-sectional analysis was conducted on Eastern Cooperative Oncology Group (ECOG) 1 and Tumor Node Metastasis (TNM) stage 1 bladder cancer patients from the Timis County Emergency Clinical Hospital in Romania. Sixty patients were evaluated each year from 2020 to 2022, utilizing a detailed selection process involving the review of both the hospital database and paper records. Key data included demographic information, medical history, and responses to the Patient Health Questionnaire (PHQ-9), Short Form (SF-36), HADS, and Generalized Anxiety Disorder (GAD-7) questionnaires. A total of 163 completed questionnaires were analyzed, providing insight into various aspects of patients' experiences during the pandemic. Notably, the mean hospitalization days ranged from 3.6 ± 2.1 days in 2020 to 4.0 ± 2.4 days in 2022 (p = 0.663). Concerns that current symptoms might be pandemic-related spiked to 63.5% in 2021, but reduced to 50.9% in 2022, with this fluctuation being significant (p = 0.026). The perception of decreased quality of or accessibility to medical care was significant over the years, with a decline to 52.7% in 2022 (p = 0.033). Quality of life assessments demonstrated an upward trend, from an average score of 55.9 ± 8.9 in 2020 to 59.3 ± 8.8 in 2022 (p = 0.049). Interestingly, anxiety levels, as indicated by the HADS survey, revealed a significant decline from a score of 7.8 in 2020 to 6.5 in 2022 (p = 0.008). On the other hand, GAD-7 scores displayed a downward trend over the years, potentially indicative of developed coping strategies (p = 0.034). This study provides a comprehensive insight into the fluctuating dynamics of psychosocial factors and quality of life among urothelial cancer patients during the pandemic years. It underscores a potential adaptive response, as evidenced by the decrease in anxiety levels and an upward trend in the quality of life scores over the period. These findings highlight the resilience and adaptability of this patient cohort amidst the challenges posed by the pandemic, potentially guiding future interventions and supports in similar health crises.

Untangling the Professional Web: Understanding the Impact of Work-Related Factors on the Mental Health of Healthcare Professionals During the Late Stages of Covid-19 Pandemic

Purpose

The COVID-19 pandemic has determined an extraordinary challenge to healthcare systems worldwide. The extraordinary circumstances, characterized by elevated stress levels, prolonged working hours, new medical procedures, media attention, and high population expectations, have created an extremely stressful situation for healthcare professionals. This period has offered a unique opportunity to examine the medical system and the responses of healthcare practitioners to stress. This research aimed to identify the work-related factors that significantly impact the mental health of healthcare professionals.

Patients and Methods

Three mental health variables were assessed: anxiety, depression and stress. The work-related factors considered were professional degree, type of medical unit (COVID or non-COVID), the number of hours spent at work in a single shift, type of shifts, monthly on-call frequency, and number of COVID-19 treated patients per month. In the spring of 2022, three inventories and a demographic survey were distributed and completed online by 300 healthcare professionals from Timisoara's public hospitals in Romania.

Results

Among the respondents, 47.7% reported mild symptoms of anxiety, 65.3% reported moderate levels of stress, and 33% of the participants reported mild symptoms of depression. The intensity of anxious, depressive, and stress symptoms varied significantly depending on the professional degree, number of on-calls per month, the type of medical unit where the participants worked, and the number of SARS CoV-2 patients treated in the previous month.

Conclusion

Current data underlines the urgency of implementing effective strategies to reduce the stress and anxiety of medical practitioners who work with COVID-19 patients. Possible interventions encompass a variety of approaches, such as improving working conditions, reducing working hours where possible, increasing access to mental health services, and promoting team-building activities to enhance social support among colleagues. Digital mental health interventions, including online counseling and stress management programs, have also shown promise in these challenging times. Sustaining the mental health of medical practitioners is vital to support the continued provision of first-rate care to patients and to build a resilient healthcare workforce capable of navigating future health crises.

Association Between Family Support and Coping Strategies of People With Covid-19: A Cross-Sectional Study

Purpose

The study aimed to determine the association between family support and coping strategies of people diagnosed with COVID-19.

Methods

The study was analytical and cross-sectional. The sample consisted of 500 participants who were selected by non-probabilistic and snowball sampling and included residents of both sexes who belonged to the city of Lima, with a diagnosis of COVID-19, who lived with relatives, and who accepted to participate in the research. For data collection, the scales "family support" and "Coping and Adaptation Process-Coping Adaptation Processing Scale (CAPS)" were used. The technique used was the survey through the home visit and the questionnaire instrument. To measure the relationship of the study variables, binary logistic regression was chosen, considering coping strategies as the dependent variable and socio-demographic data and family support as independent variables.

Results

Of the 500 participants, 50.4% were women, and 49.6% were men. The results revealed that most participants presented a high capacity for coping strategies and high perceived family support (97.2% and 81%, respectively). In the bivariate analysis, socio-demographic aspects and family support and their dimensions were related to high or low capacity for coping strategies. Significant differences were verified between marital status (p=0.026), having children (p=0.037), family support (p=0.000), and its dimensions with coping strategies. Finally, the multivariate analysis found that people with COVID-19 who perceived high family support were 33.74 times (95% CI: 7266-156,739) more likely to have a high capacity for coping strategies.

Conclusion

Therefore, it is necessary to promote the development of parental and family support skills in the face of the health emergency caused by COVID-19.

Post-Severe-COVID-19 Cardiopulmonary Rehabilitation: A Comprehensive Study on Patient Features and Recovery Dynamics in Correlation with Workout Intensity

The aftermath of severe COVID-19 frequently involves considerable cardiopulmonary damage, necessitating rehabilitation. This study aimed to evaluate the impact of COVID-19 on cardiopulmonary health and assess the effectiveness of various rehabilitative interventions. Conducted between September 2021 and September 2022, this prospective study included patients who had been diagnosed with severe COVID-19 and admitted at the "Victor Babes" Infectious Diseases and Pulmonology Hospital, Timisoara, Romania. The patients were stratified into low- and high-intensity rehabilitation groups. The rehabilitation protocols were individually tailored, and the patient recovery was closely monitored over a 3-month period. Our cohort comprised 84 patients, with a mean age of 56.3 years for the low-intensity group (n = 42) and 53.1 years for the high-intensity group (n = 42). Both groups showed significant improvements in the lung injury area, need for oxygen supplementation, ejection fraction, systolic pulmonary artery pressure, and forced vital capacity. Additionally, considerable enhancements were observed in maximal voluntary ventilation, FEV1, FEV1/FVC ratio, peak expiratory flow, and forced expiratory flow at 25-75%. The work intensity also demonstrated substantial improvements from the initial testing to the 3-month mark in both groups. This study provides evidence that personalized, targeted rehabilitation strategies can improve long-term cardiopulmonary health in patients recovering from severe COVID-19, proving both low-intensity and high-intensity training as sufficient to improve heart and lung function if performed correctly and over a relatively short duration of 3 months. The study findings underscore the importance of implementing comprehensive cardiopulmonary rehabilitation protocols in the care of post-COVID-19 patients and highlight the value of stratified rehabilitation intensity based on individual patient dynamics and recovery features.

The Effects of Lack of Awareness in Age-Related Quality of Life, Coping with Stress, and Depression among Patients with Malignant Melanoma

Almost one-third of all malignant melanoma patients exhibit emotional stress indicating the need for professional care. Considering this, patients' psychological needs are routinely overlooked and unfulfilled, even though there is substantial evidence that psychological therapies may enhance psychosocial outcomes for melanoma patients, such as low mood, sadness, and anxiety. Among developing countries and some health systems in developed regions, the lack of awareness and screening methods for skin cancer creates a high risk of psychological issues associated with more advanced diseases. Therefore, the current study aimed to investigate and compare the impact of malignant melanoma awareness for screening, prevention, and treatment on the patient's quality of life and coping with stress and depression, based on patients' age. This cross-sectional study recruited 238 patients with malignant melanoma distributed into two groups, Group A patients between 18 and 65 years and Group B patients older than 65. There were no significant gender differences and cancer staging differences between groups, although self-reported depressed mood and anhedonia were significantly more frequent in younger adults with malignant melanoma (43.8% vs. 28.9%). From the unstandardized surveys, it was observed that significantly fewer patients from Group B knew that melanoma could be caused by sun exposure (34.2% vs. 52.2%), and they were less likely to use sunscreen or visit a doctor to evaluate their skin moles (25.9% vs. 14.5%). Elderly patients preferred television as the main source of information, and only 68.4% of patients from Group B were using smart devices. There was a significantly higher physical score on the SF-12 scale among Group A patients, although patients from Group B scored higher in the mental health assessment, and the perceived helplessness on the PSS-10 scale was significantly higher compared to younger adults with melanoma (2.97 vs. 2.71, p-value = 0.036). Lower scores on the physical and mental SF-12 questionnaire determined a higher presence of depressive symptoms (rho = -0.352, respectively rho = -0.273). Higher scores on the DLQI sexual difficulties and treatment difficulties also correlated significantly with the presence of depressive symptoms and anhedonia (rho = 0.341, respectively rho = 0.264). Awareness campaigns for malignant melanoma should focus on the elderly population, too, using the television as the main communication channel. On the other hand, the more informed and knowledgeable group of adults younger than 65 are more likely to experience psychological problems and should be targeted for psycho-oncological aid.

Differences in Stress Perception of Medical Students Depending on In-Person Communication and Online Communication during the COVID-19 Pandemic: A Japanese Cross-Sectional Survey

BACKGROUND

Excessive psychological stress in medical students affects their mental health and causes problems such as burnout and depression. Furthermore, changes in the learning environment to online learning due to the COVID-19 pandemic have had a psychological effect on medical students. However, the relationships between medical students' perceived stress and different methods of communication, including in-person and online communication, remain unclear. The purpose of this study was to investigate the differences in stress perception of medical students depending on in-person communication and online communication during the COVID-19 pandemic.

METHODS

This study was a cross-sectional study conducted from September to October in 2020. All of the students of Okayama University School of Medicine were asked to participate in a questionnaire survey. The explanatory variables were the frequency and length of communications with others (by in-person or online communication), empathy, and lifestyle. The main outcome measure was perceived stress. Subgroup analysis was conducted for students who preferred to be by themselves and students who preferred to study together and interact with other people. Univariate analysis and multivariate multiple regression analysis were conducted. Gender and grade, which have been shown to be associated with stress in previous studies, were used as covariates for multiple regression analysis.

RESULTS

Valid responses to the questionnaire survey were received from 211 (29.4%) of the 717 students. There was no significant association between perceived stress and online communication, but the number of people with which students had in-person communication (1-2 people compared to 0 as a control, regression coefficient [B] = -4.4, 95% confidence interval [CI]; -7.8, -1.1, more than 10 people, B = -12, 95% CI: -18, -5.8) and the length of communication (more than 120 min, B = -4.5, 95% CI: -8.1, -0.92) were associated with a reduction in perceived stress. In subgroup analysis, the number of people with in-person communication and the length of communication had significant associations with stress reduction even in the group of students who had a preference for being by themselves.

CONCLUSION

In-person communications rather than online communications were associated with a lower level of perceived stress. In subgroup analysis, this trend was statistically significant in the group of students who had a preference for being by themselves.

Response of Polish Psychiatric Patients to the Russian Invasion of Ukraine in February 2022-Predictive Role of Risk Perception and Temperamental Traits

This study examined the impact of the Russian invasion of Ukraine in February 2022 on Polish patients with depression and schizophrenia. It has been hypothesized that possible changes in symptoms may be predicted by the subjective risk perception related with the Russo-Ukraine War (RUW) as well as by temperamental traits. The study was conducted with 80 patients with schizophrenia or depression. A questionnaire measuring sociodemographic characteristics, perception of risk, temperamental characteristics, and symptoms of depression and schizophrenia were used as research tools. Symptom intensity was compared with the average symptom intensity calculated on the basis of archival symptom measurements from the three consecutive months preceding the outbreak of the RUW. Predictors of change in symptoms were also analyzed, taking into account sociodemographic variables, the level of risk perception, and temperamental traits. The results indicate the specific patterns of reactions to war danger for patients with different types of psychiatric diagnosis. Depressed patients reacted with an increase in seven symptoms related to unworthiness and/or guilt, lack of interest, and/or pleasure and pessimism. The response of schizophrenic patients was related only with an increase in positive symptoms. This study highlights the need to provide more support to psychiatric patients in acute emergencies.

The First Year of the Psychiatric Diseases Section

Since its inception in May 2021, the Psychiatric Diseases Section of Brain Sciences has grown to include a staff of 28 academic editors with expertise related to clinical psychiatry, in addition to its supporting staff of managing and English-language editors [...].

The Implication of Misinformation and Stigma in Age-Related Quality of Life, Depression, and Coping Mechanisms of Adult Patients with Psoriasis

Background and Objectives: Stigma and lack of acceptance in society might have detrimental effects on the quality of life of patients with psoriasis, sometimes being comparable with other chronic diseases and conditions that affect the appearance of a patient, such as burns. Therefore, we surveyed our patients diagnosed with psoriasis to determine the implications of misinformation and stigma for their quality of life, depression, and coping strategies stratified by different age categories. Materials and Methods: A cross-sectional study was designed for a sample size of a minimum of 45 patients considering a prevalence of psoriasis of 2–3% in the general population. The study participants (patients and controls) were given both a paper-based unstandardized questionnaire and an online version of three standardized surveys. The cohort of patients was further split into three age groups to determine their age-related quality of life and coping mechanisms. Results: The proportion of patients with a history of depression and depressive symptoms among patients with psoriasis was significantly higher. Multiple discrepancies were observed between patients and controls regarding questions that targeted stigma and misinformation. On the Coping Orientation to Problems Experienced Inventory (COPE-60) questionnaire, older patients were more likely to use positive coping mechanisms such as engagement and problem-focused coping, while the young patients were using more emotion-focused coping mechanisms. However, patients in the 30–50 age range group scored the highest on physical and mental health among all participants who filled the 12-Item Short Form Survey (SF-12) survey. The Dermatology Life Quality Index (DLQI) results showed significantly more patients answering “a lot and very much” concerning embarrassment and social activities, while sexual difficulties affected the older patients. The strongest correlations with depression were observed in the young patient group, who believed that psoriasis can cause skin cancer (rho = 0.418) and who had sexual difficulties (rho = 0.414) and embarrassment (rho = 0.359) as evaluated by the DLQI survey. In the 30- to 50-year-old group, the strongest correlations were with the feeling of being stigmatized (rho = 0.376), having sexual difficulties (rho = 0.367) and disengagement coping style (rho = 273). Conclusions: While the respondents are reasonably well-informed regarding psoriasis, a degree of stigma remains, likely due to involuntary emotional responses such as repulsion and embarrassment. It is essential to establish initiatives aimed at educating the general public, raising awareness, and establishing a more tolerant social environment for psoriasis patients.

Postpartum Maternal Emotional Disorders and the Physical Health of Mother and Child

Purpose

The purpose of this study is to identify the relationships between postpartum emotional manifestations and various neonatal variables, as well as variables within this category, in the context of hospitalization together after birth.

Patients and Methods

Between 1 March 2020 and 1 September 2020, a cross-sectional research design was used including mother–child couples (112 mothers, 121 newborns - 13 twins/triplets).

Results

Using a t-test for independent samples, we observed: a) the symptoms of depression were more severe in mothers of newborns hospitalized in neonatal intensive care units (NICUs) [t(110) = 4.334)], provided oxygen therapy [t(109.99) = 3.162], born prematurely [t(110) = 3.157], or with adjustment disorders [t(109) = −2.947] (p < 0.01); b) a similar, for anxiety as a state [t(82.38) = 5.251], t(107.29) = 4.523, t(110) = 3.416, t(109) = −3.268, p < 0.01], and as a trait was more common [t(80.79) = 4.501, t(108.790) = 4.669, t(109) = −3.268, p < 0.001] compared to other mothers. Using Pearson’s test (p < 0.001), several very strong correlations were observed between neonatal variables, including number (no.) of days of hospitalization with birth weight (BW) (r = −0.802), head circumference (HC) (r = −0.822), and gestational age (GA) (r = −0.800) and the mother’s postpartum anxiety as a state/trait (r = 0.770). Using Poisson regression, it was observed that anxiety as a state (Λ = 0.020, z = 4.029, p < 0.001) and as a trait (Λ = 0.800, z = 6.160, p < 0.001) stimulated the intensity of symptoms of postpartum depression (optimal models).

Conclusion

Postpartum maternal psychological manifestations were associated with NICU hospitalization, pathology, and some neonatal therapies. We also noticed, that the duration of hospitalization, BW, HC, and GA, were correlated with maternal emotional disorders. Results will facilitate future optimization of birth management and postnatal care.

Evaluation of FIB-4, NFS, APRI and Liver Function Tests as Predictors for SARS-CoV-2 Infection in the Elderly Population: A Matched Case-Control Analysis

Several investigations have revealed that COVID-19 causes a significant death rate due to acute respiratory distress syndrome, alterations in the quantity of ACE2 receptor expression, or the intensity of cytokine storm. Similarly, patients with hepatic impairment that are co-infected with SARS-CoV-2 are more likely to display upregulations of ACE2 receptors and cytokine storm overload, which exacerbates hepatic impairment, potentially increasing the death rate. Moreover, it is expected that the aging population develops a higher degree of hepatic fibrosis in association with other comorbid conditions that are likely to influence the course of COVID-19. Therefore, this research was developed to describe the differences in liver test parameters in elderly individuals with COVID-19 in relation to other inflammatory markers and outcomes. This current observational single-center research followed a case-control design of elderly patients hospitalized for SARS-CoV-2 infection. The research was conducted at a tertiary emergency hospital in western Romania during a two-year period. There were 632 patients included in the analysis that were split into two equal groups matched 1:1 based on gender and body mass index. Three hundred sixteen patients made the group of cases with COVID-19 patients older than 65 years, while the other half were the 316 patient controls with COVID-19 that were younger than 65 years old. Disease outcomes showed a higher prevalence of ICU admissions (22.8% vs. 12.7%, p-value < 0.001) and in-hospital mortality (17.1% vs. 8.9%, p-value = 0.002) in the group of cases. Specific and non-specific liver biomarkers were identified as risk factors for mortality in the elderly, such as ALP (OR = 1.26), LDH (OR = 1.68), AST (OR = 1.98), and ALT (OR = 2.34). Similarly, patients with APRI and NFS scores higher than 1.5 were, respectively, 2.69 times and, 3.05 times more likely to die from COVID-19, and patients with FIB-4 scores higher than 3.25 were 3.13 times more likely to die during hospitalization for SARS-CoV-2 infection. Our research indicates that abnormally increased liver biomarkers and high liver fibrosis scores are related to a worse prognosis in SARS-CoV-2 infected individuals.

The Impact of the COVID-19 Pandemic on Inpatient Admissions for Psychotic and Affective Disorders: The Experience of a Large Psychiatric Teaching Hospital in Romania

The COVID-19 pandemic resulted in a global sanitary crisis and, in addition, elicited serious mental health consequences. The utilization of psychiatric hospital-based services acts as an indicator of public mental health. Therefore, this research sought to investigate differences in the numbers and characteristics of inpatient admissions for psychotic and affective disorders at the largest Romanian psychiatric hospital between the period of lockdown (16 March−15 May 2020) and another three corresponding periods: the same year in the pre-lockdown period (16 January−15 March 2020), the immediate post-lockdown period (16 May−15 July 2020), and two years later (16 March−15 May 2022). A retrospective analysis was performed. The study included a total of 6604 patients. Inpatient admissions decreased during lockdown in comparison with the pre-lockdown period and immediate post-lockdown period for psychotic disorders (p < 0.001 and p < 0.001, respectively) and affective disorders (p < 0.001 and p < 0.001, respectively). For both psychotic and affective disorders, a decrease in the age of the patients admitted during lockdown, as compared with the pre-lockdown period (p < 0.05 and p < 0.001, respectively), was observed. The length of the hospital stay for affective disorders was higher immediately post-lockdown in comparison with the lockdown period (p < 0.001). Collectively, the present findings provide a glimpse of the immediate and long-term consequences of the COVID-19 pandemic and lockdown measures on patients’ access to mental healthcare in the form of hospitalization, and these findings could provide the basis for the development of a different approach to times of crisis.

The Impact of SARS-CoV-2 Pandemic on Patients Undergoing Radiation Therapy for Advanced Cervical Cancer at a Romanian Academic Center: A Four-Year Retrospective Analysis

Background and Objectives: Throughout the COVID-19 pandemic, health systems worldwide adapted to support COVID-19 patients while continuing to provide assistance to patients with other potentially fatal illnesses. While patients with cancer may be at an elevated risk of severe COVID-19-related complications, their oncologic therapies generally cannot be postponed indefinitely without a negative effect on outcomes. Taking this into account, a thorough examination of the therapy management of various cancers is necessary, such as cervical cancer. Therefore, we aimed to develop a retrospective cohort study to measure the impact of the COVID-19 pandemic on the delivery of cancer care services for women diagnosed with cervical cancer staged IB2-IVA, necessitating chemo- and radiotherapy in Romania, as well as determine the difference in cervical cancer staging between the pandemic and pre-pandemic period. Materials and Methods: Using a multicentric hospital database, we designed a retrospective study to compare the last 24 months of the pre-pandemic period to the first 24 months of the SARS-CoV-2 pandemic to evaluate the variation in the proportion of women diagnosed with cervical cancer and the percentage of inoperable cases requiring chemotherapy and radiotherapy, as well as to detail their clinical presentation and other findings. Results: We observed that the likelihood of cervical cancer patients requiring radiation therapy at a later stage than before the pandemic increased by about 20% during the COVID-19 pandemic. Patients at an advanced FIGO stage of cervical cancer had a 3.39 higher likelihood of disease progression after radiotherapy (CI [2.06−4.21], p-value < 0.001), followed by tumor size at diagnosis with a hazard ratio (HR) of 3.12 (CI [2.24−4.00], p-value < 0.001). The factors related to the COVID-19 pandemic, postponed treatment and missed appointments, were also identified as significant risk factors for cervical cancer progression (HR = 2.51 and HR = 2.24, respectively). Conclusions We predict that there will be a considerable rise in cervical cancer cases over the next several years based on existing data and that expanding screening and treatment capacity will attenuate this with a minimal increase in morbidity and fatality.

The Impact of Hyper-Acute Inflammatory Response on Stress Adaptation and Psychological Symptoms of COVID-19 Patients

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection induces a significant inflammatory response that are amplified by persistent stress. The pathophysiology of mental illnesses is explored in terms of inflammatory processes. Thus, anxious, depressed, or psychotic episodes may occur as a result of metabolic and immunological imbalances, as a direct result of their effect on the central nervous system, or as a side effect of the COVID-19 medication protocols. As such, the primary objective of this research is to establish if the psychological profiles of COVID-19 patients change substantially according to illness severity. The secondary objective is to determine if particular biological inflammatory indicators are associated with anxiety, sadness, psychoticism, and paranoid ideation. A cross-sectional study was performed on 90 hospitalized patients admitted during a 3-month period in the COVID-19 unit. All patients received the COPE-60 and SCL-90R questionnaires. Clinical and paraclinical data were collected and the information was classified according to the severity of COVID-19.The hyper-acute inflammation encountered in patients with severe COVID-19 infection characterized 80.0% of patients using disengagement coping methods, significantly more than patients with mild or moderate SARS-CoV-2 infection severity (p-value = 0.012), respectively, 73.3% severe COVID-19 patients engaging in emotion-focused coping strategies based on the COPE-60 scale (p-value = 0.037). Additionally, it was determined that negative coping mechanisms (disengagement) and emotion-focused methods are independent risk factors for developing psychoticism symptoms following acute SARS-CoV-2 infection, based on the SCL-90 questionnaire (OR = 2.07; CI = 1.44–3.01), respectively (OR = 2.92; CI = 1.44–3.01). Elevated white blood cells and monocytes and inflammatory markers, such as fibrinogen, procalcitonin, IL-6, and D-dimers, were also identified as risk factors for psychoticism symptoms in multivariate analysis. It is particularly important to consider the constant mental-state evaluation in patients with severe COVID-19 that might benefit from early intervention before psychotic symptoms onset.

Analysis of the Coping Strategies of Primary Health Care Professionals: Cross-Sectional Study in a Large Brazilian Municipality

Objective: To analyze the coping strategies used by primary healthcare (PHC) professionals. Methods: A cross-sectional, descriptive-analytical study realized with professionals working in primary healthcare units in São José do Rio Preto, a large city in the interior of São Paulo, Brazil. For data collection, we used an instrument developed by the researchers containing sociodemographic and professional variables, as well as the Problem Coping Modes Scale (EMEP). Results: We evaluated 333 PHC professionals. A difference was observed between the scores of the four coping strategies (p < 0.001), with the highest score for the problem-focused strategy (3.8) and the lowest score for the emotion-focused strategy (2.4). Physicians had the lowest scores in coping strategies focused on religious practices/fantastical thinking (p < 0.001) and pursuit of social support (p = 0.045), while community health agents had the highest scores in these coping strategies. Conclusions: Professionals working in PHC have different coping strategies for the problems and stressful situations experienced in the work environment. These strategies can involve more positive attitudes focused on confrontation and problem solving, and on emotional responses that involve attitudes of avoidance and denial of the problem.

Analysis of Deaths and Favorable Developments of Patients with SARS-CoV-2 Hospitalized in the Largest Hospital for Infectious Diseases and Pneumo-Phthisiology in the West of the Country

Purpose

Romania is one of the European countries that has been hit the hardest by the severe acute respiratory syndrome caused by the new coronavirus SARS-CoV-2, with over 1.91 million reported cases and over 59,257 deaths. The aim of this study was to identify the main predictors of death in hospitalized patients.

Patients and Methods

In the period from 1 March 2020 to 30 June 2021, an observational, retrospective, randomized, case-control study was conducted, which included a sample of 139 patients who died in hospital and another sample of 275 patients who had been discharged in an improved or healed condition. Confirmation of COVID-19 cases was performed by RT-PCR from nasopharyngeal and oropharyngeal exudates. Statistical data were analyzed by logistic regression, Cox regression and a comparison of survival curves by the log-rank (Mantel-Cox) test.

Results

The most powerful logistic regression model identified the following independent predictors of death: history of coagulopathy HR = 30.73 [1.94–487.09], p = 0.015; high percentage of neutrophils HR = 1.09 [1.01–1.19], p = 0.027; and decreased blood-oxygenation HR = 53881.97 [1762.24–1647489.44], p < 0.001. Cox regression identified the following factors that influenced the evolution of cases: history of coagulopathy HR = 2.44 [1.38–4.35], p = 0.000; O₂ saturation HR = 0.98 [0.96–0.99], p = 0.043; serum creatinine HR = 1.23 [1.08–1.39], p = 0.001; dyspnea on admission HR = 2.99 [1.42–6.30], p = 0.004; hospitalization directly in the ICU HR = 3.803 [1.97–7.33], p < 0.001; heart damage HR = 16.76 [1.49–188.56], p = 0.022; and decreased blood-oxygenation HR = 35.12 [5.92–208.19], p < 0.001.

Conclusion

Knowledge of the predictors of death in hospitalized patients allows for the future optimization of triage and therapeutic case management for COVID-19.