Search Results (110)

The COVID-19 pandemic has significantly increased the incidence of post-infection cardiovascular events, particularly myocardial infarction, in individuals over 40. While the underlying mechanisms remain elusive, this study employs a hybrid machine learning approach to analyze epidemiological data in assessing 13 key heart attack risk factors and their susceptibility. Based on a unique dataset that combines demographic, biochemical, ECG, and thallium stress tests, this study aims to design, develop, and deploy a clinical decision support system. Assimilating outcomes from five clustering techniques applied to the ‘Kaggle heart attack risk’ dataset, the study categorizes distinct subpopulations against varying risk profiles and then divides the population into ‘at-risk’ (AR) and ‘not-at-risk’ (NAR) groups using clustering algorithms. The GMM algorithm outperforms its competitors (with clustering accuracy and Silhouette coefficient scores of 84.24% and 0.2623, respectively). Subsequent analyses, employing Pearson correlation and linear regression as descriptors, reveal a strong association between the likelihood of experiencing a heart attack and the 13 risk factors studied, and these are statistically significant (p < 0.05). Our findings provide valuable insights into the development of targeted risk stratification and preventive strategies for high-risk individuals based on heart attack risk scores. The aggravated risk for postmenopausal patients indicates compromised individual risk factors due to estrogen depletion that may be further compromised by extraneous stress impacts, like anxiety and fear, aspects that have traditionally eluded data modeling predictions. The model can be repurposed to analyze the impact of COVID-19 on vulnerable populations. Full article

A cross-sectional survey conducted between July and September 2020 and August and September 2021 estimated the prevalence and predictors of common mental disorders (CMDs) and post-traumatic stress disorder (PTSD) among healthcare workers (HCWs) at an infectious disease referral center during the COVID-19 pandemic. CMDs were assessed using the General Health Questionnaire (GHQ-12), and PTSD using the Impact of Event Scale-Revised (IES-R). Multivariate logistic regressions identified predictors of CMD and PTSD. The study included 371 HCWs in 2020 and 167 in 2021. The CMD prevalence was 34.3% (95% confidence interval (CI): 29.5–39.4) in 2020 and 30.5% (95% CI: 23.7–38.1) in 2021. The PTSD prevalence was 25.4% (95% CI: 21.0–30.2) in 2020 and 32.7% (95% CI: 25.6–40.5) in 2021. Factors increasing CMD odds included lower education (adjusted odds ratio (AOR) = 3.71, 95% CI: 1.60–8.61), lack of physical activity (AOR = 2.23, 95% CI: 1.33–3.73), and experiencing COVID-19 symptoms (AOR = 1.64, 95% CI: 1.02–2.64) in 2020; chronic diseases (AOR = 3.14, 95% CI: 1.34–7.35) and SARS-CoV-2 testing (AOR = 3.39, 95% CI: 1.13–10.17) raised CMD odds in 2021. Frontline HCWs had lower CMD odds in 2020 (AOR = 0.60, 95% CI: 0.36–1.00) and 2021 (AOR = 0.33, 95% CI: 0.14–0.75). PTSD was associated with having COVID-19 symptoms (AOR = 2.06, 95% CI: 1.23–3.45), living with high-risk individuals (AOR = 1.75, 95% CI: 1.03–2.95), and losing loved ones (AOR = 1.86, 95% CI: 1.09–3.17) in 2020. Chronic diseases increased PTSD odds in 2020 (AOR = 2.20, 95% CI: 1.25–3.86) and 2021 (AOR = 2.30, 95% CI: 1.03–5.13), while age decreased them in 2020 (AOR = 0.95, 95% CI: 0.93–0.98) and 2021 (AOR = 0.95, 95% CI: 0.91–0.99). Younger HCWs with chronic conditions living with high-risk individuals were particularly affected. These findings highlight the urgent need for targeted emotional support and stress management programs for HCWs. Full article

(1) Background: This study evaluated whether physical activity and sports serve as a protective factor in mitigating COVID-19 pandemic long-term consequences. (2) Methods: A survey of 1702 participants (8–18 years) used the Impact of Event Scale (IES), Generalized Anxiety Disorder Scale (GAD-7), and Center for Epidemiological Studies Depression Scale for Children (CES-DC). Participants were categorized based on their engagement in sports, cultural activities, or sedentary behaviors. Statistical analysis included non-parametric tests, CHAID models, and clustering. (3) Results: In total, 65.5% of participants experienced minimal to mild anxiety, and 34.5% reported moderate to severe anxiety. The main predictor of depression is the sample age, followed by the training experience. Depressive symptoms were identified in 71.3% of participants (75.7% adolescents; 64% children). Adolescents with longer training experience (67.6%) showed lower depression compared to those with shorter experience (77.2%). For post-traumatic stress, 38% of children and 46% of adolescents exceeded cut-off scores for significant symptoms, with age and training level identified as key predictors. Among children, sport experience with low weekly frequency was associated with the lowest depression rates (59.5%). (4) Conclusions: Four years after the pandemic, a high percentage of anxiety and depression disorders is observed in the youth population, particularly among adolescents. Sports appear to slightly alleviate this serious condition. Full article

The COVID-19 pandemic significantly impacted the lives of families worldwide. Findings suggest a substantial impact of the COVID-19 pandemic on maternal mental health. Yet, much less is known about the impact of COVID-19 on paternal mental health. This study describes depression and anxiety and risk and protective factors among fathers of young children largely residing in Canada during the COVID-19 pandemic. Fathers (N = 70) of children 0 to 8 years old self-reported depression (EPDS, CESD, CESD-R) and anxiety (PASS, GAD-7) symptoms, while mothers (N = 236) provided reports of paternal depressive symptoms using the EPDS-P. Fathers evidenced clinically significant depression (37.1%) and anxiety (22.9%). Linear regression models with significant bivariate correlates indicated that depressive symptoms were associated with a mental health history and experiencing recent stressful events in the past month, while anxiety symptoms were related to mental health history over and above other correlates. Mother-reported paternal depression was prevalent (61.9%) and associated with lower mother-reported marital quality and higher maternal depressive symptoms. Of the fathers reporting clinically significant mental health concerns, less than one-third reported accessing mental health services. Paternal depression and anxiety symptoms were elevated during the pandemic, when compared to pre-pandemic comparisons. The risk and protective factors for paternal depression and anxiety included mental health history, recent stressful events, maternal marital quality, and maternal depressive symptoms. Longitudinal studies evaluating the persistent impact of the COVID-19 pandemic on paternal mental health are needed to inform continued efforts to repair the pandemic’s impact on family wellbeing. Full article

Tourism still represents a means of generating revenues in the coastal areas in the Mexican Caribbean, despite the growing concern about the social and environmental impacts. The Nichupte Lagoon System (NLS), the most representative lagoon of Quintana Roo State for being in the middle of Cancun’s hotel development, has experienced a continuous drop-off in its water quality due to several factors, including dredging and wastewater discharges from different anthropogenic activities, which modify the flux of nutrients, increase the number of pathogenic microorganisms, and promote physicochemical changes in this ecosystem. Three sampling campaigns (2018, 2019, and 2020) were carried out in the NLS in August, which is the month of greatest tourist occupancy. To evidence the presence of anthropogenic wastewater in the NLS, the caffeine tracer was used, and to determine the water quality, 43 sampling stations were monitored for “in situ” physicochemical parameters (salinity and dissolved oxygen), and water samples were collected for the quantification of nutrients (NO₂⁻ + NO₃⁻, NH₄⁺, SRP and SRSi) and chlorophyll-a (Chl-a). For data analysis, the lagoon was subdivided into five zones (ZI, ZII, ZIII, ZIV, and ZV). Caffeine spatial and time variation evidence (1) the presence of anthropogenic wastewater in all areas of the NLS probably resulting from the tourist activity, and (2) wastewater presence is directly influenced by the coupling of the hydrological changes driven by anomalous rain events and the number of tourists. This same tendency was observed for nutrients that increased from 2018 to 2019 and the trophic state changed from oligotrophic to hypertrophic in all areas, as a result of previous anomalous precipitations in 2018, followed by normal precipitations in 2019. From 2019 to 2020, the nutrients decreased due to the drop in tourism due to COVID-19, promoting fewer nutrients in the lagoon, but, also coupled with an anomalous precipitation event (Cristobal storm), resulted in a dilution phenomenon and an oligotrophic state. The cluster analysis indicated that the least similar zones in the lagoon were the ZI and ZV due to their geomorphology that restricts the connection with the rest of the system. Principal component analysis revealed that wastewater presence evidenced by the caffeine tracer had a positive association with dissolved oxygen and chlorophyll-a, indicating that the arrival of nutrients from wastewater amongst other sources promotes algal growth, but this could develop into an eutrophic or hypertrophic state under normal precipitation conditions as seen in 2019. This study shows the relevance of monitoring in time of vulnerable karstic systems that could be affected by anthropogenic contamination from wastewater inputs, stressing the urgent need for efficient wastewater treatment in the area. The tourist industry in coastal karstic lagoons such as the NLS must have a Wastewater Treatment Program as a compensation measure for the anthropic pressure that is negatively changing the water quality of this highly relevant socio-environmental system. Full article

There is limited information regarding factors related to education workers’ responses to traumatic stress during the COVID-19 pandemic. The study goal was to determine whether personal factors, behaviours that mitigate viral spread, and work-related factors were associated with post-traumatic symptoms. This observational study, embedded within a cohort study, recruited Ontario education workers from February 2021 to June 2023. Exposure data were collected at enrollment and updated annually. Participants completed the Impact of Event Scale (IES) at withdrawal/study completion. Modified Poisson regression was used to build hierarchical models of dichotomized IES scores (≥26: moderate/severe post-traumatic symptoms). Of the 1518 education workers who submitted an IES between September 2022 and December 2023, the incidence rate ratio of IES scores ≥26 was significantly higher among participants who usually/always wore a mask at work (1.48; 95% confidence interval 1.23, 1.79), usually/always practiced physical distancing (1.31; 1.06, 1.62), lived in larger households (1.06; 1.01, 1.12), and reported poor/fair/good health (1.27; 1.11, 1.46). However, models accounted for little of the variance in IES scores, suggesting the need for future studies to collect data on other factors associated with the development of PTSD, such as pre-existing mental health challenges. Early identification of those experiencing traumatic stress and the implementation of stress reduction strategies are needed to ensure the ongoing health of education workers. Full article

Mounting evidence supports the key role of the disrupted integrity of the blood-brain barrier (BBB) in stress- and inflammation-associated depression. We assumed that variations in genes regulating the expression and coding proteins constructing and maintaining this barrier, along with those involved in inflammation, have a predisposing or protecting role in the development of depressive symptoms after experiencing severe stress. To prove this, genome-by-environment (GxE) interaction analyses were conducted on 6.26 M SNPS covering 19,296 genes on PHQ9 depression in interaction with adult traumatic events scores in the UK Biobank (n = 109,360) in a hypothesis-free setup. Among the 63 genes that were significant in stress-connected depression, 17 were associated with BBB, 23 with inflammatory processes, and 4 with neuroticism. Compared to all genes, the enrichment of significant BBB-associated hits was 3.82, and those of inflammation-associated hits were 1.59. Besides some sex differences, CSMD1 and PTPRD, encoding proteins taking part in BBB integrity, were the most significant hits in both males and females. In conclusion, the identified risk genes and their encoded proteins could provide biomarkers or new drug targets to promote BBB integrity and thus prevent or decrease stress- and inflammation-associated depressive symptoms, and possibly infection, e.g., COVID-19-associated mental and neurological symptoms. Full article

Low-grade endotoxemia by lipopolysaccharide (LPS) has been detected in COVID-19 and could favor thrombosis via eliciting a pro-inflammatory and pro-coagulant state. The aim of this study was to analyze the mechanism accounting for low-grade endotoxemia and its relationship with oxidative stress and clotting activation thrombosis in COVID-19. We measured serum levels of sNOX2-dp, zonulin, LPS, D-dimer, and albumin in 175 patients with COVID-19, classified as having or not acute respiratory distress syndrome (ARDS), and 50 healthy subjects. Baseline levels of sNOX2-dp, LPS, zonulin, D-dimer, albumin, and hs-CRP were significantly higher in COVID-19 compared to controls. In COVID-19 patients with ARDS, sNOX2-dp, LPS, zonulin, D-dimer, and hs-CRP were significantly higher compared to COVID-19 patients without ARDS. Conversely, concentration of albumin was lower in patients with ARDS compared with those without ARDS and inversely associated with LPS. In the COVID-19 cohort, the number of patients with ARDS progressively increased according to sNOX2-dp and LPS quartiles; a significant correlation between LPS and sNOX2-dp and LPS and D-dimer was detected in COVID-19. In a multivariable logistic regression model, LPS/albumin levels and D-dimer predicted thrombotic events. In COVID-19 patients, LPS is significantly associated with a hypercoagulation state and disease severity. In vitro, LPS can increase endothelial oxidative stress and coagulation biomarkers that were reduced by the treatment with albumin. In conclusion, impaired gut barrier permeability, increased NOX2 activation, and low serum albumin may account for low-grade endotoxemia and may be implicated in thrombotic events in COVID-19. Full article

Oxidative stress (OS) occurs from excessive reactive oxygen species or a deficiency of antioxidants—primarily endogenous glutathione (GSH). There are many illnesses, from acute and post-COVID-19, diabetes, myocardial infarction to Alzheimer’s disease, that are associated with OS. These dissimilar illnesses are, in order, viral infections, metabolic disorders, ischemic events, and neurodegenerative disorders. Evidence is presented that in many illnesses, (1) OS is an early initiator and significant promotor of their progressive pathophysiologic processes, (2) early reduction of OS may prevent later serious and irreversible complications, (3) GSH deficiency is associated with OS, (4) GSH can likely reduce OS and restore adaptive physiology, (5) effective administration of GSH can be accomplished with a novel nano-product, the GSH/cyclodextrin (GC) complex. OS is an overlooked pathological process of many illnesses. Significantly, with the GSH/cyclodextrin (GC) complex, therapeutic administration of GSH is now available to reduce OS. Finally, rigorous prospective studies are needed to confirm the efficacy of this therapeutic approach. Full article

The COVID-19 pandemic has been one of the most stressful events in recent times across the world. The long-term effect of these experiences raises several concerns, including the development of post-traumatic stress symptomatology. However, little is known about the psychological processes that mediate this association. The aim of this study was to explore the association of emotional exhaustion and anxiety in post-traumatic stress symptomatology, and the mediating role of resilience and psychological well-being in university students. A total of 526 university students of both sexes participated in this study, and they were aged between 17 and 62 years old. Symptoms of anxiety and emotional exhaustion were significantly higher in females, in contrast, males showed on average more resilience and psychological well-being. Additionally, participants with COVID-19 infection had higher levels of emotional exhaustion, anxiety, and PTSD. The results indicated that the variables were correlated with each other (p < 0.001). A conceptual model was confirmed that describes anxiety and emotional exhaustion as predictors, post-traumatic stress symptomatology as an outcome variable, and resilience and psychological well-being as mediators. Resilience and psychological well-being can be important protective factors for adaptive responses in stressful situations. The findings obtained in this study will provide a theoretical basis for designing targeted interventions to improve psychological health, whether for crisis intervention, the process of adapting to higher education, or for recovery plans from psychological trauma. Full article

Introduction: COVID-19, caused by the SARS-CoV-2 virus, has been associated with oligosymptomatic cases or severe acute respiratory syndrome, with multiple organ failure and death. One of the most significant events for clinical outcomes is Acute Kidney Injury (AKI). It is known that AKI in COVID-19 is multifactorial, and the main mechanisms are cytokine storm, metabolic stress, use of nephrotoxic drugs, rhabdomyolysis, viral tropism to kidney tissues, and multiple organ failure. However, little is known about the impact of AKI clinical presentation and pathophysiological mechanisms on the outcome of patients affected by COVID-19. Objectives: To identify AKI clinical presentation and etiology, also known as phenotypes, and pathophysiological mechanisms, also known as subphenotypes, in patients affected by COVID-19 and associate them with death. This cohort and retrospective study evaluate the medical records of patients with SARS-CoV-2 infection admitted to a tertiary public hospital from 1 June 2020, to 31 July 2021, from admission to clinical outcome (hospital discharge or death). Clinical and laboratory data were analyzed during the hospitalization. Renal function was estimated by urine output and serum creatinine; therefore, the diagnosis and AKI classification were based on the 2012 KDIGO criteria. The occurrence of AKI was the inclusion criterion. According to clinical and laboratory presentations, we recognized two phenotypes of AKI (the direct and indirect impact of SARS-CoV-2 on the kidney) and several pathophysiological mechanisms. Subphenotypes of the direct impact of SARS-CoV-2 on kidneys were associated with Kidney Viral Tropism, Cytokine Storm, COVID-19-Related Multiple Organ Failure, and Mixed (more than one mechanism associated with COVID-19). Subphenotypes of indirect impact of SARS-CoV-2 on kidney phenotypes were Ischemic, Nephrotoxic due to rhabdomyolysis, and Septic. Univariate and multivariate analyses were performed to identify risk factors associated with death. Result: In total, 372 patients were included; 55.6% were male, 82.3% were Caucasians, and the mean age was 61.4 years. The majority of patients were admitted to the ICU (88.2%) and required mechanical ventilation (86.3%). AKI was predominantly KDIGO 3 (65.6%). When classifying our patients’ AKI in two kidney phenotypes based on their clinical presentation, the direct impact of the SARS-CoV-2 phenotype was predominant (71,5%) and associated with higher mortality (83.8 vs. 46.3%, p = 0.001). Among the AKI pathophysiological mechanisms, Mixed—synergism of viral mechanisms—was the most prevalent (23.4%), followed by Viral Tropism (19.9%), Multiple Organ Failure—MOF (18%), Septic (15.6%), Ischemic (12.9%), and Cytokine Storm (10.2%). Mortality was high (73.1%). Logistic regression identified APACHE II, ATN-ISS, and the direct impact of SARS-CoV-2 on the kidney as factors associated with death, while ischemic AKI was associated with lower mortality. Conclusions: We can conclude that APACHE II and ATN-ISS scoring are clinical predictions of hospital mortality in COVID patients with AKI, as well as AKI etiology involving the direct impact of SARS-CoV-2 on the kidney, while ischemic pathophysiological mechanisms of AKI are associated with lower mortality. Full article

Background and objectives: Although previous research has found a high prevalence of anxiety during the COVID-19 pandemic among healthcare workers, longitudinal studies on post-pandemic anxiety and predictor variables have been less abundant. To examine the evolution of anxiety in healthcare workers from the beginning of the pandemic until one and a half years later, analyzing the influence of occupational and psychosocial variables, as well as their possible predictors. Materials and Methods: This was a prospective longitudinal design with three periods of data collection: (1) between 5 May and 21 June 2020, (2) six months after the end of the state of alarm (January–March 2021), and (3) one year after this second assessment (April–July 2022), in which generalized anxiety (GAD-7) was evaluated, as well as occupational and psycho-emotional variables (i.e., social support, self-efficacy, resilience, and cognitive fusion) in healthcare workers in direct contact with COVID-19 patients in Spain. Results: A high prevalence of anxiety was found, with a clear decrease over time. Associations were found between anxiety and certain sociodemographic and work variables (i.e., years of experience, p = 0.046; COVID-19 symptoms, p = 0.001; availability of PPE, p = 0.002; workload, p < 0.001; family contagion concern, p = 0.009). Anxiety maintained negative relationships with social support (p < 0.001), self-efficacy (p < 0.001), and resilience (p < 0.001) and positive associations with cognitive fusion (p < 0.001). Cognitive fusion seemed to be a clear predictor of anxiety. Conclusions: Our findings suggest that social support, self-efficacy, and resilience act as buffers for anxiety, whilst cognitive fusion was found to be a clear risk factor for anxiety. It is important to emphasize the risk role played by cognitive fusion on HCWs as a clear risk factor for stressful work events. The findings emphasize the need to implement specific interventions to promote the mental well-being of healthcare workers, particularly in crisis contexts such as the COVID-19 pandemic. Full article

This research on sleep disturbances emerged during the COVID-19 pandemic. Our study investigated the association between self-reported sleep disturbances among teleworkers and the preventive measures employers took to improve their working environment. Answers obtained via a web survey gathered from 1086 teleworkers (517 in the spring of 2021 and 569 in the spring of 2022) were analysed. The odds of self-reported sleep disturbances were significantly higher for all preventive measures in the group of respondents reporting a lack of a particular measure. The highest odds ratios were observed for the statement “My employer identified conditions where I am teleworking” (adjusted OR = 2.98, 95% CI 2.10–4.23) and “Online team-building events were organised” (adjusted OR = 2.85, 95% CI 1.88–4.35). The results of our study have revealed that workplace interventions that serve as a mediator for sleep disorders, even if they are not directly targeted at managing sleep disturbances or stress, can reduce the number of teleworkers reporting sleep disturbances. According to our knowledge, this is the first study reporting the effectiveness of employer interventions that help teleworkers manage their sleep disturbances. Full article

The COVID-19 pandemic had a significant impact on the general quality of life (GQOL) of a large number of individuals, including those in the academic environment. This study investigated GQOL in a sample of 613 Romanian medicine students (81.57% were female; mean age = 21.40 ± 1.749 years) in relation to their Big Five personality characteristics, Perceived Stress and Fear of COVID-19. The study was conducted between June 2020 and March 2022. These variables were investigated with the Big Five Inventory-2: Extra-Short Form, the Fear of COVID-19 Scale (FCV-19S), the Perceived Stress Scale-10 and the Satisfaction with Life Scale (SWLS). Statistical analysis included hierarchical linear regression and t-tests. The results indicated a significant direct relationship between GQOL and the personality traits of Conscientiousness, Extraversion and Agreeableness. However, a significant inverse relationship was observed between GQOL and Perceived Stress and Neuroticism. Fear of COVID-19 was significantly higher in women, while no other socio-demographic variables were associated with GQOL. A total of 61.7% of the studied population returned to their original residency during the pandemic years. These results could be important for better understanding the vulnerability to significant epidemiological events in academic populations and for planning adequate preventive or interventional measures. Full article

Background: Premature birth remains a public health problem worldwide, involving a broader context and a multidisciplinary team aimed at combating this phenomenon as much as possible. The consumption of addictive substances by women who are pregnant can occur in different social contexts and at different stages of their lives, which modulate its extent. Obstetricians and anesthetists should consider the anesthetic maternal risks that may arise due to these addictive behaviors. The maternal anesthetic risk is higher in women who are pregnant with a medium-level of education, imbalanced nutrition, stress associated with physical or mental activity, affected sleep hygiene, and failed marriages. Objectives: The objectives of the study refer to analyzing the impact of exogenous factors and the anesthetic risk on premature birth for women who were pregnant during the pandemic period and in women who were pregnant without COVID-19 infection. The authors studied a significant sample of 3588 women who were pregnant without COVID-19 infection, among whom 3291 gave birth at term and 297 gave birth prematurely. Methods: The methods analyzed consist of studying the specialized literature regarding the impact of exogenous factors and parturient’s anesthetic risk on premature birth and identifying the regional risk profile of women who are pregnant in the southeast region of Romania compared to that identified in the specialized literature. In the analytical methods, we used a linear regression to study the incidence of exogenous risk factors on anesthetic risk in women who were pregnant with premature births compared to those with full-term births. Results: The results confirm the significant impact of exogenous factors on anesthetic risk and the significant impact of anesthetic risk on premature births. The novelty of the study lies in highlighting the modification of the regional exogenous risk profile during the pandemic period in southeast Romania due to unfavorable socio-economic causes and the translation of grade I and II prematurity events to higher frequencies with an increased level of maternal anesthetic risk. Conclusions: The study findings show that the anesthetic risk is maximized in parturients with a middle school education. Additionally, the anesthetic risk of patients who are pregnant increases with the intensification of smoking adherence and its maintenance throughout the pregnancy at the same intensity. Our study aims to provide a basis for the diversification and development of community intervention programs in the post-COVID-19 era, considering the reshaping of social models and the repositioning of social principles and values. Obstetricians and anesthetists must know and promote family values to harmonize the lives of family members and provide a better life for the mother and child. Full article