Risk Factors for Relapse in People with Severe Mental Disorders during the COVID-19 Pandemic: A Multicenter Retrospective Study

Background: Evidence suggests that different variables associated with the COVID-19 pandemic may increase the risk of relapse in people with Severe Mental Disorders (SMDs). However, no studies have yet looked closely at the different risk factors involved to determine their influence on the worsening of these patients’ illnesses. Objective: To analyze which variables related to the COVID-19 pandemic have increased the risk of relapse in patients with SMDs. Method: A multicenter retrospective cohort study in which data were collected from 270 patients with mental disorders who had been under follow-up in day hospitals during the year 2020. Results: The proportion of full mental health inpatient admissions was significantly higher in those who lost their employment (40.7% vs. 18.1%; p = 0.01), in those who were not receiving psychotherapy interventions (33.9% vs. 16.6%; p = 0.006), and in those who were not receiving occupational therapy (25.7% vs. 13.6%: p = 0.013). Significant associations were detected between urgent mental health consultations, the number of COVID-19 symptoms (B = 0.274; p = 0.02), and the low-income group (1.2424 vs. 0.4583; p = 0.018). Conclusions: COVID-19 symptoms and certain consequences of the pandemic, such as loss of employment, economic hardship, and loss of interventions, have brought about clinical worsening in people with SMDs. Knowledge of these factors is important for health-related decision-making in future outbreaks or pandemics.

Epidemiological trends in tuberculosis in Ukraine at the beginning of the COVID­-19 pandemic

Objective — to examine the tendencies of the epidemiological situation on tuberculosis in Ukraine at the beginning of the COVID-19 pandemic in 2020. Materials and methods. The analysis of the data of official statistics in 2015—2020, a survey of 157 medical experts and a telephone questionnaire survey of 69 residents of the Volyn region. Results and discussion. It was established that the disease of COVID-19 has found its imprint on the epidemiological situation of tuberculosis and on the functioning of the TB care service. In 2020, the rate of decline in the incidence of pulmonary and extrapulmonary tuberculosis was significantly more intensive than in previous years. However, the incidence of tuberculosis among contacts with bacterial excretion in tuberculosis foci increased 1.85 times in each year. The frequency of tuberculosis recurrences is steadily decreasing.The prevalence and mortality from all forms of active tuberculosis among the entire population of Ukraine has a tendency similar to a decrease in morbidity.The effectiveness of treatment of patients of all categories is proportional to the severity of the tuberculosis process, but still insufficient. Mortality in TB care institutions increased in the previous year against the decrease of this indicator in previous years. Against the background of the inaccessibility of the population to TB care, day hospitals are underused, and the sanatorium network needs to be reorganized. The surgical method of treatment of patients is extremely insufficiently realized. Conclusions. The dispensary contingent of TB care institutions is decreasing every year. There is a reduction in the infrastructure of the TB care service, and in each year, the largest reduction was in the bed stock of TB care institutions and sanatoriums, as well as a decrease in the number of TB doctors.

Vaccination Coverage in Cancer Outpatients: An Interventional Multicenter Before-and-After Study

Purpose: Despite widely disseminated guidelines, pneumococcal and influenza vaccination coverage (VC) remains insufficient in cancer patients receiving chemotherapy. We aimed to perform an interventional study to evaluate and improve VC in cancer patients treated in the medical oncology departments of three North-of-France hospitals. Methods: A standardized questionnaire assessed VC in adult cancer patients receiving anticancer treatment in three day hospitals from December 2–7, 2019. Subsequently (January 2020), we organized educational training sessions for medical staff in each hospital to discuss the current vaccination guidelines. To assess the impact of training on pneumococcal and influenza VC, we re-administered the same questionnaire in March 2020. Because there were no specific guidelines on Diphtheria-Tetanus-Pertussis (DTP) vaccination and no improvement was expected, DTP VC acted as an internal control. Results: In total, 272 patients were enrolled in the “before study” in all three hospitals; 156 patients were enrolled in the “after study” in only two hospitals, as data collection in the third was impossible because of COVID-19 pandemic national containment. The predictors were age for DTP VC, treatment center for pneumococcal VC, and age, sex, and tumor histology (adenocarcinoma vs. others) for influenza VC. Influenza VC was significantly improved post-intervention (42.6% vs. 55.1%, p=0.0169), especially in fragile patients, whereas pneumococcal VC was not (11.8% vs. 15.4%, p=0.3575).Conclusion:As expected, VC was very low in cancer patients, consistent with the literature. The intervention’s impact was limited for pneumococcal VC. The increased influenza VC may reflect the result of the national influenza vaccination campaign.

The Increased Burden of Sickle Cell Disease in Italy: Findings from the Greatalys (Generating Real world Evidence Across ITALy In SCD) Study

Introduction. Sickle Cell Disease (SCD) is an evolving public health issue with a significant impact on patient survival, quality of life and costs for health systems also in Italy, a multiethnic country where epidemiology has deeply changed. We present final results from the GREATalyS study that aimed to better understand the SCD burden in Italy in terms of prevalence, clinical features, treatments and resource consumption in the clinical practice setting. Methods. Retrospective observational analysis of administrative databases for health resources consumption from a representative sample of Region/Local Health Units in Italy, covering approximately 15.3 million inhabitants. All patients with ≥1hospitalization (outside Emergency Room, ER) with main or secondary discharge diagnosis of SCD (with/without crisis) identified by ICD-9-CM codes were included between January-2010 to December-2017 (up to December 2018 for epidemiologic analysis). Prevalence of SCD in 2018 was projected to the Italian population. Patients were followed-up from the first diagnosis identified within the inclusion period (index date) to death or end of data availability. Treatments and healthcare resource consumption were evaluated on patients with at least 1 year of data availability before and after index date. SCD treatments were classified as SCD-specific, SCD-related, SCD-complication-related. Both day hospitals and ordinary hospitalizations were evaluated. Vaso-occlusive crisis (VOCs) (identified by hospitalization discharge diagnosis for SCD with crisis) and main SCD organ complications were assessed during follow-up. Mean annual healthcare resource costs were analyzed during follow-up according to the NHS perspective in terms of overall treatments, all-cause hospitalizations and out-patients services. Results. SCD prevalence in 2018 was 13 cases per 100,000 inhabitants. Prevalence projected to Italian population estimated in total 7,977 SCD patients in Italy in 2018 (of whom 1,690 and 6,287 were <18 and ≥18 years, respectively, figure 1): 1,279 were estimated with crisis, 5,894 without crisis and 804 unspecified. The study population included in the analysis comprised 1,816 patients (mean age 43.8 years, 58.4% female). Of them, 74.3% were without diagnosis of crisis, 16.1% with crisis, and 9.6% unspecified. Hematology and general medicine were the most frequent admission/discharge hospital departments for a subcohort of patients for which these data were available. During the first year of follow-up (index date included), 50.7% of patients had one all-cause hospitalization, 27.8% had 2, 10.4% had 3 and 11.1% had ≥4, in the second year 44% had at least one hospitalization, while in the third and fourth years 38.2% and 35.8%, respectively (table 1). During the available follow-up period (mean years±SD: 4.9±2.2) the average length of hospitalization stays (table 2) was around 8 days (ordinary hospitalizations) and 130 days (day hospitals). Proportion of patients with a VOC or one SCD complication was 3.7% and 15.2%, with 2 was 2.3% and 6.2% and with ≥3 was 7.7% and 12.8%, respectively. The mean annual number of SCD specific drugs was 0.6±2.7, of SCD related drugs was 3.2±4.5 and of SCD-complications-related drugs was 8.6±10.5. Antibacterials were the more frequently prescribed drugs (53-63%), followed by drugs for acid related disorders (35-48%) and antithrombotic agents (25-34%). Considering all available follow-up, mean annual number of all drugs was 14.9, of hospitalizations was 1.1 and of outpatient specialist services 5.3. Total mean annual cost per patient was €7,917 (€2,201 for prescribed drugs, €3,320 for hospitalizations, and €2,397 for outpatient specialist services, figure 2). Conclusions. This Italian real-world study may have revealed a SCD sub-population probably not noticed yet to SCD centers of reference, and still probably underestimated since ER flows were not present. Similarly, also VOC could be underestimated as only most severe episodes requiring hospitalization were captured. Proportion of patients with antithrombotic agents might be an indicator of the underlying multiorgan complications. The present data describe an SCD population with high resource utilization and heavy economic burden and warrants further efforts to increase an earlier patient identification that could lead to a timely and comprehensive treatment with less SCD-related complications. Figure 1 Figure 1. Disclosures Forni: Bluebirdbio: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees. Castiglioni: Novartis Farma SpA: Current Employment. Condorelli: Novartis Farma SpA: Current Employment. Valsecchi: Novartis Farma SpA: Current Employment. Premoli: Novartis Farma SpA: Current Employment. Fiocchi: Novaris Farma SpA: Current Employment.

Dermatovenereology of Russian Federation in 2020: Working Under a Pandemic

The article presents an analysis of the resources and activities of medical organizations providing medical care in the field of dermatovenereology for the period 20152020. Up-to-date data on the number of medical organizations and units providing specialized medical care in the field of dermatovenereology are provided. A description of the main changes in the provision of the population of the Russian Federation with dermatovenereologists, staffing with dermatovenereologists of medical organizations is given. Changes in the number of outpatient visits in 2020 are given. The dynamics of the bed fund of 24-hour and day hospitals of a dermatovenereological profile, the bed occupancy, the number of patients treated is described. The data on the incidence of sexually transmitted infections, infectious skin diseases are presented. Prevalence and incidence rates of diseases of the skin and subcutaneous tissue, including atopic dermatitis and psoriasis, are given. The impact of measures aimed at preventing the spread of a new coronavirus infection and organizing the provision of medical care to patients with COVID-19 on the performance rates of dermatovenereologic medical organizations has been demonstrated.

Ethical and Legal Aspects of Using the Abortion Pill RU-486 in Italy in the Years 2020-2021

In some countries, one of the most difficult bioethical challenges of the SARS-CoV-2 coronavirus pandemic has been a sharp rise in the number of chemical abortions performed in hospitals, outpatient clinics, or at home. Limited access to medical services at public and private healthcare facilities and the development of telemedicine have resulted in the practice of chemical abortion having largely moved from hospitals and clinics to the home. Chemical abortion is a method used only in the early stages of pregnancy, i.e. up to 7-9 weeks. The first stage of abortion involves taking RU-486, a pill containing a preparation called Mifepristone which kills the newly conceived life in the mother’s womb. The second stage of chemical abortion involves the use of a preparation called Misoprostol, which leads to the expulsion of the dead embryo from the woman’s body. The main goal of the article is to analyze the ethical and legal dispute in Italy in the years 2020 and 2021 concerning new ways of using the abortion pill RU-486. In August 2020, the Italian Ministry of Health decided that chemical abortion – performed using the medical preparation RU-486 – should not be practiced at hospital gynecological and obstetric wards, but in day hospitals, without the requirement of hospitalization for women performing such abortions. Analyses carried out in the article show that chemical abortion not only kills the life of a human embryo, but in some cases may also be dangerous to the life and health of the mother. The liberalization of chemical abortion in Italy has led to an increase in the number of unborn children who are aborted, as it facilitates access to this type of abortion and makes it a procedure that is largely self-administered at home. The Italian dispute over home abortion and the RU-486 pill is linked to other serious bioethical debates that are currently taking place in many countries around the world

ANALYSIS OF THE AVAILABILITY AND EFFICIENCY OF MEDICAL CARE PROVIDED TO PATIENTS IN THE PROFILE "MEDICAL REHABILITATION" IN ASTRAKHAN REGION

The relevance of the study due to the need to pay more attention to the effective planning of health care volumes under the compulsory health insurance and the creation of an accessible system of medical rehabilitation for adults in the region. The purpose of the study is to analyze the availability and effectiveness of medical care provided to adults in the "medical rehabilitation" profile within the framework of compulsory medical insurance in the Astrakhan region. Materials and methods - on the basis of data from the Federal State Statistics Service, the territorial fund of compulsory medical insurance in the Astrakhan region, annual reporting statistical forms No. 30, 14, 14-DS, the calculation and analysis of indicators of the optimal volume of medical care for the profile of medical rehabilitation was carried out, taking into account the profile of the disease (the number of hospitalizations per one inhabitant per year, funding per unit of the volume of medical care) of adult patients aged 18 years and older. Results and discussion - the article presents the results of assessing the planned and actual indicators of the volume of medical care for medical rehabilitation for adults, taking into account the profile of diseases in the conditions of round-the-clock and day hospitals of medical organizations participating in the territorial program of state guarantees of free provision of medical care to citizens in the region in 2019. It was revealed that at the expense of the compulsory medical insurance fund, the largest proportion of treated patients in rehabilitation beds is noted among those who receive medical services for neuro- and cardiac rehabilitation. However, rehabilitation care for critically ill patients with scores on the rehabilitation routing scale of 5 and 6 points, with a high rehabilitation potential, as well as for other categories of patients with somatic diseases, remains inaccessible. Conclusion. The obtained research data can be used for further organizational and methodological work to increase the availability and efficiency of medical rehabilitation care for adults, the development of available routing schemes, selection procedures, digitalization of the management of patient flows sent to medical rehabilitation within the framework of compulsory medical insurance at the regional level.

Occupational Therapy in Mental Health via Telehealth during the COVID-19 Pandemic

The COVID-19 pandemic has brought about changes in mental health occupational therapy. Research into these changes and the associated risks of relapse is insufficient. To explore the changes that have taken place in forms of occupational intervention (face-to-face and online) during the pandemic, and to analyze their association with subsequent relapses, a multicenter retrospective cohort study was carried out of 270 patients with mental disorder diagnoses under follow-up in day hospitals during 2020. Our results show that the frequency of face-to-face occupational therapy interventions decreased during lockdown and subsequently recovered. Interventions via telehealth increased during lockdown and have since been continued to a greater extent than before lockdown. Patients who received occupational intervention via telehealth relapsed less in the following six months (10.7% vs. 26.3%; χ2 = 10.372; p = 0.001), especially those who received intervention via videoconferencing (4.2% vs. 22%; χ2 = 5.718; p = 0.017). In conclusion, lockdown subsequent to the COVID-19 outbreak led to a reduction in face-to-face occupational therapy interventions, putting people with prior mental disorders at risk, while the implementation of telehealth tools helped reduce relapses.

CHANGES IN MENTAL HEALTH AFTER COVID-19 TRANSFER AND HEALTH CARE RESOURCES

The article analyzes the incidence of COVID-19 and complications after the disease, especially in terms of the mental health of the world’s population. The purpose of the study was to analyze changes in the mental health of the population of Ukraine after the transfer of COVID-19 and determine the resources of health professionals in the field of health, summarize the most common complaints that arose during the disease, identify compliance with quarantine measures and duration of treatment as in the hospital and at home, in the systematization of complications after the disorder, the duration of antidepressants and the assessment of respondents’ attitudes towards vaccination against COVID-19. A sociological survey has been conducting of 611 respondents mostly students, and teachers of Vinnytsia National University Pirogov. According to the results of the questionnaire, complaints from the nervous system: fatigue – 85.6%, sleep disorders during the disease were noted – 41.4%, irritability – 38.6%, anxiety disorders – 26.0%, memory impairment – 23,2%, depression – 17.9%, fear – 13.3%, confusion – 11.9%, panic attacks – 10.2%, convulsions – 4.9% and suicidal thoughts in 2.1% (66.6% of men) respondents. In Ukraine, it is necessary to create new conditions for alternative treatment of the mentally ill and the population that has negative consequences in mental health after the transfer of COVID-19 based on primary health care, namely: in psychiatric wards of general hospitals, day hospitals, in crisis centers, mental health centers. It is necessary to create a single electronic medical system for recording appeals from the public (personal data) to improve the health care system, as is done in European countries.