Special Issue "COVID-19: Prognosis, Outcomes and Long-Term Sequelae"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Infectious Disease Epidemiology".

Deadline for manuscript submissions: 15 January 2022.

Special Issue Editors

Dr. Manoj Sivan
E-Mail Website
Guest Editor
Department of Rehabilitation Medicine, Chapel Allerton Hospital, Leeds LS7 4SA, UK
Interests: long-term medical conditions; global health; rehabilitation technology; pain medicine; sleep medicine; outcome measurement
Dr. Ng Yee Sien
E-Mail Website
Guest Editor
Department of Rehabilitation Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
Interests: disability epidemiology; rehabilitation health-services research; neurorehabilitation
Dr. Sofia Straudi
E-Mail Website
Guest Editor
Neuroscience and Rehabilitation Department, Ferrara University Hospital, 44100 Ferrara, Italy
Interests: neurorehabilitation; rehabilitation technology

Special Issue Information

Dear Colleagues, 

IJERPH cordially invites you to contribute to this special issue on “Covid-19: Prognosis, Outcomes and Long-Term Sequelae" 

The first cases of Coronavirus disease 2019 (Covid-19) were reported in China in Dec 2019 and since then the pandemic has rapidly spread across the continents. The World Health Organisation (WHO) declared the outbreak to be a Public Health Emergency of International Concern in January 2020. It causes severe acute respiratory syndrome (SARS-CoV2) which is associated with considerable morbidity and mortality in the acute phase. More than 1.35 million cases has been tested positive for infection with more than 75,900 deaths reported so far. Worldwide case fatality rate ranges from 0.7% (Germany) to more than 10% (Italy). Several adverse prognostic factors have been identified so far including advanced age, male sex and presence of comorbidity. 

The long-term problems and outcomes in Covid-19 survivors is currently unknown. We however know that previous outbreaks of coronavirus and Ebola virus have caused immunological, radiological, functional and psychological abnormalities of varying degrees. Persistent problems of pulmonary function, weakness, chronic pain, fatigue, depression, anxiety, PTSD, vocational problems and reduced quality of life have been observed in survivors of these previous outbreaks. 

This special issue is aimed at articles of high academic standard investigating these persistent or emerging long-term problems in the physical, psychological and social domains. We would like to focus on the management of survivors beyond the acute stages of illness and help maximise functional ability by optimised interventions. Authors can submit original research, systematic review, case report and service evaluation audits related to any of these aspects of Covid-19 or previous coronavirus outbreaks. 

We look forward to your contributions.

Dr. Manoj Sivan
Dr. Ng Yee Sien
Dr. Sofia Straudi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • coronavirus
  • follow-up
  • pulmonary function/ fibrosis
  • critical illness neuropathy/myopathy/weakness
  • chronic pain
  • fatigue
  • depression
  • anxiety
  • post-traumatic stress disorder
  • vocation
  • quality of life

Published Papers (14 papers)

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Research

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Article
Effect of Resilience on Health-Related Quality of Life during the COVID-19 Pandemic: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2021, 18(21), 11394; https://doi.org/10.3390/ijerph182111394 - 29 Oct 2021
Viewed by 444
Abstract
The unprecedented outbreak of coronavirus disease 2019 (COVID-19) has caused a huge global health and economic crisis. The aim of the study was to examine the extent to which the resilience of a person is associated with the quality of life (QoL) of [...] Read more.
The unprecedented outbreak of coronavirus disease 2019 (COVID-19) has caused a huge global health and economic crisis. The aim of the study was to examine the extent to which the resilience of a person is associated with the quality of life (QoL) of adults amongst Saudi Arabia. A cross-sectional study was conducted among a sample of adults in Saudi Arabia. A total of 385 adults voluntarily participated in and completed the survey. The quality of life was measured using the “World Health Organization QoL”. The “Connor-Davidson Resilience Scale” instrument was also used to assess resilience during the COVID-19 pandemic. Amongst the 385 participants, 179 (46%) showed a good QoL, and 205 (54%) reported a relatively poor QoL. The resilience was found to be significantly associated with QoL. The study further revealed that gender-based differences were dominant in the QoL; the men respondents reported a significantly higher QoL in all the domains in comparison to the women respondents. The gender, income, and psychological health and interaction effect of resilience and age explained 40% of the variance in the total score of QoL. In reference to the predictors of the physical health domain of QoL, resilience, gender, and psychological health were significantly associated with the physical health domain of the QoL (R2 = 0.26, p = 0.001). It was also noted that gender was not associated with the social relationships and environmental domains of QoL (p > 0.05). Findings showed a statistically significant association between the score of QoL and resilience, age, gender, income, and psychological health. These findings highlight the significant contribution of gender-based differences, psychological health, and resilience on the domains of QoL. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)
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Article
Long-Term Survival of Older Patients Hospitalized for COVID-19. Do Clinical Characteristics upon Admission Matter?
Int. J. Environ. Res. Public Health 2021, 18(20), 10671; https://doi.org/10.3390/ijerph182010671 - 12 Oct 2021
Viewed by 595
Abstract
Older adults are particularly susceptible to COVID-19 in terms of both disease severity and risk of death. To compare clinical differences between older COVID-19 hospitalized survivors and non-survivors, we investigated variables influencing mortality in all older adults with COVID-19 hospitalized in Poznań, Poland, [...] Read more.
Older adults are particularly susceptible to COVID-19 in terms of both disease severity and risk of death. To compare clinical differences between older COVID-19 hospitalized survivors and non-survivors, we investigated variables influencing mortality in all older adults with COVID-19 hospitalized in Poznań, Poland, through the end of June 2020 (n = 322). In-hospital, post-discharge, and overall 180-day mortality were analyzed. Functional capacity prior to COVID-19 diagnosis was also documented. The mean age of subjects was 77.5 ± 10.0 years; among them, 191 were females. Ninety-five (29.5%) died during their hospitalization and an additional 30 (9.3%) during the post-discharge period (up to 180 days from the hospital admission). In our study, male sex, severe cognitive impairment, underlying heart disease, anemia, and elevated plasma levels of IL-6 were independently associated with greater mortality during hospitalization. During the overall 180-day observation period (from the hospital admission), similar characteristics, excluding male sex and additionally functional impairment, were associated with increased mortality. During the post-discharge period, severe functional impairment remained the only determinant. Therefore, functional capacity prior to diagnosis should be considered when formulating comprehensive prognoses as well as care plans for older patients infected with SARS-CoV-2. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)
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Article
Sex Differences and Predictors of In-Hospital Mortality among Patients with COVID-19: Results from the ANCOHVID Multicentre Study
Int. J. Environ. Res. Public Health 2021, 18(17), 9018; https://doi.org/10.3390/ijerph18179018 - 26 Aug 2021
Viewed by 866
Abstract
Spain is one of the countries most affected by the COVID-19 pandemic. Although risk factors for severe disease are published, sex differences have been widely neglected. In this multicentre study, we aimed to identify predictors of in-hospital mortality in men and women hospitalised [...] Read more.
Spain is one of the countries most affected by the COVID-19 pandemic. Although risk factors for severe disease are published, sex differences have been widely neglected. In this multicentre study, we aimed to identify predictors of in-hospital mortality in men and women hospitalised with COVID-19. An observational longitudinal study was conducted in the cohort of patients admitted to four hospitals in Andalusia, Spain, from 1 March 2020 to 15 April 2020. Sociodemographic and clinical data were collected from hospital records. The Kaplan–Meier method was used to estimate 30-day survival and multiple Cox regression models were applied. All analyses were stratified by sex. A total of 968 patients were included (54.8% men, median age 67.0 years). In-hospital mortality reached 19.1% in men and 16.0% in women. Factors independently associated with an increased hazard of death were advanced age, higher CURB-65 score and not receiving azithromycin treatment, in both sexes; active cancer and autoimmune disease, in men; cardiovascular disease and chronic lung disease, in women. Disease outcomes and predictors of death differed between sexes. In-hospital mortality was higher in men, but the long-term effects of COVID-19 merit further research. The sex-differential impact of the pandemic should be addressed in public health policies. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)
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Article
Musculoskeletal Disorders, Pain Medication, and in-Hospital Mortality among Patients with COVID-19 in South Korea: A Population-Based Cohort Study
Int. J. Environ. Res. Public Health 2021, 18(13), 6804; https://doi.org/10.3390/ijerph18136804 - 24 Jun 2021
Cited by 1 | Viewed by 1015
Abstract
We aimed to investigate whether comorbid musculoskeletal disorders (MSD)s and pain medication use was associated with in-hospital mortality among patients with coronavirus disease 2019 (COVID-19). Adult patients (≥20 years old) with a positive COVID-19 diagnosis until 5 June 2020 were included in this [...] Read more.
We aimed to investigate whether comorbid musculoskeletal disorders (MSD)s and pain medication use was associated with in-hospital mortality among patients with coronavirus disease 2019 (COVID-19). Adult patients (≥20 years old) with a positive COVID-19 diagnosis until 5 June 2020 were included in this study, based on the National Health Insurance COVID-19 database in South Korea. MSDs included osteoarthritis, neck pain, lower back pain, rheumatoid arthritis, and others, while pain medication included paracetamol, gabapentin, pregabalin, glucocorticoid, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids (strong and weak opioids), and benzodiazepine. Primary endpoint was in-hospital mortality. A total of 7713 patients with COVID-19 were included, and in-hospital mortality was observed in 248 (3.2%) patients. In multivariate logistic regression analysis, no MSDs (p > 0.05) were significantly associated with in-hospital mortality. However, in-hospital mortality was 12.73 times higher in users of strong opioids (odds ratio: 12.73, 95% confidence interval: 2.44–16.64; p = 0.002), while use of paracetamol (p = 0.973), gabapentin or pregabalin (p = 0.424), glucocorticoid (p = 0.673), NSAIDs (p = 0.979), weak opioids (p = 0.876), and benzodiazepine (p = 0.324) was not associated with in-hospital mortality. In South Korea, underlying MSDs were not associated with increased in-hospital mortality among patients with COVID-19. However, use of strong opioids was significantly associated with increased in-hospital mortality among the patients. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)
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Article
Six Months Follow-Up of Patients with Invasive Mechanical Ventilation Due to COVID-19 Related ARDS
Int. J. Environ. Res. Public Health 2021, 18(11), 5861; https://doi.org/10.3390/ijerph18115861 - 29 May 2021
Cited by 3 | Viewed by 1367
Abstract
Although patients who recovered from acute coronavirus disease 2019 (COVID-19) may have prolonged disabilities, follow-up data of those who have survived COVID-19 related acute respiratory distress syndrome (ARDS) is still very scarce. Therefore, COVID-19-ARDS survivors requiring invasive mechanical ventilation (IMV) were followed six [...] Read more.
Although patients who recovered from acute coronavirus disease 2019 (COVID-19) may have prolonged disabilities, follow-up data of those who have survived COVID-19 related acute respiratory distress syndrome (ARDS) is still very scarce. Therefore, COVID-19-ARDS survivors requiring invasive mechanical ventilation (IMV) were followed six months after discharge. Pulmonary function tests (PFTs), 6-min walk test (6MWT) and echocardiography were performed. Quality of life (QoL), depression and anxiety were assessed using validated questionnaires. Patients were compared based on respiratory mechanics and CT-phenotype during intensive care unit (ICU) stay. Eighteen patients were included (61 ± 7 years; ICU-stay: 34 ± 16 days; IMV: 30 ± 15 days). At follow-up (197 ± 15 days after discharge), PFTs did not reveal significant limitations (VC: 92 ± 16%; FEV1: 92 ± 20%; DLco/VA: 81 ± 16%). Cardiac systolic function was normal in all patients, but 50% of them had diastolic dysfunction. 6MWT was under the lower limit of normal in only two patients. Eight patients (44%) reported tiredness, six (33%) suffered from fatigue and one patient (6%) had depression and anxiety. Surprisingly, patients with worse respiratory mechanics during IMV reported fewer symptoms and less exertional dyspnea at follow-up. In conclusion, patients with COVID-19-ARDS have the possibility to fully recover regarding pulmonary function and exercise capacity, which seems to be independent of disease severity during ICU stay. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)
Article
Geographic Factors Associated with Poorer Outcomes in Patients Diagnosed with COVID-19 in Primary Health Care
Int. J. Environ. Res. Public Health 2021, 18(7), 3842; https://doi.org/10.3390/ijerph18073842 - 06 Apr 2021
Viewed by 994
Abstract
Background: The prognosis of older age COVID-19 patients with comorbidities is associated with a more severe course and higher fatality rates but no analysis has yet included factors related to the geographical area/municipality in which the affected patients live, so the objective [...] Read more.
Background: The prognosis of older age COVID-19 patients with comorbidities is associated with a more severe course and higher fatality rates but no analysis has yet included factors related to the geographical area/municipality in which the affected patients live, so the objective of this study was to analyse the prognosis of patients with COVID-19 in terms of sex, age, comorbidities, and geographic variables. Methods: A retrospective cohort of 6286 patients diagnosed with COVID-19 was analysed, considering demographic data, previous comorbidities and geographic variables. The main study variables were hospital admission, intensive care unit (ICU) admission and death due to worsening symptoms; and the secondary variables were sex, age, comorbidities and geographic variables (size of the area of residence, distance to the hospital and the driving time to the hospital). A comparison analysis and a multivariate Cox model were performed. Results: The multivariate Cox model showed that women had a better prognosis in any type of analysed prognosis. Most of the comorbidities studied were related to a poorer prognosis except for dementia, which is related to lower admissions and higher mortality. Suburban areas were associated with greater mortality and with less hospital or ICU admission. Distance to the hospital was also associated with hospital admission. Conclusions: Factors such as type of municipality and distance to hospital act as social health determinants. This fact must be taken account in order to stablish specifics prevention measures and treatment protocols. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)
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Article
Prevalence and Risk Factors for Post-Traumatic Stress in Hospitalized and Non-Hospitalized COVID-19 Patients
Int. J. Environ. Res. Public Health 2021, 18(4), 2079; https://doi.org/10.3390/ijerph18042079 - 20 Feb 2021
Cited by 5 | Viewed by 1683
Abstract
This population-based study assessed the prevalence and determinants of symptom-defined post-traumatic stress disorder (PTSD) in a cohort of hospitalized and non-hospitalized patients about 1.5–6 months after their COVID-19 onset. The data were acquired from two mixed postal/web surveys in June–September 2020 from patients [...] Read more.
This population-based study assessed the prevalence and determinants of symptom-defined post-traumatic stress disorder (PTSD) in a cohort of hospitalized and non-hospitalized patients about 1.5–6 months after their COVID-19 onset. The data were acquired from two mixed postal/web surveys in June–September 2020 from patients all aged ≥18 years with a positive polymerase chain reaction for severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) until 1 June 2020, comprising both hospitalized and non-hospitalized subjects. The catchment areas of the two included hospitals covers about 17% of the population of Norway. In total, 211 hospitalized and 938 non-hospitalized subjects received invitation. The prevalence of symptom-defined PTSD was assessed using the PTSD checklist for DSM-5 (PCL-5). Determinants of symptom-defined PTSD and PTSD symptoms were analyzed using multivariable logistic and linear regression analysis. In total, 583 (51%) subjects responded at median 116 (range 41–200) days after COVID-19 onset. The prevalence of symptom-defined PTSD was 9.5% in hospitalized and 7.0% in non-hospitalized subjects (p = 0.80). Female sex, born outside of Norway, and dyspnea during COVID-19 were risk factors for persistent PTSD symptoms. In non-hospitalized subjects, previous depression and COVID-19 symptom load were also associated with persistent PTSD symptoms. In conclusion, COVID-19 symptom load, but not hospitalization, was associated with symptom-defined PTSD and PTSD symptom severity. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)
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Article
Physical Activity during COVID-19 in German Adults: Analyses in the COVID-19 Snapshot Monitoring Study (COSMO)
Int. J. Environ. Res. Public Health 2021, 18(2), 507; https://doi.org/10.3390/ijerph18020507 - 09 Jan 2021
Cited by 6 | Viewed by 2019
Abstract
The novel coronavirus (COVID-19) and the resulting outbreak response measures in Germany and worldwide led to severe limitations in everyday life. This affected all sorts of daily activities and the possibility for physical activity (PA), which represents a major coping strategy against stress. [...] Read more.
The novel coronavirus (COVID-19) and the resulting outbreak response measures in Germany and worldwide led to severe limitations in everyday life. This affected all sorts of daily activities and the possibility for physical activity (PA), which represents a major coping strategy against stress. The objective of this study was to analyse PA in German adults during a total lockdown phase including school closures in April 2020 in certain subgroups and in relation to other coping strategies. Data from the COVID-19 Snapshot Monitoring (COSMO) survey, an online cross-sectional study with 1034 participants between 18 and 74 years, were utilised (14/15 April 2020). In addition to descriptive analyses, the odds of performing PA according to the World Health Organization (WHO) recommendations for adults (at least 2.5 h/week of at least moderate intensity) were analysed by univariate and multivariate logistic regression analyses. In total, 440 (42.6%) participants fulfilled this criterion. Participants with children <6 years were less likely to meet the WHO recommendation (OR = 0.51; 95% CI: 0.33–0.78), while those with a higher level of education, good coping behaviour, regular alcohol consumption, and being satisfied with life were more likely to meet the WHO recommendation. In conclusion, PA intervention strategies tailored to specific vulnerable subgroups such as individuals with low educational background and parents with young children are needed in future pandemic response. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)
Article
Post-Acute COVID-19 Rehabilitation Network Proposal: From Intensive to Extensive and Home-Based IT Supported Services
Int. J. Environ. Res. Public Health 2020, 17(24), 9335; https://doi.org/10.3390/ijerph17249335 - 14 Dec 2020
Cited by 2 | Viewed by 1954
Abstract
Management of COVID-19 post-acute syndrome is an emerging health issue in rehabilitation. This article aims to present a proposal, based on the principles of clinical governance, health management and information technology (IT), and to respond to the need for a structured organization model [...] Read more.
Management of COVID-19 post-acute syndrome is an emerging health issue in rehabilitation. This article aims to present a proposal, based on the principles of clinical governance, health management and information technology (IT), and to respond to the need for a structured organization model for post-acute COVID-19 rehabilitation. The authors present a regional-based model of a network of clinicians and healthcare managers using a dedicated IT platform to achieve both effectiveness and efficiency objectives, to ensure coordination of the available resources and the most appropriate rehabilitative treatment for patients. The proposed post-acute COVID-19 rehabilitation network has been designed according to the model of a clinical management project within the Italian national healthcare system, and its context is an easily adjustable model for the European healthcare systems. The authors base the project on current laws and scientific guidelines in rehabilitation in Italy and in Europe and use the SWOT analysis technique to assess the proposal feasibility. The primary aims of the project are: (1) standardizing the minimum assessment tools of post-COVID-19 patients with disabilities; (2) ensuring an individual rehabilitation project for each patient with international classification of functioning, disability and health (ICF) coding and (3) reporting the activity performance with appropriate indicators. The secondary aims are: (1) developing educational programs for patients and care givers also aimed at acquiring better empowerment and positive behavior; (2) creating a regional database for data collection and (3) improving IT, and specifically tele-rehabilitation, as a suitable approach during the COVID-19 emergency and also in the future. Expected results are: continuum of care; effectiveness, efficacy and appropriateness in the delivery of rehabilitation treatments through a standardized minimum assessment and the wording of the individual rehabilitation project and a precise reporting of performance indicators to measure the effectiveness of clinical activities and the satisfaction of patients and caregivers. The assessment of results will be analyzed at three and six months to implement corrective actions according to the concept of continuous improvement of the Deming cycle. The IT remote approach allows the patient to meet the needs of proximity of care and empowerment, and, at the same time, to contain the spread of infection. This project could have a significant healthcare impact ensuring a more efficient and effective management of the demand of rehabilitation post-acute COVID-19, expanding the professional skills of the rehabilitation team members, improving both clinical and process data, in addition to optimal allocation of available economic resources. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)
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Communication
Applying the WHO ICF Framework to the Outcome Measures Used in the Evaluation of Long-Term Clinical Outcomes in Coronavirus Outbreaks
Int. J. Environ. Res. Public Health 2020, 17(18), 6476; https://doi.org/10.3390/ijerph17186476 - 05 Sep 2020
Cited by 12 | Viewed by 2849
Abstract
(1) Objective: The World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) classification is a unified framework for the description of health and health-related states. This study aimed to use the ICF framework to classify outcome measures used in follow-up [...] Read more.
(1) Objective: The World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) classification is a unified framework for the description of health and health-related states. This study aimed to use the ICF framework to classify outcome measures used in follow-up studies of coronavirus outbreaks and make recommendations for future studies. (2) Methods: EMBASE, MEDLINE, CINAHL and PsycINFO were systematically searched for original studies assessing clinical outcomes in adult survivors of severe acute respiratory distress syndrome (SARS), middle east respiratory syndrome (MERS) and coronavirus disease-19 (COVID-19) after hospital discharge. Individual items of the identified outcome measures were linked to ICF second-level and third-level categories using ICF linking rules and categorized according to an ICF component. (3) Results: In total, 33 outcome measures were identified from 36 studies. Commonly used (a) ICF body function measures were Pulmonary Function Tests (PFT), Impact of event scale (IES-R) and Hospital Anxiety and Depression Scale (HADS); (b) ICF activity was 6-Minute Walking Distance (6MWD); (c) ICF participation measures included Short Form-36 (SF-36) and St George’s Respiratory Questionnaire (SGRQ). ICF environmental factors and personal factors were rarely measured. (4) Conclusions: We recommend future COVID-19 follow-up studies to use the ICF framework to select a combination of outcome measures that capture all the components for a better understanding of the impact on survivors and planning interventions to maximize functional return. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)
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Article
A Proposal for Multidisciplinary Tele-Rehabilitation in the Assessment and Rehabilitation of COVID-19 Survivors
Int. J. Environ. Res. Public Health 2020, 17(13), 4890; https://doi.org/10.3390/ijerph17134890 - 07 Jul 2020
Cited by 39 | Viewed by 6663
Abstract
A global pandemic of a new highly contagious disease called COVID-19 resulting from coronavirus (severe acute respiratory syndrome (SARS)-Cov-2) infection was declared in February 2020. Though primarily transmitted through the respiratory system, other organ systems in the body can be affected. Twenty percent [...] Read more.
A global pandemic of a new highly contagious disease called COVID-19 resulting from coronavirus (severe acute respiratory syndrome (SARS)-Cov-2) infection was declared in February 2020. Though primarily transmitted through the respiratory system, other organ systems in the body can be affected. Twenty percent of those affected require hospitalization with mechanical ventilation in severe cases. About half of the disease survivors have residual functional deficits that require multidisciplinary specialist rehabilitation. The workforce to deliver the required rehabilitation input is beyond the capacity of existing community services. Strict medical follow-up guidelines to monitor these patients mandate scheduled reviews within 12 weeks post discharge. Due to the restricted timeframe for these events to occur, existing care pathway are unlikely to be able to meet the demand. An innovative integrated post-discharge care pathway to facilitate follow up by acute medical teams (respiratory and intensive care) and a specialist multidisciplinary rehabilitation team is hereby proposed. Such a pathway will enable the monitoring and provision of comprehensive medical assessments and multidisciplinary rehabilitation. This paper proposes that a model of tele-rehabilitation is integrated within the pathway by using digital communication technology to offer quick remote assessment and efficient therapy delivery to these patients. Tele-rehabilitation offers a quick and effective option to respond to the specialist rehabilitation needs of COVID-19 survivors following hospital discharge. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)
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Article
COVID-19 Pandemic in the Italian Population: Validation of a Post-Traumatic Stress Disorder Questionnaire and Prevalence of PTSD Symptomatology
Int. J. Environ. Res. Public Health 2020, 17(11), 4151; https://doi.org/10.3390/ijerph17114151 - 10 Jun 2020
Cited by 99 | Viewed by 8281
Abstract
Since December 2019, the COVID-19 pandemic has attracted worldwide attention for its rapid and exponential diffusion. The long-term psychological impact, of both the spread of the virus and the restrictive policies adopted to counteract it, remains uncertain. However, recent studies reported a high [...] Read more.
Since December 2019, the COVID-19 pandemic has attracted worldwide attention for its rapid and exponential diffusion. The long-term psychological impact, of both the spread of the virus and the restrictive policies adopted to counteract it, remains uncertain. However, recent studies reported a high level of psychological distress and Post-Traumatic Stress Disorder (PTSD) symptoms. The purpose of this study is to assess the psychometric properties of a new questionnaire, to evaluate PTSD risk related to the COVID-19 emergency. A total of Italian people completed a web-based cross-sectional survey broadcasted through different social-media. Demographic data and some psychological dimensions, such as general distress and sleep disturbance, were collected. A new self-report questionnaire (COVID-19-PTSD), consisting of 19 items, was developed starting from the PTSD Check List for DSM-5 (PCL-5) questionnaire, and it was administered in order to analyze its psychometric properties. The results highlighted the adequate psychometric properties of the COVID-19-PTSD questionnaire. The confirmatory factor analysis indicated that a seven-factor model (Intrusion, Avoidance, Negative Affect, Anhedonia, Dysphoric arousal, Anxious arousal and Externalizing behavior) best fits the data. Significant correlations were found among COVID-19-PTSD scores, general distress and sleep disturbance. A high percentage of PTSD symptomatology (29.5%) was found in the Italian population. COVID-19-PTSD appears to be effective in evaluating the specific stress symptoms related to the COVID-19 pandemic in the Italian population. These results are relevant from a clinical point of view because they suggest that the COVID-19 pandemic could be considered as a traumatic event. Psychological interventions to counteract short- and long-term psychopathological effects, consequent to the COVID-19 pandemic, appear to be necessary. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)

Review

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Review
Factors Associated with Mortality among Elderly People in the COVID-19 Pandemic (SARS-CoV-2): A Systematic Review and Meta-Analysis
Int. J. Environ. Res. Public Health 2021, 18(15), 8008; https://doi.org/10.3390/ijerph18158008 - 29 Jul 2021
Cited by 3 | Viewed by 948
Abstract
The objective of this meta-analysis was to evaluate the factors associated with the mortality of elderly Italians diagnosed with coronavirus who resided in institutions or who were hospitalized because of the disease. Methods: A systematic review following the recommendations of The Joanna Briggs [...] Read more.
The objective of this meta-analysis was to evaluate the factors associated with the mortality of elderly Italians diagnosed with coronavirus who resided in institutions or who were hospitalized because of the disease. Methods: A systematic review following the recommendations of The Joanna Briggs Institute (JBI) was carried out, utilizing the PEO strategy, i.e., Population, Exposure and Outcome. In this case, the population was the elderly aged over 65 years old, the exposure referred to the SARS-CoV-2 pandemic and the outcome was mortality. The National Center for Biotechnology Information (NCBI/PubMed), Latin American and Caribbean Literature in Health Sciences (LILACS), Excerpta Medica Database (EMBASE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were used until 31 July 2020. Results: Five Italian studies were included in this meta-analysis, with the number of elderly people included varying between 18 and 1591 patients. The main morbidities presented by the elderly in the studies were dementia, diabetes, chronic kidney disease and hypertension. Conclusions: The factors associated with the mortality of elderly Italian people diagnosed with SARS-CoV-2 who lived in institutions or who were hospitalized because of the disease were evaluated. It was found that dementia, diabetes, chronic kidney disease and hypertension were the main diagnosed diseases for mortality in elderly people with COVID-19. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)
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Review
Effects of COVID-19 Infection during Pregnancy and Neonatal Prognosis: What Is the Evidence?
Int. J. Environ. Res. Public Health 2020, 17(11), 4176; https://doi.org/10.3390/ijerph17114176 - 11 Jun 2020
Cited by 29 | Viewed by 4404
Abstract
Background: This study’s aims are to assess the current evidence presented in the literature regarding the potential risks of COVID-19 infection among pregnant women and consequent fetal transmission. Methods: a systematic literature review assessing papers published in the most comprehensive databases in the [...] Read more.
Background: This study’s aims are to assess the current evidence presented in the literature regarding the potential risks of COVID-19 infection among pregnant women and consequent fetal transmission. Methods: a systematic literature review assessing papers published in the most comprehensive databases in the field of health intended to answer the question, “What are the effects of COVID-19 infection during pregnancy, and what is the neonatal prognosis?” Results: 49 papers published in 2020 were eligible, presenting low levels of evidence. A total of 755 pregnant women and 598 infants were assessed; more than half of pregnant women had C-sections (379/65%). Only 493 (82%) infants were tested for SARS-CoV-2, nine (2%) of whom tested positive. There is, however, no evidence of vertical transmission based on what has been assessed so far, considering there are knowledge gaps concerning the care provided during and after delivery, as well as a lack of suitable biological samples for testing SARS-CoV-2. Conclusions: We cannot rule out potential worsening of the clinical conditions of pregnant women infected with SARS-CoV-2, whether the infection is associated with comorbidities or not, due to the occurrence of respiratory disorders, cardiac rhythm disturbances, and acid-base imbalance, among others. We recommend relentless monitoring of all pregnant women in addition to testing them before delivery or the first contact with newborns. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)
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