In the fight against COVID-19, vaccination is vital in achieving herd immunity. Many Asian countries are starting to vaccinate frontline workers; however, expedited vaccine development has led to ...hesitancy among the general population. We evaluated the willingness of healthcare workers to receive the COVID-19 vaccine.
From 12 to 21 December 2020, we recruited 1720 healthcare workers from 6 countries: China, India, Indonesia, Singapore, Vietnam and Bhutan. The self-administrated survey collected information on willingness to vaccinate, perception of COVID-19, vaccine concerns, COVID-19 risk profile, stigma, pro-socialness scale, and trust in health authorities.
More than 95% of the healthcare workers surveyed were willing to vaccinate. These respondents were more likely to perceive the pandemic as severe, consider the vaccine safe, have less financial concerns, less stigmatization regarding the vaccine, higher pro-socialness mindset and trust in health authorities. A high perceived pandemic risk index, low vaccine harm index and high pro-socialness index were independent predictors in multivariable analysis.
The majority of healthcare workers in Asia are willing to receive COVID-19 vaccination. Perceived COVID-19 susceptibility, low potential risk of vaccine harm and pro-socialness are the main drivers. These findings may help formulate vaccination strategies in other countries.
•Virtual reality shows promising results in improving rote memory and executive function post-stroke.•Combination of cognitive and motoric rehabilitation simultaneously shows best result.•Virtual ...reality rehabilitation using task generator shows best result for cognitive improvement.
Stroke is one of the leading causes of disability worldwide. In the next few decades, post-stroke disability is expected to increase by up to 35% due to the current increase in cerebrovascular risk factors. Disabilities caused by stroke can include cognitive and motor impairment. The current research on post-stroke rehabilitation mostly focuses on the motor disability aspect. Recently, the International Stroke Recovery and Rehabilitation Alliance 2018 stated that post-stroke cognitive impairment (PSCI) is one of the research priorities. Following recent technological developments, virtual reality (VR)-based therapy is now emerging. This technology is attractive because it can simulate various activities in a safe environment. However, research on VR for post-stroke patients still does not have specific guidelines that must be followed, so the types of interventions carried out through VR still vary. Therefore, this study aims to assess how the benefits of using VR in improving cognitive function in post-stroke patients and what VR interventions show the greatest benefits.
This research is a systematic review and meta-analysis conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. The data used for this study were obtained from PubMed, Scopus, and Science Direct databases. The search conducted in this systematic review was done without any year restriction. The studies included were randomized controlled trials (RCTs) and pilot RCTs.
This systematic review included eight studies involving 313 participants in total. All studies were used for the meta-analysis, with five, four, and six studies used in the rote memory function, executive function, and general cognitive analyses, respectively. Assessment using the trail making test (TMT) on the TMT-A test related to rote memory function (MD = -26.43, 95% CI -43.18 – -9.68, P = 0.002) and TMT-B test related to executive function (MD = -59.23, 95% CI -103.21 – -15.25, P = 0.008) showed significantly better results with shorter processing time in the VR group. In contrast, in the general cognitive assessment using the Montreal cognitive assessment (MoCA), although it showed better results in the VR group (MD = 1.45, 95% CI -0.20 – 3.09, P = 0.08), the results were not significant. The meta-analysis showed homogeneous result in rote memory (I2 = 6%) and executive function (I2 = 0%) analyses. For general cognitive analysis the result was heterogeneous (I2 = 86%).
Interventions using VR have shown promising results in improving rote memory and executive function, especially when VR intervention is combined with a motorized assistive devices. This combination therapy not only trains cognitive skills, but also trains the patient's motor skills simultaneously. For general cognitive interventions, adaptive VR with task generators that represent daily activities showed the best results, but studies using this technology only focused on cognitive interventions. A new trial that uses the combination of these two technologies would be interesting to investigate further, especially considering that the existing trials still use small populations.
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As the COVID-19 pandemic evolves, challenges in frontline work continue to impose a significant psychological impact on nurses. However, there is a lack of data on how nurses fared compared to other ...health care workers in the Asia-Pacific region.
This study aims to investigate (1) the psychological outcome characteristics of nurses in different Asia-Pacific countries and (2) psychological differences between nurses, doctors, and nonmedical health care workers.
Exploratory data analysis and visualization were conducted on the data collected through surveys. A machine learning modeling approach was adopted to further discern the key psychological characteristics differentiating nurses from other health care workers. Decision tree-based machine learning models (Light Gradient Boosting Machine, GradientBoost, and RandomForest) were built to predict whether a set of psychological distress characteristics (ie, depression, anxiety, stress, intrusion, avoidance, and hyperarousal) belong to a nurse. Shapley Additive Explanation (SHAP) values were extracted to identify the prominent characteristics of each of these models. The common prominent characteristic among these models is akin to the most distinctive psychological characteristic that differentiates nurses from other health care workers.
Nurses had relatively higher percentages of having normal or unchanged psychological distress symptoms relative to other health care workers (n=233-260 86.0%-95.9% vs n=187-199 74.8%-91.7%). Among those without psychological symptoms, nurses constituted a higher proportion than doctors and nonmedical health care workers (n=194 40.2%, n=142 29.5%, and n=146 30.3%, respectively). Nurses in Vietnam showed the highest level of depression, stress, intrusion, avoidance, and hyperarousal symptoms compared to those in Singapore, Malaysia, and Indonesia. Nurses in Singapore had the highest level of anxiety. In addition, nurses had the lowest level of stress, which is the most distinctive psychological outcome characteristic derived from machine learning models, compared to other health care workers. Data for India were excluded from the analysis due to the differing psychological response pattern observed in nurses in India. A large number of female nurses emigrating from South India could not have psychologically coped well without the support from family members while living alone in other states.
Nurses were least psychologically affected compared to doctors and other health care workers. Different contexts, cultures, and points in the pandemic curve may have contributed to differing patterns of psychological outcomes amongst nurses in various Asia-Pacific countries. It is important that all health care workers practice self-care and render peer support to bolster psychological resilience for effective coping. In addition, this study also demonstrated the potential use of decision tree-based machine learning models and SHAP value plots in identifying contributing factors of sophisticated problems in the health care industry.
Background Coronavirus disease 2019 (COVID-19) is a disease designated as a global pandemic by the WHO that can manifest clinically as neurological disorders that can occur in the acute phase or ...after the acute phase (long COVID-19), such as headache, myalgia, anosmia, and cognitive impairment. These neurological disorders as symptoms of long COVID-19 are presumably caused by hypercoagulable conditions characterized by an increase in D-dimer level. This study aims to determine the correlation of long COVID-19 neurological symptoms with hypercoagulable conditions and the role of D-dimer as a biomarker of long COVID-19 neurological symptoms.
MethodsThis was a cross-sectional study involving 31 patients with long COVID-19 symptoms. Admitted long COVID-19 cases with recorded D-dimer levels and definitive outcomes were included consecutively. Long COVID-19 neurological symptoms were collected. D-dimer level was measured using immunofluorescence assay and reported in fibrinogen equivalent units (ìg/mL). The correlation between D-dimer levels and neurological clinical manifestations was assessed by using ordinal regression analysis. The p-value of <0.05 was considered statistically significant.
ResultsThe mean age of the subjects was 38.81 ± 11.58 years and 18 (58.06%) were female. Long COVID neurological symptoms comprised myalgia, anosmia and cephalgia, and most subjects complained of myalgia (80.65%). On multivariable analysis, long-COVID-19 neurological symptoms were significantly correlated with D-dimer odds ratio (OR) = 1.05; p=0.020.
ConclusionThe number of neurological long COVID symptoms were significantly correlated with level of D-Dimer. Ultimately, more clarity is needed on the neurological impact of COVID-19, its diagnosis, and its treatment.
Coronavirus disease 2019 (COVID-19) can cause systemic and respiratory symptoms. Acute respiratory distress syndrome (ARDS), anemia, acute heart injury, secondary infection, and stroke are the ...complications of COVID-19. Age, oxidative stress, endothelial dysfunction, inflammatory status, vascular risk factors, and hypoxemia are risk factors for stroke associated with COVID-19. In this case report, two cases of COVID-19 complicated by stroke and other thromboembolic diseases were discussed. Case 1: a 46-year-old man presented with right extremities weakness, dysarthria, cough, colds, chest pain radiating to left upper extremity. He was diagnosed with moderate COVID-19, with complication of embolic stroke and myocardial infarction. After administration of IV furosemid and recombinant tissue plasminogen activator (rTPA), his condition improved, and he was discharged from our facility. Case 2: a 54-year-old woman presented with a decreased level of consciousness, skin discoloration, tenderness on her left calf, cough, fever, and shortness of breath. She was diagnosed with moderate COVID-19 with a complication of thrombotic stoke and deep vein thrombosis (DVT). She was treated with rTPA, IV citicoline, and fondaparinux for 5 days. In conclusion, COVID-19 carries a risk of thromboembolic complication. COVID-19 patients have a higher risk of bleeding, therefore, medications, particularly anticoagulant, should be administered with more caution.
يساهم الانتشار المرتفع لتدخين التبغ في ارتفاع معدل الإصابة بالسكتة الدماغية الحادة في إندونيسيا. من المعروف أن تصلب الشرايين الكبير هو سبب مهم للسكتة الدماغية الحادة. هدفت الدراسة الحالية إلى تقييم ...العلاقة بين السكتة الدماغية الحادة وتصلب الشرايين بناءً على قياسات سماكة الطبقة الداخلية للشريان السباتي في مستشفى المستشفيات التخصصية الإندونيسية.
إجمالا، تم تضمين 79 مريضا يعانون من السكتة الدماغية الحادة (مجموعة دراسة الحالة) و 79 فردا بدون سكتة إقفارية حادة (مجموعة التحكم). تم استخدام اختبار كاي تربيع ونسب الأرجحية لمقارنة المجموعات وتحديد ارتباطها. أخذنا في الاعتبار أيضا عوامل مثل العمر، ومؤشر كتلة الجسم، والجنس، وداء السكري من النوع 2، وارتفاع ضغط الدم، وعادات التدخين، وعسر شحميات الدم، والحالة الاجتماعية والاقتصادية، والمستوى التعليمي في التحليلات الإحصائية.
أظهر التقسيم الطبقي لتصلب الشرايين في دراسة الحالة ومجموعات الضبط فيما يتعلق بجميع متغيرات الدراسة علاقة معنوية بين تصلب الشرايين وجميع المتغيرات باستثناء الحالة الاجتماعية والاقتصادية المنخفضة والمستوى التعليمي المنخفض. أظهر تحليل الانحدار أن مؤشر كتلة الجسم 25 كجم / م 2 كان مرتبطا بخطر الإصابة بتصلب الشرايين بمقدار 2.139 ضعفا من مؤشر كتلة الجسم الطبيعي
ارتبطت السكتة الدماغية الحادة بتصلب الشرايين على أساس قياسات سماكة الطبقة الداخلية للشريان السباتي مع مراعاة العمر، ومؤشر كتلة الجسم، والجنس، وارتفاع ضغط الدم من النوع 2، وعادات التدخين، وخلل شحميات الدم، والحالة الاجتماعية والاقتصادية، ومستوى التعليم لدى السكان الإندونيسيين
A high prevalence of tobacco smoking contributes to a high incidence of acute ischemic stroke (AIS) in Indonesia. Large-artery atherosclerosis is known to be a significant cause of AIS. The present study was aimed at evaluating the association between AIS and atherosclerosis on the basis of carotid intima-media thickness (CIMT) measurements in a tertiary care hospital in Indonesia.
A total of 79 patients with AIS (case study group) and 79 individuals without AIS (control group) were included. Chi-squared tests and odds ratios were used to compare the groups and determine associations. We also considered factors such as age, body mass index (BMI), sex, type-2 diabetes mellitus (T2DM), hypertension, smoking status, dyslipidemia, socioeconomic status, and educational level in the statistical analyses. A p-value <0.05 was considered statistically significant.
Stratification of atherosclerosis into case study and control groups with respect to all study variables indicated a significant relationship (p > 0.05) between atherosclerosis and all variables except low socioeconomic status (p = 0.265) and low educational level (p = 0.180). Regression analysis demonstrated that a BMI ≥25 kg/m2, compared with a normal BMI, was associated with a 2.139-fold higher risk of atherosclerosis.
AIS was associated with atherosclerosis, on the basis of CIMT measurements, according to age, BMI, sex, T2DM, hypertension, smoking status, dyslipidemia, socioeconomic status, and education level in the Indonesian population.
Coronavirus disease 2019 (COVID-19) is an infectious disease that was later declared a pandemic. During a pandemic, excessive workloads cause an increase in physical symptoms, such as tension-type ...headaches, in medical personnel. Tension-type headache (TTH) is associated with decreased sleep quality which will lead to excessive daytime sleepiness (EDS) and fatigue syndrome. This study aims to determine the relationship between TTH and sleep quality, EDS, and fatigue syndrome in medical personnel during the pandemic. This study is a cross-sectional study conducted on health workers at Sebelas Maret University Hospital, Surakarta, Indonesia in March–August 2020. The relationship between TTH and three other variables was analyzed using the Spearman correlation test. Multiple logistic regression analysis was used to calculate the odds ratio (OR) of headache associated with the covariate. The Kruskal-Wallis test was used to compare sleep quality, EDS, and fatigue syndrome in the TTH, non-TTH headache, and control groups. There were 120 respondents (mean age 30.93±12.48) in this study. The Spearman correlation test found a weak positive correlation between TTH and the three dependent variables. OR sleep quality, EDS, and fatigue syndrome with the incidence of TTH respectively 2.33 (95% CI=1.18–5.11, p<0.001); 2.52 (CI 95%=1.17–4.79, p=0.001), and 4.46 (95% CI=2.71–7.69, p<0.001). The Kruskal-Wallis test showed that the TTH group had poorer sleep quality and more frequent EDS and fatigue syndrome. There is a significant relationship between TTH and sleep quality, EDS, and fatigue syndrome in medical personnel during the pandemic. HUBUNGAN NYERI KEPALA TIPE TEGANG DENGAN KUALITAS TIDUR, RASA KANTUK BERLEBIHAN DI SIANG HARI, DAN SINDROM KELELAHAN PADA TENAGA MEDIS SELAMA COVID-19Coronavirus disease 2019 (COVID-19) merupakan penyakit menular yang kemudian dinyatakan sebagai pandemi. Selama pandemi, beban kerja yang berlebihan menyebabkan peningkatan gejala fisik, seperti nyeri kepala tipe tegang (tension-type headache) pada tenaga medis. Tension-type headache (TTH) dikaitkan dengan penurunan kualitas tidur yang akan menyebabkan rasa kantuk berlebihan di siang hari (excessive daytime sleepiness, EDS) dan sindrom kelelahan. Penelitian ini bertujuan mengetahui hubungan TTH dengan kualitas tidur, EDS, dan sindrom kelelahan pada tenaga medis selama pandemi. Penelitian ini merupakan studi potong lintang yang dilakukan pada petugas kesehatan di RS Universitas Sebelas Maret, Surakarta, Indonesia pada Maret–Agustus 2020. Hubungan antara TTH dan tiga variabel lainnya dianalisis menggunakan uji korelasi Spearman. Analisis regresi logistik ganda digunakan untuk menghitung odds ratio (OR) nyeri kepala yang terkait dengan kovariat. Uji Kruskal-Wallis digunakan untuk membandingkan kualitas tidur, EDS, dan sindrom kelelahan pada kelompok TTH, nyeri kepala non-TTH, dan kontrol. Terdapat 120 responden (rerata usia 30,93±12,48). Uji korelasi Spearman menemukan korelasi positif lemah antara TTH dan tiga variabel terikat. OR kualitas tidur, EDS, dan sindrom kelelahan dengan kejadian TTH secara berurutan 2,33 (IK 95%=1,18–5,11; p<0,001); 2,52 (IK95 %=1,17–4,79; p=0,001); dan 4,46 (IK 95%=2,71–7,69; p<0,001). Uji Kruskal-Wallis menunjukkan bahwa kelompok TTH memiliki kualitas tidur yang lebih buruk dan lebih sering mengalami EDS, serta sindrom kelelahan. Terdapat hubungan yang signifikan TTH dengan kualitas tidur, EDS, dan sindrom kelelahan pada tenaga medis selama pandemi.
Carotid plaque is a biomarker of generalized atherosclerosis, and may predict ischemic stroke. Carotid intima-media thickness (C-IMT) measurement with ultrasonography imaging could capture the ...condition of carotid plaque. However, manual measurement of C-IMT is observer- dependent, resulting in observer bias and low reproducibility. In this study, we develop artificial intelligence (AI) framework that could automatically measure the C-IMT, and compared it with C-IMT measured by board of expert. This is a retrospective study done in Dr. Moewardi General Hospital, Surakarta, Indonesia. Carotid B-mode ultrasonography images were measured by panel of expert and by AI. After annotation process on Neurabot platform, AI could detect region of interest (ROI), and would do segmentation on the area to measure C-IMT autonomously. Dependent T-test was used to evaluate validity, and Cronbach’s alpha was used to find the reliability of C-IMT measured by panel of expert and AI. There was strong correlation (r=0.874; p=0.014) on dependent t-test for C-IMT measured by AI with C-IMT measured by board of expert. The internal consistency reliability coefficients (Cronbach’s alpha) were 0.938 and 0.909, for pretest and posttest, respectively. We also analyzed the test-retest reliability by comparing pretest and posttest score with dependent t-test, and we observed strong correlation with r=0.871 (p=0.000). AI developed on Neurabot platform are valid and reliable to measure C-IMT.
Background:
Worldwide, stroke is the second leading cause of death and the third leading cause of disability. According to WHO in 2016, 70% of stroke cases were found in low and middle income ...countries, 87% of deaths from stroke were also found in these countries.
Objective:
This study aims to determine the factors that influence the mortality of stroke patients.
Method:
This study was conducted on all stroke patients in the Neuro HCU Dr. Moewardi Hospital in the period January to June 2020. The independent variables were assessed for their effect on patient mortality using a quantitative observational analytic approach with logistic regression analysis.
Results:
There were 124 patients in this study. From eleven variables, only hypertension and stroke type passed the verification test. Further tests were carried out and it was found that patients with hypertension and subarachnoid hemorrhage (SAH) had the highest probability of mortality (0.888).
Conclusion:
The probability of mortality for hypertension and SAH in this study is in accordance with previous studies that hypertension increases the risk of mortality in stroke patients and SAH patients have high mortality and morbidity rates. Therefore, optimizing the management of blood pressure and SAH is needed to reduce the mortality of stroke patients.
The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers.
In this multicentre study, we compared the psychological outcomes during the COVID-19 ...pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes.
From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country.
A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries.
This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.
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