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"Die Innenstadt braucht den Handel, der Handel aber nicht die Innenstadt", lautet eine oft formulierte These bezüglich des Verhältnisses von Handel und Innenstadt – nicht erst seit der Covid-19-Pandemie. Die Krise hat die Herausforderungen des Strukturwandels im Einzelhandel erneut offengelegt und teils Entwicklungen beschleunigt. Besonders hervorzuheben sind zum einen Handlungsbedarfe im Bereich der Digitalisierung sowie die dringende Notwendigkeit einer überdachten Auseinandersetzung über das Verhältnis von Innenstadt und Einzelhandel. Neben Fragen zur zukünftigen Gestaltung des Einzelhandels und seiner Bedeutung für Innenstädte, sind auch Fragen zur Bedeutung anderer Branchen/Einrichtungen/Angebote (z.B. Gastronomie, Handwerk, Kultureinrichtungen, Kitas, Sport- und Bildungseinrichtungen, aber auch Freiräume, Grünflächen, verkehrsberuhigte Bereiche oder lokale Kurierdienste) für den Einzelhandel vermehrt aus Perspektive der geographischen Handelsforschung zu beantworten. Mit der Krise wurden Defizite und Handlungsfelder in den Blick gerückt, deren Bearbeitung schon lange ansteht. Die Chance liegt darin, diesen Aufmerksamkeitsschub konstruktiv zu nutzen und realistische fall- und standortspezifische Perspektiven für Innenstädte und ihre Akteur*innen jetzt zu verhandeln und nicht weiter auf die lange Bank zu schieben. Der vorliegende Band vereint neun handelsgeographische Beiträge von Wissenschaftler*innen und Praktiker*innen, die die Auswirkungen der Covid-19-Pandemie erörtern und damit einen wichtigen Beitrag für die notwendige Diskussion der Zukunft von Innenstädten und Handel leisten.
Background
The onset of mental illness such as depression and anxiety disorders in pregnancy and postpartum period is common. The coronavirus induced disease 2019 (COVID-19) pandemic and the resulting public policy responses represent an exceptional situation worldwide and there are hints for adverse psychosocial impact, hence, the study of psychological effects of the pandemic in women during hospitalization for delivery and in the postpartum period is highly relevant.
Methods
Patients who gave birth during the first wave of the COVID-19 pandemic in Germany (March to June 2020) at the Department of Obstetrics and Gynecology, University of Würzburg, Germany, were recruited at hospital admission for delivery. Biosamples were collected for analysis of SARS-CoV-2 infection and various stress hormones and interleukin-6 (IL-6). In addition to sociodemographic and medical obstetric data, survey questionnaires in relation to concerns about and fear of COVID-19, depression, stress, anxiety, loneliness, maternal self-efficacy and the mother–child bonding were administered at T1 (delivery stay) and T2 (3–6 months postpartum).
Results
In total, all 94 recruited patients had a moderate concern of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at T1 with a significant rise at T2. This concern correlated with low to low-medium general psychosocial stress levels and stress symptoms, and the women showed a significant increase of active coping from T1 to T2. Anxiety levels were low and the Edinburgh Postnatal Depression Scale showed a medium score of 5 with a significant (T1), but only week correlation with the concerns about SARS-CoV-2. In contrast to the overall good maternal bonding without correlation to SARS-CoV-2 concern, the maternal self-efficiency correlated negatively with the obstetric impairment caused by the COVID-19 pandemic.
Conclusion
Obstetric patients` concerns regarding SARS-CoV-2 and the accompanying pandemic increased during the course of the pandemic correlating positively with stress and depression. Of note is the increase in active coping over time and the overall good mother–child-bonding. Maternal self-efficacy was affected in part by the restrictions of the pandemic.
Background
Severe COVID-19 induced acute respiratory distress syndrome (ARDS) often requires extracorporeal membrane oxygenation (ECMO). Recent German health insurance data revealed low ICU survival rates. Patient characteristics and experience of the ECMO center may determine intensive care unit (ICU) survival. The current study aimed to identify factors affecting ICU survival of COVID-19 ECMO patients.
Methods
673 COVID-19 ARDS ECMO patients treated in 26 centers between January 1st 2020 and March 22nd 2021 were included. Data on clinical characteristics, adjunct therapies, complications, and outcome were documented. Block wise logistic regression analysis was applied to identify variables associated with ICU-survival.
Results
Most patients were between 50 and 70 years of age. PaO\(_{2}\)/FiO\(_{2}\) ratio prior to ECMO was 72 mmHg (IQR: 58–99). ICU survival was 31.4%. Survival was significantly lower during the 2nd wave of the COVID-19 pandemic. A subgroup of 284 (42%) patients fulfilling modified EOLIA criteria had a higher survival (38%) (p = 0.0014, OR 0.64 (CI 0.41–0.99)). Survival differed between low, intermediate, and high-volume centers with 20%, 30%, and 38%, respectively (p = 0.0024). Treatment in high volume centers resulted in an odds ratio of 0.55 (CI 0.28–1.02) compared to low volume centers. Additional factors associated with survival were younger age, shorter time between intubation and ECMO initiation, BMI > 35 (compared to < 25), absence of renal replacement therapy or major bleeding/thromboembolic events.
Conclusions
Structural and patient-related factors, including age, comorbidities and ECMO case volume, determined the survival of COVID-19 ECMO. These factors combined with a more liberal ECMO indication during the 2nd wave may explain the reasonably overall low survival rate. Careful selection of patients and treatment in high volume ECMO centers was associated with higher odds of ICU survival.