Risultati per: Long COVID: principali risultati, meccanismi e raccomandazioni

Objectives
Long-acting reversible contraception (LARC) provides continuous pregnancy prevention to women for a period of 3 to 12 years, and it is very safe and effective. The aim of this study was to determine the prevalence, determinants and willingness to use LARC among undergraduate female students attending public and private universities in Ekiti State, Southwest Nigeria

Design
This survey employed a cross-sectional comparative study design.

Setting
Public and private universities in Ekiti State, Southwest Nigeria.

Participants
418 female students in their undergraduate years at public and private universities (208 students in public universities and 210 students in private universities).

Primary and secondary outcomes
A semistructured questionnaire was used to gather data, and analysis was done using IBM SPSS V.25. Prevalence, willingness and determinants of LARC were determined and compared between public and private universities at the level of bivariate analysis using 2. Multivariate regression analysis was used to determine the predictor of LARC use. The statistical significance level was placed at a p value of

Annals of Internal Medicine, Ahead of Print.

Objective
To identify the early predictors of a self-reported persistence of long COVID syndrome (LCS) at 12 months after hospitalisation and to propose the prognostic model of its development.

Design
A combined cross-sectional and prospective observational study.

Setting
A tertiary care hospital.

Participants
221 patients hospitalised for COVID-19 who have undergone comprehensive clinical, sonographic and survey-based evaluation predischarge and at 1 month with subsequent 12-month follow-up. The final cohort included 166 patients who had completed the final visit at 12 months.

Main outcome measure
A self-reported persistence of LCS at 12 months after discharge.

Results
Self-reported LCS was detected in 76% of participants at 3 months and in 43% at 12 months after discharge. Patients who reported incomplete recovery at 1 year were characterised by a higher burden of comorbidities (Charlson index of 0.69±0.96 vs 0.31±0.51, p=0.001) and residual pulmonary consolidations (1.56±1.78 vs 0.98±1.56, p=0.034), worse blood pressure (BP) control (systolic BP of 138.1±16.2 vs 132.2±15.8 mm Hg, p=0.041), renal (estimated glomerular filtration rate of 59.5±14.7 vs 69.8±20.7 mL/min/1.73 m2, p=0.007) and endothelial function (flow-mediated dilation of the brachial artery of 10.4±5.4 vs 12.4±5.6%, p=0.048), higher in-hospital levels of liver enzymes (alanine aminotransferase (ALT) of 76.3±60.8 vs 46.3±25.3 IU/L, p=0.002) and erythrocyte sedimentation rate (ESR) (34.3±12.1 vs 28.3±12.6 mm/h, p=0.008), slightly higher indices of ventricular longitudinal function (left ventricular (LV) global longitudinal strain (GLS) of 18.0±2.4 vs 17.0±2.3%, p=0011) and higher levels of Hospital Anxiety and Depression Scale anxiety (7.3±4.2 vs 5.6±3.8, p=0.011) and depression scores (6.4±3.9 vs 4.9±4.3, p=0.022) and EFTER-COVID study physical symptoms score (12.3±3.8 vs 9.2±4.2, p

Objectives
To assess the prevalence of UK healthcare workers (HCWs) who reported symptoms of COVID-19 lasting for longer than 5 weeks and examine associated factors with experiencing long COVID in an ethnically diverse cohort.

Design
A cross-sectional study using data from the UK Research study into Ethnicity And COVID-19 Outcomes in HCWs cohort study.

Setting
Data were collected electronically between December 2020 and March 2021.

Participants
Individuals aged 16 years or older, residing in the UK, and working as HCWs or ancillary workers in a healthcare setting and/or registered with one of the seven major UK healthcare professional regulators.

Primary and secondary outcome measures
The main outcome was long COVID (symptoms >5 weeks). The primary exposure of interest was self-reported ethnicity. We employed univariable and multivariable logistic regression to identify associations. We adjusted for demographic information, health status and existing long-term conditions in our multivariate analysis.

Results
In our analysis of 11 513 HCWs, we found that 2331 (20.25%) reported COVID-19, of whom 525 (22.52%) experienced long COVID. There were no significant differences in risk of long COVID by ethnic group. In terms of other demographic characteristics, the majority of those experiencing long COVID were female (80.0%) and were slightly older than those who did not experience long COVID (median age 46 (IQR 36–54)). In multivariable analyses of those who reported having had COVID-19, HCWs in nursing/midwifery roles (adjusted OR (aOR) 1.76, 95% CI 1.26 to 2.46; p=0.001) and allied health professions (aOR 1.42, 95% CI 1.05 to 1.93; p=0.023) had higher odds of experiencing long COVID compared with those in medical roles. Other factors significantly associated with long COVID included self-reported psychological conditions (eg, depression and anxiety) and respiratory conditions (eg, asthma).

Conclusions
In this large ethnically diverse cohort study, more than one in five UK HCWs reported experiencing long COVID after acute COVID-19 during the first year of the pandemic. We found that specific demographic (older age and female gender) and occupational factors (nursing/midwifery and allied health professions) were associated with higher odds of long COVID. Notably, there were no significant differences in the risk of long COVID by ethnic group. Further research and collaborative efforts are urgently needed to address these factors effectively, develop targeted interventions and understand the temporal and longitudinal dynamics of the condition.

The Centers for Disease Control and Prevention (CDC) recommended a second dose of the 2024-2025 COVID-19 vaccine, administered 6 months after the first dose, for people aged 65 years or older and individuals who are immunocompromised.

Objectives
To evaluate the effectiveness of localised Tier 3 restrictions, implemented in England in December 2020, on reducing COVID-19 hospitalisations compared with less stringent Tier 2 measures and the variations by neighbourhood deprivation and the prevalence of Alpha (B.1.1.7) variant, the primary variant of concern then, to measure hospital services’ burden and inequalities across different communities.

Design
Observational study using a synthetic control method, comparing weekly hospitalisation rates in Tier 3 areas to a synthetic control from Tier 2 areas.

Setting
England between 4 October 2020 and 21 February 2021.

Participants
23 million people under Tier 3 restrictions, compared with a synthetic control group derived from 29 million people under Tier 2 restrictions.

Interventions
Tier 3 restrictions in designated areas were implemented from 7 December 2020, imposing stricter limits on gatherings and hospitality than Tier 2, followed by a national lockdown on 6 January 2021.

Primary and secondary outcome measures
Weekly COVID-19-related hospitalisations for neighbourhoods in England over 11 weeks following the interventions.

Results
Implementing Tier 3 restrictions were associated with a 17% average reduction in hospitalisations compared with Tier 2 areas (95% CI 13% to 21%; 8158 (6286 to 9981) in total). The effects were similar across different levels of neighbourhood deprivation and prevalence of the Alpha variant.

Conclusions
Regionally targeted Tier 3 restrictions in England had a moderate but significant effect on reducing hospitalisations. The impact did not exacerbate socioeconomic inequalities during the pandemic. Our findings suggest that regionally targeted restrictions can be effective in managing infectious diseases.

Objectives
To explore the impact of the SARS-CoV-2/COVID-19 pandemic on the diagnosis, management and patient journey for children and young people with a newly diagnosed brain tumour in the UK.

Design
Exploratory qualitative study focused on patient journeys from multiple perspectives, conducted as part of a wider mixed-methods study.

Setting
Three paediatric oncology tertiary centres in the UK.

Participants
10 children and young people with brain tumours (n=6 females, n=4 males), 20 caregivers (n=16 females, n=4 males) and 16 stakeholders (specialist nurses, consultant neurosurgeons and oncologists, and representatives from brain tumour charities) were interviewed between January 2022 and June 2023.

Results
The paper incorporates multiple perspectives, including those of children and young people, parents/caregivers, clinical staff and charity representatives, to explore the patient journey. Five themes describe the journey for new patients with paediatric brain tumour during the pandemic, focusing on (1) challenges getting into the healthcare system, (2) managing as a family during restrictions imposed by the pandemic, (3) complexities of building a cohesive and supportive healthcare team, (4) difficulties caregivers experienced in accessing practical and emotional support in hospital and (5) ongoing difficulties experienced by families in the community.

Conclusions
Findings from this study offer practical insights from children, parents/caregivers and relevant stakeholders to improve the healthcare system during future disruptions. Overall, this study not only sheds light on the challenges faced by families during the pandemic but also provides suggestions for improving healthcare services to ensure a more comprehensive and effective response in times of crisis.

Objective
This qualitative study sought to understand how sufficient economy philosophy (SEP) was applied to cope with and recover from the COVID-19 pandemic.

Design
A qualitative study conducted through focus group discussions.

Participants
19 focus groups, with 161 participants, selected for the diverse backgrounds in gender, profession, education and region (urban/rural) and different levels of impact from the pandemic.

Setting
Bangkok, the capital city, and the four regions of Thailand: north, northeast, south and central.

Findings
Participants highlighted the moderation, reasonableness and prudence as key themes that mitigated adverse economic impacts during the pandemic. Communities practising the SEP reported resilience through balanced consumption, prudent planning and social cooperation. Many participants mentioned that the SEP was crucial to their survival and should have been better practised. Though the market structure failed during the pandemic, they still could secure the essential items to maintain livelihood.

Conclusion
In a society where changes are complicated by multiple factors, crises may occur more frequently, unsuspectedly and in various forms. Tools and a mechanism for resilience are increasingly needed. This study highlights the importance of the SEP, which incorporates five key concepts: moderation, reasonableness, prudence, knowledge and morality. These concepts help affected communities survive and become resilient, which is crucial for achieving several Sustainable Development Goals, such as poverty and hunger reduction, enhanced health and well-being and the sustainability of cities and communities.

Nella settimana prima delle feste si sono aggiunti quasi 600mila pazienti, numeri in crescita ma inferiori alla stagione record dell’anno scorso

Background
Following the COVID-19 pandemic, there was an increase in teenage pregnancies nationally, however, limited data exists regarding the same among girls living in refugee settlements.

Objectives
We evaluated the prevalence of teenage pregnancy and associated factors in Palorinya and Bidi Bidi refugee settlements in Obongi and Yumbe districts of northern Uganda, in the post-COVID-19 era.

Design
We conducted a cross-sectional study.

Setting
Refugee settlements in northern Uganda.

Participants
We included 385 teenage girls aged 15–19 years.

Methods
We used convenience sampling techniques between March and May 2023. Prevalence of teenage pregnancy was assessed by self-reported pregnancies between January 2020 and May 2023 among participants. We conducted Pearson’s 2 and Fisher’s exact tests for bivariate analysis. All variables with a p value

Objectives
To examine quality of maternal and newborn care (QMNC) around childbirth in facilities in Belgium during the COVID-19 pandemic and trends over time.

Design
A cross-sectional observational study.

Setting
Data of the Improving MAternal Newborn carE in the EURO region study in Belgium.

Participants
Women giving birth in a Belgian facility from 1 March 2020 to 1 May 2023 responded a validated online questionnaire based on 40 WHO standards-based quality measures organised in four domains: provision of care, experience of care, availability of resources and organisational changes related to COVID-19.

Primary and secondary outcome measures
Quantile regression analysis was performed to assess predictors of QMNC; trends over time were tested with the Mann-Kendall test.

Results
897 women were included in the analysis, 67% (n=601) with spontaneous vaginal birth, 13.3% (n=119) with instrumental vaginal birth (IVB) and 19.7% (n=177) with caesarean section. We found overall high QMNC scores (median index scores >75) but also specific gaps in all domains of QMNC. On provision of care, 21.0% (n=166) of women who experienced labour reported inadequate pain relief, 64.7% (n=74) of women with an instrumental birth reported fundal pressure and 72.3% (n=86) reported that forceps or vacuum cup was used without their consent. On experience of care, 31.1% (n=279) reported unclear communication, 32.9% (n=295) reported that they were not involved in choices,11.5% (n=104) stated not being treated with dignity and 8.1% (n=73) experienced abuse. Related to resources, almost half of the women reported an inadequate number of healthcare professionals (46.2%, n=414). Multivariable analyses showed significantly lower QMNC scores for women with an IVB (–20.4 in the 50th percentile with p

Objective
This study aims to examine the reduction and subsequent recovery of routine digital screening (RDS) uptake in England from 2018 to 2022, exploring national, regional and individual Diabetic Eye Screening Programme (DESP) levels. The COVID-19 lockdown in most areas of England was from 26 March 2020 to 23 June 2020 (first national lockdown), 5 November 2020 to 2 December 2020 (second national lockdown) and 6 January 2021 to 8 March 2021 (third national lockdown).

Design
Retrospective data analysis.

Setting
DESPs of England.

Participants
Individuals with diabetes who were invited to take part in the DESP programmes.

Methods
Publicly available data from Public Health England (2018–2019) and National Health Service England (2019–2022) were examined to identify the rate of uptake (proportion of those who attended the DESPs to those who were invited) of RDS at national and regional levels and by each DESP in England.

Primary outcome measures
Rate of uptake of RDS.

Results
The national uptake of RDS decreased from 82% (2019–2020) to 68% (2020–2021) and then increased to 78% (2021–2022). At the regional level, the sharpest drop was in the Midlands which decreased from 79% (2019–2020) to 53% (2020–2021), increasing to 73% (2021–2022) but did not reach pre-COVID-19 levels. At individual DESP levels across England, the greatest drop in attendance (2020–2021) was recorded in Derbyshire (79% to 45%), Barnsley and Rotherham (78% to 45%) and Arden, Herefordshire and Worcestershire (78% to 46%). Although these DESPs showed an increase in 2021–2022 of 33%, 21% and 31%, they did not reach prepandemic (2018–2019) rates of 81%, 85% and 82%, respectively. Data suggest that West Sussex, East Sussex and East and North Hertfordshire DESPs maintained relatively higher uptake rates (86%–89%) in 2020–2021.

Conclusion
COVID-19 had an impact on England’s diabetic eye screening attendance, with notable variations across regions and DESPs. Different regions and DESPs showed variable post-COVID-19 recovery. More importantly, what was not evident is the increased uptake that should have occurred after the COVID-19 lockdown to compensate for the low uptake during the lockdown. In some areas, addressing some of the barriers that affect retinal screening uptake may improve future attendance.

Introduction
Urinary incontinence is associated with social isolation, deconditioning, depression, falls and early mortality. It impairs quality of life, even in residents of nursing homes, and, in the community, increases the risk of institutionalisation. Care focused on the preservation of dignity during intimate care is important in the care of older adults. Despite this, there are few data which seek to define the quality of care or desired outcomes of care from the older adult’s perspective. This scoping review aims to assess the research literature addressing the question of what is known about the quality of continence care from the perspective of older adults ( >65 years old) in long-term care and from those in receipt of home care to identify gaps in the literature and direct further research.

Methods and analysis
The Joanna Briggs Institute (JBI) method will be followed. The CINAHL, Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, SCOPUS, PROSPERO, Web of Science and JBI Evidence Synthesis databases will be searched using keywords for publications within the last 20 years without restriction on publication type or language. A search of grey literature and websites will be conducted. Reference lists of the retrieved articles will be used to identify additional literature. A preliminary search of MEDLINE was performed (21 November 2023), to identify articles. Search results will be exported into a management tool for screening and analysis. Article screening will be undertaken by two authors, and a third will be included if needed to resolve any differences. Data analysis will be guided by theoretical frameworks. The protocol for this study was registered at Open Science Framework (https://osf.io/bprq9/).

Potential impact
Information on what constitutes quality of care or desired outcomes of care from the perspective of this segment of the population is lacking. This review will synthesise knowledge and provide research direction. Findings can potentially lead to new directions in the provision of care for vulnerable older adults.

Ethics and dissemination
Formal ethics approval for a scoping review is not required. The results will be published in a high-impact journal with a focus on open access publication.

Objectives
To investigate the social support status and associated factors among Vietnamese methadone maintenance patients during the COVID-19 pandemic.

Design
Cross-sectional study.

Setting
Three methadone clinics.

Participants
540 patients.

Primary and secondary outcome measures
The Medical Outcomes Study—Social Support Survey questionnaire was employed to measure patients’ social support. Factors associated with the social support status of patients were determined through multivariate linear regression models. Variables in these models were selected using the Bayesian model averaging method.

Results
The average social support score of patients was 63.50±26.54 (ranger: 0–100). The average social support scores of patients living in mountainous areas (Dien Bien: 63.74±23.67, Son La: 46.15±20.31) were significantly lower than that of patients residing in metropolitan areas (Hanoi: 80.61±23.47) (p

Stroke, Ahead of Print. BACKGROUND:Sparse information regarding the long-term risk of acute myocardial infarction (MI) following a transient ischemic attack (TIA) emphasizes further research to guide preventive strategies and risk stratification in patients with a TIA.METHODS:We conducted a nationwide cohort study to investigate the 5-year risk of MI and all-cause mortality in patients with a first-time TIA. Patients with a first-time TIA were identified in the Danish Stroke Registry (2013–2020), matched on age, sex, and calendar year (1:4) with the general population and (1:1) with patients with first-time ischemic stroke. The 5-year risks of MI and all-cause mortality were estimated by the Aalen-Johansen and Kaplan-Meier estimators. The groups were compared using Cox regression, while adjusting for cardiovascular comorbidities.RESULTS:We identified 21 743 patients with TIA, 86 972 matched individuals from the general population, and 21 743 matched control patients with ischemic stroke. Median age was 70 (25th to 75th percentile, 60–78) years; 52% were male. Comorbidity burden was the lowest in general population controls, intermediate in patients with TIA, and the highest in patients with ischemic stroke. The 5-year risk of MI was 2.0% in patients with TIA, 1.5% in the general population (P

Stroke, Ahead of Print. BACKGROUND:Long-term patterns of functional outcome after intracerebral hemorrhage (ICH) have not been well elucidated in population-based studies from low- and middle-income countries. The aim of this study was to define long-term functional outcomes, associated prognostic factors, and recovery patterns for patients with acute ICH.METHODS:We conducted a prospective population-based stroke incidence study in Ulaanbaatar, Mongolia, with prospective follow-up. Multiple overlapping strategies were used to prospectively ascertain all strokes over 2 years. Patients were followed up at 28, 90, and 365 days. Associated factors of unfavorable outcome (defined as modified Rankin Scale scores, 3–6) and death at 365 days were identified using separate binary logistic regressions. Recovery pattern in terms of the proportions of patients with favorable outcomes (defined as modified Rankin Scale scores, 0–2) as the outcome was analyzed over time at 28, 90, and 365 days using generalized estimating equations with baseline covariates.RESULTS:A total of 1172 first-ever ICH cases were registered. Among these patients, 625 (56.4% of available modified Rankin Scale) cases had died and 853 (77.0%) had an unfavorable outcome at 365 days. The proportion of favorable outcomes increased from 12.1% at day 28 to 17.4% at day 90 and then to 23.0% at 1 year. Multivariable analysis revealed that older age, low socioeconomic status, absence of hypertension, hospital admission, neurosurgical intervention, and ICH severity, side, and intraventricular extension were independently associated with death/unfavorable outcome 365 days post-ICH. Most of these factors were also associated with the recovery pattern.CONCLUSIONS:The prognosis from ICH in low- and middle-income countries is dismal, with 56% of patients dead and 77% having an unfavorable functional outcome at 365 days, although there was a pattern of continuous recovery over this time period. These findings stress the importance of developing effective primary prevention and continuous active care for survivors to reduce the burden of ICH in low- and middle-income countries.