Risultati per: Anticoagulazione nei pazienti con COVID-19

Objectives
Telehealth, the provision of healthcare through digital communication, has been proposed as a potential solution to meet the increasing demand for healthcare, particularly in the setting of the COVID-19 pandemic. Sweden has an established national telehealth service for triage and referral by phone (1177) since 2013 which has the potential to meet this increasing demand. However, little is known about the development and retention in demand during and after the pandemic in Sweden. The objective of this study was to investigate the utilisation of the national telehealth service in Sweden before, during and after the pandemic in relation to emergency department (ED) visits.

Methods
This was a retrospective observational study of telephone calls to the national telehealth service in Sweden. We collected the number of calls, number of answered calls and visits to ED in Sweden from 2017 through 2021, aggregated by month. The difference in number of calls and visits was analysed using Student’s t-test for related samples.

Results
Data were collected from all 21 healthcare regions in Sweden, serving 10.5 million citizens. The average number of monthly calls was 48 (SD 10) calls per 1000 citizens. The first month of the pandemic, March 2020, had the highest monthly calls per capita during the whole study period: 62 (diff 14, 95% CI 9 to 19, p

Objective
To examine inpatient COVID-19-related outcomes among patients with and without diabetes alone or with a history of established heart failure (HF) or established atherosclerotic cardiovascular disease (ASCVD).

Design
Observational study; longitudinal analysis of registry data.

Setting
Hospitals in the USA reporting to the American Heart Association (AHA) COVID-19 Registry from January 2020 to May 2021.

Participants
20 796 individuals with diabetes (11 244 men; mean age 64.2) and 30 798 without diabetes (15 980 men; mean age 59.0) hospitalised for COVID-19 in the USA.

Primary and secondary outcome measures
Primary outcome measures were all-cause mortality, inpatient major adverse cardiovascular events (MACE) and/or inpatient mechanical ventilation. Secondary outcome measures included the association with diabetes and these outcomes among those with and without pre-existing ASCVD and HF and the association with insulin use and these outcomes in patients hospitalised for COVID-19.

Results
After adjustment for relevant covariates diabetes increased the risk of mortality (HR 1.12, 95% CI: 1.03 to 1.21), MACE (HR 1.32, 95% CI: 1.17 to 1.48) and mechanical ventilation (HR 1.33, 95% CI: 1.26 to 1.42). Among patients with established ASCVD or HF, diabetes did not modify the risk of adverse outcomes. There was a significant difference in the risk of mortality between patients taking insulin compared with those who were not (HR 1.32, 95% CI: 1.01 to 1.26); however, there was no difference in the risk of MACE or mechanical ventilation.

Conclusions
Diabetes was associated with a higher risk of in-hospital all-cause mortality, MACE and need for mechanical ventilation in patients hospitalised for COVID-19. Diabetes was independently associated with adverse outcomes, particularly among those without pre-existing cardiovascular disease.

Objectives
This study investigates the relationship between flat rate pricing for unlimited alcohol consumption in restaurants and bar and problematic alcohol consumption patterns identified by the Alcohol Use Disorders Identification Test (AUDIT) during the COVID-19 pandemic.

Methods
A cross-sectional study was conducted using data from the Japan Society and New Tobacco Internet Survey in February 2022. A total of 19 585 current drinkers (55% of drinkers were men, and the mean age was 48.3 years) were categorised based on AUDIT scores; non-problem drinking (an AUDIT Score of 0–7), problem drinking (an AUDIT Score of 8 or over), hazardous alcohol use (an AUDIT Score of 8–14) and probable alcohol use disorders (an AUDIT Score of 15 or over). A score of 2 or higher in the third question of the AUDIT is identified as binge drinking. The explanatory variable was the presence of using flat rate pricing for unlimited alcohol consumption in the previous 12 months during the COVID-19 pandemic (February 2021 to February 2022). The associations of using the flat rate pricing with the problem or binge drinking, and with hazardous alcohol use or probable alcohol use disorders were analysed.

Results
People who used flat rate pricing during the COVID-19 pandemic were likely to be problem drinking and binge drinking compared with non-users of flat rate pricing; the respective adjusted ORs were 4.64 (95% CI: 4.24 to 5.07) and 3.65 (95% CI: 3.33 to 4.00) through multivariable binary logistic regression. The users of the flat rate pricing were associated with hazardous alcohol use and probable alcohol use disorder; the adjusted relative risk ratios were 3.40 (95% CI: 3.06 to 3.77) and 8.58 (95% CI: 7.51 to 9.80) through multinomial logistic regression.

Conclusions
Overall, using flat rate pricing for unlimited alcohol consumption was associated with both binge drinking and problem drinking, including hazardous alcohol use and probable alcohol use disorders.

In questi grandi raduni internazionali serve una sorveglianza epidemiologica per monitorare eventuali focolai di contagio di virus respiratori

A un anno da impianto microchip, leggono fino a 12 righe in più

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

The US Food and Drug Administration (FDA) recently granted authorization to market the first at-home influenza and COVID-19 combination test outside of emergency use.

Introduction
Understanding how RNA viral load changes (viral load kinetics) during acute infection in SARS-CoV-2 can help to identify when and which patients are most infectious. We seek to summarise existing data on the longitudinal RNA viral load kinetics of SARS-CoV-2 sampled from different parts of the respiratory tract (nose, nasopharynx, oropharynx, saliva and exhaled breath) and how this may vary with age, sex, ethnicity, immune status, disease severity, vaccination, treatment and virus variant.

Methods and analysis
We will conduct a systematic review and meta-analysis, using studies identified through MEDLINE and EMBASE (via Ovid). All research studies reporting primary data on longitudinal RNA viral load kinetics of infected patients with SARS-CoV-2 will be included. Methodological quality will be assessed using a validated checklist for longitudinal studies as well as predefined quality criteria for assessment of individual-level RNA viral load. Should the data allow, we will aim to perform individual patient-level meta-analysis. Our primary outcomes are duration to, and quantity of peak RNA viral load, and total duration of viral load shedding within different respiratory compartments. Secondary outcomes include duration of lateral flow antigen and virus culture positivity and variation of RNA viral load by age, immune status, disease severity, vaccination, treatment, lateral flow tests, viral culture positivity and SARS-CoV-2 variant. Study-level effects affecting observations, but not related to properties of the patient, such as the PCR platform and gene target will also be recorded. Random-effects models will estimate the population mean and individual-level variation in viral shedding conditional on the aforementioned variables. Finally, we will summarise the key mechanistic models used in the literature to reconstruct individual-level viral kinetics and estimate how different factors shape viral dynamics over time.

Ethics and dissemination
Ethical approval is not needed as data will be obtained from published articles or studies with data that have already received and ethical review for analysis. Manuscript(s) will be prepared for publication.

Systematic review protocol registration
PROSPERO ID: CRD42023385315

Incontro a Treviso, 2.500 nuovi casi e 61 morti in una settimana

This cohort study investigates the long-term risk of autoimmune and autoinflammatory diseases among patients in South Korea who had a COVID-19 diagnosis using an extended observational period.

The COVID-19 pandemic is officially endemic, with more than 775 million cases now reported by the World Health Organization. Thanks to the effectiveness of vaccination combined with natural immunity, SARS-CoV-2 infection is no longer the novel and life-threatening virus it was in the early days of the pandemic, although it still carries risk to some.

Objectives
We aimed to assess the effects of risk-based travel restrictions on (1) international travel frequency, (2) SARS-CoV-2 case importation risk, (3) national SARS-CoV-2 incidence and (4) importation of SARS-CoV-2 variants into Scotland.

Design
Population-based surveillance study.

Setting
The study utilises SARS-CoV-2 community testing from February 2021 to May 2022 in Scotland, UK and spans the introduction of the UK’s ‘traffic light system’ policy in May 2021.

Primary outcome measures
Travel-related cases of COVID-19 were defined as PCR-positive Scottish residents self-reporting international travel within 14 days of booking a postarrival travel test. The Red-Amber-Green (RAG) status of the reported travel destination was determined through data linkage using country and date.

Results
International flight passengers arriving into Scotland increased by 754% during the traffic light period. Amber list countries were the most frequently visited and ranked highly for both SARS-CoV-2 importations and contribution to national case incidence. Rates of international travel and associated SARS-CoV-2 case rates varied significantly across age, health board and deprivation groups. Multivariable logistic regression revealed SARS-CoV-2 case detections were less likely through travel-based than community-based surveillance systems, although increased from green-to-amber and amber-to-red lists. When examined according to travel destination, SARS-CoV-2 importation risks did not strictly follow RAG designations, and red lists did not prevent establishment of novel SARS-CoV-2 variants.

Conclusions
Our findings suggest that country-specific postarrival screening undertaken in Scotland did not prohibit the public health impact of COVID-19 in Scotland. Travel rates likely contributed to patterns of SARS-CoV-2 case importation and population incidence.

Solo nel 2023 il valore dei ricoveri fuori Regione ha sfiorato i 3 miliardi, Con Emilia Romagna, Lombardia e Veneto ad attrarre più di tutti

Objective
The impact of COVID-19 on medical students has predominantly been assessed by one-off survey studies at the pandemic onset. This national study investigated the sustained impacts of the COVID-19 pandemic on medical students’ rural clinical placement learning and well-being.

Design
Repeated cross-sectional survey design.

Setting
Annual Federation of Rural Australian Medical Educators (FRAME) survey across 2020 to 2022.

Participants
Medical students completing an extended (mostly 12 months) rural placement.

Outcome measure
A mixed-methods survey with closed-ended and open-ended question. Quantitative data were analysed using 2 and Kruskal-Wallis tests. Qualitative responses were analysed through content analysis.

Results
Quantitative findings: in 2022 (43%), respondents were more likely to interact with COVID-19 patients in a clinical capacity compared with 2020 (26%) and 2021 (23%; p

Objective
The aim of this study was to determine how the COVID-19 pandemic affected patient demographics, injury mechanisms, interhospital transfers and mortality of patients with traumatic brain injuries (TBIs) treated in US emergency departments (EDs).

Design
This cross-sectional study analysed 2016–2020 Nationwide Emergency Department Sample (NEDS) data.

Setting
US EDs contained in the NEDS.

Participants
Participants were patients with moderate and severe TBI who visited the ED.

Primary and secondary outcome measures
Probability sampling design and survey weights generated nationally representative estimates of ED visits by patient demographics, hospital characteristics and COVID-19 diagnosis and the top four leading TBI causes. To assess COVID-19 impact, we calculated the per cent change of estimated TBI ED visits and disposition outcomes from 2016 to 2019 and 2019 to 2020, and proportion and 95% CI of injury severity groups and admitted/transfer by hospital type and trauma centre level. A multivariable logistic regression model identified the mortality OR by patient demographics, injury severity, hospital characteristics and COVID-19 positive diagnosis.

Results
In 2020, there were 527 123 ED visits nationally for TBI, 4.3% higher than 2016 but 1.0% lower than 2019. Patients with TBI transferring to short-term hospitals and other facilities increased by 16.0% and 18.2%, respectively, from 2016 to 2019 and were 3.7% and 14.1% higher in 2020 than in 2019. An estimated 3317 patients with TBI died (in ED or later in hospital) in 2020, which is 9.8% higher than 2019. Firearm-related TBI proportion was 15.1% higher in 2020 than in 2019. Patients with TBI with injury severity scores 25–75 were significantly higher at nontrauma (29.4% vs 31.9 %) and level III trauma centres (34.9% vs 38.2%) in 2020 than in 2019. Patients with TBI treated at rural hospitals had significantly higher odds of mortality (OR=1.95, CI=1.58–2.40) than those at urban hospitals.

Conclusions
TBI patient mortality was higher at all US hospital types and almost all trauma centre levels in 2020 than in 2019. Patients with TBI treated at rural hospitals had a significantly higher mortality risk.