Risultati per: Vaccinare l’adulto ai tempi del COVID-19

This Medical News article discusses new US household survey data that found differences in long COVID rates based on preexisting chronic conditions and other factors.

Objectives
To determine acceptability and feasibility of a theatre-based wellness programme to support the health and well-being of people with long COVID.

Design
Single-group, repeated-measures feasibility study.

Setting
Community centre and online.

Participants
Adults with diagnosed long COVID experiencing breathlessness, pain and/or loneliness.

Intervention
Six-week participatory creative programme delivered to one online and one in-person group facilitated by movement, voice and drama consultants using breathing, visualisation, singing, poetry, storytelling and movement exercises.

Primary outcome measures
Programme acceptability and feasibility measured via uptake, reasons for non-attendance and barriers to engagement.

Secondary outcome measures
Feasibility of recruitment and data collection procedures measured through proportion of missing data and follow-up rates, mechanisms of action of the programme identified through qualitative interviews, changes in mental health, well-being, quality of life, loneliness, social support, fatigue, breathlessness and post-COVID-19 functional status at 8-week follow-up.

Results
21 people expressed interest in participating, 20 people took part in the programme, 19 completed baseline and 16 completed follow-up assessments. Participants attended an average of 4.8 of 6 sessions (SD=1.5, range 2–6). Exploratory analyses demonstrated significant improvements in self-rated health (t-test mean difference=0.12, 95% CI=0.00, 0.23, p=0.04) and chronic fatigue symptoms (mean difference=–3.50, 95% CI=–6.97, –0.03, p=0.05) at 8 weeks. Key mechanisms of action that supported health and well-being included: increased sense of community, illness acceptance, experiencing joy, increased confidence in managing everyday life, increased ability to relax and reconnection with previous identity. Barriers to engagement included: activities being outside of the participant’s comfort zone, ongoing long COVID symptoms, emotional consequences of sharing experiences and connectivity and connecting online.

Conclusions
A 6-week theatre-based programme was perceived as acceptable to most participants and resulted in some positive psychosocial impacts. The findings provide a rationale for supporting the ongoing development and scale-up of this and related arts programmes to support people living with long COVID.

Circulation, Volume 150, Issue 1, Page 82-85, July 2, 2024.

Early in the COVID-19 pandemic, in response to hospital overcrowding, some state governments mandated that nursing homes could not refuse patients transferred from hospitals based on their COVID-19 status. Other states provided financial incentives for nursing homes to accept such patients. In this issue of JAMA Internal Medicine, McGarry and colleagues examine the consequences of these actions and quantify the harm it caused in a well-designed and clearly presented study. They studied nursing homes in the weeks before and after admission of a patient infected with COVID-19, compared with matched facilities in the same locale with no such admissions. They estimated that each COVID-19–positive admission was associated with approximately 6 additional infections and 1.5 additional deaths among the facility residents in the 15 weeks after the COVID-19 admission.

This cohort study evaluates the changes in COVID-19 case counts and death rates among residents of skilled nursing facilities (SNFs) weeks before and weeks after their facility accepted hospital-discharged patients who still had COVID-19.

Il 30 giugno è la scadenza dell’ultima proroga dell’ordinanza del ministero della Salute che ora è pronto a togliere l’obbligo

Introduction
Although the prognosis of Langerhans cell histiocytosis (LCH) is excellent, the high recurrence rate and permanent consequences, such as central diabetes insipidus and LCH-associated neurodegenerative diseases, remain to be resolved. Based on previous reports that patients with high-risk multisystem LCH show elevated levels of inflammatory molecules, we hypothesised that dexamethasone would more effectively suppress LCH-associated inflammation, especially in the central nervous system (CNS). We further hypothesised that intrathecal chemotherapy would effectively reduce CNS complications. We administer zoledronate to patients with multifocal bone LCH based on an efficacy report from a small case series.

Methods and analysis
This phase II study (labelled the LCH-19-MSMFB study) is designed to evaluate the significance of introducing dexamethasone and intrathecal chemotherapy for multisystem disease and zoledronate for multifocal bone disease in previously untreated, newly diagnosed children, adolescents (under 20 years) and adults under 40 years. The primary endpoint is the 3-year event-free survival rate by risk group of under 20 years and the 3-year event-free survival rate of 20 years and over.

Ethics and dissemination
This study was approved by the Central Review Board of the National Hospital Organisation Nagoya Medical Centre (Nagoya, Japan) on 21 January 2022 and was registered in the Japan Registry of Clinical Trials (https://jrct.niph.go.jp/en-latest-detail/jRCTs041210027). Written informed consent will be obtained from all patients and/or their guardians.

Trial registration number
jRCTs041210027.

Objectives
To identify the needs of people with long COVID (LC) in the UK.

Design
Qualitative study using the Framework Analysis to analyse focus group discussions.

Participants
25 adults with LC aged 19–76 years including 17 men and 8 women. Average disease duration was 80.1 weeks.

Setting
Eight focus groups were conducted in April 2023 online and in-person at the University of Leeds (UoL), UK. Recruitment routes included advertisement via Leeds Community Healthcare services, the English National Opera Breathe Programme and within the UoL.

Results
Three key themes/needs were identified. (Theme 1) Support systems including community groups, disability benefits, clinical services and employment support should be accessible and tailored to the needs of people with LC. (Theme 2) Research should investigate the physiology of symptoms, new clinical tests and treatment interventions to improve clinical understanding of the condition and symptom management. (Theme 3) Societal awareness should be promoted via local and national initiatives to educate the public about the condition and reduce stigma.

Conclusions
Participants experienced varied and individual challenges to daily life due to LC. There is a need for government acknowledgement of LC as a disability to ensure people with LC have access to disability support and legal protection. Policy development should be patient-driven and acknowledge the individual needs of people with LC in order to improve their quality of life.

Purpose
COVID-19 continues to affect millions of individuals worldwide, both in the short and long term. The post-acute complications of SARS-CoV-2 infection, referred to as long COVID, result in diverse symptoms affecting multiple organ systems. Little is known regarding how the symptoms associated with long COVID progress and resolve over time. The Johns Hopkins COVID Long Study aims to prospectively examine the short-term and long-term consequences of COVID-19 in individuals both with and without a history of SARS-CoV-2 infection using self-reported data collected in an online survey.

Participants
16 764 adults with a history of SARS-CoV-2 infection and 799 adults without a history of SARS-CoV-2 infection who completed an online baseline survey.

Findings to date
This cohort profile describes the baseline characteristics of the Johns Hopkins COVID Long Study. Among 16 764 participants with a history of SARS-CoV-2 infection and defined long COVID status, 75% reported a very good or excellent health status prior to infection, 99% reported experiencing at least one COVID-19 symptom during the acute phase of infection, 9.9% reported hospitalisation and 63% were defined as having long COVID using the WHO definition.

Future plans
Analysis of longitudinal data will be used to investigate the progression and resolution of long COVID symptoms over time.

New England Journal of Medicine, Volume 390, Issue 23, Page 2200-2207, June 20, 2024.

Annals of Internal Medicine, Ahead of Print.

The US Food and Drug Administration (FDA) granted emergency use authorization to pemivibart, marketed as Pemgarda, to protect people who are immunocompromised from COVID-19. Pemivibart is the only long-acting monoclonal antibody available in the US for preexposure prophylaxis after the FDA revoked authorization of tixagevimab copackaged with cilgavimab, also known as Evusheld, in January 2023.

Introduction
In 2020, the UK government established a large-scale testing programme to rapidly identify individuals in England who were infected with SARS-CoV-2 and had COVID-19. This comprised part of the UK government’s COVID-19 response strategy, to protect those at risk of severe COVID-19 disease and death and to reduce the burden on the health system. To assess the success of this approach, the UK Health Security Agency (UKHSA) commissioned an independent evaluation of the activities delivered by the National Health System testing programme in England. The primary purpose of this evaluation will be to capture key learnings from the roll-out of testing to different target populations via various testing services between October 2020 and March 2022 and to use these insights to formulate recommendations for future pandemic preparedness strategy. In this protocol, we detail the rationale, approach and study design.

Methods and analysis
The proposed study involves a stepwise mixed-methods approach, aligned with established methods for the evaluation of complex interventions in health, to retrospectively assess the combined impact of key asymptomatic and symptomatic testing services nationally. The research team will first develop a theory of change, formulated in collaboration with testing service stakeholders, to understand the causal pathways and intended and unintended outcomes of each testing service and explore contextual impacts on each testing service’s intended outcomes. Insights gained will help identify indicators to evaluate how the combined aims of the testing programme were achieved, using a mixed-methods approach.

Ethics and dissemination
The study protocol was granted ethics approval by the UKHSA Research Ethics and Governance Group (reference NR0347). All relevant ethics guidelines will be followed throughout. Findings arising from this evaluation will be used to inform lessons learnt and recommendations for UKHSA on appropriate pandemic preparedness testing programme designs; findings will also be disseminated in peer-reviewed journals, a publicly available report to be published online and at academic conferences. The final report of findings from the evaluation will be used as part of a portfolio of evidence produced for the independent COVID-19 government inquiry in the UK.

Transparency declaration
The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; no important aspects of the study have been omitted, and any discrepancies from the study as planned have been explained.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Objectives
To determine COVID-19 vaccine uptake among physicians in Ontario, Canada from 14 December 2020 to 13 February 2022.

Design
Population-based retrospective cohort study.

Setting
All registered physicians in Ontario, Canada using data from linked provincial administrative healthcare databases.

Participants
41 267 physicians (including postgraduate trainees) who were Ontario residents and registered with the College of Physicians and Surgeons of Ontario were included. Physicians who were out of province, had not accessed Ontario Health Insurance Plan-insured services for their own care for ≥5 years and those with missing identifiers were excluded.

Primary and secondary outcome measures
Primary outcomes were the proportions of physicians who were recorded to have received at least one, at least two and three doses of a Health Canada-approved COVID-19 vaccine by study end date. Secondary outcomes were how uptake varied by physician characteristics (including age, sex, specialty and residential location) and time elapsed between doses.

Results
Of 41 267 physicians, (56% male, mean age 47 years), 39 359 (95.4%) received at least one dose, 39 148 (94.9%) received at least two doses and 35 834 (86.8%) received three doses of a COVID-19 vaccine. Of those who received three doses, the proportions were 90.4% among those aged ≥60 years and 81.2–89.5% among other age groups; 88.7% among family physicians and 89% among specialists. 1908 physicians (4.6%) had no record of vaccination, and this included 3.4% of family physicians and 4.1% of specialists; however, 28% of this group had missing specialty information.

Conclusions
In Ontario, within 14 months of COVID-19 vaccine availability, 86.8% of physicians had three doses of a COVID-19 vaccine, compared with 45.6% of the general population. Findings may signify physicians’ confidence in the safety and effectiveness of COVID-19 vaccines.