Questo è quello che abbiamo trovato per te
All’Università di Pittsburgh hanno dimostrato che anche gli anticorpi che riconoscono le proteine interne di Sars-CoV2 potrebbero essere importanti per migliorare le terapie ed essere di supporto allo sviluppo di vaccini pan-coronavirus
Objective
To provide a comprehensive review of registered COVID-19-related randomised controlled trials (RCTs) in mainland China and evaluate the transparency of reporting through comparison of registrations, protocols and full reports.
Design
Systematic review of trial registrations and publications.
Data sources
International Clinical Trials Registry Platform, Chinese Clinical Trial Registry, ClinicalTrials.gov, the ISRCTN registry and EU Clinical Trial Register were accessed on 1 February 2022. Publications were searched in PubMed, Embase, Cochrane Library, Google Scholar, CNKI.net and Wanfangdata from 10 February 2022 to 12 February 2022.
Eligibility criteria
Eligible trials were COVID-19 related RCTs carried out in mainland China. Observational studies, non-randomised trials and single-arm trials were excluded.
Data extraction and synthesis
Two reviewers independently extracted data from registrations, publications and performed risk of bias assessment for trial reports. Information provided by registrations and publications was compared. The findings were summarised with descriptive statistics.
Results
The number of eligible studies was 415. From these studies 20 protocols and 77 RCT reports were published. Seven trials published both protocol and RCT full report. Between registrations and publications, discrepancy or omission was found in sample size (7, 35.0% for protocols and 47, 61.0% for reports, same below), trial setting (13, 65.0% and 43, 55.8%), inclusion criteria (12, 60.0% and 57, 74.0%), exclusion criteria (10, 50.0% and 54, 70.1%), masking method (9, 45.0% and 35, 45.5%) and primary outcome or time frame of primary outcome measurement (14, 70.0% and 51, 66.2%). Between protocols and full reports, 5 (71.4%) reports had discrepancy in primary outcome or time frame of primary outcome measurement.
Conclusions
Discrepancy among registrations, protocols and reports revealed compromised transparency in reporting of COVID-19-related RCTs in mainland China. The importance of trial registration should be further emphasised to enhance transparent RCT reporting.
Objective
To survey parents and carers of children with a congenital anomaly across Europe about their experiences of healthcare services and support during the COVID-19 pandemic.
Design
Cross-sectional study.
Setting
Online survey in 10 European countries, open from 8 March 2021 to 14 July 2021.
Population
1070 parents and carers of children aged 0–10 years with a cleft lip, spina bifida, congenital heart defect (CHD) requiring surgery and/or Down syndrome.
Main outcome measures
Parental views about: the provision of care for their child (cancellation/postponement of appointments, virtual appointments, access to medication), the impact of disruptions to healthcare on their child’s health and well-being, and satisfaction with support from medical sources, organisations and close relationships.
Results
Disruptions to healthcare appointments were significantly higher (p
Introduction
The COVID-19 pandemic is forcing changes to clinical practice within traditional addiction treatment programmes, including the increased use of telehealth, reduced restrictions on methadone administration (eg, increased availability of take-home doses and decreased requirements for in-person visits), reduced reliance on group counselling and less urine drug screening. This paper describes the protocol for a mixed-methods study analysing organisational-level factors that are associated with changes in clinic-level practice changes and treatment retention.
Methods and analysis
We will employ an explanatory sequential mixed-methods design to study the treatment practices for opioid use disorder (OUD) patients in New York State (NYS). For the quantitative aim, we will use the Client Data System and Medicaid claims data to examine the variation in clinical practices (ie, changes in telehealth, pharmacotherapy, group vs individual counselling and urine drug screening) and retention in treatment for OUD patients across 580 outpatient clinics in NYS during the pandemic. Clinics will be categorised into quartiles based on composite rankings by calculating cross-clinic Z scores for the clinical practice change and treatment retention variables. We will apply the random-effects modelling to estimate change by clinic by introducing a fixed-effect variable for each clinic, adjusting for key individual and geographic characteristics and estimate the changes in the clinical practice changes and treatment retention. We will then employ qualitative methods and interview 200 key informants (ie, programme director, clinical supervisor, counsellor and medical director) to develop an understanding of the quantitative findings by examining organisational characteristics of programmes (n=25) representative of those that rank in the top quartile of clinical practice measures as well as programmes that performed worst on these measures (n=25).
Ethics and dissemination
The study has been approved by the Institutional Review Board of NYU Langone Health (#i21-00573). Study findings will be disseminated through national and international conferences, reports and peer-reviewed publications.
Objectives
The aim of this study was to comparatively explore the social representations of risk in individuals categorised ‘at risk’ based on age during the COVID-19 pandemic. What characterised their sense-making of being at risk and what effects did this have on their lives, behaviour and identities?
Design
Interview-based qualitative study.
Setting
UK and Germany, July–August 2020.
Participants
11 individuals from Germany and eight from the UK were recruited purposively. Inclusion criteria: to be at risk for a severe course of COVID-19 due to age ≥50 years (Germany) and ≥70 years (UK) based on official communication by the respective national public health authority.
Exclusion criteria: any form of dementia, pre-existing mental health issues, congenital physical or mental disabilities, being resident in a care home, having a personal relationship to the principal investigator.
Methods
Semistructured in-depth interviews were conducted remotely. Reflexive thematic analysis was carried out to inductively develop themes illustrative of shared patterns of meaning across the whole data set.
Results
Three main themes are reported. ‘Establishing safe spaces’ (perceiving safety and risk in relation to others and implementing prevention measures to maintain safe spaces); ‘Assessing and responding to risk’ (risk as danger relative to others and risk management as a responsibility of the individual) and ‘Considerations on the value of a life’ (in relation to quality of life, length of life and capacity to contribute to society). Cross cutting all of these, is the notion of relational assessment.
Conclusions
The experience of risk and related behaviour is contingent on the individuals’ mindset, body and the setting (geographical, political and sociocultural) one is positioned in. Negotiating identities is an inevitable process accompanying sense-making of (new) risks. Public health practice and communication could benefit from at least being informed by and at best being based on the meanings and representations of those whose health and well-being we want to ensure.
Objectives
Assessment of the significance of online queries regarding smell impairment to evaluate the epidemiological status and effectiveness of COVID-19 epidemic control measures using levofloxacin as an example.
Setting
There are 81 regions of Russia and several large cities, such as Moscow, St. Petersburg and Nizhny Novgorod.
Methods
Weekly online queries from Yandex Russian users regarding smell impairment and levofloxacin were analysed in regions and large cities of Russia from 16 March 2020 to 21 February 2021.
Results
A strong positive direct correlation (r >0.7) was found between the number of smell-related queries in Yandex new cases of COVID-19 in 59 out of 85 Russian regions and large cities (70%). During the ‘first’ peak of COVID-19 incidence in Russia (April–May 2020), the increase in the number of smell-related queries outpaced the increase in new cases by 1–2 weeks in 23 out of 59 regions of Russia. During the ‘second’ peak of COVID-19 incidence in Russia (October–December 2020), the increase in the number of smell-related queries outpaced the increase in the number of new cases by 1–2 weeks in 36 regions of Russia, including Moscow. It was found that the query/new case ratio increased by more than 100% in 24 regions. The regions where the increase in queries was more than 160% compared with new infection cases during the ‘second’ peak of incidence demonstrated significantly higher search activity related to levofloxacin than the regions where the increase in queries was lower than 160% compared with the increase in new infection cases.
Conclusion
The sudden interest in certain symptoms of COVID-19, such as smell impairment and the growing frequency of online queries among the population, can be used as an indicator of the spread of coronavirus infection among the population and for evaluation of the effectiveness of the COVID-19 epidemic control measures.
Introduction
During the COVID-19 pandemic, approximately 10%–35% of COVID-19 infected patients experience post-COVID sequela. Among these sequelae, pain symptoms should not be neglected. In addition, the sequelae of COVID-19 also decrease the quality of life of these populations. However, meta-analyses that systematically evaluated post-COVID pain are sparse.
Methods and analysis
A comprehensive screening will be performed by searching MEDLINE and Embase without language restriction from inception to August 2021. Cohort studies, case–control studies, cross-sectional studies and case series will be included. Case report and interventional studies will be excluded. Studies with less than 20 participants will be also excluded. We aim to investigate the prevalence of pain-related symptoms in patients after the acute phase of COVID-19. The impact of COVID-19 on the quality of life and pain symptoms among these populations in the post-acute phase will also be evaluated. ROBINS-I tool will be used to assess the risk of bias of cohort studies. The risk of bias tool developed by Hoy et al will be used to assess the risk of bias of prevalence studies. Metaprop command in Stata will be used to estimate the pooled prevalence of pain symptoms. DerSimonian and Laird random-effects models will be used to calculate the pooled relative risks. All analyses will be calculated using Stata software (V.15.0; StataCorp)
Ethics and dissemination
Ethics approval is not required. Results of our study will be submitted to a peer-review journal.
PROSPERO registration number
CRD42021272800.
Objective
The early days of the COVID-19 pandemic placed enormous pressure and subsequent negative psychological problems on nurses, but at this stage of the year-long COVID-19 outbreak, the level of stress and negative emotions that nurses experience is unclear. Our study attempted to assess the factors influencing mental health status in nurses during the postepidemic period of COVID-19.
Design
Cross-sectional study.
Setting
COVID-19 designated hospitals.
Participants
1284 Chinese nurses.
Main outcome measures
Electronic questionnaires, including the Chinese version of the Perceived Stress Scale (CPSS) and Symptom Checklist-90 (SCL-90), were distributed for self-evaluation. Regression analysis was used to analyse the associated factors of psychological stress among variables such as age, years of nursing experience, weekly working hours, anxiety symptoms, somatisation symptoms and compulsive symptoms.
Results
A total of 1284 respondents from COVID-19-designated hospitals in Guangdong Province were studied. The average CPSS score for all respondents was 22.91±7.12. A total of 38.5% of respondents scored ≥26 on the CPSS, indicating a significant degree of psychological stress. Nurses with high psychological stress had higher levels of anxiety symptoms (41.7% vs 8.0%), somatisation symptoms (31.4% vs 7.7%) and compulsion symptoms (62.3% vs 27.0%) than nurses with low psychological stress. Stepwise multiple linear regression revealed that weekly working hours, years of nursing experience, anxiety symptoms, somatisation symptoms and compulsion symptoms had a linear relationship with the participants’ psychological stress scores.
Conclusion
Nurses experienced significant physical and psychological risk while working in the postepidemic period. Our findings suggest that nurses still need support to protect their physical and mental health.
Objectives
A large number of COVID-19 outbreaks/clusters have been reported in a variety of workplace settings since the start of the pandemic but the rate of outbreak occurrence in the workplace has not previously been assessed. The objectives of this paper are to identify the geographical areas and industrial sectors with a high rate of outbreaks of COVID-19 and to compare infection attack rates by enterprise size and sector in England.
Methods
Public Health England (PHE) HPZone data on COVID-19 outbreaks in workplaces, between 18 May and 12 October 2020, were analysed. The workplace outbreak rates by region and sector were calculated, using National Population Database (NPD) with the total number of workplaces as the denominator. The infection attack rates were calculated by enterprise size and sector using PHE Situations of Interest data with the number of test-confirmed COVID-19 cases in a workplace outbreak as the numerator and using NPD data with the number employed in that workplace as the denominator.
Results
The highest attack rate was for outbreaks in close contact services (median 16.5%), followed by outbreaks in restaurants and catering (median 10.2%), and in manufacturers and packers of non-food products (median 6.7%). The overall outbreak rate was 66 per 100 000 workplaces. Of the nine English regions, the North West had the highest workplace outbreak rate (155 per 100 000 workplaces). Of the industrial sectors, manufacturers and packers of food had the highest outbreak rate (1672 per 100 000), which was consistent across seven of the regions. In addition, high outbreak rates in warehouses were observed in the East Midlands and the North West.
Conclusions
Early identification of geographical regions and industrial sectors with higher rates of COVID-19 workplace outbreaks can inform interventions to limit transmission of SARS-CoV-2.
Objectives
To describe the prevalence and sources of experienced moral stress and anxiety by Swedish frontline healthcare staff in the early phase of COVID-19.
Design
Cross-sectional survey, quantitative and qualitative.
Participants and setting
1074 healthcare professionals (75% nurses) in intensive, ward-based, primary and municipal care in one Swedish county.
Measures
A study-specific closed-ended and an open-ended questionnaire about moral stress and the Generalised Anxiety Disorder 7-item scale measuring anxiety, followed by an open question about anxiety.
Findings
Moral stress was experienced by 52% of respondents and anxiety by 40%. Moral stress in concern for others attributed to institutional constraints comprised experiences of being deprived of possibilities to respond to humane and professional responsibility. Staff experienced being restricted in fulfilling patients’ and families’ need for closeness and security as well as being compelled to provide substandard and inhumane care. Uncertainty about right and good, without blame, was also described. However, a burdensome guilt also emerged as a moral distress, blaming oneself. This comprised feeling complicit in the spread of COVID-19, inadequacy in care and carrying patients’ suffering. Staff also experienced an exhausting distress as a self-concern in an uncontrollable work situation. This comprised a taxing insecurity by being in limbo, being alone and fear of failing, despair of being deprived control by not being heard; unable to influence; distrusting management; as well as an excessive workload.
Conclusions
We have not only contributed with knowledge about experiences of being in the frontline of COVID-19, but also with an understanding of a demarcation between moral stress/distress as a concern for patients and family, and exhausting distress in work situation as self-concern. A lesson for management is that ethics support should first include acknowledgement of self-concern and mitigation of guilt before any structured ethical reflection. Preventive measures for major events should focus on connectedness between all parties concerned, preventing inhumane care and burn-out.
Objective
To compare outcomes between O and non-O blood groups, and by modified RNA (mRNA) and adenovirus-vectored (Ad-V) vaccines.
Design
Population-based cohort study.
Setting
All of Ontario, Canada. Linked data sets captured clinical encounters, vaccinations and laboratory testing for SARS-CoV-2.
Participants
Individuals aged 12+ years with known ABO blood group and free of SARS-CoV-2 before 15 January 2021.
Main outcomes measures
The main exposure, first SARS-CoV-2 vaccination, was modelled in a time-varying manner. O and non-O blood group was known prior to vaccination. SARS-CoV-2 infection, and severe COVID-19 (hospitalisation or death), were assessed starting 14 days after vaccination, up to 27 June 2021.
Results
2 472 261 individuals were included. 1 743 916 (70.5%) had at least one vaccination, of which 24.6% were fully vaccinated. Those vaccinated were more likely to be women, older in age, residing in a higher-income area and have higher rates of certain comorbid conditions, like cancer, diabetes and hypertension. Relative to unvaccinated, after receiving their first mRNA (adjusted HR (aHR) 0.46, 95% CI 0.44 to 0.47) or Ad-V (aHR 0.49, 95% CI 0.44 to 0.54) vaccine, the risk of SARS-CoV-2 infection was lower, as was severe COVID-19 (aHR 0.29, 95% CI 0.20 to 0.43 (mRNA); aHR 0.29, 95% CI 0.26 to 0.33 (Ad-V)). Stratifying by blood group produced similar results. For example, after first mRNA vaccination, the aHR of severe COVID-19 was 0.31 (95% CI 0.27 to 0.36) among non-O blood groups, and 0.27 (95% CI 0.22 to 0.32) among O blood groups, relative to unvaccinated. Fully vaccinated individuals had the lowest risk of SARS-CoV-2 and severe COVID-19.
Conclusions
SARS-CoV-2 infection and severe COVID-19 are reduced by vaccination. This effect does not vary by vaccine type or blood group, but is more pronounced among fully, than partially, vaccinated individuals.
Background
Following a virtual standstill in the delivery of elective procedures in England, a national block contract between the NHS and the independent sector aimed to help restart surgical care. This study aims to describe subsequent changes in trends in elective care service delivery following implementation of the initial iteration of this contract.
Methods
Population-based retrospective cohort study, assessing the delivery of all publicly funded and privately funded elective care delivered in England between 1 April 2020 and 31 July 2020 compared with the same period in 2019. Discharge data from the Hospital Episode Statistics and private healthcare data from the Private Health Information Network was stratified by specialty, procedure, length of stay and patient complexity in terms of age and Charlson Comorbidity Index.
Results
COVID-19 significantly reduced publicly funded elective care activity, though changes were more pronounced in the independent sector (–65.1%) compared with the NHS (–52.7%), whereas reductions in privately funded elective care activity were similar in both independent sector hospitals (–74.2%) and NHS hospitals (–72.9%). Patient complexity increased in the independent sector compared with the previous year, with mixed findings in NHS hospitals. Most specialties, irrespective of sector or funding mechanisms, experienced a reduction in hospital admissions. However, some specialities, including medical oncology, clinical oncology, clinical haematology and cardiology, experienced an increase in publicly-funded elective care activity in the independent sector.
Conclusion
Elective care delivered by the independent sector remained significantly below historic levels, although this overlooks significant variation between regions and specialities. There may be opportunities to learn from regions which achieved more significant increases in publicly funded elective care in independent sector providers as a strategy to address the growing backlog of elective care.
Comunicato del 15/07/2022 n°34
Objective
By using health code blockchain, cities can maximise the use of personal information while maximising the protection of personal privacy in the monitoring and evaluation of the effectiveness of listed vaccines.
Design
This study constructs an urban COVID-19 listed vaccine effectiveness (VE) monitoring, evaluation and application system based on the health code blockchain. This study uses this system and statistical simulation to analyse three urban application scenarios, namely evaluating the vaccination rate (VR) and determining the optimal vaccination strategy, evaluating herd immunity and monitoring the VE on variant.
Main outcome measures
The primary outcomes first establish an urban COVID-19 listed VE monitoring, evaluation and application system by using the health code blockchain, combined with the dynamic monitoring model of VE, the evaluation index system of VE and the monitoring and evaluation system of personal privacy information use, and then three measures are analysed in urban simulation: one is to take the index reflecting urban population mobility as the weight to calculate the comprehensive VR, the second is to calculate the comprehensive basic reproduction number (R) in the presence of asymptomatic persons, the third is to compare the difference between the observed effectiveness and the true effectiveness of listed vaccines under virus variation.
Results
Combining this system and simulation, this study finds: (1) The comprehensive VR, which is weighted to reflect urban population mobility, is more accurate than the simple VR which does not take into account urban population mobility. Based on population mobility, the algorithm principle of urban optimal vaccination strategy is given. In the simulation of urban listed vaccination involving six regions, programmes 1 and 5 have the best protective effect among the eight vaccination programmes, and the optimal vaccination order is 3-5-2-4-6-1. (2) In the presence of asymptomatic conditions, the basic reproduction number, namely R0*(1-VR*VE), does not accurately reflect the effect of herd immunity, but the comprehensive basic reproduction number (R) should be used. The R is directly proportional to the proportion of asymptomatic people (aw) and the duration of the incubation period (ip), and inversely proportional to the VR, the VE and the number of days transmitted in the ip (k). In the simulation analysis, when symptomatic R0=3, even with aw=0.2, the R decreases to nearly 1 until the VR reaches 95%. When aw=0.8, even when the entire population is vaccinated, namely VR=1, the R is 1.688, and still significantly greater than 1. If the R is to be reduced to 1, the VE needs to be increased to 0.87. (3) This system can more comprehensively and accurately grasp the impact of the variant virus on urban VE. The traditional epidemiological investigation can lose the contacts of infected persons, which leads to the deviation between the observed effectiveness and the true effectiveness. Virus variation aggravates the loss, and then increases the deviation. Simulation case 1 assumes the unvaccinated rate of 0.8, the ongoing VR of 0.1, the completed VR of 0.1 and an average infection rate of 2% for the variant virus. If a vaccine is more than 90% effectiveness against the premutant virus, but only 80% effectiveness against the mutant virus, and because 80% of the unvaccinated people who are not infected are not observed, the observed effectiveness of the vaccine is 91.76%, it will lead to the wrong judgement that the VE against the variant virus is not decreased. Simulation case 2 assumes the unvaccinated rate of 0.8, the ongoing VR of 0.1, the completed VR of 0.1 and an average infection rate of 5% for the variant virus. Simulation finds that the higher the proportion of unvaccinated infected people who are not observed, the lower the estimate of observed effectiveness; and the lower the true effectiveness, the larger the gap between observed effectiveness and true effectiveness. Simulation case 3 assumes the unvaccinated rate of 0.2, the ongoing VR of 0.2, the completed VR of 0.6 and an average infection rate of 2% for the variant virus. Simulation finds that the higher the proportion of unobserved completed vaccination patients who are not infected, the lower the estimate of observed effectiveness; and the lower the true effectiveness, the larger the gap between observed effectiveness and true effectiveness. Simulation case 4 assumes the unvaccinated rate of 0.2, the ongoing VR of 0.2, the completed VR of 0.6 and an average infection rate of 5% for the variant virus. If a vaccine is more than 90% effectiveness against the premutant virus, but only 80% effectiveness against the mutant virus, and because 80% of the infected people with complete vaccination are not observed, the observed effectiveness of the vaccine is 91.95%, similar to case 1, it will lead to the wrong judgement that the VE against the variant virus is not decreased.
Conclusion
Compared with traditional epidemiological investigation, this system can meet the challenges of accelerating virus variation and a large number of asymptomatic people, dynamically monitor and accurately evaluate the effectiveness of listed vaccines and maximise personal privacy without locking down the relevant area or city. This system established in this study could serve as a universal template for monitoring and evaluating the effectiveness of COVID-19 listed vaccines in cities around the world. If this system can be promoted globally, it will promote countries to strengthen unity and cooperation and enhance the global ability to respond to COVID-19.
Objectives
This survey aimed to assess the status of a range of health-related behaviours 1 year after the coronavirus outbreak was declared a pandemic in adults living with disabilities comparative with those with no disabilities.
Design
This cross-sectional study reports findings from an online survey conducted in March 2021. Mann-Whitney U and X2 tests were used to compare a range of health behaviours including time spent self-isolating, smoking, alcohol consumption, exercise frequency and diet in adults with and without disabilities.
Setting
A convenience sample of UK adults was recruited through the researchers’ personal and professional networks including UK-based sight loss sector charities, social media platforms and professional forums.
Participants
A total of 123 UK participants completed the survey.
Outcome measures
COVID-19 diagnosis, time spent self-isolating, alcohol consumption frequency, exercise frequency, change in smoking habit and eating habits.
Results
No significant differences were found in alcohol consumption, smoking, water intake, breakfast, or fruit and vegetable intake. There were statistically significant differences in the time spent self-isolating (U=2061, p=0.001), exercise frequency (U=1171.5, p=0.005) and the amount of food eaten (2 (2)=9.60, p=0.008, Cramer’s V=0.281). Although the majority in both groups reported exercising three to four times per week and eating what they should, those with disabilities were more likely to eat less than they should, not exercise at all and to have been self-isolating for over 6 months than participants with no disabilities.
Conclusions
The data in this study present some key differences between the two groups, with those living with disabilities being more likely to report that they had been self-isolating for prolonged periods of time, not exercising at all, and not eating as much as they should . This raises concerns for the health and well-being of individuals with disabilities.
Objective
Investigate the impact of the COVID-19 pandemic on perinatal outcomes in an Australian high migrant and low COVID-19 prevalent population to identify if COVID-19 driven health service changes and societal influences impact obstetric and perinatal outcomes.
Design
Retrospective cohort study with pre COVID-19 period 1 January 2018–31 January 2020, and first year of global COVID-19 period 1 February 2020–31 January 2021. Multivariate logistic regression analysis was conducted adjusting for confounders including age, area-level socioeconomic status, gestation, parity, ethnicity and body mass index.
Setting
Obstetric population attending three public hospitals including a major tertiary referral centre in Western Sydney, Australia.
Participants
Women who delivered with singleton pregnancies over 20 weeks gestation. Ethnically diverse women, 66% overseas born. There were 34 103 births in the district that met inclusion criteria: before COVID-19 n=23 722, during COVID-19 n=10 381.
Main outcome measures
Induction of labour, caesarean section delivery, iatrogenic and spontaneous preterm birth, small for gestational age (SGA), composite neonatal adverse outcome and full breastfeeding at hospital discharge.
Results
During the first year of COVID-19, there was no change for induction of labour (adjusted OR, aOR 0.97; 95% CI 0.92 to 1.02, p=0.26) and a 25% increase in caesarean section births (aOR 1.25; 95% CI 1.19 to 1.32, p
