Risultati per: Le linfoadenopatie vaccino COVID-19 correlate: ruolo della POCUS in Medicina Generale

Objectives
Patient lead users can be defined as patients or relatives who use their knowledge and experience to improve their own or a relative’s care situation and/or the healthcare system, and who are active beyond what is usually expected. The objective of this study is to explore patient lead users’ experiences and engagement during the early COVID-19 pandemic.

Design
Qualitative in-depth interviews with a cross-sectional time horizon.

Setting
The early COVID-19 pandemic in Sweden, from 1 June through 14 September, 2020.

Participants
A total of 10 patient lead users were recruited from the Swedish patient lead users (spetspatient) network. All participants were living with different long-term conditions and matched the definition of being patient lead users.

Results
We found that during the early pandemic, patient lead users experienced that they no longer knew how to best manage their own health and care situations. On an individual level, they described an initial lack of knowledge, new routines, including a change in their health and an experience of people without a disease being in the same situation as them, for a while. On a systemic level, they described a fear of imminent unmet-care backlogs and decreased opportunities for sharing patient perspectives in care organisation, but also described increased networking.

Conclusions
Patient lead users can be seen as an emerging community of practice, and as such could be a valuable resource as a complementary communication channel for an improved health system. The health systems were not able to fully acknowledge and engage with the resource of patient lead users during the pandemic.

Objectives
To explore public reactions to the COVID-19 pandemic across diverse ethnic groups.

Design
Remote qualitative interviews and focus groups in English or Punjabi. Data were transcribed and analysed through inductive thematic analysis.

Setting
England and Wales, June to October 2020.

Participants
100 participants from 19 diverse ‘self-identified’ ethnic groups.

Results
Dismay, frustration and altruism were reported across all ethnic groups during the first 6–9 months of the COVID-19 pandemic. Dismay was caused by participants’ reported individual, family and community risks, and loss of support networks. Frustration was caused by reported lack of recognition of the efforts of ethnic minority groups (EMGs), inaction by government to address COVID-19 and inequalities, rule breaking by government advisors, changing government rules around: border controls, personal protective equipment, social distancing, eating out, and perceived poor communication around COVID-19 and the Public Health England COVID-19 disparities report (leading to reported increased racism and social isolation). Altruism was felt by all, in the resilience of National Health Service (NHS) staff and their communities and families pulling together. Data, participants’ suggested actions and the behaviour change wheel informed suggested interventions and policies to help control COVID-19.

Conclusion
To improve trust and compliance future reports or guidance should clearly explain any stated differences in health outcomes by ethnicity or other risk group, including specific messages for these groups and concrete actions to minimise any risks. Messaging should reflect the uncertainty in data or advice and how guidance may change going forward as new evidence becomes available. A contingency plan is needed to mitigate the impact of COVID-19 across all communities including EMGs, the vulnerable and socially disadvantaged individuals, in preparation for any rise in cases and for future pandemics. Equality across ethnicities for healthcare is essential, and the NHS and local communities will need to be supported to attain this.

Objectives
The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patients awaiting surgery.

Design
This was an observational retrospective study.

Settings
A tertiary-level multicentre study of neurosurgery activity between 1 March and 30 June 2020.

Participants
A total of 680 patients awaiting any scheduled neurosurgical procedure were enrolled. 470 patients (69.1%) were awaiting surgery because of spine degenerative disease, 86 patients (12.6%) due to functional disorders, 58 patients (8.5%) due to brain or spine tumours, 25 patients (3.7%) due to cerebrospinal fluid (CSF) disorders and 17 patients (2.5%) due to cerebrovascular disease.

Primary and secondary outcome measures
The primary outcome was mortality due to any reason and any deterioration of the specific neurosurgical condition. Second, we analysed the rate of confirmed SARS-CoV-2 infection.

Results
More than one-quarter of patients experienced clinical or radiological deterioration. The rate of worsening was higher among patients with functional (39.5%) or CSF disorders (40%). Two patients died (0.4%) during the waiting period, both because of a concurrent disease. We performed a multivariate logistic regression analysis to determine independent covariates associated with maintaining the surgical indication. We found that community SARS-CoV-2 incidence (OR=1.011, p

Objective
To examine the association between financial incentives from entry into a vaccine competition with the probability of vaccination for COVID-19.

Design
A cross-sectional study with adjustment for covariates using logistic regression.

Setting
October and November 2021, Australia.

Participants
2375 respondents of the Taking the Pulse of the Nation survey.

Primary and secondary outcome measures
The proportion of respondents who had any vaccination, a first dose only, or second dose after the competition opened.

Results
Those who entered the competition were 2.27 (95% CI 1.73 to 2.99) times more likely to be vaccinated after the competition opened on 1 October than those who did not enter—an increase in the probability of having any dose of 0.16 (95 % CI 0.10 to 0.21) percentage points. This increase was mostly driven by those receiving second doses. Entrants were 2.39 (95% CI 1.80 to 3.17) times more likely to receive their second dose after the competition opened.

Conclusions
Those who entered the Million Dollar Vax competition were more likely to have a vaccination after the competition opened compared with those who did not enter the competition, with this effect dominated by those receiving second doses.

Introduction
The COVID-19 pandemic has a significant spill-over effect on people with non-communicable diseases (NCDs) over the long term, beyond the direct effect of COVID-19 infection. Evaluating changes in health outcomes, health service use and costs can provide evidence to optimise care for people with NCDs during and after the pandemic, and to better prepare outbreak responses in the future.

Methods and analysis
This is a population-based cohort study using electronic health records of the Hong Kong Hospital Authority (HA) CMS, economic modelling and serial cross-sectional surveys on health service use. This study includes people aged ≥18 years who have a documented diagnosis of diabetes mellitus, hypertension, cardiovascular disease, cancer, chronic respiratory disease or chronic kidney disease with at least one attendance at the HA hospital or clinic between 1 January 2010 and 31 December 2019, and without COVID-19 infection. Changes in all-cause mortality, disease-specific outcomes, and health services use rates and costs will be assessed between pre-COVID-19 and-post-COVID-19 pandemic or during each wave using an interrupted time series analysis. The long-term health economic impact of healthcare disruptions during the COVID-19 pandemic will be studied using microsimulation modelling. Multivariable Cox proportional hazards regression and Poisson/negative binomial regression will be used to evaluate the effect of different modes of supplementary care on health outcomes.

Ethics and dissemination
The study was approved by the institutional review board of the University of Hong Kong, the HA Hong Kong West Cluster (reference number UW 21–297). The study findings will be disseminated through peer-reviewed publications and international conferences.

Objectives
The COVID-19 pandemic has influenced people’s concerns regarding infectious diseases and their preventive measures. However, the magnitude of the impact and the difference between countries are unclear. This study aimed to assess the magnitude of the impact of COVID-19 on public interest and people’s behaviours globally in preventing infectious diseases while comparing international trends and sustainability.

Design
An infodemiology and infoveillance study.

Setting
The study employed a web-based data collection to delineate public interest regarding COVID-19 preventive measures using Google Trends.

Primary and secondary outcome measures
A relative search volume was assigned to a keyword, standardising it from 0 to 100, with 100 representing the highest share of the term searches. The search terms “coronavirus”, “wash hand”, “social distancing”, “hand sanitizer” and “mask” were investigated across 196 different countries and regions from July 2018 to October 2021 and weekly reports of the relative search volume were obtained. Persistence of interest was assessed by comparing the first 20 weeks with the last 20 weeks of the study period.

Results
Although the relative search volume of “coronavirus” increased and was sustained at a significantly higher level (p

Objective
To investigate whether Swedish men living with children had elevated risk for severe COVID-19 or infection with SARS-CoV-2 during the first three waves of the pandemic.

Design
Prospective registry-based cohort study.

Participants
1 557 061 Swedish men undergoing military conscription between 1968 and 2005 at a mean age of 18.3 (SD 0.73) years.

Main outcome measures
Infection with SARS-CoV-2 and hospitalisation due to COVID-19 from March 2020 to September 2021.

Results
There was a protective association between preschool children at home and hospitalisation due to COVID-19 during the first and third waves compared with only older or no children at all, with ORs (95% CIs) 0.63 (0.46 to 0.88) and 0.75 (0.68 to 0.94) respectively. No association was observed for living with children 6–12 years old, but for 13–17 years old, the risk increased. Age in 2020 did not explain these associations. Further adjustment for socioeconomic and health factors did not attenuate the results. Exposure to preschool children also had a protective association with testing positive with SARS-CoV-2, with or without hospitalisation, OR=0.91 (95% CI 0.89 to 0.93), while living with children of other ages was associated with increased odds of infection.

Conclusions
Cohabiting with preschool children was associated with reduced risk for severe COVID-19. Living with school-age children between 6 and 12 years had no association with severe COVID-19, but sharing the household with teenagers and young adults was associated with elevated risk. Our results are of special interest since preschools and compulsory schools (age 6–15 years) in Sweden did not close in 2020.

We have read with interest the recent papers of Kennedy et al1 2 regarding the attenuated anti-SARS-CoV-2 antibody response in patients with IBD and the crucial role of the COVID-19 vaccine in this cohort. The COVID-19 vaccine has been recommended especially for the vulnerable population, including immune-mediated inflammatory diseases.3–5 Therefore, we explored the rate of adverse events (AEs) and the onset of GI symptoms after vaccination with different COVID-19 vaccines in a large cohort of patients with IBD. In this prospective study, we collected data (demographic and clinical variables, COVID-19 vaccine type, local, systemic or allergic AEs, and GI symptoms) from 488 (mean age±SD 55.3±14.4 years, 44.9% male) patients with IBD (UC 50.4%, Crohn’s disease 47.8% and undetermined IBD 1.8%) on regular follow-up at our IBD unit who had been administered COVID-19 vaccination from June to July 2021. The…

Objectives
To examine how ecological inequalities in COVID-19 mortality rates evolved in England, and whether the first national lockdown impacted them. This analysis aimed to provide evidence for important lessons to inform public health planning to reduce inequalities in any future pandemics.

Design
Longitudinal ecological study.

Setting
307 lower-tier local authorities in England.

Primary outcome measure
Age-standardised COVID-19 mortality rates by local authority, regressed on Index of Multiple Deprivation (IMD) and relevant epidemic dynamics.

Results
Local authorities that started recording COVID-19 deaths earlier were more deprived, and more deprived authorities saw faster increases in their death rates. By 6 April 2020 (week 15, the earliest time that the 23 March lockdown could have begun affecting death rates) the cumulative death rate in local authorities in the two most deprived deciles of IMD was 54% higher than the rate in the two least deprived deciles. By 4 July 2020 (week 27), this gap had narrowed to 29%. Thus, inequalities in mortality rates by decile of deprivation persisted throughout the first wave, but reduced during the lockdown.

Conclusions
This study found significant differences in the dynamics of COVID-19 mortality at the local authority level, resulting in inequalities in cumulative mortality rates during the first wave of the pandemic. The first lockdown in England was fairly strict—and the study found that it particularly benefited those living in more deprived local authorities. Care should be taken to implement lockdowns early enough, in the right places—and at a sufficiently strict level—to maximally benefit all communities, and reduce inequalities.

Introduction
Hyposmia and anosmia are common in COVID-19. Most patients regain normal smell within 4 weeks, but severe loss of smell persists roughly in 20% after 2 months and may last up to a year or longer. These persistent smell disorders greatly influence daily life. It is hypothesised that COVID-19 induces inflammation around the olfactory nerve and in the olfactory pathway, leading to smell disorders. Corticosteroids might reduce this local inflammatory response and improve smell.

Methods and analysis
We will conduct a single-centre, randomised, placebo-controlled trial to determine the efficacy of a short high-dose treatment of oral prednisolone for persistent loss of smell after COVID-19 in the early phase. We will include 116 patients with persistent ( >4 weeks) loss of smell within 12 weeks of COVID-19 diagnosis, based on a positive PCR/antigen test. One group receives 40 mg of prednisolone for 10 days and the other group receives matching placebo treatment. In addition, all patients will perform smell training for 12 weeks. The primary outcome is objective olfactory function measured by means of sniffin’ sticks test. Secondary outcomes are objective gustatory function by means of taste strips test and subjective taste and smell ability, trigeminal sensations, quality of life and nasal symptoms, measured by three questionnaires. These outcomes will be measured at inclusion before treatment and 12 weeks later.

Ethics and dissemination
The Institutional Review Board of the University Medical Center Utrecht approved the research protocol (21-635/G-D, October 2021). The trial results will be shared in peer-reviewed medical journals and scientific conferences.

Trial registration number
NL9635. EUCTR2021-004021-71-NL.

Objectives
To describe the impact of the COVID-19 pandemic on outpatient appointments for children and young people.

Setting
All National Health Service (public) hospitals in England.

Participants
All people in England aged

Introduction
COVID-19 is a global pandemic caused by the SARS-CoV-2 virus. Although most COVID-19 cases are asymptomatic or mild, a significant number of patients experienced adverse outcomes. In addition, studies have shown that cardiac abnormalities are associated with increased mortality in hospitalised patients with COVID-19. This finding sets a precedent for the potential use of ECG tracing as an indicator of patient mortality and morbidity. This study aims to determine associations between the 12-lead ECG findings and various clinical outcomes of hospitalised patients with COVID-19, measured as incidence of endotracheal intubation, intensive care unit (ICU) admission and mortality rate.

Methods and analysis
An electronic literature search will identify all potentially relevant articles using specific databases and websites. The search will be limited to studies published from December 2019 to May 2021. In addition, studies will include hospitalised patients with COVID-19 with normal and abnormal 12-lead ECG findings assessed for clinical outcomes, including the incidence of endotracheal intubation, ICU admission and mortality rate. The risk of bias in individual studies will be evaluated using the Quality in Prognostic Studies tool or the Cochrane risk of bias tool. A meta-analysis will be conducted if at least two studies indicate a prognostic factor’s effect. Moreover, subgroup and sensitivity analyses will be performed accordingly to address heterogeneity. Reporting the review results will comply with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. The quality of evidence generated will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation system.

Ethics and dissemination
This study has been exempted from ethics review. There will be no patient or public involvement in this study. Furthermore, the findings will be disseminated via conferences, seminars, symposia and congresses on top of peer-reviewed journals.

PROSPERO registration number
CRD42021257155.

Objective
Compliance with COVID-19 prevention measures limits infection occurrence and spread in healthcare settings. According to research conducted in Ethiopia, compliance with COVID-19 preventative strategies is inconsistent among healthcare providers. This systematic review and meta-analysis aimed to estimate the national pooled proportion of healthcare workers (HCWs) who adhere to COVID-19 preventive measures and associated factors with good compliance.

Design
A systematic review and meta-analysis of all identified studies with cross-sectional study design.

Data sources
A comprehensive search was conducted in PubMed/MEDLINE, POPLINE, HINARI, Science Direct, Cochrane Library databases and Google Scholar search engines from January 2020 to September 2021.

Data extraction and synthesis
This review included all observational studies conducted in Ethiopia that reported the proportion of compliance with COVID-19 preventive measures and associated factors among HCWs. Two independent authors assessed the methodological quality of studies using Joanna Briggs Institute’s meta-analysis of statistical assessment and review instrument. The effect estimates for pooled proportion and pooled OR (POR) were determined.

Results
From retrieved 611 original studies, 21 studies were included in the meta-analysis with a total of n=7933 HCWs. The pooled proportion of good compliance with COVID-19 preventive measures among HCWs was 49.7% (95% CI: 42.3% to 57.1%). Being male (POR=2.21, 95% CI: 1.52 to 3.21), service years ( >3 years) (POR=2.65, 95% CI: 1.94 to 3.64), training (POR=2.30, 95% CI: 1.78 to 2.98), positive attitude (POR=3.14, 95% CI: 1.66 to 5.94) and good knowledge (POR=2.36, 95% CI: 1.92 to 2.89) were factors significantly associated with good compliance towards COVID-19 preventive measures.

Conclusion
Our study indicated that approximately one in every two HCWs had good compliance with COVID-19 preventive measures. There must be more emphasis on providing further training sessions for the HCWs to improve their compliance with COVID-19 preventative measures.

Introduction
Initial reports suggest people experiencing homelessness (PEH) are at high risk for SARS-CoV-2 infection and associated morbidity and mortality. However, there have been few longitudinal evaluations of the spread and impact of COVID-19 among PEH. This study will estimate the prevalence and incidence of COVID-19 infections in a cohort of PEH followed prospectively in Toronto, Canada. It will also examine associations between individual-level and shelter-level characteristics with COVID-19 infection, adverse health outcomes related to infection and vaccination. Finally, the data will be used to develop and parameterise a mathematical model to characterise SARS-CoV-2 transmission dynamics, and the transmission impact of interventions serving PEH.

Design, methods and analysis
Ku-gaa-gii pimitizi-win will follow a random sample of PEH from across Toronto (Canada) for 12 months. 736 participants were enrolled between June and September 2021, and will be followed up at 3-month intervals. At each interval, specimens (saliva, capillary blood) will be collected to determine active SARS-CoV-2 infection and serologic evidence of past infection and/or vaccination, and a detailed survey will gather self-reported information, including a detailed housing history. To examine the association between individual-level and shelter-level characteristics on COVID-19-related infection, adverse outcomes, and vaccination, shelter and healthcare administrative data will be linked to participant study data. Healthcare administrative data will also be used to examine long-term (up to 5 years) COVID-19-related outcomes among participants.

Ethics and dissemination
Ethical approval was obtained from the Unity Health Toronto and University of Toronto Health Sciences Research Ethics Boards (# 20-272). Ku-gaa-gii pimitizi-win was designed in collaboration with community and service provider partners and people having lived experience of homelessness. Findings will be reported to groups supporting Ku-gaa-gii pimitizi-win, Indigenous and other community partners and service providers, funding bodies, public health agencies and all levels of government to inform policy and public health programs.

Objectives
The implementation of COVID-19 vaccination globally poses unprecedented stress to health systems particularly for countries with persisting health workforce shortages prior the pandemic. The present paper estimates the workforce requirement to reach 70% COVID-19 vaccination coverage in all countries by mid-2022 using service target–based estimation.

Methods
Health workforce data from National Health Workforce Accounts and vaccination coverage reported to WHO as of January 2022 were used. Workload parameters were used to estimate the number of health workers needed with a service target–based approach, the gap and the scale-up required partially accounting for countries’ challenges, as well as the associated costs in human resources.

Results
As of 1 January 2022, only 34 countries achieved 70% COVID-19 vaccination coverage and 61 countries covered less than a quarter of their population. This analysis showed that 1 831 000 health workers working full time would be needed to reach a global coverage of 70% COVID-19 vaccination by mid-2022. To avoid severe disruptions to health system, 744 000 additional health workers should be added to domestic resources mostly (77%) in low-income countries. In a sensitivity analysis, allowing for vaccination over 12 months instead of 6 months would decrease the scale-up to 476 000 health workers. The costing for the employment of these 744 000 additional health workers is estimated to be US$2.5 billion. In addition to such a massive scale-up, it is estimated that 29 countries would have needed to redeploy more than 20% of their domestic workforce, placing them at serious risk of not achieving the mid-year target.

Conclusion
Reaching 70% global coverage with COVID-19 vaccination by mid-2022 requires extraordinary efforts not before witnessed in the history of immunisation programmes. COVID-19 vaccination programmes should receive rapid and sustainable investment in health workforce.

Objectives
To assess the risk of severe COVID-19 outcomes in patients with autoimmune rheumatic diseases (ARDs) and transplant recipients compared with matched general population comparators.

Design
Population-based matched cohort study using administrative health data sets.

Setting
British Columbia, Canada.

Participants
All adults with test-positive SARS-CoV-2 infections. SARS-CoV-2-positive patients with ARDs and those with transplantation were matched to SARS-CoV-2-positive general population comparators on age (±5 years), sex, month/year of initial positive SARS-CoV-2 test and health authority.

Outcome measures
COVID-19-related hospitalisations, intensive care unit (ICU) admissions, invasive ventilation and COVID-19-specific mortality. We performed multivariable conditional logistic regression models adjusting for socioeconomic status, Charlson Comorbidity Index, hypertension, rural address and number of previous COVID-19 PCR tests.

Results
Among 6279 patients with ARDs and 222 transplant recipients, all SARS-CoV-2 test positive, risk of hospitalisation was significantly increased among patients with ARDs (overall ARDs (adjusted OR (aOR) 1.30; 95% CI 1.19 to 1.43)); highest within ARDs: adult systemic vasculitides (aOR 2.18; 95% CI 1.17 to 4.05) and transplantation (aOR 10.56; 95% CI 6.88 to 16.22). Odds of ICU admission were significantly increased among patients with ARDs (overall ARDs (aOR 1.30; 95% CI 1.11 to 1.51)); highest within ARDs: ankylosing spondylitis (aOR 2.03; 95% CI 1.18 to 3.50) and transplantation (aOR 8.13; 95% CI 4.76 to 13.91). Odds of invasive ventilation were significantly increased among patients with ARDs (overall ARDs (aOR 1.60; 95% CI 1.27 to 2.01)); highest within ARDs: ankylosing spondylitis (aOR 2.63; 95% CI 1.14 to 6.06) and transplantation (aOR 8.64; 95% CI 3.81 to 19.61). Risk of COVID-19-specific mortality was increased among patients with ARDs (overall ARDs (aOR 1.24; 95% CI 1.05 to 1.47)); highest within ARDs: ankylosing spondylitis (aOR 2.15; 95% CI 1.02 to 4.55) and transplantation (aOR 5.48; 95% CI 2.82 to 10.63).

Conclusions
The risk of severe COVID-19 outcomes is increased in certain patient groups with ARDs or transplantation, although the magnitude differs across individual diseases. Strategies to mitigate risk, such as booster vaccination, prompt diagnosis and early intervention with available therapies, should be prioritised in these groups according to risk.