Risultati per: Il significato della carica virale e l’effetto del vaccino anti-COVID-19

Objective
To examine changes in the prevalence of six key chronic disease risk factors (the “Big 6”), from before (2019) to during (2021) the COVID-19 pandemic, among a large and geographically diverse sample of adolescents, and whether differences over time are associated with lockdown status and gender.

Design
Prospective cohort study.

Setting
Three Australian states (New South Wales, Queensland and Western Australia) spanning over 3000 km.

Participants
983 adolescents (baseline Mage=12.6, SD=0.5, 54.8% girl) drawn from the control group of the Health4Life Study.

Primary outcomes
The prevalence of physical inactivity, poor diet (insufficient fruit and vegetable intake, high sugar-sweetened beverage intake, high discretionary food intake), poor sleep, excessive recreational screen time, alcohol use and tobacco use.

Results
The prevalence of excessive recreational screen time (prevalence ratios (PR)=1.06, 95% CI=1.03 to 1.11), insufficient fruit intake (PR=1.50, 95% CI=1.26 to 1.79), and alcohol (PR=4.34, 95% CI=2.82 to 6.67) and tobacco use (PR=4.05 95% CI=1.86 to 8.84) increased over the 2-year period, with alcohol use increasing more among girls (PR=2.34, 95% CI=1.19 to 4.62). The prevalence of insufficient sleep declined across the full sample (PR=0.74, 95% CI=0.68 to 0.81); however, increased among girls (PR=1.24, 95% CI=1.10 to 1.41). The prevalence of high sugar-sweetened beverage (PR=0.61, 95% CI=0.64 to 0.83) and discretionary food consumption (PR=0.73, 95% CI=0.64 to 0.83) reduced among those subjected to stay-at-home orders, compared with those not in lockdown.

Conclusion
Lifestyle risk behaviours, particularly excessive recreational screen time, poor diet, physical inactivity and poor sleep, are prevalent among adolescents. Young people must be supported to find ways to improve or maintain their health, regardless of the course of the pandemic. Targeted approaches to support groups that may be disproportionately impacted, such as adolescent girls, are needed.

Trial registration number
Australian New Zealand Clinical Trials Registry (ACTRN12619000431123)

Quest’anno dovrebbe crescere del 5% la spesa per gli acquisti diretti: lo sfondamento del tetto oltre i 2 miliardi, la metà a carico delle aziende

This cohort study investigates the association of individual and structural social determinants of health and vaccinations with child mental health during the COVID-19 pandemic in the US.

This cohort study assesses the association of the structural racism/COVID-19 syndemic with postpartum mental health of Black birthing individuals.

Stroke, Ahead of Print.

Diretta Live con Claudio Mastroianni (Professore Ordinario di Malattie Infettive, Università Sapienza Roma. Presidente Società Italiana Malattie Infettive e Tropicali) e Walter Ricciardi (Professore Ordinario di Igiene e Medicina Preventiva, Università Cattolica Sacro Cuore, Roma. Consigliere scientifico del Ministro della Salute per la pandemia da coronavirus)

Le incognite maggiori sono legate alla vaccinazione nei Paesi più poveri, ma pesano anche i conflitti internazionali e la poca collaborazione internazionale

La seconda generazione potrebbe garantire immunità più completa e minore probabilità che l’infezione sviluppi malattie negli organi

Sono stati 2,8 milioni gli screening oncologici saltati nei primi 17 mesi di pandemia. Manca un programma di recupero delle cure saltate e il Piano oncologico

Stroke, Ahead of Print. The main burden of SARS-CoV-2 falls on the lungs but neurological manifestations, the most disabling of which are strokes and which correlate with disease severity, are common. We proffer a novel mechanism for acute COVID-19 stroke whereby pulmonary vein clots developing within the characteristic pulmonary intravascular thrombotic lesions can embolize to the brain. Appreciation of this mechanism requires an understanding of the tricompartmental model of lung parenchyma oxygenation (the alveolus, the bronchial artery, and the pulmonary artery), all of which are compromised in COVID-19. Of these 3 sources, the bronchial artery plays a crucial role in COVID-19 stroke because the unique collaterals from bronchial artery to pulmonary vein which exist under normal physiological conditions (and which maintain venous patency when the pulmonary artery is blocked by embolus) are occluded, thus leading to venular thrombosis in the presence of hypercoagulability. Dislodgement of clots from this source translocates the pathology to the brain and is a disease mechanism, formerly rare, which may account for many cases of large vessel occlusion stroke in COVID-19. This mechanism extends the concept of cardioembolic stroke from endocardium retrogradely into the pulmonary circulation with which the left cardiac chambers lie in direct continuity, and which is an accepted stroke mechanism under other circumstances such as lung lobectomy, where surgical ligation of the pulmonary vein creates a blind sac from which thrombi can embolize. The proposed model is supported by postmortem studies which have demonstrated venular thrombosis and by case reports of pulmonary vein thrombosis in COVID-19. This concept provides a more plausible cause for COVID-19 associated large vessel occlusion stroke than other putative mechanisms, such as cerebral endotheliitis, cytokine storm, and hypercoagulopathy, although it is acknowledged that the latter mechanism contributes to the genesis of pulmonary vein clots. Recognizing that extrapulmonary manifestations including stroke arise within thrombosed pulmonary veins is key to understanding of neurological manifestations of SARS-CoV-2 infection.

L’immunologo americano Fauci consigliere della Casa Bianca ha già detto di ritenere molto probabile una nuova dose booster per tutti in autunno

BackgroundThe COVID-19 Ambulance Response Assessment (CARA) study was a prospective, longitudinal survey of UK ambulance staff providing both direct and remote patient care during the first wave of the COVID-19 pandemic. CARA aimed to evaluate perceptions of preparedness and wellbeing, and to collect staff suggestions to benefit working practices and conditions.MethodThree online questionnaires were presented, coinciding with the acceleration, peak and deceleration phases of the first COVID-19 wave. Inductive thematic analysis was employed to represent 14,237 free text responses from 3,717 participants to 18 free-text questions overall.ResultsA thematic framework was constructed from across the variety of questions that demonstrated participants’ objectives to minimise infection risks, maintain service delivery and support their own wellbeing. Additionally, the following requirements of national and organisational leadership were identified as enablers to achieving those objectives.Evidence-based policies, that are consistently applied, clearly communicated and accompanied by adequate training improve confidence and allay anxiety. Demonstrating learning, planning, and astute use of resources will further benefit trust in leadership and to support staff wellbeing there must also be meaningful dialogue and demonstrable empathy with further appropriate preventative and therapeutic interventions enabled.ConclusionInclusive, compassionate leadership will support both ambulance staff wellbeing and service delivery whilst working within pandemic conditions. New working practices should be introduced with transparency and staff experiences of implementing changes should be heeded by leadership to enable further policy development.Conflict of interestNone.FundingCollege of Paramedics.

BackgroundTRIM is an evaluation of the triage models used by emergency ambulance services caring for patients with suspected COVID-19 during the pandemic’s first wave in 2020. We aimed to understand experiences and concerns of staff about implementation of triage protocols.MethodResearch paramedics interviewed stakeholders from four ambulance services (call handlers, clinical advisors, paramedics, managers) and ED clinical staff from receiving hospitals. Interviews (n=23) were conducted remotely using MS Teams, recorded, and transcribed in full. Analysis generated themes from implicit and explicit ideas within participants’ accounts (Braun and Clarke 2021), conducted by researchers and PPI partners working together.ResultsWe identified the following themes:Constantly changing guidelines – at some points, updated several times a day.The ambulance service as part of the wider healthcare system – changes elsewhere in the system left ambulance services as the default.Peaks and troughs of demand – fluctuating greatly over time, and varying across the staff groups.A stretched system – resources were overextended by staff sickness and isolation, longer job times, and increased handover delays at ED.Emotional load of responding to the pandemic – including call centre staff. Doing the best they can in the face of uncertainty – a rapidly evolving situation unlike any which ambulance services had faced before.ConclusionImplementing triage protocols in response to the COVID-19 pandemic was complex and had to be actively managed by a range of frontline staff, dealing with external pressures and a heavy emotional load.Conflict of interestNone.FundingUKRI-DHSC Covid-19 Rapid Response Funding.