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

Objectives
Men have a higher mortality rate and more severe COVID-19 infection than women. The mechanism for this is unclear. We hypothesise that innate sex differences, rather than comorbidity burden, drive higher male mortality.

Design
Retrospective cohort.

Setting
Montefiore Health System (MHS) in Bronx, New York, USA.

Participants
A cohort population of 364 992 patients at MHS between 1 January 2018 and 1 January 2020 was defined, from which individuals hospitalised during the pre-COVID period (1 January 2020–15 February 2020) (n=5856) and individuals hospitalised during the COVID-19 surge (1 March 2020–15 April 2020) (n=4793) were examined for outcomes. A subcohort with confirmed COVID-19+ hospitalisation was also examined (n=1742).

Primary and secondary outcome measures
Hospitalisation and in-hospital mortality.

Results
Men were older, had more comorbidities, lower body mass index and were more likely to smoke. Unadjusted logistic regression showed a higher odds of death in hospitalised men than women during both the pre-COVID-19 and COVID-19 periods (pre-COVID-19, OR: 1.66 vs COVID-19 OR: 1.98). After adjustment for relevant clinical and demographic factors, the higher risk of male death attenuated towards the null in the pre-COVID-19 period (OR 1.36, 95% CI 1.05 to 1.76) but remained significantly higher in the COVID-19 period (OR 2.02; 95% CI 1.73 to 2.34).
In the subcohort of COVID-19+ hospitalised patients, men had 1.37 higher odds of in-hospital death (95% CI 1.09 to 1.72), which was not altered by adjustment for comorbidity (OR remained at 1.38 (95% CI 1.08 to 1.76)) but was attenuated with addition of initial pulse oximetry on presentation (OR 1.26, 95% CI 0.99 to 1.62).

Conclusions
Higher male mortality risk during the COVID-19 period despite adjustment for comorbidity supports the role of innate physiological susceptibility to COVID-19 death. Attenuation of higher male risk towards the null after adjustment for severity of lung disease in hospitalised COVID-19+ patients further supports the role of higher severity of COVID-19 pneumonia in men.

Objectives
Across diverse ethnic groups in the UK, explore attitudes and intentions towards COVID-19 vaccination and sources of COVID-19 information.

Design
Remote qualitative interviews and focus groups (FGs) conducted June–October 2020 before UK COVID-19 vaccine approval. Data were transcribed and analysed through inductive thematic analysis and mapped to the Theoretical Domains Framework.

Setting
England and Wales.

Participants
100 participants from 19 self-identified ethnic groups.

Results
Mistrust and doubt were reported across ethnic groups. Many participants shared concerns about perceived lack of information about COVID-19 vaccine safety and efficacy. There were differences within each ethnic group, with factors such as occupation and perceived health status influencing intention to accept a vaccine once made available. Across ethnic groups, participants believed that public contact occupations, older adults and vulnerable groups should be prioritised for vaccination. Perceived risk, social influences, occupation, age, comorbidities and engagement with healthcare influenced participants’ intentions to accept vaccination once available. All Jewish FG participants intended to accept, while all Traveller FG participants indicated they probably would not.
Facilitators to COVID-19 vaccine uptake across ethnic groups included: desire to return to normality and protect health and well-being; perceived higher risk of infection; evidence of vaccine safety and efficacy; vaccine availability and accessibility.
COVID-19 information sources were influenced by social factors and included: friends and family; media and news outlets; research literature; and culture and religion. Participants across most different ethnic groups were concerned about misinformation or had negative attitudes towards the media.

Conclusions
During vaccination rollout, including boosters, commissioners and providers should provide accurate information, authentic community outreach and use appropriate channels to disseminate information and counter misinformation. Adopting a context-specific approach to vaccine resources, interventions and policies and empowering communities has potential to increase trust in the programme.

To the Editor Nersesjan et al report on cognitive and neuropsychiatric outcomes in COVID-19 survivors vs control individuals. Their study is a robust foray into the neurocognitive sequalae of COVID-19 that provides both follow-up and control data for comparison and context. However, there are 2 critical caveats that may impair generalizability: sleep-disordered breathing and cerebrovascular disease as drivers of cognitive impairment in both patients with COVID-19 and control individuals without COVID-19. The former caveat stems from screening that was not included in the authors measurements; the latter is a direct generalization of their results and may also imply other confounders, such as medication status.

This cohort study analyzes data from US residents to examine the mental health effect of everyday discrimination during the early phase of the COVID-19 pandemic.

In Reply We thank Vavougios and colleagues for their letter suggesting sleep-disordered breathing and cerebrovascular disease as potential driving variables in the association between COVID-19 hospitalization and neurocognitive sequalae found in our study. We acknowledge that sleep-disordered breathing and cerebrovascular disease can potentially influence the observed cognitive impairment and thus investigated this further in our data set.

To the Editor In their article, Dr Qian and colleagues reported the results of a trial comparing awake prone positioning (APP) with usual care in nonintubated adults with COVID-19–induced hypoxemia. Although it provides insights into the nuances and perils of APP, their findings contrast with the results of a recent metatrial in which lower intubation rates were observed with APP.

This randomized clinical trial assesses high-dose dexamethasone vs standard care and 3 oxygenation strategies for intensive care unit (ICU) patients with severe COVID-19 acute hypoxemic respiratory failure.

This systematic review and meta-analysis used databases, such as PubMed, ProQuest, and Scopus, to investigate the association between the COVID-19 pandemic and decreased rates of breast, colorectal, and cervical cancer screening globally.

To the Editor In their nonrandomized controlled trial of awake prone positioning (APP) in patients hospitalized with COVID-19, Dr Qian and colleagues describe the short-term potential harm from APP that was no longer apparent by day 28. This potential for harm needs to be explained and reconciled with contrasting evidence of benefit demonstrated in our larger metatrial and further confirmed in a recent meta-analysis that included more than 4000 patients, approximately 2000 of whom were included in randomized clinical trials.

In Reply We thank Dr Pavlov and colleagues and Dr Meza-Comparán and colleagues for their commentary regarding our article. We acknowledge the reticence of Dr Pavlov and colleagues regarding our speculation that awake prone positioning (APP) may obscure natural progression of disease; however, higher daily fraction of inspired oxygen (FiO2) with APP does not necessarily contradict this hypothesis because this measure is simply the highest FiO2 achieved at any point during the day, independent of position. We also agree that similar mortality and lower rates of intubation may have to do with patient preference and their do not intubate status, which may differ among patient populations. However, it is essential to disentangle the timing of these elections in regard to enrollment and disease progression. If the real benefit of APP is prevention of intubation—no studies have demonstrated a mortality benefit—the most important group to study may be those who have chosen not to be intubated.

Objectives
There are no established mortality risk equations specifically for unplanned emergency medical admissions which include patients with SARS-19 (COVID-19). We aim to develop and validate a computer-aided risk score (CARMc19) for predicting mortality risk by combining COVID-19 status, the first electronically recorded blood test results and the National Early Warning Score (NEWS2).

Design
Logistic regression model development and validation study.

Setting
Two acute hospitals (York Hospital—model development data; Scarborough Hospital—external validation data).

Participants
Adult (aged ≥16 years) medical admissions discharged over a 24-month period with electronic NEWS and blood test results recorded on admission. We used logistic regression modelling to predict the risk of in-hospital mortality using two models: (1) CARMc19_N: age+sex+NEWS2 including subcomponents+COVID19; (2) CARMc19_NB: CARMc19_N in conjunction with seven blood test results and acute kidney injury score. Model performance was evaluated according to discrimination (c-statistic), calibration (graphically) and clinical usefulness at NEWS2 thresholds of 4+, 5+, 6+.

Results
The risk of in-hospital mortality following emergency medical admission was similar in development and validation datasets (8.4% vs 8.2%). The c-statistics for predicting mortality for CARMc19_NB is better than CARMc19_N in the validation dataset (CARMc19_NB=0.88 (95% CI 0.86 to 0.90) vs CARMc19_N=0.86 (95% CI 0.83 to 0.88)). Both models had good calibration (CARMc19_NB=1.01 (95% CI 0.88 to 1.14) and CARMc19_N:0.95 (95% CI 0.83 to 1.06)). At all NEWS2 thresholds (4+, 5+, 6+) model, CARMc19_NB had better sensitivity and similar specificity.

Conclusions
We have developed a validated CARMc19 scores with good performance characteristics for predicting the risk of in-hospital mortality. Since the CARMc19 scores place no additional data collection burden on clinicians, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.

Annals of Internal Medicine, Volume 175, Issue 10, Page 1401-1410, October 2022.

Il 1 settembre l’Agenzia Ue del farmaco darà il via libera ai nuovi vaccini bivalenti efficaci anche contro Omicron. Attesa anche la circolare della Salute che introduce l’isolamento “light”.

Objectives
The COVID-19 outbreak beginning in late 2019 has resulted in negative emotions among the public. However, many healthcare workers risked their lives by voluntarily travelling to the worst-hit area, Hubei Province, to support antipandemic work. This study explored the mental health changes in these healthcare workers and tried to discover the influencing factors.

Design
A longitudinal online survey was begun on 8 February 2020, using the snowball sampling method, and this first phase ended on 22 February 2020 (T1). The follow-up survey was conducted from 8 February to 22 February 2021 (T2).

Setting
Healthcare workers from outside of the Hubei area who went to the province to provide medical assistance.

Participants
963 healthcare workers who completed both surveys.

Measures
Self-Rating Scale of Sleep (SRSS), Generalised Anxiety Scale (GAD-7) and 9-item Patient Health Questionnaire (PHQ-9).

Results
There were no significant differences in the SRSS scores or in the GAD-7 scores between T1 and T2 (t=0.994, 0.288; p >0.05). However, the PHQ-9 score at T2 was significantly higher than the score at T1 (t=–10.812, p

Objectives
The aim of this study was to examine the well-being experiences of consultants working in paediatric critical care (PCC) settings in the UK during the COVID-19 pandemic.

Design
Qualitative design using individual interviews and thematic analysis.

Setting
PCC.

Participants
Eleven medical consultants working in PCC in a range of PCC settings/transport teams in the UK from nine units participated. Participants ranged in years of experience as a consultant from four to 23 years.

Methods
A set of open semistructured questions were used to elicit information about participants’ experiences of workplace well-being. Interviews were audiorecorded and transcribed.

Findings
Thematic analysis identified six themes and data saturation was reached. These were as follows: (1) positive and negative impact of working during COVID-19, (2) job satisfaction and public scrutiny in the unique environment of PCC, (3) supporting the workforce through modified shift work, (4) perceptions of support and recognition offered from the hospital management, (5) successful coping strategies are personal and adaptive, and (6) importance of civility and good teamwork

Conclusion
Findings show that consultants’ well-being is challenged in a number of ways and that the solutions to the problem of burn-out are multifaceted. Action is required from individual consultants, clinical teams, hospital management and national regulatory bodies. Our work corroborates the recent General Medical Council report highlighting doctors’ core needs for well-being: autonomy, belonging, competence. Burn-out is a long-term problem, requiring sustainable solutions. Future research needs to develop and evaluate the effectiveness of evidence-based interventions to improve consultants’ well-being. Trials of effectiveness need to present evidence that will persuade hospital management to invest in their consultants’ well-being within the economic context of reduced budgets and limited PCC workforce.