Risultati per: Long COVID: principali risultati, meccanismi e raccomandazioni

In HIV and ID Observations, Dr. Paul Sax discusses the results of the SCORPIO-HR study.

Minore diffusione al Sud per la qualità di una molecola

Objectives
This study explores the drug use behaviour in the US general population in the early days of the COVID-19 pandemic with a focus on the relationship between sociopsychological factors, mobility restrictions from March to June 2020 and mental health conditions.

Design
A retrospective anonymous online survey representing a cross-section of the US population in 2020.

Setting
A qualified panel of 500 000 Qualtrics participants stratified by gender, race, age and geographical region to represent the US population.

Participants
3340 participants voluntarily consented to respond.

Measures
Outcome measure for illicit and non-medical use of prescription drugs based on the National Institute on Drug Abuse-Modified Alcohol, Smoking and Substance Involvement Screening Test Level-2 Substance Use for Adult Questionnaire and predictor measures include self-reports of mobility behaviours, demographics and mental states using psychometrically validated scales.

Results
2 tests showed that those who stayed home reported higher odds (p

Introduction
SARS-CoV-2 disease (COVID-19) has had an enormous health and economic impact globally. Although primarily a respiratory illness, multi-organ involvement is common in COVID-19, with evidence of vascular-mediated damage in the heart, liver, kidneys and brain in a substantial proportion of patients following moderate-to-severe infection. The pathophysiology and long-term clinical implications of multi-organ injury remain to be fully elucidated. Age, gender, ethnicity, frailty and deprivation are key determinants of infection severity, and both morbidity and mortality appear higher in patients with underlying comorbidities such as ischaemic heart disease, hypertension and diabetes. Our aim is to gain mechanistic insights into the pathophysiology of multiorgan dysfunction in people with COVID-19 and maximise the impact of national COVID-19 studies with a comparison group of COVID-negative controls.

Methods and analysis
COmorbidities and Sociodemographic factors on Multiorgan Injury following COVID-19 (COSMIC) is a prospective, multicentre UK study which will recruit 200 subjects without clinical evidence of prior COVID-19 and perform extensive phenotyping with multiorgan imaging, biobank serum storage, functional assessment and patient reported outcome measures, providing a robust control population to facilitate current work and serve as an invaluable bioresource for future observational studies.

Ethics and dissemination
Approved by the National Research Ethics Service Committee East Midlands (REC reference 19/EM/0295). Results will be disseminated via peer-reviewed journals and scientific meetings.

Trial registration number
COSMIC is registered as an extension of C-MORE (Capturing Multi-ORgan Effects of COVID-19) on ClinicalTrials.gov (NCT04510025).

Introduction
The incidence of severe natural disasters has been increasing worldwide. The residents of long-term care facilities (LTCFs) are particularly vulnerable to such events. Therefore, promoting disaster preparedness among LTCF stakeholders is urgent. However, the optimal preparedness process remains unclear. To close this gap, we use a realist review (RR) to promote an understanding of under what circumstances and what works for promoting the disaster preparedness among LTCF stakeholders and develop theories for the process.

Methods and analysis
RR will be guided by the Realist and Meta-Narrative Evidence Synthesis: Evolving Standard. The following five steps will be employed: (1) literature review and search for evidence, (2) study selection, (3) data extraction, (4) data synthesis and (5) development of the initial programme theory (IPT). Evidence will be searched using MEDLINE, CINAHL, PsycINFO, Web of Science, Cochrane Library, Scopus and ICHUSHI (a Japanese database). Grey literature and citation tracking will also be used. Documents of any design or publication type will be included. The study selection, coding and synthesis will be conducted independently by two authors. An IPT will be developed in the Context–Mechanism–Outcome configuration to understand how to promote disaster preparedness among LTCF stakeholders. The developed IPT will be verified by experts or stakeholders to enhance its validity.

Ethics and dissemination
Ethical approval will not be required because this is a review of published literature. The results will be disseminated at scientific conferences and peer-reviewed journals. The developed IPT will be used in subsequent research and iteratively tested or refined to better explain under what circumstances and what works for promoting disaster preparedness among LTCF stakeholders.

Registration details
This protocol has been registered at the Open Science Framework https://doi.org/10.17605/OSF.IO/J4TU6.

Background
Aberrant Wnt pathway activation is a key driver of colorectal cancer (CRC) and is essential to sustain tumour growth and progression. Although the downstream protein-coding target genes of the Wnt cascade are well known, the long non-coding transcriptome has not yet been fully resolved.

Objective
In this study, we aim to comprehensively reveal the Wnt-regulated long non-coding transcriptome and exploit essential molecules as novel therapeutic targets.

Design
We used global run-on sequencing to define β-catenin-regulated long non-coding RNAs (lncRNAs) in CRC. CRISPRi dropout screens were subsequently used to establish the functional relevance of a subset of these lncRNAs for long-term expansion of CRC.

Results
We uncovered that LINC02418 is essential for cancer cell clonogenic outgrowth. Mechanistically, LINC02418 regulates MYC expression levels to promote CRC stem cell functionality and prevent terminal differentiation. Furthermore, we developed effective small interfering RNA (siRNA)-based therapeutics to target LINC02418 RNA in vivo.

Conclusion
We propose that cancer-specific Wnt-regulated lncRNAs provide novel therapeutic opportunities to interfere with the Wnt pathway, which has so far defied effective pharmacological inhibition.

Objectives
To investigate the long-term safety and efficacy of otilimab, an antigranulocyte-macrophage colony-stimulating factor monoclonal antibody, for patients with rheumatoid arthritis (RA).

Methods
ContRAst X (NCT04333147) was a phase 3, multicentre, long-term extension trial. Patients with RA aged ≥18 years who completed a qualifying contRAst trial (contRAst 1–3) and who the investigator thought might benefit from long-term otilimab treatment were eligible to enter contRAst X. Patients who received otilimab (90 mg/150 mg) in their qualifying trial maintained the same dose; patients who received tofacitinib or sarilumab were rerandomised 1:1 to either otilimab dose. Patients could continue background conventional synthetic disease-modifying antirheumatic drugs. The primary objective was long-term safety (up to 4 years).

Results
Of the 2916 patients who entered contRAst X, 2915 received otilimab (exposure range: 7–896 days); the majority were withdrawn due to early trial termination. For otilimab 90 mg and 150 mg, the incidence of adverse events (AEs) was 62% (n=902/1456) and 64% (n=931/1459), the incidence of AEs of special interest was 8% (n=120/1456) and 7% (n=95/1459) and the incidence of serious AEs was 8% (n=123/1456) and 8% (n=114/1459), respectively. There were no instances of pulmonary alveolar proteinosis (PAP), active tuberculosis (TB), TB reactivation or serious hypersensitivity reactions. The proportions of clinical disease activity index low disease activity responders remained relatively stable throughout, with no apparent reduction following the switch from tofacitinib/sarilumab to otilimab.

Conclusion
No new safety signals or instances of PAP were associated with long-term (≤2.5 years) treatment with otilimab.

Trial registration number
ClinicalTrials.gov: NCT04333147.

‘Cambiamento in corso, Regioni stanno dando attuazione a norme’

Objectives
The COVID-19 pandemic highlighted the deterioration of nurses’ working conditions and a growing global nursing shortage. Little is known about the factors, strategies and interventions that could improve nurse retention in the peri- and post-COVID-19 period. An improved understanding of strategies that support and retain nurses will provide a foundation for developing informed approaches to sustaining the nursing workforce. The aim of this scoping review is to investigate and describe the (1) factors associated with nurse retention, (2) strategies to support nurse retention and (3) interventions that have been tested to support nurse retention, during and after the COVID-19 pandemic.

Design
Scoping review.

Data sources
This scoping review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. MEDLINE, Embase, CINAHL and Scopus databases were searched on 17 April 2024. The search was limited to a publication date of ‘2019 to present’.

Eligibility criteria
Qualitative, quantitative, mixed-methods and grey literature studies of nurses (Registered Nurse (RN), Licenced Practical Nurse (LPN), Registered Practical Nurse (RPN), Publlic Health Nurse (PHN), including factors, strategies and/or interventions to support nurse retention in the peri- and post-COVID-19 period in English (or translated into English), were included. Systematic reviews, scoping reviews and meta-syntheses were excluded, but their reference lists were hand-screened for suitable studies.

Data extraction and synthesis
The following data items were extracted: title, journal, authors, year of publication, country of publication, setting, population (n=), factors that mitigate intent to leave (or other retention measure), strategies to address nurse retention, interventions that address nurse retention, tools that measure retention/turnover intention, retention rates and/or scores. Data were evaluated for quality and synthesised qualitatively to map the current available evidence.

Results
Our search identified 130 studies for inclusion in the analysis. The majority measured some aspect of nurse retention. A number of factors were identified as impacting nurse retention including nurse demographics, safe staffing and work environments, psychological well-being and COVID-19-specific impacts. Nurse retention strategies included ensuring safe flexible staffing and quality work environments, enhancing organisational mental health and wellness supports, improved leadership and communication, more professional development and mentorship opportunities, and better compensation and incentives. Only nine interventions that address nurse retention were identified.

Conclusions
Given the importance of nurse retention for a variety of key outcomes, it is imperative that nursing leadership, healthcare organisations and governments work to develop and test interventions that address nurse retention.

Stroke, Ahead of Print. Subarachnoid hemorrhage is a critical neurological condition accounting for about 5% of all strokes, and survivors experience long-term cognitive deterioration and increased risk of dementia. The major processes involved in such decline include early brain injury, delayed cerebral ischemia, neuroinflammation, superficial siderosis, and hydrocephalus. These have emerging treatments that offer promise for the mitigation of effects such as inflammation, iron chelation, and microvascular dysfunction. Genetic predispositions have been associated with post-subarachnoid hemorrhage cognitive outcomes and emphasize a role for personalized care strategies. Management techniques reviewed include long-term cognitive health, such as endovascular coiling and surgical clipping. Other rehabilitation strategies that enhance cognitive reserve and pharmacological interventions are discussed about improving the quality of life in survivors. The review highlights the need for further research into targeted therapies, genetic markers, and innovative approaches to prevent cognitive decline, ultimately aiming to optimize long-term outcomes for individuals affected by subarachnoid hemorrhage.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Patients with cardiovascular disease can achieve very low levels of low-density lipoprotein (LDL) cholesterol with evolocumab without worrying about cognitive impairment, according to a study published in NEJM Evidence.

Objectives
This study aimed to explore how emergency department (ED) organisations and clinicians adapted to altered prerequisites during the first wave of the COVID-19 pandemic, the processes involved and the consequences. In addition, we examined how the ordinary state affected resilient performance during this period.

Design
This qualitative study involved inductive thematic analysis of semi-structured interviews and narratives.

Setting
Three hospital-based EDs, one county and two rural hospitals, located in two Swedish regions were studied.

Participants
A total of 12 participants, 80% of whom were women, were recruited. The participants included two physicians, three registered nurses, three assistant nurses and four nursing managers working at the three EDs before and during the first pandemic wave.

Results
The overarching theme ‘anchored in the eye of the storm’ emerged. This theme suggests that resilient performance during the pandemic was facilitated by ordinary adaptive capacity in the ED. A thematic map and seven main themes with a total of 25 subthemes explain the process. The ordinary state of conditions in the ED was challenged with the emergence of the COVID-19 pandemic. Altered prerequisites were perceived partly as a new reality in addition to business as usual. The adaptations included organise to regain control and developing new strategies to manage the situation, mainly by initiatives among clinicians. The consequences included perceived strain and frustration and partially impacted quality of care. However, an increased sense of cohesion among clinicians and enhanced knowledge were also noted.

Conclusion
During the pandemic, a partially new reality was experienced, although work also continued largely as business as usual based on experiences of crowding, established preparedness plans and ordinary adaptive capacity. Despite dealing with a previously unknown patient group, the experience of working with critically ill patients and establishing structured work processes proved advantageous and facilitated resilient performance.

Objectives
To investigate the prevalence and factors of COVID-19 infection in children aged 0–6 years within Hunan Province following the deregulation of epidemic control.

Design
This is an observational study in epidemiology, using an on-site questionnaire survey to investigate the current status of COVID-19 infection and its influencing factors in children aged 0–6 years in Hunan Province from 16 February to 24 March 2023.

Setting
Multi-stage stratified sampling method was applied in this study. The regions were categorised as developed, medium and underdeveloped. One municipality was selected from each category. In each municipality, one district and one county were chosen for cluster sampling.

Participants
Children aged 0–6 years in Hunan Province.

Results
A total of 78 115 children aged 0–6 years were enrolled in this study, of 30 659 (39.2%) had a confirmed positive SARS-CoV-2 test result or related clinical symptoms. The majority of COVID-19 infections in children were of mild type (92.0%), and very few were severe and critical (0.4% and 0.1%). The majority (74.6%–88.7%) of children had minimal lifestyle behavioural changes after infected with COVID-19. Parents of the child working as a staff member (OR=0.654, 95% CI: 0.603, 0.709) and civil servant (OR=0.865, 95% CI: 0.794, 0.941), living in a rural area (OR=0.384, 95% CI: 0.369, 0.400) and no COVID-19 exposure (OR=0.108, 95% CI: 0.104, 0.113) were protective factors for COVID-19 infection in children.

Conclusion
Children experienced a large number of COVID-19 infections following the deregulation, fewer severe cases and fewer changes in lifestyle. Easing epidemic control measures in the later stage of the pandemic did not aggravate the consequences of the epidemic.

Background
Understanding the impact of COVID-19 on the unplanned patient flow within hospitals is crucial for future preparedness planning and response strategies. We examined the impact of COVID-19 on the unplanned patient flow in a Danish healthcare region, with particular focus on emergency departments (EDs).

Methods
A descriptive multicentre cohort study was conducted comparing unplanned patient contacts during the first year of the COVID-19 pandemic (1 March 2020–28 February 2021) with the previous year (1 March 2019–29 February 2020). The study examined changes in patient flow and key flow variables—number of contacts, length of stay (LOS), triage, re-contacts, mortality, International Classification of Diseases (ICD)-10 codes, isolations and SARS-CoV-2-positive patients—and compared differences between five EDs in the Central Denmark Region.

Results
The overall number of unplanned patient contacts decreased 3.6% from the previous period (257 657) to the COVID-19 period (248 706). The decrease was lowest in EDs compared with other departments and was primarily detected during lockdowns, which were followed by months of increased ED contacts.
Although overall patient contacts decreased, an increase in proportions was observed in contacts with a LOS