Risultati per: Un po' di chiarezza sulla risposta immunitaria al COVID-19 e vaccini anti-COVID-19

Objective
During the COVID-19 pandemic, many parents faced heightened stress, anxiety and depression due to the local and global COVID-19 mitigation measures and lockdowns.

Design
This is a cross-sectional study.

Setting
This study used stratified whole-cluster sampling to randomly select three elementary schools within Ezhou City.

Participants
An online survey was administered to the parents of students in one or two classes in grades 1–6, respectively, of each school. Among them, males account for 30.4% and females account for 69.6%. The inclusion criteria included (1) the parent or legal guardian of a primary school student or a person directly responsible for the child’s education and (2) the ability to operate a computer or smartphone to complete the survey. Only one representative from each family was allowed to participate, and surveys with incomplete data were considered invalid and thus excluded.

Results
A total of 764 participants completed the online survey. Overall, 90.4% of the participants were concerned about their children’s mental health and learning during the pandemic. Additionally, 97.0% were aware of the typical symptoms of COVID-19. Only 48.0% of the participants felt the pandemic negatively impacted their lives. The average psychological status score among parents was 87.79±8.91, with 51.6% showing signs of high psychological distress. Significant differences in psychological status were linked to age, education, professional background, sleep status, personal views on the pandemic’s impact and concern for children’s learning (p

Introduction
The SARS-CoV-2 pandemic has caused global devastations in social, economic and health systems of every nation, but disproportionately of nations in Africa. In addition to its grave effects on the global systems, there is continuation or development of new symptoms among individuals who have contracted the virus, with the potential to further stress the health systems on the continent. Therefore, the aim of this scoping review was to collate and summarise the existing research evidence on the prevalence and health effects of post–COVID-19 conditions in Africa.

Methods and analysis
Five main databases were thoroughly searched from 1 September 2023 to 10 May 2024 for eligible articles based on the pre-established inclusion and exclusion criteria. These databases included PubMed, Central, Scopus, Dimensions AI and JSTOR. A total of 17 papers were included in the review. The protocol for this review is already published in BMJ Open; doi:10.1136/bmjopen-2023-082519.

Results
The prevalence of post–COVID-19 conditions in Africa ranged from 2% to as high as 94.7%. Fatigue, dyspnoea and brain fog were among the commonly reported symptoms of post–COVID-19 conditions. Reduced functional status as well as physical and psychosocial disorders were the main health effects reported by the studies reviewed, but no study yet reported the effects of post–COVID-19 conditions on the health systems in Africa.

Conclusions
There is an evidence of high prevalence of post–COVID-19 conditions in the African setting. However, there is limited evidence of the health effects of the post–COVID-19 conditions on patients and health systems in Africa.

Ethics and dissemination
This scoping review involved analysis of secondary data; therefore, no ethical approval was needed. Dissemination of the result is being done through international journals and may also be presented at available research conferences.

Objective
To identify the early predictors of a self-reported persistence of long COVID syndrome (LCS) at 12 months after hospitalisation and to propose the prognostic model of its development.

Design
A combined cross-sectional and prospective observational study.

Setting
A tertiary care hospital.

Participants
221 patients hospitalised for COVID-19 who have undergone comprehensive clinical, sonographic and survey-based evaluation predischarge and at 1 month with subsequent 12-month follow-up. The final cohort included 166 patients who had completed the final visit at 12 months.

Main outcome measure
A self-reported persistence of LCS at 12 months after discharge.

Results
Self-reported LCS was detected in 76% of participants at 3 months and in 43% at 12 months after discharge. Patients who reported incomplete recovery at 1 year were characterised by a higher burden of comorbidities (Charlson index of 0.69±0.96 vs 0.31±0.51, p=0.001) and residual pulmonary consolidations (1.56±1.78 vs 0.98±1.56, p=0.034), worse blood pressure (BP) control (systolic BP of 138.1±16.2 vs 132.2±15.8 mm Hg, p=0.041), renal (estimated glomerular filtration rate of 59.5±14.7 vs 69.8±20.7 mL/min/1.73 m2, p=0.007) and endothelial function (flow-mediated dilation of the brachial artery of 10.4±5.4 vs 12.4±5.6%, p=0.048), higher in-hospital levels of liver enzymes (alanine aminotransferase (ALT) of 76.3±60.8 vs 46.3±25.3 IU/L, p=0.002) and erythrocyte sedimentation rate (ESR) (34.3±12.1 vs 28.3±12.6 mm/h, p=0.008), slightly higher indices of ventricular longitudinal function (left ventricular (LV) global longitudinal strain (GLS) of 18.0±2.4 vs 17.0±2.3%, p=0011) and higher levels of Hospital Anxiety and Depression Scale anxiety (7.3±4.2 vs 5.6±3.8, p=0.011) and depression scores (6.4±3.9 vs 4.9±4.3, p=0.022) and EFTER-COVID study physical symptoms score (12.3±3.8 vs 9.2±4.2, p

Objectives
To assess the prevalence of UK healthcare workers (HCWs) who reported symptoms of COVID-19 lasting for longer than 5 weeks and examine associated factors with experiencing long COVID in an ethnically diverse cohort.

Design
A cross-sectional study using data from the UK Research study into Ethnicity And COVID-19 Outcomes in HCWs cohort study.

Setting
Data were collected electronically between December 2020 and March 2021.

Participants
Individuals aged 16 years or older, residing in the UK, and working as HCWs or ancillary workers in a healthcare setting and/or registered with one of the seven major UK healthcare professional regulators.

Primary and secondary outcome measures
The main outcome was long COVID (symptoms >5 weeks). The primary exposure of interest was self-reported ethnicity. We employed univariable and multivariable logistic regression to identify associations. We adjusted for demographic information, health status and existing long-term conditions in our multivariate analysis.

Results
In our analysis of 11 513 HCWs, we found that 2331 (20.25%) reported COVID-19, of whom 525 (22.52%) experienced long COVID. There were no significant differences in risk of long COVID by ethnic group. In terms of other demographic characteristics, the majority of those experiencing long COVID were female (80.0%) and were slightly older than those who did not experience long COVID (median age 46 (IQR 36–54)). In multivariable analyses of those who reported having had COVID-19, HCWs in nursing/midwifery roles (adjusted OR (aOR) 1.76, 95% CI 1.26 to 2.46; p=0.001) and allied health professions (aOR 1.42, 95% CI 1.05 to 1.93; p=0.023) had higher odds of experiencing long COVID compared with those in medical roles. Other factors significantly associated with long COVID included self-reported psychological conditions (eg, depression and anxiety) and respiratory conditions (eg, asthma).

Conclusions
In this large ethnically diverse cohort study, more than one in five UK HCWs reported experiencing long COVID after acute COVID-19 during the first year of the pandemic. We found that specific demographic (older age and female gender) and occupational factors (nursing/midwifery and allied health professions) were associated with higher odds of long COVID. Notably, there were no significant differences in the risk of long COVID by ethnic group. Further research and collaborative efforts are urgently needed to address these factors effectively, develop targeted interventions and understand the temporal and longitudinal dynamics of the condition.

The Centers for Disease Control and Prevention (CDC) recommended a second dose of the 2024-2025 COVID-19 vaccine, administered 6 months after the first dose, for people aged 65 years or older and individuals who are immunocompromised.

Objectives
To evaluate the effectiveness of localised Tier 3 restrictions, implemented in England in December 2020, on reducing COVID-19 hospitalisations compared with less stringent Tier 2 measures and the variations by neighbourhood deprivation and the prevalence of Alpha (B.1.1.7) variant, the primary variant of concern then, to measure hospital services’ burden and inequalities across different communities.

Design
Observational study using a synthetic control method, comparing weekly hospitalisation rates in Tier 3 areas to a synthetic control from Tier 2 areas.

Setting
England between 4 October 2020 and 21 February 2021.

Participants
23 million people under Tier 3 restrictions, compared with a synthetic control group derived from 29 million people under Tier 2 restrictions.

Interventions
Tier 3 restrictions in designated areas were implemented from 7 December 2020, imposing stricter limits on gatherings and hospitality than Tier 2, followed by a national lockdown on 6 January 2021.

Primary and secondary outcome measures
Weekly COVID-19-related hospitalisations for neighbourhoods in England over 11 weeks following the interventions.

Results
Implementing Tier 3 restrictions were associated with a 17% average reduction in hospitalisations compared with Tier 2 areas (95% CI 13% to 21%; 8158 (6286 to 9981) in total). The effects were similar across different levels of neighbourhood deprivation and prevalence of the Alpha variant.

Conclusions
Regionally targeted Tier 3 restrictions in England had a moderate but significant effect on reducing hospitalisations. The impact did not exacerbate socioeconomic inequalities during the pandemic. Our findings suggest that regionally targeted restrictions can be effective in managing infectious diseases.

Objectives
To explore the impact of the SARS-CoV-2/COVID-19 pandemic on the diagnosis, management and patient journey for children and young people with a newly diagnosed brain tumour in the UK.

Design
Exploratory qualitative study focused on patient journeys from multiple perspectives, conducted as part of a wider mixed-methods study.

Setting
Three paediatric oncology tertiary centres in the UK.

Participants
10 children and young people with brain tumours (n=6 females, n=4 males), 20 caregivers (n=16 females, n=4 males) and 16 stakeholders (specialist nurses, consultant neurosurgeons and oncologists, and representatives from brain tumour charities) were interviewed between January 2022 and June 2023.

Results
The paper incorporates multiple perspectives, including those of children and young people, parents/caregivers, clinical staff and charity representatives, to explore the patient journey. Five themes describe the journey for new patients with paediatric brain tumour during the pandemic, focusing on (1) challenges getting into the healthcare system, (2) managing as a family during restrictions imposed by the pandemic, (3) complexities of building a cohesive and supportive healthcare team, (4) difficulties caregivers experienced in accessing practical and emotional support in hospital and (5) ongoing difficulties experienced by families in the community.

Conclusions
Findings from this study offer practical insights from children, parents/caregivers and relevant stakeholders to improve the healthcare system during future disruptions. Overall, this study not only sheds light on the challenges faced by families during the pandemic but also provides suggestions for improving healthcare services to ensure a more comprehensive and effective response in times of crisis.

Objective
This qualitative study sought to understand how sufficient economy philosophy (SEP) was applied to cope with and recover from the COVID-19 pandemic.

Design
A qualitative study conducted through focus group discussions.

Participants
19 focus groups, with 161 participants, selected for the diverse backgrounds in gender, profession, education and region (urban/rural) and different levels of impact from the pandemic.

Setting
Bangkok, the capital city, and the four regions of Thailand: north, northeast, south and central.

Findings
Participants highlighted the moderation, reasonableness and prudence as key themes that mitigated adverse economic impacts during the pandemic. Communities practising the SEP reported resilience through balanced consumption, prudent planning and social cooperation. Many participants mentioned that the SEP was crucial to their survival and should have been better practised. Though the market structure failed during the pandemic, they still could secure the essential items to maintain livelihood.

Conclusion
In a society where changes are complicated by multiple factors, crises may occur more frequently, unsuspectedly and in various forms. Tools and a mechanism for resilience are increasingly needed. This study highlights the importance of the SEP, which incorporates five key concepts: moderation, reasonableness, prudence, knowledge and morality. These concepts help affected communities survive and become resilient, which is crucial for achieving several Sustainable Development Goals, such as poverty and hunger reduction, enhanced health and well-being and the sustainability of cities and communities.

This case series examines treatment with anti–programmed cell death 1 (PD1) immunotherapy for patients with basal cell nevus syndrome.

Fimmg denuncia “gravi ritardi negli aggiornamenti degli elenchi

Fimmg denuncia “gravi ritardi negli aggiornamenti degli elenchi

Nella settimana prima delle feste si sono aggiunti quasi 600mila pazienti, numeri in crescita ma inferiori alla stagione record dell’anno scorso

Background
Following the COVID-19 pandemic, there was an increase in teenage pregnancies nationally, however, limited data exists regarding the same among girls living in refugee settlements.

Objectives
We evaluated the prevalence of teenage pregnancy and associated factors in Palorinya and Bidi Bidi refugee settlements in Obongi and Yumbe districts of northern Uganda, in the post-COVID-19 era.

Design
We conducted a cross-sectional study.

Setting
Refugee settlements in northern Uganda.

Participants
We included 385 teenage girls aged 15–19 years.

Methods
We used convenience sampling techniques between March and May 2023. Prevalence of teenage pregnancy was assessed by self-reported pregnancies between January 2020 and May 2023 among participants. We conducted Pearson’s 2 and Fisher’s exact tests for bivariate analysis. All variables with a p value

Objective
This study aims to examine the reduction and subsequent recovery of routine digital screening (RDS) uptake in England from 2018 to 2022, exploring national, regional and individual Diabetic Eye Screening Programme (DESP) levels. The COVID-19 lockdown in most areas of England was from 26 March 2020 to 23 June 2020 (first national lockdown), 5 November 2020 to 2 December 2020 (second national lockdown) and 6 January 2021 to 8 March 2021 (third national lockdown).

Design
Retrospective data analysis.

Setting
DESPs of England.

Participants
Individuals with diabetes who were invited to take part in the DESP programmes.

Methods
Publicly available data from Public Health England (2018–2019) and National Health Service England (2019–2022) were examined to identify the rate of uptake (proportion of those who attended the DESPs to those who were invited) of RDS at national and regional levels and by each DESP in England.

Primary outcome measures
Rate of uptake of RDS.

Results
The national uptake of RDS decreased from 82% (2019–2020) to 68% (2020–2021) and then increased to 78% (2021–2022). At the regional level, the sharpest drop was in the Midlands which decreased from 79% (2019–2020) to 53% (2020–2021), increasing to 73% (2021–2022) but did not reach pre-COVID-19 levels. At individual DESP levels across England, the greatest drop in attendance (2020–2021) was recorded in Derbyshire (79% to 45%), Barnsley and Rotherham (78% to 45%) and Arden, Herefordshire and Worcestershire (78% to 46%). Although these DESPs showed an increase in 2021–2022 of 33%, 21% and 31%, they did not reach prepandemic (2018–2019) rates of 81%, 85% and 82%, respectively. Data suggest that West Sussex, East Sussex and East and North Hertfordshire DESPs maintained relatively higher uptake rates (86%–89%) in 2020–2021.

Conclusion
COVID-19 had an impact on England’s diabetic eye screening attendance, with notable variations across regions and DESPs. Different regions and DESPs showed variable post-COVID-19 recovery. More importantly, what was not evident is the increased uptake that should have occurred after the COVID-19 lockdown to compensate for the low uptake during the lockdown. In some areas, addressing some of the barriers that affect retinal screening uptake may improve future attendance.

Objectives
To investigate the social support status and associated factors among Vietnamese methadone maintenance patients during the COVID-19 pandemic.

Design
Cross-sectional study.

Setting
Three methadone clinics.

Participants
540 patients.

Primary and secondary outcome measures
The Medical Outcomes Study—Social Support Survey questionnaire was employed to measure patients’ social support. Factors associated with the social support status of patients were determined through multivariate linear regression models. Variables in these models were selected using the Bayesian model averaging method.

Results
The average social support score of patients was 63.50±26.54 (ranger: 0–100). The average social support scores of patients living in mountainous areas (Dien Bien: 63.74±23.67, Son La: 46.15±20.31) were significantly lower than that of patients residing in metropolitan areas (Hanoi: 80.61±23.47) (p

Objectives
To examine quality of maternal and newborn care (QMNC) around childbirth in facilities in Belgium during the COVID-19 pandemic and trends over time.

Design
A cross-sectional observational study.

Setting
Data of the Improving MAternal Newborn carE in the EURO region study in Belgium.

Participants
Women giving birth in a Belgian facility from 1 March 2020 to 1 May 2023 responded a validated online questionnaire based on 40 WHO standards-based quality measures organised in four domains: provision of care, experience of care, availability of resources and organisational changes related to COVID-19.

Primary and secondary outcome measures
Quantile regression analysis was performed to assess predictors of QMNC; trends over time were tested with the Mann-Kendall test.

Results
897 women were included in the analysis, 67% (n=601) with spontaneous vaginal birth, 13.3% (n=119) with instrumental vaginal birth (IVB) and 19.7% (n=177) with caesarean section. We found overall high QMNC scores (median index scores >75) but also specific gaps in all domains of QMNC. On provision of care, 21.0% (n=166) of women who experienced labour reported inadequate pain relief, 64.7% (n=74) of women with an instrumental birth reported fundal pressure and 72.3% (n=86) reported that forceps or vacuum cup was used without their consent. On experience of care, 31.1% (n=279) reported unclear communication, 32.9% (n=295) reported that they were not involved in choices,11.5% (n=104) stated not being treated with dignity and 8.1% (n=73) experienced abuse. Related to resources, almost half of the women reported an inadequate number of healthcare professionals (46.2%, n=414). Multivariable analyses showed significantly lower QMNC scores for women with an IVB (–20.4 in the 50th percentile with p