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

New England Journal of Medicine, Volume 392, Issue 7, Page 719-721, February 2025.

Objective brain injury and associated cognitive impairment were noted as long as 1 year after infection with SARS-CoV-2.

Objectives
Primary care clinicians are especially prone to burn-out. The primary objective of this study was to investigate factors contributing to burn-out and moral distress and their relationship among practising family physicians (FPs) in California early in the COVID-19 pandemic.

Design
Cross-sectional study, online survey evaluating burn-out, moral distress and associated factors.

Setting
California FPs between July and August 2020 practising in community health centres, hospital systems, private clinics and university systems were surveyed with a 22-item online questionnaire.

Participants
FPs practising in California were eligible. The final sample included 218 physicians.

Primary and secondary outcome measures
The primary independent variable was frequency of moral distress and the primary outcome variable was worsening burn-out. Moderator variables included gender and employer support.

Results
FPs experiencing higher burn-out and moral distress were more likely to report concerns regarding personal COVID-19 risk and lack of personal protective equipment. Practising self-care and personal wellness were associated with decreased moral distress. Female physicians were 3.86-fold more likely to report worsening burn-out compared with male physicians. Employer support was associated with a 59% reduced burn-out risk and 54% reduction in frequent moral distress. Frequent moral distress was associated with a 3.12- fold higher burn-out risk. Gender moderated the relationship between moral distress and burn-out. Moral distress was associated with a 3.55-fold increase in burn-out risk among females.

Conclusions
Female FPs experienced greater levels of moral distress and burn-out than male physicians. Moral distress was differentially associated with increased burn-out among female physicians. Employer support was a protective factor against moral distress and burn-out.

Objectives
This study aims to characterise the diversity of post-COVID-19 physical and mental health outcomes, known as the post-COVID-19 condition (PCC), and the determining factors 3–6 months after acute SARS-CoV-2 infection.

Design
This is a prospective cohort study.

Setting
This study took place at the European Hospital of Marseille, France.

Participants
Participants include patients with acute COVID-19 treated as inpatients or outpatients.

Interventions
Interventions include face-to-face assessment of physical and mental health symptoms.

Main outcome measures
Main outcome measures include symptom scores and scales, as well as paraclinical elements (thoracic CT scan, pulmonary functional tests). Multiple component analysis was used to identify clinical phenotypic clusters of PCC patients, as well as their initial comorbidity groups. A multinomial regression model was used to evaluate the association between the initial comorbidities and disease severity with PCC phenotype.

Results
A total of 210 patients agreed to participate, of which 157 (75%) reported at least one symptom at the 3–6 months visit; mostly asthenia, dyspnoea, psychiatric disorders such as anxiety, depression, post-traumatic stress disorder and cognitive disorders. Four PCC clusters were recognised: (1) paucisymptomatic PCC (n=82, 39%); (2) physical sequelae PCC (n=39, 18.6%), (3) pre-existing pulmonary comorbidities PCC (n=29, 13.8%); and (4) functional somatic and/or mental symptoms PCC (n=60, 28.6%). In addition to their PCC symptoms, the patients in these clusters differed in terms of their demographic characteristics (sex), comorbidities and severity of COVID-19.

Conclusions
The four identified PCC clusters corresponded to distinct and coherent clinical and paraclinical entities, making it possible to consider adapted and personalised prognosis and therapeutic interventions.

Objectives
This study examines the relationship between adolescent mothers’ mental health problems (postnatal depression and generalised anxiety) and adherence to COVID-19 public health prevention strategies in rural Malawi. It is part of a larger previously published study investigating the impact of social and cultural factors on the mental health in adolescent mothers.

Design
A cross-sectional study was conducted from September 2021 to March 2022. The Edinburgh Postnatal Depression Scale (EPDS) and the Generalised Anxiety Disorder-7 (GAD-7) were used to identify the risk of postnatal depression (PND) and generalised anxiety disorder (GAD), respectively. Participants also responded to questions about their perception of COVID-19 and how they practiced the recommended COVID-19 prevention strategies.

Setting
The study was conducted at a rural hospital in Lilongwe, Malawi.

Participants
Adolescent postnatal mothers aged 19 years and below, with children aged less than 1 year, who understood the study and could consent.

Results
Adolescent mothers (n=395) completed the researcher-administered survey. The mean age was±17 (SD 1.157). Most participants had recently given birth to their first child (91%, n=358). Almost half (45%, n=113) of participants agreed with the COVID-19 prevention strategies recommended by the Malawian government. However, overall adherence to public health COVID-19 prevention strategies, including hand hygiene practices, was low among adolescent mothers. Participants with probable GAD and probable PND were more likely to practice COVID-19 prevention strategies than participants with low GAD-7 or EPDS scores, except for restrictions on religious gatherings.

Conclusions
Adolescent perception of the potential threats or risks of COVID-19 was low. However, adolescents with probable PND and probable GAD reported higher adherence to some COVID-19 prevention strategies than adolescents without PND and GAD. The findings support the need for policies that integrate mental health within the public health response due to the potential direct and indirect effects the pandemic might have on perinatal mothers’ mental health. Additionally, recommended pandemic responses should be appropriate and relevant to the social environment.

Thomas B, Pattinson R, Edwards D, et al. Defining and measuring long COVID fatigue: a scoping review. BMJ Open 2024;14:e088530. doi: 10.1136/bmjopen-2024–0 88 530 The authors have identified several copyediting errors in their paper since it was published online. Results In the third paragraph, the eligibility criteria were met by 57 studies; however, the country-wise breakdown was not clearly provided. Additionally, the count for Italy was previously incorrect and has been revised from 8 to 7. The corrected text now reads: ‘Studies spanned 22 countries: Italy (n=7),27 44 54 60 67 71 72 Spain (n=6),30 39 43 57 59 65 UK (n=7),31 48 53 56 61 73 74 USA (n=6),32 35 36 52 75 76 Germany (n=5),28 38 50 63 77 Ireland (n=3),8 47 62 the Netherlands (n=3),51 68 78 Denmark (n=2),26 41 Egypt (n=2),66 79 Brazil (n=2),45 55 Hungary (n=2),40 80 France (n=1),64 India (n=2),37 81 Canada (n=1),9 Poland…

Introduction
Energy management education (EME) is a manualised, evidence-based self-management education programme developed and delivered by occupational therapists for persons living with chronic disease-related fatigue. Studies have shown that EME can positively affect self-efficacy, fatigue impact and quality of life in persons with chronic conditions, while data on persons with long COVID are lacking.
The primary aim is to evaluate if adding EME to the standard care improves outcomes in persons with long COVID-related fatigue. The secondary aim is to explore the energy management behavioural strategies applied in daily routines and investigate the influencing factors of implementing behavioural changes. The third aim is to perform a cost-effectiveness analysis of EME.

Methods and analysis
Using observational data, we will emulate a prospective two-parallel arms target trial to assess whether adding EME to the standard care is associated with improved outcomes in patients with long COVID-related fatigue. The estimated sample size to detect a post-intervention difference of 1.5 points in self-efficacy to implement energy conservation strategies with 90% power (0.05 alpha) is 122 people (1:1 ratio).
Persons with long COVID-related fatigue who follow EME as part of their standard care will be recruited and included in the experimental group (EG), while potential participants for the control group (CG) will be recruited from a register and prospectively matched to a participant in the EG by applying the propensity score technique. The ‘standard of care’ of the CG will include any intervention, except occupational therapy-based EME in peer groups. The causal contrast of interest will be the per-protocol effect. Four self-reported questionnaires (fatigue impact, self-efficacy in performing energy management strategies, competency in performing daily activities, health-related quality of life) will be administered at baseline (T0; week 0), after lesson 7 (T1; week 6), post-intervention (T2; week 14) and follow-up (T3, week 24). Our main assessment will be at T2. Disease-related and productivity cost data will be collected, and a cost-effectiveness profile of the EME intervention will be compared with standard care.

Ethics and dissemination
Ethical approval has been obtained from the competent Swiss ethics commission.
Findings will be reported (1) to the study participants; (2) to patient organisations and hospitals supporting EMERGE; (3) to funding bodies; (4) to the national and international occupational therapy community and healthcare policy; (5) will be presented at local, national, and international conferences and (6) will be disseminated by peer-review publications.

Background
Up to 15% of survivors of COVID-19 infection experience long-term health effects, including fatigue, myalgia and impaired cognitive function, termed post-COVID-19 condition or long COVID. Several trials that study the benefits and harms of various interventions to manage long COVID have been published and hundreds more are planned or are ongoing. Trustworthy systematic reviews that clarify the benefits and harms of interventions are critical to promote evidence-based practice.

Objective
To create and maintain a living systematic review and network meta-analysis addressing the benefits and harms of pharmacologic and non-pharmacologic interventions for the treatment and management of long COVID.

Methods
Eligible trials will randomise adults with long COVID to pharmacologic or non-pharmacologic interventions, placebo, sham or usual care. We will identify eligible studies by searching MEDLINE, EMBASE, CINAHL, PsycINFO, AMED and CENTRAL from inception, without language restrictions.
Reviewers will work independently and in duplicate to screen search records, collect data from eligible trials, including trial and patient characteristics and outcomes of interest and assess risk of bias. Our outcomes of interest will include patient-reported fatigue, pain, postexertional malaise, changes in education or employment status, cognitive function, mental health, dyspnoea, quality of life, physical function, recovery and serious adverse events.
For each outcome, when possible, we will perform a frequentist random-effects network meta-analysis. When there are compelling reasons to suspect that certain interventions are only applicable or effective for a subtype of long COVID, we will perform separate network meta-analyses. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach will guide our assessment of the certainty of evidence.
We will update our living review biannually, on the publication of a seminal trial, or when new evidence emerges that may change clinical practice.

Conclusion
This living systematic review and network meta-analysis will provide comprehensive, trustworthy and up-to-date summaries of the evidence addressing the benefits and harms of interventions for the treatment and management of long COVID. We will make our findings available publicly and work with guideline-producing organisations to inform their recommendations.

Ethics and dissemination
The study describes the protocol for a systematic review that uses data from published trial reports. Therefore, the study is exempt from ethics review. We intend to deposit all data in a public repository and publish each iteration of the living review online.

Ricerca della Cattolica di Milano sugli effetti della pandemia

A large study confirmed that COVID-19 can be followed by new-onset myalgic encephalomyelitis/chronic fatigue syndrome.

‘Gli strumenti ci sono ma bisogna applicarli’

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Saltamartini: ‘passo avanti nella strategia vaccinale Regione’

Decisione finale da Commissione europea nel 2° trimestre 2025

Background
The COVID-19 pandemic has widened inequities, affecting migrant and refugee populations in vulnerable situations, who may face elevated risks of infection, constrained healthcare access and discrimination. Inclusive vaccination campaigns are recommended, but barriers persist. This study aimed to identify barriers and facilitators and estimate vaccination coverage among refugees and migrants in low- and middle-income countries, emphasising inclusive policies for effective rollout.

Methods
A mixed-method study was conducted in two phases in Ecuador, Nepal, Pakistan, the Philippines and Rwanda. Phase 1 (March–May 2022) included policy analysis, in-depth interviews and focus-group discussions with 52 key informants analysed with thematic and grounded theory approaches using hybrid coding. Phase 2 (June–August 2022) included a cross-sectional study among refugees and migrants in regular (MIRS) and irregular situations (MIIS) and used descriptive analysis and a COVID-19 Vaccine Equity Index (CVEI).

Results
A total of 1378 individuals responded to the survey (43.8% MIRS, 31.2% MIIS and 25% refugees). 87% reported receiving at least one dose of the COVID-19 vaccine. The CVEI at the global level (0.824) suggested differences in complete vaccination between migrants and other residents in most of the study countries (refugees reported more access to vaccines than MIRS and MIIS). However, the qualitative phase reported delays and inequities in the early stage of the vaccination process in all countries. Overall, 64.2% of respondents perceived that government’ campaigns were successful. Both the qualitative and quantitative phases identified several barriers and facilitators. The main barriers included a lack of trust in authorities, extended waiting times and distance to vaccination centres, discrimination and xenophobia, lack of identity documentation, and adverse reaction concerns. On the other hand, the primary facilitators were the widespread distribution of vaccination centres, sources and provision of information, specific campaigns for refugees and migrants, free vaccination and the motivation to protect others’ health.

Conclusions
Despite the high coverage of COVID-19 vaccines among refugees and migrants in the study countries, the process had significant barriers. Simple vaccination registration procedures, targeted campaigns, mobile vaccination teams for hard-to-reach and vulnerable groups, and building trust in the host country authorities are pivotal for future and inclusive vaccine deployments.