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

In this issue of JAMA Internal Medicine, Luo et al presented compelling evidence for awake prone positioning for patients with acute hypoxemic respiratory failure from COVID-19. Their meta-analysis based on individual patient data from 3019 patients in 14 randomized clinical trials demonstrated that awake prone positioning significantly improved survival without intubation and reduced both the risk of intubation and hospital mortality. The improved survival was most pronounced in individuals who had moderate to severe hypoxemia (pulse saturation to inhaled oxygen fraction ratio between 155 and 232), were younger than 68 years, had a body mass index between 26 and 30 (calculated as weight in kilograms divided by height in meters squared), and had prone positioning initiated within 1 day of hospitalization. Notably, patients who maintained prone positioning for at least 8.3 hours daily during the first 3 days of hospitalization had better outcomes than those with shorter prone times. This rigorous meta-analysis provides important evidence for managing critically ill patients with acute hypoxemic respiratory failure.

This meta-analysis examines awake prone positioning to treat patients with COVID-19 and acute hypoxemic respiratory failure and its association with increased odds of survival without intubation.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Background
Adolescent pregnancy is associated with multifaceted challenges that impact countries’ health, education and economic stability. Despite ongoing interventions, in developing countries such as Kenya, adolescent pregnancy rates continue to be high. There is a need for more synthesised evidence on regional-specific risk factors to support tailored prevention strategies.

Objective
This scoping review aims to explore what is known about the risk factors and intervention strategies focused on adolescent pregnancy prevention in Kenya.

Methods and analysis
Using the Arksey and O’Malley framework combined with a three-step search strategy as recommended by the Joanna Briggs Institute, relevant articles will be identified from the PubMed, Scopus, Web of Science, CINAHL and PsycINFO databases. The focus will be on literature published from 1 January 2008 to 31 December 2023, addressing risk factors and public health strategies aimed at adolescent pregnancy prevention in Kenya. The analysis will involve thematic data extraction and charting to highlight patterns in adolescent pregnancy risk factors, intervention outcomes and existing gaps.

Ethics and dissemination
No ethical approval is needed. The dissemination strategy includes peer-review publication and presentation to relevant stakeholders.

Conclusion
This review will provide a comprehensive summary of the literature on the risk contributors and interventions for adolescent pregnancy prevention in Kenya. The evidence map may be used by relevant stakeholders to address adolescent pregnancy prevention gaps in strategy as well as inform interventions that are context-specific.

Registration
Open Science Framework (https://doi.org/10.17605/OSF.IO/Q5F9G); Pre-results.

Objective
The objective is to examine the correlation of anti-phosphatidylethanolamine (aPE) antibodies with premature birth. Premature birth is an important risk factor for infant mortality and subsequent development of mental, metabolic and cardiovascular diseases. However, the risk factors associated with preterm birth are not well understood. aPE antibodies are an anti-phospholipid autoantibody that is thought to be a factor in pathological pregnancy. However, aPE antibodies have not been included in the classification criteria for antiphospholipid syndrome. Therefore, we aimed to check the clinical significance of aPE antibodies in association with premature birth.

Design
We conducted a retrospective analysis of 442 pregnant women who had experienced at least one unexplained miscarriage and were tested for aPE antibodies and compared their clinical characteristics, coagulation indicators, immune biomarkers and pregnancy outcomes. Logistic regression analysis was employed to identify factors associated with premature birth.

Setting
Ruian City, Wenzhou, Zhejiang Province, China.

Participants
A total of 442 patients with ultrasound-confirmed intrauterine pregnancy from the Third Affiliated Hospital of Wenzhou Medical University between May 2018 and December 2022 were retrospectively selected and included in the study. The inclusion criteria were as follows: having been tested for aPE and having experienced at least one unexplained miscarriage. The exclusion criteria were as follows: (a) incomplete clinical records, (b) being positive for typical antiphospholipid antibodies (aPL, aβ2-GP1 and LA), (c) hormone or metabolic disorder, (d) lost to follow-up, (e) known clinical autoimmune diseases, (f) severe reproductive system infection or malformation, (g) fetal loss: pregnancy loss before 24 weeks and (h) multiple pregnancy. In this study, preterm birth was defined as birth before 37 weeks.

Primary and secondary outcome measures
We enrolled 442 patients in our study: 60 pregnancies with premature birth and 382 pregnancies with term birth.

Results
Our findings revealed that among the 442 participants, 13.6% had a premature birth (

Background
Long covid describes a syndrome of persistent symptoms following COVID-19 and is responsible for substantial healthcare and economic burden. Currently, no effective treatments have been established. Ashwagandha (Withania somnifera (L.) Dunal) is a medicinal herb traditionally used in India for its immune-strengthening and anti-inflammatory properties. Withanolides, a family of steroid-derived molecules unique to Ashwagandha, have been shown to modulate inflammatory pathways in animal models, and several small randomised trials in humans support its effectiveness for reducing symptoms that are also associated with long covid. Therefore, this study aims to assess whether Ashwagandha is effective and safe for improving functional status and reducing symptom burden in adults living with long covid.

Methods
A randomised double-blind placebo-controlled trial will be performed at participating general practice (GP) surgeries and long covid clinics across the UK. Individuals diagnosed with long covid will be screened for eligibility and then randomised 1:1 to take 1000 mg daily of Ashwagandha root extract tablets (standardised to

Objectives
To assess the degree to which we can replicate a study between a regional and a national database of electronic health record data in the UK. The original study examined the risk factors associated with hospitalisation following COVID-19 infection in people with diabetes.

Design
A replication of a retrospective cohort study.

Setting
Observational electronic health record data from primary and secondary care sources in the UK. The original study used data from a large, urbanised region (Greater Manchester Care Record, Greater Manchester, UK—2.8 m patients). This replication study used a national database covering the whole of England, UK (NHS England’s Secure Data Environment service for England, accessed via the BHF Data Science Centre’s CVD-COVID-UK/COVID-IMPACT Consortium—54 m patients).

Participants
Individuals with a diagnosis of type 1 diabetes or type 2 diabetes prior to a positive COVID-19 test result. The matched controls (3:1) were individuals who had a positive COVID-19 test result, but who did not have a diagnosis of diabetes on the date of their positive COVID-19 test result. Matching was done on age at COVID-19 diagnosis, sex and approximate date of COVID-19 test.

Primary and secondary outcome measures
Hospitalisation within 28 days of a positive COVID-19 test.

Results
We found that many of the effect sizes did not show a statistically significant difference, but that some did. Where effect sizes were statistically significant in the regional study, then they remained significant in the national study and the effect size was the same direction and of similar magnitude.

Conclusions
There is some evidence that the findings from studies in smaller regional datasets can be extrapolated to a larger, national setting. However, there were some differences, and therefore replication studies remain an essential part of healthcare research.

Objective
The UK government’s response to the COVID-19 pandemic included a ‘test, trace and isolate’ strategy. Testing services for healthcare workers, care homes and schools accounted for the greatest spend and volume of tests. We reviewed relevant literature to identify common and unique barriers and facilitators to engaging with each of these testing services.

Design
Scoping review.

Search strategy
PubMed, Scopus and the WHO COVID-19 Research Database were searched for evidence published between 1 January 2020 and 7 November 2022. This was supplemented by evidence identified via free-text searches on Google Scholar and provided by the UK Health Security Agency (UKHSA).

Data extraction and synthesis
Data were extracted by a team of reviewers and synthesised thematically under the broad headings of perceptions, experiences, barriers and facilitators to engaging with the COVID-19 testing programme.

Results
This study included 40 sources, including 17 from projects that informed UKHSA’s decisions during the pandemic. Eight themes emerged and were used to categorise barriers and facilitators to engaging with the testing services for healthcare workers, care homes and schools: (1) perceived value, (2) trust in the tests and public bodies, (3) importance of infrastructure, (4) impact of media and social networks, (5) physical burden of the test, (6) perceived capability to undertake testing, (7) importance of relevant information and 8) consequences of testing.

Conclusions
Universal barriers and facilitators to engagement with the testing programme related to the core elements of each testing service, such as uncomfortable specimen collection and the influence of media and peers; these could be mitigated or leveraged to increase engagement across settings. However, the individuals involved, perceptions of value and available resources differed across services, leading to unique experiences between settings. Thus, consideration of context is crucial when designing and implementing a testing programme in response to a pandemic.

Intervento al Comune di Mazara dopo scandalo referti istologici

Objectives
To determine uptake of the COVID-19 vaccine and identify the associated factors among health professionals in major cities of the Amhara region in Ethiopia.

Design
Institution-based, cross-sectional study.

Setting
The study was conducted from July to September 2022 across 40 health centres and 13 hospitals, representing 10 major cities within the Amhara region.

Participants
1251 participants, all of whom were vaccine-eligible health professionals, were selected using a systematic random sampling procedure.

Outcome measures
The level of vaccine uptake in the study was determined by the proportion of health professionals who had received at least one dose of a COVID-19 vaccine.

Results
1251 health professionals participated, with 848 (67.8%) reporting that they had received at least one dose of a COVID-19 vaccine. Key findings from the multivariable logistic regression analysis revealed that health professionals aged 46 years and older were four times more likely to be vaccinated (95% CI, 1.656 to 9.510), married participants were 1.4 times more likely to take the vaccine (95% CI, 1.010 to 1.933) and those with good knowledge of COVID-19 vaccines were 1.75 times more likely to get vaccinated (95% CI, 1.307 to 2.331). Additionally, participants with a positive attitude towards vaccination were 3.65 times more likely to have received a vaccine (95% CI, 2.753 to 4.732).

Conclusions
The study reveals a commendable level of COVID-19 vaccine uptake among health professionals, emphasising their critical role in public health initiatives. However, the observed disparities in vaccination rates indicate the need for targeted interventions to improve vaccine coverage, particularly among younger professionals and those with limited knowledge of the vaccine. Addressing these gaps requires the implementation of tailored educational programmes that enhance understanding of COVID-19 vaccines. Furthermore, fostering positive attitudes through targeted campaigns, workplace-based initiatives and peer influence, particularly among younger and unmarried professionals, will be crucial. Encouraging vaccinated professionals to share their experiences and establishing regular follow-ups will also be essential strategies to improve vaccine acceptance and coverage in the region.

Objectives
This cross-sectional study aimed to assess parents’ knowledge, attitude and practice (KAP) towards myopia amidst increased children’s online course participation during the COVID-19 pandemic, potentially impacting visual health.

Design
The study adopted a cross-sectional design to analyse parent KAP regarding myopia.

Setting and participants
Conducted from 19 August 2022 to 19 October 2022, in the Jinan High-tech District, the study included 3261 participants, comprising 800 males (24.5%).

Interventions
A self-administered questionnaire assessed KAP, with a good KAP defined as a score >75% of the total.

Primary and secondary outcome measures
The KAP scores were the primary outcome measures. The factors associated with a practice score >75% were also investigated.

Results
Parents had mean KAP scores of 10.2±2.4 (10.2/14=72.9%), 41.8±4.9 (41.8/50=83.6%) and 54.3±7.1 (54.3/65=83.5%), respectively. The knowledge scores (OR 1.11, 95% CI 1.06 to 1.16, p

Objective
To describe challenges posed by COVID-19 on tuberculosis (TB) commodity supply, care cascade, active case finding and responses taken by healthcare workers (HCWs) and community health workers (CHWs) during the first year of the pandemic (March 2020 to February 2021).

Design
A qualitative descriptive study involving 25 in-depth interviews and 10 focus group discussions conducted in July 2022.

Setting
37 TB treatment facilities were purposively selected from seven regions due to high TB case notifications in 2019 and their provision of TB and COVID-19 services during the first year of the pandemic (March 2020 to February 2021).

Participants
Purposive selection of 58 HCWs and 55 CHWs who provided TB services in the first year of the COVID-19 pandemic.

Results
HCWs reported unusual stockouts and delayed receipt of GeneXpert cartridges and sputum containers. TB services faced a decline in client attendance, as clients were hesitant to undergo TB screening, sputum sample collection and contact tracing due to fear of contracting or being diagnosed with COVID-19 and subsequently being quarantined. To mitigate these challenges, HCWs used alternative containers for sputum sample collection, optimised GeneXpert cartridge use by prioritising GeneXpert testing for TB risk groups and diagnosed TB by microscopy, chest X-ray and sputum pooling method. Moreover, they extended drug refill schedules to minimise the risk of contracting COVID-19 in clinics. CHWs used mobile communication for client tracing and focused household visits on TB risk groups.

Conclusion
COVID-19 disrupted TB commodity availability and TB treatment-seeking behaviour. Adaptations like multi-month drug refills and optimised GeneXpert use supported the TB healthcare system’s resilience. While these adaptations offer valuable insights for strengthening TB service delivery, their effectiveness and sustainability require further evaluation. Thus, prospective studies could clarify their long-term impact. National Tuberculosis Program could consider adapting these practices postpandemic, with appropriate modifications to suit different contexts.

Objective
Minority ethnic groups disproportionately experienced adverse COVID-19 outcomes, partly a consequence of disproportionate exposure to socioeconomic disadvantage and high-risk occupations. We examined whether minority ethnic groups were also disproportionately vulnerable to the consequences of socioeconomic disadvantage and high-risk occupations in Scotland.

Design
We investigated effect modification and interaction between area deprivation, education and occupational risk and ethnicity (assessed as both a binary white vs non-white variable and a multi-category variable) in relation to severe COVID-19 (hospitalisation or death). We used electronic health records linked to the 2011 census and Cox proportional hazards models, adjusting for age, sex and health board. We were principally concerned with additive interactions as a measure of vulnerability, estimated as the relative excess risk due to interaction (RERI).

Results
Analyses considered 3 730 837 individuals aged ≥16 years (with narrower age ranges for analyses focused on education and occupation). Severe COVID-19 risk was typically higher for minority ethnic groups and disadvantaged socioeconomic groups, but additive interactions were not consistent. For example, non-white ethnicity and highest deprivation level experienced elevated risk ((HR=2.7, 95% CI: 2.4, 3.2) compared with the white least deprived group. Additive interaction was not present (RERI=–0.1, 95% CI: –0.4, 0.2), this risk being less than the sum of risks of white ethnicity/highest deprivation level (HR=2.4, 95% CI: 2.3, 2.5) and non-white ethnicity/lowest deprivation level (1.4, 95% CI: 1.2, 1.7). Similarly, non-white ethnicity/no degree education (HR=2.5, 95% CI: 2.2, 2.7; RERI=–0.1, 95% CI: –0.4, 0.2) and non-white ethnicity/high-risk occupation (RERI=0.3, 95% CI: –0.2, 0.8) did not experience greater than additive risk. No clear evidence of effect modification was identified when using the multicategory ethnicity variable or on the multiplicative scale either.

Conclusion
We found no definitive evidence that minority ethnic groups were more vulnerable to the effect of social disadvantage on the risk of severe COVID-19.

Objectives
To evaluate if 10 sessions of hyperbaric oxygen treatments (HBOTs) improve short- and long-term health related quality of life, symptoms and physical performance in long covid patients compared with placebo.

Design
Parallel, randomised, placebo-controlled, double-blind trial.

Setting
Single-centre, university hospital, Sweden.

Participants
Previously healthy subjects aged 18–60 years, diagnosed with long covid were included. We excluded pregnant women, patients with RAND-36 (role limitations due to physical health (RP) and physical functioning (PF)) above 70, diabetes, hypertension and contraindications for HBOT.

Interventions
Subjects were randomly assigned to 10 sessions of HBOT or sham (placebo) treatments over 6 weeks. HBOT involved 100% oxygen, 2.4 bar, 90 min, placebo medical air, 1.34–1.2 bar. Randomisation (1:1) was done electronically, in blocks stratified by sex and disease severity. Subjects and investigators were blinded to allocation.

Primary and secondary outcome measures
Primary endpoints were changes from baseline in RAND-36 PF and RP at 13 weeks. Efficacy was analysed on an intention-to-treat basis. Harms were evaluated according to the actual treatment given.

Results
Between 15 September 2021 and 20 June 2023, 80 subjects (65 women, 15 men) were enrolled and randomised (40 in each group). The trial is completed. The primary endpoint analysis included 79 subjects (40 in HBOT and 39 in control). At 13 weeks, both groups showed improvement, with no significant difference between HBOT and placebo in PF (least square mean difference between groups (LSD), 0.63 (95% CI –7.04 to 8.29), p=0.87) and RP (LSD, 2.35 (95% CI –5.95 to 10.66), p=0.57). Harms: 43 adverse events (AEs), most commonly cough and chest pain/discomfort, occurred in 19 subjects (49%) of the HBOT group and 38 AEs in 18 subjects (44%) of the placebo group, one serious AE in HBOT and one death in the placebo group.

Conclusions
10 HBOT sessions did not show more short-term benefits than placebo for long covid patients. Both groups improved, with a notable sex difference. HBOT has a favourable harm profile.

Trial registration number
ClinicalTrials.gov (NCT04842448), EudraCT (2021-000764-30). The trial was funded by Vetenskapsrådet (2022-00834), Region Stockholm (2020-0731, 2022-0674), Hjärt-Lungfonden and OuraHealth Oy.

Introduction
Increasing awareness of the high frequency, wide spectrum and disabling nature of symptoms that can persist following COVID-19 infection has prompted the investigation of management strategies. Our study aims to determine the effectiveness of atorvastatin on cognitive function, physical activity, mood, health-related quality of life and features of neurovascular impairment and neuroinflammation in adults with ongoing neurological symptoms after COVID-19 infection.

Methods and analysis
The STatin TReatment for COVID-19 to Optimise NeuroloGical recovERy study is an ongoing international, investigator-initiated and conducted, multicentre, prospective, randomised, open label, blinded endpoint trial with fixed time points for outcome assessments. A total of 410 participants with long covid neurological symptoms were planned to be randomly assigned to either the intervention group to receive 40 mg atorvastatin for 12 months or to a control group of no treatment, on top of usual care.

Ethics and dissemination
This study protocol was designed, implemented and reported, in accordance with the International Conference on Harmonisation guidelines for Good Clinical Practice, the National Health and Medical Research Council of Australia, the National Statement on Ethical Conduct in Human Research and with the ethical principles laid down in the World Medical Association Declaration of Helsinki. Central ethics committee approval was obtained from Sydney Local Health District Royal Prince Alfred Hospital Ethics (No: X21-0113 and 2021/ETH00777 10) in Australia. Site-specific ethics committee approvals were obtained elsewhere before any local study activities. All participants provided written informed consent.

Trial registration number
The study protocol is registered at Clinicaltrials.gov (NCT04904536).