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

Our novel risk prediction tool uses a simple method to adjust for temporal changes and can be implemented to facilitate uptake of evidence-based therapies. The study provides proof-of-concept for leveraging real-time data to support risk prediction that incorporates changing population-level trends and variation patient-level risk.

Introduction
Acute pain levels following orthopaedic injury (eg, fracture) are a predictor of the onset of chronic pain, which affects nearly 50% of fracture patients and impairs functional recovery. Among current pharmacological treatments for acute pain, non-steroidal anti-inflammatory drugs have been associated with delayed bone healing, while opioids inhibit effective bone remodelling, increase the risk of pseudarthrosis and carry a high risk of addiction. In light of this, the development of new pain treatments is essential. Cannabidiol (CBD), a non-addictive and non-psychotropic cannabis component stands out as a potential therapeutic agent, given its analgesic and anti-inflammatory properties as well as its potential benefits for bone healing. This randomised controlled trial aims to investigate the effect of acute CBD treatment, compared with placebo, on patients’ self-reported pain, inflammation and well-being following a fracture injury.

Methods and analysis
This is a triple-blind, randomised, placebo-controlled clinical trial. A total of 225 adults aged 18–70 years, who have suffered a long bone fracture and were treated at the Hôpital du Sacré-Coeur de Montréal, will be randomly assigned within 1 week to one of three treatment arms (25 mg or 50 mg of CBD or placebo) for 1 month. The primary outcome will be the difference in the pain score between groups at 1-month follow-up. Secondary outcomes will include measures of persistent pain, inflammation, opioid usage, quality of life, sleep quality, depression, anxiety, cognition and orthopaedic function. Data will be collected at baseline, 1-month and 3-month follow-ups.

Ethics and dissemination
This study obtained a Health Canada licence for use of cannabis products. It has also been approved by Health Canada and the Research Ethics Board of the CIUSSS du Nord-de-l’Île-de-Montréal (Project ID 2025-2105). The findings will be published in a peer-reviewed journal and presented at local, national and international conferences. The trial’s results will be made publicly available on the ClinicalTrials.gov database.

Trial registration number
NCT06448923.

Objectives
This study aimed to compare mortality rates and length of hospital stay between patients with critical COVID-19 transferred to another hospital due to capacity constraints and those who remained at their initial admission hospital.

Design
Single-centre cohort study.

Setting and participants
665 patients were treated for SARS-CoV-2 at two intensive care units (ICUs) in Stockholm, Sweden, from 1 March 2020 to 30 June 2021. Data on interhospital transfers (IHTs) were retrieved from medical records and patient data management systems according to predefined protocols.

Main outcome measures
The outcomes were 30-day and 90-day mortality, days alive and out of ICU. HR with 95% CI were calculated using Cox proportional hazard models with adjustments for age, sex, body mass index, severity of illness, comorbidity, invasive ventilation, treatment limitations and pandemic waves.

Results
Of 665 patients, 133 (20%) were transferred to another hospital. The mortality rate of transferred patients compared with non-transferred patients at 30 days was 19% vs 26% (p=0.13) and at 90 days 26% vs 30% (p=0.43). In the adjusted Cox regression analysis, IHT was associated with a lower mortality risk at 30 days (HR 0.47, 95% CI 0.30 to 0.76) and 90 days (HR 0.52, 95% CI 0.34 to 0.79). However, the number of days alive and out of ICU was significantly lower for the IHT group at 30 days.

Conclusion
In our study, IHT due to capacity constraints among critically ill COVID-19 patients was not associated with a higher mortality risk. The suitability for transfer was likely associated with lower mortality, although residual confounding cannot be ruled out. The requirement for invasive ventilation among transferred patients might account for the extended length of ICU stay, rather than the transfer itself. However, the difficulty in studying this issue lies in the fact that while patients are likely exposed to risks during transfer, they are simultaneously the patients stable enough to be transported.

Objectives
Advances in the treatment of opioid use disorder (OUD) have seen the development of long-acting injectable opioid substitutes which could improve outcomes for people with OUD. However, comparative quantitative analysis of individual outcomes is lacking. The present study sought to investigate factors associated with prescribing long-acting injectable buprenorphine (LAIB), and changes in outcome variables compared with oral medication for OUD.

Design
Cross-sectional retrospective analysis of electronic health records.

Setting
Community substance use treatment service Via. Six sites shared their data between 15 August 2022 and 15 August 2023.

Participants
Anonymised data were extracted for 235 people receiving LAIB and 266 people receiving oral medication for OUD.

Primary and secondary outcomes
Prescribing data, sociodemographic information (age, sex, indices of multiple deprivation decile of individual’s residence, primary and secondary substance, number of previous treatment episodes, employment and ethnicity) and treatment outcome profiles (substance use, physical and mental health, quality of life, employment) were extracted and analysed. To examine predictors of receiving LAIB (vs medication for OUD), we conducted logistic regression including the demographic predictors. Psychological health, physical health and quality of life scores were analysed using Welch’s t-tests.

Results
LAIB was associated with positive changes in quality of life between the first and last assessments. Demographic and situational factors were predictors of LAIB initiation, indicating the potential for increasing health inequalities in substance use treatment.

Conclusions
LAIB is associated with changes in quality of life over a 1-year period. Further research is needed to investigate the aetiology of improved well-being and outcomes over time.

Objectives
Herpes zoster (HZ) infection is associated with a higher risk of major adverse cardiovascular events (MACE), including stroke and coronary artery disease (CAD). Patients with diabetes are at an increased risk of MACE, highlighting the importance of studying this population to assess the potential protective effects of HZ vaccination. This study aims to investigate the risk of MACE after HZ vaccination in patients with diabetes.

Design
Retrospective cohort study.

Setting
Community-based population in the USA.

Participants
Using the TriNetX database, the study included 4.9 million patients with diabetes from 2006 to 2022. It established two cohorts: 68 178 patients in the HZ vaccination (comprising any HZ vaccine, Shingrix or Zostavax) and 4 835 246 patients in the no HZ vaccination group. After excluding patients with a history of MACE, immune disease and complications of HZ prior to the index date, the study cohort was reduced to 45 960 patients. Propensity score matching, accounting for age, sex, race, socio-economic status and disease comorbidities, was conducted to minimise study bias.

Interventions
HZ vaccination.

Outcome measures
MACE outcomes are defined as the first occurrence of CAD or stroke. Comparative risk analysis was conducted using HRs.

Results
Post matching, the mean patient age was 63.5 years, with 49.2% females. The incidence rate of MACE was lower among vaccinated patients compared with unvaccinated individuals, with an HR of 0.76 (0.72–0.79). For secondary endpoints, the HRs were 0.73 (0.69–0.78) for CAD, 0.79 (0.74–0.84) for stroke and 0.54 (0.52–0.57) for all-cause mortality. These protective effects remained consistent across different age groups, sexes and diabetes types, supporting the potential benefit of HZ vaccination in reducing cardiovascular risk.

Conclusions
HZ vaccination is associated with a lower risk of MACE in patients with diabetes. Further prospective studies are critically needed to confirm this finding.

Palamara (Iss), ‘il virus va ancora monitorato anche senza emergenza’

Rehabilitation involving cognitive behavioral therapy could help improve functional capacity for those with post–COVID-19 condition, also known as long COVID, according to a randomized clinical trial published in JAMA Network Open. Patients who had undergone a brief outpatient program incorporating cognitive and behavioral approaches reported greater improvements in physical function after 1 year than those who had undergone rehabilitation care as usual.

FEP incidence in South London increased during the peak of the COVID-19 pandemic, particularly among Black and Asian individuals.

Sondaggio Cimo Fesmed tra camici bianchi del Ssn

In patients hospitalised for COVID-19 receiving ventilatory support, we found no evidence that higher dose corticosteroids reduced the risk of death compared to usual care, which included low dose corticosteroids.

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

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
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 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.

Stroke, Ahead of Print. BACKGROUND:Although the relationship between cervical carotid tortuosity and cardiovascular risk in patients with Loeys-Dietz syndrome has been studied, it is unclear whether cervical carotid tortuosity influences the risk of neurovascular events.METHODS:This is a single-institution retrospective cohort study. Cervical carotid tortuosity and morphology were assessed in patients with Loeys-Dietz syndrome who underwent baseline computed tomography/magnetic resonance imaging of the cervical and cerebral arteries from 2010 to 2022. The primary end point was a composite of adverse neurovascular events (multiple vessel cervical artery dissection, ischemic stroke, intracerebral hemorrhage, and any neurovascular intervention) at 5- and 10-year follow-ups. Independent risk factors were identified using univariate and multivariate logistic regression analyses. Single-variable predictors of 5- and 10-year outcomes were analyzed via receiver operating curve analyses. Cutoff values were determined per the Youden J index. Stratification analyses were performed for ages

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…