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

In Reply We agree with Ophir and Shir-Raz that our study did not directly assess protection by COVID-19 vaccination against severe COVID-19 infection. This was not our aim. Such protection is well established, as noted in our Introduction. We studied 3 cohorts: pre–vaccine availability, vaccinated, and unvaccinated (ie, people who had not been vaccinated 12 weeks after vaccine eligibility).

This cohort study assesses the severity and long-term mortality of COVID-19, influenza, and respiratory syncytial virus in a large cohort of nonhospitalized veterans.

To the Editor The claim in the study by Walker et al that vaccination may mitigate psychiatric implications of COVID-19 infection comprises 2 subclaims: (1) vaccination protects against COVID-19 infections/severe illness, and (2) COVID-19 infections/severe illness have psychiatric outcomes.

Studio di Università Milano-Bicocca e Brescia su 6.609 studenti

Objective
To explore the impact of South Africa’s COVID-19 hard lockdown on the provision of services to survivors of violence against women (VAW).

Design
We conducted a qualitative study using semistructured interviews. Data was analysed thematically. We conducted 18 semistructured interviews (10 face-to-face and 8 online or by phone) with service providers and key informants (KIs).

Setting
The study was conducted across healthcare facilities, social services, national helplines and shelters in Gauteng province, South Africa. Data was collected between September 2022 and October 2023.

Participants
The sample included 18 participants, purposively selected, comprising 13 frontline service providers (nurses, social workers and managers) and 5 KIs. Participants shared their experiences of delivering VAW services during the lockdown.

Results
The findings highlight five key themes affecting VAW service provision during COVID-19. (1) Confusion and uncertainty: initial uncertainty about whether VAW services were essential led to temporary closures and reduced availability. (2) Decreased demand for services: fear of mobility restrictions and reporting barriers reduced access, particularly in the first lockdown month. (3) Adaptations by providers: services shifted to remote counselling, while shelters paused new intakes. (4) Challenges in service provision: staff shortages, resource constraints (eg, personal protective equipment shortages) and disrupted referral systems hindered service delivery. (5) Emotional impact on frontline workers: health and helpline workers faced stress, fear of infection, social stigma and burnout, affecting their well-being and capacity to respond effectively.

Conclusions
The study highlights how South Africa’s COVID-19 hard lockdown disrupted essential VAW services, emphasising the need for resilient service delivery models during crises. Strengthening staffing, resources and improving referral pathways are critical for mitigating the emotional and operational challenges faced by service providers and for ensuring sustained support for survivors.

In Europa copertura all’11%, somministrati 15 milioni di vaccini

Computed tomographic angiography–guided management lowered incidence of myocardial infarction and death, but invasive angiography rates were similar.

Objectives
To explore the literature about the role of unpaid informal carers in medication management for people with long-term conditions.

Design
Systematic review designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Information source
MEDLINE (Ovid), Embase (Ovid), PsycINFO, Cumulated Index in Nursing and Allied Health Literature (EBSCO), Scopus and Web of Science were searched from inception until April 2024. Additional papers were identified by searching backwards and forwards the reference lists of included papers.

Eligibility criteria
Primary research studies were included if they reported medication-related activities undertaken by carers for people with long-term conditions. Qualitative and mixed methods studies were considered without restriction on language or country.

Data extraction and synthesis
Relevant data were extracted and summarised in a table. The Mixed Method Appraisal Tool was used for quality assessment. Data were narratively synthesised.

Results
From 12 473 identified records, 107 underwent full text screening and 20 studies were included. Family carers were the predominant type of carer. Spouses and adult children constituted the largest caregiving dyads. Based on the required skills, two groups of roles were identified: physical roles, such as prescription management, and cognitive roles, such as decision-making. Carers used different strategies and tools to undertake medication-related activities including compliance aids and alarms. However, carers reported challenges in their experiences of caregiving, flagging up their need for additional support and education to commence such activities.

Conclusion
Informal carers undertake a wide variety of medication-related activities. The studies emphasised the need to support families as partners in health outcomes. This systematic review identifies the importance of bridging the gap between carers and healthcare providers. More efforts are needed to empower carers towards better and safer caregiving. Future work could address how to optimise carer involvement and engagement and provide best practice recommendations for carers’ support.

PROSPERO registration number
CRD42024506694.

Background
During the COVID-19 pandemic, 40 mental health and well-being hubs were funded in England to support health and social care staff affected by the pandemic.

Aims
To describe the characteristics of staff accessing four hubs for support and identify characteristics associated with clinically significant mental health difficulties and work and social functioning.

Method
Routinely collected screening data were analysed from 1973 individuals across 4 hubs, including mental health, demographic and occupational data and pandemic-related stressors. Factors associated with clinically significant mental health difficulties were identified via logistic regression.

Results
Most hub clients identified as white women who worked for the UK National Health Service; other groups were less well represented. Hub clients reported high levels of clinically significant mental health difficulties: 60% had severe and often co-occurring difficulties (ie, depression, anxiety, post-traumatic stress disorder or alcohol use) and 80% reported significantly impaired functioning. Younger age, disability status, identifying as from a minority ethnic group, and sexual orientations excluding heterosexual were associated with higher likelihood of having clinically significant mental health difficulties. Suffering financial loss during the pandemic, and prepandemic emotional well-being concerns were the most consistent factors associated with higher difficulties.

Conclusions
The hubs supported health and social care staff with significant mental health difficulties. Outreach and engagement with under-represented groups should be undertaken to address potential barriers to service access. The findings add to the knowledge base on the support needs of the health and social care workforce and the planning of support in response to future crises.

In Reply We thank Drs Yang and Tebbutt for their critical analysis of our recent study on the long-term clinical outcomes of COVID-19 vaccine–related myocarditis.

To the Editor Myocarditis, pericarditis, and myopericarditis are inflammatory heart conditions recognized as adverse events linked to COVID-19 mRNA vaccines, but their population-level clinical outcomes remain underdocumented. In a recent JAMA article, Ms Semenzato and colleagues provided valuable insights by comparing different myocarditis etiologies; the exclusion of pericarditis is notable. Accurate identification of myocarditis is crucial for both diagnosis and management. Case definitions from the Centers for Disease Control and Prevention and the Brighton Collaboration offer structured criteria, especially for vaccine-related cases. In the study by Semenzato and colleagues, myocarditis occurring within 7 days of vaccination was classified as postvaccine myocarditis, while myocarditis occurring within 30 days of SARS-CoV-2 infection was labeled post–COVID-19 myocarditis. In contrast, the Brighton Collaboration’s definitions, widely used in Canada for evaluating myocarditis and pericarditis after vaccination, include graduated levels of diagnostic certainty (definite, probable, possible) and consider events occurring within 6 weeks of vaccination as likely vaccine-associated. The Centers for Disease Control and Prevention reports onset of myocarditis symptoms ranging from 0 to 40 days after vaccination. while data from the Vaccine Adverse Event Reporting System, one of the largest global systems for tracking vaccine-associated adverse events, suggest that onset of myocarditis and pericarditis can extend beyond 120 days after vaccination. The study’s 7-day window may underestimate vaccine-associated myocarditis.

This prospective, observational cohort study uses data from the Researching COVID to Enhance Recovery adult cohort to assess post–COVID-19 condition (or long COVID) with additional participant data and an expanded symptom list.

Noting that approximately 30% of individuals hospitalized with COVID-19 experience acute kidney injury, a study published in JAMA Network Open suggests that effects on the organ could persist over time.

This Viewpoint examines poor uptake of the annual updated COVID vaccines among US residents despite strong evidence of their effectiveness in lowering the risk of death, serious illness, and hospitalization.

Objective
The purpose of the study is to compare the prevalence and associated risk factors of smell and/or taste disorders depending on different virus strains in Hiroshima, Japan.

Design
A cross-sectional design was used.

Setting and participants
Data were collected for all COVID-19-confirmed inpatients admitted to 27 hospitals in Hiroshima prefecture, Japan, between 8 April 2020 and 31 January 2023.

Main outcome measures
Smell and/or taste disorders were indicated by physicians on Hiroshima prefecture COVID-19 version J-SPEED forms completed at discharge.

Results
The COVID-19 data from this period corresponds to the following four strains: Wild-dominant, Alpha-dominant, Delta-dominant and Omicron-dominant. A total of 11 353 confirmed cases were analysed and 1261 cases (11.11%) were reported for smell and/or taste disorders.
Among patients with Wild-dominant, 241 out of 1141 cases (21.12%) exhibited smell and/or taste disorders. For Alpha, 223 out of 1265 cases (17.63%), for Delta, 480 out of 1516 cases (31.66%) and for Omicron, 317 out of 7431 cases (4.27%) presented with smell and/or taste disorders. For all four variants, age

Objectives
Despite widespread vaccination programmes and consensus recommendations, the understanding of the durability of COVID-19 vaccination against ensuing infection and transmission at the individual level is incomplete. The objective of this study was to estimate the effects of time-varying covariates including time since vaccination and symptoms on subsequent positive SARS-CoV-2 test results and assess the stability of these effects between March 2020 and April 2022.

Design
Prospective cohort study.

Setting
Urban university in the USA.

Participants
Drexel University students, faculty, and staff (n=15 527) undergoing mandatory COVID-19 symptom tracking, testing and vaccinations.

Intervention
Systematic symptom tracking and SARS-COV-2 testing starting in September 2020 and mandatory COVID-19 vaccination starting in September 2021.

Main outcomes and measures
COVID-19 vaccine effectiveness modified by time since vaccination and symptoms.

Results
Using fit-for-purpose digitally based symptom and vaccine tracking and mandatory comprehensive testing for SARS-CoV-2 infection, we estimate the time-dependent effects of vaccination, symptoms and covariates on the risk of infection with a Cox proportional hazards model based on calendar time scale. We found a strong protective effect of vaccination against symptomatic infection. However, there was strong evidence of a protective effect against infection only in the first 90 days after completed vaccination, and only against symptomatic versus asymptomatic infection. The overall estimated effect of vaccination within 30 days, including asymptomatic infections, was 37.3% (95% CI 26%, 47%). Vaccine effect modification by reported symptoms and time period was estimated, revealing the protective effect of vaccination within 90 days against symptomatic infection that varied from 90% (95% CI 84%, 94%) to 49%(95% CI –77%, 85%) across time periods.

Conclusions
This study is among the first to prospectively capture complete COVID-19 symptom, testing and vaccination data over a multiyear period. Overall effectiveness of the COVID-19 vaccine against subsequent infection, including transmissible asymptomatic infections, is modest and wanes after 90 days. Vaccination policies may need to take these issues into account.