Search Results for: Flowchart decisionale: vaccinare l’adulto ai tempi del COVID-19

Objectives
The COVID-19 pandemic induced significant changes in access policies to general practice (GP) in most countries. This study aimed to compare and discuss changes in the diagnostic patterns and GP procedures before and during the pandemic.

Design and setting
A register study including data from 11 Danish GP clinics.

Participants
Enlisted patients from GP followed 1 year before (February 2019 to January 2020; n=48 650) and 1 year during (April 2020 to March 2021; n=47 207) the COVID-19 pandemic.

Outcome measures
Diagnostic patterns, consultation type (face-to-face, email and phone), contact persons (GP or GP staff) and patient characteristics.

Results
The average number of contacts with GP increased from 6.3 contacts per year per patient before the pandemic to 8.3 annual contacts during the pandemic (p

Circulation, Ahead of Print. BACKGROUND:Despite the significant global impact of the COVID-19 pandemic, limited studies have investigated the long-term cardiovascular sequelae of SARS-CoV-2 infection, particularly among Asian populations. This large-scale, population-based binational cohort study with long-term follow-up aimed to investigate the association between SARS-CoV-2 infection and the risk of cardiovascular events.METHODS:We used binational, large-scale, and population-based cohorts, including a Korean nationwide cohort (K-COV-N; discovery cohort; n=18 989 129) and a Japanese nationwide cohort (Japan Medical Data Center; validation cohort; n=12 218 680). Individuals aged 20 years or older were included from January 1, 2020, to December 31, 2022. We assessed the long-term risk of incident cardiovascular outcomes after SARS-CoV-2 infection. The primary outcome was the risk of cardiovascular diseases based onInternational Classification of Diseases, Tenth Revisioncode diagnosis. After propensity score–based overlap weighting, Cox proportional hazard models were used to estimate adjusted hazard ratios for cardiovascular outcomes. We assessed the time attenuation effect of cardiovascular outcomes after SARS-CoV-2 infection. Multiple subgroup analyses were conducted by 16 cardiovascular outcomes, COVID-19 severity, vaccination, and SARS-CoV-2 strain.RESULTS:In the overlap-weighted discovery cohort, 7 960 357 individuals were included (mean age, 48.52 years [SD, 9.33]; men, 4 283 878 [53.82%]). SARS-CoV-2 infection was associated with a long-term increased risk of overall cardiovascular outcomes (adjusted hazard ratio, 1.62 [95% CI, 1.60–1.64]), particularly ischemic heart disease (1.81 [95% CI, 1.77–1.84]), heart failure (1.79 [95% CI, 1.73–1.85]), cerebrovascular disorders (1.65 [95% CI, 1.60–1.69]), major adverse cardiovascular events (1.65 [95% CI, 1.60–1.70]), inflammatory heart diseases (1.53 [95% CI, 1.31–1.80]), dysrhythmia (1.44 [95% CI, 1.42–1.46]), and thrombotic disorders (1.42 [95% CI, 1.35–1.48]). The increased risk persisted up to 18 months, with the highest association observed for 1 to 6 months after infection. The risk of cardiovascular diseases was pronounced with COVID-19 severity; however, it decreased with the administration of complete vaccination and subsequent booster doses. A similar risk of cardiovascular outcomes existed across every SARS-CoV-2 era (pre-delta, delta, and omicron). Similar patterns were observed in the validation cohort. The absolute risk of cardiovascular disease events after SARS-CoV-2 infection remained remarkably low (2.12% versus 1.31% in the noninfected population), particularly stroke (0.24% versus 0.13%) and ischemic heart disease (0.73% versus 0.39%).CONCLUSIONS:This binational study observed associations between SARS-CoV-2 infection and cardiovascular events during extended follow-up across viral eras. Complete vaccination was linked to lower cardiovascular events. However, the absolute risk of cardiovascular disease events after SARS-CoV-2 infection remained remarkably low, particularly for stroke and ischemic heart disease. Although these findings suggest ongoing vigilance and preventive measures remain crucial, they should be interpreted within the context of these low absolute risks when considering long-term cardiovascular complications.

Annals of Internal Medicine, Ahead of Print.

In the Original Investigation titled “Stereotactic Body Radiotherapy vs Sorafenib Alone in Hepatocellular Carcinoma: The NRG Oncology/RTOG 1112 Phase 3 Randomized Clinical Trial,” published online December 19, 2024, and in the February 2025 issue, there were errors in the Key Points and Table 1. In the Key Points Findings section, the percentage of patients with macrovascular invasion was updated to 74%. In Table 1, the values in the HCC volume/liver volume row were updated to percentages. This article was corrected online.

This cross-sectional study assesses the prevalence of incomplete team staffing in the post–COVID-19 pandemic health care landscape and its association with burnout and work intentions among US physicians.

Riguarda il 36% dei bambini tra 5 e 19 anni; tra le cause l’uso prolungato di tablet e smartphone

Introduction
Systemic racism exposes Black and Latinx adolescents to a range of traumatic stressors that increase the risk for long-term emotional and behavioural health (EBH) problems. Researchers have theorised that critical consciousness (CC)—awareness of societal inequities and engagement in action to promote social justice—may serve as a protective factor that promotes youth well-being. There are few rigorous longitudinal research studies, however, that examine the development of CC among adolescents, the association over time of CC with EBH and the potential of CC to protect against harmful effects of race-related stress. This longitudinal study, Resilience in a Stressful Era (RISE), addresses these gaps using a mixed methods approach with Black, Latinx and White adolescents in Baltimore.

Methods and analysis
We plan to enrol up to 650 Black, Latinx and White adolescents ages 14–19 who reside in Baltimore, Maryland. The recruitment will include outreach through youth-serving organisations, community events, youth networks, social media, snowball sampling and re-contacting adolescents who participated in a prior study (R01HD090022; PI: Mendelson). Participants will complete online questionnaires assessing exposure to pandemic- and race-related stress, CC and EBH twice per year over 4 years as they transition into early adulthood. Using an explanatory sequential mixed methods approach, in-depth interviews exploring the development and impact of CC will be conducted with a subset of participants selected based on their CC scores and, separately, their caregivers. A Youth Advisory Board comprised of adolescents who are representative of our target study population will be developed to provide input on the study and its implementation. Growth mixture modelling and latent variable modelling will be used to analyse quantitative data. Themes identified through qualitative analyses will expand the understanding of quantitative findings.

Ethics and dissemination
All study procedures were approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board. Findings will be disseminated through publications in peer-reviewed journals and presentations at academic conferences. We will also communicate research findings with study participants and disseminate findings to the Baltimore community, such as developing briefs for the Baltimore City Health Department and/or hosting a town hall meeting for Baltimore families.

Introduction
The COVID-19 pandemic, driven by the SARS-CoV-2 virus, has had a significant global impact, with over 775 million cases reported and more than 7 million deaths as of July 2024. In Chile, approximately 5.4 million people have been infected, with a substantial proportion experiencing persistent symptoms known as post-COVID-19 syndrome. This study aims to estimate the prevalence of post-COVID-19 syndrome in Punta Arenas, Chile, and to explore the associated symptoms, mainly focusing on psychological, physical and molecular impacts on the affected population.

Methods and analysis
This cross-sectional study will use stratified random sampling to select a representative sample of 282 adults from Punta Arenas. Participants eligible for the study are those who had tested positive for SARS-CoV-2 by reverse transcription-quantitative PCR between July 2022 and July 2023. Data collection will include comprehensive clinical assessments, psychological evaluations and laboratory analyses of inflammatory biomarkers. Standardised instruments will be used to ensure consistency and reliability in measuring persistent symptoms. Statistical analyses will include descriptive statistics, regression models and subgroup analyses to identify risk factors and the prevalence of post-COVID-19 syndrome.

Ethics and dissemination
The Human Research Ethics Committee of the Clinical Hospital of the University of Chile approved the study protocol (Memorandum No 007/2023). We will present the results in peer-reviewed publications and national and international professional and academic meetings.

Trial registration number
NCT05855382.

Background
Patients and their caregivers incur significant financial burden from health care costs, but the financial burden often does not consider additional impacts from non-monetary burdens.

Objectives
Examine the extent to which non-monetary burdens have been investigated and identify the methods and instruments used to collect non-monetary burdens through a systematic scoping review.

Methods
Scoping review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Joanna Briggs Institute guidance for scoping reviews.

Data sources
PubMed, CINAHL, EconLit and Web of Science were searched from 1 January 2013 to 7 November 2023. The search identified 950 articles.

Data extraction and synthesis
A dual independent review of titles, abstracts and full texts was conducted for inclusion, and data were extracted using DistillerSR software; 166 articles met the inclusion criteria.

Results
The included studies suggest three overarching categories of non-monetary burdens: material, psychological or psychosocial and coping behaviour. Within each of these categories, the literature has identified subcategories of burdens that vary in the extent to which they have been studied. This review also identifies 29 instruments used to collect non-monetary burdens from patients and caregivers across the included studies, of which 19 were validated. Many of these instruments were used in a single study.

Conclusions
The findings help illustrate the gaps in the literature on non-monetary burdens for patients and caregivers and provide a starting point for further investigation of this topic as well as implications for policy. Future research may reference the instruments highlighted in this study to help develop new instruments for capturing non-monetary burdens to better reflect the patient and caregiver experiences with financial toxicity due to medical expenses. Collecting more comprehensive data will provide a better understanding of the range and the extent of the non-monetary burdens faced by patients and caregivers. It will also increase the evidence to support new or existing targeted programmes and policies to help patients and caregivers better cope with these non-monetary burdens.

Objective
The aim of this study was to compare in-hospital mortality across waves in patients without and with a ceiling of care at hospital admission.

Design
A multicentre prospective cohort study.

Setting
Five tertiary hospitals in Catalonia, Spain, during four waves of the COVID-19 pandemic. Data from the first wave embraced from March to April 2020, second wave from October to November 2020, third wave from January to February 2021 and fourth wave from July to August 2021.

Participants
All consecutive adult subjects (older than 18 years old) admitted to any of the five aforementioned centres. All subjects had a confirmed SARS-CoV-2 infection (with a positive PCR test or antigen test) and an overnight hospital stay. Ceiling of care defined as the highest level of care that a patient will receive during medical treatment was assessed at hospital admission for all patients.

Primary measure
In-hospital mortality.

Results
A total of 3982 hospitalised patients without ceiling of care and 1831 hospitalised patients with ceiling of care were included in the analysis. The adjusted ORs of in-hospital mortality in the second wave were 0.57 (95% CI 0.40 to 0.80), in the third 0.56 (95% CI 0.37 to 0.84) and in the fourth 0.34 (95% CI 0.21 to 0.56) compared with the first wave in subjects without ceiling of care. The adjusted OR was significantly lower in the fourth (0.38, 95% CI 0.25 to 0.58) wave compared with the first wave in subjects with ceiling of care.

Conclusions
In patients without ceiling of care, mortality decreased over time, suggesting better disease knowledge and management. In ceiling of care, only fourth wave patients were less likely to die than first wave patients. In a future infectious disease pandemic, it will be a challenge to improve the management of patients with ceiling of care.

Incide la variante NB.1.8.1, intanto ospedali sotto controllo

Incide la variante NB.1.8.1, intanto ospedali sotto controllo

Introduction
Olfactory dysfunction (OD) following COVID-19 affected up to 70% of patients, with more than 30% still reporting lingering symptoms a year later. Treatment is essential, as previous research has linked (postviral) OD to depression, impaired quality of life (QoL) and even heightened mortality rates.

Methods and analysis
We designed a monocentric, single-blinded randomised controlled trial evaluating the efficacy of olfactory training (OT) in individuals with persisting COVID-19-associated loss of smell. Randomisation will be done in a 1:1 manner. OT will be performed using the Sniffin’ Sticks Duft Quartett over a period of 12 weeks, two times per day. The primary endpoint of this study is the change in olfactory score between baseline and after 12 weeks, measured by the combined score of the identification and discrimination subscales of the Sniffin’ Sticks testing battery. QoL, overall health, mood, personal well-being and symptom severity will be assessed at baseline and during a follow-up visit, using multiple validated questionnaires and scales. OT is offered to the second cohort during an open-label phase extension. This manuscript highlights and discusses the study protocol.

Ethics and dissemination
Ethical approval for the study was obtained from the Ethics Commission of the Medical University of Innsbruck, Austria. Results of this study will be shared through conferences and publications in peer-reviewed journals.

Trial registration number
NCT05421221.

Objective
Antimicrobial resistance is a significant global health challenge, exacerbated by unnecessary antibiotic prescribing. Respiratory tract infections (RTIs) are common reasons for antibiotic prescribing in primary care, despite most being viral or bacterial infections that are self-limiting. C-reactive protein (CRP) point-of-care tests (POCTs) are promising tools to support antibiotic stewardship by guiding the management of lower RTIs (LRTIs). The aim of this study was to develop best practice guidance for using CRP POCT in the management of LRTIs in primary care.

Design
Scoping review findings informed guidance statements, which were then evaluated through a three-round Delphi process with an expert panel via web-based questionnaires. Statements focused on intended use, detection of bacterial LRTIs, communication strategies, device features, performance and ease of use of CRP POCT.

Setting and participants
The panel of experts included 19 healthcare professionals across several specialties, including general practitioners, community pharmacists, hospital pharmacists and respiratory physicians.

Main outcome measures
Panellists rated each guidance statement using a 5-point Likert scale, with acceptance, revision or rejection determined using predefined cut-off scores for medians and interquartile ranges. Statements were revised between rounds using the feedback provided by panellists.

Results
In the first round, 49 statements were evaluated; 16 were accepted, nine removed and 24 revised for the second round. Of the 24 statements evaluated in the second round, 17 were accepted and seven were revised. In the third round, consensus was reached on four of the seven statements presented, resulting in 37 final guidance statements. These statements covered key areas, including the appropriate use of CRP POCTs to guide antibiotic prescribing, CRP cut-off values, integration with clinical decision rules, device performance and operational considerations, training requirements and financial reimbursement. The panel emphasised the need for structured guidelines to align CRP POCT use with clinical context and highlighted its role in improving diagnostic confidence while supporting antibiotic stewardship.

Conclusions
This study provides a set of best practice guidance statements to support the use of CRP POCT in the management of LRTIs in primary care. Dissemination and further research are required to assess their impact.