Risultati per: Flowchart decisionale: vaccinare l’adulto ai tempi del COVID-19

Objectives
During the COVID-19 pandemic, healthcare professionals were faced with prioritisation dilemmas due to limited surgical capacity. While the views of healthcare professionals on fair allocation have been given considerable attention, the views of patients have been overlooked. To address this imbalance, our study aimed to identify which ethical principles are most supported by patients regarding the fair allocation of surgical resources.

Design
A Q-methodology study was conducted. Participants ranked ordered 20 statements covering different viewpoints on fair allocation according to their point of view, followed by an interview. Principal component analysis followed by varimax rotation was used to identify subgroups who broadly agreed in terms of their rankings.

Setting
The setting of this study was in the Netherlands.

Participants
16 patient representatives were purposively sampled.

Results
Two perspectives were identified, both of which supported utilitarianism. In perspective 1, labelled as ‘clinical needs and outcomes’, resource allocation should aim to maximise the health gains based on individual patient characteristics. In perspective 2, labelled as ‘population outcomes and contribution to society’, allocation should maximise health gains as with perspective 1, but this should also consider societal gains.

Conclusions
There was a broad agreement among patient representatives that utilitarianism should be the guiding ethical principle for fair allocation of scarce surgical resources. The insights gained from this study should be integrated into policymaking and prioritisation strategies in future healthcare crises.

Objective
To estimate the effect of (a) the COVID-19 pandemic and (b) COVID-19 restriction stringency on daily minutes of device-measured moderate-to-vigorous physical activity (MVPA).

Design
Physical activity data were collected from the INTerventions, Equity, Research and Action in Cities Team (INTERACT) cohorts in Montreal, Saskatoon and Vancouver before (May 2018 to February 2019, ‘phase 1’) and during the pandemic (October 2020 to February 2021, ‘phase 2’). We estimated the effect of the two exposures by comparing daily MVPA measured (a) before vs during the pandemic (phase 1 vs phase 2) and (b) at different levels of COVID-19 restriction stringency during phase 2. Separate mixed effects negative binomial regression models were used to estimate the association between each exposure and daily MVPA, with and without controlling for confounders. Analyses were conducted on person-days with at least 600 min of wear time. Effect modification by gender, age, income, employment status, education, children in the home and city was assessed via stratification.

Setting
Montreal (Quebec), Saskatoon (Saskatchewan) and Vancouver (British Columbia), Canada.

Main outcome measure
Daily minutes of MVPA, as measured using SenseDoc, a research-grade accelerometer device.

Results
Daily minutes of MVPA were 21% lower in phase 2 (October 2020 to February 2021) compared with phase 1 (May 2018 to February 2019), controlling for gender, age, employment status, household income, education, city, weather and wear time (rate ratio=0.79, 95% CI 0.69, 0.92). This did not appear to be driven by changes in the sample or timing of data collection between phases. The results suggested effect modification by employment, household income and education. Restriction stringency was not associated with daily MVPA between October 2020 and February 2021 (adjusted rate ratio=0.99, 95% CI 0.96, 1.03).

Conclusions
Between October 2020 and February 2021, daily minutes of MVPA were significantly lower than 2 years prior, but were not associated with daily COVID-19 restriction stringency.

Se dalla fine dell’emergenza si sono contati quasi 8mila morti quello che non è sempre noto è l’impatto economico della mancata vaccinazione

la nuova circolare del ministero della Salute consente anche la doppia iniezione di vaccino: influenza-Covid.

Campagna adattata alla variante JN.1, raccomandata ai fragili

A small absolute reduction in noncardiovascular-related mortality among semaglutide recipients was attributable partly to fewer COVID-19 deaths.

Ora che ci sono i vaccini per far partire la campagna vaccinale si aspetta la nuova circolare del ministero della Salute attesa a giorni

Introduction
Post-COVID-19 condition (post COVID, also known as long COVID) is a global public health issue estimated to affect over 100 million people. Common symptoms include fatigue, dyspnoea and cognitive dysfunction (‘brain fog’). Over time, these symptoms have an adverse effect on mental health, physical activity and quality of life (QoL). The condition requires innovative and feasible treatment approaches that can be effective and self-managed. Physical activity is essential for good health; however, aerobic exercise or weightlifting may not be suitable for post COVID patients who experience fatigue or breathlessness. The benefits of yoga include improved flexibility, mobility, body strength and balance. It is also shown to reduce symptoms of fatigue and improve breathing efficiency, mental health and QoL. This study protocol describes the rationale and methods for a randomised controlled trial (RCT) of a yoga-based intervention designed for adults with post COVID.

Methods and analysis
A two-group, parallel, RCT with blinded follow-up assessments. Participants will be randomised with a 1:1 allocation to either a 12-week yoga-based intervention or a 12-week health promotion (active comparison) intervention. In total, 88 participants aged 30–65 years will be recruited and randomised. The primary outcome is health-related QoL (36-item Short-Form). Secondary outcomes are dyspnoea, fatigue, sleep quality, cognitive functions, mental fatigue, depression, anxiety, physical activity, demographic data and physical health measures. Data will be analysed as intention-to-treat basis, using linear mixed modelling. All assessments are conducted at Karolinska Institutet in Stockholm, Sweden. The yoga-based intervention will take place at a yoga studio centrally located in Stockholm city.

Ethics and dissemination
The study is approved by the Swedish Ethical Review Authority, reference number 2023/06518-01. All participants must sign written informed consent before enrolment and are free to withdraw from the study at any point. Key results will be available through research articles and seminars.

Trial registration number
German Clinical Trials Register, DRKS00032837.

Così dicono i segnali che arrivano dall’emisfero Sud del mondo dove con il passaggio dell’inverno i virus si sono massicciamente affacciati

New England Journal of Medicine, Volume 391, Issue 10, September 12, 2024.

Objectives
To appraise the quality of clinical practice guidelines (CPGs) and expert consensus statements on rehabilitation for patients with COVID-19, summarise recommendations of rehabilitation assessments and interventions and evaluate the heterogeneity of the recommendations.

Design
Systematic review.

Data sources
PubMed and Embase databases and five online guideline repositories: The National Guideline Clearinghouse, Guidelines International Network, Scottish Intercollegiate Guidelines Network, National Institute for Health and Clinical Excellence and WHO were searched from their inception to August 2024. In addition, we reviewed reference lists of eligible citations and searched the grey literature on the relevant websites.

Eligibility criteria for selecting studies
We included CPGs and expert consensus statements which provided information about rehabilitation of patients with COVID-19. To be eligible, the CPGs and expert consensus statements were issued in English by a nationally or internationally recognised government authority, medical/academic society or organisation. If there were multiple versions of the guidelines, we included the latest one. The translations, interpretations and abstracts of guidelines were excluded.

Data extraction and synthesis
All recommendations on rehabilitation assessments and interventions for COVID-19 were extracted and summarised. Two reviewers independently evaluated the methodological quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and two other reviewers assessed the reporting quality using the Reporting Items for Practice Guidelines in Healthcare (RIGHT) statement of included CPGs and expert consensus statements. We used the Measurement Scale of Rate of Agreement to evaluate the heterogeneity of the recommendations in different CPGs and expert consensus statements.

Results
A total of 31 CPGs and expert consensus statements were included. 14 guidelines provided recommendations for rehabilitation assessments. At the early, development, critical and recovery stages of COVID-19, the most frequently recommended were exercise therapy (25.8%, 35.5%, 25.8% and 58.1%, respectively). According to AGREE II, 17 included guidelines were assessed as low methodological quality (35%–56%), 10 guidelines were rated as moderate quality (46%– 62%) and four had high quality (69%–79%). Among 31 eligible guidelines, the reporting rate of 22 items in the RIGHT checklist ranged from 10% to 100%. The included guidelines were consistent with the reference guidelines (80%–100%). Only one guideline existed minor (60%–80%) disagreements in respiratory muscle training relative to the reference guideline.

Conclusions
Rehabilitation assessments and interventions should be implemented consistently throughout the entire process of COVID-19. The recommendations should be tailored to each stage of COVID-19. The methodological and reporting qualities of several guidelines remain suboptimal. Therefore, developers should adhere strictly to the AGREE II standard and RIGHT checklist to formulate and publish CPGs and expert consensus statements with high quality.

PROSPERO registration number
CRD42020190761.

Objectives
This study addressed two research questions: What factors do doctors in training describe as influencing their choices to apply (or not apply) for specialty training during their Foundation Year 2? Which of these factors are specific to the context of the COVID-19 pandemic, and the unique experiences of the cohort of doctors who qualified early during the pandemic?

Design
Sequential explanatory mixed methods study: Quantitative survey. Qualitative semistructured interviews. Quantitative data were analysed with logistic regression. Qualitative data were analysed using reflexive thematic analysis.

Setting
UK-wide.

Participants
Junior doctors who graduated medical school in 2020. Survey: 320 participants (22% of those contacted). 68% (n=219) were female, 60% (n=192) under 25 and 35% (n=112) 25–30. 72% (n=230) were white, 18% (n=58) Asian and 3% (n=10) black. Interviews: 20 participants, 10 had applied for specialty training, 10 had not.

Results
A minority of respondents had applied for specialty training to start in 2022 (114, 36%). While burnout varied, with 15% indicating high burnout, this was not associated with the decision to apply. This decision was predicted by having taken time off due to work-related stress. Those who had not taken time off were 2.4 times more likely to have applied for specialty training (OR=2.43, 95% CI 1.20 to 5.34). Interviews found reasons for not applying included wanting to ‘step off the treadmill’ of training; perceptions of training pathways as inflexible, impacting well-being; and disillusionment with the community and vocation of healthcare, based, in part, on their experiences working through COVID-19.

Conclusions
Participants infrequently cited factors specific to the pandemic had impacted their decision-making but spoke more broadly about challenges associated with increasing pressure on the health service and an eroded sense of vocation and community.

Objective
Liver function test (LFT) abnormalities are higher in patients with severe COVID-19. Most of the studies on this theme were conducted in foreign nations, and the association with LFT abnormalities was not sufficiently addressed in the study areas. Therefore, the current study aimed to investigate the effects of COVID-19 infection on liver function of patients.

Setting
A facility-based comparative cross-sectional study was carried out from 10 April to 15 June 2022, among COVID-19 infected individuals admitted in Eka Kotebe General Hospital and Saint Petrous Specialized Hospitals, Addis Ababa, 2022.

Participants
A total of 284 confirmed COVID-19-positive and COVID-19-negative controls matched by gender and age were included in the present study.

Results
Among SARS-COV-2 positive groups, 63 (44.4%) had one or more LFT abnormalities. The most common elevated level of the LFTs among patients with COVID-19 were gamma-glutamyl transferase (GGT) 50 (35.2%), while the most common lowered level was albumin 58 (40.8%). The mean values of aspartate aminotransferase (AST) (35.4±26.9 vs 22.9±12.6, p

Objectives
This study aims to describe the incidence, symptom clusters and determinants of post-acute COVID symptoms using data from the COVID RADAR app in the Netherlands.

Design
Prospective cohort.

Setting
General population in the Netherlands from April 2020 to February 2022.

Participants
A total of 1478 COVID RADAR app users, with data spanning 40 days before to 100 days after positive SARS-CoV-2 test.

Outcome measures
Incidence and duration of 10 new symptoms that developed during acute infection, defined as 10 days prior and 10 days after positive test. Clustering of these post-acute COVID symptoms and associations between factors known in the acute phase and 100-day symptom persistence.

Results
The most frequent post-acute symptoms were cough, loss of smell or taste and fatigue. At 100 days postinfection, 86 (8%) participants still experienced symptoms. Three post-acute COVID symptom clusters were identified: non-respiratory (headache and fatigue; 49% of participants with post-acute COVID symptoms); olfactory (15%) and respiratory (8%). Vaccination was associated with a lower risk of post-acute COVID symptoms 100 days after infection, although CIs were wide (OR: 0.5; 95% CI: 0.2 to 1.5), but not with non-respiratory symptoms (OR: 1.0; 95% CI: 0.3 to 4.4). Severe acute disease increased the risk of post-acute COVID symptoms (OR: 1.4; 95% CI: 1.2 to 1.5; per additional acute symptom).

Conclusions
In this cohort of infected community-dwelling app users, 5%–10% experienced post-acute COVID symptoms. The symptoms cluster in several distinct entities, which differ in incidence, patient characteristics and vaccination effects. This suggests multiple mechanisms underlying the development of post-acute COVID symptoms.

Objectives
While older adults showed higher mortality during COVID-19 pandemic, protective behaviours (knowledge regarding coping with COVID-19 symptoms and preventive behaviours) were highlighted to be important to prevent the spread of infection. This study aimed to identify individual and community-level variables influencing deficient knowledge regarding coping with COVID-19 and not-practicing COVID-19 of older adults during the pandemic.

Design
This is a secondary analysis of a cross-sectional study using the 2020 Korea Community Health Survey (KCHS).

Setting
255 community public health centres nationwide, South Korea.

Methods and analysis
Using 2020 KCHS data, multilevel logistic regression analysis was conducted on 55 005 adults aged 65 years or older.

Results
Older adults who reside alone, as opposed to with their spouse and who lack the support of another individual exhibited insufficient COVID-19 coping-related knowledge (OR: 1.142, p

4,2 anni in più per le femmine, 1,4 per i maschi