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

Objective
To estimate the herd effects of anti-microbial-based decontamination (ABD) interventions on bloodstream infections (BSIs) among groups of intensive care unit (ICU) patients in relation to group mean length of stay (LOS). To deduce which of three competing hypotheses of ABD effect mediation best accounts for the observed effects.

Design
Arms-based meta-regression of ICU-acquired BSI incidence against group mean LOS for control and interventions arms of ABD and non-ABD controlled trials each versus that in arms of observational studies.

Exposures
Within controlled trials of ABD, intervention, concurrent control (CC) and non-concurrent (NCC) groups are directly, indirectly and non-exposed, respectively.

Main outcomes and measures
BSI incidence, both overall and for BSI subtypes.

Results
In the arms-based meta-regression, the predicted BSI incidence per 100 patients in the ABD intervention arms increased from 4.6 (95% CI 3.8 to 5.5) at mean LOS 7 days to 13.0 (10.4–16.0) at mean LOS 20 days (n=60 arms) and CC arms 8.5 (6.7–11.0) increasing to 19.3 (14.8–24.8; n=52). These increases were double those in the observational (7.2; 6.1–8.5 increasing to 12.9; 10.4–16.7; n=99) and NCC arms and non-ABD arms. These results triangulate with the notional effect size observed in contrast-based meta-analyses.

Conclusions
The increased tempo of BSI acquisition, both overall and for various BSI subtypes, within intervention and CC groups of ABD randomised concurrent controlled trials versus other groups implicate rebound and spillover, respectively. Mechanisms other than colonisation resistance mediate ABD effects.

Multiple autoimmune diseases developed more often among people who had COVID-19 than among those who did not.

Background
COVID-19 vaccination rates remain low for children aged 11 and below, and understanding the extent to which parental decisions impact their children’s vaccination status remains a challenge. This study aimed to explore the concordance and motivations for vaccination among parent–child dyads and determine the associated factors influencing their children’s vaccination status.

Design
A cross-sectional study was conducted from 1 March 2023 to 30 March 2023, recruiting parents from six representative primary schools across Butuan City, the Philippines. Pilot-tested, self-administered questionnaires were used during the face-to-face surveys with parent participants. To determine the associated factors of parental decisions to vaccinate their children, mixed-effects logistic regression was used, with school districts as a random effect.

Participants
A total of 593 participating parents were included in the study, with the majority being females (n=484, 81.6%) and underserved, characterised by lacking a college degree (n=305, 51.4%) and having low to no income (n=511, 86.1%).

Results
While 80.6% (n=478) of parents reported being vaccinated against COVID-19, only 36.2% (n=215) of them chose to vaccinate their children. A significant number of parents (n=285, 48.1%) reported psychological distress, with higher levels of distress prevalent among those who are indigenous, reside in rural areas and have lower income levels. Parental education and vaccination status emerged as influential factors. Specifically, parents with advanced degrees were 48% less likely to have unvaccinated children (adj OR (AOR)=0.52; 95% CI 0.30, 0.87), while unvaccinated parents had a sixfold increase in the likelihood of having unvaccinated children (AOR 6.1; 95% CI 3.14, 12.02) compared with their counterparts.

Conclusions
Efforts to increase paediatric vaccination rates should focus more on actively engaging parents, educating them about the vaccine’s benefits and necessity, rather than solely relying on mandates to improve paediatric vaccination rates. Further research is needed to understand the reluctance of unvaccinated parents to vaccinate themselves and their children against COVID-19, identifying specific facilitators and barriers to develop more effective communication strategies and bolster vaccine acceptance.

Objective
The objective is to externally validate and assess the opportunity to update the Canadian COVID-19 Mortality Score (CCMS) to predict in-hospital mortality among consecutive non-palliative COVID-19 patients infected with Omicron subvariants at a time when vaccinations were widespread.

Design
This observational study validated the CCMS in an external cohort at a time when Omicron variants were dominant. We assessed the potential to update the rule and improve its performance by recalibrating and adding vaccination status in a subset of patients from provinces with access to vaccination data and created the adjusted CCMS (CCMSadj). We followed discharged patients for 30 days after their index emergency department visit or for their entire hospital stay if admitted.

Setting
External validation cohort for CCMS: 36 hospitals participating in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). Update cohort for CCMSadj: 14 hospitals in CCEDRRN in provinces with vaccination data.

Participants
Consecutive non-palliative COVID-19 patients presenting to emergency departments.

Main outcome measures
In-hospital mortality.

Results
Of 39 682 eligible patients, 1654 (4.2%) patients died. The CCMS included age, sex, residence type, arrival mode, chest pain, severe liver disease, respiratory rate and level of respiratory support and predicted in-hospital mortality with an area under the curve (AUC) of 0.88 (95% CI 0.87 to 0.88) in external validation. Updating the rule by recalibrating and adding vaccination status to create the CCMSadj changed the weights for age, respiratory status and homelessness, but only marginally improved its performance, while vaccination status did not. The CCMSadj had an AUC of 0.91 (95% CI 0.89 to 0.92) in validation. CCMSadj scores of 56.8%.

Conclusions
The CCMS remained highly accurate in predicting mortality from Omicron and improved marginally through recalibration. Adding vaccination status did not improve the performance. The CCMS can be used to inform patient prognosis, goals of care conversations and guide clinical decision-making for emergency department patients with COVID-19.

Objectives
Among nurse leaders, gender should receive particular attention, because life and work experiences and burnout during COVID-19 pandemic may vary between women and men, potentially requiring different strategies to achieve well-being. Thus, information about gender differences in burnout might be critical to burnout prevention in nurse leaders. Additionally, there has been a substantial call for attention to gender during the COVID-19 pandemic, reflecting a concern that responses to the pandemic that fail to consider gender differences and norms will be ineffective. Therefore, the objective of the current study is to examine personal burnout, client burnout and work-related burnout of nurse leaders while considering the impact of COVID-19 pandemic and work-life balance through a gender lens.

Design
A cross-sectional study design was implemented in 2023 using a convenience sampling approach.

Setting
Data on personal burnout, work-related burnout, client burnout, work-life balance and COVID-19 impact were collected electronically and assessed through a gender lens.

Participants
A sample of 210 nurse leaders filled out the online surveys that were posted on the American Organization for Nursing Leadership and on Facebook.

Conclusion
Females had significantly higher personal burnout than males (mean 56.2 vs 49.3, F=5.853, p=0.019). Males had significantly higher client-related burnout than females (mean 45.3 vs 34.8, F=7.014, p=0.008). Findings demonstrate the importance of addressing gender when examining how nurse leaders react to different factors leading to burnout. In employing a gender lens framework, future researchers might study how the pressures that working men and women nurse leaders face were intensified during the COVID-19 pandemic. To support nurse leaders in executing their roles, there is a need to widen the scope of conversations about including family-friendly policies and attention to the needs of men and women as nurse leaders. These policies might include but are not limited to paid childcare, flexible time off, access to paid time off and mandatory overtime laws.

Annals of Internal Medicine, Volume 177, Issue 11, Page 1598-1599, November 2024.

Annals of Internal Medicine, Volume 177, Issue 11, Page 1598, November 2024.

Annals of Internal Medicine, Volume 177, Issue 11, Page 1599-1600, November 2024.

The Administration for Strategic Preparedness and Response, an agency within the US Department of Health and Human Services, has announced the reopening of COVIDTests.gov to deliver free COVID-19 tests to households. The agency’s investment of $600 million to 12 domestic test manufacturers will supply 200 million home tests.

Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA.

Objectives
To investigate how post-traumatic growth (PTG) and moral sensitivity influence service behaviour among healthcare workers (HCWs) in mainland China post-COVID-19, with a focus on the mediating role of moral sensitivity.

Design
Cross- sectional survey design.

Setting
This study was conducted in 27 provinces across mainland China, from 16 March to 2 April 2023.

Participants
1,193 HCWs, including 378 physicians and 815 nurses, were selected using convenience and snowball sampling methods.

Methods
The survey included the Post-traumatic Growth Inventory-Chinese version (PTGI-C), the Moral Sensitivity Questionnaire-Revised Chinese Version (MSQ-R-CV) and a service behaviour scale. Structural equation modelling was employed to analyse the data, focusing on the associations between PTG, moral sensitivity, and service behaviours.

Results
The study found significant associations between PTG and moral sensitivity (r=0.49, p

Introduction
Healthcare workers (HCWs) have been of particular relevance for overcoming the SARS-CoV-2 pandemic. At the same time they have been affected by SARS-CoV-2 infections with above average probability. Around 6.5% of the overall infected persons are likely to develop persistent symptoms resulting from the infection, known as long-COVID or post-COVID syndrome (PCS). The aim of this study is (1) to investigate the prevalence, course and characteristics of PCS in German HCWs, (2) to examine its effects on psychosocial variables, (3) to identify rehabilitation and healthcare needs and (4) to analyse treatment experiences.

Methods and analysis
In a cohort study with a randomised selection of participants (N=20 000) from the Employer’s Liability Insurance Association for Health and Welfare Care, the health status of HCWs, who had COVID-19 in their professional context will be examined. There will be two measurement points: baseline (T1) and a 12-month follow-up (T2). The outcome measures are the health status with a particular focus on persistent or newly occurring symptoms after a SARS-CoV-2 infection, health-related quality of life, functional capacity, the subjective need for and utilisation of healthcare services. Pre-existing conditions, the course of the acute infection and sociodemographic factors are considered as predictors. An advisory board made up of affected HCWs supports the study by contributing to the surveys’ contents.

Ethics and dissemination
The study has been approved by the Local Ethics Committee of the Center for Psychosocial Medicine at the University Hospital Hamburg-Eppendorf (LPEK-0518). For dissemination, the results will be published in peer-reviewed journals, presented at conferences and communicated to relevant stakeholders in general and rehabilitation medicine.

Trail registration number
https://drks.de/search/de/trial/DRKS00029314

This randomized trial showed no difference in local or systemic side effects in patients receiving their vaccines on either schedule.

Neurologi: ‘si apre una nuova storia per i pazienti’