Risultati per: La fase post-acuta del COVID-19: una nuova sfida per il medico di medicina generale

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.

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.

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.

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

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.

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

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.

Objectives
We conducted an implementation science mental health treatment study in western Kenya, testing strategies for scale up of evidence-based mental health services for common adult disorders using a non-specialist workforce, integrated with existing primary care (Sequential Multiple, Assignment Randomized Trial of non-specialist-delivered psychotherapy (Interpersonal Psychotherapy) and/or medication (fluoxetine) for major depression and post-traumatic stress disorder (PTSD) (SMART DAPPER)). Because study launch coincided with the COVID-19 pandemic, participants were allowed to attend treatment visits via mHealth (audio-only mobile phone) or in-person. We conducted a secondary data analysis of the parent study to evaluate preference for mHealth or in-person treatment among our study participants, including rationale for choosing in-person or mHealth treatment modality, and comparison of baseline demographic and clinical characteristics.

Design, setting, participants and interventions
Participants were public sector primary care patients at Kisumu County Hospital in western Kenya with major depression and/or PTSD and were individually randomised to non-specialist delivery of evidence-based psychotherapy or medication (n=2162).

Outcomes
Treatment modality preference and rationale were ascertained before randomised assignment to treatment arm (psychotherapy or medication). The parent SMART DAPPER study baseline assessment included core demographic (age, gender, relationship status, income, clinic transport time and cost) and clinical data (eg, depression and PTSD symptoms, trauma exposures, medical comorbidities and history of mental healthcare). Given that this evaluation of mHealth treatment preference sought to identify the demographic and clinical characteristics of participants who chose in-person or mHealth treatment modality, we included most SMART DAPPER core measurement domains (not all subcategories).

Results
649 (30.3%) SMART DAPPER participants preferred treatment via mHealth, rather than in person. The most cited rationales for choosing mHealth were affordability (18.5%) (eg, no transportation cost) and convenience (12.9%). On multivariate analysis, compared with those who preferred in-person treatment, participants who chose mHealth were younger and had higher constraints on receiving in-person treatment, including transport time 1.004 (1.00, 1.007) and finances 0.757 (0.612, 0.936). Higher PTSD symptoms 0.527 (0.395, 0.702) and higher disability 0.741 (0.559, 0.982) were associated with preference for in-person treatment.

Conclusions
To our knowledge, this is the first study of public sector mental healthcare delivered by non-specialists via mHealth for major depression and/or PTSD in Sub-Saharan Africa. Our finding that mHealth treatment is preferred by approximately one-third of participants, particularly younger individuals with barriers to in-person care, may inform future mHealth research to (1) address knowledge gaps in mental health service implementation and (2) improve mental healthcare access to evidence-based treatment.

Trial registration number
NCT03466346.