Does active transport lead to improved mood and performance? A panel study of travel changes during the Covid-19 lockdown in Norway

Everyday commuting is seen as a burden and an unwanted necessity for people. Recent studies have challenged this notion and have found that certain aspects of commuting can be positive. In particular, research has shown that active commuting can be an important source of everyday physical activity and a pause between arenas for daily routine. The current study uses the Covid-19 lockdown situation in Norway, and the associated travel restrictions, as a backdrop to study the relationship between active travel and self-reported mood and work performance. In a situation where people are strongly encouraged to take up active mobility forms in place of more passive forms, the often-encountered challenge of self-selection is reduced. A convenience sample was recruited via social media (N = 1319) in May 2020 and completed a total of six follow-up surveys over a period of four months, thus allowing for a panel design as well as a within-subjects comparison. The survey covered topics related to commute mode, experience of travel, current mood, and work performance. Background variables related to personality, general wellbeing as well as sociodemographic measures were also captured. Multivariate models show that those who during this period commute with active modes (walking and cycling) report a higher degree of travel satisfaction than users of passive modes (driving and public transport). Further, active modes are associated with being in a better mood, and with reporting higher work performance. Finally, looking at individuals who over time change travel mode (N = 151), we find that they report improved mood and work performance when travelling with active vs passive modes. The results have implications for policy makers and for employers looking for justification to spend company money on measures to increase active travel. © 2023 The Authors

Serology results after COVID vaccine in multiple sclerosis patients treated with fingolimod.

INTRODUCTION: While it is recommended that patients with multiple sclerosis (MS) be vaccinated against COVID-19, it is unknown what the vaccine response is in MS patients treated with fingolimod, an agent which modulates the humoral response. We aimed to characterize the immune response to the COVID-19 vaccine in MS patients treated with fingolimod and to explore which factors influenced response. METHOD: We collected the following data from 59 MS patients treated with fingolimod and vaccinated against COVID-19: age, sex, duration of treatment, number of vaccine doses, date of last vaccination, type of vaccine, lymphocyte count, history of COVID-19, and serology to measure the vaccine response. We used Student's t-test and Chi2 test to see whether there was a relationship between these variables and seropositivity. A multivariate logistic regression model was used to identify factors influencing the serology result. A multivariate linear regression model was used to identify factors influencing the antibody titer. RESULTS: Twenty-eight participants (47%) developed a positive serology. Age (P<0.001) and the duration of treatment (P=0.002) were significantly related to seropositivity. Gender (P=0.73), number of vaccinations (P=0.78), lymphocyte count (P=0.46), and the time between the last vaccine dose and blood sampling (P=0.84) were not significant variables. Multivariate analysis using logistic regression (n=59) showed that age (P=0.003, RR = 2.28, 95%CI = 1.28, 4.07) and duration of treatment (P=0.04, RR=1.91, 95%CI=1.04, 3.50) were significantly and independently correlated with COVID serology. Multivariate linear regression analysis of the antibody titer (n=59) found the duration of treatment to be significant (P = 0.015), but not age (P = 0.53). After removing three outliers, age (P = 0.005, RR=6.82, 95%CI=1.66, 27.98) and duration of treatment (P = 0.008, RR=5.12, 95%CI=1.24, 21.03) were significantly correlated with the antibody titer. CONCLUSION: COVID-19 seropositivity was present in 47% of our sample of 59 MS patients on fingolimod. A strong relationship was found between antibody development, age, and duration of treatment, as well as between antibody titer and age and duration of treatment.

Does gender influences outcome of stroke in COVID+ and COVID- patients: a large collaborative study in Northern Italy

Background and aims: The impact of the COVID-19 pandemic during the first wave in Italy caused a decrease of hospital admissions, delays in reperfusion treatments and an overall worse outcome in COVID+ patients with stroke. However, few data are available on outcome of stroke stratified by gender. Methods: A multi-center observational study on neurological complications in COVID-19 patients was conducted in 19 Neurology Units by the Italian society of Hospital Neuroscience (SNO). Adult patients admitted to Neurological units between March-April 2020 with ischaemic stroke were recruited. Demographic, clinical, treatment and outcome data were compared in patients with (COVID19+) and without COVID-19 (COVID19-), as well as in male and female patients. Results: 812 patients with ischemic stroke were enrolled (682 COVID-, 129 COVID+);males were 54.1% and 52.7%. Intra-hospital mortality was 31.9% in COVID+ patients (38.6% in male and 27.8% in female) and 7.2% in COVID- (8.4% in males and 6% in females). Male patients with COVID+ were more likely to have cPAP (30.9% vs 14.8%;p=0.03) or being intubated (14.9% vs 3.3%;p=0.02) than females. Reperfusion treatment was administered more frequently in women if COVID- (34.5% vs 29.8%), while less frequently if COVID+ (11.5% vs 29.4%;p=0.01). COVID+ patients had a higher frequency of ESUS than COVID- (31.8% vs 22.3%;p=0.02), with a higher frequency in COVID+ females compared to males (36.1% vs 27.9%). Conclusion: Our study detected some differences due to gender in ischaemic stroke with and without COVID-19. Multivariate analyses is ongoing to define predictors of mortality across gender categories.

LONG-TERM OUTCOME OF CEREBRAL VENOUS THROMBOSIS DUE TO SARS-COV-2 VACCINE-INDUCED IMMUNE THROMBOTIC THROMBOCYTOPENIA

Background and aims: Since initiation of COVID-19 vaccination, cases of cerebral venous thrombosis (CVT) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) have been reported. Reported in-hospital mortality varies between 20-50%, but data on longterm outcome of surviving patients with CVT-VITT are not available. Methods: We report follow-up data of CVT-VITT cases after COVID- 19 vaccination from an international registry. VITT was classified according to the Pavord criteria. Outcomes were mortality, functional dependency, relapse of VITT, new thrombosis, and new bleeding events. Results: Of 62 patients with CVT-VITT who survived initial hospital admission, follow-up data were available for 48/62 (77%) cases (32 (67%) definite VITT, 7 (15%) probable VITT, 9 (19%) possible VITT). Median time from diagnosis to last follow-up was 110 days (IQR 86-174). There were no new venous or arterial thrombotic events reported in any case. Among 35/44 (80%) cases that achieved clinical remission, 0/29 cases had a relapse of VITT. Major bleeding was reported in 1/45 (2%) cases (intracranial bleed). Mortality at follow-up was 1/48 (2%, 95%CI 0-11%). 44/48 (92%) cases had a modified Rankin Scale score of 0-2 at follow-up, compared to 32/46 (70%) at hospital discharge. 16/34 (47%) of cases had returned to work or school. Conclusions: In patients who survive the acute phase of CVT-VITT, long-term mortality is low and thrombotic and bleeding events are rare. Approximately half of the CVT-VITT patients at follow-up could resume all daily activities.

CHANGE IN MANAGEMENT AND DECREASE IN MORTALITY OF CEREBRAL VENOUS SINUS THROMBOSIS WITH THROMBOCYTOPENIA AFTER SARS-COV-2 VACCINATION

Background and aims: Cerebral venous sinus thrombosis with thrombocytopenia syndrome (CVST-TTS) is a rare adverse effect of adenovirus- based SARS-CoV-2 vaccines. After the autoimmune pathogenesis of TTS was discovered, treatment recommendations were issued. The aim of this study was to evaluate if adherence to treatment recommendations was associated with lower mortality. Methods: TTS was defined according to the Brighton criteria. Cases from a prospective international CVT registry with symptom onset within 28 days of adenovirus-based SARS-CoV-2 vaccination were analysed. Treatment recommendations, following the International Society of Thrombosis and Haemostasis, included use of immunomodulation, non-heparin anticoagulants, and avoidance of platelet transfusions, unless needed for surgery. Results: Out of 178 CVT cases from 117 centres in 19 countries reported between March 29 and September 3, 2021, 95 patients fulfilled inclusion criteria. Five of 37 (14%), 13/25 (52%), and 29/33 (88%) of patients diagnosed in March, April, and from May onwards, respectively, were treated according to recommendations. Proportion of patients diagnosed in March, April, and from May onwards who received immunomodulation increased from 19/37 (51%) over 15/25 (60%) to 30/33 (90%), and the percentage of patients who were treated with heparins [26/37 (70%), 4/25 (16%), 1/33 (3%)] and platelet transfusion [15/37 (41%), 4/25 (16%), 7/33 (21%), respectively] decreased accordingly. Mortality of patients treated according to recommendations was 14/47 (30%, 95%CI 19-44%) compared to 28/48 (58%, 95%CI 44-71%) in patients not treated according to recommendations (OR 3.30, 95%CI 1.41-7.71). Conclusions: Over time, adherence to treatment recommendations improved, and mortality rate of patients with CVST-TTS decreased.

DECOMPRESSIVE SURGERY IN CEREBRAL VENOUS SINUS THROMBOSIS WITH VACCINE-INDUCED IMMUNE THROMBOTIC THROMBOCYTOPENIA

Background and aims: Cerebral venous sinus thrombosis with thrombosis with thrombocytopenia syndrome (CVST-TTS) is a serious adverse drug reaction after adenoviral SARS-CoV-2 vaccinations. CVST-TTS patients may need decompressive surgery to avoid fatal brain herniation, but despite this intervention, many CVST-TTS patients die during the initial hospital admission. Here, we describe the characteristics and outcomes of CVST-TTS patients who underwent decompressive surgery and explore predictors of mortality in CVST-TTS patients. Methods: We used data from an ongoing international registry collecting data from patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March and 9 December 2021. TTS was defined in accordance with the Brighton Collaboration case definition. Results: Out of 97 CVST-TTS patients, 29 (30%) underwent decompressive surgery. All operated patients had an intracerebral haemorrhage before the surgery. In-hospital mortality was 19/29 (66%) in the operated and 23/68 (34%) in the non-operated group. In the operated group, the highest mortality rate was among patients who were in coma before the surgery (14/15, 93% vs 4/12, 33% in those not in coma), had bilateral absence of the pupillary response (7/7, 100% vs 8/16, 50% in patients with uni/bilateral pupillary response) and platelet count <50 x103/μL (11/14, 79% vs 6/12, 50% in cases with a platelet count ≥50 x103/μL). Conclusion: Mortality rate of CVST-TTS patients who underwent decompressive surgery is extremely high. Among the operated patients, coma before the surgery, bilateral absence of the pupillary response, and platelet count <50 x103/μL were the predictors of mortality.

Encephalitis during first year of SARS-COV-2 pandemic– first results of the European ENCOVID registry

Background and aims: Objective: Several preclinical and clinical investigations have argued for nervous system involvement in SARS-CoV-2 infection. No data about clinical, imaging and biomarkers presentations as well as long-term outcomes are available for SARS-CoV-2 encephalitis in comparison with infectious and autoimmune encephalitis. Methods: The ENCOVID European registry included patients with probable or definite diagnosis of encephalitis with and without SARS-CoV-2 infection admitted for hospitalization in the European recruiting centers between February 1st 2020 and March 30th, 2021. Each patient underwent a standardized assessment including full infectious screening, CSF, EEG, MRI data. Clinical presentation and laboratory markers, severity of COVID-19 disease, response to treatment and outcomes were recorded. Results: Results – Out of 155 cases screened, forty-five cases of encephalitis positive for SARS-CoV-2 infection and 63 without COVID-19 with full available data were included. SARS-CoV-2 encephalitis exhibited common presentation with aphasia and dysarthria compared to non-COVID- encephalitis and exhibited higher prevalence of patients with normal MRI but mild hyperproteinorracchia/pleocytosis. Most SARS-CoV-2 cases appeared during the onset of COVID-19 and exhibited different response to treatment and long-term outcomes compared to non COVID encephalitis. Conclusions: Conclusions –The registry identified a wide spectrum of encephalitis associated with COVID19 infection, with clinical characteristics and course different from classical infectious and autoimmune encephalitis. Biomarkers studies are warranted in order to evaluate the specific inflammatory pathways associated with SARS-Cov-2 encephalitis.

Primary intracerebral haemorrhage during SARS-CoV-2 outbreak

Background and aims: Mounting data has been published as to the impact of SARS-CoV-2 on cerebrovascular events, particularly on ischemic strokes. Our study addresses the clinical course of patients with cerebral haemorrhage and simultaneous SARS-CoV-2 infection, paying particular attention to both SARS-CoV-2 positive and negative patients hospitalized during the pandemic. Methods: The Italian Society of Hospital Neurosciences (SNO) promoted a multicentre, retrospective, observational study (SNO-COVID-19), involving 20 Neurology Units in Northern Italy. Data were collected on patients consecutively admitted to neurological departments, from March 1st to April 30th with cerebrovascular diseases, occurring either at home or during hospitalization for other causes. Results: 949 patients were enrolled (average age 73.4 years;52.7% males);135 patients had haemorrhagic stroke and 127 (13.4%) had a primary ICH. Only 16 patients with ICH (12.6%) had laboratory confirmed SARS-CoV-2 infection, clinically expressed or not. SARS-CoV-2 related pneumonia or respiratory distress, lobar location and previous antiplatelet or anticoagulant treatment were the only factors significantly associated with increased mortality in ICH. SARS-CoV-2 infection, regardless of respiratory involvement, led to a nonsignificantly increased risk of in-hospital death. Conclusion: Our study confirms that age, ICH location and previous antiplatelet or anticoagulant treatment are predictors of in-hospital death. Unlike ischemic stroke, ICH in SARS-CoV-2 patients led only to a slight increase in mortality, mainly due to respiratory involvement.