ABSTRACT
School attendance is crucial for the development of a child. Sickness absence is the most common type of absenteeism and can be a red flag for underlying problems. To address sickness absence, the intervention Medical Advice for Sick-reported Students for Primary School (MASS-PS) was recently developed. It targets children at risk and is a school-based child and youth health care intervention. The present study is a process evaluation of the intervention. MASS-PS was implemented and evaluated in 29 schools in the West-Brabant region of the Netherlands, during three school years (2017-2020). Attendance coordinators (ACs) from the different schools were interviewed in six focus group interviews as well as in over 200 individual conversations, of which logbooks were kept. Content analysis was used based on a framework of implementation elements. During the first year of the study, the uptake was low. Changes were made by the project group to improve the uptake. The ACs generally considered the MASS-PS as compatible and relevant, but suggested improvements by adding a medical consultation function with a child and youth healthcare physician and increasing the threshold for selecting children at risk. They saw several personal benefits, although time was necessary to learn to use the intervention. An organisational barrier was the lack of teaching staff. A strength in the organisational structure was the appointment of ACs. A major event in the sociological structure was the COVID-19 pandemic. ACs felt that the intervention helped them keep track of sickness absence during the pandemic. The Medical Advice for Sick-reported Students for Primary School intervention was implemented successfully, and the process evaluation gave insight into possible improvements.
Subject(s)
COVID-19 , Students, Medical , Absenteeism , Adolescent , COVID-19/epidemiology , Child , Delivery of Health Care , Humans , Pandemics , SchoolsABSTRACT
Imprinting of the specific molecular image of a given protein antigen into immunological memory is one of the hallmarks of immunity. A later contact with a related, but different antigen should not trigger the memory response (because the produced antibodies would not be effective). The preferential expansion of cross-reactive antibodies, or T-lymphocytes for that matter, by a related antigen has been termed the original antigenic sin and was first described by Thomas Francis Jr. in 1960. The phenomenon was initially described for influenza virus, but also has been found for dengue and rotavirus. The antibody dependent enhancement observed in feline coronavirus vaccination also may be related to the original antigenic sin. For a full interpretation of the effectivity of the immune response against SARS-CoV-2, as well as for the success of vaccination, the role of existing immunological memory against circulating corona viruses is reviewed and analyzed.
ABSTRACT
Infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes Coronavirus Disease 2019 (COVID-19), which has reached pandemic proportions. A number of effective vaccines have been produced, including mRNA vaccines and viral vector vaccines, which are now being implemented on a large scale in order to control the pandemic. The mRNA vaccines are composed of viral Spike S1 protein encoding mRNA incorporated in a lipid nanoparticle and stabilized by polyethylene glycol (PEG). The mRNA vaccines are novel in many respects, including cellular uptake and the intracellular routing, processing, and secretion of the viral protein. Viral vector vaccines have incorporated DNA sequences, encoding the SARS-CoV-2 Spike protein into (attenuated) adenoviruses. The antigen presentation routes in MHC class I and class II, in relation to the induction of virus-neutralizing antibodies and cytotoxic T-lymphocytes, will be reviewed. In rare cases, mRNA vaccines induce unwanted immune mediated side effects. The mRNA-based vaccines may lead to an anaphylactic reaction. This reaction may be triggered by PEG. The intracellular routing of PEG and potential presentation in the context of CD1 will be discussed. Adenovirus vector-based vaccines have been associated with thrombocytopenic thrombosis events. The anti-platelet factor 4 antibodies found in these patients could be generated due to conformational changes of relevant epitopes presented to the immune system.
ABSTRACT
BACKGROUND: Studies have shown increased anxiety, depression, and stress levels among different populations during the coronavirus disease 2019 (COVID-19) pandemic. However, the impact of the pandemic on the mental health of dialysis patients remains unknown. The aim of this study was to investigate the mental health of dialysis patients during the COVID-19 pandemic compared to the period preceding the pandemic. METHODS: Data originate from the ongoing multicentre observational Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO). Patients who filled in a health-related quality of life (HRQoL) questionnaire during the pandemic and six to three months prior were included. The mean difference in Mental Component Summary (MCS) score of the Short Form 12 (SF-12) was analysed with multilevel linear regression. A McNemar test was used to compare presence of mental health-related symptoms during and prior to the COVID-19 pandemic. RESULTS: A total of 177 patients were included. The mean MCS score prior to COVID-19 was 48.08 ± 10.15, and 49.00 ± 10.04 during the COVID-19 pandemic. The adjusted mean MCS score was 0.93 point (95% CI - 0.57 to 2.42) higher during the COVID-19 pandemic than during the period prior to the pandemic. Furthermore, no difference in the presence of the following mental health-related symptoms was found during the COVID-19 pandemic: feeling anxious, feeling sad, worrying, feeling nervous, trouble falling asleep, and trouble staying asleep. CONCLUSIONS: The mental health of dialysis patients appears to be unaffected by the COVID-19 pandemic. Dialysis patients may be better able to cope with the pandemic, since they have high resilience and are less impacted by social distancing measures. TRIAL REGISTRATION NUMBER: Netherlands Trial Register NL6519, date of registration: 22 August 2017.