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Background: Patients with systemic lupus erythematosus (SLE) are at an increased risk of infection relative to the general population. We aimed to describe the frequency and risk factors for serious infections in patients with moderate-to-severe SLE treated with rituximab, belimumab, and standard of care therapies in a large national observational cohort. Method(s): The British Isles Lupus Assessment Group Biologics Register (BILAG-BR) is a UK-based prospective register of patients with SLE. Patients were recruited by their treating physician as part of their scheduled care from 64 centres across the UK by use of a standardised case report form. Inclusion criteria for the BILAG-BR included age older than 5 years, ability to provide informed consent, a diagnosis of SLE, and starting a new biological therapy within the last 12 months or a new standard of care drug within the last month. The primary outcome for this study was the rate of serious infections within the first 12 months of therapy. Serious infections were defined as those requiring intravenous antibiotic treatment, hospital admission, or resulting in morbidity or death. Infection and mortality data were collected from study centres and further mortality data were collected from the UK Office for National Statistics. The relationship between serious infection and drug type was analysed using a multiple-failure Cox proportional hazards model. Finding(s): Between July 1, 2010, and Feb 23, 2021, 1383 individuals were recruited to the BILAG-BR. 335 patients were excluded from this analysis. The remaining 1048 participants contributed 1002.7 person-years of follow-up and included 746 (71%) participants on rituximab, 119 (11%) participants on belimumab, and 183 (17%) participants on standard of care. The median age of the cohort was 39 years (IQR 30-50), 942 (90%) of 1048 patients were women and 106 (10%) were men. Of the patients with available ethnicity data, 514 (56%) of 911 were White, 169 (19%) were Asian, 161 (18%) were Black, and 67 (7%) were of multiple-mixed or other ethnic backgrounds. 118 serious infections occurred in 76 individuals during the 12-month study period, which included 92 serious infections in 58 individuals on rituximab, eight serious infections in five individuals receiving belimumab, and 18 serious infections in 13 individuals on standard of care. The overall crude incidence rate of serious infection was 117.7 (95% CI 98.3-141.0) per 1000 person-years. Compared with standard of care, the serious infection risk was similar in the rituximab (adjusted hazard ratio [HR] 1.68 [0.60-4.68]) and belimumab groups (1.01 [0.21-4.80]). Across the whole cohort in multivariate analysis, serious infection risk was associated with prednisolone dose (>10 mg;2.38 [95%CI 1.47-3.84]), hypogammaglobulinaemia (<6 g/L;2.16 [1.38-3.37]), and multimorbidity (1.45 [1.17-1.80]). Additional concomitant immunosuppressive use appeared to be associated with a reduced risk (0.60 [0.41-0.90]). We found no significant safety signals regarding atypical infections. Six infection-related deaths occurred at a median of 121 days (IQR 60-151) days from cohort entry. Interpretation(s): In patients with moderate-to-severe SLE, rituximab, belimumab, and standard immunosuppressive therapy have similar serious infection risks. Key risk factors for serious infections included multimorbidity, hypogammaglobulinaemia, and increased glucocorticoid doses. When considering the risk of serious infection, we propose that immunosupppressives, rituximab, and belimumab should be prioritised as mainstay therapies to optimise SLE management and support proactive minimisation of glucocorticoid use. Funding(s): None.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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The term "Tomato Flu” or "Tomato Fever” is the colloquial term in India used to describe multiple diseases that present with a fever and rash, with characteristic red, "tomato” shaped blister that appears on different parts of the body, which begin small and increase in size as disease progresses. Some controversy exists on this ‘new viral "flu” that emerged in May 2022 over a period of 2 weeks in areas in the south of India. Currently, local healthcare workers have been encouraged to address the disease as a variant of Hand Foot and Mouth Disease to avoid unnecessary panic on the emergence of a "new outbreak”. With the circulation of other viruses, inadequate testing and poor-quality surveillance in a low resource setting, where healthcare systems are already burdened with ongoing monkeypox outbreak and COVID-19 pandemic, the use of colloquial terms may cause unnecessary panic in the current hypervigilant climate. Confirmation from Government is required to confirm whether this outbreak is due to a mixed infection or a variant of the highly infectious Hand Foot and Mouth Disease virus. © 2022, The authors.
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The COVID-19 pandemic presents significant risks to population mental health. Despite evidence of detrimental effects for adults, there has been limited examination of the impact of COVID-19 on parents and children specifically. We aim to examine patterns of parent and child (0-18 years) mental health, parent substance use, couple conflict, parenting practices, and family functioning during COVID-19, compared to pre-pandemic data, and to identify families most at risk of poor outcomes according to pre-existing demographic and individual factors, and COVID-19 stressors. Participants were Australian mothers (81%) and fathers aged 18 years and over who were parents of a child 0-18 years (N = 2365). Parents completed an online self-report survey during 'stage three' COVID-19 restrictions in April 2020. Data were compared to pre-pandemic data from four Australian population-based cohorts. Compared to pre-pandemic estimates, during the pandemic period parents reported higher rates of parent depression, anxiety, and stress (Cohen's d = 0.26-0.81, all p < 0.001), higher parenting irritability (d = 0.17-0.46, all p < 0.001), lower family positive expressiveness (d = - 0.18, p < 0.001), and higher alcohol consumption (22% vs 12% drinking four or more days per week, p < 0.001). In multivariable analyses, we consistently found that younger parent age, increased financial deprivation, pre-existing parent and child physical and mental health conditions, COVID-19 psychological and environmental stressors, and housing dissatisfaction were associated with worse parent and child functioning and more strained family relationships. Our data suggest wide-ranging, detrimental family impacts associated with the COVID-19 pandemic; and support policy actions to assist families with financial supports, leave entitlements, and social housing.
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Objectives: To review the evidence of the transmissibility and severity of infection with the Delta variant of SARS-CoV-2 in children. Design: Systematic review. Data sources: PubMed, Embase, medRxiv, Web of Science, and WHO COVID database. Study selection: English language original articles, case reports, commentaries, and letters with relevant primary data, which examined evidence for the transmissibility and severity of infection with the Delta variant of SARS-CoV-2 in children. Methods: Five databases were searched for articles from the period October 2020 to March 2022. Reference lists of eligible studies and grey literature were hand searched for additional studies for inclusion. Articles that provided adequate epidemiological data including infection, transmission, or severity (including hospitalisation and death) with probable or confirmed cases of the Delta variant of SARS-CoV-2 in children (aged ≤9 years) and adolescents (aged 10 to 19 years) were included. Data were extracted for country of origin;participant characteristics (age and sex);sample size;vaccination status;and outcomes, including incidence, secondary attack rate, hospitalisation, ICU, and mortality. All included studies were assessed for bias using the Joanna Briggs Institute Critical Appraisal checklists. Results: 298 studies were found through database searching. After screening, 21 studies were included in the systematic review. Of the included studies, all were deemed to be of moderate to high quality, therefore all were included in the final analysis. Increased incidence was reported in two population studies in the USA and Australia during the period of Delta predominance. Age-related data were available for 14 studies and showed higher rates of infection in older children compared to younger children. Attack rates in educational settings were higher when an adult was the primary case. Data on severity were available from 12 studies and showed that severe disease remained rare, with increasing hospitalisation numbers in proportion to increasing paediatric cases. Vaccination was protective for severe disease, with studies in the United States, Israel and Europe showing less healthcare encounters, emergency department presentations and hospitalisations amongst vaccinated adolescents. Several studies pointed to educational and household settings as key sites for paediatric infection with the Delta variant. Conclusion: A growing proportion of COVID-19 cases were diagnosed in children during the study period due to increased transmissibility of the SARS-CoV-2 Delta variant, with an increasing number of outbreaks observed in household and educational settings likely attributed to low vaccine coverage among children. While severe disease remains uncommon, the impact of vaccination in both adults and adolescents has been shown to reduce paediatric hospitalisation rates. © 2022 The Author(s).
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AIMS: This study examined the trajectory of alcohol use frequency among parents from April-2020 to May-2021 during the COVID-19 pandemic in the state of Victoria, Australia (who experienced one of the longest lockdowns in the world), compared to parents from the other states of Australia (who experienced relatively fewer restrictions). We further examined the extent to which baseline demographic factors were associated with changes in alcohol use trajectories among parents. METHOD: Data were from the COVID-19 Pandemic Adjustment Survey (2,261 parents of children 0-18 years). Alcohol use frequency was assessed over 13 waves. Baseline demographic predictors included parent gender, age, speaking a language other than English, number of children, partnership status, education, employment, and income. RESULTS: Overall, alcohol trajectories declined over time. Victorian parents, in comparison to parents from other states, reported a smaller reduction in alcohol use frequency across 2020, with a more notable decline during 2021. Female/other gender, speaking a language other than English at home, unemployment, and lower income (Victoria only) were associated with alcohol trajectories of less frequent use, and older age was associated with a trajectory of more frequent use. CONCLUSIONS: Results suggest subtle difference in alcohol trajectories reflecting COVID-19 restrictions, when comparing Victoria and other states in Australia. Socioeconomically advantaged groups were most at risk for elevated trajectories of alcohol use frequency. Population level support may beneficial to reduce drinking behaviours.
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Background. The case fatality rate of patients hospitalized with COVID-19 is estimated at 13-17% with higher rates in the critically ill (37-45%). Attenuation of the inflammatory cascade has potential to reduce mortality. The purpose of this retrospective cohort study was to evaluate risk factors for 30-day all-cause mortality in hospitalized patients with COVID-19 who received tocilizumab or baricitinib. Methods. This was a retrospective cohort study of the first 100 patients that received each medication. Cases were patients with 30-day all-cause mortality from start of immunomodulator, with controls those who received the medication and survived. Patient demographics, laboratory results, vital signs, and clinical management of COVID-19 were evaluated. Inferential statistics were used to analyze risk factors associated with 30-day all-cause mortality. Variables with p < 0.2 on univariate analysis were analyzed via multivariate logistic regression. Results. From February-September 2021, 194 patients treated with an immunomodulator (97 in each group) were evaluated. Patients who received tocilizumab were less likely to be fully vaccinated (4.1% vs. 19.6%, p = 0.001) and were more likely to require mechanical ventilation at baseline (23.7% vs. 11.3%, p = 0.023). There were no between group differences in remdesivir or dexamethasone use. For the primary outcome, 81 patients (41.8%) experienced 30-day all-cause mortality with no difference between groups (tocilizumab: 46.4% vs. baricitinib: 37.1%;p = 0.19). Variables associated with higher odds for 30-day all-cause mortality in multivariate analysis: age >= 65, mechanical ventilation at baseline, and higher daily dexamethasone use. Fully vaccinated patients had lower odds for mortality (Table 1). Conclusion. In COVID-19 hospitalizations, age >= 65, mechanical ventilation at baseline, and higher daily dexamethasone doses were associated with 30-day all-cause mortality. Mortality was lower in patients fully vaccinated compared to those unvaccinated. Use of a specific immunomodulator did not impact mortality.
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We examined the buffering effects of virtual coaching during the COVID-19 pandemic. Through a pre-post quasi-experimental design, we compared change in well-being, social behaviour, and work outcomes for coached and non-coached samples (n = 1,005). We found that post-COVID outcomes were generally more positive for those who received coaching: they experienced positive gains in optimism, life satisfaction, authenticity, and productivity while those who did not receive coaching experienced a decline in those outcomes. Further, those who received coaching experienced larger growth in resilience and social connection. Changes in work engagement did not differ by group. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Background: A growing number of studies have reported both positive and negative outcomes associated with COVID-19 in children with attention-deficit/hyperactivity disorder (ADHD) and their families. However, very few longitudinal studies have examined outcomes over multiple time points over the pandemic. Objectives: To examine COVID-19-related mental health (MH) impacts for children with ADHD and their families over a 12-month period over the pandemic. Methods: The parents of 213 Australian children (5-17 years) with ADHD were recruited in May 2020 when COVID-19 restrictions were in place. Parents completed surveys at repeated time points assessing MH (CoRonavIruS Health Impact Survey [CRISIS] - mood states subscale) and predictors. Latent profile analyses were used to examine the patterns of MH difficulties over the pandemic using the first four waves of data collected from May to August 2020, and the fifth wave of data collected in May-July 2021. Numerous baseline predictors of MH patterns were examined. Findings: Using the first four waves of data, three groups were identified comprising: (1) children with unchanging (36%), (2) increasing resolved (30%) and (3) increasing persistent (34%) MH difficulties. The most robust predictor of increasing persistent MH difficulties was stress related to COVID-19 (e.g. stress associated with restrictions related to COVID-19). Analyses are being updated to include our fifth wave of data collection (May-July 2021) (70% retention rate). Conclusion: A subgroup of children with ADHD appears to be struggling with MH, which is related to the stress associated with COVID-19 restrictions.
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Use of personal protective equipment (PPE) increased during the COVID-19 pandemic to reduce virus transmission. Here, we quantitatively analyse emergence of PPE and COVID-19-related litter over 14 months for 11 countries using the litter collection application Litterati. The proportion of masks in litter increased by >80-fold as a result of COVID-19 legislation, from <0.01% to >0.8%. Gloves and wipes, more prevalent at similar to 0.2% of litter before the pandemic, doubled to 0.4%, but this has since fallen. Glove litter increased in the initial stages of the pandemic but fell after the introduction of facemask policies, whereupon there was an increase of facemask litter. National COVID-19 policy responses and international World Health Organization announcements and recommendations are a probable driver of PPE litter dynamics, especially the implementation of facemask policies. Waste management should be incorporated in designing future pandemic policies to avoid negative environmental legacies of mismanaged PPE.
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New Zealand (NZ) opted for complete suppression of the spread of COVID-19. We summarise how the rules, introduced by the NZ government, affected the operation and staffing of the biggest regional museum and science centre, the Otago Museum.