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BackgroundTreatment with Rituximab (RTX) in patients with rheumatic diseases (RD) has presented a challenge during the COVID-19 pandemic, as RTX leads to markedly reduced and often undetectable antibody responses after COVID-19 vaccination (1).ObjectivesTo investigate the effect of COVID-19 mRNA revaccination (two doses) on the antibody response in patients with RD who were initial vaccine non-responders. Further, to examine if B-cell levels or T-cell responses before revaccination predicted seroconversion.MethodsFrom a RD cohort (COPANARD) vaccinated with the standard two-dose COVID-19 vaccinations, we enrolled cases without detectable antibody responses (n=17) and controls with detectable antibody response (n=29). Blood donors (n=32) were included as additional controls. Samples were collected before and six weeks after completed revaccination. Total antibodies (abs) and specific IgG, IgA, and IgM against SARS-CoV-2 spike protein, SARS-CoV-2 neutralizing abs, and SARS-CoV-2 reacting CD4+ and CD8+ T-cells were measured before and after revaccination. B-cells (CD19+CD45+) were quantified before revaccination. This study was funded by the Danish Rheumatism Association.ResultsPatient demographics are given in Table 1. Forty-seven percent of cases had detectable total SARS-CoV-2 abs and neutralizing abs after revaccination. However, antibody levels were significantly lower than in controls and blood donors (p<0.008), Figure 1A+B. Revaccination induced an antibody class switch in cases with a decrease in detectable IgM abs (Baseline 11/17, Followup 3/17) and increase in IgG. No significant difference was observed in T-cell responses before and after revaccination between the three groups, Figure 1C. The proportion of cases with detectable CD4+ T cells increased from 69% to 88% (p=0.25), and for CD8+ T cells, the proportion decreased from 88% to 82% (p=1.00). Only 29% of cases had measurable B-cells compared to 100% of controls and blood donors, Figure 1D. Fifty percent of revaccinated cases who seroconverted had measurable B-cells before revaccination, Figure 1D.Univariate logistic regression analysis was performed to analyze if active RTX treatment, the presence of B-cells, or a positive T-cell response prior to revaccination predicted seroconversion of total SARS-CoV-2-abs in the patient cohort. We did not find a significant explanatory effect of either variable in the univariate logistic models, data not shown.Table 1.DemographicsCases Revaccination, n=17Controls Boost, n=29Female sex, no(%)1482%2172%Age, median (IQR)6549 - 706762 - 72Disease duration, years1510 - 18229 - 31Rheumatoid Arthritis/SLE13/410/19None DMARD529%828%Prednisone424%13%Methotrexate741%1241%Hydroxychloroquine212%414%None biologic treatment424%931%Rituximab1271%0TNF-inhibitors16%724%JAK-inhibitors0621%IL-6-inhibitors, Abatacept, Benlysta0724%Previous rituximab treatmentAny rituximab treatment1694%13%RTX within the last 15 months, no1488%0Cumulative total dose, mg134-242Time from RTX to revaccination, months95-1249Figure 1.ConclusionIn conclusion, forty-seven percent of initial non-responders were able to seroconvert after two-dose revaccination. However, plasma concentrations of the antibodies against SARS-COV-2 and the levels of neutralizing capacity remained significantly lower than in immunocompetent blood donors. B-cell levels or T-cell responses before revaccination did not predict seroconversion. Our study suggests that patients with RDs who did not mount a detectable serological response to a COVID-19 mRNA vaccine have a T cell response similar to immunocompetent controls. Future studies should establish the antibody levels that identify RD patients without sufficient protection against SARS-CoV-2 infection.References[1]Troldborg A, et al. Time Since Rituximab Treatment Is Essential for Developing a Humoral Response to COVID-19 mRNA Vaccines in Patients With Rheumatic Diseases. J Rheumatol. 2022.AcknowledgementsThe Danish Rheumatism Association [grant number R203-A7217]. We acknowledge all patients and blood donors contributing to the stud for their invaluable participation. The authors would like to thank Sif Kaas Nielsen and Mads Engelhardt Knudsen, the Laboratory of Molecular Medicine at Rigshospitalet, for their excellent technical assistance in analyzing the samples.Disclosure of InterestsNone Declared.
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BACKGROUND: Foreign-born workers in high-income countries experience higher rates of COVID-19 but the causes are only partially known. AIMS: To examine if the occupational risk of COVID-19 in foreign-born workers deviates from the risk in native-born employees in Denmark. METHODS: Within a registry-based cohort of all residents employed in Denmark (n = 2 451 542), we identified four-digit DISCO-08 occupations associated with an increased incidence of COVID-19-related hospital admission during 2020-21 (at-risk occupations). The sex-specific prevalence of at-risk employment in foreign born was compared with the prevalence in native born. Moreover, we examined if the country of birth modified the risk of a positive SARS-CoV-2 polymerase chain reaction (PCR) test and COVID-19-related hospital admission in at-risk occupations. RESULTS: Workers born in low-income countries and male workers from Eastern Europe more often worked in at-risk occupations (relative risks between 1.16 [95% confidence interval {CI} 1.14-1.17] and 1.87 [95% CI 1.82-1.90]). Being foreign-born modified the adjusted risk of PCR test positivity (test for interaction P < 0.0001), primarily because of higher risk in at-risk occupations among men born in Eastern European countries (incidence rate ratio [IRR] 2.39 [95% CI 2.09-2.72] versus IRR 1.19 [95% CI 1.14-1.23] in native-born men). For COVID-19-related hospital admission, no overall interaction was seen, and in women, country of birth did not consistently modify the occupational risk. CONCLUSIONS: Workplace viral transmission may contribute to an excess risk of COVID-19 in male workers born in Eastern Europe, but most foreign-born employees in at-risk occupations seem not to be at higher occupational risk than native born.
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Background: Social distancing measures introduced during the COVID-19 pandemic have reduced admission rates for a variety of respiratory tract infections. We hypothesized that rates of asthma exacerbations would decline following the national lockdown introduced on March 12, 2020, in Denmark. Aim(s): To determine weekly rates of in- and out of hospital asthma exacerbations prior to and during the national lockdown. Method(s): All persons >18 years with at least one outpatient hospital contact with asthma as the primary diagnosis from January 1, 2013, to December 31, 2017, were included. Weekly asthma exacerbation rates from January 1, 2018, to May 22, 2020, were assessed. An interrupted time-series (ITS model) with March 12, 2020, as the point of interruption was conducted. Result(s): A total of 38,225 patients with asthma were identified. The ITS model showed no immediate changes in exacerbation rates during the first week after March 12, 2020. However, there was a significant decrease in weekly exacerbation rates in the following 10 weeks (change in trend for exacerbations requiring hospitalisation: -0.75 [95% CI -1.39,-0.12], (p < 0.02) corresponding to a reduction of about 1 exacerbation per year per 100 patients in the cohort, and a change in trend for all asthma exacerbations: -12.2 [95% CI -19.1,-5.4], p<0.001 corresponding to a reduction of 16.5 exacerbations per year per 100 patients in the cohort). Conclusion(s): The introduction of the social distancing measures in Denmark on March 12, 2020, did not lead to an immediate reduction in asthma exacerbation rates, however a gradual decline in exacerbation rates during the following 10-weeks period was observed.
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Background: Venous thromboembolia have been reported in patients with COVID-19. However, it remains unclear if COVID-19 patients who, for other indications, take anti-coagulant medication on a regular basis, are protected against thrombosis-mediated death. The aim of this study was to estimate the risk of all-cause mortality, hospital admission, and intensive care unit (ICU) admission for verified COVID-19 patients who did vs. did not use oral anticoagulant therapy (OAC). Method(s): Data was obtained by using national registries. Patients were followed for 90 days or until death or hospital admission. An adjusted Cox proportional hazard regression was used to estimate the risk of all-cause mortality, hospital admission and ICU admission. Result(s): A total of 243,039 confirmed COVID-19 patients were included in the study (mean age 35 years;123,448 [50.79%] male), among whom 4,482 were OAC users. We observed an increased risk of all-cause mortality (HR 1.12, 95% CI 1.011-1.24, p=0.015) and hospital admission (HR 1.22, 95% CI 1.13-1.31, p<0.0001) in OAC users. Among admitted patients, however, we observed a decreased risk of ICU admission (HR 0.78, 95% CI 0.63-0.96, p=0.02) in OAC users. Conclusion(s): OAC was not associated with a lower risk of death or hospital admission, but our data support that hospitalized patients without anticoagulant treatment, may be at increased risk of respiratory deterioration and need for intensive care admission.
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Background: Patients with bronchiectasis are at high risk of community acquired pneumonia. It remains unclear if this risk is reduced by social distancing (SD) measures. Method(s): Nationwide registry study with data from patients with specialist verified bronchiectasis between 1 January 2019 and 20 May 2020. Pneumonia hospitalisation was the primary outcome. Patients with COVID-19 and age < 18 were excluded. The incidence of pneumonia hospitalisations in the SD period (12 March 2020 to 20 May 2020) was compared to the same period in 2019 (control period). Result(s): A total of 672 patients with bronchiectasis were followed in the SD period and the control period. Median age was 68, and 36% were males. During the SD intervention, 7 incidents of pneumonia hospitalisation were observed, compared to 31 during the control period (Fig. 1). The corresponding incidence rate ratio was 0.24 (95% confidence interval: 0.17 to 0.33, p < 0.001). 6/642 (0.9%) patients died during the SD period compared to 8/672 (1.2%) during control period (p = 0.9). Conclusion(s): The social distancing intervention was associated with a substantially lower incidence of pneumoniahospitalizations among patients with bronchiectasis. Hygienic measures as used during SD are important in preventing serious life-threatening infections like pneumonias that require hospitalisation.
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We examine the externalisation of labour as a strategic response to a temporary exogenous shock (i.e. COVID-19). Combining ideas from employment externalisation theory and the CATO framework (which are both extensions of transaction costs economics), we argue that firms that are hit harder by the COVID-19 shock are more likely to plan hiring freelancers that replace permanent employees. The mechanism we argue for is that firms seek to reposition quickly, which lowers comparative adjustment costs and reduces constraints on switching employment modes in future, depending on the extent of task co-specialisation. Analysing survey data obtained from 1,090 Danish small medium enterprises during the initial COVID-19 lockdown supports our hypotheses. Our findings contribute to the research on strategic responses to crises and provide novel understanding of why firms may externalise employment. © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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Anticipated regret, the feeling that we might regret a decision in the future, has been identified as a strong predictor of vaccination behavior, and the proliferation of anticipated regret appeals underscores the need for the empirical study of messages that target regret. The current study evaluated the persuasiveness of narrative depictions of regret and character death on COVID-19 booster vaccine intention. Data were collected from 944 adults in a 2 (no depicted regret, depicted regret) × 2 (character survives, dies) between-participants online message experiment. Results demonstrated that depicting regret had a positive effect on booster vaccine intention, especially among Republicans. Moderated serial mediation analysis supported a model where depicted regret had a positive effect on booster vaccine intention via audience replotting of story events and anticipated regret. While this persuasive process occurred for both Republicans and Democrats, the pathway was stronger for Republicans. Additionally, messages depicting character death produced greater anticipated regret. We discuss the theoretical and practical implications of these results. © 2022 Elsevier Ltd
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Background: Large randomized controlled trials (RCT) have shown that COVID-19 vaccines are effective at preventing severe COVID-19. However, the RCT's are not powered to detect rare adverse events. It has been reported that the new mRNA based COVID-19 vaccines may increase the risk of thromboembolic and ischemic events. Likewise, thromboembolic and ischemic events are also known complications to infection with SARS-CoV-19. Currently, less is known about the risk-reward relationship of receiving an mRNA-based COVID-19 vaccine versus contracting COVID-19 infection with respect to thromboembolic and ischemic outcomes. Purpose: To compare the risk of thromboembolic and ischemic events following COVID-19 vaccination to the risk following infection with SARS-CoV-19. Methods: The study period was from March 2020 to August 2021. All individuals were >18 years old. The population was stratified into two different groups. The vaccinated group consisted of recipients of the first dose of either Moderna (mRNA-1273, n=488,220) or Pfizer-BioNTech (BNT162b2 mRNA, n=3,186,164) vaccines. Individuals who had previously tested positive for SARS-CoV-19 were excluded. The other group consisted of individuals who had tested positive for SARS-CoV-19 in the same period who had not yet received their first vaccination dose (n=233,926). The exposure period for both groups was set to 28 days following vaccination/testing positive for SARS-CoV-19 (Figure 1). Patient level data were obtained on all included individuals using nationwide registries. Primary outcomes were acute myocardial infarction (AMI), ischemic stroke, pulmonary embolism (PE), and deep venous thrombosis (DVT). Odds ratios were obtained from logistic regression models with the vaccinated group acting as reference. Multivariable models were adjusted for demographics and comorbidities. Results: In the vaccinated group, mean age was 53±19 years and 50.3% were female. In the group of participants testing positive for SARS-CoV-19, mean age was 42.1±17.4 years and 50.2% were female. In total, 773 suffered a stroke, 472 suffered a PE, 500 suffered an AMI, and 484 suffered a DVT during the 28-day exposure period. We observed an increased absolute risk of all outcomes for participants testing positive for SARS-CoV-19 as compared to participants being vaccinated (stroke: 0.049% vs 0.019%, p<0.001), (PE: 0.91% vs 0.0072%, p<0.001), (AMI: 0.021 vs 0.013, p=0.0004), and (DVT: 0.037% vs 0.011%, p<0.001). In multivariable models, participants testing positive for SARS-CoV-19 had a significantly increased risk of all outcomes compared to participants being vaccinated: (stroke: OR: 4.0, 95% CI: [2.9–5.6], p<0.001), (PE: OR: 38.6 95% CI: [30.3–48.5], p<0.001), (AMI: OR: 3.3, 95% CI: [2.1–5.00], p<0.001), and (DVT: OR: 5.3, 95% CI: [3.8–7.5], p<0.001) (Figure 2). Conclusion: The risks of thromboembolic and ischemic events were substantially higher after SARS-CoV-19 infection than after vaccination in the Danish population. Funding Acknowledgement: Type of funding sources: Public hospital(s). Main funding source(s): Gentofte University HospitalFigure 1Figure 2
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By the end of January 2020, the World Health Organization had declared the COVID-19 pandemic a global health emergency. This chapter presents a rationale for producing messages that promote critical reflection through discrete emotion, focusing on surprise. It presents two message experiments conducted at different timepoints during the COVID-19 pandemic. These experiments illustrate message features that generate surprise, the surprise-critical reflection process, the outcomes of critical reflection, and the effect of information overload and perceived COVID-19 exaggeration on the hypothesized relationships. In a crisis media environment, messages must be designed to cut through message overload and contradictory messages in order to encourage and promote critical reflection. Critical reflection may also support the epistemology of critical communication research and theory. Future research should build on the arguments to form a greater theoretical understanding of critical reflection related to communication. © 2021 John Wiley and Sons Inc.
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Introduction: The COVID-19 pandemic continues to evolve internationally, increasing levels of psychological stress in adolescents around the world, and thereby increasing their risk for emotional disorders associated with chronic stress. This ongoing threat to adolescents mental health requires that we identify factors that contribute to their ability to cope with situations shown to carry significant risks, such as the COVID-19 pandemic (i.e., their resiliency).Negative emotions are associated with chronic stress, and factors that reduce levels of negative emotions are associated with improved resiliency. Healthier sleep is associated with lower levels of negative emotions. Cognitive reappraisal (changing the way one thinks about potentially emotioneliciting events) is an emotional regulation strategy that downregulates negative emotions. However, there is little information about the associations between sleep quality, emotional regulation, and resiliency in adolescents. The present study sought to fill this gap by examining the associations between adolescents sleep quality and disturbances, emotional regulation strategies and adolescents resiliency during the COVID-19 pandemic. Methods: Forty-five adolescents (M=13.47, SD=1.7 years) participated in the study during the first wave of the COVID-19 pandemic in Canada (May 15 to June 30, 2020). The Pittsburgh Sleep Quality Index was used to assess adolescents self-reported sleep quality and disturbances. The Emotion Regulation Questionnaire was used to assess respondents' tendencies to regulate their emotions using cognitive reappraisal or expressive suppression. The Connor-Davidson Resilience Scale was used to measure resilience. Behavioral/emotional problems were assessed before the pandemic using the Youth Self Report (YSR). Results: Hierarchical multiple linear regression analyses revealed that lower levels of sleep disturbances and frequent use of cognitive reappraisal to regulate emotions were associated with a higher level of resiliency during the COVID-19 pandemic, above and beyond the contributions of gender or pre-pandemic emotional or behavioral problems. Conclusion: Better sleep quality and the habitual use of an emotional regulation strategy that is effective in downregulating negative emotions are associated with higher resiliency in adolescents facing the COVID-19 pandemic. The cross-sectional nature of the study does not allow the inference of causation.
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Due to the implementation of the Tax Cuts and Jobs Act of 2017, rising expenses within the industry of intercollegiate athletics, and the financial impact of the Covid-19 pandemic, there is a growing need for practitioners to reexamine their fundraising practices in order to increase revenue. One fundraising strategy that is commonly utilized among intercollegiate athletic programs in the National Collegiate Athletic Association (NCAA) is the concept of tiered reward systems. Currently, there is no published research or empirical analysis that examines the structure and pricing strategies of these systems. For this reason, this study provides practitioners with valuable insight to the current economic landscape of tiered reward systems within NCAA Division I FBS programs. Institutional theory was utilized as a lens to examine tiered reward systems strategies across athletic departments. Methodologically, a multiple regression analysis was conducted to examine the relationships between market variables and tiered reward systems at 121 FBS institutions. Ultimately, this study revealed the number of tiered reward levels are not associated with the identified market variables. Further, total university enrollment, all-time NCAA men's basketball appearances, and all-time football bowl game appearances significantly predicted tiered reward level pricing.
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INTRODUCTION: Fast and accurate detection of SARS-CoV-2 is essential in limiting the COVID-19 pandemic. Rapid antigen (AG) tests provide results within minutes;however, their accuracy has been questioned. The study aims to determine the accuracy and cost of the STANDARD Q COVID-19 AG test compared with RT-PCR. METHODS: Individuals 18 years or older with an appointment for a RT-PCR test on 26-31 December 2020 at a public test centre in Copenhagen, Denmark were invited to participate. An oropharyngeal swab was collected for RT-PCR analysis, followed by a nasopharyngeal swab examined by the AG test (SD Biosensor). The diagnostic accuracy of the AG test was calculated with RT-PCR as reference. Costs were evaluated for both tests. RESULTS: A total of 4,811 paired conclusive test results were collected (median age: 45 years, female: 53%). The RT-PCR test revealed 221 (4.6%) positive tests. The overall sensitivity and specificity of the AG test were 69.7% and 99.5%, respectively. Viral cycle threshold values were significantly higher in individuals with false negative AG tests than in individuals who were true positives. The RT-PCR test and AG test costs were 67.0 DKK (10.8 USD) and 35.0 DKK (5.7 USD), respectively, per positive case detected at 100,000 daily tests. CONCLUSIONS: The AG test enables mass testing and provides immediate results, which is important in SARS-CoV-2 screening. The AG test is a good and relevant supplement to RT-PCR testing in public SARS-CoV-2 screenings. FUNDING: This project received no external funding. Copenhagen Medical A/S delivering the rapid AG tests and provided test personnel but were not otherwise involved. TRIAL REGISTRATION: Clinicaltrials.org: NCT04716088.