Postexercise oxygen uptake recovery delay among patients with heart failure: A systematic review

Background: Peak oxygen uptake (VO 2) is often the focal point of cardiopulmonary exercise testing among patients with heart failure (HF). Breath-by-breath VO 2 kinetic patterns at exercise onset, during low-level and submaximal exercise, and during recovery may provide incremental insight into HF severity and etiologies of exercise limitation. Objective: The aim of this systematic review was to explore VO 2 recovery delay (VO 2 RD) across the spectrum of left ventricular function. Methods: A systematic review was conducted using several online databases (EMBASE, Cumulative Index to Nursing and Allied Health Literature, PubMed and Web of Science). Steps outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Search terms included VO 2 RD OR VO 2 off kinetics AND HF, peak VO 2 AND recovery. All articles were uploaded to Covidence. Results: Four studies met the inclusion criteria. The definition of VO 2 RD varied across studies. Recovery delay was consistently observed in HF patients compared to controls indicating VO 2 RD discriminates between those with and without HF. Control groups showed VO 2 decline almost immediately after exercise. VO 2 RD had a significant positive linear relationship to N-terminal prohormone of brain natriuretic and Doppler echo E/e' while demonstrating an inverse relationship with peak cardiac output and survival duration. Conclusions: VO 2 RD, unlike peak VO 2, is relatively cardiospecific. Oxygen recovery kinetics offer insight into disease severity and discrimination of healthy participants from those with HF. © 2023 Heart and Mind ;Published by Wolters Kluwer - Medknow.

Outcomes of Immunosuppression Reduction During Covid-19 Infection in Heart Transplant Patients

Reduction in immunosuppression (IS) is universally recommended in the setting of infection, but its effect on outcomes in the setting of COVID-19 has not been established. The purpose of this study is to characterize the impact of IS reduction strategies on disease severity and outcomes of COVID infection in heart transplant patients (HTPs). This was a single center, retrospective review of HTPs with COVID infection managed inpatient or outpatient, examined in cohorts by approach to IS reduction. Demographics, severity at diagnosis and peak based on NIH Classification of COVID Illness Severity, and secondary clinical outcomes were collected (Table 1). The primary outcome was the difference in COVID severity score after IS regimen changes at time of diagnosis. Descriptive statistics, ANOVA, independent t-tests, and chi square analyses were used to evaluate baseline characteristics, primary outcome, and secondary outcomes. Data was collected for 110 patients with 113 COVID infections between March 2020 and June 2022. Patients were on average 54 years old, 75% white, 15% Hispanic ethnicity, and 5 years post HT at the time of their infection. Approaches to IS changes were antimetabolite (antiM) reduction (62%), all IS reduced (6%), or no change (32%). There was a significant difference in clinical severity from diagnosis to peak across all groups (p = 0.004), contributed largely by the All IS Reduced group with significantly higher peak severity (p = 0.002) leading to drastic IS reductions. In a sub-analysis to compare the protocolized approach of antiM reduction to no change in IS, no difference was noted in mortality, superimposed infections, or treated graft rejection (Table 1). Change in severity of infection over time is noted by variant in Figure 1. As COVID vaccination and therapeutic agents evolve, drastic IS modifications may not be necessary if baseline infection is mild. However, reduced duration IS reduction did not lead to more treated graft rejection. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Social work practice for COVID-19 in the acute hospital setting: Recommendations for psychosocial assessment

The global coronavirus SARS-CoV2 (COVID-19) pandemic outbreak caused immediate, far-reaching social schisms and created unprecedented challenges for hospital social work services worldwide. Existing hospital disaster plans were inadequately equipped for pandemics and organisational plans needed to quickly adapt to respond to the increased clinical demands and unique logistical considerations triggered by the virus. Literature reviews provided little in the way of precise guidance for practitioners. Hospital social workers responded not only to a new cohort of patients, but also to all patients affected by the societal repercussions of the pandemic and by governments' attempts to mitigate the impacts of the virus. Psychosocial assessments, the bedrock of social work intervention, needed to adapt and evolve to encompass and address the exacerbation of existing social risks in new ways. This article originated from the authors' interest in identifying practice implications for hospital social work during the COVID-19 pandemic. The authors briefly outline the distinct impact of COVID-19 on psychosocial issues such as domestic and family violence, elder abuse, child protection, financial stress and social isolation. They create a forum of international hospital social work centres to develop a consensus approach for addressing these issues in the context of a social work psychosocial assessment. The global COVID-19 pandemic stretched hospital resources across the globe and presented unique challenges to social work services. Disaster response plans were not adequately applicable given their time-limited nature. The broader social repercussions of the pandemic and governments' approaches to mitigating it meant that the cornerstone of social work intervention in hospitals-psychosocial assessments-needed to consider the aggravation of social risks in entirely new ways. The authors briefly outline the impacts of the pandemic and response on psychosocial issues such as domestic and family violence, elder abuse, child protection, financial stress and social isolation. They consult international hospital social work centres and develop an agreed approach for addressing these issues in the context of a social work psychosocial assessment.

Changes in Crime Rates during the COVID-19 Pandemic

We estimate changes in the rates of five FBI Part 1 crimes during the 2020 spring COVID-19 pandemic lockdown period and the period after the killing of George Floyd through December 2020. We use weekly crime rate data from 28 of the 70 largest cities in the United States from January 2018 to December 2020. Homicide rates were higher throughout 2020, including during early 2020 prior to March lockdowns. Auto thefts increased significantly during the summer and remainder of 2020. In contrast, robbery and larceny significantly declined during all three post-pandemic periods. Point estimates of burglary rates pointed to a decline for all four periods of 2020, but only the pre-pandemic period was statistically significant. We construct a city-level openness index to examine whether the degree of openness just prior to and during the lockdowns was associated with changing crime rates. Larceny and robbery rates both had a positive and significant association with the openness index implying lockdown restrictions reduced offense rates whereas the other three crime types had no detectable association. While opportunity theory is a tempting post hoc explanation of some of these findings, no single crime theory provides a plausible explanation of all the results. Supplementary materials for this article are available online.

The Paradoxical Relationship Between Nicotine and SARS-CoV-2 Infection: A Systematic Review

Across the board, smoking is considered to be negative toward our health. While this information has been known for a relatively long time, the COVID19 pandemic has stirred up a controversial idea: that smokers are protected from severe COVID-19 relative to non-smokers. This suggests that smoking is a helpful agent in the evolving fight against SARS-CoV-2, and impressionable individuals are at risk of starting to smoke as a means of protecting themselves from the virus. To address the validity of this claim, a systematic review was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed was searched for relevant articles and the results were screened according to inclusion criteria. Our search yielded a total of 81 results and after removal of duplicates, non-English papers, and a quality appraisal a total of 16 papers were included in this review. We found that while smokers were more likely present with a less severe disease due to downregulation of severe cytokine storm, they were overall more likely to contract COVID-19 due to upregulation of ACE-2 receptors which SARS-CoV-2 uses to enter the cells of the respiratory epithelium. Also, long time smokers who develop COPD are more likely to have fatal outcomes from COVID-19 infection. Further, these results were due to the effects of nicotine and not cigarettes themselves. Since cigarettes contain numerous carcinogens, they are not recommended as a prophylaxis for COVID-19. However, we recommend that nicotine should be a topic for further research as potential therapy.

Using high-resolution contact networks to evaluate SARS-CoV-2 transmission and control in large-scale multi-day events.

The emergence of highly transmissible SARS-CoV-2 variants has created a need to reassess the risk posed by increasing social contacts as countries resume pre-pandemic activities, particularly in the context of resuming large-scale events over multiple days. To examine how social contacts formed in different activity settings influences interventions required to control Delta variant outbreaks, we collected high-resolution data on contacts among passengers and crew on cruise ships and combined the data with network transmission models. We found passengers had a median of 20 (IQR 10-36) unique close contacts per day, and over 60% of their contact episodes were made in dining or sports areas where mask wearing is typically limited. In simulated outbreaks, we found that vaccination coverage and rapid antigen tests had a larger effect than mask mandates alone, indicating the importance of combined interventions against Delta to reduce event risk in the vaccine era.

The Effects of the COVID-19 Pandemic on Cancer Staging in Patients Diagnosed With Head and Neck Cancer at an Academic Health Center

Purpose/Objective(s) The healthcare system across the world was forced to implement new policies, guidelines, and procedures due to the COVID-19 pandemic and led many patients to make an impossible choice about their health. For various reasons, many patients chose to remain at home and delay any interaction at medical facilities to protect themselves or others from the virus. Patients managing chronic diseases faced unprecedented challenges during this period and the long-term effects on these patient populations remain unclear. Oncology patients, specifically those diagnosed with head and neck cancers, require prompt diagnosis and initiation of treatment for better outcomes. While the overall impact of how the pandemic has affected oncology patients is unknown, this retrospective study examined how the staging of head and neck tumors at our institution has been impacted since the beginning of the pandemic. Materials/Methods Available patient data (from August 2019 through June 2021) was collected from medical records and compared to determine statistical significance. Patients were categorized into a Pre-pandemic group, a Pandemic group, and a Vaccine-approved group based on date of consultation and patient and treatment characteristics were analyzed to look for patterns. The Pre-pandemic period was defined as the period from August 2019 to March 2020, the Pandemic period was defined as the period from March 2020 to December 2020, and the Vaccine approved period was defined as the period from January 2021 to June 2021. Results Fisher's exact tests were used to compare TNM staging distributions between the three groups using the eight edition of the American Joint Committee on Cancer staging system. In the Pre-pandemic group, out of 67 patients, 33 patients (55.0%) were diagnosed with a T stage of 0-2 and 27 patients (45.0%) were diagnosed with a T stage of 3-4. In the Pandemic and Vaccine approved groups, out of 139 patients, 50 patients (39.1%) were diagnosed with a T stage of 0-2 and 78 patients (60.9%) were diagnosed with a T stage of 3-4;these differences were statistically significant (P-value = 0.0426). The Pre-pandemic group had 25 patients (41.7%) diagnosed with a Group stage of 0-2 and 35 patients (58.3%) diagnosed with a Group stage of 3-4. The Pandemic and Vaccine approved groups had 36 patients (28.1%) diagnosed with a Group stage of 0-2 and 92 patients (71.9%) diagnosed with a Group stage of 3-4;these results trended to statistical significance (P-value = 0.0688). Conclusion Our findings demonstrate that there have been a higher number of patients with head and neck cancer diagnosed with a T stage of 3 or 4 at our institution since the start of the COVID-19 pandemic. The effects of the COVID-19 pandemic are ongoing and will need further evaluation to determine the overall effects on oncology patients. Increased morbidity and mortality rates may be a potential result in the years to come.

Using high-resolution contact networks to evaluate SARS-CoV-2 transmission and control in large-scale multi-day events (preprint)

The emergence of the highly transmissible SARS-CoV-2 Delta variant has created a need to reassess the risk posed by increasing social contacts as countries resume pre-pandemic activities, particularly in the context of resuming large-scale events over multiple days. To examine how social contacts formed in different activity settings influences interventions required to control outbreaks, we combined high-resolution data on contacts among passengers and crew on cruise ships with network transmission models. We found passengers had a median of 20 (IQR 10-36) unique close contacts per day, and over 60% of their contact episodes were made in dining or sports areas where mask wearing is typically limited. In simulated outbreaks, we found that vaccination coverage and rapid antigen tests had a larger effect than mask mandates alone, indicating the importance of combined interventions against Delta to reduce event risk in the vaccine era.

Erratum: Suicide, self-harm and thoughts of suicide or self-harm in infectious disease epidemics: A systematic review and meta-analysis (Journal of Physical Chemistry (2021) 30:e41 (1-2) DOI: 10.1017/S2045796021000214)

Aims Suicide accounts for 2.2% of all years of life lost worldwide. We aimed to establish whether infectious epidemics are associated with any changes in the incidence of suicide or the period prevalence of self-harm, or thoughts of suicide or self-harm, with a secondary objective of establishing the frequency of these outcomes. Methods In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO and AMED were searched from inception to 9 September 2020. Studies of infectious epidemics reporting outcomes of (a) death by suicide, (b) self-harm or (c) thoughts of suicide or self-harm were identified. A random-effects model meta-analysis for the period prevalence of thoughts of suicide or self-harm was conducted. Results In total, 1354 studies were screened with 57 meeting eligibility criteria, of which 7 described death by suicide, 9 by self-harm, and 45 thoughts of suicide or self-harm. The observation period ranged from 1910 to 2020 and included epidemics of Spanish Flu, severe acute respiratory syndrome, human monkeypox, Ebola virus disease and coronavirus disease 2019 (COVID-19). Regarding death by suicide, data with a clear longitudinal comparison group were available for only two epidemics: SARS in Hong Kong, finding an increase in suicides among the elderly, and COVID-19 in Japan, finding no change in suicides among children and adolescents. In terms of self-harm, five studies examined emergency department attendances in epidemic and non-epidemic periods, of which four found no difference and one showed a reduction during the epidemic. In studies of thoughts of suicide or self-harm, one large survey showed a substantial increase in period prevalence compared to non-epidemic periods, but smaller studies showed no difference. As a secondary objective, a meta-analysis of thoughts of suicide and self-harm found that the pooled prevalence was 8.0% overall (95% confidence interval (CI) 5.2-12.0%;14 820 of 99 238 cases in 24 studies) over a time period of between seven days and six months. The quality assessment found 42 studies were of low quality, nine of moderate quality and six of high quality. Conclusions There is little robust evidence on the association of infectious epidemics with suicide, self-harm and thoughts of suicide or self-harm. There was an increase in suicides among the elderly in Hong Kong during SARS and no change in suicides among young people in Japan during COVID-19, but it is unclear how far these findings may be generalised. The development of up-to-date self-harm and suicide statistics to monitor the effect of the current pandemic is an urgent priority. © The Author(s), 2021. Published by Cambridge University Press.

Interventions and compliance: How the response to COVID-19 reflects decades of retail food protection efforts

Preventing the spread of infectious disease relies heavily upon the development and implementation of public health interventions. The requisite debate over the effectiveness of these interventions is accompanied by discussions about which, if any, should be made mandatory. We contend that efforts to mandate interventions in the fight to prevent the spread of COVID-19 have clear similarities to the long-standing efforts to establish and promote retail food safety interventions. Specific similarities are that science is rarely the sole driver in deciding public health mandates and individuals' responses to them, compliance is key but can be difficult to achieve, and the concurrent incorporation of two or more interventions is a barrier against poor compliance. As these factors have a direct effect on the success of public health mandates, understanding the role and relationships among them can aid government and public health officials in ongoing efforts to prevent foodborne illness and slow the spread of COVID-19.

Suffering, social work and the old masters

Working as an Australian hospital Social Worker during a major viral pandemic was always going to be an unpredictable and rapidly evolving experience. We knew the COVID-19 virus was coming, within weeks it had arrived, and Australian society transformed overnight. With so much rapid loss and change our sense of mastery over our lives was quickly lost. Health services and individuals alike battled to prepare, to understand, and to make meaning in a new world. It was an opportunity to seek meaning in literatures both professional and artistic. © The Author(s) 2020.

Using a real-world network to model localized COVID-19 control strategies.

Case isolation and contact tracing can contribute to the control of COVID-19 outbreaks1,2. However, it remains unclear how real-world social networks could influence the effectiveness and efficiency of such approaches. To address this issue, we simulated control strategies for SARS-CoV-2 transmission in a real-world social network generated from high-resolution GPS data that were gathered in the course of a citizen-science experiment3,4. We found that tracing the contacts of contacts reduced the size of simulated outbreaks more than tracing of only contacts, but this strategy also resulted in almost half of the local population being quarantined at a single point in time. Testing and releasing non-infectious individuals from quarantine led to increases in outbreak size, suggesting that contact tracing and quarantine might be most effective as a 'local lockdown' strategy when contact rates are high. Finally, we estimated that combining physical distancing with contact tracing could enable epidemic control while reducing the number of quarantined individuals. Our findings suggest that targeted tracing and quarantine strategies would be most efficient when combined with other control measures such as physical distancing.

Combining fine-scale social contact data with epidemic modelling reveals interactions between contact tracing, quarantine, testing and physical distancing for controlling COVID-19 (preprint)

Case isolation and contact tracing can contribute to the control of COVID-19 outbreaks1,2. However, it remains unclear how real-world networks could influence the effectiveness and efficiency of such approaches. To address this issue, we simulated control strategies for SARS-CoV-2 in a real-world social network generated from high resolution GPS data3,4. We found that tracing contacts-of-contacts reduced the size of simulated outbreaks more than tracing of only contacts, but resulted in almost half of the local population being quarantined at a single point in time. Testing and releasing non-infectious individuals led to increases in outbreak size, suggesting that contact tracing and quarantine may be most effective when it acts as a "local lockdown" when contact rates are high. Finally, we estimated that combining physical distancing with contact tracing could enable epidemic control while reducing the number of quarantined individuals. Our approach highlights the importance of network structure and social dynamics in evaluating the potential impact of SARS-CoV-2 control.