Crowded house: accommodation precarity and self-reported academic performance of international students

This article draws on two surveys of international students in Sydney and Melbourne, undertaken in 2019 and during the 2020 COVID-19 lockdowns. Using the concept of bounded agency, we identify how the challenges of living in one of the world's most expensive rental housing markets impact students' perceptions of their academic attainment. We find housing insecurity, unaffordability and condition, amplified by financial stress, contribute significantly to student anxiety about their studies. These relationships differ by student background and education. We argue students' agency to meet their educational ambitions in Australia is constrained by the cost of housing and the housing choices they consequently make to mitigate financial stress. Our findings suggest the importance of ‘town' or non-institutional aspects of the international student experience on their satisfaction and academic outcomes. We call for further research to explore these relationships in other global contexts. © 2023 British Association for International and Comparative Education.

Characterizing fluid intake and physical activity in university students within the United States during the COVID-19 pandemic.

PURPOSE: This study determined fluid intake and physical activity behaviors among college students during the COVID-19 pandemic. METHODS: College students (n = 1014; females, 75.6%) completed an online survey during the Spring 2020 academic semester following the initial global response to the COVID-19 pandemic. Academic standing, habitation situation, and University/College responses to COVID-19 were collected. Participants completed the Godin Leisure-Time Exercise Questionnaire and a 15-item Beverage Questionnaire (BEVQ-15) to determine physical activity level and fluid intake behaviors, respectively. RESULTS: Females (1920 ± 960 mL) consumed significantly less fluid than males (2400 ± 1270 mL, p < 0.001). Living off-campus (p < 0.01) and living with a spouse/partner (p < 0.01) was associated with increased consumption of alcoholic beverages. 88.7% of participants reported being at least moderately active; however, Black/African American and Asian participants were more likely to be less active than their Caucasian/White counterparts (p < 0.05). Participants reporting no change in habitation in response to COVID-19 had a higher fluid intake (p = 0.002); however, the plain water consumption remained consistent (p = 0.116). While there was no effect of habitation or suspension of classes on physical activity levels (p > 0.05), greater self-reported physical activity was associated with greater fluid intake (std. ß = 0.091, p = 0.003). CONCLUSIONS: Fluid intake among college students during the initial response to the COVID-19 pandemic approximated current daily fluid intake recommendations. Associations between COVID-19-related disruptions (i.e., suspension of classes and changes in habitation) and increased alcohol intake are concerning and may suggest the need for the development of targeted strategies and programming to attenuate the execution of negative health-related behaviors in college students.

Predictive capacity of COVID-19-related risk beliefs on weight management behaviors on a commercial weight loss program and speed of COVID-19 vaccination uptake: prospective cohort study.

BACKGROUND: Recent work has shown that obesity may be a risk factor for severe COVID-19. However, it is unclear to what extent individuals have heard or believe this risk factor information, and how these beliefs may predict their preventive behaviors (e.g., weight management behaviors or COVID-19 preventive behaviors). Previous work has primarily looked at overall risk likelihood perceptions (i.e., not about obesity as a risk factor) within general populations of varying weight and concentrated on COVID-19-related preventive behaviors. Therefore, this prospective cohort study explored whether beliefs about obesity as a risk factor and overall risk likelihood perceptions predicted weight management and COVID-19 preventive behaviors over the next 16 weeks in individuals with obesity or overweight. METHODS: Participants were 393 individuals in the US who joined a commercial weight management program in January, 2021. We leveraged the mobile program's automatic measurement of real-time engagement in weight management behaviors (e.g., steps taken), while surveys measured risk beliefs at baseline as well as when individuals received COVID-19 vaccination doses (asked monthly) over the next 16 weeks. Mixed effects models predicted engagement and weight loss each week for 16 weeks, while ordinal logistic regression models predicted the month that individuals got vaccinated against COVID-19. RESULTS: We found that belief in obesity as a risk factor at baseline significantly predicted greater engagement (e.g., steps taken, foods logged) in program-measured weight management behaviors over the next 16 weeks in models adjusted for baseline BMI, age, gender, and local vaccination rates (minimally adjusted) and in models additionally adjusted for demographic factors. Belief in obesity as a risk factor at baseline also significantly predicted speed of COVID-19 vaccination uptake in minimally adjusted models but not when demographic factors were taken into account. Exposure to obesity risk factor information at baseline predicted greater engagement over 16 weeks in minimally adjusted models. CONCLUSIONS: The results highlight the potential utility of effective education to increase individuals' belief in obesity risk factor information and ultimately promote engagement or faster vaccination. Future research should investigate to what extent the results generalize to other populations.

Outcomes of Tisagenlecleucel in Lymphoma Patients With Predominant Management in an Ambulatory Setting.

INTRODUCTION: Chimeric antigen receptor T-cell therapy (CAR T) is a revolutionary adoptive immunotherapy approach in lymphoma; however, substantial resources are necessary for administration and care of these patients. Our institution has administered tisagenlecleucel primarily in an outpatient setting, and here we report our clinical outcomes. PATIENTS AND METHODS: We conducted a single institution, retrospective study investigating outcomes of adult lymphoma patients treated with commercial tisagenlecleucel between 10/2017 and 12/2020. We analyzed patient characteristics and outcomes of efficacy and safety including overall response rate, progression-free survival, overall survival and cytokine-release syndrome, neurotoxicity, and hospitalizations. RESULTS: Seventy-two patients with relapsed or refractory non-Hodgkin lymphoma (NHL) who received commercial tisagenlecleucel were identified; 68 (94.4%) patients received outpatient tisagenlecleucel. The overall response rate was 43% with a complete response observed in 25 patients (34.7%). At a median follow-up of 9.1 months, the median progression-free survival was 3.3 months. Grade 3-4 cytokine release syndrome was not observed in the study group and two patients had grade 3-4 neurotoxicity. Twenty-six patients (36.1%) were admitted within 30 days after infusion with a median length of stay of 5 days. Fourteen patients (19.4%) were admitted within 72 hours of infusion. No patient died of CAR T cell-related toxicity. CONCLUSION: Our experience affirms treatment with tisagenlecleucel in the outpatient setting is safe and feasible with close supervision and adequate institutional experience. After infusion, adverse events were manageable and the majority of patients did not require hospitalization.

Clinical trial management: a profession in crisis?

Clinical trial managers play a vital role in the design and conduct of clinical trials in the UK. There is a current recruitment and retention crisis for this specialist role due to a complex set of factors, most likely to have come to a head due to the COVID-19 pandemic. Academic clinical trial units and departments are struggling to recruit trial managers to vacant positions, and multiple influences are affecting the retention of this highly skilled workforce. Without tackling this issue, we face major challenges in the delivery on the Department of Health and Social Care's Future of UK Clinical Research Delivery implementation plan. This article, led by a leading network of and for UK Trial Managers, presents some of the issues and ways in which national stakeholders may be able to address this.

How Right Now? Supporting Mental Health and Resilience Amid COVID-19

The How Right Now communication initiative (HRN) was developed to facilitate resilience amid the COVID-19 pandemic in the United States. HRN was designed as a conduit for promoting mental health and addressing feelings of grief, worry, and stress experienced during this time. This article provides an overview of the rapid, mixed-method, culturally responsive formative research process undertaken to inform the development of HRN. Specifically, it describes how HRN's disproportionately affected audiences (adults aged 65 and older and their caregivers, adults with preexisting physical and mental health conditions, adults experiencing violence, and adults experiencing economic distress) describe and discuss emotional resilience, what they need to be resilient, and what factors contribute to the perceptions of their ability to "bounce back" from the conditions caused by the COVID-19 pandemic. Data collection methods included an environmental scan (n >= 700 publications), social listening (n >= 1 million social media posts), partner needs-assessment calls (n = 16), partner-convened listening sessions with community members (n = 29), online focus groups (n = 58), and a national probability survey (n = 731), all in English and Spanish. Results revealed that HRN's audiences have diverse perceptions of what constitutes resilience. However, common factors were identified across populations to support resilience amid the COVID-19 pandemic, including informal and formal social support and access to services to meet basic needs, including food and housing resources. Stress, anxiety, depression, and experience with stigma and discrimination were also linked to resilience. Understanding the perspectives and experiences of disproportionately affected populations is vital to identifying supports and services, including the engagement of community stakeholders.

Using a digital moodle platform to deliver pulmonary rehab - a service evaluation

Keywords: Digital, Respiratory, Rehabilitation Purpose: SARS-CoV-2 restricted access to face-to-face delivery of Pulmonary Rehabilitation (PR). Evidence suggests that telehealth-PR is non-inferior to outpatient PR but studies had not evaluated an approach encompassing virtual assessment in addition to delivery. Gloucestershire Health and Care PR team worked in partnership with the University of Gloucestershire (UoG) to deliver a virtual-only PR service for patients who had attended face-to-face sessions prior to lockdown. Initial evaluation of two groups showed this approach was feasible with outcome measures exceeding the MCID for face to face groups (Lewis, A., Knight, E., Bland, M., et al: 2021). More data were required to understand if these results would be replicated with patients who had no prior experience of PR;this submission evaluates the outcomes of seven additional groups where participants had no prior experience of PR. Methods: Patients on the waiting list for PR were contacted to be offered an assessment for virtual PR between September and December 2020. All participating patients were issued pulse oximeters and IPads were issued to patients who did not have an appropriate device at home. Assessments took place remotely using ‘Attend Anywhere’ software and consisted of history taking, Rockwood frailty scoring and a one minute sit to stand test. Patients received login details for the ‘eLearn’ moodle platform for the UoG and completed two live streamed exercise classes/week for six weeks and were asked to watch 12 educational videos in their own time with support phone calls from a clinician at two and four weeks. Patients completed the Medical Research Council Score Breathlessness scale (MRC), Chronic Respiratory Disease Questionnaire (CRQ), Generalised Anxiety Disorder-7 scale (GAD7) and Patient Health Questionnaire-9 (PHQ9) on eLearn at the start and finish of the course. Completion was set at attendance for 9/12 exercise sessions and at least nine educational videos watched. Results: One hundred and thirty patients were invited to participate of which 63 underwent pre assessment and started on the course. Twenty three people declined any form of PR and were discharged, and 44 declined remote classes. Forty-five patients completed the course. Reasons for drop out were: too unwell to continue (5), technical issues (7), poor attendance (4) and other/unknown (2). Statistically significant improvements were achieved in all outcome domains of the CRQ: dyspnoea: CI 0.4(0.3-0.9) p: 0.001**, fatigue: CI 0.25(0.2-0.8) p:0.025** mastery: CI 0.25(0.3-0.9) p:0.0003** emotion: 0.3(0.2-0.7) p:0.0002**, GAD7: 0(-2.9- -0.2) p:0.019**,PHQ9: -1(-3.5 - -0.8) p:0.002**, MRC -1(-3.5 - -0.8) p:0.002**and the one minute sit to stand: CI 2.6(0.89-4.3)p: 0.004*. Conclusion(s): These results reinforce our previous findings that PR can be delivered effectively using an entirely virtual approach for appropriate patients. Further research is warranted to investigate the MCID for tele-rehabilitation physical and patient reported outcome measures. Impact: These results demonstrate the potential of Moodle as a platform to deliver tele-conferencing rehabilitation programmes;Cardiac Rehabilitation colleagues have started to deliver online rehab via the same platform, and there is potential for numerous other rehabilitation services to replicate this model. This collaboration with UoG offers potential for virtual placement models. Funding acknowledgements: The feasibility study was supported by a grant of £8000 from the University Of Gloucestershire Sport, Nutrition and Exercise programme.

Reflections on involving Experts by Experience in interviews for the Doctorate in Clinical Psychology

A discussion of the value of having Experts by Experience involved in interviews and assessments of trainees for the DClinPsy course at the University of Bath, especially in the context of digital interviewing due to the Covid-19 pandemic. © 2022, British Psychological Society. All rights reserved.

COVID-19-related motivation to lose weight on a digital weight loss program

Background: Obesity is considered a risk factor for severe COVID-19 illness. Thus, individuals with obesity may be especially motivated to lose weight because of COVID-19. To our knowledge, this is the first study to assess COVID-related motivators to lose weight and whether they predict weight loss. Methods: In this prospective study, 530 new users of a digital commercial weight loss program completed a baseline survey in January 2021 assessing overall motivation to lose weight due to COVID (one item: 'how much of your interest in losing weight is because of COVID-19 or its impact, however minor, on your life?'), and three specific COVID motivators. These specific motivators were measured by the validated Fear of COVID-19 scale (F-C), one item assessing motivation to improve eating habits which got worse during COVID-19 (EH-C), and one item assessing motivation to prevent diseases that could increase COVID-19 risk (D-C). The main outcome was weight loss at 2 months, extracted from self-reported weight on the program. Results: Participants were 84% female, had a median age of 46, mean baseline BMI of 32.12 (SD = 6.96), and lost 3.13kg (3.49%) at 2 months (SD = 2.72kg). Overall COVID motivation was high;66% reported that their interest in losing weight was due to COVID. There was high F-C (M = 25.2 out of 35) and EH-C (M = 7.7 out of 10), and moderate D-C (M = 5.4 out of 10). Despite high COVID-related motivation, overall motivation, F-C, and EH-C did not predict weight loss at 2 months. D-C marginally significantly predicted weight loss at 2 months (B = -. 09, p = .06). Conclusions: Results suggest that even though individuals showed initial high motivation due to COVID, it did not manifest in actual weight loss, except in the most at-risk individuals who sought to prevent diseases that put them at greater risk. Individuals may need support to translate initial COVID-related motivation to actual weight loss. Next, we will examine relationships between COVID motivators, vaccination status, and weight loss at 4 months.

Effect of non-alcoholic fatty liver disease on cognition in adolescents

Background: Nonalcoholic fatty liver disease (NAFLD) is characterized by macrovesicular hepatic steatosis occurring in the absence of significant alcohol consumption or identifiable secondary causes of hepatic lipid accumulation. Estimated prevalence of pediatric NAFLD in the United States has increased from 3.8% in 1988-1994 to 10% -12 % in 2007-2018. Pediatric obesity rates have also risen, with a prevalence among adolescents 12-19 years of 21% in 2018. Cognitively, recent studies have shown an association between NAFLD and deficits in executive functioning and visuospatial domains;the etiology is uncertain but may relate to increase in pro-inflammatory cytokines and microvascular changes altering neuronal functioning and cerebral perfusion. Studies associating NAFLD and decreased cerebral volume even after controlling for cardiometabolic risk factors suggest hepatic steatosis can influence brain development. Objective: To investigate the potential association between NAFLD and neurocognitive and social/emotional health in adolescents. Methods: Study of three groups comprised of a convenience-based sample of participants, 12 to 17 years of age, recruited from an outpatient pediatric gastroenterology clinic. NAFLD Group (n=15) included youth with BMI ≥ 95th% for age/sex, hepatic ultrasound with increased echogenicity compatible with hepatic steatosis, and ALT > 2 times upper limit of normal. Elevated BMI Group (n=16) included youth with BMI ≥ 95th% for age/sex and normal ALT. Non-obese Control Group (n=15) included youth with BMI <95th % for age/ and sex normal ALT. The study included subjects proficient in English and English or Spanish speaking parent/legal guardian available to participate in the consent process. Exclusion criteria included individuals with documented causes of liver disease (e.g., known hepatotoxic medications, autoimmune hepatitis, hemachromatosis, viral hepatitis, rheumatalogic diseases), or treatment with combined hormonal contraceptives, antipsychotic or diabetic medications. Using the NIH Toolbox iPad app, subjects were administered the Sadness, Emotional Support, & Anxiety self-report measures and three performance-based cognitive tasks: Picture Vocabulary Test, Flanker Inhibitory Control and Attention Test, and Dimensional Change Card Sort Test. Statistical analyses of primary outcome measures included one-way ANOVAs, unpaired Student's t-tests, and Pearson correlations to assess relationships between dependent and independent variables. Results: No significant group differences for demographics, social/emotional outcomes, vocabulary test, or dimensional card sort test were observed. ANOVA of the Flanker Test of Inhibition and Attention was significant (p= 0.047), and post-hoc t-tests revealed Elevated BMI group scored significantly lower than the non-obese controls (p=0.03). Pearson correlation analysis of the total study sample revealed a significant inverse relationship between BMI and Flanker Test (r= -0.38, p <0.001). Exploratory analysis revealed a significant increase in BMI of study subjects enrolled following onset of COVID-19 pandemic (n=22) compared to subjects enrolled pre-pandemic (n=23), p= 0.03. Conclusions: We found no significant difference in social/emotional health or cognitive functioning between adolescents with NAFLD and those without NAFLD from our pediatric GI clinic. However, adolescents with elevated BMI (without NAFLD) performed significantly below non-obese controls on a measure of attention and inhibition. We also found a significant inverse relationship between BMI and attentional processing and inhibition for our overall adolescent sample. These results are consistent with studies reporting lower cognitive function in obese adults and improved neurocognitive outcomes in adults following bariatric surgery. Studies with children and adolescents are limited but our data support findings from a previous adolescent study citing a negative correlation between elevated BMI and cognition. Our study adds to a growing body of research in pediatric populations. tudy limitations include potential impact of confounding variables, namely the environment in which the cognitive tests were administered -a busy outpatient GI clinic- as well as possible inclusion of undiagnosed NAFLD patients in the elevated BMI group, as our study included a mix of both newly referred patients and established patients. Interestingly, we must also consider and further explore the potential impact of COVID-19 pandemic, as across all three of our study groups, pre-pandemic patients had a lower BMI compared to patients enrolled during the pandemic.

How right now: The role of social determinants of health as they relate to emotional well-being amidst the COVID-19 pandemic

Pandemics are stressful times, full of uncertainty and fear. During the COVID-19 pandemic, many Americans have experienced feelings of stress, grief, and loss. How Right Now (HRN) – and its Spanish-language counterpart, Qué Hacer Ahora (QHA) – is an evidence-based, culturally-relevant communication campaign designed to promote and strengthen the emotional well-being and resiliency of populations adversely affected by the COVID-19 pandemic and beyond. Developed by the Centers for Disease Control and Prevention (CDC) with support from the CDC Foundation, the campaign aims to help all Americans but has a specific focus on some of the disproportionately affected groups, including adults over 65 and their caregivers, individuals with pre-existing physical and mental health conditions, people experiencing violence, and those experiencing economic distress. Based on rapid, but robust, formative research, HRN offers audience-centric messages representing the real, everyday experiences and emotions that these audiences are having and addresses them in actionable ways. These include messages that address the social and structural barrier that disproportionately-affected groups have been facing long before the pandemic — and which are felt more acutely now. This paper provides an overview of the rapid, mixed-method, culturally-responsive formative research process undertaken to inform the development of HRN. Specifically, it describes how HRN’s disproportionately-affected audiences describe and discuss their emotiona well-being during COVID-19 through the lens of Social Determinants of Health (SDOH). We introduce a secondary theory, Vital Conditions for Health and Well-Being (VCHW), which conceptualizes holistic well-being and the conditions that give rise to it and identifies levers for community change and improvement. Data collection methods included an environmental scan (n≥700 publications);social listening (n≥1 million social media posts);partner needs-assessment calls (n=16);partner-convened listening sessions with community members (n=29), online focus groups (n=10), and a national probability survey (n=731), all in English and Spanish. Findings suggest that HRN’s priority audiences’ emotional well-being and SDOH are interconnected. Disruptions in SDOH du to the COVID-19 pandemic can lead to emotional well-being challenges (e.g., anxiety) for HRN’s priority audiences. While some disruptions may lead some people to adapt, connect with others, and be more resilient, there is a disparate impact of emotional well-being amid COVID-19 for those already experiencing disparities linked to SDOH. Understanding the perspectives and experiences of disproportionately affected populations through the lens of SDOH is vital to identifying the kinds of supports and services – like How Right Now/Qué Hacer Ahora – required for these populations. © 2021 Weston Medical Publishing. All rights reserved.

International students struggling in the private rental sector in Australia prior to and during the pandemic

International students have emerged as a major cohort within Australia’s post-secondary education sector. Despite contributing substantially to the economy and community, they are expected to make their own way in Australia’s expensive private rental market. Drawing on two surveys—one conducted prior to Covid-19 and one fielded during the pandemic—as well as forty semi-structured in-depth interviews, the article examines strategies adopted by students to cope with high rents in Sydney and Melbourne. Drawing on the concept of risk, we argue that international students studying in these two cities must constantly manage the pressures of expensive and unstable rental housing. Access to decent accommodation often depends on finding and maintaining paid employment. Second, students adopt risky strategies to meet housing costs such as sharing bedrooms. These strategies reduce rents but invoke further challenges. Third, we find that due to the loss of paid employment, the Covid-19 pandemic has substantially increased the risks for international students dependent on the private rental sector. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

Sleep Quality and Physical Activity as Predictors of Mental Wellbeing Variance in Older Adults during COVID-19 Lockdown: ECLB COVID-19 International Online Survey

BACKGROUND: The COVID-19 lockdown could engender disruption to lifestyle behaviors, thus impairing mental wellbeing in the general population. This study investigated whether sociodemographic variables, changes in physical activity, and sleep quality from pre- to during lockdown were predictors of change in mental wellbeing in quarantined older adults. METHODS: A 12-week international online survey was launched in 14 languages on 6 April 2020. Forty-one research institutions from Europe, Western-Asia, North-Africa, and the Americas, promoted the survey. The survey was presented in a differential format with questions related to responses "pre" and "during" the lockdown period. Participants responded to the Short Warwick-Edinburgh Mental Wellbeing Scale, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and the short form of the International Physical Activity Questionnaire. RESULTS: Replies from older adults (aged >55 years, n = 517), mainly from Europe (50.1%), Western-Asia (6.8%), America (30%), and North-Africa (9.3%) were analyzed. The COVID-19 lockdown led to significantly decreased mental wellbeing, sleep quality, and total physical activity energy expenditure levels (all p < 0.001). Regression analysis showed that the change in total PSQI score and total physical activity energy expenditure (F_{(2, 514)} = 66.41 p < 0.001) were significant predictors of the decrease in mental wellbeing from pre- to during lockdown (p < 0.001, R²: 0.20). CONCLUSION: COVID-19 lockdown deleteriously affected physical activity and sleep patterns. Furthermore, change in the total PSQI score and total physical activity energy expenditure were significant predictors for the decrease in mental wellbeing.

Increased care at discharge from COVID-19: The association between pre-admission frailty and increased care needs after hospital discharge; a multicentre European observational cohort study.

BACKGROUND: The COVID-19 pandemic has placed significant pressure on health and social care. Survivors of COVID-19 may be left with substantial functional deficits requiring ongoing care. We aimed to determine whether pre-admission frailty was associated with increased care needs at discharge for patients admitted to hospital with COVID-19. METHODS: Patients were included if aged over 18 years old and admitted to hospital with COVID-19 between 27 February and 10 June 2020. The Clinical Frailty Scale (CFS) was used to assess pre-admission frailty status. Admission and discharge care levels were recorded. Data were analysed using a mixed-effects logistic regression adjusted for age, sex, smoking status, comorbidities, and admission CRP as a marker of severity of disease. RESULTS: Thirteen hospitals included patients: 1671 patients were screened, and 840 were excluded including, 521 patients who died before discharge (31.1%). Of the 831 patients who were discharged, the median age was 71 years (IQR, 58-81 years) and 369 (44.4%) were women. The median length of hospital stay was 12 days (IQR 6-24). Using the CFS, 438 (47.0%) were living with frailty (≥ CFS 5), and 193 (23.2%) required an increase in the level of care provided. Multivariable analysis showed that frailty was associated with an increase in care needs compared to patients without frailty (CFS 1-3). The adjusted odds ratios (aOR) were as follows: CFS 4, 1.99 (0.97-4.11); CFS 5, 3.77 (1.94-7.32); CFS 6, 4.04 (2.09-7.82); CFS 7, 2.16 (1.12-4.20); and CFS 8, 3.19 (1.06-9.56). CONCLUSIONS: Around a quarter of patients admitted with COVID-19 had increased care needs at discharge. Pre-admission frailty was strongly associated with the need for an increased level of care at discharge. Our results have implications for service planning and public health policy as well as a person's functional outcome, suggesting that frailty screening should be utilised for predictive modelling and early individualised discharge planning.

Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople).

BACKGROUND: Hospital admissions for non-coronavirus disease 2019 (COVID-19) pathology have decreased significantly. It is believed that this may be due to public anxiety about acquiring COVID-19 infection in hospital and the subsequent risk of mortality. AIM: To identify patients who acquire COVID-19 in hospital (nosocomial COVID-19 infection (NC)) and their risk of mortality compared to those with community-acquired COVID-19 (CAC) infection. METHODS: The COPE-Nosocomial Study was an observational cohort study. The primary outcome was the time to all-cause mortality (estimated with an adjusted hazard ratio (aHR)), and secondary outcomes were day 7 mortality and the time-to-discharge. A mixed-effects multivariable Cox's proportional hazards model was used, adjusted for demographics and comorbidities. FINDINGS: The study included 1564 patients from 10 hospital sites throughout the UK, and one in Italy, and collected outcomes on patients admitted up to April 28th, 2020. In all, 12.5% of COVID-19 infections were acquired in hospital; 425 (27.2%) patients with COVID died. The median survival time in NC patients was 14 days compared with 10 days in CAC patients. In the primary analysis, NC infection was associated with lower mortality rate (aHR: 0.71; 95% confidence interval (CI): 0.51-0.98). Secondary outcomes found no difference in day 7 mortality (adjusted odds ratio: 0.79; 95% CI: 0.47-1.31), but NC patients required longer time in hospital during convalescence (aHR: 0.49, 95% CI: 0.37-0.66). CONCLUSION: The minority of COVID-19 cases were the result of NC transmission. No COVID-19 infection comes without risk, but patients with NC had a lower risk of mortality compared to CAC infection; however, caution should be taken when interpreting this finding.