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mHealth technology has the potential to transform healthcare and realize the goal of precision medicine through systematic data collection and use. Meanwhile, mHealth applications developed during COVID-19 have had limited effect, as people have been reluctant to adopt them due to a lack of trust and willingness to share data. The aim of this empirical study is to provide insights into young people's use, trust, and willingness to share data through mHealth apps as future users of healthcare services. A survey comprising 484 Danish students was conducted. It focuses on mHealth app use, willingness to share data, and trust. The findings show that the trustworthiness of the technology and data requesting organization is important for establishing trust in mHealth apps. These insights indicate how young people can be motivated to trust mHealth apps, which can be used to develop future apps and exploit the untapped potential of the collected data. © 2023 IEEE Computer Society. All rights reserved.
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The mobile application RehaGoal app is presented for people with acquired and congenital brain damage who have difficulties with complex planning tasks. The development of the RehaGoal app was based on the Goal Management Training approach, which focuses on breaking down an overarching goal into sub-goals and manageable steps to achieve them. So far, this approach has been paper-based, which makes it difficult to transfer to everyday life. Therefore, the RehaGoal app, which can be used on various digital devices such as smartphones, smartwatches, etc., was developed. Our target group often has additional limitations, which is why the RehaGoal app has a barrierfree design, voice output, visual display options, a user-dependent display, simple menu navigation and an authoring system. We illustrate the possible applications of the RehaGoal app with patients in outpatient neuropsychological rehabilitation, during vocational reintegration and during lockdown due to COVID-19.Copyright © Hippocampus Verlag 2023.
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Introduction In early 2021, unanticipated thromboses, including cerebral venous sinus thrombosis (CVST) with thrombocytopenia, emerged as an adverse reaction (ADR) in patients who had been vaccinated with the AstraZeneca ChAdOx1 nCoV-19 vaccine. This ADR was termed vaccine-induced immune thrombotic thrombocytopenia (VITT) or thrombosis with thrombocytopenia syndrome (TTS). Although sporadic in nature, VITT can result in severe disease in the individual vaccinee. We followed up on the outcomes and status of neurological recovery of 49 cases of VITT with CVST that were reported to PEI. Method Assessment of the Extended Glasgow Outcome Scale (GOS-E) was performed within 3-6 months after the initial hospital admissions. Individual Glasgow Coma Scale (GCS) scores were reported by phone or electronically via a questionnaire or medical report by the treating physician of the hospital to which the patient was initially admitted. If a GCS score was not reported, an expert determined a score based on the patient's medical report. For most patients, follow-up was pursued about 3-6 months after hospital admission. The reported outcomes describe the patients' neurological status at 5-38 weeks (mean 20 weeks) after hospital admission. Outcomes were identified in 44 of the original 49 cases. Results Patient outcomes ranged from good recovery (13 patients, 29.6 %) to moderate disability (11 patients, 25.0 %) and severe disability or vegetative state (6 patients, 13.6 %). Fatal outcomes were reported in 14 patients (31.8 %). As anticipated, initial low GCS scores were associated with poor outcomes. By contrast, GCS scores > 10 were typically associated with improved neurological outcomes. Moreover, platelet count nadirs were correlated with patient outcomes. Low platelet counts were observed in fatal cases (GOS-E 1) with a mean count of 17,000 platelets/muL). Likewise, patients with better neurological outcomes (GOS-E scores of 5-6 and 7-8) presented with mean counts of 61,000 thrombocytes/muL. However, the course of the disease was not always predictable and showed significant individual variability. Conclusion We provide data on the outcome of VITT cases with CVST upon vaccination with the AstraZeneca adenoviral vector ChAdOx1 nCoV-19 COVID- 19 vaccine and found that the recovery of patients from CVST was very heterogeneous. While some patients exhibited good recoveries, others developed severe disabilities and major long-term complications. Collectively, our findings highlight the importance of paying attention to early signs of increased intracranial pressure and the onset of thrombocytopenia in patients with a recent history of vaccination with the AstraZeneca adenoviral vector ChAdOx1 nCoV-19 COVID-19 vaccine.
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As the critical risk of the short-term SARS-CoV-2 infection is severe lung inflammation with a hypercoagulative state that could escalate to multiorgan failure, many possible long-term implications are still under investigation. This article will review the most recent findings related to the potential contribution of SARS-CoV-2 to male infertility. Viral-induced male infertility has been studied widely and in much detail in the past. Numerous viral infections have a well-known ability to induce orchitis, resulting in impaired testicular functions and male infertility. SARS-CoV-2 may be an additional virus that is related to male infertility for several reasons that will be dealt with in this review: [1] the strong affinity of SARS-CoV-2 for the human ACE2 receptor, [2] SARS-CoV-2 induced sex steroid hormonal abnormalities, [3] increased levels of oxidative stress in COVID-19, and [4] molecular mimicry between humans and components of SARS-CoV-2 leading to antigenic cross-reactivity phenomena. As these mechanisms might be responsible for SARS-CoV-2-induced male infertility, new evidence demonstrates testicular damage and semen abnormalities following the viral infection. Pathological findings of patients who died of COVID-19 exhibit injury to Sertoli cells and seminiferous tubules with a reduction in Leydig cells, which all are critical components of spermatogenesis. Moreover, impairment of sperm quality was found in SARS-CoV-2-infected patients. Those manifestations found in COVID-19-ill patients, parallel to sex steroid hormonal abnormalities, might critically influence spermatogenesis and SARS-CoV-2-induced male infertility. © 2023 Elsevier Inc. All rights reserved.
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Innate immunity is the first line of host defense against microbes, including SARS-CoV-2. This pleiotropic immunological mechanism is initiated within minutes to hours after infection. Here, we summarize innate immune processes involved in SARS-CoV-2 recognition, cellular, and molecular response including inflammation, as well as the related immune modulatory therapies that have been evaluated in clinical trials for COVID-19. Innate immune responses limit viral replication, help identify and remove infected cells, sense pathogen-associated molecular patterns, trigger signaling pathways, inflammatory responses, cytokine production, programmed cell death, and contribute the development of adaptive immunity. Excessive activation of the host innate immune response is associated with severe disease and death. The availability and speed of implementation of these mechanisms in infected individuals may explain in part the heterogeneous disease spectrum and courses observed in patients. © 2023 Elsevier Inc. All rights reserved.
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Background and Aim: Wearing face masks to detain the COVID 19 pandemic in schools has become an integral part of fighting the virus. The most effective mask is the FFP2 mask. There is a lot of public concern, especially regarding wearing a face mask at school and especially during school sports. It is therefore important to determine whether wearing a FFP2-mask during physical activ-ity leads to changes measurable in cardiopulmonary exercise test-ing in children. Method(s): Cardiopulmonary exercise testing was performed two times by children aged 8-10 years as an incremental step test on a treadmill with and without a FFP2 within an interval of 2 weeks. A general questionnaire included medical history and sports par-ticipation since childhood. Result(s): We included 10 children (mean age 8.4 +/- 0.7 years, 6 males, 4 females). The mean parameters measured at peak exercise were comparable between both examinations (mean Peak VO2 = 39.3 +/- 3.4 vs 45.6 +/- 13.9 ml/min/kg;mean Peak HR 192/min +/- 9 vs 188/min +/- 12, mean O2pulse 6 +/- 1.4 ml/min vs. 7 +/- 1.8, mean VE 43.2 +/- 12.9 ml/min vs. 41.5 +/- 12.7 ml/min). Neither did the respiratory gases (O2 and CO2) measured 1 min into each step differ significantly (s. figure). This study is cur-rently ongoing. Conclusion(s): Since there were no significant differences with respect to peak parameters as well as with respect to the respiratory param-eters measured during each step, there is no indication to withhold physical activity even at peak capacity from children during a pan-demic which makes wearing face masks mandatory.
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Background: Since the roll-out of coronavirus disease 2019 (COVID-19) vaccines worldwide, South Africa has had to adjust and overcome challenges associated with the safe and effective distribution of COVID-19 vaccines to its citizens. Vaccines are biological products, and many supply chain factors could influence product integrity and efficacy. This study focuses on aiding the logistics industry in understanding the COVID-19 vaccine supply chain around its handling, storage, and transportation requirements. Objectives: The study had five objectives. Firstly, to understand the functionality and components of a vaccine supply chain and, secondly to identify the stakeholders involved and their roles. Thirdly, the researchers wanted to comprehend and clarify the cold chain protocols for each category of the COVID-19 vaccines procured and the appropriate international best practices. The last two objectives were to identify the skill and training requirements of stakeholders on all levels, and using these inputs in creating an educational toolkit, aimed at operationally involved supply chain stakeholders. Method: The researchers made use of both primary and secondary data, focusing mostly on collecting data through a literature review, stakeholder analysis, and interview process. Results: The study outcome was a COVID-19 vaccine educational toolkit with four tools addressing the research objectives: (1) An identification of all vaccine supply chain stakeholders, (2) vaccine categorisation according to type and equipment required, (3) handling, storage, and delivery protocols, and (4) vaccine supply chain skill and training requirements. Conclusion: These tools can be used as a basis when educating and/or training COVID-19 vaccine supply chain employees on different levels and stages. © 2022. The Authors.
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BACKGROUND: Immunocompromised patients are at high risk of complicated severe acute respiratory coronavirus 2 infection. The aim of this retrospective study was to describe the characteristics and outcomes of heart transplantation (HTx) recipients with coronavirus disease 2019 (COVID-19) in the Netherlands. METHODS: HTx patients from one of the three HTx centres in the Netherlands with COVID-19 (proven by positive reverse-transcription polymerase chain reaction or serology test result) between February 2020 and June 2021 were included. The primary endpoint was all-cause mortality and the secondary endpoint was disease severity. RESULTS: COVID-19 was diagnosed in 54/665 HTx patients (8%), with a mean (±â¯standard deviation (SD)) time after HTx of 11⯱ 8 years. Mean (±â¯SD) age was 53⯱ 14 years and 39% were female. Immunosuppressive therapy dosage was reduced in 37% patients (20/54). Hospitalisation was required in 39% patients (21/54), and 13% patients (7/54) had severe COVID-19 (leading to intensive care unit (ICU) admission or death). In-hospital mortality was 14% (3/21), and all-cause mortality was 6%. Compared with patients with moderate COVID-19 (hospitalised without ICU indication), severe COVID-19 patients tended to be transplanted earlier and had a significantly higher mean (±â¯SD) body mass index (26⯱ 3 vs 30⯱ 3â¯kg/m2, pâ¯= 0.01). Myocardial infarction, cellular rejection and pulmonary embolism were observed once in three different HTx patients. CONCLUSION: HTx patients were at increased risk of complicated COVID-19 with frequent hospitalisation, but the all-cause mortality was substantially lower than previously described (7-33%).
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Background/Aims The substantial personal and socioeconomic costs associated with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (SpA) make understanding their epidemiology crucial. The Clinical Practice Research Datalink (Aurum) is an electronic healthcare record (EHR) database, containing primary care records from ≥20% of English practices (>13 million patients currently registered). To determine RA/PsA/axial SpA epidemiology using EHR data, validated methods need to be applied to ascertain patients with these diagnoses. To address this, we updated and applied approaches validated in other primary care EHR databases in Aurum and described the annual incidence/point-prevalence of RA/PsA/axial SpA alongside patient characteristics (providing indirect evidence of coding accuracy). Methods Diagnosis and synthetic disease-modifying anti-rheumatic drug (DMARD) prescription code lists were constructed, and pre-defined approaches for ascertaining patients with RA/axial SpA/PsA applied. The annual incidence and point-prevalence of RA/PsA/axial SpA were calculated from 2004-2020. Samples were stratified by age/gender, and mean age and gender/ethnic-group relative frequencies described. The study was approved by the CPRD Independent Scientific Advisory Committee (reference 20-000244). Results From 2004-2019 the point-prevalence of RA/PsA increased annually, peaking in 2019 (RA 7.79/1,000;PsA 2.87/1,000) then falling slightly. From 2004-2020 the point-prevalence of axial SpA increased annually (except in 2018/2019), peaking in 2020 (1.13/1,000). Annual RA incidence was higher between 2013-2019 (when included in the Quality Outcomes Framework, ranging 0.491 to 0.521/1,000 personyears) than 2004-2012 (ranging 0.345 to 0.400/1,000 person-years). The annual incidence of PsA and axial SpA increased from 2006 (0.108 to a peak of 0.172/1,000 person-years) and 2010 (0.025 to a peak of 0.045/1,000 person-years), respectively. These years were when new disease classification criteria were introduced. Marked falls in the annual incidence of RA, PsA and axial SpA between 2019 and 2020 were seen, reducing by 40.1%, 67.4% and 38.1%, respectively, reflecting the impact of the COVID-19 pandemic on arthritis diagnoses. Stratifying incidence/prevalence by age/gender broadly showed expected patterns (although the incidence of axial SpA/PsA in women increased over time), and the mean age and gender proportions followed those previously reported. Conclusion The approaches we used to determine patients with RA, PsA, and axial SpA in Aurum led to incidence/prevalence estimates broadly consistent with published studies, and patient characteristics as would be expected. These data support the potential of the Aurum-updated ascertainment approaches for use in further studies of RA, PsA and axial SpA.
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Background/Aims The COVID-19 pandemic led to an overnight shift in healthcare delivery and rapid uptake of digital technology. Such approaches risk digital exclusion for people without access to or not confident in their use of technology. We sought to examine digital access and e-health literacy in people with inflammatory conditions. Methods People (n=2,024) were identified from their electronic health record and invited to participate in a survey, using SMS and postal approaches. Data were collected on age, gender, self-reported arthritis diagnosis (RA, PsA, AS, SLE and other), access to an internet-enabled device and frequency of internet access, health literacy (single-item literacy screener) and self-perceived e-health literacy (eHEALs). Ethical approval was obtained (Ref 21/PR/0867). Results 639 people completed the survey, of whom 287 (44.9%) completed it online. Mean (sd) age was 64.5 (13.1) years and 384 (64.7%) were female. 98.3% were white. Approximately 20% of people did not have access to an internet enabled device (Table). 93 (15.3%) of patients reported never accessing the internet, this proportion was higher in people with RA. Approximately 19% had low health literacy. In those reporting internet use, eHealth literacy was moderate. The most Conclusion Low health literacy, lack of digital access and low reported internet use was common, especially in people with RA, leading to high use of telephone advice and rheumatology appointments. Digital roll-out needs to take account of people requiring extra support to enable them to access care or risks excluding many patients with inflammatory conditions.
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Background/Aims Concerns about the risk of COVID-19 infection led to guidelines advocating shielding for many people with inflammatory conditions. We aimed to assess the impact of the pandemic on the self-reported physical and mental health of people with inflammatory conditions. Methods 2024 patients with inflammatory conditions (RA, PsA, AS, SLE and other) were randomly selected from electronic health records. Survey invites were sent (August 2021 to coincide with relaxation of COVID restrictions) using a combination of SMS and postal approaches. Data collected included demographics, COVID infection and shielding status, physical (MSK-HQ) and mental health (PHQ8 and GAD7) and global impact on physical or mental health (4 options: none-severe). Ethical approval was obtained (REC Ref 21/PR/0867). Results 639 people completed the survey, of whom 287 (44.9%) completed online. Mean (sd) age was 64.5 (13.1) years and 384 (64.7%) were female. The majority of people had RA although 57 (9%) reported more than one inflammatory condition. 349 (57.9%) of people were advised to shield. Rates of COVID infection were relatively low across the groups (Table 1). 254 (41.2%) reported moderate or severe impact of the pandemic on physical health, which impacted least in people with RA. 244 (39.4%) reported moderate or severe impact of the pandemic on mental health with 175 (28.7%) reporting moderate depression (PHQ8>10) and 138 (22.6%) moderate anxiety (GAD-7≥10). Conclusion Reported COVID infections were low in our cohort. The pandemic had significant effects on physical and mental health, which appeared less in people with RA than other inflammatory conditions.
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This study advances understanding of the broader social and spatial impacts of COVID-19 restrictive measures, particularly how they may have impacted individuals and households and, in turn, the geographic areas in which these individuals and households are concentrated. Data are combined and linked to a novel individual-level synthetic dataset and an interactive dashboard is developed to assist with the identification and understanding of the social and spatial impacts of restrictions. To illustrate the utility of this approach, the analysis focuses on the impact of three restrictions within a defined spatial area: Yorkshire and Humberside (UK). Results highlight the additive nature of restriction impacts and suggest areas that may have the least future resilience as policy priority areas. This approach is transferable to other regions and the use of the dashboard allows rapid consideration and communication of the social and spatial nature of inequalities to researchers, practitioners and the general public.
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As COVID-19 becoming a global epidemic, owing to the interventions' operation limited efficacy and virus' super transmission ability, the vaccine is considered the most potent method left to cease the COVID-19 effectively. At the beginning of the vaccine distribution policy design, there were many real concerns: vaccine priority, budget control, vaccine inventory limitation, and expected objectives making the problem complex. The research optimised the vaccine distribution policy (VDP) in an explicit form incorporated in an age-stratified SEIR model based on the proposed policy optimisation methodology. The VDP could explain when and how many vaccines to take for each age group. The designed evaluation system consisted of direct policy cost, indirect healthcare cost, and extra financial budget during the pandemic, combined as a weighted sum equalling one to suit flexible scenarios and decision-makers' requirements. A case study with ground truth data in the U.K was implemented, where the optimised VDP could decrease the comprehensive cost and suppress the virus transmission. Furthermore, the sensitivity analysis demonstrated the effect of some critical parameters for optimised VDP. The vaccination priority and policy objectives' weight combination play a significant role in impacting the VDP optimisation. The research could be a framework for flexible vaccination policy design in different scenarios by changing weights, vaccine limitations, and other initial parameter configurations. © 2021 ACM.
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Objectives: The COVID-19 pandemic impacted the German health system comprehensively. This study compared overall healthcare resource utilization (HCRU) in the first half of 2020 (COVID-19 lockdown time) with the utilization observed in previous years (2017-2019). Methods: The analysis was based on anonymized claims data of a German sickness fund (AOK PLUS), considering all individuals with at least one insurance day between 01/01/2017-30/06/2020. All hospitalizations, outpatient visits, and prescriptions were observed in the first half of each year. HCRU per 1,000 person-days (PTPD) observed in 2020 was compared with respective numbers of previous years. Results: We observed 3,322,504 insured persons (591,705,100 days) in the first half of 2020, with 0.68 hospitalizations PTPD (8.55% with at least one hospitalization). Hospitalization rates were considerably higher in the previous periods (2019/2018/2017: 0.79/0.80/0.82 inpatient stays PTPD;9.75%/9.95%/10.09% with at least one hospitalization). In the first half of 2020, 67.09% of the insured received at least one prescription of any medication with on average 1,936.87 DDDs PTPD. These numbers were very similar in the pre-years (2019/2018/2017: 68.94%/70.12%/69.93% and 1,925.79/1,949.66/1,982.60 DDDs PTPD). Proportion of patients with prescriptions for antiinfectives particularly decreased (-14.07%;ATC-code J-). Regarding outpatient treatment, with an unchanged overall number of outpatient visits, utilization of laboratory services increased substantially, followed by visits related to COVID-19. Cancer screening visits occurred far less frequently than in previous years (0.90 PTPD in 2020 versus 1.03/1.02/1.01 PTPD in 2019/2018/2017). Conclusions: In the first half of 2020, number of hospitalizations decreased substantially. This might be explained by lockdown measures themselves (postponement of planned inpatient treatments, general underuse of health care or reduction of the so far existent overuse) but might also be due to a lower number of non-COVID infections which as also prescriptions of antiinfectives decreased in this time.
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The present research project addresses the question of how the theological literacy and agency of volunteer church leaders can be fostered so that cooperative church leadership can be achieved. The Protestant Churches of the Canton of St. Gallen (Switzerland) and Austria, together with the Centre for Church Development of the University of Zurich, designed a participatory research process. The aim was to increase the communicative and participative competence of volunteers. Together, through a creative and discursive process, the foundations, educational processes and tools necessary for theological empowerment were developed with the volunteer church leaders. The cooperative project combines research and practice in the sense that practitioners were actively involved in generating, evaluating and discussing the data. In addition, in this project we found ways to continue participatory research - for example through online discourse formats - and thus not lose the essence of such research in times of COVID-19. © Koninklijke Brill NV, Leiden, 2021
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Random mutations and recombinations are the main sources for the genetic diversity in SARS-CoV-2, with mutations in the SARS-CoV-2 spike (S) receptor binding motif (RBM) representing a high potential for the emergence of new putative variants under investigation (VUI) or variants of concern (VOC). It is of importance, to measure the different circulating SARS-CoV-2 lineages in order to establish a regional SARS-CoV-2 surveillance program. We established whole genome sequencing (WGS) of circulating SARS-CoV-2 lineages in order to establish a regional SARS-CoV-2 surveillance program. We established a surveillance program for circulating SARS-CoV-2 lineages by performing whole genome sequencing (WGS) in SARS-CoV-2 isolates. Specimens were collected over a period of 5 months from three different sites. Specimens were collected from both patients suffering from COVID-19 and from outpatients without any clinical signs or symptoms;both in a tertiary university hospital, and two private laboratories within an urban area of eastern part Germany. Viral WGS from the 364 respiratory specimens with positive SARS-CoV-2 RT-PCR comprised 16 different SARS-CoV-2 lineages. The majority of the obtained sequences (252/364=69%) was assigned to the variant of concern (VOC) Alpha (B.1.1.7). This variant first appeared in February in our samples and quickly became the dominant virus variant. All SNP PCR results could be verified using WGS. Other VOCs found in our cohort were Beta (B.1.351, n=2) and Delta (B.1.617.2, n=1). Lineage analysis revealed 16 different virus variants among 364 respiratory samples analyzed by WGS. The number of distinct lineages dramatically decreased over time in leaving only few variants, in particular, the VOC Alpha or B.1.1.7. By closer inspection of point mutations, we found several distinct mutations of the viral spike protein that were reported to increase affinity or enable immune escape. Within a study period of only 5 months, SARS-CoV-2 lineage B.1.1.7 became the dominant lineage in our study population. This study emphasizes the benefit of SARS-CoV-2 testing by WGS. The increasing use of WGS to sequence the entire SARS-CoV-2 genome will reveal additional VUIs and VOCs with the potential to evade the immune system and, thus, will be a promising tool for data mining of relevant information for epidemiological studies. SARS-CoV-2 lineage monitoring using WGS is an important surveillance tool for early detection of upcoming new lineages of concern. © 2021