ABSTRACT
Introduction: Many COPD patients do not follow pulmonary rehabilitation (PR) or exercise training in the long-term. Objective(s): To assess the effectiveness of a 12-months home-based, minimal equipment strength exercise programme in patients with COPD who did not conduct PR<1 year. Method(s): COPD patients recruited from primary care and general population were randomized into intervention (IG) or control group (usual care, CG). Primary outcome was change in dyspnoea (Chronic Respiratory Questionnaire;CRQ) from baseline to 12 months, secondary outcomes change in exercise capacity, health status, exacerbations, and symptoms. Adjusted linear regression models were used. Result(s): 50 patients (48% of target sample size) were randomized (25 per group);23 females, mean (SD) age 69.5 (7.4) years, FEV1% 45.9 (16.3) % pred. 48 completed 12-months follow-up (IG: 25, CG: 23). On average, the IG participant trained for 10.5 months and 18 persons (72%) until study end. We found no evidence for a difference in change in CRQ dyspnoea over 12 months (adjusted mean difference 0.45, 95% CI -0.21-1.10, p=0.18, favouring IG). We found no evidence for an effect in other outcomes. Most of the IG participants liked to participate in the programme much (56%) or very much (24%). Due to the Coronavirus pandemic, 60% of follow-up visits were conducted by phone/by questionnaires without exercise tests. Conclusion(s): This trial was underpowered. There was a trend that the training provided benefit in dyspnoea. The fact that it was difficult to motivate COPD patients for participation who did not follow PR<1 year highlights the challenge to reach this patient group. However, most of the participants succeeded to train long-term.
ABSTRACT
Background Much remains unknown regarding the evolution of SARS-CoV-2 seroprev-alence in children, variability and clustering of seropositive children in schools and classes as only a few school-based cohort studies exist. Methods SARS-CoV-2 antibodies were measured in 1854 to 2585 primary and sec-ondary school children within 275-288 classes from 43-55 randomly se-lected schools in the canton of Zurich in June/July (R1) and October/No-vember 2020 (R2), in March/April (R3) and November/December 2021 (R4). Seroprevalence was estimated using Bayesian hierarchical model-ling. Variability in schools was expressed as maximum seroprevalence in a class minus minimum seroprevalence, and summarized as median (IQR). Results Median age at R1 was 11 yrs (min 6 to max 16), 47% of participants were male. At R4, 49% of participants at least 12 years old were vaccinated. Seroprevalence from R1 to R4 increased from 3% to 46.4% (95% credible interval [CrI] 42.6 to 50.9) including vaccinated children, or 24.7% (21.1 to 28.8) counting only recovered children. While in R1-R3 seropositivity rates were always higher in primary than secondary schools by 0.2-4%, at R4 much higher seropositivity rates were observed in secondary schools, 75.8% (69.6% to 82.4%), than in primary schools, 31.3% (27.1% to 36.1%). This difference was also the case if only recovered, unvaccinated children were considered. In R3 however chil-dren in primary school showed higher seroprevalence, 19.5% (16.0 to 23.7), than those in secondary school, 15.1% (10.7 to 19.6). Variability of class seroprevalence rates within schools increased steadily over time: At R2, median variability was 11% (IQR 7-17%), in R3, 24% (17-37%). At R4, median variability had increased to 40% (22-49%), and all but one of the primary schools had lower seropositivity than all the secondary schools Conclusion We observed a large increase in seroprevalence from R1 to R4, especially from R3 to R4 following introduction of the vaccine for children 12 yrs and older. Up to R3, primary school children had higher seroprevalence, how-ever at R4, secondary school children were more likely to be seropositive. This shift was in part due to introduction of the COVID-19 vaccine, but possibly also due to different behavior with more social contacts of older versus younger children outside school. Variability in seroprevalence among schools and classes was high and increased over time, even be-tween different classes in the same school.