Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 48
Filter
1.
129th ASEE Annual Conference and Exposition: Excellence Through Diversity, ASEE 2022 ; 2022.
Article in English | Scopus | ID: covidwho-2045746

ABSTRACT

An online learning environment can be effective but presents additional challenges with regard to academic integrity compared to in-person education. The onset of the COVID-19 pandemic forced many institutions to an online learning environment with less than two weeks' notice. Even before migrating to the online learning environment, violations of academic integrity have been shown to be alarmingly prevalent in United States institutions. In an online environment where students have unfettered access to online resources, “availability” would be expected to be a substantial factor making cheating easier and, thus, more prevalent. The goal of this research is to analyze student perceptions of adherence to academic integrity rules before and after the initial COVID-19 response in Spring 2020, where classes were forced to an online learning environment. Due to the COVID-19 pandemic, our university made a sudden shift from fully in-person instruction to entirely remote online learning with less than two weeks' notice to both students and faculty. This sudden shift left faculty scrambling to convert in-person lectures, which relied heavily on chalkboards and document cameras as the interface to communicate to students in the classroom, to an entirely online format using only computers from home. The faculty decided to survey the students to obtain their perspective to determine if students felt that they and their peers would adhere to academic integrity rules during this change to an online learning environment. Student surveys were administered during the first and last week of the change from in-person to online instruction for 12 engineering classes at an undergraduate institution, including civil, mechanical, electrical, and general engineering classes. Paired t-tests were performed to determine if students initially felt others would, and afterward did, adhere to academic integrity rules. Results indicate that while students had a positive perception of themselves adhering to academic integrity rules they did not feel that their peers would - with a statistically significant difference. These results are concerning since students may be more predisposed to cheat if they feel they are at a disadvantage because others are cheating. Also, grades are not an adequate assessment of learning objectives being met if students are not adhering to academic integrity requirements. © American Society for Engineering Education, 2022.

2.
Innovation in Aging ; 5:617-617, 2021.
Article in English | Web of Science | ID: covidwho-2011860
3.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003292

ABSTRACT

Background: To control the spread of COVID-19 in NYC, a stay-at-home order was issued for March 22, 2020-June 13, 2020 followed by ongoing restrictions and only partial school reopening. The health impacts of these unprecedented restrictions on children are not yet known. Our objective was to examine whether BMI change during the COVID-19 period differed from the prior year among healthy children. Methods: This is a multicenter retrospective observational study of children aged five to eighteen years who received care within the NYC public hospital system between 2018 and 2020 encompassing all the five boroughs of the city. Using the system's electronic medical records, we identified patients who had a well-child visit between June 13, 2020 and December 31, 2020. Patients were included if they had annual well-child visits in the two previous years with anthropometric data recorded at all three visits. Patients with diagnoses that may affect adiposity (e.g. hypothyroidism) were excluded. We collected sociodemographic and anthropometric data for each year and calculated a modified body mass index z-score (mBMIz), which is a measure of relative BMI adjusted for age and sex. We compared change in mBMIz/month between the 2019 and 2020 visits (which included the pandemic) with the change in mBMIz/month between the 2018 and 2019 visits using generalized estimating equations (GEE). We examined whether the mBMIz/month change differed between the two periods and whether 2018 BMI category (underweight (5%), normal (5-85%), overweight (85-95%), obese (95-99%), extremely obese(>99%))modified this effect. Analyses were conducted using STATA software. Results: Of 23,458 patients seen between June 13, 2020 and December 31, 2020, 7,575 (32.3%) met our inclusion and exclusion criteria. The mean mBMIz was 0.68 in 2018, 0.69 in 2019 and 0.90 in 2020. (Table 1). In GEE analysis, the change in mBMIz/month was statistically significantly higher in 2019-2020 than in 2018-2019 (mean difference in mBMIz/month change=0.0152, p < 0.0001). While the change in mBMIz/month in 2019-2020 was lowest in patients in the extremely obese category, the difference in mBMIz/month between the two periods was greatest in this group (interaction effect of period and 2018 baseline category p < 0.0001). (Table 2). Conclusion: Our study suggests that the activity restrictions due to the COVID-19 outbreak are associated with greater excess weight gain in a diverse NYC population of healthy children as measured by mBMIz relative to the year prior to the outbreak. These findings correspond to the mean BMI percentile of our population changing from approximately 75th to the 82nd. These findings require further monitoring to better understand the specific reasons for the observed patterns across children in different BMI categories, assessment of longer-term health impact on this population and interventions to modify or reverse these worrisome trends. (Table Presented).

4.
Journal of General Internal Medicine ; 37:S248, 2022.
Article in English | EMBASE | ID: covidwho-1995811

ABSTRACT

BACKGROUND: Latinos are among the most heavily impacted populations by the COVID-19 pandemic in the United States due to intersectional barriers to care. Crowdsourcing open contests can be an effective means of community engagement but have not been well studied in Latino populations nor in addressing the COVID-19 pandemic. The objectives of this study were to implement a crowdsourcing open contest to solicit a name for a social marketing campaign addressing COVID-19 for Latinos in Maryland, and evaluate the contest through mixed-methods analysis. METHODS: We conducted descriptive statistics of entries and votes, and demographics of participants. Submitted text was analyzed through inductive thematic analysis to understand community attitudes towards the COVID-19 pandemic. RESULTS: We received 74 entries within a brief 2-week period, limited by the urgency COVID-19 pandemic. The top 10 entries were chosen by a panel of community judges and the winner was decided by popular votes. We received 383 votes within 1 week. The most common themes were collective efficacy, self-efficacy, and perceived benefits of COVID-19 testing. We subsequently incorporated these themes into campaign advertisements, and these ended up being the highest performing ads. CONCLUSIONS: Crowdsourcing is an effective means of community engagement and an agile tool for guiding interventions to address COVID-19, including in populations impacted by healthcare disparities such as Latino communities.

5.
Journal of General Internal Medicine ; 37:S228, 2022.
Article in Spanish | EMBASE | ID: covidwho-1995810

ABSTRACT

BACKGROUND: Latino communities are disproportionately affected by COVID-19. In response, our Johns Hopkins based team of investigators and community health workers expanded access to free COVID-19 testing, and later vaccinations, through trusted community venues in Baltimore, MD. To promote these services, we developed a community-driven culturally congruent social marketing campaign and website. This work was supported by the NIH RADxUP (Rapid Acceleration of Diagnostics - Underserved Populations) initiative. METHODS: The campaign name was chosen using a crowdsourcing open contest, evaluated by community judges and a popular vote. Campaign messaging was informed by prior focus groups and our community advisory board. The reach of the campaign was evaluated through online metrics (Google analytics and Facebook) as well as surveys of individuals obtaining COVID-19 testing or vaccination. Surveys were conducted over a 2-week period (6/25/21-7/9/21) at our main community-based venue, Sacred Heart Church. RESULTS: The campaign was named “Mejor Vive Sin Duda" ("Better to Live Without Doubt") based on the results of the crowdsourcing open contest, after which we developed the social marketing advertisements and website which launched in February 2021. Among 252 individuals surveyed in the 2-week period, 33% of respondents had seen or heard of the Mejor Vive Sin Duda campaign, with Facebook being the most popular means of campaign exposure. From March 1, 2021 to December 31, 2021, we received 9,100 unique visitors to the website and reached 254,910 people through paid social media advertisements. CONCLUSIONS: Social marketing campaigns present an opportunity to promote COVID-19 testing and vaccine uptake among Latino populations who face barriers to traditional healthcare settings. Community partnerships were integral to campaign success. Campaigns must be paired with accessible and culturally competent healthcare services to lead to equitable improvements in health outcomes.

6.
Hormone Research in Paediatrics ; 95(SUPPL 1):39-40, 2022.
Article in English | Web of Science | ID: covidwho-1980867
7.
Computing Conference, 2022 ; 508 LNNS:359-378, 2022.
Article in English | Scopus | ID: covidwho-1971555

ABSTRACT

This paper aims to explore the ways in which tertiary education was disrupted in Japan due to the COVID-19 pandemic, and what new skills were acquired by teachers and students during this process. The paper will go on to explore in detail how these skills may well prepare both stakeholders for the uncertain future that 4IR (Fourth Industrial Revolution) may have in store. The value of this study lies in it attempting to give an insight into how this global crisis has the potential to leave not only despair in its wake, but also the opportunity to improve learning environments for all;it will specifically look at the new teaching methods that were hurriedly put in place, and how familiarizing oneself with these new technologies and tactics could be of great benefit in the 4IR future that lays ahead. To get a rounded understanding of this field of study, key texts written before, during and in reflection of the pandemic will be explored. These texts are largely focused on either 4IR, teaching approaches used during the pandemic, or a combination of these two fields of study. Paired with this, a small scale questionnaire was distributed amongst 8 HE (Higher Education) teachers based in Japan;the questionnaire collected both quantitative data for statistical analysis, and qualitative data for thematic analysis. The aim of this study is to explore the thoughts and opinions of Japanese HE teachers and existing literature, in the hope of discovering successful teaching methods that could be of benefit to both teachers and students, as the influence of 4IR continues to increase. Furthermore, this study will also look at any apprehension or fear associated with this influx of modern technology, and how these fears may be alleviated or avoided altogether. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

8.
Biol Invasions ; 24(11): 3441-3446, 2022.
Article in English | MEDLINE | ID: covidwho-1935829

ABSTRACT

Recent global trade disruptions, due to blockage of the Suez Canal and cascading effects of COVID-19, have altered the movement patterns of commercial ships and may increase worldwide invasions of marine non-indigenous species. Organisms settle on the hulls and underwater surfaces of vessels and can accumulate rapidly, especially when vessels remain stationary during lay-ups and delays. Once present, organisms can persist on vessels for long-periods (months to years), with the potential to release propagules and seed invasions as ships visit ports across the global transportation network. Shipborne propagules also may be released in increasing numbers during extended vessel residence times at port or anchor. Thus, the large scale of shipping disruptions, impacting thousands of vessels and geographic locations and still on-going for over two years, may elevate invasion rates in coastal ecosystems in the absence of policy and management efforts to prevent this outcome. Concerted international and national biosecurity actions, mobilizing existing frameworks and tools with due diligence, are urgently needed to address a critical gap and abate the associated invasion risks.

9.
The Routledge Handbook of Health Communication, Third Edition ; : 475-488, 2021.
Article in English | Scopus | ID: covidwho-1934440

ABSTRACT

Effective communication is essential before, during, and after public health crises such as hurricanes, oil spills, or COVID-19. When crises threaten public health, decades of communication scholarship can provide guidance regarding which sources should share what messages and when. This chapter provides an overview of the current state of public health crisis communication before explaining three primary types of public health crises (infectious diseases, natural disasters, human-caused disasters), overviewing relevant theories (e.g., crisis and emergency risk communication model, chaos theory), and providing recommendations for future research. This information can help readers better understand strategies for engaging diverse stakeholders to co-construct messages that can help mitigate risk and reduce negative health consequences from public health crises. © 2022 Taylor and Francis

10.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880361
11.
Heart Rhythm ; 19(5):S88-S89, 2022.
Article in English | EMBASE | ID: covidwho-1866206

ABSTRACT

Background: Social distancing restrictions resulted in increased utilization of virtual visits (VVs) for arrhythmia care in 2020. Over time, there has been a return to in-person visits (IPVs);however, utilization of VVs may continue to offer advantages for patients. Objective: To assess characteristics of patients durably adopting virtual care. Methods: All appointments in our arrhythmia clinics from March 2020 through November 2021 were analyzed. Completed appointments by EP providers were categorized as VV or IPV. The VV rate was calculated as number of VVs divided by total Visits (IPVs and VVs). Pt characteristics collected included self-identified race and ethnicity as well as age, gender, and insurance status. We compared VV rates amongst patients of different ethnicity, race, and insurance status. We also assessed enrollment in an internet-based patient portal that interfaces with the electronic medical record (EMR) and allows for communication with providers. Results: A total of 6,084 VVs and 10,942 IPVs were included in the analysis. In 2020, 3,550 VVs comprised the majority (52.8% of 6,723) of all outpatient visits, whereas in 2021, this proportion dropped to 24.6% (2,534/10,303) as IPVs became more common. The largest reduction in VV utilization was amongst Black patients (65.2% reduction to a 19% VV rate) followed by Hispanics (62.3% reduction to a 15.8% VV rate). Both groups had a significantly reduced VV utilization rate compared to others in 2021 (P<0.01). There was no significant difference in VV rates for underinsured patients in 2020 or 2021, indicating social but not economic influence on telehealth adoption. Enrollment in the EMR patient portal during the study period was significantly reduced for Black and Hispanic patients (67.4% and 63.1% vs 80.6%;P<0.01) but did not significantly change over time. Conclusion: There was a large reduction in the overall use of VVs for arrhythmia care from 2020 to 2021. The largest reductions in VV utilization were observed in the Black and Hispanic communities, where digital health resources appeared to be underutilized. [Formula presented]

12.
Heart Rhythm ; 19(5):S89, 2022.
Article in English | EMBASE | ID: covidwho-1867190

ABSTRACT

Background: The COVID-19 pandemic created an increased need for inpatient hospital beds. This need along with advances in AF ablation technology led us to develop a program to discharge patients the same day as their AF ablation. Objective: To develop and implement a protocol to allow safe Same Day Discharge (SDD) of eligible patients after AF ablation. Methods: A multi-disciplinary team of providers and nurses developed an institutional-wide protocol to identify patients for safe SDD. Eligibility was based on comorbidities, home support, and distance from hospital. Adjusted procedural workflow included use of vascular closure devices to decrease bedrest time, avoidance of urinary catheters, and careful monitoring of volume status. A post discharge automated call system was developed to trigger nurse-level outreach to identify and treat potential post-operative complications. A retrospective analysis was performed to review enrollment and complications to ensure safety of the program. Results: SDD for AF ablation was performed in 113 patients in 2020. There was 1 complication in the immediate post-op period due to traumatic foley insertion, 1 visit to urgent care for pericarditis, and 1 hospital readmission within 30 days due to volume overload;a total complication rate of 2.7%. There was no mortality observed and no major complications. Average general anesthesia time was 168.7 +/- 58.5min and average procedural time (vascular access to reversal) was 105.6 +/- 53.1 min. Conclusion: A safe and effective same day discharge program was developed for patients undergoing AF ablation by a multidisciplinary team. This program resulted in improved patient satisfaction and had favorable impacts on healthcare utilization. [Formula presented]

13.
Heart Rhythm ; 19(5):S288, 2022.
Article in English | EMBASE | ID: covidwho-1867185

ABSTRACT

Background: Following restrictions imposed by the Covid-19 pandemic, virtual care became frequently employed. The adoption and maintained utilization of virtual care in Cardiac Arrhythmia specialty compared to other parts of cardiology may be greater owing to the nature of the care being given. Objective: To assess digital health resource utilization over time in EP and non-EP providers. Methods: All patient appointments in our cardiovascular medicine clinics at our Center from March 2020 through November 2021 were analyzed. Completed appointments by EP and non-EP providers were categorized as Virtual (VV) or In-Person (IPV). Routine remote device transmissions were excluded from the analysis. The VV rate was defined as the number of VVs divided by total Visits (IPVs and VVs). Results: Over the 21-month observation period, a total of 23,052 VVs (37%) and 39,882 IPVs (63%) were completed. The monthly percentage of virtual visits ranged from 13.5% (N=454/3383) in November 2021 to 97.5% in April of 2020 (N=2123/2178). Compared to other cardiovascular subspecialties, EP had a consistently higher proportion of virtual visits that has persisted throughout the observation period (range 29%-98.4%). With regard to new visits only, in 2020 there were 395/735 (53.7%) new EP VVs vs. 1608/3523 45.6% Non-EP VVs (p<.01). This discrepancy widened in 2021 as there were 524/1353 (38.7%) of all new EP VVs vs. 1400/6181 (22.7%) of all new non-EP VVs. The same widening discrepancy was seen with return visits (RPV). RPVs in 2020 were 3155/4720 (66.8%) EP VVs vs. 9659/16516 (58.5%;p<.01). This discrepancy for RPVs also widened in 2021 as there were 2010/4662 (43.1%) of all RPV EP VVs vs. 4301/19607 (21.9%;p<.01) of all new non-EP VVs. (see attached figure). Conclusion: Cardiac electrophysiologists and arrhythmia patients have adopted and maintained virtual visits to a greater extent compared to other areas of cardiovascular medicine. This may reflect improved at home sensor use and outpatient monitors to facilitate virtual visits in EP. [Formula presented] [Formula presented]

14.
Infect. Dis. Clin. Pract. ; 30(3):9, 2022.
Article in English | Web of Science | ID: covidwho-1794995

ABSTRACT

Background Early reports on COVID-19 patient outcomes showed a marked fatality rate among patients requiring invasive mechanical ventilation (IMV). Objective Our aim was to compare case fatality rate (CFR) outcomes for patients requiring IMV due to severe acute respiratory syndrome (SARS)-associated coronavirus 2 (COVID-19), SARS-associated coronavirus 1, Middle East respiratory syndrome (MERS), and influenza (H1N1). Materials and Methods We searched PubMed, EMBASE, MEDLINE, Google Scholar, and Cochrane Library for relevant studies published between December 2019 and April 2021 for COVID-19, between January 2002 and December 2008 for SARS, between January 2012 and December 2019 for MERS, and between January 2009 and December 2016 for influenza (H1N1). Results Overall, this study included 81 peer-reviewed studies, pertaining to 65,058 patients requiring IMV: 61 studies including 62,809 COVID-19 patients, 4 studies including 148 SARS patients, 9 studies including 875 MERS patients, and 7 studies including 1226 influenza (H1N1) patients. The CFR for COVID-19 patients requiring IMV was not significantly different from the CFR for SARS and influenza (H1N1) patients (45.5% [95% confidence interval (CI), 38.5%-52.8%] vs. 48.1% [95% CI, 39.2%-57.2%] and 39.7% [95% CI, 29.3%-51.3%], respectively). However, CFR for COVID-19 patients was significantly lower compared with that for MERS patients (CFR, 70.6%;95% CI, 60.9%-78.8%). Conclusions COVID-19 patients requiring IMV show a similar CFR compared with SARS and H1N1 influenza patients but a lower CFR compared with MERS patients. To improve survival in future pandemics, we recommend examining the pros and cons of the liberal use of endotracheal intubation and considering drafting guidelines for the selection of patients to intubate and the timing of intubation.

15.
Oral Oncology ; 118:7, 2021.
Article in English | EMBASE | ID: covidwho-1735118

ABSTRACT

smoking. Evidence shows that smokers who develop oral cancer have poorer outcomes than non-smokers. Additionally, smoking incidence is reported to be increased because of the COVID pandemic.We have a duty to discuss smoking with our patients and offer appropriate advice or referrals. Objectives are as follows: - To assess department compliance with the recording of smoking and tobacco history at initial consultation appointments - To aim for 100% compliance with the recording of smoking and tobacco quantity and duration - To increase number of successful referrals to smoking cessation services. Materials and Methods: Retrospective data collectionwas completed from 20 initial new patient consultations. Notes were assessed for the presence of the following: Smoking status and history, duration of smoking history, number of cigarettes smoked daily, and whether smoking cessation advice was given and/or a smoking cessation referral offered. Results of first round data collectionwere presented to the department and a ‘help to stop smoking’ referral form for smoking cessation services made readily available in the department. A second round of data collection was subsequently completed. Results: 60% of initial consultations recorded patient smoking status. Of this group, 42% are confirmed smokers. When smoking history has been recorded, the quantity of cigarettes was always recorded. The duration of smoking history was only successfully recorded in 60% of cases. No referrals were made to the smoking cessation service;however 60% of the confirmed smokers declined a referral offer. After intervention, a vast improvement is noted – 85% of clinical notes recorded patient status, with 25% confirmed smokers. There was an increase in referrals to smoking cessation referral services. Conclusions: All patients should be asked about smoking status and evidence recorded in clinical notes. Furthermore, smoking cessation advice should be given to all patients and referrals to smoking cessation services offered. Collaborative projects with the smoking cessation service have begun to further improve our patient care and oral health improvement.

16.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1630153

ABSTRACT

Introduction: We validated the “Familial Hypercholesterolemia (FH) Decision Aid” to promote shared decision making (SDM) about lipid lowering therapy, based on patient-clinician encounters. Methods: Validation of the DA included an assessment of whether the content and design of the tool facilitated SDM and patient engagement and to determine how well the tool integrated with clinical workflow. Validation was conducted during patient-clinician encounters in the Mayo preventive cardiology clinic. As inclusion criteria we considered an upcoming appointment in the clinic, an LDL-C level ≥ ∼160 mg/dL, and no prior diagnosis of FH. Prior to the encounters, each clinician viewed a demonstration of the online, interactive DA. During the encounters, the DA was shared with patients using the clinic room computer screen, either in-person or virtually. Patientclinician encounters were video recorded for further analysis by two design researchers and experts in SDM. Results: Ten patients were enrolled in the study (7 male;average age 51 years). The average patient LDL-C level was 207 mg/dL, range 157 - 248 mg/dL. Review and qualitative analysis of the encounter recordings yielded 4 key findings: i) clinicians primarily used the cardiovascular risk estimate in the DA to guide conversation with patients;ii) highly trained specialists needed to change their usual approach to care and conversation to integrate the DA with their clinical workflows;iii) as clinicians became more familiar with the DA, they moved through the tool at a more efficient pace;and iv) each clinician developed his/her own style of navigating the DA, either moving through it one screen at a time or focusing on one specific section for the duration of the conversation. The DA effectively guided conversation and facilitated active patient engagement in 6 of 10 encounters. Social distancing and use of telemedicine encounters, due to the COVID-19 pandemic, limited patient engagement in 2 of 10 encounters. Overall, the DA promoted SDM regarding FH management in 9 of 10 encounters. Conclusion: Using patient-clinician encounters, we found the FH DA to facilitate SDM regarding lipid-lowering therapy. The tool has potential to improve care of FH patients and increase patient engagement and knowledge.

17.
24th ACM Conference on Computer-Supported Cooperative Work and Social Computing, CSCW 2021 ; : 352-355, 2021.
Article in English | Scopus | ID: covidwho-1515326

ABSTRACT

Online health communities (OHCs) are spaces where people gather for informational and emotional support around specific medical conditions and concerns. Although OHCs are an active and exciting research area that continuously attracts a wide range of approaches and methodologies, the focus has been mostly on a limited selection of OHCs or medical conditions. At the same time, there are novel challenges that OHCs face, including changes to the medical system resulting from the COVID-19 crisis, increased medical misinformation propagating online, and additional focus on personalized medical advice that is less attainable in traditional medical systems. This workshop will bring together researchers to discuss and produce generalizable lessons about membership, structure, and support in OHCs in the context of these novel changes, generating research agendas for future exploration and design of OHCs. © 2021 ACM.

18.
Sci Total Environ ; 812: 151431, 2022 Mar 15.
Article in English | MEDLINE | ID: covidwho-1500242

ABSTRACT

SARS-CoV-2 was discovered among humans in late 2019 and rapidly spread across the world. Although the virus is transmitted by respiratory droplets, most infected persons also excrete viral particles in their feces. This fact prompted a range of studies assessing the usefulness of wastewater surveillance to determine levels of infection and transmission and produce early warnings of outbreaks in local communities, independently of human testing. In this study, we collected samples of wastewater from 13 locations across Oklahoma City, representing different population types, twice per week from November 2020 to end of March 2021. Wastewater samples were collected and analyzed for the presence and concentration of SARS-CoV-2 RNA using RT-qPCR. The concentration of SARS-CoV-2 in the wastewater showed notable peaks, preceding the number of reported COVID-19 cases by an average of one week (ranging between 4 and 10 days). The early warning lead-time for an outbreak or increase in cases was significantly higher in areas with larger Hispanic populations and lower in areas with a higher household income or higher proportion of persons aged 65 years or older. Using this relationship, we predicted the number of cases with an accuracy of 81-92% compared to reported cases. These results confirm the validity and timeliness of using wastewater surveillance for monitoring local disease transmission and highlight the importance of differences in population structures when interpreting surveillance outputs and planning preventive action.


Subject(s)
COVID-19 , Humans , Oklahoma/epidemiology , Population Groups , RNA, Viral , SARS-CoV-2 , Waste Water , Wastewater-Based Epidemiological Monitoring
19.
Multiple Sclerosis Journal ; 27(2 SUPPL):741-743, 2021.
Article in English | EMBASE | ID: covidwho-1496078

ABSTRACT

Background: As the COVID-19 pandemic continues, evidencebased clinical guidance for managing the care of people with multiple sclerosis (MS) is an ongoing concern. In recent months, data from cohorts of people with MS has indicated that certain demographic and clinical characteristics, including use of some disease- modifying therapies (DMTs), leads to worse outcomes from SARS-CoV-2 infection. The COVID-19 in MS global data sharing initiative, which now includes over 4,500 confirmed COVID- 19 cases in people with MS, gives the opportunity to corroborate previous findings with greater certainty. Methods: Clinician-reported data from 32 countries were aggregated into a dataset of 5,543 patients who had suspected or confirmed COVID-19. Demographic and clinical covariates were queried, alongside COVID-19 clinical severity outcomes. These outcomes (hospitalisation, admission to ICU, requiring artificial ventilation, and death) were assessed in patients with suspected/ confirmed COVID-19 using multilevel mixed-effects logistic regression. All models were corrected for age, sex, EDSS, and MS type. DMTs were individually compared to glatiramer acetate (GA), as well as to pooled other DMTs and natalizumab. Results: Of 5,543 patients in the clinician-reported dataset, 909 with suspected and 4,634 with confirmed COVID-19 were included in the analysis. Previous demographic findings were confirmed: male sex, older age, progressive MS, and higher disability were associated with worse outcomes from SARS-CoV-2 infection. Use of anti-CD20 DMTs (ocrelizumab and rituximab) was associated with worse COVID-19 outcomes. Compared to GA, ocrelizumab and rituximab were associated with increased risk of hospitalisation (aOR=1.61(95%CI=1.06-2.43);aOR=2.42(95%CI=1.54-3.81) and ICU admission (aOR=3.13(95%CI=1.22-8.00);aOR=4.46 (95%CI=1.64-12.09)). Rituximab was associated with increased risk of artificial ventilation (aOR=3.57(95%CI=1.38-9.20));ocrelizumab showed a positive trend (aOR=1.86(95%CI=0.76-4.55). Rituximab showed a positive trend with increased risk of death (aOR=2.74(95%CI=0.68-11.09). Associations persisted on restriction to confirmed COVID-19 cases. Conclusions: Analysing the largest international real world dataset of people with MS who have suspected or confirmed COVID- 19 confirms previous findings that male sex, older age, progressive MS, higher disability, the use of anti-CD20 medication (ocrelizumab and rituximab) are associated with worse COVID-19 outcomes.

20.
Multiple Sclerosis Journal ; 27(2 SUPPL):766-767, 2021.
Article in English | EMBASE | ID: covidwho-1496064

ABSTRACT

Introduction and Objective: Whether therapies for Multiple Sclerosis (MS) might reduce the efficiency of the immune response to COVID19 disease or vaccination is a major concern. The rapid COVID19 vaccination program in Israel provides a unique opportunity to assess the anti-COVID19 IgG response in MS patients. Methods: This multi-center study coordinated by the Israeli Neuroimmunology Research Group included 331 MS patients and 53 healthy controls, vaccinated against SARS-CoV-2 (BNT162b2- Pfizer) (n=361) or recovered from COVID19. IgG against the spike receptor-binding domain of SARS-CoV-2 (Abbott) was measured in sera collected 2-23 weeks after the 2nd vaccination or after COVID19 diagnosis. Serum positivity was defined at > 50 AU/ml. Results: IgG levels were comparable in vaccinated MS patients (in general) and healthy controls, but were significantly lower in treated compared to untreated MS patients, and in COVID19- recovered compared to vaccinated patients. All patients treated with Interferon-β preparations, Dimethyl Fumarate, Alemtuzumab, Glatiramer Acetate, Natalizumab, Ofatumumab, Ponesimod, Siponimod or Teriflunomide were positive for IgG anti-spike antibodies, following vaccination or COVID19 disease. 90% of Cladribine-, 31% of Ocrelizumab- and 51% of Fingolimod-treated patients were IgG positive after vaccination, and 50%, 63% and 68%, respectively, after recovery from COVID19. No significant correlation was found between IgG-levels and the interval from last treatment of Ocrelizumab or Cladribine, or the lymphocyte counts in Fingolimod-treated patients. IgG-levels negatively correlated with time from 2nd vaccination, whereas no correlation was found with time since COVID19 disease. There were no significant gender differences or associations with smoking or BMI. Aging was associated with lower titers of IgGs after vaccination, but not after COVID19 disease. Conclusions: Most DMTs did not interfere with elicitation of a sufficient humoral immune response to vaccination or disease, but ≥50% of MS patients treated with Fingolimod or Ocrelizumab did not develop anti- spike antibodies. Following vaccination, IgG levels declined over time, while appeared to be stable (though lower) after COVID19 disease. Testing of cellular responses in IgG-negative patients and an update of COVID19 vaccination guidelines for MS according to therapy and patient's characteristics, seem to be warranted.

SELECTION OF CITATIONS
SEARCH DETAIL