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1.
Brain Commun ; 4(4): fcac206, 2022.
Article in English | MEDLINE | ID: covidwho-2107373

ABSTRACT

Post-COVID cognitive deficits (often referred to as 'brain fog') are common and have large impacts on patients' level of functioning. No specific intervention exists to mitigate this burden. This study tested the hypothesis, inspired by recent experimental research, that post-COVID cognitive deficits can be prevented by inhibiting receptor-interacting protein kinase. Using electronic health record data, we compared the cognitive outcomes of propensity score-matched cohorts of patients with epilepsy taking phenytoin (a commonly used receptor-interacting protein kinase inhibitor) versus valproate or levetiracetam at the time of COVID-19 diagnosis. Patients taking phenytoin at the time of COVID-19 were at a significantly lower risk of cognitive deficits in the 6 months after COVID-19 infection than a matched cohort of patients receiving levetiracetam (hazard ratio 0.78, 95% confidence interval 0.63-0.97, P = 0.024) or valproate (hazard ratio 0.73, 95% confidence interval 0.58-0.93, P = 0.011). In secondary analyses, results were robust when controlling for subtype of epilepsy, and showed specificity to cognitive deficits in that similar associations were not seen with other 'long-COVID' outcomes such as persistent breathlessness or pain. These findings provide pharmacoepidemiological support for the hypothesis that receptor-interacting protein kinase signaling is involved in post-COVID cognitive deficits. These results should prompt empirical investigations of receptor-interacting protein kinase inhibitors in the prevention of post-COVID cognitive deficits.

2.
Preprint in English | medRxiv | ID: ppmedrxiv-22282338

ABSTRACT

Certain serum proteins, including CRP and D-dimer, have prognostic value in patients with SARS-CoV-2 infection. Nonetheless, these factors are non-specific, and provide limited mechanistic insight into the peripheral blood mononuclear cell (PBMC) populations which drive the pathogenesis of severe COVID-19. To identify novel cellular phenotypes associated with disease progression, we here describe a comprehensive, unbiased analysis of the total and plasma membrane proteomes of PBMCs from a cohort of 40 unvaccinated individuals with SARS-CoV-2 infection, spanning the whole spectrum of disease severity. Combined with RNA-seq and flow cytometry data from the same donors, we define a comprehensive multi-omic profile for each severity level, revealing cumulative immune cell dysregulation in progressive disease. In particular, the cell surface proteins CEACAMs1, 6 and 8, CD177, CD63 and CD89 are strongly associated with severe COVID-19, corresponding to the emergence of atypical CD3+CD4+CD177+ and CD16+CEACAM1/6/8+ mononuclear cells. Utilisation of these markers may facilitate real-time patient assessment by flow cytometry, and identify immune cell populations that could be targeted to ameliorate immunopathology.

3.
Science ; 376(6590): eabi9591, 2022 04 15.
Article in English | MEDLINE | ID: covidwho-2088383

ABSTRACT

In this work, we find that CD8+ T cells expressing inhibitory killer cell immunoglobulin-like receptors (KIRs) are the human equivalent of Ly49+CD8+ regulatory T cells in mice and are increased in the blood and inflamed tissues of patients with a variety of autoimmune diseases. Moreover, these CD8+ T cells efficiently eliminated pathogenic gliadin-specific CD4+ T cells from the leukocytes of celiac disease patients in vitro. We also find elevated levels of KIR+CD8+ T cells, but not CD4+ regulatory T cells, in COVID-19 patients, correlating with disease severity and vasculitis. Selective ablation of Ly49+CD8+ T cells in virus-infected mice led to autoimmunity after infection. Our results indicate that in both species, these regulatory CD8+ T cells act specifically to suppress pathogenic T cells in autoimmune and infectious diseases.


Subject(s)
Autoimmune Diseases , COVID-19 , Animals , CD8-Positive T-Lymphocytes , Humans , Mice , Receptors, KIR , T-Lymphocytes, Regulatory
4.
Viruses ; 14(10)2022 09 30.
Article in English | MEDLINE | ID: covidwho-2066551

ABSTRACT

Molecular therapies exploiting mRNA vectors embody enormous potential, as evidenced by the utility of this technology for the context of the COVID-19 pandemic. Nonetheless, broad implementation of these promising strategies has been restricted by the limited repertoires of delivery vehicles capable of mRNA transport. On this basis, we explored a strategy based on exploiting the well characterized entry biology of adenovirus. To this end, we studied an adenovirus-polylysine (AdpL) that embodied "piggyback" transport of the mRNA on the capsid exterior of adenovirus. We hypothesized that the efficient steps of Ad binding, receptor-mediated entry, and capsid-mediated endosome escape could provide an effective pathway for transport of mRNA to the cellular cytosol for transgene expression. Our studies confirmed that AdpL could mediate effective gene transfer of mRNA vectors in vitro and in vivo. Facets of this method may offer key utilities to actualize the promise of mRNA-based therapeutics.


Subject(s)
Adenoviridae Infections , COVID-19 , Humans , Adenoviridae/genetics , Genetic Vectors/genetics , Gene Transfer Techniques , Polylysine , RNA, Messenger/genetics , RNA, Messenger/metabolism , Pandemics , Capsid Proteins/genetics , Capsid Proteins/metabolism , Biology
5.
Telemed J E Health ; 28(10): 1525-1533, 2022 10.
Article in English | MEDLINE | ID: covidwho-1733626

ABSTRACT

Introduction: Cost studies of telehealth (TH) and virtual visits are few and report mixed results of the economic impact of virtual care and TH. Largely missing from the literature are studies that identify the cost of delivering TH versus in-person care. The objective was to demonstrate a modified time-driven activity-based costing (TDABC) approach to compare weighted labor cost of an in-person pediatric clinic sick visit before COVID-19 to the same virtual and in-person sick-visit during COVID-19. Methods: We examined visits before and during COVID-19 using: (1) recorded structured interviews with providers; (2) iterative workflow mapping; (3) electronic health records time stamps for validation; (4) standard cost weights for wages; and (5) clinic CPT billing code mix for complexity weighs. We examined the variability in estimated time using a decision tree model and Monte Carlo simulations. Results: Workflow charts were created for the clinic before COVID-19 and during COVID-19. Using TDABC and simulations for varying time, the weighted cost of clinic labor for sick visit before COVID-19 was $54.47 versus $51.55 during COVID-19. Discussion: The estimated mean labor cost for care during the pandemic has not changed from the pre-COVID period; however, this lack of a difference is largely because of the increased use of TH. Conclusions: Our TDABC approach is feasible to use under virtual working conditions; requires minimal provider time for execution; and generates detailed cost estimates that have "face validity" with providers and are relevant for economic evaluation.


Subject(s)
COVID-19 , Telemedicine , Ambulatory Care , Ambulatory Care Facilities , COVID-19/epidemiology , Child , Humans , Pandemics , Telemedicine/methods
7.
Gesundheitswesen, Supplement ; 84(8-9):773, 2022.
Article in English | EMBASE | ID: covidwho-2062337

ABSTRACT

Einleitung Social medicine and other social sciences have long shown that health is not born of pure biology operating separately from social structures. Social health, itself a contested term, has variously attempted to stress the social aspects of health. Existing understandings, however, reify social life. To move beyond such reifications and develop a more nuanced understanding of social health in the making, we investigate how political measures, undertaken to curtail the spread of Covid-19, effected everyday lives with a particular focus on social health understood as something which is enacted in and through social practice. Methoden The presentation draws on empirical data collected in an ethnographic study of the Covid-19 pandemic between March 2020 and April 2022. 80 individuals from across Germany participated in the study. Interviews, focused on everyday practices, were conducted in three-months-intervals. Additionally, participants had the possibility of adding audio-visual materials from their everyday lives. The paper adopts an interplay between a deductive theoretical concept and inductive understandings found in the data. We asked: what is social health and how is it lived? This approach enabled us to engage intriguing findings that challenged or enriched our deductive model and in returning to the data we further interrogated our initial understandings through comparison and reflection. Constructing our empirical account was an ongoing pragmatic process of 'puzzling out' and problem solving that drew on our existing theoretical understandings. Ergebnisse Our presentation concretizes our theoretical understandings with original data sourced during the pandemic to advance a robust notion showing health to be lived social practices sustained in care work. Facing both threats to their biological and social health, our data shows how care work both for self and other, long rendered invisible, became indispensable for participants innovatively maintaining their social health during the pandemic. The analysis shows creative, reflexive, meaning-making actors not over-determined by structural realities or behavioral choices but rather exercising agency to develop new modes of care for self and other. Ultimately, it reveals that health is lived and practiced in the minutiae of the everyday and that it unfolds in the complexity, fluidity and dynamicity of social relations, precisely that which was altered in an instant by the Maßnahmen. Schlussfolgerung Health as this ethnographic study during a time of crisis demonstrates cannot be reduced to behaviors with consequences for biological and psychological? health but needs to be widened to grasp the importance of social practices long understood to be meaningless for health. Studying social health through the lens of ethnography enables a robust and novel understanding of social health capable of grasping health as lived social practice sustained in care work.

8.
Preprint in English | medRxiv | ID: ppmedrxiv-22281373

ABSTRACT

BackgroundDexamethasone, a widely available glucocorticoid, was approved for use in hospitalized COVID-19 patients early in the pandemic based on the RECOVERY trial; however, evidence is still needed to support its real-world effectiveness in patients with a wide range of comorbidities and in diverse care settings. ObjectivesTo conduct a comparative effectiveness analysis of dexamethasone use with and without remdesivir in hospitalized COVID-19 patients using electronic health record data. MethodsWe conducted a retrospective real-world effectiveness analysis using the harmonized, highly granular electronic health record data of the National COVID Cohort Collaborative (N3C) Data Enclave. Analysis was restricted to COVID-19 patients in an inpatient setting, prior to vaccine availability. Primary outcome was in-hospital death; secondary outcome was combined in-hospital death and severe outcome as defined by use of ECMO or mechanical ventilation during stay. Missing data were imputed with single imputation. Matching of dexamethasone-treated patients to non-dexamethasone-treated controls was accomplished using propensity score (PS) matching, stratified by remdesivir treatment and based on demographics, baseline laboratory values, and comorbidities. Treatment benefit was quantified using logistic regression. Further sensitivity analyses were performed using clinical adjusters in matched groups and in strata defined by quartiles of PS. ResultsRegression analysis revealed a statistically significant association between dexamethasone use and reduced risk of in-hospital mortality for those not receiving remdesivir (OR=0.77, 95% CI: 0.62 to 0.95, p=0.017), and a borderline statistically significant risk for those receiving remdesivir (OR=0.74, 95% CI: 0.53 to 1.02, p=0.054). Treatment also showed secondary outcome benefit. In sensitivity analyses, treatment effect size generally remained similar with some heterogeneity of benefit across strata of PS. ConclusionsWe add evidence that dexamethasone provides benefit with respect to mortality and severe outcomes in a diverse, national hospitalized sample, prior to vaccine availability.

9.
Frontiers in immunology ; 13, 2022.
Article in English | EuropePMC | ID: covidwho-2046411

ABSTRACT

Background The COVID-19 pandemic has created pressure on healthcare systems worldwide. Tools that can stratify individuals according to prognosis could allow for more efficient allocation of healthcare resources and thus improved patient outcomes. It is currently unclear if blood gene expression signatures derived from patients at the point of admission to hospital could provide useful prognostic information. Methods Gene expression of whole blood obtained at the point of admission from a cohort of 78 patients hospitalised with COVID-19 during the first wave was measured by high resolution RNA sequencing. Gene signatures predictive of admission to Intensive Care Unit were identified and tested using machine learning and topological data analysis, TopMD. Results The best gene expression signature predictive of ICU admission was defined using topological data analysis with an accuracy: 0.72 and ROC AUC: 0.76. The gene signature was primarily based on differentially activated pathways controlling epidermal growth factor receptor (EGFR) presentation, Peroxisome proliferator-activated receptor alpha (PPAR-α) signalling and Transforming growth factor beta (TGF-β) signalling. Conclusions Gene expression signatures from blood taken at the point of admission to hospital predicted ICU admission of treatment naïve patients with COVID-19.

10.
J Air Waste Manag Assoc ; 2022 Sep 23.
Article in English | MEDLINE | ID: covidwho-2042444

ABSTRACT

BACKGROUND: Most Caribbean islands do not have air pollution surveillance programs. Those who live in these countries are exposed to ambient air pollution from a variety of sources including motor vehicles, ocean-going vessels, and Saharan dust. OBJECTIVES: We conducted an air sampling exposure study in Grenada to describe daily changes in fine particulate matter (PM2.5) pollution, and during Saharan dust episodes. Further, we assessed the impacts of COVID-19 public health interventions on PM2.5 concentrations in 2020. METHODS: Four fixed-site PurpleAir monitors were installed throughout Grenada, and one on the neighboring island of Carriacou. PM2.5 was measured between January 6 and December 31, 2020. We classified each of these days as to whether COVID-19 public health mitigation measures were in place or not. Descriptive analyses were performed to characterize fluctuations in PM2.5, and we assessed the impacts of public health restriction on PM2.5 using multivariate regression. RESULTS: The mean daily PM2.5 concentration in 2020 was 4.4 µg/m3. During the study period, the minimum daily PM2.5 concentration was 0.7 µg/m3, and the maximum was 20.4 µg/m3. Daily mean PM2.5 concentrations more than doubled on Saharan dust days (8.5 vs 3.6 µg/m3; p<0.05). Daily mean PM2.5 concentrations were estimated to be 1.2 µg/m3 lower when COVID-19 restrictions were in effect. SIGNIFICANCE: Ambient PM2.5 concentrations in Grenada are relatively low compared to other countries, however, Saharan dust episodes represent an important source of exposure. Low costs sensors provide an opportunity to increase surveillance of air pollution in the Caribbean, however their value would be enhanced with the development of correction algorithms that more closely approximate values from reference grade monitors.

11.
Journal of the Intensive Care Society ; 23(1):21, 2022.
Article in English | EMBASE | ID: covidwho-2043055

ABSTRACT

Introduction: The worldwide COVID-19 pandemic was a major challenge for all medical actors and in particular for intensive care units.1 Its management is essentially supportive and in its severe form, requires high-flow oxygen therapy for which the ideal application modalities remain to be defined.2 Objectives: This study compares data from two waves during which the management differed substantially: early invasive ventilation during the first wave versus high flow oxygen therapy (Optiflow™ Nasal High Flow, Fisher & Paykel Healthcare) with salvage mechanical invasive ventilation during the second wave. Methods: This single-center observational study included 108 patients: 21 from the first wave and 87 from the second. The two groups were comparable in terms of age, sex, obesity, hypertension, diabetes, and underlying lung disease. The study was conducted from March 2020 to March 2021. The primary outcome was length of hospitalisation. The secondary outcomes were duration of mechanical ventilation and patient mortality at 28 days. As the two groups were matched, the main difference was dexamethasone corticosteroid therapy for 10 days for the second wave. Results: The results show a higher mortality in the high flow oxygen therapy group when compared to the early mechanical ventilation group. This result could be explained by patient fatigue before being placed on mechanical ventilation but also by a higher frequency of pneumonia and bacteraemia in the latter group probably linked to the systematic administration of steroids. On the other hand, the duration of hospitalisation and the duration of mechanical ventilation are shorter in the high flow oxygen therapy group.3 Conclusion: High-flow oxygen therapy can be considered as an alternative to conventional ventilation in the event of respiratory distress following a SARS-CoV-2 infection. Further research should be co-considered. Conflict of interest: None declared. This study was conducted in accordance with the Declaration of Helsinki.

12.
Intensive Care Med ; 48(9): 1260-1261, 2022 09.
Article in English | MEDLINE | ID: covidwho-2041270
13.
BMC Pregnancy Childbirth ; 22(1): 708, 2022 Sep 16.
Article in English | MEDLINE | ID: covidwho-2038679

ABSTRACT

BACKGROUND: Early and appropriate use of antenatal care services is critical for reducing maternal and neonatal mortality and morbidity. Yet most women in sub-Saharan Africa, including Uganda, do not seek antenatal care until later during pregnancy. This qualitative study explored pregnant women's reliance on social ties for information about initiation of antenatal care. METHODS: We conducted semi-structured, in-depth interviews with 30 pregnant women seeking their first antenatal care visit at Kawempe Referral Hospital in Kampala, Uganda. Recruitment was done purposively to obtain variation by parity and whether women currently had a male partner. Study recruitment occurred from August 25th 2020 - October 26th, 2020. We used thematic analysis following a two-stage coding process, with both deductive and inductive codes. Deductive codes followed the key domains of social network and social support theory. RESULTS: We found that the most important source of information about antenatal care initiation was these women's mothers. Other sources included their mothers-in-law, female elders including grandmothers, and male partners. Sisters and female friends were less influential information sources about antenatal initiation. One of the primary reasons for relying on their own mothers, mothers-in-law, and elder women was due to these women's lived experience with pregnancy and childbirth. Trust in the relationship was also an important factor. Some pregnant women were less likely to rely on their sisters or female friends, either due to lack of trust or these women's lack of experience with pregnancy and childbirth. The advice that pregnant women received from their mothers and others on the ideal timing for antenatal care initiation varied significantly, including examples of misinformation about when to initiate antenatal care. Pregnant women seemed less likely to delay care when more than one social tie encouraged early antenatal care. CONCLUSIONS: Educating women's social networks, especially their mothers, mothers-in-law, and community elders, about the importance of early antenatal care initiation is a promising avenue for encouraging pregnant women to seek care earlier in pregnancy.


Subject(s)
Pregnant Women , Prenatal Care , Aged , Female , Humans , Infant, Newborn , Male , Parity , Patient Acceptance of Health Care , Pregnancy , Social Networking , Uganda
14.
Am J Respir Crit Care Med ; 206(6): 712-729, 2022 09 15.
Article in English | MEDLINE | ID: covidwho-2038405

ABSTRACT

Rationale: Patients with chronic obstructive pulmonary disease (COPD) develop more severe coronavirus disease (COVID-19); however, it is unclear whether they are more susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and what mechanisms are responsible for severe disease. Objectives: To determine whether SARS-CoV-2 inoculated primary bronchial epithelial cells (pBECs) from patients with COPD support greater infection and elucidate the effects and mechanisms involved. Methods: We performed single-cell RNA sequencing analysis on differentiated pBECs from healthy subjects and patients with COPD 7 days after SARS-CoV-2 inoculation. We correlated changes with viral titers, proinflammatory responses, and IFN production. Measurements and Main Results: Single-cell RNA sequencing revealed that COPD pBECs had 24-fold greater infection than healthy cells, which was supported by plaque assays. Club/goblet and basal cells were the predominant populations infected and expressed mRNAs involved in viral replication. Proteases involved in SARS-CoV-2 entry/infection (TMPRSS2 and CTSB) were increased, and protease inhibitors (serpins) were downregulated more so in COPD. Inflammatory cytokines linked to COPD exacerbations and severe COVID-19 were increased, whereas IFN responses were blunted. Coexpression analysis revealed a prominent population of club/goblet cells with high type 1/2 IFN responses that were important drivers of immune responses to infection in both healthy and COPD pBECs. Therapeutic inhibition of proteases and inflammatory imbalances reduced viral titers and cytokine responses, particularly in COPD pBECs. Conclusions: COPD pBECs are more susceptible to SARS-CoV-2 infection because of increases in coreceptor expression and protease imbalances and have greater inflammatory responses. A prominent cluster of IFN-responsive club/goblet cells emerges during infection, which may be important drivers of immunity. Therapeutic interventions suppress SARS-CoV-2 replication and consequent inflammation.


Subject(s)
COVID-19 , Pulmonary Disease, Chronic Obstructive , Serpins , Cytokines , Epithelial Cells , Humans , Peptide Hydrolases , Pulmonary Disease, Chronic Obstructive/drug therapy , SARS-CoV-2 , Sequence Analysis, RNA , Serpins/pharmacology , Serpins/therapeutic use
15.
Lancet Psychiatry ; 9(10): 815-827, 2022 10.
Article in English | MEDLINE | ID: covidwho-2036658

ABSTRACT

BACKGROUND: COVID-19 is associated with increased risks of neurological and psychiatric sequelae in the weeks and months thereafter. How long these risks remain, whether they affect children and adults similarly, and whether SARS-CoV-2 variants differ in their risk profiles remains unclear. METHODS: In this analysis of 2-year retrospective cohort studies, we extracted data from the TriNetX electronic health records network, an international network of de-identified data from health-care records of approximately 89 million patients collected from hospital, primary care, and specialist providers (mostly from the USA, but also from Australia, the UK, Spain, Bulgaria, India, Malaysia, and Taiwan). A cohort of patients of any age with COVID-19 diagnosed between Jan 20, 2020, and April 13, 2022, was identified and propensity-score matched (1:1) to a contemporaneous cohort of patients with any other respiratory infection. Matching was done on the basis of demographic factors, risk factors for COVID-19 and severe COVID-19 illness, and vaccination status. Analyses were stratified by age group (age <18 years [children], 18-64 years [adults], and ≥65 years [older adults]) and date of diagnosis. We assessed the risks of 14 neurological and psychiatric diagnoses after SARS-CoV-2 infection and compared these risks with the matched comparator cohort. The 2-year risk trajectories were represented by time-varying hazard ratios (HRs) and summarised using the 6-month constant HRs (representing the risks in the earlier phase of follow-up, which have not yet been well characterised in children), the risk horizon for each outcome (ie, the time at which the HR returns to 1), and the time to equal incidence in the two cohorts. We also estimated how many people died after a neurological or psychiatric diagnosis during follow-up in each age group. Finally, we compared matched cohorts of patients diagnosed with COVID-19 directly before and after the emergence of the alpha (B.1.1.7), delta (B.1.617.2), and omicron (B.1.1.529) variants. FINDINGS: We identified 1 487 712 patients with a recorded diagnosis of COVID-19 during the study period, of whom 1 284 437 (185 748 children, 856 588 adults, and 242 101 older adults; overall mean age 42·5 years [SD 21·9]; 741 806 [57·8%] were female and 542 192 [42·2%] were male) were adequately matched with an equal number of patients with another respiratory infection. The risk trajectories of outcomes after SARS-CoV-2 infection in the whole cohort differed substantially. While most outcomes had HRs significantly greater than 1 after 6 months (with the exception of encephalitis; Guillain-Barré syndrome; nerve, nerve root, and plexus disorder; and parkinsonism), their risk horizons and time to equal incidence varied greatly. Risks of the common psychiatric disorders returned to baseline after 1-2 months (mood disorders at 43 days, anxiety disorders at 58 days) and subsequently reached an equal overall incidence to the matched comparison group (mood disorders at 457 days, anxiety disorders at 417 days). By contrast, risks of cognitive deficit (known as brain fog), dementia, psychotic disorders, and epilepsy or seizures were still increased at the end of the 2-year follow-up period. Post-COVID-19 risk trajectories differed in children compared with adults: in the 6 months after SARS-CoV-2 infection, children were not at an increased risk of mood (HR 1·02 [95% CI 0·94-1·10) or anxiety (1·00 [0·94-1·06]) disorders, but did have an increased risk of cognitive deficit, insomnia, intracranial haemorrhage, ischaemic stroke, nerve, nerve root, and plexus disorders, psychotic disorders, and epilepsy or seizures (HRs ranging from 1·20 [1·09-1·33] to 2·16 [1·46-3·19]). Unlike adults, cognitive deficit in children had a finite risk horizon (75 days) and a finite time to equal incidence (491 days). A sizeable proportion of older adults who received a neurological or psychiatric diagnosis, in either cohort, subsequently died, especially those diagnosed with dementia or epilepsy or seizures. Risk profiles were similar just before versus just after the emergence of the alpha variant (n=47 675 in each cohort). Just after (vs just before) the emergence of the delta variant (n=44 835 in each cohort), increased risks of ischaemic stroke, epilepsy or seizures, cognitive deficit, insomnia, and anxiety disorders were observed, compounded by an increased death rate. With omicron (n=39 845 in each cohort), there was a lower death rate than just before emergence of the variant, but the risks of neurological and psychiatric outcomes remained similar. INTERPRETATION: This analysis of 2-year retrospective cohort studies of individuals diagnosed with COVID-19 showed that the increased incidence of mood and anxiety disorders was transient, with no overall excess of these diagnoses compared with other respiratory infections. In contrast, the increased risk of psychotic disorder, cognitive deficit, dementia, and epilepsy or seizures persisted throughout. The differing trajectories suggest a different pathogenesis for these outcomes. Children have a more benign overall profile of psychiatric risk than do adults and older adults, but their sustained higher risk of some diagnoses is of concern. The fact that neurological and psychiatric outcomes were similar during the delta and omicron waves indicates that the burden on the health-care system might continue even with variants that are less severe in other respects. Our findings are relevant to understanding individual-level and population-level risks of neurological and psychiatric disorders after SARS-CoV-2 infection and can help inform our responses to them. FUNDING: National Institute for Health and Care Research Oxford Health Biomedical Research Centre, The Wolfson Foundation, and MQ Mental Health Research.


Subject(s)
Brain Ischemia , COVID-19 , Dementia , Ischemic Stroke , Sleep Initiation and Maintenance Disorders , Stroke , Adolescent , Adult , Aged , COVID-19/epidemiology , Child , Cohort Studies , Dementia/epidemiology , Female , Humans , Male , Retrospective Studies , SARS-CoV-2 , Seizures
17.
JMIR Form Res ; 6(7): e38263, 2022 Jul 28.
Article in English | MEDLINE | ID: covidwho-2022392

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, several home monitoring programs have described the success of reducing hospital admissions, but only a few studies have investigated the experiences of patients and health care professionals. OBJECTIVE: The objective of our study was to determine patients' and health care professionals' experiences and satisfaction with employing the COVID-box. METHODS: In this single-center, retrospective, observational study, patients and health care professionals were asked to anonymously fill out multiple-choice questionnaires with questions on a 5-point or 10-point Likert scale. The themes addressed by patients were the sense of reassurance and safety, experiences with teleconsultations, their appreciation for staying at home, and the instructions for using the COVID-box. The themes addressed by health care professionals who treated patients with the COVID-box were the characteristics of the COVID-box, the technical support service and general satisfaction, and their expectations and support for this telemonitoring concept. Scores were interpreted as insufficient (≤2 or ≤5, respectively), sufficient (3 or 6-7, respectively), or good (≥4 or ≥8, respectively) on a 5-point or 10-point Likert scale. RESULTS: A total of 117 patients and 25 health care professionals filled out the questionnaires. The median score was 4 (IQR 4-5) for the sense of safety, the appreciation for staying at home, and experiences with teleconsultations, with good scores from 76.5% (88/115), 86% (56/65), and 83.6% (92/110) of the patients, respectively. Further, 74.4% (87/117) of the patients scored the home monitoring program with a score of ≥8. Health care professionals scored the COVID-box with a minimum median score of 7 (IQR 7-10) on a 10-point scale for all domains (ie, the characteristics of the COVID-box and the technical support service and general satisfaction). For the sense of safety, user-friendliness, and additional value of the COVID-box, the median scores were 8 (IQR 8-10), 8 (IQR 7-9), and 10 (IQR 8-10), respectively, with good scores from 86% (19/22), 75% (15/20), and 96% (24/25) of the health care professionals, respectively. All health care professionals (25/25, 100%) gave a score of ≥8 for supporting this home monitoring concept, with a median score of 10 (IQR 10-10). CONCLUSIONS: The positive experiences and satisfaction of involved users are key factors for the successful implementation of a novel eHealth solution. In our study, patients, as well as health care professionals, were highly satisfied with the use of the home monitoring program-the COVID-box project. Remote home monitoring may be an effective approach in cases of increased demand for hospital care and high pressure on health care systems.

18.
J Am Heart Assoc ; 11(19): e025914, 2022 10 04.
Article in English | MEDLINE | ID: covidwho-2020596

ABSTRACT

Background A recent randomized trial, the MICHELLE trial, demonstrated improved posthospital outcomes with a 35-day course of prophylactic rivaroxaban for patients hospitalized with COVID-19 at high risk of venous thromboembolism. We explored how often these findings may apply to an unselected clinical population of patients hospitalized with COVID-19. Methods and Results Using a 35-hospital retrospective cohort of patients hospitalized between March 7, 2020, and January 23, 2021, with COVID-19 (MI-COVID19 database), we quantified the percentage of hospitalized patients with COVID-19 who would be eligible for rivaroxaban at discharge per MICHELLE trial criteria and report clinical event rates. The main clinical outcome was derived from the MICHELLE trial and included a composite of symptomatic venous thromboembolism, pulmonary embolus-related death, nonhemorrhagic stroke, and cardiovascular death at 35 days. Multiple sensitivity analyses tested different eligibility and exclusion criteria definitions to determine the effect on eligibility for postdischarge anticoagulation prophylaxis. Of 2016 patients hospitalized with COVID-19 who survived to discharge and did not have another indication for anticoagulation, 25.9% (n=523) would be eligible for postdischarge thromboprophylaxis per the MICHELLE trial criteria (range, 2.9%-39.4% on sensitivity analysis). Of the 416 who had discharge anticoagulant data collected, only 13.2% (55/416) were actually prescribed a new anticoagulant at discharge. Of patients eligible for rivaroxaban per the MICHELLE trial, the composite clinical outcome occurred in 1.2% (6/519); similar outcome rates were 5.7% and 0.63% in the MICHELLE trial's control (no anticoagulation) and intervention (rivaroxaban) groups, respectively. Symptomatic venous thromboembolism events and all-cause mortality were 6.2% (32/519) and 5.66% in the MI-COVID19 and MICHELLE trial control cohorts, respectively. Conclusions Across 35 hospitals in Michigan, ≈1 in 4 patients hospitalized with COVID-19 would qualify for posthospital thromboprophylaxis. With only 13% of patients actually receiving postdischarge prophylaxis, there is a potential opportunity for improvement in care.


Subject(s)
COVID-19 , Venous Thromboembolism , Aftercare , Anticoagulants/therapeutic use , COVID-19/complications , Humans , Patient Discharge , Randomized Controlled Trials as Topic , Retrospective Studies , Rivaroxaban/therapeutic use , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control
19.
International Conference on Big Data and Cloud Computing, ICBDCC 2021 ; 905:333-338, 2022.
Article in English | Scopus | ID: covidwho-2014029

ABSTRACT

SARS-CoV, mostly referred as COVID-19, has excogitated as a pandemic that has spread in 220 countries and territories across the globe. With various mutants emerging in countries, the infection has mounted to a greater extent inescapably affecting millions of people. The unceasing deaths and the extended rise in the infected cases indicate very feeble sign of a well-controlled situation as the medical world is constantly challenged. The current disrupting situation has pushed governments across the globe to inflict partial or complete lockdowns to avoid the second wave of the epidemic. The need of the hour is to alert people towards very close contact of the infected persons exposed to coughing and sneezing and thereby avoiding huge catastrophes. Persuaded with the recent elevation in the research and development of devices and equipment to shield and prevent the proliferation of this deadly disease, Internet of Things (IoT) and cloud-based remote monitoring can provide suitable solution in contagious transmission. The paper presents an overview of the contemporary unfurl of SARS-CoV, the exercising measures taken to fight against it, the ultimatum of the applications and recommendation of a new IoT-based healthcare framework. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

20.
Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR ; 58:136-136, 2022.
Article in English | EuropePMC | ID: covidwho-2011003

ABSTRACT

Canadian Respiratory Therapist COVID-19 vaccination uptake rates and responses were investigated with a look at the reasons behind any delays or non-vaccinations as well as other demographics, attitudes, or factors that may be shown to play a role. An anonymous survey using SurveyMonkey® on vaccination uptake rates, responses, and attitudes was available to Student, Graduate, and Registered Respiratory Therapists in Canada from July to October of 2021. A total of 1066 surveys (8.4% of target population) were started, 983 in English and 83 in French with 1013 completed fully and included in the data analysis. Canadian RT Vaccination uptake rates were compared to those of all Canadian healthcare workers which showed that 90.42% of the surveyed RT population in Canada received their vaccination right away compared to the posted rate at the time of 86.27% for all Canadian Healthcare Workers. Pearson Chi-Square Tests were performed to evaluate association between vaccination status and other categorical parameters evaluated in the survey. There was a significant (P = 0.013) association between early vaccination and age, a significant (P = 0.036) association between vaccination status and participants’ response on whether or not they have a family member or know someone who has had COVID-19, a significant (P < 0.001) association between vaccination status and attitudes towards trusting science to develop safe, effective, new vaccines, and a significant (P < 0.001) association between vaccination status and attitudes towards trusting the Ministry of Health to ensure that vaccines are safe. There was no significant association between vaccination status and gender, province/territory of residency/work, level of education, level of involvement with COVID-19 patients. The results suggest that the RT groups across Canada had higher early vaccination uptake rates than the general Healthcare worker groups and that age, relationship to people with COVID-19 and trust in science played a significant role in their vaccination uptake rates.

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