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1.
PLoS Pathog ; 18(9):e1010802, 2022.
Article in English | PubMed | ID: covidwho-2021984

ABSTRACT

The impact of vaccination on SARS-CoV-2 infectiousness is not well understood. We compared longitudinal viral shedding dynamics in unvaccinated and fully vaccinated adults. SARS-CoV-2-infected adults were enrolled within 5 days of symptom onset and nasal specimens were self-collected daily for two weeks and intermittently for an additional two weeks. SARS-CoV-2 RNA load and infectious virus were analyzed relative to symptom onset stratified by vaccination status. We tested 1080 nasal specimens from 52 unvaccinated adults enrolled in the pre-Delta period and 32 fully vaccinated adults with predominantly Delta infections. While we observed no differences by vaccination status in maximum RNA levels, maximum infectious titers and the median duration of viral RNA shedding, the rate of decay from the maximum RNA load was faster among vaccinated;maximum infectious titers and maximum RNA levels were highly correlated. Furthermore, amongst participants with infectious virus, median duration of infectious virus detection was reduced from 7.5 days (IQR: 6.0-9.0) in unvaccinated participants to 6 days (IQR: 5.0-8.0) in those vaccinated (P = 0.02). Accordingly, the odds of shedding infectious virus from days 6 to 12 post-onset were lower among vaccinated participants than unvaccinated participants (OR 0.42 95% CI 0.19-0.89). These results indicate that vaccination had reduced the probability of shedding infectious virus after 5 days from symptom onset.

2.
PLoS Global Public Health ; 2(7), 2022.
Article in English | GIM | ID: covidwho-2021485

ABSTRACT

Therapeutic efficacy in COVID-19 is dependent upon disease severity (treatment effect heterogeneity). Unfortunately, definitions of severity vary widely. This compromises the meta-analysis of randomised controlled trials (RCTs) and the therapeutic guidelines derived from them. The World Health Organisation 'living' guidelines for the treatment of COVID-19 are based on a network meta-analysis (NMA) of published RCTs. We reviewed the 81 studies included in the WHO COVID-19 living NMA and compared their severity classifications with the severity classifications employed by the international COVID-NMA initiative. The two were concordant in only 35% (24/68) of trials. Of the RCTs evaluated, 69% (55/77) were considered by the WHO group to include patients with a range of severities (12 mild-moderate;3 mild-severe;18 mild-critical;5 moderate-severe;8 moderate-critical;10 severe-critical), but the distribution of disease severities within these groups usually could not be determined, and data on the duration of illness and/or oxygen saturation values were often missing. Where severity classifications were clear there was substantial overlap in mortality across trials in different severity strata. This imprecision in severity assessment compromises the validity of some therapeutic recommendations;notably extrapolation of "lack of therapeutic benefit" shown in hospitalised severely ill patients on respiratory support to ambulant mildly ill patients is not warranted. Both harmonised unambiguous definitions of severity and individual patient data (IPD) meta-analyses are needed to guide and improve therapeutic recommendations in COVID-19. Achieving this goal will require improved coordination of the main stakeholders developing treatment guidelines and medicine regulatory agencies. Open science, including prompt data sharing, should become the standard to allow IPD meta-analyses.

3.
Counseling Outcome Research and Evaluation ; 2022.
Article in English | Scopus | ID: covidwho-1878713

ABSTRACT

Behavioral health provider shortages continue to grow in the United States, with the need for related services increasing as the SARS-COVID-19 pandemic persists. The implementation of integrated primary and behavioral healthcare (IPBH) practices represents one viable approach to leverage existing resources and maximize the potential for client outcomes;however, best practices for counselors within an IPBH paradigm remain unclear. We report the findings of a mixed method evaluation of an IPBH training program with 45 (36 females;9 males;M age = 31.65) professional counseling students who predominately identified with ethnic minority identities (55%), urban residences (66%), and disadvantaged backgrounds (44%). We detected statistically and practically significant changes in self-efficacy (p = .01, d =.55) and interprofessional valuing and socialization (p <.01, d =.76), but mixed findings for variables associated with multicultural competence. Stakeholder interviews and document analysis identified four key facilitators (Financial Support;Facilitated Engagement;Witnessing Collaboration;Holistic Representation of Clients and Client Care) and four barriers (Awareness Raising and Recruitment;Logistics and Coordination;Inconsistent Culture of IPBH;Momentum Maintenance) to program success. © 2022 Association for Assessment and Research in Counseling (AARC).

4.
Assistive Technology Outcomes and Benefits ; 16(1):1-20, 2022.
Article in English | Scopus | ID: covidwho-1787127

ABSTRACT

This explanatory sequential mixed-methods study sought to describe the implementation process of AT/AAC from school to home during the COVID-19 pandemic, including the extent to which AT/AAC was used, how AT/AAC was used, and what, if any, support the school systems provided. A researcher-designed survey was completed by 104 special educators and 45 parents. Seventeen follow-up interviews were conducted with educators and parent participants. Results of the study demonstrated the importance of clear communication, explicit expectations and procedures for AT/AAC use, and collaboration among stakeholders if AT/AAC implementation is to be as effective as possible. © ATIA 2022.

5.
Wellcome Open Research ; 5:1-21, 2021.
Article in English | Scopus | ID: covidwho-1485497

ABSTRACT

There is no proven preventative therapy or vaccine against COVID-19. Theinfection has spread rapidly and there has already been a substantial adverse impact on the global economy. Healthcare workers have been affected disproportionately in the continuing pandemic. Significant infection rates in this critical group have resulted in a breakdown of health services in some countries. Chloroquine, and the closely related hydroxychloroquine, are safe and well tolerated medications which can be given for years without adverse effects. Chloroquine and hydroxychloroquine have significant antiviral activity against SARS-CoV-2, and despite the lack of benefit of hydroxychloroquine treatment in patients hospitalised with severe COVID-19, these drugs could still work in prevention. The emerging infection paradigm of an early viral peak, and late inflammation where there is benefit from corticosteroids. If these direct actiing antivirals are to work, they have the best chance given either early in infection infection occurs. We describe the study protocol for multi-centre, multi-country randomised, double blind, placebo controlled trial to answer the question can chloroquine/ hydroxychloroquine prevent COVID-19. 40,000 participants working in healthcare facilities or involved in the management of COVID-19 will be randomised 1:1 to receive chloroquine/ hydroxychloroquine or matched placebo as daily prophylaxis for three months. The primary objective is the prevention of symptomatic, virological or serologically proven coronavirus disease (COVID-19). The study could detect a 23% reduction from an incidence of 3% in the placebo group for either drug with 80% power. Secondary objectives are to determine ifchloroquine/hydroxychloroquine prophylaxis attenuates severity, prevents asymptomaticCOVID-19 and symptomatic acute respiratory infections of another aetiology (non-SARS-CoV-2). © 2020. Schilling WH et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

6.
Antimicrobial Resistance and Infection Control ; 10(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1448340

ABSTRACT

Introduction: The World Health Organization recommends improving hand hygiene (HH) practices of the general public as one aspect of controlling the transmission of novel coronaviruses and influenza virus epidemics or pandemics. Objectives: To systematically review the evidence on the effectiveness of HH interventions for preventing transmission or acquisition of viral infections in the community. Methods: PubMed, MEDLINE, CINAHL and Web of Science databases were searched for empirical studies published between 2002-May 2020, on HH in the general public and acquisition or transmission of novel coronavirus infections or influenza. Study selection, data extraction and quality assessment were conducted by one reviewer, with all decisions checked by another. We conducted a sub-set analysis of intervention studies included in this review, by calculating the effect estimates. Results: The review identified four intervention studies, all of which used cluster randomised designs evaluating the effectiveness of HH education paired with provision of HH products or hand washing with soap and water (HW) against influenza transmission or acquisition amongst the populations of schoolchildren (n = 2) or the general public (n = 2). Three indicated a protective effect of HH interventions (Figure);yet, this effect was significant for only one school-based intervention, which consisted of the provision of HH education and performing HW twice a day (OR: 0.64;95% CI 0.51, 0.80). However, the risk of bias of this study was assessed as unclear;whereas the remaining three studies were assessed as high risk. Conclusion: There is some limited evidence demonstrating that hand hygiene interventions were effective in preventing influenza in school children. Thus, whilst provision of HH education to school children will be beneficial from a public health perspective, it's impact on influenza transmission is unclear. Research is needed to evaluate the effectiveness of HH interventions for prevention of respiratory infections, including SARS-CoV-2, amongst more diverse groups of the general public populations.

7.
J Vet Med Educ ; : e20210015, 2021 Aug 31.
Article in English | MEDLINE | ID: covidwho-1379933

ABSTRACT

Peer evaluation of teaching (PET) serves an important role as a component of faculty development in the medical education field. With the emergence of COVID-19, the authors recognized the need for a flexible tool that could be used for a variety of lecture formats, including virtual instruction, and that could provide a framework for consistent and meaningful PET feedback. This teaching tip describes the creation and pilot use of a PET rubric, which includes six fixed core items (lesson structure, content organization, audiovisual facilitation, concept development, enthusiasm, and relevance) and items to be assessed separately for asynchronous lectures (cognitive engagement-asynchronous) and synchronous lectures (cognitive engagement-synchronous, discourse quality, collaborative learning, and check for understanding). The instrument packet comprises the rubric, instructions for use, definitions, and examples of each item, plus three training videos for users to compare with authors' consensus training scores; these serve as frame-of-reference training. The instrument was piloted among veterinary educators, and feedback was sought in a focus group setting. The instrument was well received, and training and use required a minimum time commitment. Inter-rater reliability within 1 Likert scale point (adjacent agreement) was assessed for each of the training videos, and consistency of scoring was demonstrated between focus group members using percent agreement (0.82, 0.85, 0.88) and between focus members and the authors' consensus training scores (all videos: 0.91). This instrument may serve as a helpful resource for institutions looking for a framework for PET. We intend to continually adjust the instrument in response to feedback from wider use.

8.
Wellcome Open Research ; 6:71, 2021.
Article in English | MEDLINE | ID: covidwho-1359433

ABSTRACT

The World Health Organization living guideline on drugs to prevent COVID-19 has recently advised that ongoing trials evaluating hydroxychloroquine in chemoprophylaxis should stop. The WHO guideline cites "high certainty" evidence from randomised controlled trials (RCTs) that hydroxychloroquine prophylaxis does not reduce mortality and does not reduce hospital admission, and "moderate certainty" evidence of poor tolerability because of a significantly increased rate of adverse events leading to drug discontinuation. Yet there is no such evidence. In the three pre-exposure chemoprophylaxis RCTs evaluated in the guideline there were no deaths and only two COVID-19-related hospital admissions, and there was a mistake in the analysis of the number of discontinuations (after correction there is no longer a statistically significant difference between those taking the drug and the controls). Guidelines on the prevention and treatment of COVID-19 should be based on sufficient verified evidence, understanding of the disease process, sound statistical analysis and interpretation, and an appreciation of global needs.

9.
Frontiers in Communication ; 5:7, 2020.
Article in English | Web of Science | ID: covidwho-1339473

ABSTRACT

Health communicators help promote recommended health behaviors by providing accurate, actionable health information that is easy to read and understand. The COVID-19 public health crisis presents a special challenge to clear health communication because some populations most affected by the virus are also at risk for limited health literacy. We collected 28 consumer COVID-19 materials from the internet using popular search engines. We then assessed the materials for readability, understandability, and actionability using validated tools. Aggregate results suggest that the sample of materials was difficult to read and lacked a number of recommended features that promote a readers' ability to understand and act upon the information. We present these findings, their implications for health equity, and their limitations and then suggest ways to improve future health communication about time-sensitive infectious diseases.

10.
J Laryngol Otol ; 135(6): 545-546, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1313524

ABSTRACT

BACKGROUND: This technical note describes a novel method of cauterising the posterior nasal cavity through the use of a plastic straw and silver nitrate. OBJECTIVE: This technique aims to prevent unwanted damage to surrounding nasal mucosa. METHODS: Once the nasal cavity has been prepared for cauterisation, the silver nitrate stick is navigated to the bleeding point covered by the plastic straw. The silver nitrate stick is then advanced onto the bleeding point allowing precise cauterisation of the nasal mucosa, without effecting surrounding healthy mucosa.


Subject(s)
Cautery/instrumentation , Cautery/methods , Nasal Cavity/surgery , Silver Nitrate , Equipment Design , Humans
11.
Age and Ageing ; 50(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1254397

ABSTRACT

Introduction COVID-19 Trauma Guidance suggests opportunities for structured,time-limited discussions about challenging experiences should beoffered. It is unknown if such discussions can be effectivelydelivered online by palliative care specialists to support care home(CH) staff in relation to death/dying. Funded by Scotland's ChiefScientist Office COVID-19 “rapid research” fund, online OSCaRS isbeing piloted. Methods Fortnightly OSCaRS delivered to small groups of CH staff via asecure online platform in three local CHs over 10 weeks. Sessionsare digitally recorded. The shortened version of the Chesneycoping self-efficacy questionnaire is completed by all staffpre/post. Additional post-study questions asked of OSCaRSparticipants and in-depth staff interviews will be undertaken (n = 10). Thematic analysis of the recorded sessions and interviews willbe undertaken and related to the staff questionnaire and context of each CH. Results New learning on the feasibility and acceptability of providingOSCaRS to frontline staff. The benefit of OSCaRS to CH staff copingmechanisms, team cohesion and communicaton with relativesduring the COVID-19 pandemic will be presented. Initial results show that OSCaRS are feasible, valued by all care home staff and support staff in coping with the challenges of COVID-19/. Key Conclusions The analysis will inform future practice, and an ImplementationGuide for OSCaRS in CHs will be produced. Key learning on thepotential for online support in relation to death/dying during thepandemic and beyond will contribute to future education, trainingand staff wellbeing resources. It will also inform the role of suchsessions in developing individual coping mechanisms and teamworking alongside communication with relatives duringlockdown.

12.
Annals of Behavioral Medicine ; 55:S8-S8, 2021.
Article in English | Web of Science | ID: covidwho-1250629
13.
Oman Medical Journal ; 35 (1):6, 2020.
Article in English | EMBASE | ID: covidwho-820375

ABSTRACT

Objectives: Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe respiratory illness. The majority of cases worldwide have been reported by Saudi Arabia. Clinicians and health authorities in Saudi Arabia are required to report all suspected MERS-CoV cases to the Health Electronic Surveillance Network (HESN), a national electronic surveillance platform. We aimed to describe trends in MERS-CoV surveillance and laboratory testing in Saudi Arabia over a three-year period. Method(s): Demographic information and laboratory results were collected for all suspected MERS-CoV cases reported to HESN between 1 March 2016 and 20 March 2019. Demographic and laboratory data of suspected and confirmed cases was analyzed. Data were stratified by local Health Affairs Directorate (HAD) and population estimates obtained from the Ministry of Health. Result(s): During the study period, 200 937 suspected MERS-CoV cases were reported to HESN. MERS-CoV was detected in 698 (0.3%;0.7 per 100 000 population per year). The majority of suspected cases were male (54.3%) and Saudi nationals (72.8%). Among the confirmed cases, 517 (74.1%) were male, 501 (71.8%) were Saudi nationals, and the median age was 54 years (interquartile range: 40 years-65 years). No MERS-CoV cases were identified among Hajj pilgrims. Percent positivity varied by region, with the highest percentage in Hafer Al- Baten HAD (1.2%), followed by Najran HAD (1.1%). Conclusion(s): Saudi Arabia continues to perform extensive surveillance for MERS-CoV, with an average of ~5400 suspected cases identified and tested per month. Continued surveillance is needed to better understand transmission and to monitor testing practices.

14.
Preprint in English | medRxiv | ID: ppmedrxiv-20207878

ABSTRACT

BackgroundCOVID-19 mitigation strategies have been challenging to implement in resource-limited settings such as Malawi due to the potential for widespread disruption to social and economic well-being. Here we estimate the clinical severity of COVID-19 in Malawi, quantifying the potential impact of intervention strategies and increases in health system capacity. MethodsThe infection fatality ratios (IFR) in Malawi were estimated by adjusting reported IFR for China accounting for demography, the current prevalence of comorbidities and health system capacity. These estimates were input into an age-structured deterministic model, which simulated the epidemic trajectory with non-pharmaceutical interventions. The impact of a novel therapeutic agent and increases in hospital capacity and oxygen availability were explored, given different assumptions on mortality rates. FindingsThe estimated age-specific IFR in Malawi are higher than those reported for China, however the younger average age of the population results in a slightly lower population-weighted IFR (0.48%, 95% uncertainty interval [UI] 0.30% - 0.72% compared with 0.60%, 95% CI 0.4% - 1.3% in China). The current interventions implemented, (i.e. social distancing, workplace closures and public transport restrictions) could potentially avert 3,100 deaths (95% UI 1,500 - 4,500) over the course of the epidemic. Enhanced shielding of people aged [≥] 60 years could avert a further 30,500 deaths (95% UI 17,500 - 45,600) and halve ICU admissions at the peak of the outbreak. Coverage of face coverings of 60% under the assumption of 50% efficacy could be sufficient to control the epidemic. A novel therapeutic agent, which reduces mortality by 0.65 and 0.8 for severe and critical cases respectively, in combination with increasing hospital capacity could reduce projected mortality to 2.55 deaths per 1,000 population (95% UI 1.58 - 3.84). ConclusionThe risks due to COVID-19 vary across settings and are influenced by age, underlying health and health system capacity. Summary BoxO_ST_ABSWhat is already known?C_ST_ABSO_LIAs COVID-19 spreads throughout Sub-Saharan Africa, countries are under increasing pressure to protect the most vulnerable by suppressing spread through, for example, stringent social distancing measures or shielding of those at highest risk away from the general population. C_LIO_LIThere are a number of studies estimating infection fatality ratio due to COVID-19 but none use data from African settings. The estimated IFR varies across settings ranging between 0.28-0.99%, with higher values estimated for Europe (0.77%, 95% CI 0.55 - 0.99%) compared with Asia (0.46%, 95% CI 0.38 - 0.55). C_LIO_LIThe IFR for African settings are still unknown, although several studies have highlighted the potential for increased mortality due to comorbidities such as HIV, TB and malaria. C_LIO_LIThere are a small number of studies looking at the impact of non-pharmaceutical interventions in Africa, particularly South Africa, but none to date have combined this with country-specific estimates of IFR adjusted for comorbidity prevalence and with consideration to the prevailing health system constraints and the impact of these constraints on mortality rates. C_LI What are the new findings?O_LIAfter accounting for the health system constraints and differing prevalences of underlying comorbidities, the estimated infection fatality ratio (IFR) for Malawi (0.48%, 95% uncertainty interval 0.30% - 0.72%) is within the ranges reported for the Americas, Asia and Europe (overall IFR 0.70, 95% CI 0.57 - 0.82, range 0.28 - 0.89). C_LIO_LIIntroducing enhanced shielding of people aged [≥] 60 years could avert up to 30,500 deaths (95% UI 17,500 - 45,600) and significantly reduce demand on ICU admissions. C_LIO_LIMaintaining coverage of face coverings at 60%, under the assumption of 50% efficacy, could be sufficient to control the epidemic. C_LIO_LICombining the introduction of a novel therapeutic agent with increases in hospital capacity could reduce projected mortality to 2.55 deaths per 1,000 population (95% UI 1.58 - 3.84). C_LI What do the new findings imply?O_LIAdjusting estimates of COVID-19 severity to account for underlying health is crucial for predicting health system demands. C_LIO_LIA multi-pronged approach to controlling transmission, including face coverings, increasing hospital capacity and using new therapeutic agents could significantly reduce deaths to COVID-19, but is not as effective as a theoretical long-lasting lockdown. C_LI

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