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1.
Embase; 23.
Preprint in English | EMBASE | ID: ppcovidwho-346595

ABSTRACT

The first step in SARS-CoV-2 genomic surveillance is testing to identify infected people. However, global testing rates are falling as we emerge from the acute health emergency and remain low in many low- and middle-income countries (LMICs) (mean = 27 tests/100,000 people/day). We simulated COVID-19 epidemics in a prototypical LMIC to investigate how testing rates, sampling strategies, and sequencing proportions jointly impact surveillance outcomes and showed that low testing rates and spatiotemporal biases delay time-to-detection of new variants by weeks-to-months and can lead to unreliable estimates of variant prevalence even when the proportion of samples sequenced is increased. Accordingly, investments in wider access to diagnostics to support testing rates of ~100 tests/100,000 people/day could enable more timely detection of new variants and reliable estimates of variant prevalence. The performance of global SARS-CoV-2 genomic surveillance programs is fundamentally limited by access to diagnostic testing. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.

2.
Cardiology in the Young ; 32(Supplement 2):S18-S19, 2022.
Article in English | EMBASE | ID: covidwho-2062116

ABSTRACT

Background and Aim: Kawasaki disease (KD) is a paediatric vasculitis with an unknown aetiology. The aim of this study was to assess the clinical course, treatment and cardiovascular outcomes in children with KD. The secondary purpose of this study was to make a com-parison with the Kawasaki-like disease Multisystem Inflammatory Syndrome in Children (MIS-C), which is triggered by SARS-CoV-2. Method(s): In this observational cohort study, clinical information from KD and MIS-C patients was collected. Data were described and a multivariate analysis was performed to identify risk factors for coronary artery aneurysms (CAAs). Clinical characteristics between KD and MIS-C were compared using chi-squared and Mann-Whitney U tests. Result(s): 1003 KD patients were included. The male-to-female ratio was 3:2, a majority of the patients were lt;5 years old (78.3%), treated with a single dose of intravenous immunoglobulin (IVIG) (90.8%) and treated promptly (lt;10 days) (81.7%). A second dose of IVIG was needed in minority of the patients (24.7%). The main complication of KD were CAAs and known risk factors (i.e., male, young age, delayed treatment) for CAAs were confirmed. A total of 35 MIS-C patients were included for the comparison. These patients were older than the KD patients (Plt;0.0005), more often had an incomplete KD presentation (Plt;0.0005). MIS-C patients mainly presented with acute cardiac dysfunction, with complete recovery after treatment. Conclusion(s): KD and MIS-C are severe post-infectious inflamma-tory diseases. Due to the risk of cardiovascular complications, vigi-lance and prompt treatment are advised to reduce risk of cardiovascular complications.

3.
Chest ; 162(4):A351-A352, 2022.
Article in English | EMBASE | ID: covidwho-2060571

ABSTRACT

SESSION TITLE: Post-COVID-19 Infection Complications SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Coccidioidomycosis caused by the fungi C. immitis and C. Posadasii is well known to be endemic to the Southwest United States. Less than 1% of these infections will manifest as extrapulmonary symptoms and multiple sites causing dissemination fungemia [1]. Risk factors for disseminated infection include exogenous immunosuppression, immunodeficiency, pregnancy, and ethnic backgrounds of African and Filipino descent [2]. CASE PRESENTATION: A 39-year-old previously immunocompetent Congolese male with recent onset of recurrent skin abscess, and positive testing for COVID-19 three week prior (not treated with steroids). He presents with shortness of breath, back pain, fevers after recently migrating from the Southwest region to the Midwest. Upon admission imaging with Computed Tomography (CT) revealed extensive pulmonary infiltrates (Fig 1), intra-abdominal abscesses, and magnetic resonance imaging revealing (MRI) osteomyelitis of the thoracic (Fig 2) and lumbar spine (Fig 3). His work of breathing continued to worsen, requiring prompt intubation, and he was initiated on a broad-spectrum antimicrobial regimen, including fluconazole, voriconazole, cefepime and vancomycin. Immunoglobulins, HIV and oxidative burst testing was unremarkable. Cultures from image-guided aspiration of the psoas abscess, incision, and drainages of skin abscess and bronchoalveolar lavage fluid were all positive for coccidioidomycosis, transitioned to amphotericin B. Course complicated with the development of multidrug-resistance pseudomonas aerogenes VAP treated with inhaled tobramycin and meropenem. He developed progressive acute respiratory distress syndrome with refractory hypoxemia. After 3 weeks of antimicrobial and anti-fungal treatment, a decision was made to transfer the patient to a lung transplant center, however, due to ongoing fungemia, he was deemed to be not a candidate for extracorporeal membrane exchange and lung transplantation. About a month into his hospitalization, the family decided to withdraw care. DISCUSSION: Reactivation of latent coccidiomycosis has been largely studied in the immunosuppressed population that includes HIV, hematological malignancies, and diabetes mellitus, however little is known about this fungal infection in the immunosuppressed state in the setting of COVID-19. Thus far only two case reports have been reported of co-infection if COVID-19 and pulmonary coccidioidomycosis [3]. The days of the COVID-19 pandemic might contribute to further delays in diagnosing this fungal infection due to similarities of pulmonary manifestation. CONCLUSIONS: This case demonstrates a COVID-19 infection leading to an immunosuppressed status resulting in disseminated infection from reactivation of latent coccidiomycosis. As a result, physicians must maintain a high level of suspicion for superimposed fungal infections in those with even relative immunosuppression from a recent COVID infection. Reference #1: Odio CD, Marciano BE, Galgiani JN, Holland SM. Risk Factors for Disseminated Coccidioidomycosis, United States. Emerg Infect Dis. 2017;23(2):308-311. doi:10.3201/eid2302.160505 Reference #2: Hector RF, Laniado-Laborin R. Coccidioidomycosis–a fungal disease of the Americas. PLoS Med. 2005;2(1):e2. doi:10.1371/journal.pmed.0020002 Reference #3: Shah AS, Heidari A, Civelli VF, et al. The Coincidence of 2 Epidemics, Coccidioidomycosis and SARS-CoV-2: A Case Report. Journal of Investigative Medicine High Impact Case Reports. January 2020. doi:10.1177/2324709620930540 DISCLOSURES: No relevant relationships by Stephen Doyle No relevant relationships by Connor McCalmon No relevant relationships by John Parent No relevant relationships by Jay Patel No relevant relationships by Angela Peraino No relevant relationships by Keval Ray

4.
Netherlands Journal of Critical Care ; 30(5):152-155, 2022.
Article in English | EMBASE | ID: covidwho-2058639

ABSTRACT

In this paper we describe how the data infrastructure of an existing national quality registry was adapted to meet public health, research and capacity needs for information on COVID-19 hospitalisations in the Netherlands. Copyright © 2022, Netherlands Society of Intensive Care. All rights reserved.

5.
Investigative Ophthalmology and Visual Science ; 63(7):258-A0112, 2022.
Article in English | EMBASE | ID: covidwho-2058041

ABSTRACT

Purpose : To battle the spreading of the COVID-19 virus, all over the world measures like home confinement and nation-wide lockdowns have been implemented at regular intervals. These measures have shown an increase in myopic incidence particularly in China, which applied a very strict lockdown and home confinement. The Netherlands used a so called “intelligent lockdown” which allowed children to go outside. We evaluated the association between COVID restrictions and myopia risk factors in an European cohort of adolescents. Methods : A total of 1101 participants (mean age 16.3 ± 3.65 yrs) of the population-based prospective birth-cohort study Generation R filled in a questionnaire about their behavior before, during, and after lockdown in the Netherlands. These participants had undergone cycloplegic refractive error measurement at 13 years of age. We evaluated time spent outdoors, time spent online (handheld or other devices), time spent on near work (education and non-educational) from March-October 2020 in myopic (spherical equivalent <-0.5D) and non-myopic children. We used a repeated measures ANOVA to compare differences between these time periods, and logistic regression corrected for age, gender, and ethnicity to evaluate differences between myopic and non myopic children. Results : During and after lockdown the children spent signicantly more time online (+113 and +59min/day) on both hand held (+64 and +10 min/day) and other devices (+49 and +7 min/day), and on educational nearwork (+73 and +63min/day). Non-educational near work increased only significantly during lockdown (+176 min/day). Time spent outside did not change significantly and was ±2 hours/day. Children of non-European descent spent more time online (235min/day vs 260 min/day, P= 0.004) and on non-educational near work (452 min/day vs 559 min/day, p=0.0002). We found no significant difference in behavior between myopic and non-myopic children. Conclusions : The Dutch lockdown for COVID increased digitized near work in adolescents, but did not affect outdoor exposure. Children without myopia did not do better than those already myopic. Based on these results, we expect that the COVID pandemic will also lead to an increase in myopia prevalence and progression in European children, but to a lesser extent than in Asia.

6.
NTT Journal for Theology and the Study of Religion ; 76(3):193-214, 2022.
Article in English | Scopus | ID: covidwho-2055994

ABSTRACT

This article explores the possible relationship between religion and the COVID-19 vaccination coverage in the Netherlands by addressing the following research questions: (1) to what extent is religious affiliation a factor in the COVID-19 vaccination coverage in the Netherlands? and (2) to what extent has this possible effect of religious affiliation changed over time? Our analyses reveal a strong and persistent effect of the proportion of orthodox Protestants per municipality on the vaccination coverage per municipality and no such effect for the proportion of Catholics. Furthermore, the analysis also reveals a similar effect for the proportion of Muslims, but this effect disappears when controlled for the proportion of non-Western migrants. © Paul Vermeer & Joris Kregting.

7.
Equality, Diversity and Inclusion: An International Journal ; 41(8):1225-1242, 2022.
Article in English | ProQuest Central | ID: covidwho-2051849

ABSTRACT

Purpose>The aim of this article is twofold: (1) to identify gender equality organizational interventions implemented by a selected number of Dutch companies to increase the number of women at the corporate top and (2) to identify how these interventions overcome barriers to women's advancement and contribute to more women at the corporate top.Design/methodology/approach>A comparative case study method was applied through conducting qualitative research. The research was conducted at four large Dutch companies.Findings>The research identified 23 organizational interventions that were classified in four categories. The cross-case analysis focuses on specific themes, such as the type of interventions, the identified barriers, the successfulness of the interventions and factors contributing to increasing the number of women at the corporate top. The research shows that top-level commitment to this topic is important for the success of interventions and for increasing the number of women at the corporate top and throughout the rest of the organization. Some of the barriers could be overcome by the interventions identified.Practical implications>This research provides companies with better insight into the quality and quantity of gender equality organizational interventions implemented by Dutch companies to increase the number of women at the corporate top. It can assist them in deciding which interventions could be implemented in order to achieve gender equality at their corporate top.Originality/value>The research provides in-depth insight into the types and number of implemented gender equality organizational interventions for women at the corporate top and into the results and perceived effectiveness of such interventions.

8.
Drug Safety ; 45(10):1305-1306, 2022.
Article in English | ProQuest Central | ID: covidwho-2046534

ABSTRACT

Introduction: Some COVID-19 vaccines (Moderna and Pfizer) have been associated with an elevated risk of myocarditis in younger adults. However, observational studies were unable to stratify by dose and had limited ability to evaluate the effect of adenovirus-based COVID-19 vaccines due to the limited distribution of these in their study populations [1-4]. Objective: Estimate the incidence rates (IR), rate differences (RD) and incidence rate ratios (IRR) of myocarditis and pericarditis before and after each dose of mRNA (Pfizer and Moderna) and adenovirusplatform (AstraZeneca and Janssen) COVID-19 vaccines. Methods: We conducted a population-based cohort design with nested self-controlled risk interval (SCRI) study. Participants were followed from 1st January 2020 to 31st December 2021. Data were derived from healthcare data from five population-based data sources in four European countries: Italy, the Netherlands, the United Kingdom (UK), and Spain. The main outcome was first occurrence of myocarditis or pericarditis. RD and IR before COVID-19 disease and after each COVID-19 vaccine dose in those without COVID-19 were calculated. The SCRI calculated IRR with 60-day control period prior to vaccination and 28-day risk windows, with adjustment for seasonality. All analyses were stratified by age (< 30 and > 30 years) and in the cohorts refined age-bands for < 30 were utilised. Results: The study cohort comprised 35,365,669 persons with median age between 39-49 years, 57.4% received at least one COVID-19 vaccine dose and 77.6% of these received two. Myocarditis background rates were highest in persons 18-29 years (IR 2.8, 95% CI [1.5-4.1] to 6.4 [3.8-9.0] across UK, the Netherlands and Spain, and for 12-17 years in Italy (IR = 9.9 [5.3-14.4]). Pericarditis rates were higher in persons > 30 years (standardised IR from 11.6 [10.9-12.4] to 29.7 [19.8-22.1] across databases). RD of myocarditis were significantly elevated after Moderna dose 2 in persons between 18-29 years in Italy. Significantly reduced RD of pericarditis in the age group above 30 years was seen for Pfizer, Moderna and AstraZeneca. The SCRI showed significantly higher myocarditis IRR after dose 1 of Pfizer (IRR = 3.3 [1.2-9.4]), and also after dose 2 of Pfizer and Moderna in persons 12-29 years (IRR of 7.8 [2.6-23.5] and 6.1 [1.1-33.5], respectively). No association was observed between COVID-19 vaccination and pericarditis in the SCRI. In a sensitivity analysis, occasional significant association was seen for AstraZeneca dose 2 and myocarditis. Conclusion: Myocarditis is rare, but rates were increased significantly after both doses of Pfizer and the second dose of Moderna vaccines in persons below 30 years of age. This was not seen for pericarditis.

9.
Drug Safety ; 45(10):1306-1307, 2022.
Article in English | ProQuest Central | ID: covidwho-2046533

ABSTRACT

Introduction: Since the WHO declared the COVID-19 global pandemic in March 2020, vaccines to prevent severe SARS-CoV-2 infection have been developed at unprecedented speed. Several vaccines have been conditionally authorized by regulators in December 2020 already. The large-scale vaccination campaigns have undeniably raised the importance of post-authorization evaluations not only through spontaneous reporting but also by cohort event monitoring to obtain more in-depth vaccine safety information, rapidly after launch. Objective: To monitor COVID-19 vaccine safety and estimate the frequency of solicited and non-solicited, non-serious and serious reactions. Methods: We designed a prospective cohort event monitoring (CEM) study as part of the Covid-Vaccine-Monitor (CVM) project. The CEM collects baseline data, adverse reactions (ADRs) of authorized COVID-19 vaccines in the general and special populations (pregnant and lactating women, children, and adolescents, immunocompromised, allergic, and prior COVID-19 infection people) in twelve countries (Germany, Croatia, Netherlands, Belgium, Italy, France, Spain, Portugal, Slovakia, Romania, Switzerland, and UK). The current results comprise data from February 2021-February 2022. Depending on the dose and cohort, two data collection platforms are used: the Lareb-managed Intensive Monitoring (LIM) and the UMC Utrecht Research Online (RO). Germany and Croatia used their national tools. Participants meet local age criteria, have a first vaccination cycle or a booster dose within 48 hours, and are followed up for 6 months. Data are pooled, stratified by special cohorts, and analyzed. Results: We included more than 30,000 general population participants data from Belgium, Croatia, France, Italy, Netherlands, and UK, and more than 520,000 from Germany with the first vaccinations. Across different vaccines, 0.2-0.3% reported at least one serious ADR after receiving the first doses. More than 7,400 special cohorts vaccinees participated. 0.2% and 0.4% reported at least one serious ADR and adverse event of special interest (AESI), respectively, after the first vaccinations. The most-reported ADRs among vaccines were injection site pain, locally, and fatigue, headache, malaise, and myalgia, systemically. Serious ADRs and AESIs were uncommon. More than 11,100 vaccinees from general and special cohorts receiving a booster dose were also included. Among different cohorts, children/adolescents reported the lowest number of ADRs, while lactating women reported the highest. Conclusion: We collected and analyzed COVID-19 vaccines safety evidence in more than 550,000 general and special population persons after the first cycle and booster doses, combining data from twelve countries. Data confirm common ADR rates that are already listed in the summary of product characteristics, and that serious reactions are uncommon. Additional follow-up is ongoing.

10.
Drug Safety ; 45(10):1311, 2022.
Article in English | ProQuest Central | ID: covidwho-2046485

ABSTRACT

Introduction: COVID-19 vaccines were rapidly authorized leaving many questions and the need to monitor safety intensively. Objective: Multi-national collaboration was established with the aim to monitor the safety of the COVID-19 vaccines through prospective cohort event monitoring in Europe. Methods: A prospective cohort event monitoring study was con- ducted with primary consented data collection in seven countries between December 2020 and November 2021. Participants in Bel- gium, France, Italy, the Netherlands and United Kingdom registered using the LIM web app and received follow-up questionnaires for six months. Participants from Croatia and Germany registered with the OPeN and SafeVac2.0 apps respectively. Rates of self-reported reactions were described by type (solicited, non-solicited), adverse event of special interest (AESI), seriousness, and stratified by vaccine brand. The rate of self-reported adverse reaction was calculated after dose 1 and prior to dose 2 among all subjects who responded with at least one questionnaire. Results: 117,791 participants were included and responded to the first questionnaires after baseline: 88,196 from Germany, 27,588 from the Netherlands, 984 from France, 570 from Italy, 326 from Croatia, 89 from the United Kingdom and 38 from Belgium. 89,377 respondents received AstraZeneca, 14,658 BioNTech/Pfizer, 11,266 Moderna and 2490 Janssen. Reporting included all vaccine brands from all coun- tries, except Germany which only included data on Moderna until May 2021 and AstraZeneca until September 2021. Median time to completion was 8 days for the first questionnaire after dose 1 (Netherlands, Belgium, Italy, France, United Kingdom) and 3 days in Croatia. Median age category was 40-49 for all vaccine exposed groups except for BioNtech/Pfizer where median age was 70-79. Fatigue and headache were the most commonly reported solicited systemic adverse reactions, injection site reactions the most common solicited local reaction. AESIs were very rare (< 0.1%) and serious adverse reactions were uncommon (< 1%) across all vaccine brands. Conclusion: This study that collated self-reported data from more than 100,000 COVID-19 vaccine recipients, demonstrated feasibility of setting up and conducting cohort event monitoring across multiple European countries to collect safety data on novel vaccines that are rolled out at scale in populations which may not have been included in pivotal trials. Different vaccination schedules in countries and dif- ferent web applications resulted in some heterogeneity. The study confirmed the safety information in the product labels: reactogenic reactions, related to immunogenic response, and local injection site reactions were very common across all vaccines, whereas serious reactions or AESIs were (very) rare.

11.
Academy of Marketing Studies Journal ; 26(6), 2022.
Article in English | ProQuest Central | ID: covidwho-2045854

ABSTRACT

Today’s consumer has varied choices of digital payment methods in different point-of-sale locations. It becomes pertinent to have a profound understanding of users’ behavior towards digital payment methods relating to the types of purchases. This study highlights the association between the choice of digital payment methods 89+98 and the types of purchases. The literature review analyses the databases for literature of nationally and internationally reputed journals spanned from 2015 to 2022. It focuses on describing types of purchases and its effect and significance of the COVID-19 on usage of varied digital payment methods and evolution of a new theory of payment behavior. The findings of this meticulous literature review presented a deep understanding of this under-examined dimension of usage of digital payment methods. It will further facilitate providing users with a more conducive digital ecosystem which finally leads India towards a cashless economy. Further this study may offer a framework for the research scholars in this emerging research area.

12.
Drug Safety ; 45(10):1190-1191, 2022.
Article in English | ProQuest Central | ID: covidwho-2045393

ABSTRACT

Introduction: In March 2021 first cases of thrombosis with thrombocytopenia syndrome (TTS), also called vaccine induced thrombosis with thrombocytopenia (VITT), were published and reported, raising a concern with the adenovector vaccine of AstraZeneca [1, 2]. One month later, TTS was also associated with the Janssen vaccine [3]. No conclusive evidence of VITT with mRNA vaccines is found [4]. In Europe, vaccination programmes were put on hold and the indications for use restricted. The role of pharmacovigilance was to monitor the events closely and estimate its frequency of occurrence. While mass vaccination campaigns were ongoing, information on case criteria and definitions was limited. In the Netherlands, internists wrote guidelines, organised centralised diagnostics for PF4 ELISA and HIPA tests and encouraged expert physicians to report suspected cases to The Netherlands Pharmacovigilance Centre Lareb [5]. Lareb managed to monitor TTS cases closely by a fast triage of relevant reports and strong collaboration with external specialists. Objective: Spontaneously reported cases of TTS in The Netherlands are described. Methods: We used CDC classification criteria combined with Dutch guidelines to determine confirmed and strongly suspected cases. CDC classification recognizes 'tier 1' with thrombosis at unusual sites not requiring tests and 'tier 2' with common types of thrombosis and requiring confirmatory tests [6]. Results: In total, 75 cases of thrombocytopenia with any kind of thrombosis were reported. Only 26 reports met criteria of TTS, concerning 19 AstraZeneca, 5 Janssen and 2 mRNA vaccines. The majority (23;89%) of the cases was reported following the first dose. Reporting rates for AstraZeneca and Janssen were 7.7 and 5.7 per million vaccinations in total, respectively, and 13.4 per million vaccinations of the first dose with AstraZeneca. Patient and report characteristics are described in table 1. 'Tier 1' criteria were met in 15 cases. 'Tier 2' criteria were met in 6 cases and in 5 cases TTS was strongly suspected based on the Dutch guidelines. A functional HIPA test was performed in 20 cases of which 17 were positive and 3 negative. Also, two reports were received with mRNA vaccines, one well documented with positive PF4-ELISA and HIPA-tests (Moderna, 3rd dose) and the other poorly documented but meeting 'tier 1' criteria (Pfizer, 1st dose). Conclusion: In The Netherlands, TTS was predominantly reported after the first dose of the AstraZeneca vaccine, similar to other countries [1]. Intensive collaboration between clinical practice and pharmacovigilance resulted in good monitoring of TTS cases with spontaneous reporting.

13.
Journal of Neuromuscular Diseases ; 9:S110, 2022.
Article in English | EMBASE | ID: covidwho-2043397

ABSTRACT

Importance: Viral infection or vaccination has the potential to increase disease activity in immune-mediated neuromuscular diseases. Objective: We aimed to evaluate whether SARSCoV- 2 vaccination and infection leads to increase of disease activity in patients with immune-mediated neuromuscular diseases. Methods: This is an interim analysis of a subset of patients from an ongoing prospective multi-center cohort study on SARS-CoV-2 vaccination in patients with various immune mediated inflammatory diseases in the Netherlands, the Target to-B!-COVID study (T2B!). Patients received digital questionnaires every two months from study entry to assess disease activity compared to previous visit using a 5-point Likert scale. In addition, in case of SARS CoV-2 infection (prior to vaccination) patients received an extra questionnaire to assess disease activity in the four weeks after infection. In cases of self-reported increase of disease activity, medical files were used to assess whether disease activity was reported by the treating physician, and whether changes were made in type or dose of immunosuppressive or immunomodulating treatment. Results: In total, we included 303 patients with immune-mediated neuromuscular disease of which 127 patients with inflammatory neuropathies, 133 patients with myasthenia gravis, and 43 patients with myositis. In the four months after completed vaccination, 67 (22.1%) patients indicated an increase in disease activity, of which 62 (93%) was reported as worse and 5 (7%) as much worse. In 10 (3.3%) of the cases with self-reported increase, disease activity was also reported by the treating physician in the medical chart. In 4 (1.3%) of patients with self-reported increase disease activity treatment was adjusted because of the increase in disease activity. A SARS-CoV-2 infection prior to vaccination occurred in 24 (8%) patients, from which 3 (12.5%) indicated an increase in disease activity, not leading to change in treatment. Conclusion: Increase of disease activity after SARS-CoV-2 vaccination or infection was reported infrequently, and was self-limiting in most cases. Findings from our cohort may help physicians in neuromuscular disease to adequately inform patients on the risk of increased disease activity due to SARS-CoV-2 vaccination or infection. Full and verified results will be reported at the ICNMD 2022.

14.
Journal of Neuromuscular Diseases ; 9:S158-S160, 2022.
Article in English | EMBASE | ID: covidwho-2043392

ABSTRACT

Background: Myocarditis without myositis has been described following mRNA SARS-CoV-2 vaccination. The literature on post-vaccine antibody mediated myositis is limited and to date no case series have been reported with a distinct clinical syndrome and a single myositis specific antibody, related to SARS-CoV-2 mRNA vaccination or COVID-19. Over a 6-month period in 2021, 54 patients were referred to our tertiary referral centre for suspected myositis. Out of 25 patients with a diagnosis of myositis, we identified three patients with a distinct clinical syndrome with myositis and myocarditis with anti-Jo-1 antibodies, following SARS-CoV-2 mRNA vaccination (BNT162-Pfizer-BioNtech;n=2) or following a mild COVID-19 infection (n=1). Results: Three patients (one woman, two men;49, 50 and 58 years old) developed progressive muscle weakness and muscle pain following either vaccination (patient 1 and 2) or mild COVID-19 infection (patient 3). Patients 2 and 3 had a history of anti- CCP positive rheumatoid arthritis (RA), which had been untreated for three years in patient 2. Both post-vaccine cases had severe pitting edema of the legs, patient 2 also had arthritis. None of the patients had mechanic's hands, Raynaud's phenomenon, or interstitial lung disease (ILD). The time interval between the SARS-CoV-2 trigger and the onset of progressive muscle weakness was between 10 and 14 days (patient 1 and 3) and was estimated cybetween three and seven days in patient 2. Laboratory tests showed highly elevated CK levels (17-32 times upper limit of normal (ULN)) and troponine T levels (14-34 times ULN). In patient 2, in addition, troponin I was tested (42 times ULN), which is more specific for myocardial involvement. In patient 1 supraventricular tachycardia, unspecific ST- and Twave abnormalities and elevated NTproBNP were found. In all patients, testing for myositis specific antibodies (MSAs;EUROline myositis 16 Ag. lineblot assay) showed anti-Jo-1 antibodies (semi-quantitatively in the highest possible range). Muscle MRI showed widespread muscle edema in all patients and extensive fascial and subcutaneous edema in the legs in the post-vaccine cases (figure 1). Muscle biopsies showed inflammatory myopathy. Cardiac MRI showed abnormalities in all patients: Pericardial effusion and/or late contrast enhancement of the epicardial myocardium (figure 1). All patients showed major improvement in response to immunosuppressive therapy and could discontinue highdosed steroids after three and six months. Discussion: In conclusion, we report three patients with a distinct clinical picture of anti-Jo-1 myositis and myocarditis without ILD, following SARS-CoV-2 mRNA vaccination or COVID-19. Although it is difficult to determine a causal relationship between SARS-CoV-2 and anti-Jo-1 myositis based on these small numbers, we suspect a SARSCoV- 2 trigger of anti-synthetase syndromes given the typical combination of symptoms and previously demonstrated association with antecedent viral infections. In addition, we have collected nationwide data on myositis specific antibodies (MSAs) in 2019 (pre- COVID-19) and 2021 (during COVID-19) from six medical centers in the Netherlands. We are currently analysing these data to examine whether the proportion of positive MSAs in 2021 is higher as compared to 2019. The results will be presented at the ICNMD.

15.
Journal of Neuromuscular Diseases ; 9:S250-S251, 2022.
Article in English | EMBASE | ID: covidwho-2043381

ABSTRACT

Background: Biweekly infusions with alglucosidase alfa (recombinant human alpha-glucosidase), are the cornerstone of treatment in late onset Pompe disease. Home infusion therapy may improve quality of life. In many countries providing enzyme replacement therapy (ERT) at home is not possible due to safety concerns related to the risk of infusion associated reactions (IARs) or logistical constraints. The COVID-19 pandemic has prompted the need to provide ERT for Pompe patients at home. In the Netherlands, currently over 80% of infusions are given at home. Here we present data on the safety of homebased infusions in adult patients with late-onset Pompe disease (LOPD). Methods: Data on patient descriptives, infusion characteristics and IARs from patients starting ERT between 1999 and 2018 were collected and analyzed. The Dutch infusion schedule for adult lateonset patients differs from the schedule recommended by the pharmaceutical company and is as follows: 0.2, 0.8, 3.5, 10 mg/kg/hour with steps of 30 minutes for the first three steps and 10 mg/kg/ hour for the remainder of the infusion. IARs were graded by the healthcare provider. If no classification was available infusions were retrospectively classified using the Common Terminology Criteria for Adverse Events (CTCAE) classification. Descriptive analyses were performed tabulating patient and infusion characteristics as well as types of IARs and actions needed to resolve these. Results: Data on 18380 infusions with alglucosidase alfa in 121 adult LOPD patients were analysed. 4961 infusions (27.0 %) were given in hospital and 13419 (73.0 %) at home. The majority of infusions (88.4%) was administered using a standard infusion schedule. In 144 (2.9%) of hospital infusions and 113 (0.8%) of home infusions an IAR occurred. Mild IARs occurred in 115 hospital infusions and in 104 infusions at home. Twenty-five moderate IARs were reported in hospital and 8 at home. Very few severe IARs occurred (4 in hospital, 1 at home). The most prevalent symptoms in hospital were itching and chills;at home chills and trembling were most prevalent. The most common most severe interventions taken in hospital in response to an IAR were giving medication (antihistamines), or pausing the infusion and restarting it later. This was also the most common intervention at home. Sixteen infu-sions (11.1%) in hospital and 6 infusions (5.3%) at home were stopped completely after the IAR occurred. Only one IAR in the home situation required immediate clinical evaluation in hospital. The consecutive infusion after an IAR occurred in hospital, patients most commonly received premedication or the infusion scheme was adapted, whereas at home after the majority of IARs no action was taken. The most common premedication in hospital were an antihistamine and a corticosteroid and at home an antipyretic and antihistamine were most common. Conclusion: Our data demonstrate that very few IARs occur during alglucosidase alfa infusions in adult patients with LOPD. Very few severe IARs occurred. The majority of IARs at home were mild and did not require additional medical intervention. This demonstrates that alglucosidase alfa can be safely administered in the home situation, provided the appropriate infrastructure is present.

16.
Annals of Oncology ; 33:S1261, 2022.
Article in English | EMBASE | ID: covidwho-2041557

ABSTRACT

Background: Exercise is a promising strategy to improve fatigue and quality of life in patients with metastatic breast cancer (MBC). However, little is known about patients’ barriers, facilitators, and preferences for supervised exercise programs. An in-depth understanding of the patients’ perspective could help to define the role of exercise professionals in this regard and support the development and implementation of successful exercise interventions. Methods: Eleven online focus groups were held, including a total of 44 participants from four European countries (DE, ESP, PL, SE). In semi-structured group sessions, patients were encouraged to discuss their reasons to participate in supervised exercise programs, experienced barriers and exercise preferences. Interviews were transcribed verbatim, translated into English, and coded based on a preliminary coding framework, supplemented by themes that emerged during the sessions. Results: Participants expressed positive attitudes towards exercise. Facilitating factors for participation in supervised programs included the benefits of social contact, professional guidance, and the experience of physical and psychological benefits. The main barriers cited were practical issues, physical limitations due to cancer and its treatment, and safety concerns due to Covid-19. Participants did not have a clear, shared preference regarding exercise type or setting, but would appreciate mixed exercises (i.e., aerobic, strength, and mind-body exercises) in flexible training modules. Individualized training programs and feedback from exercise professionals were strongly desired. Conclusions: While there was common ground regarding several barriers and facilitators, patients expressed mixed preferences for exercise programs. This related to benefits of social interaction in group exercise on the one hand, and the need for individualized tailoring to deal with physical restrictions on the other hand. Exercise professionals can play an important role in supporting exercise for MBC patients by identifying individual needs and providing training programs that are adjusted to patients' abilities and preferences. Legal entity responsible for the study: Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital. Funding: European Commission Research & Innovation Horizon 2020. Disclosure: A.M. May: Financial Interests, Institutional, Advisory Role, Paid to institution: COMPASS. K. Steindorf: Financial Interests, Personal, Expert Testimony, < €5,000: Institut National contre le cancer (INCA), Paris, France;Financial Interests, Personal, Expert Testimony, Member of Data Monitoring Board;< €1,000: Swiss Group for Clinical Research (SAAK), Switzerland;Financial Interests, Personal, Invited Speaker, < €1,000: Adviva, Heidelberg, Germany, Pierre Fabre, Freiburg, Germany, Takeda, Breast Cancer Care Center, Unna, Germany, Audi Health Care Insurance, Ingolstadt, Germany, University of Mainz, Germany;Financial Interests, Personal, Invited Speaker, Lecturer fee in Master Course, < €2,000: University of Heidelberg, Germany;Financial Interests, Personal, Expert Testimony, compensation of travel costs, no further fees: German Research Foundation (DFG), Bonn, Germany;Financial Interests, Personal, Expert Testimony, < €1,000: University of Vienna, Vienna, Austria. All other authors have declared no conflicts of interest.

17.
Montenegrin Journal of Economics ; 18(4):61-70, 2022.
Article in English | ProQuest Central | ID: covidwho-2040445

ABSTRACT

This paper aims to assess the European tax havens in terms of corporate financial misconduct risks. The study relies on an index method developed by a group of economists belonging to the international non-governmental organization - the Tax Justice Network. The method allowed the authors to calculate the Corporate Tax Harbor Index (CTHI) and determine the role of a particular jurisdiction in global corporate financial misconduct risks. The study established a ranking of European tax havens and jurisdictions with features of tax havens and classified these tax havens based on corporate financial misconduct risks. The study found that European tax havens and tax haven jurisdictions accounted for nearly 40% of global corporate financial misuse risks in 2020. The classification of European tax havens according to corporate financial misconduct risks demonstrated that the Netherlands, Switzerland, the UK, Ireland, and Luxembourg accounted for more than half of the risks. The shares of Liechtenstein (1%), Monaco (1%), Andorra, and San Marino (less than 1%) did not exceed 3% of the European share of the global risk. The results show the need for adjustments to the regulatory policy of international organizations currently focused on fighting classic tax havens. Their real share of global misuse risks is very small compared to the share of 'gray cardinals' of the offshore market.

18.
Health Econ Policy Law ; : 1-16, 2022 Sep 19.
Article in English | MEDLINE | ID: covidwho-2036734

ABSTRACT

The COVID-19 pandemic has been an ultimate challenge for health systems as a whole rather than just single sectors (e.g. hospital care). Particularly, interface management between health system sectors and cooperation among stakeholders turned out to be crucial for an adequate crisis response. Dealing with such interfaces, it is argued in the literature, demands from health care systems to become resilient. One way to analyse this is to focus on the ways in which bottlenecks in health systems are dealt with during the pandemic. This paper investigates six bottlenecks, including overburdened public health agencies, neglected nursing homes and insufficient testing capacities that have been encountered in the health systems of Germany, Sweden and the Netherlands during the pandemic. Based on empirical findings we identify and critically discuss preliminary lessons in terms of health system resilience, an increasingly popular theoretical concept that frames crises as an opportunity for health system renewal. We argue that in practice health system resilience is hindered by path dependencies of national health systems and, owed to the crisis, interim policies that lack ambition for broader reforms.

19.
Health Policy ; 126(10): 933-944, 2022 10.
Article in English | MEDLINE | ID: covidwho-2036029

ABSTRACT

The COVID-19 pandemic has boosted the adoption of digital health technologies such as teleconsultation. This research aimed to assess and compare barriers and facilitators for teleconsultation uptake for primary care practitioners in Hong Kong and the Netherlands and evaluate the role of their different healthcare funding models in this adoption process within the context of the COVID-19 pandemic. A qualitative research following a social constructivist paradigm was performed. The study employed a conceptual framework from Lau and colleagues that identifies four levels of factors influencing change in primary care: (1) external contextual factors; (2) organization-related factors; (3) professional factors; and (4) characteristics of the intervention. The four levels were studied through semi-structured, open-ended interviews with primary care physicians. External factors were additionally assessed by means of a literature review. Hong Kong and the Netherlands showed different penetration rates of teleconsultation. Most stakeholders in both settings shared similar barriers and facilitators in the organizational, professional, and intervention levels. However, external contextual factors (i.e., current teleconsultation legislation, available incentives, and level of public awareness) played an important and differing role in teleconsultation uptake and had a direct effect on the organization, the professionals involved, and the type of technology used. Political and organizational actions are required to develop a comprehensive legal framework for the sustainable development of teleconsultation in both settings.


Subject(s)
COVID-19 , Remote Consultation , Hong Kong , Humans , Netherlands , Pandemics , Primary Health Care , Qualitative Research
20.
Zycie Weterynaryjne ; 96(1):15-23, 2021.
Article in Polish | CAB Abstracts | ID: covidwho-2034286

ABSTRACT

SARS-CoV-2, the betacoronavirus that causes COVID-19, has spread rapidly around the world since December 2019. It was suspected from the beginning that the primary outbreak in China, was of a zoonotic origin, but the SARS- CoV-2 animal reservoir(s) has not been definitively identified yet. So far, it has been confirmed that numerous animal species are susceptible to infection and that experimentally infected cats, shrews, hamsters and ferrets can also shed the virus. The SARS-CoV-2 was also detected in farmed mink (Neovison vison), in which it caused both, the clinical and subclinical disease, with respiratory symptoms and increased mortality. In April 2020, the first SARS-CoV-2 cases were detected in minks in the Netherlands, and to date (November 2020), further outbreaks have been confirmed in Denmark, Italy, Spain, Sweden, the United States, Greece, France and Poland. It has also been shown that the transmission of infection from humans to minks and from minks to humans may occur. The OIE is working on the inclusion of mink in the WAHIS database and encouraging the Members to provide appropriate data for this species to improve the monitoring of the epidemiological situation worldwide and prevent the establishment of a possible new reservoir for SARS-CoV-2.

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