Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 110
Filter
1.
BMC Neurosci ; 23(1): 41, 2022 06 30.
Article in English | MEDLINE | ID: covidwho-1913435

ABSTRACT

Exercise could prevent physical and psychological deteriorations, especially during pandemic times of lock-down scenarios and social isolation. But to meet both, the common exercise protocols require optimization based on holistic investigations and with respect to underlying processes. This study aimed to explore individual chronic and acute effects of continuous and interval running exercise on physical and cognitive performance, mood, and affect and underlying neurophysiological factors during a terrestrial simulated space mission. Six volunteers (three females) were isolated for 120 days. Accompanying exercise training consisted of a continuous and interval running protocol in a cross-over design. Incremental stage tests on a treadmill were done frequently to test physical performance. Actigraphy was used to monitor physical activity level. Cognitive performance, mood (MoodMeter®), affect (PANAS), brain-derived neurotrophic factor (BDNF), insulin-like growth factor 1 (IGF-1), vascular-endothelial growth factor (VEGF), and saliva cortisol were investigated prior to, four times during, and after isolation, pre- and post-exercise on two separate days, respectively. As a chronic effect, physical performance increased (and IGF-1 tended) in the course of isolation and training until the end of isolation. Subjective mood and affect state, as well as cognitive performance, basal BDNF and VEGF levels, were well-preserved across the intervention. No acute effects of exercise were detected, besides slower reaction time after exercise in two out of nine cognitive tests, testing sensorimotor speed and memory of complex figures. Consistently higher basal IGF-1 concentrations and faster reaction time in the psychomotor vigilance test were found for the continuous compared to the interval running protocol. The results suggest that 120 days of isolation and confinement can be undergone without cognitive and mental deteriorations. Regular, individual aerobic running training supporting physical fitness is hypothesized to play an important role in this regard. Continuous running exercise seems to trigger higher IGF-1 levels and vigilance compared to interval running. Systematic and prolonged investigations and larger sample size are required to follow up on exercise-protocol specific differences in order to optimize the exercise intervention for long-term psycho-physiological health and well-being.


Subject(s)
Brain-Derived Neurotrophic Factor , Insulin-Like Growth Factor I , Cross-Over Studies , Exercise/physiology , Female , Humans , Hydrocortisone , Insulin-Like Growth Factor I/metabolism , Male , Vascular Endothelial Growth Factor A
2.
N Engl J Med ; 387(19): 1759-1769, 2022 11 10.
Article in English | MEDLINE | ID: covidwho-2112693

ABSTRACT

BACKGROUND: Invasive mechanical ventilation in critically ill adults involves adjusting the fraction of inspired oxygen to maintain arterial oxygen saturation. The oxygen-saturation target that will optimize clinical outcomes in this patient population remains unknown. METHODS: In a pragmatic, cluster-randomized, cluster-crossover trial conducted in the emergency department and medical intensive care unit at an academic center, we assigned adults who were receiving mechanical ventilation to a lower target for oxygen saturation as measured by pulse oximetry (Spo2) (90%; goal range, 88 to 92%), an intermediate target (94%; goal range, 92 to 96%), or a higher target (98%; goal range, 96 to 100%). The primary outcome was the number of days alive and free of mechanical ventilation (ventilator-free days) through day 28. The secondary outcome was death by day 28, with data censored at hospital discharge. RESULTS: A total of 2541 patients were included in the primary analysis. The median number of ventilator-free days was 20 (interquartile range, 0 to 25) in the lower-target group, 21 (interquartile range, 0 to 25) in the intermediate-target group, and 21 (interquartile range, 0 to 26) in the higher-target group (P = 0.81). In-hospital death by day 28 occurred in 281 of the 808 patients (34.8%) in the lower-target group, 292 of the 859 patients (34.0%) in the intermediate-target group, and 290 of the 874 patients (33.2%) in the higher-target group. The incidences of cardiac arrest, arrhythmia, myocardial infarction, stroke, and pneumothorax were similar in the three groups. CONCLUSIONS: Among critically ill adults receiving invasive mechanical ventilation, the number of ventilator-free days did not differ among groups in which a lower, intermediate, or higher Spo2 target was used. (Supported by the National Heart, Lung, and Blood Institute and others; PILOT ClinicalTrials.gov number, NCT03537937.).


Subject(s)
Critical Illness , Oxygen , Respiration, Artificial , Adult , Humans , Critical Illness/therapy , Hospital Mortality , Intensive Care Units , Oxygen/administration & dosage , Oxygen/blood , Oxygen/therapeutic use , Respiration, Artificial/methods , Critical Care/methods , Cross-Over Studies , Emergency Service, Hospital , Academic Medical Centers , Oximetry
3.
Environ Health Perspect ; 130(11): 117006, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2117113

ABSTRACT

BACKGROUND: Studies have suggested links between ambient air pollution and coronavirus 2019 (COVID-19) mortality, yet confirmation by well-designed epidemiological studies with individual data is needed. OBJECTIVES: We aimed to examine whether short-term exposure to air pollution is associated with risk of mortality from COVID-19 for those infected with COVID-19. METHODS: The Cook County Medical Examiner's Office reports individual-level data for deaths from COVID-19 that occur in its jurisdiction, which includes all confirmed COVID-19 deaths in Cook County, Illinois. Case-crossover analysis was conducted to estimate the associations of estimated short-term exposures to particulate matter (PM) with aerodynamic diameter ≤2.5µm (PM2.5) and ozone (O3) on the day of death and up to 21 d before death at location of death with COVID-19. A total of 7,462 deaths from COVID-19 that occurred up to 28 February 2021 were included in the final analysis. We adjusted for potential confounders by time-stratified case-crossover design and by covariate adjustments (i.e., time-invariant factors, meteorological factors, viral transmission, seasonality, and time trend). RESULTS: Of the 7,462 case and 25,457 self-control days, almost all were days with exposure levels below the PM2.5 24-h National Ambient Air Quality Standard (NAAQS) (35 µg/m3); 98.9% had O3 levels below the maximum 8-h NAAQS (35.7 µg/m3 or 70 parts per billion). An interquartile range (IQR) increase (5.2 µg/m3) in cumulative 3-wk PM2.5 exposure was associated with a 69.6% [95% confidence interval (CI): 34.6, 113.8] increase in risk of COVID-19 mortality. An IQR increase (8.2 µg/m3) in 3-d O3 exposure was associated with a 29.0% (95% CI: 9.9, 51.5) increase in risk of COVID-19 mortality. The associations differed by demographics or race/ethnicity. There was indication of modification of the associations by some comorbid conditions. DISCUSSION: Short-term exposure to air pollution below the NAAQS may increase the mortality burden from COVID-19. https://doi.org/10.1289/EHP10836.


Subject(s)
Air Pollutants , Air Pollution , COVID-19 , Humans , Cross-Over Studies , Air Pollutants/analysis , Coroners and Medical Examiners , Environmental Exposure/analysis , Air Pollution/analysis , Particulate Matter/analysis , Registries
4.
Ann Saudi Med ; 42(5): 305-308, 2022.
Article in English | MEDLINE | ID: covidwho-2080739

ABSTRACT

BACKGROUND: COVID-19 infection affects the quality of the medical services globally. The pandemic required changes to medical services in several institutions. We established a virtual clinic for anticoagulation management during the pandemic using the Whatsapp application. OBJECTIVES: Compare anticoagulation management quality in virtual versus in-person clinics. DESIGN: A retrospective crossover study SETTINGS: Specialized cardiac care center PATIENTS AND METHODS: The study included patients who presented to Prince Sultan Cardiac Center in Riyadh for anticoagulation management during the pandemic from March 2020 to January 2021. We compared time in therapeutic range (TTR) in the same patients during virtual and in-person clinics. All international normalized ratio (INR) measures during the virtual clinic visits and prior ten INR measures from the in-person clinic were recorded. Patients who had no prior follow-up in the in-person clinic were excluded. MAIN OUTCOME MEASURE: TTR calculated using the Rosendaal method. SAMPLE SIZE: 192 patients RESULTS: The mean age was 58.6 (16.6) years and 116 (60.4%) were males. Patients were diagnosed with atrial fibrillation (n=101, 52.6%), mechanical mitral valve (n=88, 45.8%), mechanical aortic valve (n=79, 41%), left ventricular thrombus (n=5, 2.6%) and venous thromboembolism (n=8, 4.2%). Riyadh residents represented 56.7% of the study population (n=93). The median (IQR) percent TTR was 54.6 (27.3) in the in-person clinic versus 50.0 (33.3) (P=.07). CONCLUSION: Virtual clinic results were comparable to in-person clinics for anticoagulation management during the COVID-19 pandemic. LIMITATIONS: Number of INR measures during the virtual clinic visits, retrospective nature and single-center experience. CONFLICT OF INTEREST: None.


Subject(s)
COVID-19 , Warfarin , Anticoagulants/therapeutic use , Cross-Over Studies , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , Warfarin/therapeutic use
5.
Eur Radiol Exp ; 6(1): 50, 2022 10 10.
Article in English | MEDLINE | ID: covidwho-2064870

ABSTRACT

BACKGROUND: The use of facemasks is one of the consequences of the coronavirus disease 2019 (COVID-19) pandemic. We used resting-state functional magnetic resonance imaging (fMRI) to search for subtle changes in brain functional connectivity, expected notably related to the high-level salience network (SN) and default mode network (DMN). METHODS: Prospective crossover design resting 3-T fMRI study with/without wearing a tight FFP2/KN95 facemask, including 23 community-dwelling male healthy controls aged 29.9 ± 6.9 years (mean ± standard deviation). Physiological parameters, respiration frequency, and heart rate were monitored. The data analysis was performed using the CONN toolbox. RESULTS: Wearing an FFP2/KN95 facemask did not impact respiration or heart rate but resulted in a significant reduction in functional connectivity between the SN as the seed region and the left middle frontal and precentral gyrus. No difference was found when the DMN, sensorimotor, visual, dorsal attention, or language networks were used as seed regions. In the absence of significant changes of physiological parameter respiration and heart rate, and in the absence of changes in lower-level functional networks, we assume that those subtle modifications are cognitive consequence of wearing facemasks. CONCLUSIONS: The effect of wearing a tight FFP2/KN95 facemask in men is limited to high-level functional networks. Using the SN as seed network, we observed subtle yet significant decreases between the SN and the left middle frontal and precentral gyrus. Our observations suggest that wearing a facemask may change the patterns of functional connectivity with the SN known to be involved in communication, social behavior, and self-awareness.


Subject(s)
Brain , COVID-19 , N95 Respirators , Adult , Brain/diagnostic imaging , Brain/physiology , COVID-19/prevention & control , Cross-Over Studies , Humans , Male , Prospective Studies
6.
Diabetes Technol Ther ; 24(9): 635-642, 2022 09.
Article in English | MEDLINE | ID: covidwho-2062818

ABSTRACT

Background: Automated insulin delivery (AID) systems have proven effective in increasing time-in-range during both clinical trials and real-world use. Further improvements in outcomes for single-hormone (insulin only) AID may be limited by suboptimal insulin delivery settings. Methods: Adults (≥18 years of age) with type 1 diabetes were randomized to either sensor-augmented pump (SAP) (inclusive of predictive low-glucose suspend) or adaptive zone model predictive control AID for 13 weeks, then crossed over to the other arm. Each week, the AID insulin delivery settings were sequentially and automatically updated by an adaptation system running on the study phone. Primary outcome was sensor glucose time-in-range 70-180 mg/dL, with noninferiority in percent time below 54 mg/dL as a hierarchical outcome. Results: Thirty-five participants completed the trial (mean age 39 ± 16 years, HbA1c at enrollment 6.9% ± 1.0%). Mean time-in-range 70-180 mg/dL was 66% with SAP versus 69% with AID (mean adjusted difference +2% [95% confidence interval: -1% to +6%], P = 0.22). Median time <70 mg/dL improved from 3.0% with SAP to 1.6% with AID (-1.5% [-2.4% to -0.5%], P = 0.002). The adaptation system decreased initial basal rates by a median of 4% (-8%, 16%) and increased initial carbohydrate ratios by a median of 45% (32%, 59%) after 13 weeks. Conclusions: Automated adaptation of insulin delivery settings with AID use did not significantly improve time-in-range in this very well-controlled population. Additional study and further refinement of the adaptation system are needed, especially in populations with differing degrees of baseline glycemic control, who may show larger benefits from adaptation.


Subject(s)
Diabetes Mellitus, Type 1 , Insulin , Adult , Blood Glucose , Cross-Over Studies , Diabetes Mellitus, Type 1/drug therapy , Humans , Hypoglycemic Agents/therapeutic use , Infant, Newborn , Insulin/therapeutic use , Insulin Infusion Systems , Insulin, Regular, Human/therapeutic use , Middle Aged , Outpatients , Young Adult
7.
Int J Infect Dis ; 123: 54-57, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2049302

ABSTRACT

OBJECTIVES: The purpose of this study was to analyze face-touching patterns with and without a face mask. METHODS: The behavior of face touching with and without a mask during an interview was assessed in 40 individuals. The frequency of touching in different areas of the face covered by the mask was compared with areas not covered by the face mask. RESULTS: There was an increase in the number of individuals who touched the hair and the eye when they were not wearing the mask. There was an increase in the number of touches on the lips and hair when individuals were not wearing the face mask. When analyzing the area covered by the face mask, no difference was observed in the number of touches while using or not using masks. However, when the area not covered by a face mask was analyzed, a higher number of touches in individuals without masks was observed when compared with individuals wearing masks. CONCLUSION: Using a face mask can reduce or change the face-touching patterns in normal individuals, especially in areas not covered by the mask. Using face masks can possibly reduce the chances of being infected by autoinoculation.


Subject(s)
COVID-19 , Masks , COVID-19/epidemiology , COVID-19/prevention & control , Cross-Over Studies , Humans
8.
Environ Res ; 214(Pt 4): 114116, 2022 11.
Article in English | MEDLINE | ID: covidwho-2035993

ABSTRACT

BACKGROUND: Whether ambient temperature exposure contributes to death from asthma remains unknown to date. We therefore conducted a case-crossover study in China to quantitatively evaluate the association and burden of ambient temperature exposure on asthma mortality. METHODS: Using data from the National Mortality Surveillance System in China, we conducted a time-stratified case-crossover study of 15 888 individuals who lived in Hubei and Jiangsu province, China and died from asthma as the underlying cause in 2015-2019. Individual-level exposures to air temperature and apparent temperature on the date of death and 21 days prior were assessed based on each subject's residential address. Distributed lag nonlinear models based on conditional logistic regression were used to quantify exposure-response associations and calculate fraction and number of deaths attributable to non-optimum ambient temperatures. RESULTS: We observed a reverse J-shaped association between air temperature and risk of asthma mortality, with a minimum mortality temperature of 21.3 °C. Non-optimum ambient temperature is responsible for substantial excess mortality from asthma. In total, 26.3% of asthma mortality were attributable to non-optimum temperatures, with moderate cold, moderate hot, extreme cold and extreme hot responsible for 21.7%, 2.4%, 2.1% and 0.9% of asthma mortality, respectively. The total attributable fraction and number was significantly higher among adults aged less than 80 years in hot temperature. CONCLUSIONS: Exposure to non-optimum ambient temperature, especially moderate cold temperature, was responsible for substantial excess mortality from asthma. These findings have important implications for planning of public-health interventions to minimize the adverse respiratory damage from non-optimum ambient temperature.


Subject(s)
Asthma , Cold Temperature , Adult , Asthma/epidemiology , China/epidemiology , Cross-Over Studies , Hot Temperature , Humans , Mortality , Temperature
9.
PLoS One ; 17(9): e0273511, 2022.
Article in English | MEDLINE | ID: covidwho-2029778

ABSTRACT

BACKGROUND: Observations based on the spread of SARS-CoV-2 early into the COVID-19 pandemic have suggested a reduced burden in tropical regions leading to the assumption of a dichotomy between cold and dry and wet and warm climates. OBJECTIVES: Analyzing more than a whole year of COVID-19 infection data, this study intents to refine the understanding of meteorological variables (temperature, humidity, precipitation and cloud coverage) on COVID-19 transmission in settings that experience distinct seasonal changes. METHODS AND FINDINGS: A time stratified case-crossover design was adopted with a conditional Poisson model in combination with a distributed lag nonlinear model to assess the short-term impact of mentioned meteorological factors on COVID-19 infections in five US study sites (New York City (NYC); Marion County, Indiana (MCI); Baltimore and Baltimore County, Maryland (BCM); Franklin County, Ohio (FCO); King County, Washington (KCW)). Higher-than-average temperatures were consistently associated with a decreased relative risk (RR) of COVID-19 infection in four study sites. At 20 degrees Celsius COVID-19 infection was associated with a relative risk of 0.35 (95%CI: 0.20-0.60) in NYC, 1.03 (95%CI:0.57-1.84) in MCI, 0.34 (95%CI: 0.20-0.57) in BCM, 0.52 (95%CI: 0.31-0.87) in FCO and 0.21 (95%CI: 0.10-0.44) in KCW. Higher-than-average humidity levels were associated with an increased relative risk of COVID-19 infection in four study sites. Relative to their respective means, at a humidity level of 15 g/kg (specific humidity) the RR was 5.83 (95%CI: 2.05-16.58) in BCM, at a humidity level of 10 g/kg the RR was 3.44 (95%CI: 1.95-6.01) in KCW. CONCLUSIONS: The results of this study suggest opposed effects for higher-than-average temperature and humidity concerning the risk of COVID-19 infection. While a distinct seasonal pattern of COVID-19 has not yet emerged, warm and humid weather should not be generally regarded as a time of reduced risk of COVID-19 infections.


Subject(s)
COVID-19 , COVID-19/epidemiology , Cross-Over Studies , Humans , Humidity , Pandemics , SARS-CoV-2 , Temperature
10.
PLoS One ; 17(9): e0274298, 2022.
Article in English | MEDLINE | ID: covidwho-2021964

ABSTRACT

OBJECTIVE: To develop a machine learning algorithm utilizing heart rate variability (HRV) and salivary cortisol to detect the presence of acute stress among pregnant women that may be applied to future clinical research. METHODS: ECG signals and salivary cortisol were analyzed from 29 pregnant women as part of a crossover study involving a standardized acute psychological stress exposure and a control non-stress condition. A filter-based features selection method was used to identify the importance of different features [heart rate (HR), time- and frequency-domain HRV parameters and salivary cortisol] for stress assessment and reduce the computational complexity. Five machine learning algorithms were implemented to assess the presence of stress with and without salivary cortisol values. RESULTS: On graphical visualization, an obvious difference in heart rate (HR), HRV parameters and cortisol were evident among 17 participants between the two visits, which helped the stress assessment model to distinguish between stress and non-stress exposures with greater accuracy. Eight participants did not display a clear difference in HR and HRV parameters but displayed a large increase in cortisol following stress compared to the non-stress conditions. The remaining four participants did not demonstrate an obvious difference in any feature. Six out of nine features emerged from the feature selection method: cortisol, three time-domain HRV parameters, and two frequency-domain parameters. Cortisol was the strongest contributing feature, increasing the assessment accuracy by 10.3% on average across all five classifiers. The highest assessment accuracy achieved was 92.3%, and the highest average assessment accuracy was 76.5%. CONCLUSION: Salivary cortisol contributed a significant increase in accuracy of the assessment model compared to using a range of HRV parameters alone. Our machine learning model demonstrates acceptable accuracy in detection of acute stress among pregnant women when combining salivary cortisol with HR and HRV parameters.


Subject(s)
Hydrocortisone , Stress, Psychological , Cross-Over Studies , Female , Heart Rate/physiology , Humans , Machine Learning , Pregnancy , Stress, Psychological/diagnosis
11.
PLoS One ; 17(8): e0269470, 2022.
Article in English | MEDLINE | ID: covidwho-2002295

ABSTRACT

AIMS: Surgical and FFP2 masks are recommended to reduce transmission of SARS-CoV-2. The cardiopulmonary effects of facemasks in patients with chronic heart failure are unknown. This prospective, cross-over study quantified the effects of wearing no mask (nm), surgical mask (sm), and FFP2 mask (ffpm) in patients with stable heart failure. METHODS: 12 patients with clinically stable chronic heart failure (HF) (age 63.8±12 years, left ventricular ejection fraction (LVEF) 43.8±11%, NTProBNP 573±567 pg/ml) underwent spiroergometry with and without masks in a randomized sequence. Comfort/discomfort was assessed using a standardized questionnaire. RESULTS: Maximum power was reduced with both types of masks (nm: 108.3 W vs. sm: 101.2 W vs. ffpm: 95.6 W, p<0.01). Maximum respiratory oxygen uptake (1499ml/min vs. 1481 ml/min vs. 1300 ml/min, p = 0.95 and <0.01), peak ventilation (62.1 l/min vs. 56.4 l/min vs. 50.3 l/min, p = 0.15 and p<0.05) and O2-pulse (11.6 ml/beat vs. 11.8 ml/beat vs. 10.6 ml/beat, p = 0.87 and p<0.01) were significantly changed with ffpm but not sm. Discomfort was moderately but significantly increased (nm: 1.6 vs. sm: 3.4 vs. ffpm: 4.4, p<0.05). CONCLUSION: Both surgical and FFP masks reduce exercise capacity in heart failure patients, while FFP2 masks reduce oxygen uptake and peak ventilation. This reduction in cardiopulmonary performance should be considered in heart failure patients whose daily life activities are often just as challenging as exercise is for healthy adults.


Subject(s)
COVID-19 , Heart Failure , Adult , Aged , COVID-19/prevention & control , Cross-Over Studies , Exercise Test , Exercise Tolerance , Heart Failure/therapy , Humans , Middle Aged , Oxygen , Prospective Studies , SARS-CoV-2 , Stroke Volume , Ventricular Function, Left
12.
J Sports Med Phys Fitness ; 62(6): 846-850, 2022 06.
Article in English | MEDLINE | ID: covidwho-1979877

ABSTRACT

BACKGROUND: At the time of the coronavirus disease 2019 (COVID-19) pandemic wearing surgical mask (SM) is recommended for the prevention of contracting or exposing others to airborne transmission of COVID-19. It is somewhat controversial whether wearing SM during exercise affects performance and health status and/or may influence the results. In order to give an answer we planned a prospective, randomized, crossover study to evaluate the effects of wearing a SM or no-SM in 33 (17 male) physically active healthy subjects during a graded exercise cycle ergometry test. METHODS: The two tests were performed in random order in the same subjects. The participants were all tested the same day, after a recovery time of at least of one hour, in order to avoid interferences on physical performances. Arterial oxygen saturation, heart rate and arterial blood pressure were assessed throughout the exercise tests every step of two minutes, at the end of exercise, performed at the same time with and without mask. RESULTS: Wearing SM had no effect on performance, since the duration of cycle ergometry test with SM and without SM median, respectively, was 14.2 (lower-upper quartile 13.9-14.8) versus 14.3 (13.9-15.5) minutes (P=0.094), and median peak power was 150 W (150-180) versus 150 W (120-180) (P=0.754). CONCLUSIONS: When expressed relative to peak exercise performance, no differences were found between wearing or not wearing SM regarding arterial oxygen saturation, or heart rate at any time during the exercise tests. Wearing SM during vigorous exercise had no detrimental effect on cardiovascular parameters, as well as on exercise metrics in all participants. No ventricular repolarization abnormalities and no arrhythmias were reported on the electrocardiograms.


Subject(s)
COVID-19 , Masks , COVID-19/prevention & control , Cross-Over Studies , Exercise/physiology , Exercise Test , Humans , Male , Prospective Studies
13.
Trials ; 23(1): 643, 2022 Aug 09.
Article in English | MEDLINE | ID: covidwho-1978787

ABSTRACT

BACKGROUND: Physical exercise induces a coordinated response of multiple organ systems, including the immune system. In fact, it has been proposed that physical exercise may modulate the immune system. However, the potential effect of an exercise program on COVID-19 survivors has not been investigated. Thus, the aim of this study is to evaluate the modifications in immunological parameters, physical condition, inflammatory profile, and perceived persistent symptoms after 6 weeks of supervised resistance training (RT), in addition to the standard care on the clinical status of patients with persistent COVID-19 symptoms. The objective of this protocol is to describe the scientific rationale in detail and to provide information about the study procedures. METHODS/DESIGN: A total of 100 patients with postdischarge symptoms after COVID-19 will be randomly allocated into either a group receiving standard care (control group) or a group performing a multicomponent exercise program two times a week over a period of 6 weeks. The main hypothesis is that a 6-week multicomponent exercise program (EXER-COVID Crossover Study) will improve the immunological and inflammatory profile, physical condition, and persistent perceived symptoms (fatigue/tiredness, musculoskeletal pain, and shortness of breath) in patients with postdischarge symptoms after COVID-19. DISCUSSION: Our results will provide insights into the effects of a multicomponent exercise program on immunological parameters, physical condition, inflammatory profile, and persistent perceived symptoms in patients with postdischarge symptoms after COVID-19. Information obtained by this study will inform future guidelines on the exercise training rehabilitation of patients with postdischarge symptoms after COVID-19. TRIAL REGISTRATION: NCT04797871 , Version 2. Registered on March 15, 2021.


Subject(s)
COVID-19 , Resistance Training , Aftercare , Cross-Over Studies , Fatigue/diagnosis , Fatigue/etiology , Fatigue/therapy , Humans , Patient Discharge , Randomized Controlled Trials as Topic , Treatment Outcome
14.
BMJ Open ; 12(6): e056594, 2022 06 27.
Article in English | MEDLINE | ID: covidwho-1978555

ABSTRACT

INTRODUCTION: Several studies have demonstrated dysbiosis in irritable bowel syndrome (IBS). Therefore, faecal microbiota transplantation, whose effect and safety have been proven in Clostridioides difficile infections, may hold promise in other conditions, including IBS. Our study will examine the effectiveness of stool transfer with artificially increased microbial diversity in IBS treatment. METHODS AND ANALYSIS: A three-group, double-blind,randomised, cross-over, placebo-controlled study of two pairs of gut microbiota transfer will be conducted in 99 patients with diarrhoeal or mixed type of IBS. Patients aged 18-65 will be randomised into three equally sized groups: group A will first receive two enemas of study microbiota mixture (deep-frozen stored stool microbiota mixed from eight healthy donors); after 8 weeks, they will receive two enemas with placebo (autoclaved microbiota mixture), whereas group B will first receive placebo, then microbiota mixture. Finally, group C will receive placebos only. The IBS Severity Symptom Score (IBS-SSS) questionnaires will be collected at baseline and then at weeks 3, 5, 8, 11, 13, 32. Faecal bacteriome will be profiled before and regularly after interventions using 16S rDNA next-generation sequencing. Food records, dietary questionnaires, anthropometry, bioimpedance, biochemistry and haematology workup will be obtained at study visits during the follow-up period. The primary outcome is the change in the IBS-SSS between the baseline and 4 weeks after the intervention for each patient compared with placebo. Secondary outcomes are IBS-SSS at 2 weeks after the intervention and 32 weeks compared with placebo and changes in the number of loose stools, Bristol stool scale, abdominal pain and bloating, anthropometric parameters, psychological evaluation and the gut microbiome composition. ETHICS AND DISSEMINATION: The study was approved by the Ethics Committee of Thomayer University Hospital, Czechia (G-18-26); study results will be published in peer-reviewed journals and presented at international conferences and patient group meetings. TRIAL REGISTRATION NUMBER: NCT04899869.


Subject(s)
Irritable Bowel Syndrome , Microbiota , Cross-Over Studies , Diarrhea/therapy , Dysbiosis/therapy , Fecal Microbiota Transplantation/methods , Humans , Irritable Bowel Syndrome/therapy , Randomized Controlled Trials as Topic
16.
Scott Med J ; 67(4): 189-195, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-1925715

ABSTRACT

BACKGROUND AND AIMS: Bystanders should be protected against aerosols, droplets, saliva, blood and vomitus during resuscitation after cardiac arrest The SARUS (safer - airway - resuscitation) CPR airway hood™ is a clear plastic cover and integrated mask that envelopes the head and torso. Our objectives were to test leakage using saline aerosol generation tests, then assess the performance of the hood during mock cardio-pulmonary resuscitation on a manikin. METHODS: A checklist was validated by comparing the performance of 10 novices against 10 experts during mock resuscitation. Thereafter, 15 novices were tested with and without the hood, in a randomised cross-over study, one week apart. RESULTS: Laboratory analysis showed a > 99% reduction of saline particles detected 5 cm, 75 cm and 165 cm above volunteers wearing the hood. On manikins, experts scored better compared to novices, 8.5 (0.7) vs 7.6 (1.2), difference (95%CI) 0.9 (0.4-1.3), P = 0.0004. Novice performance was equivalent using the hood and standard equipment, 7.3 (1.4) vs 7.3 (1.1) respectively, difference (90%CI) 0.0 (-0.3 - 0.3), P = 0.90. CONCLUSION: Aerosol transmission reduced in the breathing zone. Simulated resuscitation by novices was equivalent with and without the hood.


Subject(s)
Cardiopulmonary Resuscitation , Heart Arrest , Humans , Cross-Over Studies , Manikins , Aerosols
17.
Int J Environ Res Public Health ; 19(13)2022 06 23.
Article in English | MEDLINE | ID: covidwho-1934034

ABSTRACT

South Asian women living in the UK are particularly at high risk of obesity-related complications, such as type 2 diabetes and cardiovascular disease. Exposure to large portion sizes is a risk factor for obesity. Specifically designed tableware helps individuals to manage weight by controlling food portion sizes. Thirty-one (n = 31) overweight or obese South Asian adult women participated in a randomised cross-over trial aimed to assess the efficacy, acceptance, and weight change of two guided/calibrated commercially available portion control tools (Utensil set and Crockery Set) used in free-living conditions. Data on acceptance, perceived changes in portion size, frequency, and meal type was collected using paper questionnaires and 3-day diet diaries. Scores describing acceptance, ease of use, and perceived effectiveness were derived from five-point Likert scales from which binary indicators (high/low) were analysed for significance using multivariate variance analysis for repeated measurements. A reduction in BMI was observed at each point of measurement (p = 0.007). For overall tool use, the crockery set scored higher in all areas of acceptance, ease of use, and perceived efficacy for all comparisons. Self-selected portion sizes increased for salads and decreased for cooking oil and breakfast cereals with both tools. Further research to scale up and evaluate similar weight management interventions for this group is warranted.


Subject(s)
Diabetes Mellitus, Type 2 , Portion Size , Adult , Body Mass Index , Cross-Over Studies , Female , Humans , Obesity , Overweight , Weight Loss
19.
Pharm Stat ; 21(4): 778-789, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1930084

ABSTRACT

Written during the SARS-CoV-2 pandemic, and in recognition of Andy Grieve, the polymath, this article looks at an eclectic mix of topics where statistical thinking and practices should transcend typical dividing lines-with a particular focus on the areas of drug development, public health and social science. The case is made for embedding an experimental (or quasi-experimental) framework within clinical practice for vaccines and treatments following their marketing authorisation. A similar case is made for public health interventions-facilitated by pre-specification of effect size and by the greater use of data standards. A number of recommendations are made whilst noting that progress is being made in some areas.


Subject(s)
COVID-19 , Pandemics , COVID-19/epidemiology , Cross-Over Studies , Humans , SARS-CoV-2
20.
J Affect Disord ; 311: 604-613, 2022 08 15.
Article in English | MEDLINE | ID: covidwho-1914532

ABSTRACT

BACKGROUND: The COVID-19 pandemic has been suggested to constitute a broad base stressor with severe mental health consequences. mHealth applications are accessible self-help tools that can be used to reduce psychological distress during the pandemic. This randomized controlled trial evaluated the effects of mobile-based cognitive training exercises on COVID-19 related distress and maladaptive cognitions. METHODS: Following initial screening (n = 924), participants scoring 1 standard deviations above the mean of the COVID-19 Distress Scale were randomized into two groups. Participants in the immediate-app group (iApp; n = 25) started using the application at baseline (T0) for 12 days (from T0 to T1). Participants in the delayed-app group (dApp; n = 22) started using the mobile application at T1 (crossover) and used it for the following 12 days (T1 to T2). RESULTS: Intention to treat analyses indicated that the iApp group exhibited lower COVID-19 distress, lower depression, fewer intolerance of uncertainty and obsessive beliefs than the dApp group at T1. In addition, using the app for 12 consecutive days was associated with large effect-size reductions (Cohen's d ranging from 0.81 to 2.35) in COVID-19 distress and related maladaptive cognitions in the iApp group (from T0 to T1) and the dApp group (from T1 to T2). Moreover, these reductions were maintained at the follow-up. LIMITATIONS: This study was a crossover trial with a relatively limited sample size and mainly female participants. CONCLUSION: Our findings underscore the usefulness of brief, low-intensity, portable interventions in alleviating the negative effects of the pandemic on mental health.


Subject(s)
COVID-19 , Mobile Applications , Adaptation, Psychological , Cognition , Cross-Over Studies , Female , Humans , Pandemics
SELECTION OF CITATIONS
SEARCH DETAIL