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1.
J Glob Health ; 11: 05029, 2021.
Article in English | MEDLINE | ID: covidwho-1614230

ABSTRACT

Background: The COVID-19 pandemic prompted movement restrictions in countries worldwide, impacting on physical activity (PA), a major non-communicable disease risk factor, and thus may have unintentional long-term health implications. In semi-rural areas of low-middle-income-countries (LMICs), where occupational activity is the main source of PA, changes in PA associated with COVID-19 restrictions are unknown. We investigated the impact of Movement Control Order (MCO) restrictions in a semi-rural region of Malaysia. Methods: The South East Asia Community Observatory (SEACO) is a dynamic prospective community cohort. We contacted a random sample of 1007 adults (18+) who had previously provided PA data in 2018. We asked about PA during the MCO (March-May 2020) and at the time of interview (June 2020). Results: During the MCO, PA reduced by a mean of 6.7 hours/week (95% confidence interval (CI) = 5.3, 8.0) compared to 2018, with the largest reductions among those in employment. By June, PA was 3.4 hours/week (95% CI = 2.0, 4.8) less than 2018, leaving 34% of adults currently inactive (20% in 2018). Reductions in occupational PA were not replaced with active travel or activity at home. Despite these observed reductions, most participants did not think the MCO had affected their PA. Conclusions: Movement restrictions are associated with lower PA lasting beyond the period of strict restrictions; such longer-term reductions in PA may have a detrimental impact on health. Future MCOs should encourage people to be active, but may additionally need targeted messaging for those who don't necessarily realise they are at risk. In particular, policies developed in more affluent countries may not easily translate to LMICs.


Subject(s)
COVID-19 , Adult , Exercise , Humans , Longitudinal Studies , Malaysia , Pandemics , Prospective Studies , Rural Population , SARS-CoV-2
2.
J Glob Health ; 11: 05026, 2021.
Article in English | MEDLINE | ID: covidwho-1614229

ABSTRACT

Background: The dynamics of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission and severity of disease among children and young people (CYP) across different settings are of considerable clinical, public health and societal interest. Severe COVID-19 cases, requiring hospitalisations, and deaths have been reported in some CYP suggesting a need to extend vaccinations to these age groups. As part of the ongoing Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) study, we aim to investigate the uptake, effectiveness and safety of COVID-19 vaccines in children and young people (CYP) aged 0 to 17 years in Scotland. Specifically, we will estimate: (i) uptake of vaccines against COVID-19, (ii) vaccine effectiveness (VE) against the outcomes of symptomatic SARS-CoV-2 infection, hospitalisation, intensive care unit (ICU) admissions, and death; (iii) VE for first/second dose timing among different age groups and risk groups; and (iv) the safety of vaccines. Methods and analysis: We will conduct an open prospective cohort study classifying exposure as time-varying. We will compare outcomes amongst first dose vaccinated and second dose vaccinated CYP to those not yet vaccinated. A Test Negative Design (TND) case control study will be nested within this national cohort to investigate VE against symptomatic infection. The primary outcomes will be (i) uptake of vaccines against COVID-19, (ii) time to COVID-19 infection, hospitalisation, ICU admissions or death, and (iii) adverse events related to vaccines. Vaccination status (unvaccinated, one dose and two doses) will be defined as a time-varying exposure. Data from multiple sources will be linked using a unique identifier. We will conduct descriptive analyses to explore trends in vaccine uptake, and association between different exposure variables and vaccine uptake will be determined using multivariable logistic regression models. VE will be assessed from time-dependent Cox models or Poisson regression models, adjusted for relevant confounders, including age, sex, socioeconomic status, and comorbidities. We will employ self-controlled study designs to determine the risk of adverse events following COVID-19 vaccination. Ethics and dissemination: Ethics approval was obtained from the National Research Ethics Committee, South East Scotland 02. We will present findings of this study at international conferences, in peer-reviewed journals and to policy-makers.


Subject(s)
COVID-19 Vaccines , COVID-19 , Adolescent , Case-Control Studies , Child , Humans , Pandemics , Prospective Studies , SARS-CoV-2 , Scotland/epidemiology
3.
Cells ; 10(12)2021 11 30.
Article in English | MEDLINE | ID: covidwho-1613627

ABSTRACT

The COVID-19 pandemic drastically highlighted the vulnerability of the elderly population towards viral and other infectious threats, illustrating that aging is accompanied by dysregulated immune responses currently summarized in terms like inflammaging and immunoparalysis. To gain a better understanding on the underlying mechanisms of the age-associated risk of adverse outcome in individuals experiencing a SARS-CoV-2 infection, we analyzed the impact of age on circulating monocyte phenotypes, activation markers and inflammatory cytokines including interleukin 6 (IL-6), IL-8 and tumor necrosis factor (TNF) in the context of COVID-19 disease progression and outcome in 110 patients. Our data indicate no age-associated differences in peripheral monocyte counts or subset composition. However, age and outcome are associated with differences in monocyte activation status. Moreover, a distinct cytokine pattern of IL-6, IL-8 and TNF in elderly survivors versus non-survivors, which consolidates over the time of hospitalization, suggests that older patients with adverse outcomes experience an inappropriate immune response, reminiscent of an inflammaging driven immunoparalysis. Our study underscores the value, necessity and importance of longitudinal monitoring in elderly COVID-19 patients, as dynamic changes after symptom onset can be observed, which allow for a differentiated insight into confounding factors that impact the complex pathogenesis following an infection with SARS-CoV-2.


Subject(s)
Aging/pathology , COVID-19/blood , COVID-19/pathology , Cytokines/blood , Monocytes/pathology , Acute Disease , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Biomarkers/metabolism , Humans , Longitudinal Studies , Middle Aged , Neutrophils/metabolism , Prospective Studies , SARS-CoV-2 , Young Adult
4.
Crit Care ; 26(1): 16, 2022 01 07.
Article in English | MEDLINE | ID: covidwho-1613247

ABSTRACT

BACKGROUND: In patients with COVID-19-related acute respiratory failure (ARF), awake prone positioning (AW-PP) reduces the need for intubation in patients treated with high-flow nasal oxygen (HFNO). However, the effects of different exposure times on clinical outcomes remain unclear. We evaluated the effect of AW-PP on the risk of endotracheal intubation and in-hospital mortality in patients with COVID-19-related ARF treated with HFNO and analyzed the effects of different exposure times to AW-PP. METHODS: This multicenter prospective cohort study in six ICUs of 6 centers in Argentine consecutively included patients > 18 years of age with confirmed COVID-19-related ARF requiring HFNO from June 2020 to January 2021. In the primary analysis, the main exposure was awake prone positioning for at least 6 h/day, compared to non-prone positioning (NON-PP). In the sensitivity analysis, exposure was based on the number of hours receiving AW-PP. Inverse probability weighting-propensity score (IPW-PS) was used to adjust the conditional probability of treatment assignment. The primary outcome was endotracheal intubation (ETI); and the secondary outcome was hospital mortality. RESULTS: During the study period, 580 patients were screened and 335 were included; 187 (56%) tolerated AW-PP for [median (p25-75)] 12 (9-16) h/day and 148 (44%) served as controls. The IPW-propensity analysis showed standardized differences < 0.1 in all the variables assessed. After adjusting for other confounders, the OR (95% CI) for ETI in the AW-PP group was 0.36 (0.2-0.7), with a progressive reduction in OR as the exposure to AW-PP increased. The adjusted OR (95% CI) for hospital mortality in the AW-PP group ≥ 6 h/day was 0.47 (0.19-1.31). The exposure to prone positioning ≥ 8 h/d resulted in a further reduction in OR [0.37 (0.17-0.8)]. CONCLUSION: In the study population, AW-PP for ≥ 6 h/day reduced the risk of endotracheal intubation, and exposure ≥ 8 h/d reduced the risk of hospital mortality.


Subject(s)
COVID-19 , Oxygen Inhalation Therapy , Respiratory Insufficiency , Administration, Intranasal , COVID-19/complications , Humans , Oxygen/administration & dosage , Oxygen Inhalation Therapy/methods , Prone Position , Prospective Studies , Respiratory Insufficiency/therapy , Respiratory Insufficiency/virology , Time Factors , Treatment Outcome , Wakefulness
5.
BMJ Open ; 12(1): e052752, 2022 01 06.
Article in English | MEDLINE | ID: covidwho-1613004

ABSTRACT

OBJECTIVES: It has been suggested that ethnic minorities have been disproportionally affected by the COVID-19. We aimed to determine whether prevalence and correlates of past SARS-CoV-2 exposure varied between six ethnic groups in Amsterdam, the Netherlands. DESIGN, SETTING, PARTICIPANTS: Participants aged 25-79 years enrolled in the Healthy Life in an Urban Setting population-based prospective cohort (n=16 889) were randomly selected within ethnic groups and invited to participate in a cross-sectional COVID-19 seroprevalence substudy. OUTCOME MEASURES: We tested participants for SARS-CoV-2-specific antibodies and collected information on SARS-CoV-2 exposures. We estimated prevalence and correlates of SARS-CoV-2 exposure within ethnic groups using survey-weighted logistic regression adjusting for age, sex and calendar time. RESULTS: Between 24 June and 9 October 2020, we included 2497 participants. Adjusted SARS-CoV-2 seroprevalence was comparable between ethnic Dutch (24/498; 5.1%, 95% CI 2.8% to 7.4%), South-Asian Surinamese (22/451; 4.9%, 95% CI 2.2% to 7.7%), African Surinamese (22/400; 8.3%, 95% CI 3.1% to 13.6%), Turkish (30/408; 7.9%, 95% CI 4.4% to 11.4%) and Moroccan (32/391; 7.2%, 95% CI 4.2% to 10.1%) participants, but higher among Ghanaians (95/327; 26.3%, 95% CI 18.5% to 34.0%). 57.1% of SARS-CoV-2-positive participants did not suspect or were unsure of being infected, which was lowest in African Surinamese (18.2%) and highest in Ghanaians (90.5%). Correlates of SARS-CoV-2 exposure varied across ethnic groups, while the most common correlate was having a household member suspected of infection. In Ghanaians, seropositivity was associated with older age, larger household sizes, living with small children, leaving home to work and attending religious services. CONCLUSIONS: No remarkable differences in SARS-CoV-2 seroprevalence were observed between the largest ethnic groups in Amsterdam after the first wave of infections. The higher infection seroprevalence observed among Ghanaians, which passed mostly unnoticed, warrants wider prevention efforts and opportunities for non-symptom-based testing.


Subject(s)
COVID-19 , SARS-CoV-2 , Aged , Child , Cross-Sectional Studies , Ghana , Humans , Netherlands/epidemiology , Prevalence , Prospective Studies , Seroepidemiologic Studies
7.
Eur J Neurol ; 28(10): 3348-3359, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1607398

ABSTRACT

BACKGROUND AND PURPOSE: To assess neurological manifestations and health-related quality of life (QoL) 3 months after COVID-19. METHODS: In this prospective, multicenter, observational cohort study we systematically evaluated neurological signs and diseases by detailed neurological examination and a predefined test battery assessing smelling disorders (16-item Sniffin Sticks test), cognitive deficits (Montreal Cognitive Assessment), QoL (36-item Short Form), and mental health (Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist-5) 3 months after disease onset. RESULTS: Of 135 consecutive COVID-19 patients, 31 (23%) required intensive care unit (ICU) care (severe), 72 (53%) were admitted to the regular ward (moderate), and 32 (24%) underwent outpatient care (mild) during acute disease. At the 3-month follow-up, 20 patients (15%) presented with one or more neurological syndromes that were not evident before COVID-19. These included polyneuro/myopathy (n = 17, 13%) with one patient presenting with Guillain-Barré syndrome, mild encephalopathy (n = 2, 2%), parkinsonism (n = 1, 1%), orthostatic hypotension (n = 1, 1%), and ischemic stroke (n = 1, 1%). Objective testing revealed hyposmia/anosmia in 57/127 (45%) patients at the 3-month follow-up. Self-reported hyposmia/anosmia was lower (17%) at 3 months, however, improved when compared to the acute disease phase (44%; p < 0.001). At follow-up, cognitive deficits were apparent in 23%, and QoL was impaired in 31%. Assessment of mental health revealed symptoms of depression, anxiety, and posttraumatic stress disorders in 11%, 25%, and 11%, respectively. CONCLUSIONS: Despite recovery from the acute infection, neurological symptoms were prevalent at the 3-month follow-up. Above all, smelling disorders were persistent in a large proportion of patients.


Subject(s)
COVID-19 , Stroke , Cohort Studies , Humans , Prospective Studies , Quality of Life , SARS-CoV-2
8.
Eur J Neurol ; 28(10): 3339-3347, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1607258

ABSTRACT

OBJECTIVE: To describe the spectrum of neurological complications observed in a hospital-based cohort of COVID-19 patients who required a neurological assessment. METHODS: We conducted an observational, monocentric, prospective study of patients with a COVID-19 diagnosis hospitalized during the 3-month period of the first wave of the COVID-19 pandemic in a tertiary hospital in Madrid (Spain). We describe the neurological diagnoses that arose after the onset of COVID-19 symptoms. These diagnoses could be divided into different groups. RESULTS: Only 71 (2.6%) of 2750 hospitalized patients suffered at least one neurological complication (77 different neurological diagnoses in total) during the timeframe of the study. The most common diagnoses were neuromuscular disorders (33.7%), cerebrovascular diseases (CVDs) (27.3%), acute encephalopathy (19.4%), seizures (7.8%), and miscellanea (11.6%) comprising hiccups, myoclonic tremor, Horner syndrome and transverse myelitis. CVDs and encephalopathy were common in the early phase of the COVID-19 pandemic compared to neuromuscular disorders, which usually appeared later on (p = 0.005). Cerebrospinal fluid severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction was negative in 15/15 samples. The mortality was higher in the CVD group (38.1% vs. 8.9%; p = 0.05). CONCLUSIONS: The prevalence of neurological complications is low in patients hospitalized for COVID-19. Different mechanisms appear to be involved in these complications, and there was no evidence of direct invasion of the nervous system in our cohort. Some of the neurological complications can be classified into early and late neurological complications of COVID-19, as they occurred at different times following the onset of COVID-19 symptoms.


Subject(s)
COVID-19 , Nervous System Diseases , Neurology , COVID-19 Testing , Humans , Nervous System Diseases/epidemiology , Pandemics , Prospective Studies , Registries , SARS-CoV-2
9.
Gac Med Mex ; 157(3): 245-250, 2021.
Article in English | MEDLINE | ID: covidwho-1604118

ABSTRACT

INTRODUCTION: In patients with COVID-19, olfactory dysfunction and anosmia have been reported, which in pregnant women occur in up to 24.2 %. OBJECTIVE: To know the frequency at which pregnant women with SARS-CoV-2 infection have olfactory dysfunction. METHODS: Age, gestational age, temperature, presence of nasal constipation or rhinorrhea, myalgia, headache, cough or chest pain were asked. Whether patients perceived and identified the scent of grape juice, coffee powder and menthol was evaluated. Central tendency and dispersion measures, frequencies and percentages were used. Sensitivity, specificity, positive and negative predictive value were calculated. Mann-Whitney's U-test and contrast of proportions were used for comparisons between groups. RESULTS: There was a higher proportion of women with cough, headache, dyspnea, myalgia, odynophagia, rhinorrhea, chest pain, and anosmia in SARS-CoV-2-positive women. In patients without COVID-19, 88.9 % detected each one of the scents; only 31.8 % of the positive group detected grapes scent, 47.7 % coffee and 59.1 % menthol, which had the highest percentages of sensitivity (40 %), specificity (21 %), positive predictive value (59 %) and negative predictive value (11 %). CONCLUSION: Olfactory dysfunction occurs in a significant percentage of pregnant women with COVID-19.


Subject(s)
Anosmia/epidemiology , COVID-19/complications , Olfaction Disorders/epidemiology , Pregnancy Complications, Infectious/epidemiology , Adolescent , Adult , Anosmia/virology , COVID-19/epidemiology , Cross-Sectional Studies , Female , Humans , Olfaction Disorders/virology , Predictive Value of Tests , Pregnancy , Pregnancy Complications, Infectious/virology , Prospective Studies , Sensitivity and Specificity , Young Adult
10.
Eur J Neurol ; 28(10): 3245-3253, 2021 10.
Article in English | MEDLINE | ID: covidwho-1604031

ABSTRACT

BACKGROUND AND PURPOSE: Neurological complications of SARS-CoV-2 infection are noticed among critically ill patients soon after disease onset. Information on delayed neurological sequelae of SARS-CoV-2 infection is nil. Following a longitudinal study design, the occurrence of cognitive decline among individuals with a history of mild symptomatic SARS-CoV-2 infection was assessed. METHODS: Stroke- and seizure-free Atahualpa residents aged ≥40 years, who had pre-pandemic cognitive assessments as well as normal brain magnetic resonance imaging and electroencephalogram recordings, underwent repeated evaluations 6 months after a SARS-CoV-2 outbreak infection in Atahualpa. Patients requiring oxygen therapy, hospitalization, and those who had initial neurological manifestations were excluded. Cognitive decline was defined as a reduction in the Montreal Cognitive Assessment (MoCA) score between the post-pandemic and pre-pandemic assessments that was ≥4 points greater than the reduction observed between two pre-pandemic MoCAs. The relationship between SARS-CoV-2 infection and cognitive decline was assessed by fitting logistic mixed models for longitudinal data as well as exposure-effect models. RESULTS: Of 93 included individuals (mean age 62.6 ± 11 years), 52 (56%) had a history of mild symptomatic SARS-CoV-2 infection. Post-pandemic MoCA decay was worse in seropositive individuals. Cognitive decline was recognized in 11/52 (21%) seropositive and 1/41 (2%) seronegative individuals. In multivariate analyses, the odds for developing cognitive decline were 18.1 times higher among SARS-CoV-2 seropositive individuals (95% confidence interval 1.75-188; p = 0.015). Exposure-effect models confirmed this association (ß = 0.24; 95% confidence interval 0.07-0.41; p = 0.006). CONCLUSIONS: This study provides evidence of cognitive decline among individuals with mild symptomatic SARS-CoV-2 infection. The pathogenesis of this complication remains unknown.


Subject(s)
COVID-19 , Cognitive Dysfunction , Aged , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/etiology , Humans , Longitudinal Studies , Middle Aged , Prospective Studies , SARS-CoV-2
11.
Geroscience ; 43(5): 2333-2343, 2021 10.
Article in English | MEDLINE | ID: covidwho-1603920

ABSTRACT

COVID-19 is a particularly aggressive disease for the elderly as 86% of deaths related to COVID-19 occur in people over 65 years of age. Despite the urgent need for a preventive treatment, there are currently no serious leads, other than the vaccination. The aim of this retrospective case-control study is to find a pharmacological preventive treatment of COVID-19 in elderly patients. One-hundred-seventy-nine patients had been in contact with other COVID-19 patients at home or in hospital, of whom 89 had tested RT-PCR-positive (COVID-pos) for the virus and 90 had tested RT-PCR-negative (COVID-neg). Treatments within 15 days prior to RT-PCR (including antihypertensive drugs, antipsychotics, antibiotics, nonsteroidal anti-inflammatory drugs, proton pump inhibitors (PPIs), oral antidiabetics (OADs), corticosteroids, immunosuppressants), comorbidities, symptoms, laboratory values, and clinical outcome were all collected. COVID-pos patients more frequently had a history of diabetes (P = .016) and alcoholism (P = .023), a lower leukocyte count (P = .014) and a higher mortality rate - 29.2% versus 14.4% - (P = .014) when compared to COVID-neg patients. Patients on PPIs were 2.3 times less likely (odds ratio [OR] = 0.4381, 95% confidence interval [CI] [0.2331, 0.8175], P = .0053) to develop COVID-19 infection, compared to those not on PPIs. No other treatment decreased or increased this risk. COVID-pos patients on antipsychotics (P = .0013) and OADs (P = .0153), particularly metformin (P = .0237), were less likely to die. Thus, patients on treatment with PPI were less likely to develop COVID-19 infection, and those on antipsychotics or metformin had a lower risk of mortality. However, prospective studies, including clinical trials, are needed to confirm or not these findings.


Subject(s)
COVID-19 , Aged , Case-Control Studies , Humans , Prospective Studies , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
12.
Crit Care ; 26(1): 10, 2022 01 04.
Article in English | MEDLINE | ID: covidwho-1604921

ABSTRACT

BACKGROUND: Research on the duration of infectivity of ICU patients with COVID-19 has been sparse. Tests based on Reverse Transcriptase polymerase chain reaction (RT-PCR) detect both live virus and non-infectious viral RNA. We aimed to determine the duration of infectiousness based on viral culture of nasopharyngeal samples of patients with COVID-19. METHODS: Prospective observational study in adult intensive care units with a diagnosis of COVID-19 Pneumonia. Patients had repeated nasopharyngeal sampling performed after day 10 of ICU admission. Culture positive rate (based on viral culture on Vero cells in a level 4 lab) and Cycle threshold from RT-PCR were measured. RESULTS: Nine patients of the 108 samples (8.3%, 95% CI 3.9-15.2%) grew live virus at a median of 13 days (interquartile range 11-19) after their initial positive test. 74.1% of patients were RT-PCR positive but culture negative, and the remaining (17.6%) were RT-PCR and culture negative. Cycle threshold showed excellent ability to predict the presence of live virus, with a Ct < 25 with an AUC of 0.90 (95% CI 0.83-0.97, p < 0.001). The specificity of a Ct > 25 to predict negative viral culture was 100% (95% CI 70-100%). CONCLUSION: 8.3% of our ICU patients with COVID-19 grew live virus at a median of 13 days post-initial positive RT-PCR test. Severity of illness, use of mechanical ventilation, and time between tests did not predict the presence of live virus. Cycle threshold of > 25 had the best ability to determine the lack of live virus in these patents.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , COVID-19/therapy , COVID-19/virology , COVID-19 Nucleic Acid Testing , Critical Illness , Humans , Intensive Care Units , Nasopharynx/virology , Prospective Studies , SARS-CoV-2/isolation & purification
13.
BMJ Open ; 12(1): e053094, 2022 01 03.
Article in English | MEDLINE | ID: covidwho-1604769

ABSTRACT

OBJECTIVES: COVID-19 is having a disproportionate impact on Black, Asian and minority ethnic (BAME) groups and women. Concern over direct and indirect effects may also impact on sleep. We explore the levels and social determinants of self-reported sleep loss among the UK population during the pandemic, focusing on ethnic and gender disparities. SETTING: This prospective longitudinal study analysed data from seven waves of the Understanding Society: COVID-19 Study collected from April 2020 to January 2021 linked to prepandemic data from the 2019 mainstage interviews, providing baseline information about the respondents prior to the pandemic. PARTICIPANTS: The analytical sample included 8163 respondents aged 16 and above who took part in all seven waves with full information on sleep loss, defined as experiencing 'rather more' or 'much more' than usual sleep loss due to worry, providing 57 141 observations. PRIMARY OUTCOME MEASURES: Self-reported sleep loss. Mixed-effects regression models were fitted to consider within-individual and between-individual differences. RESULTS: Women were more likely to report sleep loss than men (OR 2.1, 95% CI 1.9 to 2.4) over the 10-month period. Being female, having young children, perceived financial difficulties and COVID-19 symptoms were all predictive of sleep loss. Once these covariates were controlled for, the bivariate relationship between ethnicity and sleep loss (1.4, 95% CI 1.6 to 2.4) was reversed (0.7, 95% CI 0.5 to 0.8). Moreover, the strength of the association between gender and ethnicity and the risk of sleep loss varied over time, being weaker among women in July (0.6, 95% CI 0.5 to 0.7), September (0.7, 95% CI 0.6 to 0.8), November (0.8, 95% CI 0.7 to 1.0) and January 2021 (0.8, 95% CI 0.7 to 0.9) compared with April 2020, but positively stronger among BAME individuals in May (1.4, 95% CI 1.0 to 2.1), weaker only in September (0.7, 95% CI 0.5 to 1.0). CONCLUSIONS: The pandemic has widened sleep deprivation disparities, with women with young children, COVID-19 infection and BAME individuals experiencing sleep loss, which may adversely affect their mental and physical health.


Subject(s)
COVID-19 , Pandemics , Child , Child, Preschool , Communicable Disease Control , Female , Humans , Longitudinal Studies , Male , Prospective Studies , SARS-CoV-2 , Sleep , United Kingdom/epidemiology
14.
BMC Med Educ ; 22(1): 3, 2022 Jan 03.
Article in English | MEDLINE | ID: covidwho-1604664

ABSTRACT

BACKGROUND: The social distancing and suspension of on-campus learning, imposed by the COVID-19 pandemic, are likely to influence medical training for months if not years. Thus, there is a need for digital replacement for classroom teaching, especially for hands-on courses, during which social distancing is hardly possible. Here, we investigated students' learning experience with a newly designed digital training course in neurophysiology, with intercalated teaching blocks in either asynchronous (unsupervised online lectures and e-labs) or synchronous (online seminars, supervised by instructors) formats. METHODS: The accompanying anonymized prospective study included 146 student participants. At the beginning and the end of the course, students were invited to answer anonymous online questionnaires with 18 and 25 items, respectively. We conducted both qualitative analyses of students' survey responses and statistical analyses of the results of cohort-specific summative examinations. The summative assessment results were compared both between 4 current cohorts and with the respective historical cohorts. RESULTS: Despite having little prior experience with e-learning (4.5 on the 1-7 scale), students adapted remarkably well to this online format. They appreciated its higher flexibility, time efficiency, student-oriented nature (especially when using inverted classroom settings), tolerance towards the individual learning style and family circumstances, and valued the ability to work through lectures and e-labs at their own learning speed. The major complaints concerned diminished social contacts with instructors and fellow students, the inability to ask questions as they occur, and the lack of sufficient technical expertise. The students valued the newly developed e-labs, especially the implementation of interactive preparative measures (PreLabs) and the intuitive lab design offered by the chosen software (Lt Platform from AD Instruments). The summative examinations at the end of the course documented the quality of knowledge transfer, which was comparable to that of previous classically instructed cohorts. CONCLUSION: Despite the missing personal contact between the faculty and the students, inherent to online teaching, the all-digital training course described here proofed to be of good educational value and, in case the pandemic continues, is worse considering for the future. Some of the described building blocks, like digital lectures or interactive PreLabs, may survive the pandemics to enrich the medical education toolbox in the future.


Subject(s)
COVID-19 , Education, Distance , Humans , Neurophysiology , Pandemics , Prospective Studies , SARS-CoV-2
15.
J Prim Care Community Health ; 13: 21501319211067349, 2022.
Article in English | MEDLINE | ID: covidwho-1608774

ABSTRACT

INTRODUCTION: Disorders of serum sodium (SNa) are common in hospitalized patients with COVID-19 and may reflect underlying disease severity. However, the association of SNa with patient-reported outcomes is not clear. METHODS: The Brigham and Women's Hospital COVID-19 Registry is a prospective cohort study of consecutively admitted adult patients with confirmed SARS-CoV-2 infection (n = 809). We examined the associations of SNa (continuous and tertiles) on admission with: (1) patient symptoms obtained from detailed chart review; and (2) in-hospital mortality, length of stay, and intensive care unit (ICU) admission using unadjusted and adjusted logistic regression models. Covariates included demographic data and comorbidities. RESULTS: Mean age was 60 years, 48% were male, and 35% had diabetes. The most frequent symptoms were cough (64%), fever (60%), and shortness of breath (56%). In adjusted models, higher SNa (per mmol/L) was associated with lower odds of GI symptoms (OR 0.96; 95% CI 0.92-0.99), higher odds of confusion (OR 1.08; 95% CI 1.04-1.13), in-hospital mortality (OR 1.06; 95% CI 1.02-1.11), and ICU admission (OR 1.09; 95% CI 1.05-1.13). The highest sodium tertile (compared with the middle tertile) showed similar associations, in addition to lower odds of either anosmia or ageusia (OR 0.30; 95% CI 0.12-0.74). CONCLUSION: In this prospective cohort study of hospitalized patients with COVID-19, hypernatremia was associated with higher odds of confusion and in-hospital mortality. These findings may aid providers in identifying high-risk patients who warrant closer attention, thereby furthering patient-centered approaches to care.


Subject(s)
COVID-19 , Adult , Female , Hospitalization , Humans , Intensive Care Units , Male , Middle Aged , Prospective Studies , SARS-CoV-2 , Sodium
16.
Front Public Health ; 9: 780039, 2021.
Article in English | MEDLINE | ID: covidwho-1608013

ABSTRACT

Introduction: With the increased emergence of SARS-CoV-2 variants, the impact on schools and preschools remains a matter of debate. To ensure that schools and preschools are kept open safely, the identification of factors influencing the extent of outbreaks is of importance. Aim: To monitor dynamics of COVID-19 infections in schools and preschools and identify factors influencing the extent of outbreaks. Methods: In this prospective observational study we analyzed routine surveillance data of Mecklenburg-Western Pomerania, Germany, from calendar week (CW) 32, 2020 to CW19, 2021 regarding SARS-CoV-2 infection events in schools and preschools considering changes in infection control measures over time. A multivariate linear regression model was fitted to evaluate factors influencing the number of students, teachers and staff tested positive following index cases in schools and preschools. Due to an existing multicollinearity in the common multivariate regression model between the variables "face mask obligation for children" and "face mask obligation for adults", two further separate regression models were set up (Multivariate Model Adults and Multivariate Model Children). Results: We observed a significant increase in secondary cases in preschools in the first quarter of 2021 (CW8 to CW15, 2021), and simultaneously a decrease in secondary cases in schools. In multivariate regression analysis, the strongest predictor of the extent of the outbreaks was the teacher/ caregiver mask obligation (B = -1.9; 95% CI: -2.9 to -1.0; p < 0.001). Furthermore, adult index cases (adult only or child+adult combinations) increased the likelihood of secondary cases (B = 1.3; 95% CI: 0.9 to 1.8; p < 0.001). The face mask obligation for children also showed a significant reduction in the number of secondary cases (B = -0.6; 95% CI: -0.9 to -0.2; p = 0.004. Conclusion: The present study indicates that outbreak events at schools and preschools are effectively contained by an obligation for adults and children to wear face masks.


Subject(s)
COVID-19 , Communicable Disease Control/methods , Schools , Adult , COVID-19/prevention & control , Child , Child, Preschool , Disease Outbreaks/prevention & control , Germany , Humans , Masks , Prospective Studies , SARS-CoV-2
17.
Acta Orthop ; 93: 198-205, 2022 01 03.
Article in English | MEDLINE | ID: covidwho-1607747

ABSTRACT

Background and purpose - Facemasks play a role in preventing the respiratory spread of SARS-CoV-2, but their impact on the physician-patient relationship in the orthopedic outpatient clinic is unclear. We investigated whether the type of surgeons' facemask impacts patients' perception of the physician-patient relationship, influences their understanding of what the surgeon said, or affects their perceived empathy. Patients and methods - All patients with an appointment in the orthopedic outpatient clinic of a tertiary university hospital during the 2-week study period were included. During consultations, all surgeons wore a non-transparent (first study week) or transparent facemask (second study week). Results of 285 of 407 eligible patients were available for analysis. The doctor-patient relationship was evaluated using the standardized Patient Reactions Assessment (PRA) and a 10-point Likert-scale questionnaire ranging from 0 (strongly disagree) to 10 (strongly agree). Results - A non-transparent facemask led to more restrictions in the physician-patient communication and a worse understanding of what the surgeon said. Patients' understanding improved with a transparent facemask with greatest improvements reported by patients aged 65 years and older (non-transparent: 6 [IQR 5-10] vs. transparent: 10 [IQR 9-10], p < 0.001) and by patients with a self-reported hearing impairment (non-transparent: 7 [IQR 3-7] vs. transparent: 9 [IQR 9-10], p < 0.001). The median PRA score was higher when surgeons wore a transparent facemask (p= 0.003). Interpretation - Surgeons' non-transparent facemasks pose a new communication barrier that can negatively affect the physician-patient relationship. While emotional factors like affectivity and empathy seem to be less affected overall, the physician-patient communication and patients' understanding of what the surgeon said seem to be negatively affected.


Subject(s)
COVID-19/prevention & control , Equipment Design , Masks , Orthopedic Surgeons , Pandemics/prevention & control , Physician-Patient Relations , Adult , Aged , Cohort Studies , Female , Hospitals, University , Humans , Male , Middle Aged , Prospective Studies , SARS-CoV-2 , Surveys and Questionnaires
18.
Lancet ; 398(10303): 843-855, 2021 09 04.
Article in English | MEDLINE | ID: covidwho-1599473

ABSTRACT

BACKGROUND: A previous efficacy trial found benefit from inhaled budesonide for COVID-19 in patients not admitted to hospital, but effectiveness in high-risk individuals is unknown. We aimed to establish whether inhaled budesonide reduces time to recovery and COVID-19-related hospital admissions or deaths among people at high risk of complications in the community. METHODS: PRINCIPLE is a multicentre, open-label, multi-arm, randomised, controlled, adaptive platform trial done remotely from a central trial site and at primary care centres in the UK. Eligible participants were aged 65 years or older or 50 years or older with comorbidities, and unwell for up to 14 days with suspected COVID-19 but not admitted to hospital. Participants were randomly assigned to usual care, usual care plus inhaled budesonide (800 µg twice daily for 14 days), or usual care plus other interventions, and followed up for 28 days. Participants were aware of group assignment. The coprimary endpoints are time to first self-reported recovery and hospital admission or death related to COVID-19, within 28 days, analysed using Bayesian models. The primary analysis population included all eligible SARS-CoV-2-positive participants randomly assigned to budesonide, usual care, and other interventions, from the start of the platform trial until the budesonide group was closed. This trial is registered at the ISRCTN registry (ISRCTN86534580) and is ongoing. FINDINGS: The trial began enrolment on April 2, 2020, with randomisation to budesonide from Nov 27, 2020, until March 31, 2021, when the prespecified time to recovery superiority criterion was met. 4700 participants were randomly assigned to budesonide (n=1073), usual care alone (n=1988), or other treatments (n=1639). The primary analysis model includes 2530 SARS-CoV-2-positive participants, with 787 in the budesonide group, 1069 in the usual care group, and 974 receiving other treatments. There was a benefit in time to first self-reported recovery of an estimated 2·94 days (95% Bayesian credible interval [BCI] 1·19 to 5·12) in the budesonide group versus the usual care group (11·8 days [95% BCI 10·0 to 14·1] vs 14·7 days [12·3 to 18·0]; hazard ratio 1·21 [95% BCI 1·08 to 1·36]), with a probability of superiority greater than 0·999, meeting the prespecified superiority threshold of 0·99. For the hospital admission or death outcome, the estimated rate was 6·8% (95% BCI 4·1 to 10·2) in the budesonide group versus 8·8% (5·5 to 12·7) in the usual care group (estimated absolute difference 2·0% [95% BCI -0·2 to 4·5]; odds ratio 0·75 [95% BCI 0·55 to 1·03]), with a probability of superiority 0·963, below the prespecified superiority threshold of 0·975. Two participants in the budesonide group and four in the usual care group had serious adverse events (hospital admissions unrelated to COVID-19). INTERPRETATION: Inhaled budesonide improves time to recovery, with a chance of also reducing hospital admissions or deaths (although our results did not meet the superiority threshold), in people with COVID-19 in the community who are at higher risk of complications. FUNDING: National Institute of Health Research and United Kingdom Research Innovation.


Subject(s)
Budesonide/administration & dosage , COVID-19/drug therapy , Glucocorticoids/administration & dosage , Administration, Inhalation , Aged , Bayes Theorem , COVID-19/mortality , Female , Hospitalization , Humans , Male , Middle Aged , Prospective Studies , Risk Factors , SARS-CoV-2 , Treatment Outcome
19.
Lancet Neurol ; 20(9): 753-761, 2021 09.
Article in English | MEDLINE | ID: covidwho-1599333

ABSTRACT

BACKGROUND: The mechanisms by which any upper respiratory virus, including SARS-CoV-2, impairs chemosensory function are not known. COVID-19 is frequently associated with olfactory dysfunction after viral infection, which provides a research opportunity to evaluate the natural course of this neurological finding. Clinical trials and prospective and histological studies of new-onset post-viral olfactory dysfunction have been limited by small sample sizes and a paucity of advanced neuroimaging data and neuropathological samples. Although data from neuropathological specimens are now available, neuroimaging of the olfactory system during the acute phase of infection is still rare due to infection control concerns and critical illness and represents a substantial gap in knowledge. RECENT DEVELOPMENTS: The active replication of SARS-CoV-2 within the brain parenchyma (ie, in neurons and glia) has not been proven. Nevertheless, post-viral olfactory dysfunction can be viewed as a focal neurological deficit in patients with COVID-19. Evidence is also sparse for a direct causal relation between SARS-CoV-2 infection and abnormal brain findings at autopsy, and for trans-synaptic spread of the virus from the olfactory epithelium to the olfactory bulb. Taken together, clinical, radiological, histological, ultrastructural, and molecular data implicate inflammation, with or without infection, in either the olfactory epithelium, the olfactory bulb, or both. This inflammation leads to persistent olfactory deficits in a subset of people who have recovered from COVID-19. Neuroimaging has revealed localised inflammation in intracranial olfactory structures. To date, histopathological, ultrastructural, and molecular evidence does not suggest that SARS-CoV-2 is an obligate neuropathogen. WHERE NEXT?: The prevalence of CNS and olfactory bulb pathosis in patients with COVID-19 is not known. We postulate that, in people who have recovered from COVID-19, a chronic, recrudescent, or permanent olfactory deficit could be prognostic for an increased likelihood of neurological sequelae or neurodegenerative disorders in the long term. An inflammatory stimulus from the nasal olfactory epithelium to the olfactory bulbs and connected brain regions might accelerate pathological processes and symptomatic progression of neurodegenerative disease. Persistent olfactory impairment with or without perceptual distortions (ie, parosmias or phantosmias) after SARS-CoV-2 infection could, therefore, serve as a marker to identify people with an increased long-term risk of neurological disease.


Subject(s)
COVID-19/complications , COVID-19/diagnostic imaging , Olfaction Disorders/diagnostic imaging , Olfaction Disorders/etiology , Olfactory Mucosa/diagnostic imaging , Brain/diagnostic imaging , Brain/physiopathology , Brain/virology , COVID-19/physiopathology , Humans , Neurodegenerative Diseases/diagnostic imaging , Neurodegenerative Diseases/etiology , Neurodegenerative Diseases/physiopathology , Olfaction Disorders/physiopathology , Olfaction Disorders/virology , Olfactory Mucosa/physiopathology , Olfactory Mucosa/virology , Prospective Studies , Smell/physiology
20.
JAMA Netw Open ; 4(12): e2140568, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1592803

ABSTRACT

Importance: Obesity, diabetes, and hypertension are common comorbidities in patients with severe COVID-19, yet little is known about the risk of acute respiratory distress syndrome (ARDS) or death in patients with COVID-19 and metabolic syndrome. Objective: To determine whether metabolic syndrome is associated with an increased risk of ARDS and death from COVID-19. Design, Setting, and Participants: This multicenter cohort study used data from the Society of Critical Care Medicine Discovery Viral Respiratory Illness Universal Study collected from 181 hospitals across 26 countries from February 15, 2020, to February 18, 2021. Outcomes were compared between patients with metabolic syndrome (defined as ≥3 of the following criteria: obesity, prediabetes or diabetes, hypertension, and dyslipidemia) and a control population without metabolic syndrome. Participants included adult patients hospitalized for COVID-19 during the study period who had a completed discharge status. Data were analyzed from February 22 to October 5, 2021. Exposures: Exposures were SARS-CoV-2 infection, metabolic syndrome, obesity, prediabetes or diabetes, hypertension, and/or dyslipidemia. Main Outcomes and Measures: The primary outcome was in-hospital mortality. Secondary outcomes included ARDS, intensive care unit (ICU) admission, need for invasive mechanical ventilation, and length of stay (LOS). Results: Among 46 441 patients hospitalized with COVID-19, 29 040 patients (mean [SD] age, 61.2 [17.8] years; 13 059 [45.0%] women and 15713 [54.1%] men; 6797 Black patients [23.4%], 5325 Hispanic patients [18.3%], and 16 507 White patients [57.8%]) met inclusion criteria. A total of 5069 patients (17.5%) with metabolic syndrome were compared with 23 971 control patients (82.5%) without metabolic syndrome. In adjusted analyses, metabolic syndrome was associated with increased risk of ICU admission (adjusted odds ratio [aOR], 1.32 [95% CI, 1.14-1.53]), invasive mechanical ventilation (aOR, 1.45 [95% CI, 1.28-1.65]), ARDS (aOR, 1.36 [95% CI, 1.12-1.66]), and mortality (aOR, 1.19 [95% CI, 1.08-1.31]) and prolonged hospital LOS (median [IQR], 8.0 [4.2-15.8] days vs 6.8 [3.4-13.0] days; P < .001) and ICU LOS (median [IQR], 7.0 [2.8-15.0] days vs 6.4 [2.7-13.0] days; P < .001). Each additional metabolic syndrome criterion was associated with increased risk of ARDS in an additive fashion (1 criterion: 1147 patients with ARDS [10.4%]; P = .83; 2 criteria: 1191 patients with ARDS [15.3%]; P < .001; 3 criteria: 817 patients with ARDS [19.3%]; P < .001; 4 criteria: 203 patients with ARDS [24.3%]; P < .001). Conclusions and Relevance: These findings suggest that metabolic syndrome was associated with increased risks of ARDS and death in patients hospitalized with COVID-19. The association with ARDS was cumulative for each metabolic syndrome criteria present.


Subject(s)
COVID-19/epidemiology , COVID-19/mortality , Hospitalization , Metabolic Syndrome/epidemiology , Respiratory Distress Syndrome/epidemiology , Adult , COVID-19/therapy , Comorbidity , Critical Care , Female , Hospital Mortality , Humans , Length of Stay , Male , Middle Aged , Prognosis , Prospective Studies , Respiration, Artificial , Risk Factors , SARS-CoV-2
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