Effectiveness of telerehabilitation and home-based falls prevention programs for community-dwelling older adults: a systematic review and meta-analysis protocol.

INTRODUCTION: Falls among older adults are associated with adverse sequelae including fractures, chronic pain and disability, which can lead to loss of independence and increased risks of nursing home admissions. The COVID-19 pandemic has significantly increased the uptake of telehealth, but the effectiveness of virtual, home-based fall prevention programmes is not clearly known. We aim to synthesise the trials on telerehabilitation and home-based falls prevention programmes to determine their effectiveness in reducing falls and adverse outcomes, as well as to describe the safety risks associated with telerehabilitation. METHODS AND ANALYSIS: This protocol was developed using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Database searches from inception to August 2022 will be conducted without language restrictions of MEDLINE, EMBASE, Ovid HealthSTAR, CINAHL, SPORTDiscus, Physiotherapy EvidenceDatabase (PEDro) and the Cochrane Library. Grey literature including major geriatrics conference proceedings will be reviewed. Using Covidence software, two independent reviewers will in duplicate determine the eligibility of randomised controlled trials (RCTs). Eligible RCTs will compare telerehabilitation and home-based fall prevention programmes to usual care among community-dwelling older adults and will report at least one efficacy outcome: falls, fractures, hospitalisations, mortality or quality of life; or at least one safety outcome: pain, myalgias, dyspnoea, syncope or fatigue. Secondary outcomes include functional performance in activities of daily living, balance and endurance. Risk of bias will be assessed using the Cochrane Collaboration tool. DerSimonian-Laird random effects models will be used for the meta-analysis. Heterogeneity will be assessed using the I2 statistic and Cochran's Q statistic. We will assess publication bias using the Egger's test. Prespecified subgroup analyses and univariate meta-regression will be used. ETHICS AND DISSEMINATION: Ethics approval is not required. The results will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42022356759.

Lessons from Animal Culling during Human Pandemics: Is Vaccination a Viable Option for Animals?

Animal reservoirs for respiratory and coronavirus have been major health concerns. Zo-onosis due to coronavirus involves bats, civet cat, camels, pangolins and now the minks. In the same vein, influenza pandemics occur when a new strain of the influenza virus is transmitted to humans from another animal species. Species thought to be of particular importance in the emer-gence of new human influenza strains are swine and poultry and these hosts are often culled during epidemics or pandemics. It is often too easy for humans to forget that millions of animals can die or be slaughtered in human pandemics, including the recent cull of minks in Europe and chickens in Asia. To co-exist with nature in a sustainable way, we must respect our animals by ensuring their welfare and immunizing them against pathogens where possible. Zoonotic diseases are here to stay and will continue to cause major epidemics and pandemics. The other side of the coin is that reverse zoonosis can also have devastating effects on animal populations if pandemics are not effectively prevented and controlled. Unfortunately, none of the COVID-19 vaccines in production are set aside to save the minks. We advocate that animals be immunized to save human lives.

Elimination, containment, and mitigation of COVID-19: A personal story about international travels.

BACKGROUND: The author and his wife report their unique experience of international travels during the COVID-19 pandemic, and discuss issues encountered in various countries. METHODS: Narrated discussion of issues encountered during the COVID-19 pandemic. DISCUSSION: "Zero-COVID" versus "Living with COVID-19" strategies are compared. Children have unique issues with COVID-19 pandemic. Evaluation of efficacy of the approaches in pandemic with time should consider the main types of interventions (e.g., border management/quarantine; physical distancing; mask use; case isolation, testing and contract tracing; vaccination). The key metrics that can be used to compare the impacts of different strategies between the cities (e.g., cumulative case rate, cumulative mortality rate, case fatality risk, stringency index, economic performance) should be identified. Research in these approaches can help manage future pandemics in coronaviruses and emerging infections. The UK started with very loose mitigation ('herd immunity') and then switched to a suppression approach for periods, whereas HK has stuck with elimination throughout. In between, countries like Singapore, Australia and New Zealand have shifted from zero-COVID strategy. It is easier to have effective social control measures in Hong Kong because it has clear borders and an authoritarian government, but it did not have a clear exit policy when Omicron spread.

Respiratory Syncytial Virus is the Most Common Causative Agent of Viral Bronchiolitis in Young Children: An Updated Review

Background: Viral bronchiolitis is a common condition and a leading cause of hospitalization in young children. Objective: This article provides readers with an update on the evaluation, diagnosis, and treatment of viral bronchiolitis, primarily due to RSV. Methods: A PubMed search was conducted in December 2021 in Clinical Queries using the key terms "acute bronchiolitis" OR "respiratory syncytial virus infection". The search included clinical trials, randomized controlled trials, case control studies, cohort studies, meta-analyses, observation-al studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to children and English literature. The information retrieved from the above search was used in the compilation of this article. Results: Respiratory syncytial virus (RSV) is the most common viral bronchiolitis in young children. Other viruses such as human rhinovirus and coronavirus could be etiological agents. Diagno-sis is based on clinical manifestation. Viral testing is useful only for cohort and quarantine purposes. Cochrane evidence-based reviews have been performed on most treatment modalities for RSV and viral bronchiolitis. Treatment for viral bronchiolitis is mainly symptomatic support. Beta-agonists are frequently used despite the lack of evidence that they reduce hospital admissions or length of stay. Nebulized racemic epinephrine, hypertonic saline and corticosteroids are generally not effective. Passive immunoprophylaxis with a monoclonal antibody against RSV, when given intramuscularly and monthly during winter, is effective in preventing severe RSV bronchiolitis in high-risk children who are born prematurely and in children under 2 years with chronic lung disease or hemodynamically significant congenital heart disease. Vaccines for RSV bronchiolitis are being developed. Children with viral bronchiolitis in early life are at increased risk of developing asthma later in childhood. Conclusion: Viral bronchiolitis is common. No current pharmacologic treatment or novel therapy has been proven to improve outcomes compared to supportive treatment. Viral bronchiolitis in early life predisposes asthma development later in childhood.