Training and reployment of non-specialists is an effective solution for the shortage of health care workers in the COVID-19 pandemic

ImportanceIn the COVID-19 pandemic many countries encounter problems arising from shortage of specialists. Short intensive training and reployment of non-specialists is an option but the effectiveness is unknown. ObjectiveTo investigate whether there was difference in in-hospital mortality rates between COVID-19 patients managed by a mixed team (including non-specialists who had short intensive training and operated to a strict protocol) and those managed by a specialist team of health care workers. DesignCohort study, from January 26, 2020 to April 7, 2020, follow up to April 7, 2020. SettingMulticenter - Wuhan Hankou Hospital and Wuhan Xiehe Hospital, Wuhan, China. Participants261 HCWs deployed to Wuhan from Guangdong emergency rescue team and the 269 COVID-19 patients they treated. ExposureAmong 261 health care workers, 130 were in the specialist team and included 33 physicians, 32 of whom (97.0%) of whom were from relevant specialties. Each physician was in charge of 25-27 beds, with a 6-hour shift time. The mixed team included 131 health care workers, with 7 of the 28 physicians (25.0%) from relevant specialties. Each physician managed 12-13 beds, with a 4-hour shift time. Non-specialists received short-term intensive training and then followed strict management protocols. Specialists practiced as normal. Main Outcomes and MeasuresMain outcome was in-hospital mortality of COVID-19 patients. Another outcome was rate of SARS-CoV-2 infection in health care workers. ResultsA total of 269 patients were included (144 male). In-hospital mortality rate of patients treated by the specialist teams and the mixed teams was 12.6% (20/159) and 12.7% (14/110) respectively (Difference = -0.1%, 95% CI -8.2% to 7.9%, p=.97). None of the health care workers were infected. Conclusions and RelevanceTraining and reployment of non-specialists is an effective solution for the shortage of health care workers in the COVID-19 pandemic. Key PointsO_ST_ABSQuestionC_ST_ABSWas there difference in mortality rates between COVID-19 patients managed by a mixed team (including non-specialists who had short intensive training and operated to a strict protocol) and those managed by a specialist team of health care workers (HCWs)? FindingsIn-hospital mortality rate among patients managed by specialist team (130 HCWs, 159 patients) and mixed team (131 HCWs, 110 patients) was 12.6% (20/159) and 12.7% (14/110) respectively (Difference = -0.1%, 95% CI -8.2% to 7.9%, p=.97). MeaningWith shortage of specialist HCWs, training and reployment of non-specialists is an effective option in the management of COVID-19 patients.

Systemic corticosteroids show no benefit in severe and critical COVID-19 patients in Wuhan, China: A retrospective cohort study

BackgroundSystemic corticosteroids are recommended by some treatment guidelines and used in severe and critical COVID-19 patients, though evidence supporting such use is limited. MethodsFrom December 26, 2019 to March 15, 2020, 1514 severe and 249 critical hospitalized COVID-19 patients were collected from two medical centers in Wuhan, China. We performed multivariable Cox models, Cox model with time-varying exposure and propensity score analysis (both inverse-probability-of-treatment-weighting (IPTW) and propensity score matching (PSM)) to estimate the association of corticosteroid use with the risk of in-hospital mortality among severe and critical cases. ResultsCorticosteroids were administered in 531 (35.1%) severe and 159 (63.9%) critical patients. Compared to no corticosteroid use group, systemic corticosteroid use showed no benefit in reducing in-hospital mortality in both severe cases (HR=1.77, 95% CI: 1.08-2.89, p=0.023), and critical cases (HR=2.07, 95% CI: 1.08-3.98, p=0.028). In the time-varying Cox analysis that with time varying exposure, systemic corticosteroid use still showed no benefit in either population (for severe patients, HR=2.83, 95% CI: 1.72-4.64, p<0.001; for critical patients, HR=3.02, 95% CI: 1.59-5.73, p=0.001). Baseline characteristics were matched after IPTW and PSM analysis. For severe COVID-19 patients at admission, corticosteroid use was not associated with improved outcome in either the IPTW analysis. For critical COVID-19 patients at admission, results were consistent with former analysis that corticosteroid use did not reduce in-hospital mortality. ConclusionsCorticosteroid use showed no benefit in reducing in-hospital mortality for severe or critical cases. The routine use of systemic corticosteroids among severe and critical COVID-19 patients was not recommended.

Association between body weight change during early and middle adulthood and the risk of type 2 diabetes in middle aged and elderly population / 中华流行病学杂志

Objective To examine the association between weight changes during early and middle adulthood and the risk of type 2 diabetes mellitus in middle aged and elderly population.Methods Based on the Guangzhou Biobank Cohort Study (GBCS),28 736 residents aged ≥50 years were included in Guangzhou.Multivariate logistic regression was used to analyze the association between body weight changes during early or middle adulthood and age when the heaviest weight reaching the threshold on the risk of type 2 diabetes mellitus in middle age or elderly population.Adjustments on age,smoking,alcohol consumption,physical activity,education level,occupation,district of residence and body mass index etc.,were made.Results The mean age was 64.3 (standard deviation=6.7) years in men and 61.0 (standard deviation=7.0) years in women,with the prevalence rates of diabetes as 13.1％ and 13.7％ in men and women,respectively.Compared to those with stable body weight,the risk of diabetes increased with weight gain during early and middle adulthood in both men and women (both P values for trend ＜0.01).Participants who gained more than 20 kg during early and middle adulthood were associated with the highest risk of diabetes in men (OR=2.83,95％ CI:1.99-4.02) and women (OR=3.13,95％CI:2.47-3.96).Compared to those who reached the highest weight at age 20,those who reaching the highest weight at 40 to 49 years were associated with the highest risk of diabetes,with OR being 5.32 (95％CI:1.92-14.8) in men and 3.41 (95％CI:2.49-4.67) in women,respectively.Weight loss in adulthood was associated with self-reported but not newly diagnosed diabetic cases in both middle and older aged men and women.Conclusion Weight gain during early and middle adulthood may increase the risk of diabetes in middle and older aged population.The detrimental effect of obesity on diabetes might become significantly visible in the next decades.

Association between body weight change during early and middle adulthood and the risk of type 2 diabetes in middle aged and elderly population / 中华流行病学杂志

Objective To examine the association between weight changes during early and middle adulthood and the risk of type 2 diabetes mellitus in middle aged and elderly population.Methods Based on the Guangzhou Biobank Cohort Study (GBCS),28 736 residents aged ≥50 years were included in Guangzhou.Multivariate logistic regression was used to analyze the association between body weight changes during early or middle adulthood and age when the heaviest weight reaching the threshold on the risk of type 2 diabetes mellitus in middle age or elderly population.Adjustments on age,smoking,alcohol consumption,physical activity,education level,occupation,district of residence and body mass index etc.,were made.Results The mean age was 64.3 (standard deviation=6.7) years in men and 61.0 (standard deviation=7.0) years in women,with the prevalence rates of diabetes as 13.1％ and 13.7％ in men and women,respectively.Compared to those with stable body weight,the risk of diabetes increased with weight gain during early and middle adulthood in both men and women (both P values for trend ＜0.01).Participants who gained more than 20 kg during early and middle adulthood were associated with the highest risk of diabetes in men (OR=2.83,95％ CI:1.99-4.02) and women (OR=3.13,95％CI:2.47-3.96).Compared to those who reached the highest weight at age 20,those who reaching the highest weight at 40 to 49 years were associated with the highest risk of diabetes,with OR being 5.32 (95％CI:1.92-14.8) in men and 3.41 (95％CI:2.49-4.67) in women,respectively.Weight loss in adulthood was associated with self-reported but not newly diagnosed diabetic cases in both middle and older aged men and women.Conclusion Weight gain during early and middle adulthood may increase the risk of diabetes in middle and older aged population.The detrimental effect of obesity on diabetes might become significantly visible in the next decades.

Association between serum uric acid and fasting plasma glucose in middle and elderly Chinese / 中华流行病学杂志

<p><b>OBJECTIVE</b>To examine the association of fasting plasma glucose (FPG) and serum uric acid (SUA) in middle and elderly Chinese.</p><p><b>METHODS</b>10 413 Guangzhou residents aged ≥50 were included in the present study. Information on personal history, physical examination and biochemical parameters were collected. Subjects were grouped by the FPG level, association between FPG and SUA. Levels of hyperuricemia (HUA) were evaluated.</p><p><b>RESULTS</b>The SUA levels and the incidence of HUA showed trends of increasing, with the increasing FPG levels in women, with statistically significant differences seen among all the FPG groups (P value for trend<0.05). While the statistical differences of SUA levels and the incidence rates of HUA among diabetes group (DM group) and impaired fasting glucose (IFG) groups were non-significant (P > 0.05) but it was higher than normal FPG group in men (P < 0.05). Logistic regression models were built between various FPG groups and HUA. After adjusting for age, smoking status, drinking status, physical activity, hypertension, body mass index and the levels of triglyceride and creatin. When compared to the normal FPG group, the risk of women suffering from HUA increased by 40% (95%CI:1.19-1.64) under the FPG in the range of 6.1-6.9 mmol/L. Compared to those non-diabetic individuals, the risk of diabetic patients suffering from HUA also increased by 44% (95% CI:1.15-1.79) in women. However, the risk of suffering from HUA did not relate to the increase of FPG in men.</p><p><b>CONCLUSION</b>The SUA level and the incidence of HUA tended to increase along with the increasing levels of FPG in middle and elderly Chinese women and the increase of FPG might also increase the risk of HUA, but not in men.</p>

Association between serum uric acid and fasting plasma glucose in middle and elderly Chinese / 中华流行病学杂志

Objective To examine the association of fasting plasma glucose (FPG) and serum uric acid (SUA) in middle and elderly Chinese. Methods 10 413 Guangzhou residents aged ≥50 were included in the present study. Information on personal history,physical examination and biochemical parameters were collected. Subjects were grouped by the FPG level,association between FPG and SUA. Levels of hyperuricemia(HUA)were evaluated. Results The SUA levels and the incidence of HUA showed trends of increasing,with the increasing FPG levels in women,with statistically significant differences seen among all the FPG groups(P value for trend<0.05). While the statistical differences of SUA levels and the incidence rates of HUA among diabetes group(DM group)and impaired fasting glucose(IFG)groups were non-significant(P>0.05)but it was higher than normal FPG group in men (P<0.05). Logistic regression models were built between various FPG groups and HUA. After adjusting for age,smoking status,drinking status,physical activity, hypertension,body mass index and the levels of triglyceride and creatin. When compared to the normal FPG group,the risk of women suffering from HUA increased by 40%(95%CI:1.19-1.64) under the FPG in the range of 6.1-6.9 mmol/L. Compared to those non-diabetic individuals,the risk of diabetic patients suffering from HUA also increased by 44%(95%CI:1.15-1.79) in women. However,the risk of suffering from HUA did not relate to the increase of FPG in men. Conclusion The SUA level and the incidence of HUA tended to increase along with the increasing levels of FPG in middle and elderly Chinese women and the increase of FPG might also increase the risk of HUA,but not in men.

Association between serum uric acid and fasting plasma glucose in middle and elderly Chinese / 中华流行病学杂志

Objective To examine the association of fasting plasma glucose (FPG) and serum uric acid (SUA) in middle and elderly Chinese. Methods 10 413 Guangzhou residents aged ≥50 were included in the present study. Information on personal history,physical examination and biochemical parameters were collected. Subjects were grouped by the FPG level,association between FPG and SUA. Levels of hyperuricemia(HUA)were evaluated. Results The SUA levels and the incidence of HUA showed trends of increasing,with the increasing FPG levels in women,with statistically significant differences seen among all the FPG groups(P value for trend<0.05). While the statistical differences of SUA levels and the incidence rates of HUA among diabetes group(DM group)and impaired fasting glucose(IFG)groups were non-significant(P>0.05)but it was higher than normal FPG group in men (P<0.05). Logistic regression models were built between various FPG groups and HUA. After adjusting for age,smoking status,drinking status,physical activity, hypertension,body mass index and the levels of triglyceride and creatin. When compared to the normal FPG group,the risk of women suffering from HUA increased by 40%(95%CI:1.19-1.64) under the FPG in the range of 6.1-6.9 mmol/L. Compared to those non-diabetic individuals,the risk of diabetic patients suffering from HUA also increased by 44%(95%CI:1.15-1.79) in women. However,the risk of suffering from HUA did not relate to the increase of FPG in men. Conclusion The SUA level and the incidence of HUA tended to increase along with the increasing levels of FPG in middle and elderly Chinese women and the increase of FPG might also increase the risk of HUA,but not in men.

Effects of psychological intervention, auricular acupuncture and smoking cessation medication on cigarette smoking behavior in soldiers: a pilot randomized controlled trial / 中华健康管理学杂志

Objective To evaluate the effects of different smoking cessation interventions on cigarette consumption for young soldiers.Methods Sixty-eight soldiers were prospectively investigated in this randomly controlled clinical trial and assigned to the psychological intervention group,auricular acupuncture group,and smoking cessation medication group.Results All the participants showed significant reduction(33.3％ to 73.9％)in post-treatment cigarette consumption.The highest quit rate was found at 7 days,although this declining trend was faded over time.One-year follow-up indicated a 6-month quit rate of 16.7％,23.8％ and 30.4％ in three groups,respectively.Conclusion Psychological intervention,auricular acupuncture and smoking cessation medication may be effective methods of reducing cigarette consumption and improving quit rate in young soldiers.

The prevalence and characteristics of aortic arch calcification among middle and elderly population in Guangzhou / 中华流行病学杂志

<p><b>OBJECTIVE</b>To examine the prevalence and characteristics of aortic arch calcification (AAC) in residents aged 50 or over in Guangzhou, China.</p><p><b>METHODS</b>Face-to-face interview, physical examination and laboratory tests were conducted on 10 413 Chinese adults aged 50 or over. Posterior-anterior plain chest X-ray radiographs were obtained from 10 305 subjects using a Toshiba KSO-15R machine. The radiographs were reviewed together by two radiologists while 300 radiographs were independently gone through by two radiologists to assess the agreement with Kappa coefficient method.</p><p><b>RESULTS</b>The rate of agreement on Diagnosis for the two radiologists was 85.0% and Kappa coefficient was 0.68, with P < 0.001 which showed a moderate agreement between the two radiologists. Among the 10 305 subjects, there were 3064 men and 7349 women, with their mean age (+/- standard deviation) as 64.0 +/- 6.0 and 66.2 +/- 5.8, respectively. Most of them had educational level of middle school or below, and most of their occupations were factory or agricultural workers. The prevalence of AAC was 40.6%. Women showed significantly higher prevalence rate than men (41.4% versus 38.6%, P < 0.001) and the prevalence of AAC increased significantly with age. Subjects with primary educational level or below had the highest prevalence of AAC. There was no significant association found between occupation and AAC prevalence. 98.7% of the subjects with AAC occurred in aortic arch. Most AAC had a length of 10 mm or longer and a width from 1-4 mm, which indicated the severity of AAC among the subjects.</p><p><b>CONCLUSION</b>The prevalence of AAC among Guangzhou Biobank Cohort was about 40.6%, higher than those reported in foreign studies, while most of the lesions were quite serious.</p>