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Iwein Gyselinck, Wim Janssens
Lancet Infectious Diseases, 15.09.2021
Tilføjet 15.09.2021
Despite the availability of effective SARS-CoV-2 vaccines, improving care for patients with symptomatic infection remains relevant. Strategies to blunt the hyperinflammatory state that characterises severe COVID-19 include broad-spectrum immunosuppressive drugs such as corticosteroids, targeted immunomodulatory treatments such as tocilizumab or baricitinib, and direct-acting antivirals to reduce viral load.
Læs mere Tjek på PubMedFlorence Ader, Maude Bouscambert-Duchamp, Maya Hites, Nathan Peiffer-Smadja, Julien Poissy, Drifa Belhadi, Alpha Diallo, Minh-Patrick Lê, Gilles Peytavin, Thérèse Staub, Richard Greil, Jérémie Guedj, Jose-Artur Paiva, Dominique Costagliola, Yazdan Yazdanpanah, Charles Burdet, France Mentré, DisCoVeRy Study Group
Lancet Infectious Diseases, 15.09.2021
Tilføjet 15.09.2021
No clinical benefit was observed from the use of remdesivir in patients who were admitted to hospital for COVID-19, were symptomatic for more than 7 days, and required oxygen support.
Læs mere Tjek på PubMedDarius Mostaghimi, Caroline N Valdez, Haleigh T Larson, Chaney C Kalinich, Akiko Iwasaki
Lancet Infectious Diseases, 15.09.2021
Tilføjet 15.09.2021
As the number of individuals vaccinated against SARS-CoV-2 rises worldwide, population-level data regarding the vaccines' ability to reduce infection are being generated. Randomised trials have shown that these vaccines dramatically reduce symptomatic COVID-19; however, less is known about their effects on transmission between individuals. The natural course of infection with SARS-CoV-2 involves infection of the respiratory epithelia and replication within the mucosa to sufficient viral titres for transmission via aerosol particles and droplets.
Læs mere Tjek på PubMedSebastian von Huth, Søren Thue Lillevang, Birgit Thorup Røge, Jonna Skov Madsen, Christian Backer Mogensen, John Eugenio Coia, Sören Möller, Ulrik Stenz Justesen, Isik Somuncu Johansen
International Journal of Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
COVID-19 (Coronavirus disease 2019) has surged as an ongoing worldwide pandemic throughout 2020 (Park et al., 2020, Siordia, 2020). The first Danish cases were reported in late February 2020, and the initial spread of infections most likely originated from ski tourists returning from Northern Italy and Austria (Madsen et al., 2021). The first epidemic wave in Denmark peaked in late March and early April, with 9.2 patients admitted to hospital per 100,000 population (Madsen et al., 2021, Statens Serum Institut).
Læs mere Tjek på PubMedQibin Liu, Xianxiang Chen, Xiyong Dai, Xiaoyu Liu, Feng Xu, PengPeng
International Journal of Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (MTB) infection and is the main infectious cause of global morbidity and mortality(Horne et al., 2019)[1]. Although osteoarticular tuberculosis only account for 1-3% of all tuberculosis cases, it is an important cause of morbidity in developing countries due to its high incidence(Agashe et al., 2020; Procopie et al., 2017)[2-3]. Spinal tuberculosis is the most common type of extrapulmonary tuberculosis, and it is an oligobacterial tuberculosis disease(Rajasekaran et al., 2018; Wang et al., 2016)[4-5].
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Abstract
Background
Chlamydia trachomatis (chlamydia) is the most diagnosed sexually transmitted infection in Belgium. Screening programs focus on young women, due to the implications of chronic asymptomatic infections for reproductive health. Thereby, the frequency of infections in men and older adults is underestimated. This study aimed to estimate the point-prevalence of chlamydia in the broader Belgian population, to inform evidence-based prevention and control strategies.
Methods
We conducted two cross-sectional prevalence studies of chlamydia infection in the population of Belgium aged 16–59 years, 2018–2020. In the CT1 study 12,000 representative individuals were randomly selected from the national register and invited by letter to collect a urine sample at home. The CT2 study used urine samples collected through the Belgian Health Examination Survey. Molecular detection of chlamydia DNA was performed using Xpert® or Abbott Real-Time CT/NG assays. Weighted estimated prevalence and 95% confidence interval (CI) was calculated per gender and age groups of 16/18–29, 30–44 and 45–59 years, relative to the general Belgian population. Data collected on sociodemographic variables and sexual behavior were used to identify potential risk factors for chlamydia infection through calculation of the odds ratio (OR).
Results
The population-wide weighted estimated prevalence was 1.54% (95% CI 0.78–3) in CT1 and 1.76% (95% CI 0.63–4) in CT2. We observed no statistically significant difference between men and women or age groups. Civil relationship status (OR = 14.1 (95% CI 1.78–112), p < 0.01), sexual intercourse with a casual partner (OR = 6.31 (95% CI 1.66–24.1), p < 0.01) and > 3 sexual partners in the last 12 months (OR = 4.53 (95% CI 1.10–18.6), p = 0.02) were associated with higher relative risk for chlamydia infection.
Conclusion
Nationwide prevalence studies are relevant to assess the distribution of chlamydia and inform public health actions. The overall low prevalence and heterogeneous distribution of chlamydia in the general Belgian population needs to be considered for future strategies and potential harm of testing and treating asymptomatic individuals need to be taken into account. Effective case management should include appropriate treatment of symptomatic patients and partner notification, and prevention strategies should encourage behaviors such as condom use.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Abstract
Background
The coronavirus disease 2019 (COVID-19) has caused a global pandemic, resulting in considerable mortality. The risk factors, clinical treatments, especially comprehensive risk models for COVID-19 death are urgently warranted.
Methods
In this retrospective study, 281 non-survivors and 712 survivors with propensity score matching by age, sex, and comorbidities were enrolled from January 13, 2020 to March 31, 2020.
Results
Higher SOFA, qSOFA, APACHE II and SIRS scores, hypoxia, elevated inflammatory cytokines, multi-organ dysfunction, decreased immune cell subsets, and complications were significantly associated with the higher COVID-19 death risk. In addition to traditional predictors for death risk, including APACHE II (AUC = 0.83), SIRS (AUC = 0.75), SOFA (AUC = 0.70) and qSOFA scores (AUC = 0.61), another four prediction models that included immune cells subsets (AUC = 0.90), multiple organ damage biomarkers (AUC = 0.89), complications (AUC = 0.88) and inflammatory-related indexes (AUC = 0.75) were established. Additionally, the predictive accuracy of combining these risk factors (AUC = 0.950) was also significantly higher than that of each risk group alone, which was significant for early clinical management for COVID-19.
Conclusions
The potential risk factors could help to predict the clinical prognosis of COVID-19 patients at an early stage. The combined model might be more suitable for the death risk evaluation of COVID-19.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Abstract
Background
The microbiological diagnosis of pulmonary tuberculosis (Tb) in a pediatric population is hampered by both low pathogen burden and noncompliance with sputum sampling. Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been found useful for the evaluation of mediastinal pathologies in adults, for children, sparse data are available. Here, we have evaluated EBUS-TBNA as a diagnostic procedure in children and adolescents with suspected pulmonary Tb.
Methods
In this retrospective analysis, we reviewed the charts of unaccompanied refugee minors (URM) who were admitted between January 2016 and July 2018 and who, during their initial medical screening upon arrival in Germany, were found to have abnormal radiological pulmonary and mediastinal findings and/or immunological results indicative of Tb. For each patient, basic sociodemographic data, clinical features and data on diagnostic procedures performed were assessed. These included imaging, immunodiagnostic tests and microbiological data derived from sputum, bronchoalveolar lavage, EBUS-TBNA, bronchoscopy and pleural fluid sampling. All patients who underwent invasive sampling procedures were included in the study.
Results
Out of 42 URM with suspected Tb, 34 fulfilled the study’s inclusion criteria. Ages ranged from 14 to 17 years. All were of African origin, with 70.0% coming from Somalia, Eritrea and Ethiopia. Among the 21 patients for whom EBUS-TBNA was performed, the diagnostic yield was high: 66.7% positive results (MTb detected either by acid-fast stain, culture or PCR in 4.8, 42.9 and 61.9% of samples, respectively). Multidrug-resistant MTb was found in two patients from Somalia. No complications were associated with the procedure. Overall, pulmonary Tb was diagnosed in 29 patients (85.3%), miliary Tb in two patients (5.9%) and latent Tb in three patients (8.8%).
Conclusions
EBUS-TBNA is a sensitive and safe method with high diagnostic yield in the evaluation of pediatric patients with mediastinal pathology and suspected Tb.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Abstract
Background
Granulomatosis with polyangiitis (GPA), also known as Wegener’s granulomatosis, is an idiopathic systemic disease typically affecting the lungs, although other organs may also be involved.
Case presentation
A 28-year-old male was admitted to Baqiyatallah university hospital in Teheran (Iran) after a 3-week history of fever and productive cough. The patient gradually developed fatigue, arthralgia, hematuria, nausea, vomiting, dyspnea, hemoptysis, weight loss, oliguria and then anuria. Chest-X-ray (CXR) and computerized tomography scan revealed cavitating nodular opacities in the right lung lobe. Furthermore, plasma creatinine increased from 2.2 to 4 mg/dl in a few days. Histopathological examination of kidney biopsy revealed peri-glomerular and peri-vascular inflammation, degeneration and necrosis of the tubular epithelial lining, red blood cell casts, distorted glomerular structure, fibrin thrombi, segmental breaks of the glomerular basal membrane, disruption of Bowman's capsular membrane and crescent formation of the affected glomeruli. An abnormal CXR, an abnormal urinary sediment and a typical kidney histology were used as criteria to diagnose glomerulonefritis with poliangiitis (GPA). Bronchoalveolar lavage smear and PCR turned out positive for mycobacterium tuberculosis. After 3 months of treatment for (GPA) and tuberculosis the patient developed headache and seizure. Cerebral Magnetic Resonance Venography revealed cerebral venous thrombosis of the sinus transverse and sigmoid.
Conclusions
Tuberculosis may coexist with GPA, as it occurred in our patient. Since a crescentic glomerulonephritis can progress to renal failure, clinicians should always be aware of potential multiple conditions when considering differential diagnoses.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Abstract
Background
Robust evidenced treatment strategy for Coronavirus disease 2019 (COVID-19) has not been established yet. Early, targeted, comprehensive management approach can be essential.
Methods
A lopinavir/ritonavir (LPV/r)-based antiviral treatment was administered to the patients with computed tomography (CT)-documented pneumonia. Medical records of patients with COVID-19, previously discharged or hospitalized for ≥ 21 days at the Seoul Medical Center from January 29 to April 15, 2020 were reviewed to analyze clinical and virological outcomes. Patients were divided into two groups (PCR-Negative conversion group vs. Non-negative conversion group and requiring oxygen group vs. Non-requiring oxygen group).
Results
In total, 136 patients with a mean age of 41.8 ± 18.2 years were included with median 3-day delay of hospitalization after illness. Thirteen (9.56%) were initially asymptomatic, and 5 (3.67%) were persistently asymptomatic. Eighty-five (62.5%) had CT-documented pneumonia, 94% of whom received LPV/r treatments. A total of 53 patients (38.97%) had negative polymerase chain reaction (PCR) results within 28 days. Eight (9.4%) out of 85 pneumonic patients received oxygen supplementation. Patients with initial lower respiratory symptoms showed significant delay in PCR negative conversion (> 28 days) (odds ratio [OR] 0.166; 95% confidence interval [CI] 0.067–0.477; P < 0.001). However, antiviral treatment for pneumonic patients was significantly related with early conversion within 28 days (OR 3.049; 95% CI 1.128–8.243; P = 0.028). Increasing age increased the likelihood of oxygen supplementation requirement in the pneumonic patient group (OR 1.108; 95% CI 1.021–1.202; P = 0.014).
Conclusions
Early, pneumonia targeted LPV/r-based antiviral therapy resulted in a significantly higher probability of negative conversion of PCR within 28 days compared to symptomatic treatment.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Abstract
Background
Emergence of drug resistant tuberculosis (DR-TB) has aggravated the tuberculosis (TB) public health burden worldwide and especially in low income settings. We present findings from a predominantly nomadic population in Karamoja, Uganda with a high-TB burden (3500 new cases annually) and sought to determine the prevalence, patterns, factors associated with DR-TB.
Methods
We used mixed methods of data collection. We enrolled 6890 participants who were treated for tuberculosis in a programmatic setting between January 2015 and April 2018. A cross sectional study and a matched case control study with conditional logistic regression and robust standard errors respectively were used to the determine prevalence and factors associated with DR-TB. The qualitative methods included focus group discussions, in-depth interviews and key informant interviews.
Results
The overall prevalence of DR-TB was 41/6890 (0.6%) with 4/64,197 (0.1%) among the new and 37/2693 (1.4%) among the previously treated TB patients respectively. The drug resistance patterns observed in the region were mainly rifampicin mono resistant (68.3%) and Multi Drug-Resistant Tuberculosis (31.7%). Factors independently associated with DR-TB were previous TB treatment, adjusted odds ratio (aOR) 13.070 (95%CI 1.552–110.135) and drug stock-outs aOR 0.027 (95%CI 0.002–0.364). The nomadic lifestyle, substance use, congested homesteads and poor health worker attitudes were a great challenge to effective treatment of TB.
Conclusion
Despite having the highest national TB incidence, Karamoja still has a low DR-TB prevalence. Previous TB treatment and drug stock outs were associated with DR-TB. Regular supply of anti TB medications and health education may help to stem the burden of TB disease in this nomadic population.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Abstract
Background
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitutes a major health burden worldwide due to high mortality rates and hospital bed shortages. SARS-CoV-2 infection is associated with several laboratory abnormalities. We aimed to develop and validate a risk score based on simple demographic and laboratory data that could be used on admission in patients with SARS-CoV-2 infection to predict in-hospital mortality.
Methods
Three cohorts of patients from different hospitals were studied consecutively (developing, validation, and prospective cohorts). The following demographic and laboratory data were obtained from medical records: sex, age, hemoglobin, mean corpuscular volume (MCV), platelets, leukocytes, sodium, potassium, creatinine, and C-reactive protein (CRP). For each variable, classification and regression tree analysis were used to establish the cut-off point(s) associated with in-hospital mortality outcome based on data from developing cohort and before they were used for analysis in the validation and prospective cohort. The covid-19 score was calculated as a sum of cut-off points associated with mortality outcome.
Results
The developing, validation, and prospective cohorts included 129, 239, and 497 patients, respectively (median age, 71, 67, and 70 years, respectively). The following cut of points associated with in-hospital mortality: age > 56 years, male sex, hemoglobin < 10.55 g/dL, MCV > 92.9 fL, leukocyte count > 9.635 or < 2.64 103/µL, platelet count, < 81.49 or > 315.5 103/µL, CRP > 51.14 mg/dL, creatinine > 1.115 mg/dL, sodium < 134.7 or > 145.4 mEq/L, and potassium < 3.65 or > 6.255 mEq/L. The AUC of the covid-19 score for predicting in-hospital mortality was 0.89 (0.84–0.95), 0.850 (0.75–0.88), and 0.773 (0.731–0.816) in the developing, validation, and prospective cohorts, respectively (P < 0.001The mortality of the prospective cohort stratified on the basis of the covid-19 score was as follows: 0–2 points,4.2%; 3 points, 15%; 4 points, 29%; 5 points, 38.2%; 6 and more points, 60%.
Conclusion
The covid-19 score based on simple demographic and laboratory parameters may become an easy-to-use, widely accessible, and objective tool for predicting mortality in hospitalized patients with SARS-CoV-2 infection.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Abstract
Background
The prognosis of patients hospitalized with community-acquired pneumonia (CAP) with regards to intensive care unit (ICU) admission, short- and long-term mortality is correlated with patient’s comorbidities. For patients hospitalized for CAP, including P-CAP, we assessed the prognostic impact of comorbidities known as at-risk (AR) or high-risk (HR) of pneumococcal CAP (P-CAP), and of the number of combined comorbidities.
Methods
Data on hospitalizations for CAP among the French 50+ population were extracted from the 2014 French Information Systems Medicalization Program (PMSI), an exhaustive national hospital discharge database maintained by the French Technical Agency of Information on Hospitalization (ATIH). Their admission diagnosis, comorbidities (nature, risk type and number), other characteristics, and their subsequent hospital stays within the year following their hospitalization for CAP were analyzed. Logistic regression models were used to assess the associations between ICU transfer, short- and 1-year in-hospital mortality and all covariates.
Results
From 182,858 patients, 149,555 patients aged ≥ 50 years (nonagenarians 17.8%) were hospitalized for CAP in 2014, including 8270 with P-CAP. Overall, 33.8% and 90.5% had ≥ 1 HR and ≥ 1 AR comorbidity, respectively. Cardiac diseases were the most frequent AR comorbidity (all CAP: 77.4%). Transfer in ICU occurred for 5.4% of CAP patients and 19.4% for P-CAP. Short-term and 1-year in-hospital mortality rates were 10.9% and 23% of CAP patients, respectively, significantly lower for P-CAP patients: 9.2% and 19.8% (HR 0.88 [95% CI 0.84–0.93], p < .0001). Both terms of mortality increased mostly with age, and with the number of comorbidities and combination of AR and HR comorbidities, in addition of specific comorbidities.
Conclusions
Not only specific comorbidities, but also the number of combined comorbidities and the combination of AR and HR comorbidities may impact the outcome of hospitalized CAP and P-CAP patients.
Læs mere Tjek på PubMedJose Mateus Jennifer M. Dan Zeli Zhang Carolyn Rydyznski Moderbacher Marshall Lammers Benjamin Goodwin Alessandro Sette Shane Crotty Daniela Weiskopf
Science, 14.09.2021
Tilføjet 15.09.2021
Julia Niessl Takuya Sekine Joshua Lange Viktoria Konya Marianne Forkel Jovana Maric Anna Rao Luca Mazzurana Efthymia Kokkinou Whitney Weigel Sian Llewellyn-Lacey Emma B. Hodcroft Annika C. Karlsson Johan Fehrm Joar Sundman David A. Price Jenny Mjösberg Danielle Friberg Marcus Buggert
Science, 14.09.2021
Tilføjet 15.09.2021
Hyeseon Cho Kristina Kay Gonzales-Wartz Deli Huang Meng Yuan Mary Peterson Janie Liang Nathan Beutler Jonathan L. Torres Yu Cong Elena Postnikova Sandhya Bangaru Chloe Adrienna Talana Wei Shi Eun Sung Yang Yi Zhang Kwanyee Leung Lingshu Wang Linghang Peng Jeff Skinner Shanping Li Nicholas C. Wu Hejun Liu Cherrelle Dacon Thomas Moyer Melanie Cohen Ming Zhao F. Eun-Hyung Lee Rona S. Weinberg Iyadh Douagi Robin Gross Connie Schmaljohn Amarendra Pegu John R. Mascola Michael Holbrook David Nemazee Thomas F. Rogers Andrew B. Ward Ian A. Wilson Peter D. Crompton Joshua Tan
Science, 14.09.2021
Tilføjet 15.09.2021
Thaís C. de Oliveira, Priscila T. Rodrigues, Ana Maria R.C. Duarte, Luísa D.P. Rona, Marcelo U. Ferreira
Trends in Parasitology, 14.09.2021
Tilføjet 15.09.2021
Plasmodium simium, a malaria parasite that infects platyrrhine monkeys and humans in the New World, is nearly identical to Plasmodium vivax. Recent genomic comparative analyses of these sister species have identified elevated divergence in a gene that may underlie P. simium adaptation to non-human primates during its gradual speciation process.
Læs mere Tjek på PubMedHae Ri Yum, Shin Hae Park, Sun Young Shin
PLoS One Infectious Diseases, 14.09.2021
Tilføjet 14.09.2021
by Hae Ri Yum, Shin Hae Park, Sun Young Shin
Purpose The outbreak of coronavirus disease 2019 (COVID-19) has caused many children to stay indoors. Increased near work and insufficient outdoor activities are considered important risk factors for myopic progression. This study aimed to compare the changes in myopic progression before and after COVID-19 in children treated with low-concentration atropine.
Methods The records of 103 eyes of 103 children who were treated with low-concentration atropine eye drops were retrospectively reviewed. We classified children according to the concentration of atropine eye drops and children’s age. The beginning of the pre-COVID-19 period was set from January 2019 to May 2019, and the endpoint was set in March 2020. The beginning of the post-COVID-19 period was set in March 2020, and the endpoint was set from January 2021 to March 2021. We evaluated the questionnaires administered to children’s parents.
Results A significant myopic progression was observed in the post-COVID-19 period compared to the pre-COVID-19 period in the 0.05% and 0.025% atropine groups (P < 0.001 and P = 0.020, respectively). For children aged 5 to 7 and 8 to 10 years, the axial elongations were significantly faster in the post-COVID-19 period than in the pre-COVID-19 period (P = 0.022 and P = 0.005, respectively). However, the rates of axial elongation and myopic progression were not significantly different between pre- and post-COVID-19 in children aged 11 to 15 years (P = 0.065 and P = 0.792, respectively). The average time spent using computers and smartphones and reading time were significantly increased, and the times of physical and outdoor activity were significantly decreased in the post-COVID-19 period compared to the pre-COVID-19 period.
Conclusions The rates of myopic progression have increased substantially after the spread of COVID-19 with an increase in the home confinement of children. Therefore, it is necessary to control the environmental risk factors for myopia, even in children undergoing treatment for the inhibition of myopic progression.
Læs mere Tjek på PubMedB. van Straten, P. D. Robertson, H. Oussoren, S. Pereira Espindola, E. Ghanbari, J. Dankelman, S. Picken, T. Horeman
PLoS One Infectious Diseases, 14.09.2021
Tilføjet 14.09.2021
by B. van Straten, P. D. Robertson, H. Oussoren, S. Pereira Espindola, E. Ghanbari, J. Dankelman, S. Picken, T. Horeman
Background Face masks, also referred to as half masks, are essential to protect healthcare professionals working in close contact with patients with COVID-19-related symptoms. Because of the Corona material shortages, healthcare institutions sought an approach to reuse face masks or to purchase new, imported masks. The filter quality of these masks remained unclear. Therefore, the aim of this study was to assess the quality of sterilized and imported FFP2/KN95 face masks.
Methods A 48-minute steam sterilization process of single-use FFP2/KN95 face masks with a 15 minute holding time at 121°C was developed, validated and implemented in the Central Sterilization Departments (CSSD) of 19 different hospitals. Masks sterilized by steam and H2O2 plasma as well as new, imported masks were tested for particle filtration efficiency (PFE) and pressure drop in a custom-made test setup.
Results The results of 84 masks tested on the PFE dry particle test setup showed differences of 2.3±2% (mean±SD). Test data showed that the mean PFE values of 444 sterilized FFP2 face masks from the 19 CSSDs were 90±11% (mean±SD), and those of 474 new, imported KN95/FFP2 face masks were 83±16% (mean±SD). Differences in PFE of masks received from different sterilization departments were found.
Conclusion Face masks can be reprocessed with 121 °C steam or H2O2 plasma sterilization with a minimal reduction in PFE. PFE comparison between filter material of sterilized masks and new, imported masks indicates that the filter material of most reprocessed masks of high quality brands can outperform new, imported face masks of unknown brands. Although the PFE of tested face masks from different sterilization departments remained efficient, using different types of sterilization equipment, can result in different PFE outcomes.
Læs mere Tjek på PubMedPatcharaporn Nonyong, Tipaya Ekalaksananan, Supranee Phanthanawiboon, Sirinart Aromseree, Juthamas Phadungsombat, Emi E. Nakayama, Tatsuo Shioda, Vorthon Sawaswong, Sunchai Payungporn, Kesorn Thaewnongiew, Hans J. Overgaard, Michael J. Bangs, Neal Alexander, Chamsai Pientong
PLoS One Infectious Diseases, 14.09.2021
Tilføjet 14.09.2021
by Patcharaporn Nonyong, Tipaya Ekalaksananan, Supranee Phanthanawiboon, Sirinart Aromseree, Juthamas Phadungsombat, Emi E. Nakayama, Tatsuo Shioda, Vorthon Sawaswong, Sunchai Payungporn, Kesorn Thaewnongiew, Hans J. Overgaard, Michael J. Bangs, Neal Alexander, Chamsai Pientong
Dengue is hyperendemic in most Southeast Asian countries including Thailand, where all four dengue virus serotypes (DENV-1 to -4) have circulated over different periods and regions. Despite dengue cases being annually reported in all regions of Thailand, there is limited data on the relationship of epidemic DENV infection between humans and mosquitoes, and about the dynamics of DENV during outbreaks in the northeastern region. The present study was conducted in this region to investigate the molecular epidemiology of DENV and explore the relationships of DENV infection in humans and in mosquitoes during 2016–2018. A total of 292 dengue suspected patients from 11 hospitals and 902 individual mosquitoes (at patient’s houses and neighboring houses) were recruited and investigated for DENV serotypes infection using PCR. A total of 103 patients and 149 individual mosquitoes were DENV -positive. Among patients, the predominant DENV serotypes in 2016 and 2018 were DENV-4 (74%) and DENV-3 (53%) respectively, whereas in 2017, DENV-1, -3 and -4 had similar prevalence (38%). Additionally, only 19% of DENV infections in humans and mosquitoes at surrounding houses were serotypically matched, while 81% of infections were serotypically mismatched, suggesting that mosquitoes outside the residence may be an important factor of endemic dengue transmission. Phylogenetic analyses based on envelope gene sequences showed the genotype I of both DENV-1 and DENV-4, and co-circulation of the Cosmopolitan and Asian I genotypes of DENV-2. These strains were closely related to concurrent strains in other parts of Thailand and also similar to strains in previous epidemiological profiles in Thailand and elsewhere in Southeast Asia. These findings highlight genomic data of DENV in this region and suggest that people’s movement in urban environments may result in mosquitoes far away from the residential area being key determinants of DENV epidemic dynamics.
Læs mere Tjek på PubMedOluwatosin O. Adeyemo, Stephanie Tu, Danya Keene
PLoS One Infectious Diseases, 14.09.2021
Tilføjet 14.09.2021
by Oluwatosin O. Adeyemo, Stephanie Tu, Danya Keene
Health Care Leaders (HCLs) faced unprecedented challenges during the initial phases of the COVID-19 pandemic. Leaders played an important role in shaping the experiences of Health Care Workers (HCWs) during this time. However, research is needed on how HCWs experienced and characterized HCLs’ response and support. The aim of our study was to examine HCWs’ experiences with leadership and to identify aspects of HCLs’ response that were effective in supporting HCWs in their roles during the early phases of the pandemic. This was a qualitative study based on open-ended semi-structured interviews conducted (June 1- July 18, 2020) with frontline HCWs during the first wave of the COVID-19 pandemic in Connecticut, USA. Participants (N = 45) included physicians, nurses, respiratory therapists and patient care assistants who worked in inpatient and outpatient settings in various specialties, roles and 3 health systems across Connecticut, USA during the COVID-19 pandemic. Participants were offered a $25 gift card as an incentive for participation. We used inductive techniques derived from grounded theory to develop themes. We identified 6 main themes related to leadership response and support of HCWs during the pandemic namely: 1) Effective communication and transparency; 2) Prioritizing their health and safety; 3) Employee scheduling considerations: autonomy, assignment support and respite; 4) Appreciation- financial and nonfinancial; 5) Showing up and listening and 6) Stepping up with resources. Our findings can inform leadership responses to future pandemics and other unanticipated crises leading to strengthening of the health care system as a whole.
Læs mere Tjek på PubMedCarolina de la Guardia, Giselle Rangel, Alcibiades Villarreal, Amador Goodridge, Patricia L. Fernández, Ricardo Lleonart
PLoS One Infectious Diseases, 14.09.2021
Tilføjet 14.09.2021
by Carolina de la Guardia, Giselle Rangel, Alcibiades Villarreal, Amador Goodridge, Patricia L. Fernández, Ricardo Lleonart
COVID-19 is the name of the acute respiratory disease caused by the new coronavirus SARS-CoV-2, a close relative of those that caused the severe outbreaks of SARS and MERS several years ago. Since first appearance on December of 2019, the COVID-19 pandemic has cause extremely high levels of mortality, morbidity, global economic breakdown, and the consequent human suffering. The main diagnostic test for the confirmation of symptomatic individuals is the detection of viral RNA by reverse transcriptase–quantitative real time PCR (RT-PCR). Additionally, serology techniques, such as ELISA are useful to measure the antibodies produced in humans after contact with the virus, as well as the direct presence of viral antigens. In this study we aim to assemble and evaluate four ELISA assays to measure the presence of IgG or IgM specific for the viral Spike protein in COVID-19 patients, using either the full recombinant SARS-CoV-2 Spike protein or the fragment corresponding to the receptor binding domain. As a control, we analyzed a group of pre-pandemic serum samples obtained before 2017. Strong reactivity was observed against both antigens. A few pre-pandemic samples displayed high OD values, suggesting the possibility of some cross reactivity. All four assays show very good repeatability, both intra- and inter-assay. Receiver operating characteristic analysis allowed the definition of cutoffs and evaluation of performance for each ELISA by estimation of the area under the curve. This performance parameter was high for all tests (AUC range: 0.98–0.99). Multiple comparisons between tests revealed no significant difference between each other (P values: 0.24–0.95). Our results show that both antigens are effective to detect both specific IgG and IgM antibodies, with high sensitivity (range 0.92–0.99), specificity (range 0.93–0.97) and congruence with the RT-PCR test (Cohen´s Kappa range 0.87–0.93). These assays will allow health authorities to have a new tool to estimate seroprevalence, in order to manage and improve the severe sanitary situation caused by this virus.
Læs mere Tjek på PubMedPia Clara Pafundi, Raffaele Galiero, Vittorio Simeon, Luca Rinaldi, Alessandro Perrella, Erica Vetrano, Alfredo Caturano, Maria Alfano, Domenico Beccia, Riccardo Nevola, Raffaele Marfella, Celestino Sardu, Carmine Coppola, Ferdinando Scarano, Paolo Maggi, Pellegrino De Lucia Sposito, Laura Vocciante, Carolina Rescigno, Costanza Sbreglia, Fiorentino Fraganza, Roberto Parrella, Annamaria Romano, Giosuele Calabria, Benedetto Polverino, Antonio Pagano, Carolina Bologna, Maria Amitrano, Vincenzo Esposito, Nicola Coppola, Nicola Maturo, Luigi Elio Adinolfi, Paolo Chiodini, Ferdinando Carlo Sasso, on behalf of COVOCA Study Group
PLoS One Infectious Diseases, 14.09.2021
Tilføjet 14.09.2021
by Pia Clara Pafundi, Raffaele Galiero, Vittorio Simeon, Luca Rinaldi, Alessandro Perrella, Erica Vetrano, Alfredo Caturano, Maria Alfano, Domenico Beccia, Riccardo Nevola, Raffaele Marfella, Celestino Sardu, Carmine Coppola, Ferdinando Scarano, Paolo Maggi, Pellegrino De Lucia Sposito, Laura Vocciante, Carolina Rescigno, Costanza Sbreglia, Fiorentino Fraganza, Roberto Parrella, Annamaria Romano, Giosuele Calabria, Benedetto Polverino, Antonio Pagano, Carolina Bologna, Maria Amitrano, Vincenzo Esposito, Nicola Coppola, Nicola Maturo, Luigi Elio Adinolfi, Paolo Chiodini, Ferdinando Carlo Sasso, on behalf of COVOCA Study Group
Introduction During COVID-19 pandemic, the use of several drugs has represented the worldwide clinical practice. However, though the current increase of knowledge about the disease, there is still no effective treatment for the usage of drugs. Thus, we retrospectively assessed use and effects of therapeutic regimens in hospitalized patients on in-hospital mortality.
Methods COVOCA is a retrospective observational cohort study on 18 COVID centres throughout Campania Region Hospitals. We included adult patients with confirmed SARS-CoV-2 infection, discharged/dead between March/June 2020.
Results 618 patients were included, with an overall in-hospital cumulative mortality incidence of 23.1%. Most prescribed early treatments were antivirals (72%), antibiotics (65%) and hydroxychloroquine/anticoagulants (≈50%). Tocilizumab, indeed, was largely prescribed late during hospitalization. Multivariable models, with a cut-off at day 2 for early COVID-19 therapy administration, did not disclose any significant association of a single drug administration on the clinical outcome.
Discussion COVOCA represents the first multicenter database in Campania region. None drug class used during the pandemic significantly modified the outcome, regardless of therapy beginning, both overall and net of those already in non-invasive ventilation (NIV)/ orotracheal intubation (OTI) at hospitalization. Our cumulative incidence of mortality seems lower than other described during the same period, particularly in Northern Italy.
Læs mere Tjek på PubMedSintayehu Asnakew, Getasew Legas, Tewachew Muche Liyeh, Amsalu Belete, Kalkidan Haile, Getachew Yideg Yitbarek, Wubet Alebachew Bayih, Dejen Getaneh Feleke, Binyam Minuye Birhane, Haile Amha, Shegaye Shumet, Ermias Sisay Chanie
PLoS One Infectious Diseases, 14.09.2021
Tilføjet 14.09.2021
by Sintayehu Asnakew, Getasew Legas, Tewachew Muche Liyeh, Amsalu Belete, Kalkidan Haile, Getachew Yideg Yitbarek, Wubet Alebachew Bayih, Dejen Getaneh Feleke, Binyam Minuye Birhane, Haile Amha, Shegaye Shumet, Ermias Sisay Chanie
Objective This study aimed to assess the prevalence and associated factors of post-traumatic stress disorder among health professionals working in South Gondar Zone hospitals in the era of the COVID-19 pandemic, Amhara Ethiopia 2020.
Methods Institutional based cross-sectional study design was conducted. A total of 396 respondents completed the questionnaire and were included in the analysis. A previously adapted self-administered pretested standard questionnaire, Impact of Event Scale-Revised (IES-R-22) was used to measure post-traumatic stress disorder. Data was entered into Epi data version 4.4.2 then exported to SPSS version 24 for analysis. Descriptive and analytical statistical procedures, bivariate, and multivariate binary logistic regressions with odds ratios and 95% confidence interval were employed. The level of significance of association was determined at a p-value < 0.05.
Results The prevalence of post-traumatic stress disorder among health care providers in this study was 55.1% (95% CI: 50.3, 59.6). Lack of standardized PPE supply (AOR = 2.5 7,95CI;1.37,4.85), respondents age > 40 years (AOR = 3.95, 95CI; 1.74, 8.98), having medical illness (AOR = 4.65, 95CI;1.65,13.12), perceived stigma (AOR = 1.97, 95CI;1.01, 3.85), history of mental illness(AOR = 8.08,95IC;2.18,29.98) and having poor social support (AOR = 4.41,95CI;2.65,7.3) were significantly associated with post-traumatic stress disorder at p-value < 0.05. Conversely, being a physician (AOR = 0.15, 95CI; 0.04, 0.56) was less affected by PTSD.
Conclusions The prevalence of post-traumatic stress disorder among health care providers in this study was high. Adequate and standardized PPE supply, giving especial emphasis to those care providers with medical illness, history of mental illness, and having poor social support, creating awareness in the community to avoid the stigma faced by health care providers who treat COVID patients is recommended.
Læs mere Tjek på PubMedNicole Zviedrite, Jeffrey D. Hodis, Ferdous Jahan, Hongjiang Gao, Amra Uzicanin
PLoS One Infectious Diseases, 14.09.2021
Tilføjet 14.09.2021
by Nicole Zviedrite, Jeffrey D. Hodis, Ferdous Jahan, Hongjiang Gao, Amra Uzicanin
Pre-emptive school closures are frontline community mitigation measures recommended by the US Centers for Disease Control and Prevention (CDC) for implementation during severe pandemics. This study describes the spatiotemporal patterns of publicly announced school closures implemented in response to the coronavirus disease 2019 (COVID-19) pandemic and assesses how public K-12 districts adjusted their methods of education delivery and provision of subsidized meals. During February 18–June 30, 2020, we used daily systematic media searches to identify publicly announced COVID-19–related school closures lasting ≥1 day in the United States (US). We also collected statewide school closure policies from state government websites. Data on distance learning and subsidized meal programs were collected from a stratified sample of 600 school districts. The first COVID-19–associated school closure occurred on February 27, 2020 in Washington state. By March 30, 2020, all but one US public school districts were closed, representing the first-ever nearly synchronous nationwide closure of public K-12 schools in the US. Approximately 100,000 public schools were closed for ≥8 weeks because of COVID-19, affecting >50 million K-12 students. Of 600 districts sampled, the vast majority offered distance learning (91.0%) and continued provision of subsidized meal programs (78.8%) during the closures. Despite the sudden and prolonged nature of COVID-19–associated school closures, schools demonstrated flexibility by implementing distance learning and alternate methods to continue subsidized meal programs.
Læs mere Tjek på PubMedStreuli, S., Ibrahim, N., Mohamed, A., Sharma, M., Esmailian, M., Sezan, I., Farrell, C., Sawyer, M., Meyer, D., El-Maleh, K., Thamman, R., Marchetti, A., Lincoln, A., Courchesne, E., Sahid, A., Bhavnani, S. P.
BMJ Open, 14.09.2021
Tilføjet 14.09.2021
Objectives
To combat misinformation, engender trust and increase health literacy, we developed a culturally and linguistically appropriate virtual reality (VR) vaccination education platform using community-engaged approaches within a Somali refugee community.
Design
Community-based participatory research (CBPR) methods including focus group discussions, interviews, and surveys were conducted with Somali community members and expert advisors to design the educational content. Co-design approaches with community input were employed in a phased approach to develop the VR storyline.
Participants
60 adult Somali refugees and seven expert advisors who specialise in healthcare, autism research, technology development and community engagement.
Setting
Somali refugees participated at the offices of a community-based organisation, Somali Family Service, in San Diego, California and online. Expert advisors responded to surveys virtually.
Results
We find that a CBPR approach can be effectively used for the co-design of a VR educational programme. Additionally, cultural and linguistic sensitivities can be incorporated within a VR educational programme and are essential factors for effective community engagement. Finally, effective VR utilisation requires flexibility so that it can be used among community members with varying levels of health and technology literacy.
Conclusion
We describe using community co-design to create a culturally and linguistically sensitive VR experience promoting vaccination within a refugee community. Our approach to VR development incorporated community members at each step of the process. Our methodology is potentially applicable to other populations where cultural sensitivities and language are common health education barriers.
Læs mere Tjek på PubMedSiddiquea, B. N., Shetty, A., Bhattacharya, O., Afroz, A., Billah, B.
BMJ Open, 14.09.2021
Tilføjet 14.09.2021
Objective
To assess the knowledge, attitude and practice (KAP) of the global general population regarding COVID-19.
Design
Systematic review and meta-analysis.
Methods
MEDLINE, Embase, CINAHL and PsycINFO were used to identify articles published between 1 January and 30 June 2021 assessing KAP regarding COVID-19 in the global general population. The quality of eligible studies was assessed. Random effects model was used to obtain the pooled proportion of each component of KAP of COVID-19. Heterogeneity (I2) was tested, and subgroup and correlation analyses were performed.
Results
Out of 3099 records, 84 studies from 45 countries across all continents assessing 215 731 participants’ COVID-19 KAP were included in this study. The estimated overall correct answers for knowledge, good attitude and good practice in this review were 75% (95% CI 72% to 77%), 74% (95% CI 71% to 77%) and 70% (95% CI 66% to 74%), respectively. Low-income countries, men, people aged below 30 years and people with 12 years of education or less had the lowest practice scores. Practice scores were below 60% in Africa and Europe/Oceania. Overall heterogeneity was high (I2 ≥98%), and publication bias was present (Egger’s regression test, p<0.01). A positive significant correlation between knowledge and practice (r=0.314, p=0.006), and attitude and practice (r=0.348, p=0.004) was observed.
Conclusions
This study’s findings call for community-based awareness programmes to provide a simple, clear and understandable message to reinforce knowledge especially regarding efficacy of the preventive measures in low and lower middle-income countries, and in Africa and Europe/Oceania, which will translate into good practice. Targeted intervention for men, people with low education, unemployed people and people aged below 30 years should be recommended. As most of the included studies were online surveys, underprivileged and remote rural people may have been missed out. Additional studies are needed to cover heterogeneous populations.
PROSPERO registration number
CRD42020203476.
Læs mere Tjek på PubMedKong, Y., Shaver, L. G., Shi, F., Yang, L., Zhang, W., Wei, X., Zhu, Y., Wang, Y., Wang, P. P.
BMJ Open, 14.09.2021
Tilføjet 14.09.2021
Objection
The objective of this study was to assess attitudes towards the use of Traditional Chinese Medicine (TCM) for COVID-19 among Chinese immigrants in Canada during the early stage of the COVID-19 pandemic.
Methods
A cross-sectional study was conducted in April 2020 in Canada. Individuals aged 16 or older who were of Chinese origin and living in Canada at the time of the survey were invited to participate in an online survey. Descriptive and univariate statistics were performed to describe participant attitudes towards various preventive and treatment measures for COVID-19. Multiple logistic regression was used to identify independent associations with sociodemographic factors and attitudes.
Results
A total of 754 eligible respondents were included in the analysis. 65.8% of the participants were female, 77.2% had a university degree or higher and 28.6% were 55 years of age or older. Overall, 48.8% of the study participants believed that TCM was effective in preventing COVID-19% and 46.2% would use TCM if they had COVID-19-related symptoms. However, the corresponding numbers for western medicine were 20.8% and 39.9%, which were statistically lower (p<0.01). Older participants (55+vs <35, OR=3.55 (95% CI 2.05 to 6.14); 35–54 vs <35, OR=1.98 (95% CI 1.27 to 3.08)) and those who were dissatisfied with their income (OR=2.47(95% CI 1.56 to 3.92)) were more likely to believe TCM was effective against COVID-19. Similarly, older participants (55+vs <35, OR=3.13 (95% CI 1.79 to 5.46); 35–54 vs <35, OR=2.25 (95% CI 1.35 to 3.74)), females (OR=1.60 (95% CI 1.15 to 2.23)), and those born in mainland China (OR=10.49 (95% CI 2.32 to 47.39)) were more likely to use TCM if they had symptoms of COVID-19.
Conclusion
Despite the lack of scientific evidence to support its use, TCM was widely believed by Chinese immigrants in Canada to be an effective means of preventing COVID-19 and many also stated they would use it if they were experiencing symptoms of COVID-19.
Læs mere Tjek på PubMedHsu, W.-T., Sherrod, C. F., Tehrani, B., Papaila, A., Porta, L., Hsu, T.-C., Sheng, W.-H., Lee, C.-C.
BMJ Open, 14.09.2021
Tilføjet 14.09.2021
Objectives
There is minimal literature examining the association of sepsis with out-of-hospital cardiac arrest (OHCA). Using a large national database, we aimed to quantify the risk of OHCA among sepsis patients after hospital discharge.
Design
Population-based cohort study.
Setting
Nationwide sepsis cohort retrieved from the National Health Insurance Research Database of Taiwan between 2000 and 2013.
Participants
We included 17 304 patients with sepsis. After hospital discharge, 144 patients developed OHCA within 30 days and 640 between days 31 and 365.
Primary and secondary outcome measures
The main outcomes were OHCA events following hospital discharge for sepsis. To evaluate the independent association between sepsis and OHCA after a sepsis hospitalisation, we constructed two non-sepsis comparison cohorts using risk set sampling and propensity score matching techniques (non-infection cohort, non-sepsis infection cohort). We plotted the daily number and daily risk of OHCA within 1 year of hospital discharge between sepsis and matched non-sepsis cohorts. We used Cox regression to evaluate the risk of early and late OHCA, comparing sepsis to non-sepsis patients.
Results
Compared with non-infected patients, sepsis patients had a higher rate of early (HR 1.66, 95% CI: 1.27 to 2.16) and late (HR 1.19, 95% CI: 1.06 to 1.33) OHCA events. This association was independent of age, sex or cardiovascular history. Compared with non-sepsis patients with infections, sepsis patients had a higher rate of both early (HR 1.28, 95% CI: 1.00 to 1.63) and late (HR 1.13, 95% CI: 1.01 to 1.27) OHCA events, especially among patients with cardiovascular disease (OR 1.35, 95% CI: 1.01 to 1.81).
Conclusions
Sepsis patients had increased risk of OHCA compared with matched non-sepsis controls, which lasted up to 1 year after hospital discharge.
Læs mere Tjek på PubMedChua, B. W. B., Huynh, V. A., Lou, J., Goh, F. T., Clapham, H., Teerawattananon, Y., Wee, H. L.
BMJ Open, 14.09.2021
Tilføjet 14.09.2021
Introduction
Several treatment options are available for COVID-19 to date. However, the use of a combination of non-pharmaceutical interventions (NPIs) is necessary for jurisdictions to contain its spread. Although the implementation cost of NPIs may be low from the healthcare system perspective, it can be costly when considering the indirect costs from the societal perspective. COVID-19 vaccination campaigns have begun in several countries worldwide. Nonetheless, the quantity of vaccines available remain limited over the next 1 to 2 years. A tool for informing vaccine prioritisation that considers both cost and effectiveness will be highly useful. This study aims to identify the most cost-effective combination of COVID-19 response policies, using Singapore as an example.
Methods and analysis
An age-stratified Susceptible-Exposed-Infectious-Recovered model will be used to generate the number of infections stratified by disease severity under different intervention scenarios. Polices of interest include test-trace-isolate, travel restriction, compulsory face mask and hygiene practices, social distancing, dexamethasone/remdesivir therapy and vaccination. The latest phase 3 trial results and the WHO Target Product Profiles for COVID-19 vaccines will be used to model vaccine characteristics. A cost (expected resource utilisation and productivity losses) and quality-adjusted life years (QALYs) will be attached to these outputs for a cost-utility analysis. The primary outcome measure will be the incremental cost-effectiveness ratio generated from the incremental cost of policy alternatives expressed as a ratio of the incremental benefits (QALYs gained). Efficacy of policy options will be gathered from literature review and from its observed impacts in Singapore. Cost data will be gathered from healthcare institutions, Ministry of Health and published data. Sensitivity analysis such as threshold analysis and scenario analysis will be conducted.
Ethics and dissemination
Ethics approval was not required for this study. The study findings will be disseminated through peer-reviewed journals.
Læs mere Tjek på PubMedNickel, N. C., Clark, W., Phillips-Beck, W., Sanguins, J., Enns, J. E., Lavoie, J. G., Romanescu, R., Katz, A., Mahar, A. L., Brownell, M., Lix, L., Urquia, M., Tso Deh, M., OConaill, C., Durksen, A., Brownell, E., The COVID Equity Team, Brownell, Chartier, Frances Chartrand, Chateau, Clark, Driedger, Dutton, Edwards, Enns, Katz, Lavoie, Lix, Mahar, Nickel, Phillips-Beck, Romanescu, Sanguins, Star, Urquia
BMJ Open, 14.09.2021
Tilføjet 14.09.2021
Introduction
Decades of research demonstrate that First Nations, Metis and Inuit (FN/M/I) populations have differential access to diagnostic and therapeutic healthcare. Emerging evidence shows that this continues to be the case during the SARS-CoV-2 pandemic. In an effort to rectify these differences in access to care, our team, which is co-led by FN/M/I partners, will generate and distribute evidence on COVID-19 diagnostic testing and vaccination in high-priority FN/M/I populations in Manitoba, with the goal of identifying system-level and individual-level factors that act as barriers to equitable care and thereby informing Indigenous-led public health responses.
Methods and analysis
Our nations-based approach focuses on FN/M/I populations with separate study arms for each group. Linked administrative health data on COVID-19 diagnostic testing and vaccinations are available on a weekly basis. We will conduct surveillance to monitor trends in testing and vaccination among each FN/M/I population and all other Manitobans, map the geographic distribution of these outcomes by health region and tribal council, and identify barriers to testing and vaccination to inform public health strategies. We will follow the course of the pandemic starting from January 2020 and report findings quarterly.
Ethics and dissemination
Ethics approvals have been granted by the University of Manitoba Research Ethics Board and from each of our FN/M/I partners’ organisations. Our team is committed to engaging in authentic relationship-based research that follows First Nations, Metis and Inuit research ethics principles. Our FN/M/I partners will direct the dissemination of new information to leadership in their communities (health directors, community health organisations) and to decision-makers in the provincial Ministry of Health. We will also publish in open-access journals. The study will create ongoing capacity to monitor Manitoba’s pandemic response and ensure potential health inequities are minimised, with learnings applicable to other jurisdictions where detailed administrative data may not be available.
Læs mere Tjek på PubMed