title: Combined Infection Control Interventions Protect the Essential Workforce from Occupationally-Acquired SARS-CoV-2 during Produce Production, Harvesting and Processing Activities

abstract:
Essential food workers experience an elevated risk of SARS-CoV-2 infection due to prolonged occupational exposures (e.g., frequent close contact, enclosed spaces) in food production and processing areas, shared transportation (car or bus), and employer-provided shared housing. The purpose of this study was to evaluate the impact of combined food industry interventions and vaccination on reducing the daily cumulative risk of SARS-CoV-2 infection for produce workers. Six linked quantitative microbial risk assessment models were developed in R to simulate daily scenarios experienced by a worker. Standard industry interventions (2 m physical distancing, handwashing, surface disinfection, universal masking, increased ventilation) and two-dose mRNA vaccinations (86-99% efficacy) were modeled individually and jointly to assess risk reductions. The infection risk for an indoor (0.802, 95% Uncertainty Interval [UI]: 0.472-0.984) and outdoor (0.483, 95% UI: 0.255-0.821) worker was reduced to 0.018 (93% reduction) and 0.060 (87.5% reduction) after implementation of combined industry interventions. Upon integration of these interventions with vaccination, the infection risk for indoor (0.001, 95% UI: 0.0001-0.005) and outdoor (0.004, 95% UI: 0.001-0.016) workers was reduced by [≥]99.1%. Food workers face considerable risk of occupationally-acquired SARS-CoV-2 infection without interventions; however, consistent implementation of key infection control measures paired with vaccination effectively mitigates these risks.

SynopsisBundled interventions, particularly if they include vaccination, produce significant reductions (>99%) in SARS-CoV-2 infection risk for essential food workers.

Graphical Abstract

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category: occupational and environmental health


title: Distinct cellular dynamics associated with response to CAR-T therapy for refractory B-cell lymphoma

abstract: Chimeric Antigen Receptor (CAR)-T cell therapy has revolutionized the treatment of hematologic malignancies. Approximately half of patients with refractory large B-cell lymphomas achieve durable responses from CD19-targeting CAR-T treatment; however, failure mechanisms are identified in only a fraction of cases. To gain novel insights into the basis of clinical response, we performed single-cell transcriptome sequencing of 105 pre- and post-treatment peripheral blood mononuclear cell samples, and infusion products collected from 32 individuals with high-grade B cell lymphoma treated with either of two CD19 CAR-T products: axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel). Expansion of proliferative memory-like CD8 clones was a hallmark of tisa-cel response, whereas axi-cel responders displayed more heterogeneous populations. Elevations in CAR-T regulatory cells (CAR-Tregs) among non-responders to axi-cel were detected, and these populations were capable of suppressing conventional CAR-T cell expansion and driving late relapses in an in vivo model. Our analyses reveal the temporal dynamics of effective responses to CAR-T therapy, the distinct molecular phenotypes of CAR-T cells with differing designs, and the capacity for even small increases in CAR-Tregs to drive relapse.

category: oncology


title: Early SARS-CoV-2 reinfections within 60 days highlight the need to consider antigenic variations together with duration of immunity in defining retesting policies

abstract: The emergence of the SARS-CoV-2 Omicron variant, characterized by a significant antigenic diversity compared to the previous Delta variant, had led to a decrease in antibody efficacy in both convalescent and vaccinees sera resulting in high number of reinfections and breakthrough cases worldwide. However, to date, reinfections are defined by the ECDC as two positive tests [≥]60 days apart, influencing retesting policies after an initial positive test in several European countries. We illustrate by a clinical case supplemental by epidemiological data that early reinfections do occur within 60 days especially in young, unvaccinated individuals. In older patient groups, unvaccinated and patients with a basic vaccination scheme are more vulnerable to reinfections compared to patients who received a first booster vaccine. For this reason, we consider that the duration of protection offered by a previous infection should be reconsidered, in particular when a shift between consecutive SARS-CoV-2 variants occurs.

category: infectious diseases


title: Risk factors for severe COVID-19 in hospitalized children in Canada: A national prospective study from March 2020--May 2021

abstract:
BackgroundChildren living with chronic comorbid conditions are at increased risk for severe COVID-19, though there is limited evidence regarding the risks associated with specific conditions and which children may benefit from targeted COVID-19 therapies. The objective of this study was to identify factors associated with severe disease among hospitalized children with COVID-19 in Canada.

MethodsWe conducted a national prospective study on hospitalized children with microbiologically confirmed SARS-CoV-2 infection via the Canadian Paediatric Surveillance Program from April 2020-May 2021. Cases were reported voluntarily by a network of >2800 paediatricians. Hospitalizations were classified as COVID-19-related, incidental infection, or infection control/social admissions. Severe disease (among COVID-19-related hospitalizations only) was defined as disease requiring intensive care, ventilatory or hemodynamic support, select organ system complications, or death. Risk factors for severe disease were identified using multivariable Poisson regression, adjusting for age, sex, concomitant infections, and timing of hospitalization.

FindingsWe identified 544 children hospitalized with SARS-CoV-2 infection, including 60{middle dot}7% with COVID-19-related disease and 39{middle dot}3% with incidental infection or infection control/social admissions. Among COVID-19-related hospitalizations (n=330), the median age was 1{middle dot}9 years (IQR 0{middle dot}1-13{middle dot}3) and 43{middle dot}0% had chronic comorbid conditions. Severe disease occurred in 29{middle dot}7% of COVID-19-related hospitalizations (n=98/330), most frequently among children aged 2-4 years (48{middle dot}7%) and 12-17 years (41{middle dot}3%). Comorbid conditions associated with severe disease included technology dependence (adjusted risk ratio [aRR] 2{middle dot}01, 95% confidence interval [CI] 1{middle dot}37-2{middle dot}95), neurologic conditions (e.g. epilepsy and select chromosomal/genetic conditions) (aRR 1{middle dot}84, 95% CI 1{middle dot}32-2{middle dot}57), and pulmonary conditions (e.g. bronchopulmonary dysplasia and uncontrolled asthma) (aRR 1{middle dot}63, 95% CI 1{middle dot}12-2{middle dot}39).

InterpretationWhile severe outcomes were detected at all ages and among patients with and without comorbidities, neurologic and pulmonary conditions as well as technology dependence were associated with increased risk of severe COVID-19. These findings may help guide vaccination programs and prioritize targeted COVID-19 therapies for children.

FundingFinancial support for the CPSP was received from the Public Health Agency of Canada.


title: Built environment's impact on COVID-19 transmission and mental health revealed by COVID-19 Participant Experience data from the All of Us Research Program

abstract:
ObjectivesThe coronavirus disease 2019 (COVID-19) pandemic has led to millions of deaths. Effectively cutting the transmission of COVID-19 is essential to reduce the impact. Previous studies have observed the potential relationship between the built environment and COVID-19 transmission; however, to date, stringent studies investigating these relationships at the individual level are still insufficient. Here, we aim to examine the relationship between household types and COVID-19 infection (or mental health) during the early stages of the pandemic by using the All of Us Research Program COVID-19 Participant Experience (COPE) survey data.

DesignBased on 62,664 participants responses to COPE from May to July 2020, we matched the cases of self-reported COVID-19 status, anxiety, or stress, with controls of the same race, sex, age group, and survey version. We conducted multiple logistic regressions between one of the outcomes and household type under the adjustment of other related covariates, such as ethnicity, age, social distancing behavior, and house occupancy.

ResultsHousehold type with a shared component was significantly associated with COVID-19 infection (OR=1.19, 95% CI 1.1 to 1.3; p=2x10-4), anxiety (OR=1.26, 95% CI 1.1 to 1.4; p=1.1x10-6), and stress (OR=1.29, 95% CI 1.2 to 1.4, p=4.3x10-10) as compared to free-standing houses after adjusting for the abovementioned confounding factors. Further, frequent nonessential shopping or outings, another indicator of the built environment, was also associated with COVID-19 infection (OR=1.36, 95% CI 1.1 to 1.8; p=0.02), but not associated with elevated mental health conditions.

ConclusionOur study demonstrated that the built environment of houses with a shared component tends to increase the risk of COVID-19 transmission, which consequently led to more anxiety and stress for their dwellers. It also suggested the necessity to improve the quality of the built environment through planning, design, and management toward a more resilient society in coping with future pandemics.


title: Drinking water chlorination impact on fecal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae in Bangladeshi children in a double-blind, cluster-randomized controlled trial

abstract:
BackgroundWater, sanitation, and hygiene (WASH) services have the potential to interrupt transmission of antimicrobial-resistant bacteria and reduce the need for antibiotics, thereby reducing selection for resistance. However, evidence of WASH impacts on antimicrobial resistance (AMR) is lacking.

MethodsWe evaluated extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and ESBL-KESC (Klebsiella spp., Enterobacter spp., Serratia spp., and Citrobacter spp.) carriage in the feces of 479 Bangladeshi children under 5 years of age enrolled in a double-blind, cluster-randomized controlled trial of in-line drinking water chlorination in two low-income urban communities in Bangladesh. We additionally assessed the interventions impact on circulating beta-lactamase genes in fecal metagenomes and in genomes of fecal ESBL-E. coli isolates.

FindingsWe detected ESBL-E. coli in 65% (n = 309) and ESBL-KESC in 12% (n = 56) of enrolled children. We observed no effect of the intervention on the prevalence of ESBL-E. coli (relative risk [95% confidence interval] = 0.98 [0.78, 1.23]) when controlling for study site and age. Although ESBL-KESC (0.76 [0.44, 1.29]) was lower among children in the intervention group, the relative risk was not significant. Concentrations of ESBL-E. coli (log10 CFU/g-wet) were on average [95% confidence interval] 0.13 [-0.16, 0.42] higher in the intervention group and ESBL-KESC (log10 CFU/g-wet) were 0.10 [-0.22, 0.02], lower in the intervention group, when controlling for study site and age. Furthermore, the distribution of ESBL-E.coli sequence types, type of beta-lactamase-encoding genes in ESBL-E. coli isolates, and the presence and relative abundance of beta-lactamase-encoding genes in childrens fecal metagenomes did not differ significantly between the intervention and control children.

InterpretationOne year of in-line drinking water chlorination in communities did not meaningfully impact the carriage of ESBL-E. coli among children in an area of high ESBL-E. coli carriage. While ESBL-KESC was at lower prevalence than ESBL-E. coli, in the intervention group, limited study power prevented a clear interpretation of treatment effect. Development and evaluation of effective interventions to reduce AMR carriage are needed to support calls for WASH embedded in current National and Global AMR Action Plans.

category: epidemiology


title: Evaluating the effects of an intervention to improve the health environment for mothers and children in health centres (BECEYA) in Mali: a qualitative study

abstract:
BackgroundAn intervention aiming to improve maternal and children environment in healthcare facilities (BECEYA) was launched in three regions of Mali. This study aimed to explore the perceptions and experiences of patients and their companions, community actors and healthcare facilities staff on the effects of the BECEYA intervention in two regions of Mali.

MethodsWe conducted a qualitative study using an empirical phenomenological approach. Through purposive sampling, women who attended antenatal care in the selected healthcare centres, companions, and health facility staff members were recruited. Data were collected during January and February 2020 through semi-structured individual interviews and focus groups. According to Braun & Clarke approach, audio recordings were transcribed verbatim, and a thematic analysis was conducted in five main steps.

ResultsWe recruited 26 participants in individual interviews and 20 participants in focus groups. Donabedian conceptual framework of quality of care was used to present the perceived changes following the implementation of the BECEYA project. The themes that emerged from data analysis are perceived changes in terms of infrastructure (perceived changes in the characteristics of the healthcare facilities setting, including the infrastructure introduced by the BECEYA project), process (changes in the delivery and use of care introduced or resulting from BECEYA activities), and outcome (the direct and indirect effects of these changes on the health status of patients and the population).

ConclusionThe study identified the positive effects of women users of the services, their companions and health centre staff following the implementation of the project. Therefore, this study contributes to the advancement of knowledge to show the link between improving the health environment of health centres in developing countries, a major aspect of the quality of care, and maternal and child health care.

category: health systems and quality improvement


title: Characteristics and outcomes of COVID-19 patients during B.1.1.529 (Omicron) dominance compared to B.1.617.2 (Delta) in 89 German hospitals

abstract:
BackgroundThe SARS-CoV-2 variant of concern B.1.1.529 (Omicron) was first described in November 2021 and soon became the dominant variant worldwide. Existing data suggests a reduced disease severity in comparison to B.1.617.2 (Delta). Differences in characteristics and in-hospital outcomes of patients with COVID-19 in Germany during the Omicron period compared to Delta are not thoroughly studied. Surveillance for severe acute respiratory infections (SARI) represents an integral part of infectious disease control in Germany.

MethodsAdministrative data from 89 German Helios hospitals was retrospectively analysed. Laboratory-confirmed SARS-CoV-2 infections were identified by ICD-10-code U07.1 and SARI cases by ICD-10-codes J09-J22. COVID-19 cases were stratified by concomitant SARI. A nine-week observational period between December 6, 2021 and February 6, 2022 was defined and divided into three phases with respect to the dominating virus variant (Delta, Delta to Omicron transition, Omicron). Regression analyses adjusted for age, gender and Elixhauser comorbidities were applied to assess in-hospital patient outcomes.

ResultsA total cohort of 4,494 inpatients was analysed. Patients in the Omicron dominance period were younger (mean age 61.6 vs. 47.8; p<0.01), more likely to be female (54.7% vs. 47.5%; p<0.01) and characterized by a lower comorbidity burden (mean Elixhauser comorbidity index 8.2 vs. 5.4; p<0.01). Comparing Delta and Omicron periods, patients were at significantly lower risk for intensive care treatment (adjusted odds ratio 0.64 [0.51-0.8]; p<0.001), mechanical ventilation (adjusted odds ratio 0.38 [0.28-0.51]; p<0.001), and in-hospital mortality (adjusted odds ratio 0.42 [0.32-0.56]; p<0.001). This also applied to the separate COVID-SARI group. During the Delta to Omicron transition, case numbers of COVID-19 without SARI exceeded COVID-SARI.

ConclusionPatient characteristics and outcomes differ during the Omicron dominance period as compared to Delta suggesting a reduced disease severity with Omicron infections. SARI surveillance might play a crucial role in assessing disease severity of future SARS-CoV-2 variants.


title: Mortality in Switzerland in 2021

abstract:
ObjectiveTo analyze mortality trends in Switzerland in 2021, the second year of the COVID-19 pandemic.

MethodsUsing data from the Swiss Federal Statistical Office, we compared mortality in Switzerland in 2021 with that of previous years in terms of standardized weekly deaths, standardized (annual) mortality rates (overall and stratified by age and sex) and life expectancy.

ResultsAfter a favorable first half of the year and a fairly standard second half in terms of mortality in Switzerland, the year 2021 ended with a wave of deaths of moderate intensity related to the 5th wave of COVID-19. Overall, and after a notable increase in mortality in 2020 (+9.2% compared to 2019), the pre-pandemic mortality level was approximately recovered in 2021 (+0.6% compared to 2019). Life expectancy, after declining by 10 months for men and 6 months for women in 2020, returned in 2021 to levels slightly above those of 2019 for women (85.7 years, +0.1 years from 2019) and regained 2018 levels for men (81.6 years, still -0.3 years from 2019). The age group responsible for the small remaining loss for men was the 50-70 age group, which had similar mortality in 2020 and 2021.

ConclusionsThe second year of the COVID-19 pandemic in Switzerland was characterized by an approximate return to pre-pandemic mortality levels, with a faster recovery for women than for men compared to 2020.

category: public and global health


title: Both COVID-19 infection and vaccination induce high-affinity cross-clade responses to SARS-CoV-2 variants

abstract: The B.1.1.529 (omicron) variant has rapidly supplanted most other SARS-CoV-2 variants. Using microfluidics-based antibody affinity profiling (MAAP), we have recently shown that current therapeutic monoclonal antibodies exhibit a drastic loss of affinity against omicron. Here, we have characterized affinity and IgG concentration in the plasma of 39 individuals with multiple trajectories of SARS-CoV-2 infection and/or vaccination as well as in 2 subjects without vaccination or infection. Antibody affinity in patient plasma samples was similar against the wild-type, delta, and omicron variants (KA ranges: 122{+/-}155, 159{+/-}148, 211{+/-}307 M-1, respectively), indicating a surprisingly broad and mature cross-clade immune response. We then determined the antibody iso- and subtypes against multiple SARS-CoV-2 spike domains and nucleoprotein. Postinfectious and vaccinated subjects showed different profiles, with IgG3 (p = 0.002) but not IgG1, IgG2 or IgG4 subtypes against the spike ectodomain being more prominent in the former group. Lastly, we found that the ELISA titers against the wildtype, delta, and omicron RBD variants correlated linearly with measured IgG concentrations (R=0.72) but not with affinity (R=0.29). These findings suggest that the wild-type and delta spike proteins induce a polyclonal immune response capable of binding the omicron spike with similar affinity. Changes in titers were primarily driven by antibody concentration, suggesting that B-cell expansion, rather than affinity maturation, dominated the response after infection or vaccination.


title: Prevalence and correlates of urogenital schistosomiasis in school going children in Maramba compound of Livingstone District, Zambia

abstract:
BackgroundSchistosomiasis is an acute and chronic parasitic disease that is caused by trematode worms (blood flukes) of the genus Schistosoma. Schistosoma haematobium (S. haematobium) is known to cause urogenital schistosomiasis. The disease is the second most common socio-economically devastating tropical parasitic disease after malaria in Africa. In Zambia, it affects over a million school going children, mostly in rural communities due to unsafe water and inadequate sanitation facilities. This study aimed to determine the presence of S. haematobium in urine specimens of school going children in Maramba compound of Livingstone and establish factors associated with the acquisition and spread of the parasite.

MethodsA structured questionnaire was administered on all children with signed consent from their guardians/parents and afterward spot urine specimens were collected in sterile containers for macroscopically/microscopically examination by an independent laboratory technologist.

ResultsA total of 173 school going children participated in the study. Parasitic eggs were detected in 6 specimens providing a prevalence of 3.47% (p<0.01) and this had a strong association with presence of microscopic red blood cells (p<0.01), dysuria (p=0.026), washing in a stream (p=0.01), and the perception on bilharzia acquisition (p<0.01).

ConclusionThe prevalence of urogenital schistosomiasis among school going children in Maramba compound was 3.47%, and the correlates of the infection included washing in a stream, older age and poor knowledge on schistosomiasis. Participants that had schistosomiasis often presented with hematuria and lacked knowledge on disease acquisition, health effects and preventive measures. This calls for more robust sensitization of school going children and periodic screening to curb the disease.


title: Potential gains in health-adjusted life expectancy by reducing burden of non-communicable diseases: a population-based study

abstract:
BackgroundThe United Nations Sustainable Development Goals (SDGs) target 3.4 aims to reduce premature mortality attributable to non-communicable diseases (NCDs) by one-third of their 2015 levels by 2030. Although meeting this target leads to longevity, survivors may suffer from long-term disability caused by NCDs. This paper quantifies the potential gains in health-adjusted life expectancy for people aged 30-70 years (HALE[30-70)) by examining the reductions in disability in addition to premature mortality. Additionally, we also assessed the feasibility of meeting the SDGs target 3.4.

MethodsWe extracted data from the Global Burden of Disease Study 2019 for all NCDs and four major NCDs (cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes mellitus) in 188 countries from 1990 to 2019. Bayesian age-period-cohort models were used to predict possible premature mortality in 2030. The life table was used to estimate the unconditional probability of death and HALE[30-70). Estimates of the potential gains in HALE[30-70) were based on three alternative future scenarios: a) eliminating all premature deaths and disability from a specific cause, b) meeting SDGs target 3.4, and survivors disability is eliminated, and c) meeting SDGs target 3.4, but survivors remain disabled for the rest of their lives.

ResultsIn 2030, the unconditional probability of premature mortality for four major NCDs in most countries remained at more than two-thirds of the 2015 baseline. In all scenarios, the high-income group has the greatest potential gains in HALE[30-70), above the global average of HALE[30-70). In scenario A, the potential gains in HALE[30-70) of reducing premature mortality for four major NCDs are significantly lower than those for all NCDs (range of difference for all income groups: 2.88 - 3.27 years). In scenarios B and C, the potential gains of HALE[30-70) in reducing premature mortality for all NCDs and the four major NCDs are similar (scenario B: 0.14 - 0.22, scenario C: 0.05 - 0.19). In scenarios A and B, countries from the high-income group have the greatest potential gains in HALE[30-70) from cancer intervention, whilst countries from the other income groups result in a greater possible HALE[30-70) gains from cardiovascular diseases control. In scenario C, countries from each income group have the largest potential gains in HALE[30-70) from diabetes reduction and chronic respiratory diseases prevention.

ConclusionsAchieving SDGs target 3.4 remains challenging for most countries. The elimination of disability among the population who benefit from the target could lead to a sizable improvement in HALE[30-70). Reducing premature death and disability at once and attaching equal importance to each to in line with the WHO goal of "leaving no one behind".


title: Household food insecurity risk indices for English neighbourhoods: measures to support local policy decisions

abstract:
BackgroundIn England, the responsibility to address food insecurity lies with local government, yet the prevalence of this social inequality is unknown in small subnational areas. In 2018 an index of small-area household food insecurity risk was developed and utilised by public and third sector organisations to target interventions; this measure needed updating to better support decisions in different contexts.

MethodsWe held interviews with stakeholders (n=11) and completed a scoping review to identify appropriate variables to create an updated risk measure. We then sourced a range of open access secondary data to develop an indices of food insecurity risk in English neighbourhoods. Following a process of data transformation and normalisation, we tested combinations of variables and identified the most appropriate data to reflect household food insecurity risk in urban and rural areas.

ResultsEight variables, reflecting both household circumstances and local service availability, were separated into two domains with equal weighting for a new index, the Complex Index, and a subset of these make up the Simple Index. Within the Complex Index the Compositional Domain includes population characteristics while the Structural Domain reflects access to resources. The Compositional Domain is correlated well with free school meal eligibility (rs=0.705) and prevalence of childhood obesity (rs=0.641). This domain was the preferred measure for use in most areas when shared with stakeholders, and when assessed alongside other configurations of the variables. Areas of highest risk were most often located in the North of England.

ConclusionWe recommend the use of the Compositional Domain for all areas, with inclusion of the Structural Domain in rural areas where locational disadvantage makes it more difficult to access services. These measures can aid local policy makers and planners when allocating resources and interventions to support households who may experience food insecurity.


title: Outpatient and Home Pulmonary Rehabilitation Program Post COVID-19: A study protocol for clinical trial

abstract:
BackgroundThe coronavirus disease 2019 (COVID-19) is a widespread, highly contagious inflammatory process that causes respiratory, physical and psychological dysfunction. COVID-19 mainly affects the respiratory system and evolves in the acute phase from mild cases with common symptoms, such as fever, cough, and fatigue, to the moderate-to-severe form, causing massive alveolar damage resulting in dyspnea and hypoxemia that can rapidly progress to pneumonia, and acute respiratory distress syndrome. The acute form usually causes severe pulmonary sequelae such as pulmonary fibrosis or progression to organ failure, leading to worsening metabolic dysfunction and/or death.

PurposeTo verify the effects of an outpatient and home pulmonary rehabilitation program (PRP) on clinical symptoms, pulmonary function, physical activity level, functional status, autonomic activity, peripheral muscle strength, static and functional balance, functional mobility, anxiety and depression, post-traumatic stress, health-related quality of life, and survival of patients with sequelae from COVID-19.

MethodsThis study will be a cohort, parallel, two-arm multicentric study, to be carried out in three clinical centers, with blind evaluation, with 06 weeks of training and follow-up. This study was designed according to the recommendations of the CONSORT statement. To be involved in this clinical study, according to the inclusion criteria, women and men aged between 16 and 75 years affected by COVID-19. The proposed PRP is based on the guidelines recommended by the Global Initiative for Chronic Obstructive Lung Disease and, consists of a combination of aerobic and muscle strengthening exercises, lasting six weeks, with a frequency of three times a week.

DiscussionIn patients infected with COVID-19 with persistent symptoms and sequelae, PRP mainly seeks to improve dyspnea, relieve anxiety and depression, prevent, and reduce complications and/or dysfunctions, reduce morbidity and mortality, and improve health-related quality of life.

Trial registrationThis study was registered at clinicaltrials.gov (ID: COVID-19 PULMONARY REHAB NCT04982042).

category: rehabilitation medicine and physical therapy


title: Psychosocial predictors of COVID-19 vaccine uptake among pregnant women: a cross-sectional study in Greece

abstract:
BackgroundUnvaccinated pregnant women with symptomatic COVID-19 have been found to have a higher risk of iatrogenic preterm births, intensive care unit admission, and invasive ventilation.

ObjectiveTo estimate the vaccination rate of pregnant women against the COVID-19 and to evaluate psychosocial factors associated with vaccine uptake among them.

MethodsWe conducted an anonymous cross-sectional study with a convenience sample in Greece from December 2021 to March 2022. We measured socio-demographic data of pregnant women, COVID-19-related vaccination status, worry about the side effects of COVID-19 vaccines, trust in COVID-19 vaccines, and COVID-19-related stress.

ResultsThe study population included 812 pregnant women with a mean age of 31.6 years. Among the pregnant women, 58.6% had received a COVID-19 vaccine. The most important reasons that pregnant women were not vaccinated were doubts about the safety and effectiveness of COVID-19 vaccines (31.4%), fear that COVID-19 vaccines could be harmful to fetus (29.4%), and fear of adverse side effects of COVID-19 vaccines (29.4%). Increased danger and contamination fears, increased fears about economic consequences, and higher levels of trust in COVID-19 vaccines were related with COVID-19 vaccine uptake. On the other hand, increased compulsive checking and reassurance seeking and increased worry about the adverse side effects of COVID-19 vaccines reduced the likelihood of pregnant women being vaccinated against the COVID-19.

ConclusionsAn understanding of the psychosocial factors associated with COVID-19 vaccine uptake in pregnant women is paramount to persuade women to get vaccinated against the COVID-19. There is a need for targeted educational campaigns to increase knowledge about COVID-19 vaccines and reduce COVID-19 vaccine hesitancy in pregnancy.

category: obstetrics and gynecology


title: Molecular identification of species of family Chaetomiaceae (Sordariomycetes, Ascomycota) from soil, dung and water in Sudan

abstract:
Species of Chaetomiaceae family are ubiquitous filamentous fungi, that responsible for a wide range of opportunistic human infections. To date, it encompasses more than 300 species have been described in genus Chaetomium. It have been globally reported as being are capable of colonizing various substrates. Due to the lack of genetic studies on the species belonging to this genus in Sudan, This work aimed to investigate the environmental fungal occurrence within the family Chaetomiaceae by using morphological characters and molecular sequencing.

A total of 260 environmental samples from soil, animal dung and water were collected from six different states in Sudan in two ecozones: .desert or semis desert ecozones (Dongola in Northern sudan, El-Obeid in western sudan); a low rainfall woodland savanna ecozone (Gazira, El Geteina and Khartoum from central Sudan and AlQadarif in eastern Sudan).

During a study of environmental fungi in Sudan, 119 isolates were identified as members of Chaetomiaceae after the ITS sequencing combined with an examination of the macro- and micromorphology. Out of 63 Chaetomium strains obtained from soil, animal dung and water samples, 25 were obtained from soil, 22 from animal dung and 16 from water. 56 additional strains isolated from other genus within the Chaetomiaceae family, such as (Amesia, Collariella, Ovatospora, Subramaniula and Thielavia) were recorded for the first time in Sudan.

In conclusion: Sequence-based identification of fungal isolates is often considered to be the most reliable and accurate identification method.

category: genetic and genomic medicine


title: Impact of SARS-CoV-2 vaccination on systemic immune responses in people living with HIV

abstract: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) and an ongoing global pandemic. Despite the development of vaccines, which protect healthy people from severe and life-threatening COVID-19, the immunological responses of people with secondary immunodeficiencies to SARS-CoV-2 mRNA vaccines are currently not well understood. Human Immunodeficiency Virus (HIV), causing acquired immunodeficiency syndrome (AIDS), targets CD4+ T helper (Th) cells that orchestrate the immune response. Anti-retroviral therapy suppresses HIV burden and restores Th cell numbers. Here, we investigated the humoral and cellular immune responses elicited by the BTN162b2 vaccine in a cohort of people living with HIV (PLWH), who receive anti-retroviral therapy. While antibody responses in PLWH increased progressively after the first and second vaccination compared to baseline, they were reduced compared to HIV negative study participants (controls). CD8+ T cells exhibited a general activated phenotype and increased effector and effector memory compartments. In contrast, CD4+ Th cell responses exhibited a vaccination-dependent increase and were comparable between PLWH and controls. In line with their reduced humoral response, the correlation between neutralizing antibodies and the CD4+ T cell response was decreased in PLWH compared to healthy controls. Interestingly, CD4+ T cell activation negatively correlated with the CD4 to CD8 ratio, indicating that low CD4 T cell numbers do not necessarily interfere with cellular immune responses. Taken together, our data demonstrate that COVID-19 mRNA vaccination in PLWH results in potent cellular immune responses, but the reduced antibody responses suggest that booster vaccination might be required for preventing disease.

category: allergy and immunology


title: Histopathological growth patterns of liver metastasis: updated consensus guidelines for pattern scoring, perspectives, and recent mechanistic insights.

abstract: The first consensus guidelines for scoring the histopathological growth patterns (HGPs) of liver metastases were established in 2017. Since then, numerous studies have applied these guidelines, have further substantiated the potential clinical value of the HGPs in patients with liver metastases from various tumour types and are starting to shed light on the biology of the distinct HGPs. In the present guidelines, we give an overview of these studies, discuss novel strategies for predicting the HGPs of liver metastases, such as deep learning algorithms for whole slide histopathology images and medical imaging, and highlight liver metastasis animal models that exhibit features of the different HGPs. Based on a pooled analysis of large cohorts of patients with liver-metastatic colorectal cancer, we propose a new cut-off to categorize patients according to the HGPs. An up-to-date standard method for HGP assessment within liver metastases is also presented with the aim of incorporating HGPs into the decision-making processes surrounding the treatment of patients with liver metastatic cancer. Finally, we propose hypotheses on the cellular and molecular mechanisms that drive the biology of the different HGPs, opening some exciting pre-clinical and clinical research perspectives.

category: pathology


title: Pretend play predicts receptive and expressive language trajectories in young children with autism

abstract: The effect of pretend play in 2 to 5-year-old children with ASD was investigated in the largest and the longest observational study to-date. Parents assessed the development of 7,069 children quarterly for three years on five subscales: combinatorial receptive language, expressive language, sociability, sensory awareness, and health. Pretend play was associated with superior developmental trajectories: 1.9-fold faster improvement of combinatorial receptive language (p<0.0001), 1.4-fold faster improvement of expressive language (p<0.0001), and 1.3-fold faster improvement of sensory awareness (p=0.0009). Pretend play had little effect on sociability and health. The strong association of pretend play with combinatorial receptive language remained significant even when controlling for expressive language. Similarly, the effect of pretend play on expressive language remained significant even when controlling for combinatorial receptive language. The effect of pretend play on combinatorial receptive language (but not on the expressive language) was stronger than the effects of seizures, sleep problems or high-TV exposure. The strong effect of pretend-play supports earlier studies indicating that it is an important stepping stone for language acquisition, particularly, the acquisition of combinatorial language.

category: pediatrics


title: Therapeutic of four antiviral drugs in treatment of COVID-19: A protocol for systematic review and Network Meta-analysis

abstract:
IntroductionThe COVID-19 pandemic has resulted in a global crisis in public health, however, there are still no safe and effective drugs to resist COVID-19 until now. We will use network meta-analysis to analysis available evidence from RCTs to compare the safety and efficacy of four antiviral drugs (including Ribavirin, Arbidol, Chloroquine Phosphate and Interferon) alone or in combination, in patients with COVID-19 on the basis of standard treatment, to reveal the robustness and strength of evidence for relative efficacy against COVID-19, which will provide better evidence for future clinical decision-making.

MethodsUsing English and Chinese search strategies to search 8 databases including PubMed, Web of Science, Embase, the Cochrane Library, CNKI, CBM, WANFANG Database and VIP. In addition, manual search for references in publications has been supplemented by electronic search. To enhance the effectiveness of this study, only randomized controlled trials of four antiviral drugs (Ribavirin, Arbidol, Chloroquine Phosphate, Interferon) used alone or in combination with the primary therapy shall be included.

AnalysisThe nucleic acid turning negative, complete absorption of lung inflammation, adverse reactions, aggravation and death shall be the primary outcome measures; whereas temperature return to normal, hospitalization, and positive rate after discharge will be the secondary outcomes. To ensure the quality of the systematic evaluation of this study, study screening, data extraction and quality evaluation will be carried out independently by two reviewers, and any differences will be resolved through consultation between them or by a third reviewer.

Ethics and disseminationThis systematic review will evaluate the efficacy of four antiviral drugs (Ribavirin, Arbidol, Chloroquine Phosphate and Interferon) for Covid-19 in adults. Since all included data will be obtained from published articles, it does not require ethical approval and will be published in a peer-reviewed journal.

PROSPERO registration numberCRD42022300104.


title: Automated Deep Brain Stimulation programming based on electrode location - a randomized, crossover trial using a data-driven algorithm

abstract:
BackgroundDeep brain stimulation (DBS) of the subthalamic nucleus (STN) is highly effective in controlling motor symptoms in patients with Parkinsons Disease (PD). However, correct selection of stimulation parameters is pivotal to treatment success and currently follows a time-consuming and demanding trial-and-error process. We conducted a double-blind, ran-domized, cross-over, non-inferiority trial to assess treatment effects of stimulation parameters suggested by a recently published algorithm (StimFit) based on neuroimaging data.

MethodsThe trial was carried out at Charite - Universitatsmedizin, Berlin, Germany and enrolled 35 PD patients treated with directional octopolar electrodes targeted at the STN. All patients had undergone DBS programming according to our centers standard of care (SoC) treatment before study recruitment. Based on perioperative imaging data DBS electrodes were reconstructed and StimFit was applied to suggest optimal stimulation settings. Patients underwent motor assessments using MDS-UPDRS-III during OFF-medication and in OFF-and ON-stimulation states under both conditions, StimFit and SoC parameter settings that were double blinded and randomized in a 1:1 ratio. The primary endpoint of this study was the absolute mean difference between MDS-UPDRS-III scores under StimFit and SoC stimulation, with a non-inferiority margin of five points.

FindingsSTN DBS resulted in mean MDS-UPDRS-III improvements of 48 % for SoC and 43 % with StimFit as compared to OFF-stimulation condition. The mean difference between MDS-UPDRS-III scores under StimFit and SoC stimulation was not significant (1.6 points), and non-inferiority was established. In six patients (17 %) initial programming of StimFit settings resulted in acute side-effects and amplitudes were reduced until side-effects disappeared.

InterpretationAutomated data-driven algorithms can predict stimulation parameters which lead to motor symptom control comparable to standard of care treatment. This approach could significantly decrease the time necessary to obtain optimal treatment parameters thereby fostering the design of more complex DBS electrodes. Long-term data including effects on quality of life require further investigation.

category: neurology


title: From months to minutes: creating Hyperion, a novel data management system expediting data insights for oncology research and patient care

abstract:
Structured AbstractO_ST_ABSObjectiveC_ST_ABSDescribe the design and implementation of a novel data management platform for an academic cancer center which meets the needs of multiple stakeholders.

Materials and MethodsA small, cross-functional technical team identified key challenges to creating a broad data management and access software solution: lowering the technical skill floor, reducing cost, enhancing user autonomy, optimizing data governance, and reimagining technical team structures in academia. The Hyperion data management platform was designed to meet these challenges in addition to usual considerations of data quality, security, access, stability, and scalability.

ResultsImplemented between May 2019 and December 2020 at the Wilmot Cancer Institute, Hyperion includes a sophisticated custom validation and interface engine to process data from multiple sources, storing it in a database. Graphical user interfaces and custom wizards permit users to directly interact with data across operational, clinical, research, and administrative contexts. The use of multi-threaded processing, open-source programming languages, and automated system tasks (normally requiring technical expertise) minimizes costs. An integrated ticketing system and active stakeholder committee support data governance and project management. A co-directed, cross-functional team with flattened hierarchy and integration of industry software management practices enhances problem solving and responsiveness to user needs.

DiscussionAccess to validated, organized, and current data is critical to the functioning of multiple domains in medicine. Although there are downsides to developing in-house customized software, we describe a successful implementation of custom data management software in an academic cancer center.

category: health informatics


title: A Voice App Design for Heart Failure Self-Management: A Pilot Study

abstract: There is a growing interest to investigate the feasibility of using voice user interfaces as a platform for digital therapeutics in chronic disease management. While mostly deployed as smartphone applications, some demographics struggle when using touch screens and often cannot complete tasks independently. This research aimed to evaluate how heart failure patients interacted with a voice app version of an already existing digital therapeutic, Medly, using a mixed-methods concurrent triangulation approach. The objective was to determine the acceptability and feasibility of the voice app by better understanding who this platform is be best suited for. Quantitative data included engagement levels and accuracy rates. Participants (n=20) used the voice app over a four week period and completed questionnaires and semi-structured interviews relating to acceptability, ease of use, and workload. The average engagement level was 73%, with a 14% decline between week one and four. The difference in engagement levels between the oldest and youngest demographic was the most significant, 84% and 43% respectively. The Medly voice app had an overall accuracy rate of 97.8% and was successful in sending data to the clinic. Users were accepting of the technology (ranking it in the 80th percentile) and felt it did not require a lot of work (2.1 on a 7-point Likert scale). However, 13% of users were less inclined to use the voice app at the end of the study. The following themes and subthemes emerged: (1) feasibility of clinical integration: user adaptation to voice apps conversational style, device unreliability, and (2) voice app acceptability: good device integration within household, users blamed themselves for voice app problems, and voice app missing desirable user features. The voice app proved to be most beneficial to those who: are older, have flexible schedules, are confident with using technology, and are experiencing other medical conditions.


title: THEMIS: A Framework for Cost-Benefit Analysis of COVID-19 Non-Pharmaceutical Interventions

abstract:
Since December 2019, the world has been ravaged by the COVID-19 pandemic, with over 150 million confirmed cases and 3 million confirmed deaths worldwide. To combat the spread of COVID-19, governments have issued unprecedented non-pharmaceutical interventions (NPIs), ranging from mass gathering restrictions to complete lockdowns. Despite their proven effectiveness in reducing virus transmission, the policies often carry significant economic and humanitarian cost, ranging from unemployment to depression, PTSD, and anxiety. In this paper, we create a data-driven system dynamics framework, THEMIS, that allows us to compare the costs and benefits of a large class of NPIs in any geographical region across different cost dimensions. As a demonstration, we analyzed thousands of alternative policies across 5 countries (United States, Germany, Brazil, Singapore, Spain) and compared with the actual implemented policy.

Our results show that moderate NPIs (such as restrictions on mass gatherings) usually produce the worst results, incurring significant cost while unable to sufficiently slow down the pandemic to prevent the virus from becoming endemic. Short but severe restrictions (complete lockdown for 4-5 weeks) generally produced the best results for developed countries, but only if the speed of reopening is slow enough to prevent a resurgence. Developing countries exhibited very different trade-off profiles from developed countries, and suggests that severe NPIs such as lockdowns might not be as suitable for developing countries in general.

category: health policy


title: An observational analysis of patient recruitment in clinical trials in France using real-word database PMSI.French patient recruitment in clinical trials using PMSI

abstract:
BackgroundFrance has significant clinical research and development potential, however, struggles in comparison to neighbouring countries. A significant reason is the difficulty to recruit patients, thus causing delays in the availability of new therapies to market. IQVIA uses Health Insurance Claims Data among other data assets, to better locate patients for trials based on the potential of hospitals.

ObjectiveThe aim of the study was to monitor whether an increased number of patients enrolled in clinical trials in France was observed when PMSI data supported patient recruitment, as well as describing clinical trial landscape worldwide and in Europe.

MethodsWe used data from ClinicalTrials.gov and Citeline to describe the clinical trial landscape in Europe between 2010 and 2019. We also looked at the IQVIA internal clinical trial tracker, Clinical Trial Management System (CTMS) to describe IQVIA-run trials and their performance after matching trials supported with PMSI data in France. We compared the average number of enrolled patients per site in PMSI and non-PMSI supported trials according to the study phase, using a Student t-test.

ResultsResults suggest that the support of PMSI on the average number of enrolled patients per site, when comparing at similar trial phase level, shows a positive trend especially for phase 4 studies (11.0 with PMSI vs 9.3 without PMSI, p=0.67), and for phases 3b, 3 and 1, when compared to non-PMSI supported studies.

ConclusionsThe findings of this study suggest that PMSI use has the potential to increase patient recruitment into clinical trials run in France, rendering France more attractive in its exploitation of the clinical research potential. Optimising patient recruitment has a direct impact on the availability and timeliness of innovative therapies to market for French patients.


title: Protocol for mixed-method study by LOng COvid Multidisciplinary consortium: Optimising Treatments and servIces acrOss the NHS (LOCOMOTION)

abstract:
IntroductionLong COVID, a new condition whose origins and natural history are not yet fully established, currently affects 1.5 million people in the UK. Most do not have access to specialist long COVID services. We seek to optimise long COVID care both within and outside specialist clinics, including improving access, reducing inequalities, helping patients manage their symptoms effectively at home, and providing guidance and decision support for primary care. We aim to establish a  gold standard of care by systematically analysing symptom clusters and current practices, iteratively improving pathways and systems of care, and working to disseminate better practices.

Methods and analysisThis mixed-method, multi-site study is informed by the principles of applied health services research, quality improvement, co-design, and learning health systems. It was developed in close partnership with patients (whose stated priorities are prompt clinical assessment; evidence-based advice and treatment; and help with returning to work and other roles) and with front-line clinicians. Workstreams and tasks to optimise assessment, treatment and monitoring are based in three contrasting settings: [1] specialist management in 10 long COVID clinics across the UK, via a quality improvement collaborative, experience-based co-design and targeted efforts to reduce inequalities of access; [2] patient self-management at home, with technology-supported monitoring; and [3] generalist management in primary care, harnessing electronic record data to study population phenotypes and develop evidence-based decision support, referral pathways and prioritisation criteria across the primary-secondary care interface, along with analysis of costs. Study governance includes an active patient advisory group.

Ethics and disseminationLOCOMOTION is sponsored by the University of Leeds and approved by Yorkshire & The Humber - Bradford Leeds Research Ethics Committee (ref: 21/YH/0276). Dissemination plans include academic and lay publications, and partnerships with national and regional policymakers to influence service specifications and targeted funding streams.

Study registrationClinicalTrials.gov: NCT05057260; ISRCTN15022307.


title: Effectiveness of convalescent plasma therapy in COVID-19 patients with haematological malignancies

abstract:
BackgroundImmunocompromised patients, including those with haematological malignancies, are among the high-risk group to develop severe coronavirus disease 2019 (COVID-19) complications. The effectiveness of passive immunotherapy with convalescent plasma (CP) on such patients diagnosed with COVID-19 has not been reviewed. Therefore, the aim of this review was to systematically appraise the current evidence for the efficacy of this therapy in haematological malignancies patients with COVID-19 infection.

MethodsA comprehensive search was conducted up-to October 2021, using four databases: PubMed, Web of Science, Science Direct, and Scopus. Two reviewers independently assessed the quality of the included studies. Data collection analysis were performed using Microsoft Excel 365 and GraphPad Prism software.

Results17 studies met the inclusion criteria; these records included 258 COVID-19 patients with haematological malignancies and treated with CP therapy (CPT). The main findings from the reviewed data suggests CPT may be associated with improved clinical outcomes including (a) higher survival rate, (b) improved SARS-CoV-2 clearance and presence of detectable anti-SARS-CoV-2 antibodies post CP transfusion, (c) improved hospital discharge time, and recovery after 1 month of CP therapy. Furthermore, treatment with convalescent plasma was not associated with development of adverse events.

ConclusionOwing to its safety and beneficial effects in improving clinical outcomes, CPT appears to be an effective supportive therapeutic option for haematological malignancy patients infected with COVID-19.

category: hematology


title: Syndemic violence victimization, alcohol and drug use, and HIV transmission risk behavior among transgender women in India: A cross-sectional, population-based study

abstract:
IntroductionTransgender women are disproportionately burdened by HIV. Co-occurring epidemics of adverse psychosocial exposures accelerate HIV sexual risk, including among transgender women; however, studies using additive models fail to examine synergies among psychosocial conditions that define a syndemic. We examined the impact of synergistic interactions among 4 psychosocial exposures on condomless anal sex (CAS) among a national probability sample of transgender women in India.

MethodsA probability-based sample of 4,607 HIV-negative transgender women completed the Indian Integrated Bio-behavioral Surveillance survey, 2014-2015. We used linear probability regression and logistic regression to assess 2-, 3-, and 4-way interactions among 4 exposures (physical and sexual violence, drug and alcohol use) on CAS.

ResultsOverall, 27.3% reported physical and 22.3% sexual violence victimization (39.2% either physical or sexual violence), one-third (33.9%) reported frequent alcohol use and 11.5% illicit drug use. Physical violence was associated with twofold higher odds of CAS in the main effects model. Significant two- and three-way interactions were identified on both multiplicative and additive scales between physical violence and drug use; physical and sexual violence; physical violence, sexual violence, and alcohol use; and physical violence, alcohol and drug use.

ConclusionsPhysical and sexual violence victimization, and alcohol and drug use are highly prevalent and synergistically interact to increase CAS among transgender women in India. Targeted and integrated initiatives to improve assessment of psychosocial comorbidities, to combat transphobic violence, and to provide tailored, trauma-informed alcohol and substance use treatment services may reduce HIV risk among transgender women.

category: hiv aids


title: Time series cross-correlation between home range and number of infected people during the medium term of COVID-19 Pandemic in a suburban city

abstract: Control of human mobility is among the most effective measures to prevent the spread of coronavirus disease 2019 (COVID-19). This study aims to clarify the correlation between home range and the number of people infected with SARS-CoV-2 during the medium-term of the COVID-19 pandemic in Ibaraki City. Home ranges are analyzed by the Minimum Convex Polygon method using mobile phone GPS location history data. We analyzed the time series cross-correlation between home range lengths and the number of infected people. Results reveal a slight positive correlation between home range and the number of infected people after one week during the medium-term of the COVID-19 pandemic. Regarding home range length, the cross-correlation coefficient is 0.4030 even at a lag level of six weeks, which has the most significant coefficient. Thus, a decrease in home range is only one of the indirect factors contributing toward a reduction in the number of infected people. This study makes a significant contribution to the literature by evaluating key public health challenges from the perspective of controliing the spread of the COVID-19 infectuion. Its findings has implications for policy makers, practitioners, and urban scientists seeking to promote urban sustainability.


title: Population-level hypertension control rate in India: A systematic review and meta-analysis of community based non-interventional studies, 2001-2020

abstract:
BackgroundHypertension is a significant contributor to mortality in India. Adequate control of hypertension is important to prevent cardiovascular morbidity and mortality.

MethodsWe conducted a systematic review and meta-analysis of community-based, non-interventional studies published between 2001 and 2020. We screened records from PubMed, Embase, and Web of Science databases, extracted data, and assessed risk of bias. We conducted random-effects meta-analysis to provide overall summary estimates and subgroup estimates, and mixed-effects meta-regression with sex, region, and study period as covariates. The risk of bias was assessed using modified New Castle-Ottawa scales. This study is registered with PROSPERO, CRD42021267973.

ResultsThe systematic review included 37 studies (n=170,631 hypertensive patients). Twelve studies (32%) reported poorer control rates among males than females, four studies (11%) reported poorer control rates among rural patients, while very few studies reported differences across socioeconomic variables. The overall control rate was 33.2% (n=84,485, 95% CI=27.9,38.6) with substantial heterogeneity (I2=99.1%, \chi^2= 3003.91, 95% CI=98.9,99.2; p <0.001). Unadjusted sub-group analysis showed significantly different hypertension control rates across regions (n=12,938, p=0.003) but not across study periods (n= 84,485, p=0.22), or sex (n= 81,197, p=0.22). Meta-regression showed that control rates increased by 14.7% during 2011-2020 compared to 2001-2010 (95%CI=5.8, 23.5, p=0.0021), and was 26.3% higher in the south (95%CI=12.6, 39.9, p=0.0005) and 15.9% higher in the west (95%CI=3.4, 31.4, p=0.0456) compared to the east. The control rates did not differ by sex.

ConclusionHypertension is adequately controlled only among one-third of patients in India. The control rate has improved during 2011-2020 compared to 2001-2010, but substantial differences exist across regions. Very few studies examined relevant socioeconomic factors relevant to hypertension control. India needs more studies at the community level to understand the health system and socioeconomic factors that determine uncontrolled hypertension in India.


title: Longitudinal associations between physical activity and other health behaviours during the COVID-19 pandemic: A fixed effects analysis

abstract:
BackgroundGovernment enforced restrictions on movement during the COVID-19 pandemic are likely to have had profound impacts on the daily behaviours of many individuals, including physical activity (PA). Given the pre-pandemic evidence for associations between PA and other health behaviours, changes in PA during the pandemic may have been detrimental for other health behaviours. This study aimed to evaluate whether changes in PA during and after the first national lockdown in the United Kingdom (UK) were associated with concurrent changes in other health behaviours, namely alcohol consumption, sleep, nutrition quality, diet quantity and sedentary time.

MethodsData were derived from the UCL COVID-19 Social Study. The analytical sample consisted of 52,784 adults followed weekly across 22 weeks of the pandemic from 23rd March to 23rd August 2020. Data were analysed using fixed effects regression.

ResultsThere was significant within-individual variation in both PA and other health behaviours throughout the study period. Increased PA was positively associated with improved sleep and nutrition quality. However, increases in PA also showed modest associations with increased alcohol consumption and sedentary time.

ConclusionOur findings indicate that, whilst the first wave of COVID-19 restrictions were in place, increases in PA were associated with improved sleep and better diet. Encouraging people to engage in PA may therefore lead to positive change in other health behaviours in times of adversity. However, increases in PA were also associated with more engagement in the negative health behaviours of alcohol consumption and sedentary time. These associations could be a result of increases in available leisure time for many people during COVID-19 restrictions and require further investigation to inform future public health guidance.


title: Genetic and environmental factors underlying parallel changes in body mass index and alcohol consumption: a 36-year longitudinal study of adult twins

abstract:
BackgroundThe genetic and environmental underpinnings of simultaneous changes in weight and alcohol consumption are poorly known.

ObjectiveWe sought to quantify the environmental and genetic components underlying parallel changes in weight and alcohol consumption, and to investigate potential covariations between them.

MethodsThe analysis comprised 4461 adult participants (58% women) from the Finnish Twin Cohort. Four measures of alcohol consumption and body mass index (BMI) were available over a 36-year follow-up. Trajectories of each trait were described by growth factors, defined as intercepts (i.e., baseline) and slopes (i.e., change over follow-up), using Latent Growth Curve Modeling. Growth values were used for male (190 MZ pairs, 293 DZ pairs) and female (316 MZ pairs, 487 DZ pairs) same-sex complete twin pairs in multivariate twin modeling. The variance and covariance of growth factors were then decomposed into genetic and environmental components.

ResultsThe baseline heritabilities were similar in men (BMI: h2=79%; alcohol consumption: h2=49%) and women (h2=77%; h2=45%). Heritabilities of BMI change were similar in men (h2=52%) and women (h2=57%), but higher in men for change in alcohol consumption (h2=45%) than in women (h2=31%). Significant genetic correlations between BMI at baseline and change in alcohol consumption were observed in both men (r =-0.17(95% Confidence Interval: -0.29,-0.04)) and women (r=-0.18(-0.31,-0.06)). The genetic components of baseline and longitudinal change were correlated for both BMI and alcohol consumption with sex differences. Non-shared environmental factors affecting changes in alcohol consumption and BMI were correlated in men (r=0.18(0.06,0.30)). Among women, non-shared environmental factors affecting baseline alcohol consumption and the change in BMI were correlated (r=-0.11(-0.20,-0.01)).

ConclusionsWe provide evidence of genetic correlations between BMI and change in alcohol consumption. Independent of genetic effects, change in BMI and change in alcohol consumption covary.


title: Characterisation of ethnic differences in DNA methylation between UK resident South Asians and Europeans

abstract:
Ethnic differences in non-communicable disease risk have been described between individuals of South Asian and European ethnicity that are only partially explained by genetics and other known risk factors. DNA methylation is one underexplored mechanism that may explain differences in disease risk. Currently there is little knowledge of how DNA methylation varies between South Asian and European ethnicities.

This study characterised differences in blood DNA methylation between individuals of self-reported European and South Asian ethnicity from two UK-based cohorts; Southall and Brent Revisited (SABRE) and Born in Bradford (BiB). DNA methylation differences between ethnicities were widespread throughout the genome (n=16,433 CpG sites, 3.4% sites tested). Specifically, 76% of associations were attributable to ethnic differences in cell composition with fewer effects attributable to smoking and genetic variation. Ethnicity associated CpG sites were enriched for EWAS Catalog phenotypes including metabolites. This work highlights the need to consider ethnic diversity in epigenetic research.


title: Comorbidity clusters associated with newly treated Type 2 diabetes mellitus: a Bayesian nonparametric analysis

abstract:
BackgroundType 2 Diabetes Mellitus (T2DM) is associated with the development of chronic comorbidities over time, which can lead to high drug utilization and adverse events. Understanding the patterns of disease progression is needed.

ObjectivesTo identify common comorbidity clusters and explore the progression over time in newly treated T2DM patients.

MethodsThe IQVIA Medical Research Data incorporating data from THIN, a Cegedim database of anonymized electronic health records, was used to identify all patients with a first-ever prescription for a non-insulin antidiabetic drug (NIAD) between January 2006 and December 2019. We selected 58 chronic comorbidities of interest and used Bayesian nonparametric latent models (BNLM) to identify disease clusters and model their progression over time.

ResultsAmong the 175,383 eligible T2DM patients, we identified the 20 most frequent comorbidity clusters, which were comprised of 14 latent features (LFs). Each LF was associated with a main disease (e.g., 98% of patients in cluster 2, characterized by LF2, had congestive heart failure [CHF]). The presence of certain LFs increased the probability of having another LF active. For example, LF2 (CHF) frequently appeared with LFs related to chronic kidney disease (CKD). Over time, the clusters associated with cardiovascular diseases, such as CHF, progressed rapidly. Moreover, the onset of certain diseases led to the appearance of further complications (e.g., CHF onset was associated with an increasing prevalence of CKD).

ConclusionsOur models identified established T2DM complications and previously unknown connections, thus, highlighting the potential for BNLMs t to characterize complex comorbidity patterns.


title: Implications of red state/blue state differences in COVID-19 death rates

abstract: The study objective was to explore state death rates pre- and post- 4/19/2021 (date vaccines were assumed available) and the relative contributions of 3 factors to state death rates post- 4/19/2021: 1) vaccination rates, 2) prevalence of obesity, hypertension, diabetes, COPD, cardiovascular disease, and asthma and 3) red vs. blue states, to better understand options for reducing deaths. The ratio of red to blue state deaths/million was 1.6 pre-4/19/2021 and 2.3 between 4/19 and 2/28/2022 resulting in >222,000 extra deaths in red states or 305/ day. Adjusted betas from linear regression showed state vaccination rates had the strongest effect on death rates while red vs. blue states explained more of the difference in state death rates (60% vs. 46% for vaccination rates) with mean vaccination rates ~10% higher in blue states. Results suggest that increasing vaccination rates in red states could potentially save thousands of lives as the pandemic continues.


title: Age-based variability in the association between restraint use and injury type and severity

abstract:
PurposePrevious studies have shown elderly individuals receive less relatively less protection from seat belts against fatal injuries, however it is less clear how seat belt protection against severe and torso injury changes with age. We estimated age-based variability in seat belt protection against fatal injuries, injuries with maximum abbreviated injury scale greater than 2 (MAIS3+), and torso injuries.

MethodsWe leveraged the Crash Outcome Data Evaluation System (CODES) to analyze binary indicators of fatal, MAIS3+, and torso injuries. Using a matched cohort design and conditional Poisson regression, we estimated age-based relative risks (RR) of the outcomes associated with seat belt use.

ResultsSeat belts were highly protective against fatal injuries for all ages. For ages 16-30, seat belt use was associated with 66% lower risk of MAIS3+ injury (RR 0.34, 95% CI 0.30, 0.38), whereas for ages 75 and older, seat belt use was associated with 38% lower risk of MAIS3+ injury (RR 0.62; 95% CI 0.45, 0.86). The association between restraint use and torso injury also appeared to attenuate with age.

ConclusionsSeat belt protection against MAIS3+ and torso injury attenuated with age. We encourage that injury prevention continues to be tailored to vulnerable populations like the elderly.


title: Effectiveness of 2 and 3 mRNA COVID-19 Vaccines Doses against Omicron and Delta-Related Outpatient Illness among Adults, October 2021 - February 2022

abstract:
BackgroundWe estimated SARS-CoV-2 Delta and Omicron-specific effectiveness of 2 and 3 mRNA COVID-19 vaccine doses in adults against symptomatic illness in US outpatient settings.

MethodsBetween October 1, 2021, and February 12, 2022, research staff consented and enrolled eligible participants who had fever, cough, or loss of taste or smell and sought outpatient medical care or clinical SARS-CoV-2 testing within 10 days of illness onset. Using the test-negative design, we compared the odds of receiving 2 or 3 mRNA COVID-19 vaccine doses among SARS-CoV-2 cases versus controls using logistic regression. Regression models were adjusted for study site, age, onset week, and prior SARS-CoV-2 infection. Vaccine effectiveness (VE) was calculated as (1 - adjusted odds ratio) x 100%.

ResultsAmong 3847 participants included for analysis, 574 (32%) of 1775 tested positive for SARS-CoV-2 during the Delta predominant period and 1006 (56%) of 1794 participants tested positive during the Omicron predominant period. When Delta predominated, VE against symptomatic illness in outpatient settings was 63% (95% CI: 51% to 72%) among mRNA 2-dose recipients and 96% (95% CI: 93% to 98%) for 3-dose recipients. When Omicron predominated, VE was 21% (95% CI: -6% to 41%) among 2-dose recipients and 62% (95% CI: 48% to 72%) among 3-dose recipients.

ConclusionsIn this adult population, 3 mRNA COVID-19 vaccine doses provided substantial protection against symptomatic illness in outpatient settings when the Omicron variant became the predominant cause of COVID-19 in the U.S. These findings support the recommendation for a 3rd mRNA COVID-19 vaccine dose.


title: Functional response to a microbial synbiotic in the gastrointestinal system of constipated children

abstract:
BackgroundOral microbial therapy has been studied as an intervention for a range of gastrointestinal and immunological disorders. Though emerging research suggests microbial exposure may intimately affect the gastrointestinal system, motility, and host immunity in a pediatric population, data has been inconsistent and variable, with the majority of prior studies conducted in neither a randomized nor placebo-controlled setting. The aim of this placebo-controlled study was to evaluate efficacy of a synbiotic (a prebiotic and rationally-defined microbial consortia) on increasing weekly bowel movement frequency in constipated children.

MethodsSixty-four children (3-17 years of age) were randomized to receive a synbiotic composition (n=33) comprised of mixed-chain length, prebiotic oligosaccharides and nine microbial strains or placebo (n=31) for 84 days. Stool microbiota was analyzed using shotgun metagenomic sequencing on samples collected at baseline (T1) and completion (T2). The primary outcome was change from baseline of Weekly Bowel Movements (WBMs) in children compared to placebo.

ResultsTreatment with a multi-strain synbiotic significantly (p < 0.05) increased the number of WBMs in children with low bowel movement frequency (< 4 WBMs and < 5 WBMs), irrespective of broadly distinctive microbiome signatures at baseline. Metagenomic shotgun sequencing revealed that low baseline microbial richness in the treatment group significantly anticipated improvements in constipation (p = 0.00074).

ConclusionsThese findings suggest the potential for (i) multi-species synbiotic interventions to improve digestive health in a pediatric population and (ii) bioinformatics-based methods to predict response to microbial interventions in children.

ImpactSynbiotic microbial treatment exerted functional improvements in the number of spontaneous Weekly Bowel Movements in children compared to placebo

Intervention induced a significant bifidogenic effect in children compared to placebo

All administered probiotic species were enriched in the gut microbiome of the intervention group compared to placebo

Baseline microbial richness demonstrated potential as a predictive biomarker for response to intervention

category: gastroenterology


title: Self-Reported Mask Use in SARS-CoV-2 Vaccinated and Unvaccinated Populations

abstract:
Wearing a facemask can help to decrease the transmission of COVID-19. We investigated self-reported mask use among subjects aged 18 years and older participating in the COVID-19 Community Research Partnership (CRP), a prospective longitudinal COVIS-19 surveillance study. We included those participants who completed [≥]5 daily surveys each month from December 1, 2020 through August 31, 2021. Mask use was defined as self-reported use of a face mask or face covering on every interaction with others outside the household within a distance of less than 6 feet. Participants were considered vaccinated if they reported receiving [≥]1 COVID-19 vaccine dose. Participants (n=17,522) were 91% non-Hispanic White, 68% female, median age 57 years, 26% healthcare workers, with 95% self-reported receiving [≥]1 COVID-19 vaccine dose through August; mean daily survey response was 85%. Mask use was higher among vaccinated than unvaccinated participants across the study period, regardless of the month of the first dose. Mask use remained relatively stable from December 2020 through April (range 71-80% unvaccinated; 86-93% vaccinated) and declined in both groups beginning in mid-May 2021 to 34% and 42% respectively in June 2021; mask use has increased again since July 2021. Mask use by all was lower during weekends and on Christmas and Easter, regardless of vaccination status. Independent predictors of higher mask use were vaccination, age [≥]65 years, female sex, racial or ethnic minority group, and healthcare worker occupation, whereas a history of self-reported prior COVID-19 illness was associated with lower use.

Trial RegistrationThe COVID-19 Community Research Partnership is listed in clinicaltrials.gov (NCT04342884).


title: SARS-CoV-2 reinfections with BA.1 (Omicron) variant among fully vaccinated individuals in the northeast of Brazil

abstract:
BackgroundThe first case of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Rio Grande do Norte, northeast Brazil, was diagnosed on March 12, 2020; thereafter, the pattern of COVID-19 followed the multiple waves as seen elsewhere. Those waves were mostly due to the SARS-CoV-2 virus mutations leading to emergence of variants of concern (VoC). The introduction of new VoCs in a population context of prior SARS-CoV-2 infections or after vaccination has been a challenge in understanding the kinetics of the protective immune response against SARS-CoV-2. The aim of this study was to investigate the outbreak of SARS-CoV-2 reinfections observed in mid-January 2022 in Rio Grande do Norte state, Brazil when the omicron variant was introduced.

Methodology/Principal findingsFrom a total of 172,965 individuals with mild to severe respiratory symptoms, 58,097 tested positive for SARS-CoV-2 between March 2020 through mid-February 2022. Of those previously infected, 444 had documented a second SARS-CoV-2 infection and 9 of these reinfection cases were selected for sequencing. Genomic analysis revealed that virus lineages diverged between primary and the reinfection, with the latter caused by the Omicron (BA.1) variant among individuals fully vaccinated against SARS-CoV-2.

Conclusions/SignificanceOnce all subjects whose samples were sequenced had prior SARS-CoV-2 infection and were also fully vaccinated, our data suggest that the Omicron variant evades natural and vaccine-induced immunities, confirming the continuous need to decrease transmission and to develop effective blocking vaccines.

Author summaryThe pattern of the COVID-19 pandemic has been characterized by multiple waves of cases with a variety of outcomes from asymptomatic, to moderate or to severe fatal cases. By December 2021, about 75.3% of Rio Grande do Norte population, northeast Brazil, had already been fully vaccinated against SARS-CoV-2 and a decrease in newer detection cases was seen to about 8% of the suspected ones. Nevertheless, with the introduction of the Omicron variant at the end of 2021, the number of new SARS-CoV-2 infections reached its highest peak since the start of the pandemic with 75% of the suspected cases testing positive. From March 2020 to February 2022, we confirmed 444 reinfection cases among the ones tested, of which 62.3% (n=277) occurred during the Omicron outbreak, from December 2021 to early February 2022. Of the reinfection cases, 9 were sequenced and genetic analysis showed that they belong to a BA.1 lineage, which seems to have been introduced multiple times into the region. The primary isolates varied. Thus, our data suggest that the Omicron variant evades immunity provided from either natural infection from any other SARS-CoV-2 variants or from different types of vaccines.


title: A systematic review of Hepatitis B virus (HBV) prevalence and genotypes in Kenya: Data to inform clinical care and health policy

abstract: More than 20% of the global disease burden from chronic hepatitis B infection (CHB) is in Africa, however there is minimal high quality seroprevalence data from individual countries and little viral sequencing data available to represent the continent. We undertook a systematic review of the prevalence and genetic data available for hepatitis B virus (HBV) in Kenya using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 checklist. We identified 23 studies reporting HBV prevalence and 25 studies that included HBV genetic data published in English between January 2000 and December 2021. We assessed study quality using the Joanna Briggs Institute critical appraisal checklist. Due to study heterogeneity, we divided the studies to represent low, moderate, high and very high-risk for HBV infection. We calculated pooled HBV prevalence within each group and evaluated available sequencing data. We also assessed whether reported HBV biomarkers could be applied to determine treatment eligibility. Eight studies were identified in the low-risk group, seven in the moderate risk group, five in the high-risk group and three in the very high-risk group for HBV infection. Pooled HBV prevalence was 3.31% (95% CI 2.62-4.01%), 5.58% (95% CI 3.46-7.7%), 6.17% (95% CI 4.4-9.94) and 31.39% (95% CI 9.5-53.09) respectively. Study quality was overall low, representing a small geographical location or a limited population subset. Only three studies detailed sample size calculation and 17/23 studies were cross sectional. Eight studies included genetic information on HBV, representing 247 individuals. Six studies sequenced one or two genes; two undertook whole genome sequencing, representing 22 participants. 92% people were infected with genotype A. Other genotypes included genotype D (6%), D/E recombinants (1%) or mixed populations (1%). Drug resistance mutations were reported by two studies. Seven studies presented additional biomarkers alongside HBsAg, however none provided sufficient information to deduce treatment eligibility.


title: Second round of the interlaboratory comparison (ILC) exercise of SARS-CoV-2 molecular detection assays being used by 45 veterinary diagnostic laboratories in the US

abstract: The coronavirus disease 2019 (COVID-19) pandemic presents a continued public health challenge across the world. Veterinary diagnostic laboratories in the U.S. use real-time reverse transcriptase PCR (RT-PCR) for animal testing, and many are certified for testing human samples, so ensuring laboratories have sensitive and specific SARS-CoV-2 testing methods is a critical component of the pandemic response. In 2020, the FDA Veterinary Laboratory Investigation and Response Network (Vet-LIRN) led the first round of an Inter-Laboratory Comparison (ILC) Exercise to help laboratories evaluate their existing real-time RT-PCR methods for detecting SARS-CoV-2. The ILC1 results indicated that all participating laboratories were able to detect the viral RNA spiked in buffer and PrimeStore molecular transport medium (MTM). The current ILC (ILC2) aimed to extend ILC1 by evaluating analytical sensitivity and specificity of the methods used by participating laboratories to detect three SARS-CoV-2 variants (B.1, B.1.1.7 (Alpha) and B.1.351 (Beta)). ILC2 samples were prepared with RNA at levels between 10 to 10,000 copies per 50 L MTM. Fifty-seven sets of results from 45 laboratories were qualitatively and quantitatively analyzed according to the principles of ISO 16140-2:2016. The results showed that over 95% of analysts detected the SARS-CoV-2 RNA in MTM at 500 copies or higher for all three variants. In addition, 81% and 92% of the analysts achieved a Level of Detection (LOD95eff. vol.) below 20 copies in the assays with nucleocapsid markers N1 and N2, respectively. The analytical specificity of the evaluated methods was over 99%. The study allowed participating laboratories to assess their current method performance, identify possible limitations, and recognize method strengths as part of a continuous learning environment to support the critical need for reliable diagnosis of COVID-19 in potentially infected animals and humans.


title: A prospective observational study on BBV152 coronavirus vaccine use in adolescents and comparison with adults- first real-world safety analysis

abstract:
BackgroundThe BBV152 COVID-19 vaccine (COVAXIN) has recently been approved for adolescents. We provide the first real world safety data of COVAXIN use in adolescents and compare this with adults.

MethodsA prospective observational study is being conducted since January 2022. Enrolled adolescents and adults were contacted telephonically after 14 days of receiving the BBV152 vaccine. Primary outcome was vaccine safety assessed as rates of adverse events following immunization (AEFI). Severity grading of AEFIs was done using the FDA scale.

FindingsA total of 698 adolescents and 326 adults were enrolled. AEFIs occurred in 36.3% adolescents after first and in 37.9% after second dose. Systemic involvement was seen in 15-17% adolescents. Injection site pain and fever were the common AEFIs. Majority of AEFIs were mild-moderate. Severe and atypical AEFIs were observed in 0.9% and 0.6% adolescents respectively. Majority of AEFIs recovered in 1-2 days. In >2% adolescents, AEFIs were persisting at 14-day follow-up since the second dose. No difference in AEFI incidence and patterns was observed between adolescents and adults. Regression analysis showed females and those with history of allergy to be respectively at 1.5-times and 3-times increased risk of AEFIs among adolescents.

InterpretationCOVAXIN carries an overall favorable short term safety profile in adolescents. The observed AEFI rates in adolescents are much lower than that reported with mRNA vaccines. Female adolescents and those with history of allergy need watchfulness. With some AEFIs persisting at 14 days, a longer follow-up is recommended to strengthen the safety data of these vaccines.

FundingNo funding support


title: Omicron BA.1 and BA.2 immune response in naive and prior infected persons

abstract: The highly transmissible SARS-CoV-2 Omicron (B.1.1.529) variant has replaced previous variants and is less susceptible to neutralizing antibodies elicited by vaccination or infection1-3. Currently, BA.2 is the dominant omicron sublineage4. Vaccinated individuals with BA.1 infection develop measurable neutralizing antibody titers against BA.1 and BA.25. The ability of BA.2 infection to induce neutralizing antibodies in unvaccinated individuals, either without or with previous SARS-CoV-2 infection, is pending definition.


title: Specific Associations Between Type of Childhood Abuse and Elevated C-Reactive Protein in Young Adult Psychiatric Rehabilitation Participants

abstract:
BackgroundEarly life adversity such as childhood emotional, physical, and sexual trauma is associated with a plethora of later-life psychiatric and chronic medical conditions, including elevated inflammatory markers. Although previous research suggests a role for chronic inflammatory dysfunctions in several disease etiologies, specific associations between childhood trauma types and later life inflammation and health status are not well understood.

MethodsWe studied patients (n=280) who were admitted to a psychiatric rehabilitation center. Self-reported histories of childhood emotional, physical, and sexual trauma history were collected. At the time of admission, we also assessed individuals body mass index (BMI) and collected blood samples that were used to examine levels of inflammatory marker C-reactive protein (CRP).

ResultsThe prevalence of all three types of abuse were quite high, at 21% or more. 50% of the sample had elevations in CRP, with clinically significant elevations in 26%. We found that compared to a history of emotional or physical abuse, a history of childhood sexual trauma was more specifically associated with elevated CRP. This result held up when controlling for BMI.

LimitationOur sample is relatively young, with an average age of 27.2 years, with minimal representation of ethnic and racial minority participants.

ConclusionRelative to childhood emotional and physical trauma, childhood sexual trauma may lead to elevated inflammatory responses, which were common overall in the sample. Future studies need to assess the causal link between childhood sexual trauma and poorer health outcomes later in life.

HIGHLIGHTSO_LI- The prevalence of both childhood abuse experiences and elevations in inflammatory markers were quite high.
C_LIO_LI- We found that the history and severity of childhood sexual abuse were differentially correlated with later life inflammatory status and body mass index, with childhood emotional and physical abuse not showing the same degree of correlation with inflammatory status later in early adulthood.
C_LIO_LI- These results demonstrate how specific elements of environmental adversity, which, when suffered at a critical developmental period, can have lingering negative physiological consequences later in life.
C_LI

category: psychiatry and clinical psychology


title: Social Support during pregnancy: A phenomenological exploration of young womens experiences of support networks on pregnancy care and wellbeing in Soweto, South Africa.

abstract:
Social support is deemed to have a crucial influence on maternal health and wellbeing during pregnancy. The objective of the study was to explore the experiences of pregnant young females and their receipt of social support in Soweto, South Africa. An interpretive phenomenological approach was employed to understand and interpret pregnant young womens lived experiences of support networks on their pregnancy care and wellbeing. Data was collected conducting 18 indepth interviews with young pregnant women. Analysis of the data resulted in the development of two superordinate themes: (1) relationships during pregnancy and (2) network involvement. Each superordinate theme was linked to subthemes that helped explain whether young women had positive or negative experiences of social support during their pregnancy care, and their wellbeing. The sub-themes emanating from the superordinate theme  relationships during pregnancy were (a) behavioural response of partner following disclosure of pregnancy, (b) behavioural response of family following disclosure of pregnancy, and (c) sense of emotional security. Accompanying subthemes of the superordinate theme  network involvement were (a) emotional and instrumental support, and (b) information support. An interpretation of the young womens experiences has revealed that young womens satisfaction with existing support networks and involvement of the various social networks contributed greatly to the participants having a greater sense of potential parental efficacy and increased acceptance of their pregnancies. Pregnant women who receive sufficient social support from immediate networks have increased potential to embrace and give attention to pregnancy-related changes. This could, in turn, foster positive behavioural outcomes that encourage engaging in good pregnancy care practices and acceptance of motherhood.

Focusing on previously unexamined factors that could improve maternal health, such as social support, could improve maternal mortality rates and help achieve reproductive health accessibility universally.


title: The effect of the COVID-19 lockdown on mental health care use in South Africa: an interrupted time series analysis

abstract:
AimsIn March 2020, South Africa introduced a lockdown in response to the COVID-19 pandemic, entailing the suspension of all non-essential activities and a complete ban of tobacco and alcohol sales. We studied the effect of the lockdown on mental health care utilisation rates in private-sector care in South Africa.

MethodsWe did an interrupted time series analysis using insurance claims from January 1, 2017, to June 1, 2020 of beneficiaries 18 years or older from a large private sector medical aid scheme. We calculated weekly outpatient consultation and hospital admission rates for organic mental disorders, substance use disorders, serious mental disorders, depression, anxiety, other mental disorders, any mental disorder, and alcohol withdrawal syndrome. We calculated adjusted odds ratios (OR) for the effect of the lockdown on weekly outpatient consultation and hospital admission rates and the weekly change in rates during the lockdown until June 1, 2020.

Results710,367 persons were followed up for a median of 153 weeks. Hospital admission rates (OR 0.38; 95% CI 0.33-0.44) and outpatient consultation rates (OR 0.74; 95% CI 0.63-0.87) for any mental disorder decreased substantially after the lockdown and did not recover to pre-lockdown levels until June 1, 2020. Health care utilisation rates for alcohol withdrawal syndrome doubled after the introduction of the lockdown, but the statistical uncertainty around the estimates was large (OR 2.24; 95% CI 0.69-7.24).

ConclusionsReduced mental health care contact rates during the COVID-19 lockdown likely reflect a substantial unmet need for mental health services with potential long-term consequences for mental health patients and their families. Steps to ensure access and continuity of mental health services during future lockdowns should be considered.


title: Antibiotic courses for acute otitis media alter human gut microbiome resistome and colonization resistance against antimicrobial resistant species in children

abstract: Antimicrobial resistance (AMR) is a major global public health problem. Human gut microbiome plays an important role in modulating AMR. On one hand, the microbiome itself can serve as a reservoir of AMR genes, i.e. resistome. On the other hand, the microbiome performs colonization resistance, preventing invasive microbes from colonizing the gastrointestinal tract. In this study, we investigated how antibiotic treatment affects the resistome and colonization resistance of the gut microbiome in children receiving amoxicillin, amoxicillin-clavulanate, or no treatment for acute otitis media in a randomized clinical trial. Fecal samples from children receiving an antibiotic or no treatment before and after the treatment were analyzed using deep metagenomic sequencing. We used a flow cytometry-based approach to quantify the bacterial load in the fecal samples. Both metagenomic sequencing-based relative abundance and flow cytometry-based absolute abundance of the microbial species were analyzed. We found that the resistome fluctuated over time and in a small fraction ([~]10%) of subjects, AMR genes increased rapidly due to colonization by AMR species, even in the control group without any antibiotic treatment. Amoxicillin significantly increased the risk for invasive species, especially pathogenic species carrying AMR genes, to colonize the gut. We also found that children lacking Blautia, Ruminococcus, Faecalibacterium, Roseburia, or Faecalitalea were more vulnerable to colonization by invasive AMR species in their gut microbiome.

category: infectious diseases


title: Evaluation and risk communication of effects of alcohol exposure on disposable procedure masks and portable air purifiers

abstract: As electret technology can drastically improve the filtration efficiency of disposable procedure masks and portable air purifiers, it is widely used to prevent the airborne transmission of SARS-CoV-2. Furthermore, alcohol disinfectants are now widely used in offices, hospitals, and homes to prevent contact infection; hence, there is a concern that alcohol exposure may inactivate electret. In this study, 5 types of high-efficiency particulate air filter (HEPA) air purifiers--of which, one was made of fiberglass HEPA filter--14 types of cubical masks, and 11 types of pleated masks available to Japanese citizens were subjected to discharge according to the alcohol exposure protocol based on ISO (International Organization for Standardization) 16890, and changes in filtration efficiency and pressure drop were measured before and after the discharge. The results revealed that 17 (68%) of the 25 masks exhibited a significant decrease in filtration efficiency; this decrease due to discharge depended on the filter material. However, masks of polypropylene, polyethylene, and poly-vinylidene-difluoride composite fiber materials exhibited no significant decrease in filtration efficiency. In addition, 4 (80%) of the 5 HEPA filters showed a 40-64% decrease in filtration efficiency, while no decrease in filtration efficiency was observed for the fiberglass HEPA filter. Our survey (n = 500 Japanese adults, including 30 healthcare professionals) revealed that approximately 90% of the general public was unaware that the performance of masks and air purifiers could be degraded by direct spraying of alcohol--for disinfection purposes--or vapor exposure. Furthermore, 36% of the surveyed healthcare professionals indicated that they had sprayed alcohol directly on their masks. Therefore, based on the results of this experiment, we examined effective consumer warnings that could be utilized on the product labels and in the instructions. The results showed that it would be more effective to detail the extent and duration of the adverse effects of disregarding the precautions.

category: occupational and environmental health