title: Assessment of Post SARS CoV 2 Fatigue among Physicians Working in COVID Designated Hospitals in Dhaka, Bangladesh

abstract:
BackgroundFatigue has been observed after a number of infectious disease outbreaks around the world. After the outbreak of SARS CoV-2 in Wuhan, China in 2019, the disease turned into a pandemic very rapidly. Mental health is a key issue associated with such outbreaks. To explore the fatigue level among physicians working in designated public and private hospitals in Bangladesh, we conducted a matched case-control study of post-SARS-CoV-2 fatigue.

MethodIn this study 105 physicians who were diagnosed as COVID-19 infected, got treatment, and declared cured at least 6 weeks before the interview date, were recruited as cases and the same number of age and designation matched healthy physicians as control who are working in the same hospital. Case and control were selected in 1:1 ratio from each of the hospitals. The study population was selected by inclusion and exclusion criteria after taking informed written consent. Data collection was done by a semi-structured questionnaire. Diagnosis of COVID--19 infection was done by detection of SARS CoV-2 antigen by RT-PCR from reference laboratories in Bangladesh or by HRCT Chest.

ResultAround two-thirds of the physicians were male (67.6% versus 32.4%). Most of them aged less than forty years (80.5%). The cases had a greater number of comorbid conditions than those who were negative. The FSS score (mean) was much higher for cases (36.7 {+/-} 5.3 versus 19.3 {+/-} 3.8) than the control group with a statistically significant difference with no significant gender differentiation. Similarly, around 67.7% of the previously COVID positive physicians represented in the highest FSS score tertile compared to the respondents in the control group had a mean score of less than 3. The difference was also highly significant.

ConclusionPhysicians, who had a previous history of COVID-19 infection had a higher total and mean FSS score, signifying a more severe level of fatigue than the physicians who had never been COVID-19 positive while working in the same hospital irrespective of their age and sex.


title: Association between COVID-19, mobility and environment in Sao Paulo, Brazil

abstract: Brazil, the country most impacted by the coronavirus disease 2019 (COVID-19) on the southern hemisphere, use intensive care admissions per day, mobility and other indices to monitor quarantines and prevent the transmissions of SARS-CoV-2. In this study we quantified the associations between residential mobility index (RMI), air pollution, meteorology, and daily cases and deaths of COVID-19 in Sao Paulo, Brazil. We applied a semiparametric generalized additive model (GAM) to estimate: 1) the association between RMI and COVID-19, accounting for ambient particulate matter (PM2.5), ozone (O3), relative humidity, temperature and delayed exposure between 3-21 days, and 2) the association between COVID-19 and exposure to for ambient particulate matter (PM2.5), ozone (O3), accounting for relative humidity, temperature and mobility. We found that an RMI of 45.28% results in 1,212 cases (95% CI: 1,189 to 1,235) and 44 deaths (95% CI: 40 to 47). Increasing the isolation from 45.28% to 50% would avoid 438 cases and 21 deaths. Also, we found that an increment of 10 g{middle dot}m-3 of PM2.5 results in a risk of 1.140 (95% CI: 1.021 to 1.274) for cases and 1.086 (95% CI: 1.008 to 1.170) for deaths, while O3 produces a relative risk of 1.075 (95% CI: 1.006 to 1.150) for cases and 1.063 (95% CI: 1.006 to 1.124) for deaths, respectively. We compared our results with observations and literature review, finding well agreement. Policymakers can use such mobility indices as tools to control social distance activities. Spatial distancing is an important factor to control COVID-19. Small increments of air pollution result in an increased number of COVID-19 cases and deaths.

category: public and global health


title: Protocol for rapid implementation of a SARS-CoV-2 sero-survey during the 2020 COVID-19 pandemic: who, where, how?

abstract: Introduction: The 2019 novel coronavirus disease (COVID-19) pandemic has had devastating consequences in the US, yet clinical research on its natural history and transmission outside hospitalized settings has faced tangible and intangible challenges due to uncertainty in testing, case ascertainment, and appropriate safety measures. To better understand temporal evolution of COVID-19 related serological and other immune responses during a pandemic, we designed and implemented a baseline cross-sectional study of asymptomatic community volunteers and first responders in metro-Atlanta before the predicted infection peak in 2020. Methods: We recruited healthy community volunteers and first responders for health history, serology, and biobanking. Through an iterative process, we identified one location on our campus and one community location which were accessible, vacant, distant from COVID-19 testing sites, open for social distancing, private for informed consent, and operational for sanitation and ventilation. Research and cleaning supplies were obtained from other researchers and private online vendors due to shortages, and faculty directly participated in consenting and phlebotomy. Results: A total of 369 participants completed the study visits over six full and three half days. Over half of Phase 1 (174/299, 58.2%) and Phase 2 (45/70, 64.3%) self-reported as healthcare workers, and there was a high percentage of participants reporting exposure to known COVID-19 cases (48.2% and 61.4%). Conclusions: Rigorous prospective clinical research with informed consents and is possible during a pandemic. Effective recruitment for moderately large sample size is facilitated by direct faculty involvement, connections with the community, and non-financial support from colleagues and the institution.


title: Electronic data management for vaccine trials in low resource settings: Upgrades, scalability and impact of ODK

abstract: Background ODK provides software and standards that are popular solutions for off-grid electronic data collection and has substantial code overlap and interoperability with a number of related software products including CommCare, Enketo, Ona, SurveyCTO and KoBoToolbox. In combination with the use of statistical analysis software such as R, these tools provide fully open-source options for off-grid use in public health data collection, management, analysis and reporting. During the 2018-2020 Ebola epidemic in the North Kivu & Ituri regions of Democratic Republic of Congo, we leveraged ODK and other tools to support the DRC Minist&egravere de la Sant&eacute RDC and World Health Organization in their efforts to administer an experimental vaccine (VSV-Zebov-GP) as part of their strategy to control the transmission of infection. Method New functions were developed to facilitate the use of ODK, Enketo and R in large scale data collection, aggregation, monitoring and near-real-time analysis during clinical research in health emergencies. We present open-source enhancements to ODK that include a built-in audit-trail, a framework and companion app for biometric registration of ISO/IEC 19794-2 fingerprint templates, enhanced performance features, better scalability for studies featuring millions of data form submissions, increased options for parallelization of research projects, and pipelines for automated management and analysis of data. We also developed novel encryption protocols for enhanced web-form security in Enketo. Results Against the backdrop of a complex and challenging epidemic response, our enhanced platform of open tools was used to collect and manage data from more than 280,000 eligible study participants who received VSV-Zebov-GP under informed consent. These data were used to determine whether the VSV-Zebov-GP was safe and effective and to guide daily field operations. Conclusions We present open-source developments that make electronic data management during clinical research and health emergencies more viable and robust. These developments will also enhance and expand the functionality of a diverse range of data collection platforms (Ona, KoBoToolbox etc.) that are based on the ODK software and standards. Funding This research is funded by the Department of Health and Social Care using UK Aid funding and is managed by the NIHR (PR-OD-1017-20001).


title: Population-Based Study of anti-SARS-CoV-2, Social Distancing and Government Responses in Joinville, Brazil

abstract: Background: The city of Joinville had been mildly affected by the COVID-19 pandemic until June 2020. This study aimed to longitudinally assess the prevalence of exposure to the virus and social distancing practices in the local population. Methods: A randomized selection of households stratified by region was created. From June 15 to August 7, 2020, a dweller was randomized in each household, answered a questionnaire, and performed a test for the detection of SARS-CoV-2 antibodies. The prevalence of positive tests was calculated for each week and adjusted for the test's sensitivity and specificity. Results: The adjusted proportion of positive results increased from 1.4% in the first week (margin of error [ME] 0% to 2.87%) to 13.38% in the eighth week (ME 10.22% to 16.54%). Among the 213 participants that tested positive, 55 (25.82%) were asymptomatic. Only 37 (17.37%) sought medical consultation for any symptom. Among the 77 (36.15%) that were leaving home to work or study, only 18 (23.38%) stopped due to any symptom. The proportion that referred going to bars, restaurants, or making non-essential shopping decreased from 20.56% in the first week to 8.61% during the peak of diagnoses. Conclusion: The low proportion of participants that sought medical consultation or stopped leaving home indicates strategies directed to isolate only those symptomatic reach a low proportion of infected patients.


title: Effect of Adapted Ergometer Setup and Rowing Speed on Lower Extremity Loading in People with and without Spinal Cord Injury

abstract:
IntroductionFunctional electrical stimulation assisted rowing (FES-rowing) on an adapted ergometer is used in spinal cord injury (SCI) rehabilitation. A primary goal is to mechanically load the lower extremity to prevent disuse osteoporosis. Recent studies reported the small foot reaction force in FES-rowing was not sufficient to prevent bone loss.

ObjectiveThis study aims to investigate the effect of ergometer setup and rowing speed on lower extremity loading in able-bodied and SCI individuals.

DesignTwenty able-bodied novice rowers and one experienced SCI rower rowed on an adapted ergometer with different speeds and setups. Motion capture system and force sensors were used to calculate forces and moments at the knee.

Main Outcome MeasuresFoot reaction force and knee moment for all participants, and tibiofemoral force of the SCI rower.

ResultsPeak foot reaction forces of able-bodied rowers ranged from 0.28 - 0.45 body weights (BW), which was less than half the force in normal rowing. A fast rowing speed, forward seat position, and large knee RoM were associated with higher foot force and knee moment during able-bodied rowing. The SCI subject had the greatest foot reaction force (0.40 BW) when rowing with small knee RoM at a rear seat position and the highest tibiofemoral force (2.23 BW) with large knee RoM at a rear seat position.

ConclusionErgometer setup and speed can double the force generation at the foot during both able-bodied rowing and FES-rowing. Rowing forms (range of motion and speed) that resulted in the greatest foot reaction force were different for able-bodied rowers and SCI rowers, indicating a trade-off between motion and force generation in FES-rowing that warrants further investigation with more SCI rowers. Clinicians and physical therapist should be aware that ergometer setups can be easily adjusted to modify rowing forms and loading patterns of users with SCI.

category: rehabilitation medicine and physical therapy


title: Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child anemia and micronutrient status: an individual participant data meta-analysis of randomized controlled trials

abstract:
BackgroundSmall-quantity lipid-based nutrient supplements (SQ-LNS) have been shown to reduce the prevalence of anemia and iron deficiency among infants and young children, but effects on other micronutrients are less well known. Identifying subgroups who may experience greater benefits from SQ-LNS, or who are more likely to respond to the intervention, may facilitate the development of public health policies and programs.

ObjectiveOur objective was to identify study-level and individual-level modifiers of the effect of SQ-LNS on child hematological and micronutrient status outcomes.

MethodsWe conducted a two-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNS provided to children 6 to 24 months of age in low- and middle-income countries (n = 15,946). Outcomes were hemoglobin (Hb), inflammation-adjusted plasma ferritin, soluble transferrin receptor, zinc, retinol and retinol binding protein (RBP), and erythrocyte zinc protoporphyrin, and respective dichotomous outcomes indicative of anemia and micronutrient deficiency. We generated study-specific estimates of SQ-LNS vs. control, including main effects and subgroup estimates for individual-level effect modifiers, and pooled the estimates using fixed-effects models. We used random effects meta-regression to examine potential study-level effect modifiers.

ResultsProvision of SQ-LNS decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin < 12 {micro}g/L) by 56% and iron deficiency anemia (IDA; Hb < 110 g/L and plasma ferritin < 12 {micro}g/L) by 64%. We observed positive effects of SQ-LNS on hematological and iron status outcomes within all subgroups of the study-level and individual-level effect modifiers, but effects were larger in certain subgroups. For example, effects of SQ-LNS on anemia and iron status were greater in trials that provided SQ-LNS for > 12 months and provided 9 mg/d vs. < 9 mg iron/d, and among later-born (vs. first-born) children. There was no effect of SQ-LNS on plasma zinc or retinol, but there was a 7% increase in plasma RBP and a 56% reduction in vitamin A deficiency (RBP < 0.70 {micro}mol/L), with little evidence of effect modification by individual-level characteristics.

ConclusionsSQ-LNS provided to infants and young children 6-24 months of age can substantially reduce the prevalence of anemia, iron deficiency, and IDA across a range of individual, population and study design characteristics. Policy-makers and program planners should consider SQ-LNS within intervention packages to prevent anemia and iron deficiency. This study was registered at www.crd.york.ac.uk/PROSPERO as CRD42020156663.

category: nutrition


title: Large-scale silane bead-based SARS-CoV-2 testing of a nursing home in Spain identifies a viral reservoir during lockdown period

abstract: Background: Spain is one of the countries most heavily affected by the COVID-19 pandemic. As in other countries such as UK and USA, nursing homes have been an important human reservoir for the virus and the population with the highest mortality worldwide. The presence of asymptomatic carriers within nursing homes is one of the factors that could provoke new outbreaks during the relaxing of lockdown measures. Methods: We developed a high-throughput protocol for RNA extraction of patient samples based on silane magnetic beads in multi-well plates. The sensitivity, specificity and reproducibility rates were assessed using positive and negative clinical samples from the Clinica Universidad de Navarra, Spain. We utilized the protocol to test a pilot cohort of 138 residents and 87 staff from a nursing home in Northern Navarre, Spain. Findings: Our protocol showed high sensitivity (100%), specificity (96.0%) and linear correlation with PCR cycle threshold values obtained with a standard testing kit (R2 = 0.807, p=3E-05). Testing of 225 individuals from the nursing home revealed 63 residents (46%) and 14 staff (16%) positive for SARS-CoV-2. Only 18 of the positive residents (28.6%) were symptomatic at time of testing. During follow-up, six PCR-negative symptomatic residents were retested and resulted positive. One-month mortality among positive residents was higher than in negative residents (15.9% vs 1.3%), regardless of age or comorbidities. Interpretation: Rapid silane bead-based RNA extraction expanded the testing capabilities and COVID-19 patients were promptly identified. Personal and public health measures were enacted to avoid spreading and tighten clinical surveillance. The ability to easily adapt the technical capabilities of academic research centers to large-scale testing for SARS-CoV-2 could provide an invaluable tool for ensuring a safe lifting of lockdown in countries with high numbers of cases.

category: infectious diseases


title: Whole-genome sequencing of SARS-CoV-2 in the Republic of Ireland during waves 1 and 2 of the pandemic

abstract: Abstract: Background: Whole-genome sequencing (WGS) of SARS-CoV-2 laboratory-confirmed cases can provide insights into viral transmission and genetic diversity at a population level. However, less is known about the impact of non-pharmaceutical interventions (NPIs), including lockdowns, on circulating SARS-CoV-2 lineages and variants of concern, the relative contribution of travel to re-emergence of pandemic waves within communities or how different lineages and variants contribute to disease severity. Methods: We have conducted an analysis within a prospective, multicentre observational study of individuals attending four hospitals in the South-East of Ireland with COVID-19. Samples underwent WGS from which lineages and variants were assigned, lineage frequency was plotted over time and phylogenetic analysis was employed to determine the origin of variants detected post-lockdown. Univariate and multivariate analyses assessed relationships between viral lineage/variant and COVID-19 disease severity. Results: We analysed 225 genome sequences across two SARS-CoV-2 waves, 134 (59.6%) from wave 1 (March to June) and 91 (40.4%) from wave 2 (July to December), representing 15.2% of COVID-19 admissions to these hospitals during the sampling periods. Four variants (B.1.1.162, B1.1.70, B.1.1.267 and B.1.1) comprised 68% of variants detected during wave 1. Of these variants, only a single B.1.1.70 sequence was detected in wave 2, while the B.1.177 lineage emerged and contributed to 82.3% of lineages detected. Phylogenetic analysis suggested multiple introductions of wave 2 variants from outside Ireland. We found no consistent association between SARS-CoV-2 lineages and disease severity. Conclusions: These data suggest elimination of common SARS-CoV-2 lineages from hospitalised cases associated with effective NPIs and that importation of new viral variants through travel was a significant contributor to the re-emergence of the pandemic in the second wave in Ireland. Our findings highlight the importance of genomic surveillance in identifying circulating viral genetic diversity and variants of concern and, also, modelling the disease burden of SARS-CoV-2.


title: Detection Of Genomic Variants Of SARS-CoV-2 Circulating In Wastewater By High-Throughput Sequencing

abstract: The use of SARS-CoV-2 metagenomics in wastewater can allow the detection of variants circulating at community level. After comparing with clinical databases, we identified three novel variants in the spike gene, and six new variants in the spike detected for the first time in Spain. We finally support the hypothesis that this approach allows the identification of unknown SARS-CoV-2 variants or detected at only low frequencies in clinical genomes.


title: Estimating the proportion of SARS-CoV-2 infections reported through diagnostic testing

abstract:
BackgroundThe number of diagnosed SARS-CoV-2 infections in the population is one of the most commonly reported measures of epidemic severity. One issue with this metric is that it represents only a fraction of the total number of infections; many infected individuals do not receive a diagnostic test, and a proportion of those who do get tested will receive a false negative result. The proportion of cases ascertained is generally unknown and expected to vary depending on natural factors and changes in test-seeking behaviour.

MethodsWe model the relationship between daily reported cases and population prevalence of SARS-CoV-2. The model is applied to surveillance and diagnostic test data from the United Kingdom to estimate the proportion of infections that have been ascertained with a positive diagnostic test. We estimate the number of infections and compare this to mortality data to obtain the infection fatality rate.

ResultsBefore November 2020, we estimate that approximately 20% of SARS-CoV-2 infections in the UK were ascertained with a positive test with results varying by time and region. Higher case ascertainment was observed during the period dominated by the the Alpha variant compared to the wild-type variants in all age categories and in 9 out of 12 regions of the UK. Ascertainment for the Delta variant was higher than for Alpha in 6 out of 7 age bands and 8 regions. Case ascertainment was higher in adults than in children. The infection fatality rate increased during the increase in the Alpha variant and declined in line with the distribution of vaccines.

ConclusionsBetween September 2020 and October 2021 the majority of people infected with SARS-CoV-2 in the UK did not receive a positive diagnostic test result. Ascertainment of cases was found to be lowest in children and was found to increase over different phases of the pandemic.

category: epidemiology


title: Estimating the proportion of SARS-CoV-2 infections ascertained through diagnostic testing


title: Methylation scores for smoking, alcohol consumption, and body mass index and risk of seven types of cancer

abstract: Methylation marks of exposure to health risk factors may be useful markers of cancer risk as they might better capture current and past exposures than questionnaires, and reflect different individual responses to exposure. We used data from seven case-control studies nested within the Melbourne Collaborative Cohort Study of blood DNA methylation and risk of colorectal, gastric, kidney, lung, prostate and urothelial cancer, and B-cell lymphoma (N cases=3,123). Methylation scores (MS) for smoking, body mass index (BMI), and alcohol consumption were calculated based on published data as weighted averages of methylation values. Rate ratios (RR) and 95% confidence intervals for association with cancer risk were estimated using conditional logistic regression and expressed per standard deviation increase of the MS, with and without adjustment for health-related confounders. The contribution of MS to discriminate cases from controls was evaluated using the area under the curve (AUC). After confounder adjustment, we observed: large associations (RR~1.5-1.7) with lung cancer risk for smoking MS; moderate associations (RR~1.2-1.3) with urothelial cancer risk for smoking MS and with mature B-cell neoplasm risk for BMI and alcohol MS; moderate to small associations (RR~1.1-1.2) for BMI and alcohol MS with several cancer types and cancer overall. Generally small AUC increases were observed after inclusion of several MS in the same model (colorectal, gastric, kidney, urothelial cancers: +3%; lung cancer: +7%; B-cell neoplasms: +8%). Methylation scores for smoking, BMI, and alcohol consumption show independent associations with cancer risk, and may provide some improvements in risk prediction.


title: Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): preliminary results of a randomised, controlled, open-label, platform trial

abstract: Findings: Between 23 April 2020 and 25 January 2021, 4116 adults were included in the assessment of tocilizumab, including 562 (14%) patients receiving invasive mechanical ventilation, 1686 (41%) receiving non-invasive respiratory support, and. 1868 (45%) receiving no respiratory support other than oxygen. Median CRP was 143 [IQR 107-205] mg/L and 3385 (82%) patients were receiving systemic corticosteroids at randomisation. Overall, 596 (29%) of the 2022 patients allocated tocilizumab and 694 (33%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0.86; 95% confidence interval [CI] 0.77-0.96; p=0.007). Consistent results were seen in all pre-specified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital alive within 28 days (54% vs. 47%; rate ratio 1.23; 95% CI 1.12-1.34; p<0.0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (33% vs. 38%; risk ratio 0.85; 95% CI 0.78-0.93; p=0.0005). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes regardless of the level of respiratory support received and in addition to the use of systemic corticosteroids.


title: Workplace sexual harassment in sexual and reproductive services: a preliminary cross-sectional study.

abstract:
INTRODUCTIONSexual harassment at the workplace in health care is most prevalent in Anglo regions, although is an emerging problem globally. No research has yet focused on the prevalence of the phenomenon within the area of sexual and reproductive health care in Anglo regions. The aim of this study is therefore to measure the prevalence of sexual harassment in sexual and reproductive health care setting and compare it with other clinical areas.

METHODA web survey to health care workers of various NHS Trusts in the United Kingdom was carried out and a cross-sectional study was conducted to measure observed counts, expected frequencies and prevalence from a total of 90 questionnaires received.

RESULTSThe prevalence of workplace sexual harassment within the sexual and reproductive health services is lower compared to other clinical areas.

CONCLUSIONSWorking in sexual and reproductive services could be a protective factor for workplace sexual harassment, therefore this study originates a new line of research aiming to identify the protective factors against sexual harassment at the workplace in sexual and reproductive health and the ways they could be used to protect every health care worker from sexual harassment in the workplace.

KEY POINTSThe prevalence of workplace sexual harassment in sexual and reproductive health services is lower compared to other clinical areas.

Working in sexual and reproductive services could be a protective factor for workplace sexual harassment.

category: sexual and reproductive health


title: Increased frequency of CHD1 deletions in prostate cancers of African American men is associated with distinct homologous recombination deficiency associated DNA aberration profiles

abstract:
BackgroundAfrican American (AA) men have significantly higher mortality rates from prostate cancer (PC) than individuals of European ancestry (EA). Therapeutically targetable molecular differences may hold the potential to reduce this disparity.

ObjectiveTo investigate chromodomain helicase DNA-binding protein 1 (CHD1) deletion both as a cause of aggressive disease and therapeutic vulnerability in the prostate cancer of AA men.

Design, setting, and participants91 AA and 109 EA prostate cancer cases were analyzed by fluorescence in situ hybridization (FISH) for the deletion of CHD1. Whole exome and whole genome sequencing data from prostate adenocarcinoma cases were analyzed for mutational signatures from AA and EA individuals.

Outcome measurements and statistical analysisAssociations with biochemical recurrence were evaluated using Cox proportional hazard regression models. Association between mutational signatures and CHD1 deletion were assessed by Wilcoxon ranked sum tests.

Results and limitationsSubclonal deletion of CHD1 is nearly three times as frequent in prostate tumors of men than in EA men. CHD1 deletion is associated with some of the homologous recombination deficiency associated mutational signatures in prostate cancer. In a cell line model CHD1 deletion induced 1-10 kb deletions resembling those induced by BRCA2 deficiency. CHD1 deficient cells showed markedly increased sensitivity to both talazoparib and the radiomimetic bleomycin.

ConclusionsCHD1 is more frequently deleted in the prostate cancer of AA men. This deletion is both associated with and induces mutational signatures characteristic of BRCA2 deficiency. CHD1 deficient prostate cancer is more sensitive to talazoparib or bleomycin treatment.

Patient summarySubclonal deletion of CHD1 is more frequent in the prostate cancer of AA men and this could be one of the reasons behind more aggressive disease. CHD1 deletion, however, also constitutes a therapeutic vulnerability to the PARP inhibitor talazoparib. This treatment may significantly improve the outcome of disease in AA men.

category: oncology


title: Clinical Validation of Automated and Rapid mariPOC SARS-CoV-2 Antigen Test

abstract: Novel SARS coronavirus causing COVID-19 was recognized in late 2019. Diagnostics was quickly ramped up worldwide based on the detection of viral RNA. Based on the scientific knowledge for pre-existing coronaviruses, it was expected that the RNA of this novel coronavirus will be detected from symptomatic and at significant rates also from asymptomatic individuals due to persistence of non-infectious RNA. To increase the efficacy of diagnostics, surveillance, screening and pandemic control, rapid methods, such as antigen tests, are needed for decentralized testing and to assess infectiousness. The objective was to validate the analytical and clinical performance, and usability of a novel automated mariPOC SARS-CoV-2 test, which is based on the detection of structural viral proteins using sophisticated optical laser technology. Clinical performance of the test was evaluated against qRT-PCR with nasopharyngeal swab specimens collected from patients suspected of acute SARS-CoV-2 infection. Sensitivity of the mariPOC test was 100.0% (13/13) directly from swab specimens and 84.4% (38/45) from swab specimens in undefined transport mediums. Specificity of the test was 100.0% (201/201). The tests limit of detection was 2.7 TCID50/test and had no cross-reactions with the tested respiratory microbes. Our study shows that the mariPOC can detect infectious individuals already in 20 minutes with clinical sensitivity close to qRT-PCR. The test targets conserved epitopes of SARS-CoV-2 nucleoprotein, making it robust against strain variations. The new test is a promising and versatile tool for syndromic testing of symptomatic cases and for high capacity infection control screening.


title: A SARS-CoV-2 lineage A variant (A.23.1) with altered spike has emerged and is dominating the current Uganda epidemic

abstract: Introductory paragraphSARS-CoV-2 genomic surveillance in Uganda provides an opportunity to provide a focused description of the virus evolution in a small landlocked East African country. Here we show a recent shift in the local epidemic with a newly emerging lineage A.23 evolving into A.23.1 which is now dominating the Uganda cases and has spread to 26 other countries. Although the precise changes in A.23.1 as it has adapted are different from the changes in the variants of concern (VOC), the evolution shows convergence on a similar set of proteins. The A.23.1 spike protein coding region has accumulated changes that resemble many of the changes seen in VOC including a change at position 613, a change in the furin cleavage site that extends the basic amino acid motif, and multiple changes in the immunogenic N-terminal domain. In addition, the A.23.1lineage encodes changes in non-spike proteins that other VOC show (nsp6, ORF8 and ORF9). The clinical impact of the A.23.1 variant is not yet clear, however it is essential to continue careful monitoring of this variant, as well as rapid assessment of the consequences of the spike protein changes for vaccine efficacy.


title: Before the Surge: Molecular Evidence of SARS-CoV-2 in New York City Prior to the First Report

abstract: New York City (NYC) emerged as a coronavirus disease 2019 (COVID-19) epicenter in March 2020, but there is limited information regarding potentially unrecognized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections before the first reported case. We utilized a sample pooling strategy to screen for SARS-CoV-2 RNA in de-identified, respiratory pathogen-negative nasopharyngeal specimens from 3,040 patients across our NYC health system who were evaluated for respiratory symptoms or influenza-like illness during the first 10 weeks of 2020. We obtained complete SARS-CoV-2 genome sequences from samples collected between late February and early March. Additionally, we detected SARS-CoV-2 RNA in pooled specimens collected in the week ending 25 January 2020, indicating that SARS-CoV-2 caused sporadic infections in NYC a full month before the first officially documented case.


title: Country specific mutational profile of SARS-CoV-2 in pre- and post-international travel ban: Effect on vaccine efficacy

abstract: In order to curb the rapid transmission of SARS-CoV-2, nation-wide lockdowns were implemented as a preliminary measure. Since most countries enforced travel-bans during end of March 2020, the country-specific patterns should be discernible in the subsequent months. We identified frequently mutated non-synonymous mutations in 2,15,000 SARS-CoV-2 sequences during pre and post-travel-ban periods in 35 countries. We further investigated the mutational profile on a bi-monthly basis and traced the progress over the time. Several new mutations have emerged post-travel-ban and on the rise in specific countries, chief among them being A222V and S477N in Spike, and A220V in Nucleocapsid protein. Consequently, we examined the Spike protein epitopes to inspect whether any of these country-specific mutations overlapped with these epitopes. Several mutations were found to be contained within one or more epitopes, including the highly mutated residues of Spike protein, advocating the requirement of active monitoring of vaccine efficacies in respective countries.


title: How much do superspreaders matter? Epidemic dynamics in inhomogeneous populations

abstract: A variant of the SIR model for an inhomogeneous population is introduced in order to account for the effect of variability in susceptibility and infectiousness across a population. An initial formulation of this dynamics leads to infinitely many differential equations. Our model, however, can be reduced to a single first-order one-dimensional differential equation. Using this approach, we provide quantitative solutions for different distributions. In particular, we use GPS data from [~] 107 cellphones to determine an empirical distribution of the number of individual contacts and use this to infer a possible distribution of susceptibility and infectivity. We quantify the effect of superspreaders on the early growth rate [R]0 of the infection and on the final epidemic size, the total number of people who are ever infected. We discuss the features of the distribution that contribute most to the dynamics of the infection.


title: Epidemic dynamics in inhomogeneous populations and the role of superspreaders


title: Substantial SF-36 score differences according to the mode of administration of the questionnaire: an ancillary study of the SENTIPAT multicenter randomized controlled trial comparing web-based questionnaire self-completion and telephone interview

abstract: Background SF-36 is a popular questionnaire for measuring self-perception of quality of life in a given population of interest. Surprisingly, no study compared score values issued from a telephone interview versus an internet-based questionnaire self-completion. Methods Patients having an Internet connection and returning home after hospital discharge were enrolled in the SENTIPAT multicenter randomized trial the day of discharge. They were randomized to either self-complete a set of questionnaires using a dedicated website (I group) or to provide answers to the same questionnaires administered during a telephone interview (T group). This ancillary study of the trial compared SF-36 data relating to the post-hospitalization period in these two groups. In order to anticipate potential unbalanced characteristics of the respondents in the two groups, the impact of the mode of administration of the questionnaire on score differences was investigated using a matched sample of individuals originating from I and T groups (ratio 1:1), the matching procedure being based on a propensity score approach. SF-36 scores observed in I and T groups were compared with a Wilcoxon-Mann-Whitney test, the score differences between the two groups were also examined according to Cohen's effect size. Results There were 245/840 (29%) and 630/840 (75%) SF-36 questionnaires completed in the I and T group, respectively (p < 0.001). Globally, score differences between groups before matching were similar to those observed in the matched sample. Mean scores observed in T group were all above the corresponding values observed in the I group. After matching, score differences in six out of the eight SF-36 scales were statistically significant, with a mean difference greater than 5 for four scales and an associated mild effect size ranging from 0.22 to 0.29, and with a mean difference near this threshold for two other scales (4.57 and 4.56) and a low corresponding effect size (0.18 and 0.16, respectively). Conclusions Telephone mode of administration of SF-36 involved an interviewer effect increasing SF-36 scores. Questionnaire self-completion via the Internet should be preferred and surveys combining various administration methods should be avoided. Trial Registration ClinicalTrials.gov NCT01769261, registered January 16, 2013.


title: Amyloid deposition in granuloma of tuberculosis patients: A pilot study

abstract: The formation of granuloma is one of the characteristic features of tuberculosis. Besides, rise in the concentration of serum amyloid A (SAA) protein is the indicator for chronic inflammation associated with tuberculosis. The predisposition of SAA driven secondary amyloidosis in tuberculosis is well documented. However, SAA derived amyloid onset and deposition start sites are not well chracterised in tuberculosis and other chronic inflammatory conditions. We hypothesized that granuloma could be a potential site for amyloid deposition because of the presence of SAA protein and proteases that cleave SAA into aggregation prone fragments. 150 tuberculosis patients were screened and biopsies were collected from the affected organs of these patients. 20 patients showed eosinophilic hyaline rich deposits within and surrounding granuloma respectively. They were further screened for the presence of amyloid deposits. The hyaline material, upon Congo red staining exhibited characteristic apple green birefringence under polarized light, confirming deposition of amyloid. Further upon immuno histochemical staining with anti-SAA antibody, the amyloid enriched areas showed positive immunoreactivity. In this pilot study, wexx have shown granuloma as a potential site for serum amyloid A derived amyloid deposition in tuberculosis patients. This study would set a stage to expxand the clinical and fundamental research for understanding the mechanism of amyloid formation in granuloma underlying tuberculosis and other chronic inflammatory conditions.

category: pathology


title: ADIPOSE-DERIVED STROMAL VASCULAR FRACTION AND FAT GRAFTS VERSUS MEDICAL TREATMENT FOR TREATING THE HANDS OF PATIENTS WITH SYSTEMIC SCLEROSIS. A RANDOMIZED CRONTOLLED TRIAL

abstract:
BackgroundIn the hand, the Systemic Sclerosis (SS) is characteristically evidenced by Raynauds phenomenon (RP) and fibrosis of the skin, tendons, ligaments, and joints as well as digital ulcers with prolonged healing. Current medical treatment not always cure these complications. Local adipose-derived stromal vascular fraction (ADSVF) administration into the hands has been proposed as an emerging treatment for these complications, due to its proangiogenic, antifibrotic, and immunoregulatory activities. The objective of this controlled trial was to evaluate the safety and clinical effects of fat micrografts plus ADSVF administration into the hands of patients with SS.

MethodsThis was an open-label, monocentric, randomized controlled study. Twenty patients diagnosed with SS were enrolled and assigned to the experimental or control group. Fat micrografts plus the ADSVF were injected into the right hand of experimental group patients. The control group continued to receive only medical treatment. Demographic, serologic data and disease severity were recorded. Digital oximetry, pain, Raynaud phenomenon (RP), digital ulcer healing (DUH), mobility, thumb opposition, vascular density of the nail bed, skin affection of the hand, Serologic antibodies, hand function, and quality of life scores were evaluated in both groups. The mean follow-up period was 168 days.

The differences between before and after the intervention were analyzed with the Wilcoxon range test, and the differences between the control and experimental groups at 0 days and 168 days were analyzed with the Mann-Whitney U test.

ResultsAdverse events were not observed in both groups. There were no changes in disease severity, serologic antibodies, nailfold capillaroscopy patterns, mobility, and hand function in both groups. There were significant improvements in pain, DUH and quality of life scores in the experimental group. RP improved significantly in both groups. However, on statistically comparing the results at 168 days between the groups, significant improvements were only observed in pain levels (p = 0.02) and DUH (p=0.003).

ConclusionsThe injection of ADSVF plus fat micrografts is a reproducible, and safe technique. Pain and digital ulcers in the hands of patients with SS can be treated with this treatment.

Trial RegistrationRetrospectively registered in ClinicalTrials.gov with identifier NCT04387825

category: rheumatology


title: "Effect of the intervention with omega-3 fatty acids on nutritional and clinical aspects in patients with breast cancer receiving medical treatment."

abstract:
BackgroundIt is known that cancer can cause loss of body weight and muscle protein wasting, which leads to a state of malnutrition, which in turn worsens the prognosis and health of the cancer patient. It has been suggested that the promoting mechanism of this state is systemic inflammation, for which reason several clinical trials have used omega-3 fatty acids, especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), as adjuvants to antineoplastic treatment, mainly due to its anti-inflammatory effects. However, few systematic reviews and meta-analyzes have analyzed the effects of omega-3s in patients with breast cancer.

ObjectiveThe aim of this study is to assess the effect of the supplementation with omega-3 fatty acids on nutritional and clinical outcomes in patients with breast cancer receiving medical treatment.

MethodsA systematic review will be conducted, starting with a search in PubMed, CENTRAL and EMBASE using search terms related to omega-3 fatty acids and breast cancer. We will include only randomized controlled trials that assess the effects of omega-3 in patients with breast cancer receiving medical treatment.. Data will be extracted in a spread sheet. Study selection and data extraction will be conducted by two reviewers independently and the Cochrane Risk of Bias Tool for RCT will be used for assessment of risk of bias. Discrepancies will be reviewed with a third reviewer.

ConclusionThis systematic review aims to provide an analysis on the outcomes of the usage of the intervention with omega-3 fatty acids on nutritional and clinical aspects in patients with breast cancer receiving medical treatment.


title: Categorizing ultra-processed food intake in large-scale cohort studies: evidence from the Nurses' Health Studies, the Health Professionals Follow-Up Study, and the Growing Up Today Study

abstract:
ObjectiveThere is limited description and documentation of the methods used for the categorization of dietary intake according to the NOVA classification, in large-scale cohort studies. This manuscript details the strategy employed for categorizing the food intake, assessed using food frequency questionnaires (FFQs), of participants in the Nurses Health Studies (NHS) I and II, the Health Professionals Follow-up Study (HPFS), and the Growing Up Today Studies (GUTS) I and II into the four NOVA groups to identify the ultra-processed portion of their diets.

MethodsA four-stage approach was employed: (1) compilation of all food items from the FFQs used at different waves of data collection; (2) assignment of food items to a NOVA group by three researchers working independently; (3) checking for consensus in categorization and shortlisting food items for which there was disagreement; (4) discussions with experts and use of additional resources (research dieticians, cohort-specific documents, online grocery store scans) to guide the final categorization of the short-listed items.

ResultsAt stage 1, 205 and 315 food items were compiled from the adult and GUTS FFQ food lists, respectively. Over 70% of food items from all cohorts were assigned to a NOVA group after stage 2 and the remainder were shortlisted for further discussion (stage 3). Two rounds of reviews at stage 4 helped with the categorization of 96.5% of items from the adult cohorts and 90.7% items from the youth cohort. The remaining products were assigned to a non-ultra-processed food group and ear-marked for sensitivity analyses. Of all items in the food lists, 36.1% in the adult cohorts and 43.5% in the GUTS cohorts were identified as ultra-processed.

ConclusionAn iterative, conservative approach was used to categorize food items from the NHS, HPFS and GUTS FFQ food lists according to their grade of processing. The approach relied on discussions with experts and was informed by insights from the research dieticians, information provided by cohort-specific documents, and scans of online supermarkets. Future work is needed to validate this approach.


title: Combinatorial analysis of phenotypic and clinical risk factors associated with hospitalized COVID-19 patients

abstract:
1Characterization of the risk factors associated with variability in the clinical outcomes of COVID-19 is important. Our previous study using genomic data identified a potential role of calcium and lipid homeostasis in severe COVID-19. This study aimed to identify similar combinations of features (disease signatures) associated with severe disease in a separate patient population with purely clinical and phenotypic data.

The PrecisionLife combinatorial analytics platform was used to analyze features derived from de-identified health records in the UnitedHealth Group COVID-19 Data Suite. The platform identified and analyzed 836 disease signatures in two cohorts associated with increased risk of COVID-19 hospitalization. Cohort 1 was formed of cases hospitalized with COVID-19 and a set of controls who developed mild symptoms. Cohort 2 included Cohort 1 individuals for whom additional laboratory test data was available.

We found several disease signatures where lower levels of lipids were found co-occurring with lower levels of serum calcium and leukocytes. Many of the low lipid signatures were independent of statin use and 50% of cases with hypocalcemia signatures were reported with vitamin D deficiency. These signatures may be attributed to similar mechanisms linking calcium and lipid signaling where changes in cellular lipid levels during inflammation and infection affect calcium signaling in host cells.

This study and our previous genomics analysis demonstrate that combinatorial analysis can identify disease signatures associated with the risk of developing severe COVID-19 separately from genomic or clinical data in different populations. Both studies suggest associations between calcium and lipid signalling in severe COVID-19.

category: health informatics


title: Estimating real-world COVID-19 vaccine effectiveness in Israel

abstract: The vaccination roll-out of the COVID-19 vaccines in Israel has been highly successful. By February 22th, approximately 47% of the population has already been administered at least one dose of the BNT162b2 vaccine. Efforts to estimate the true real-world effectiveness of the vaccine have been hampered by disease dynamics and social-economic discrepancies. Here, using counts of positive and hospitalized cases of vaccinated individuals, we conduct a sensitivity analysis of the vaccine effectiveness. Under an assumption of no effectiveness on the first two weeks after the 1st dose, we observe very low effectiveness on the third week. After the 2nd dose, on weeks 1 and 2 we find 73-85% effectiveness in reducing positive cases, hospitalizations, and severe cases, which increase to 89-97% effectiveness 14 days after the 2nd dose. As more granular data will be available, it will be possible to extract more exact estimates; however, the emerging evidence suggests that the vaccine is highly effective.


title: Estimating real-world COVID-19 vaccine effectiveness in Israel using aggregated counts


title: Association of state social distancing restrictions with nursing home COVID-19 and non-COVID-19 outcomes

abstract: The COVID-19 poses a disproportionate threat to nursing home residents. Although recent studies suggested the effectiveness of state social distancing measures in the United States on curbing COVID-19 morbidity and mortality among the general population, there is lack of evidence as to how these state orders may have affected nursing home patients or what potential negative health consequences they may have had. In this longitudinal study, we evaluated changes in state strength of social distancing restrictions from June to August of 2020, and their associations with the weekly numbers of new COVID-19 cases, new COVID-19 deaths, and new non-COVID-19 deaths in nursing homes of the US. We found that stronger state social distancing measures were associated with improved COVID-19 outcomes (case and death rates), reduced across-facility disparities in COVID-19 outcomes, but more deaths due to non-COVID-19 reasons among nursing home residents.

category: health policy


title: SARS-CoV-2 Seroprevalence Among Antenatal Clinic Attendees in Kingston, Jamaica, September-November 2020

abstract: SARS-CoV-2 seroprevalence in an antenatal population in Kingston, Jamaica was assessed for September-November 2020 in a repeated cross-sectional study using the Abbott Architect SARS-CoV-2 IgG assay. After adjusting for test performance, seroprevalence was 6.9% for September, 16.9% for October, and 24.0% for November. Of the 37 pregnant women testing SARS-CoV-2 IgG positive, only 3 were symptomatic. One symptomatic woman testing SARS-CoV-2 IgG positive had multiple co-morbidities and succumbed to COVID-19 pneumonia. Up to January 31, 2021, 8 women identified as SARS-CoV-2 IgG positive delivered, all without complications. Comparison of test adjusted seroprevalence data with cumulative PCR-confirmed COVID-19 cases within the Kingston Metropolitan Area indicated that as many as 44.4 times more people were infected with SARS-CoV-2 than identified with PCR testing. These findings provide the first evidence for the extent of SARS-CoV-2 infections in Jamaica and will inform future SARS-CoV-2 testing strategies.


title: Implementation of an in-house real-time reverse transcription-PCR assay to detect the emerging SARS-CoV-2 N501Y variants

abstract: The real-time detection of emerging SARS-CoV-2 variants is critical to manage patients appropriately, and monitor and assess their epidemiological and clinical features. Sequencing is not a feasible comprehensive detection strategy considering the very large number of SARS-CoV-2 cases in our current setting. SARS-CoV-2 variants currently of greatest concern carry the N501Y substitution within the spike receptor binding domain. They have become predominant in England (20I/501Y.V1) and were detected in South Africa (20H/501Y.V2), Brazil and dozens of other countries worldwide. The 20I/501Y.V1 variant has started to spread worldwide including in France. It has been reported as 50-74% more transmissible than preexisting strains, suspected to evade anti-spike antibodies, and it caused a reinfection. We have implemented an in-house one-step real-time reverse transcription-PCR (qPCR) assay that specifically detects SARS-CoV-2 N501Y. It was found reliable to detect specifically the N501Y substitution and preliminarily allowed estimating 20I/501Y.V1 variant prevalence to 4% among our current SARS-CoV-2 diagnoses since January.


title: Hospitalizations, resource use and outcomes of acute pulmonary embolism in Germany during the Covid-19 pandemic - Emergence of different phenotypes of thrombotic disease?

abstract:
BackgroundThere is discussion evolving around the emergence of different phenotypes of Covid-19-associated thromboembolic disease, i.e. acute pulmonary embolism vs pulmonary thrombosis and different phenotypes of in situ thrombosis. With this study, we wish to provide hospitalization, treatment and in-hospital outcome data for pulmonary embolism during the 2020 Covid-19 pandemic and a corresponding 2016 - 2019 control period.

MethodsWe performed a retrospective analysis of claims data of Helios hospitals in Germany. Consecutive cases with a hospital admission between January 1 and December 15, 2020 and pulmonary embolism as primary discharge diagnosis were analyzed and compared to a corresponding period covering the same weeks in 2016 - 2019.

ResultsAs previously reported for other emergent medical conditions, there was a hospitalization deficit coinciding with the 1st pandemic wave. Beginning with the 12-week interval May 6 - July 28, there was a stable surplus of hospital admissions in 2020. During this surplus period (May 6 - December 15, 2020), there were 2,449 hospitalizations including 45 PCR-confirmed Covid-19 cases (1.8%) as opposed to 8,717 in 2016 - 2019 (IRR 1.12, 95% CI 1.07 - 1.18, P<0.01). When excluding Covid-19 cases IRR was 1.10 (95% CI 1.05 - 1.15, P<0.01). While overall comorbidities expressed as weighted AHRQ Elixhauser Comorbidity Index (14.1 {+/-} 10.1 vs. 13.9 {+/-}10.3, P=0.28), the presence of thrombosis (46.1 vs 45.4%, P=0.55) and surgery (3.8 vs. 4.3%, P=0.33) were comparable, coagulopathy (3.3 vs 4.5%, P=0.01) and metastatic cancer (3.0 vs 4.0%, P=0.03) as contributing factors were less frequently observed during the 2020 surplus. Interventional treatments (thrombolytic therapy, thrombectomy or inferior vena cava filter placement) were less frequently used (4.7 vs 6.6%, OR 0.72, 95% CI 0.58 - 0.89, P< 0.01). Similarly, intensive care (35.1 vs 38.8%, OR 0.83, 95% CI 0.75 - 0.92, P< 0.01) and mechanical ventilation utilization (7.2 vs 8.1%, OR 0.88, 95% CI 0.74 - 1.04, P=0.14) as well as in-hospital-mortality rates (7.8 vs 9.8%, OR 0.76, 95% CI 0.64 - 0.90, P< 0.01) were lower in 2020 compared with 2016 - 2019. This was associated with a shorter length of hospital stay (6.4 {+/-}5.4 vs. 7.2 {+/-}5.7 days, P< 0.01) during the 2020 surplus period.

ConclusionsOnly a minority of cases were associated with PCR-confirmed Covid-19 but this does not rule out preceding or undetected SARS-CoV-2 infection. Although there is a shift towards milder disease course, the increased incidence of hospitalizations for pulmonary embolism requires immediate attention, close surveillance and further studies.

category: cardiovascular medicine


title: Hospitalizations for emergency-sensitive conditions in Germany during the Covid-19 pandemic - Insights from the German-wide Helios hospital network

abstract:
BackgroundWhile there are numerous reports that describe emergency care during the early Covid-19 pandemic, there is scarcity of data for later stages. This study analyzes hospitalization rates for 37 emergency-sensitive conditions in the largest German-wide hospital network during different pandemic phases.

MethodsUsing claims data of 80 hospitals, consecutive cases between January 1 and November 17, 2020 were analyzed and compared to a corresponding period in 2019. Incidence-rate ratios (IRR) comparing the both periods were calculated using Poisson regression to model the number of hospitalizations per day.

ResultsThere was a hospitalization deficit between March 12 and June 13, 2020 (coinciding with the 1st pandemic wave) with 32,807 hospitalizations as opposed to 39,379 in 2019 (IRR 0.83, 95% CI 0.82 - 0.85, P<0.01). During the following period (June 14 to November 17, 2020, including the start of 2nd wave), hospitalizations were reduced from 63,799 in 2019 to 59,910 in 2020, but this reduction was not that pronounced (IRR 0.94, 95% CI 0.93 - 0.95, P<0.01). There was an increase in hospitalizations for acute myocardial infarction, aortic aneurism/dissection and pulmonary embolism after the 1st wave during which hospitalizations had been reduced for those conditions. In contrast, hospitalizations for sepsis, pneumonia, obstructive pulmonary disease, and intracranial injuries were reduced during the entire pandemic.

ConclusionsThere was an overall reduction of hospitalizations for emergency-sensitive conditions in Germany during the Covid-19 pandemic with heterogeneous effects on different disease categories. The increase of hospitalizations for acute myocardial infarction, aortic aneurism/dissection and pulmonary embolism is an alarming signal that requires attention and further studies.

KEY MESSAGESO_ST_ABSWhat is already known on this subjectC_ST_ABSO_LIThere has been a reduction in emergency room visits and hospital admissions for several emergent medical and surgical conditions during the early Covid-19 pandemic (1st wave).
C_LI

What this study addsO_LIUsing claims data of 80 German-wide Helios hospitals, we found an overall reduction of hospitalizations for emergency-sensitive conditions in Germany during the Covid-19 pandemic until mid November 2020 with heterogeneous effects on different disease categories. While hospitalizations for sepsis, pneumonia, obstructive pulmonary disease, and intracranial injuries were reduced during the entire pandemic. There was an alarming increase of hospitalizations for acute myocardial infarction, aortic aneurism/dissection and pulmonary embolism after the 1st wave.
C_LI

category: emergency medicine


title: Community end-of-life care during the COVID-19 pandemic: Initial findings of a UK primary care survey

abstract:
BackgroundThousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning.

AimTo understand the views of general practitioners and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic.

Design and SettingA web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks during September and October 2020.

MethodResponses were analysed using descriptive statistics and an inductive thematic analysis.

ResultsValid responses were received from 559 individuals (387 community nurses, 156 General Practitioners (GPs) and 16 unspecified role), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-of-life care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress.

ConclusionPrimary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics.

How this fits in (4 sentences)O_LIThis study provides insights into experiences of delivering end-of-life care in the community during the first wave of the COVID-19 pandemic from the perspectives of UK general practitioners (GPs) and community nurses.
C_LIO_LIServices have changed and adapted rapidly to meet increased need in terms of both volume and complexity, with community nurses taking greater responsibility for most areas of palliative care clinical practice, and GPs undertaking more care planning conversations.
C_LIO_LIWhile GPs and specialist palliative care services conducted more remote consultations, community nurses carried out face-to-face end-of-life care and reported a feeling of isolation.
C_LIO_LIAs the pandemic progresses, and the increased need for end-of-life care in the community persists, more effective service models and multi-disciplinary teamwork in primary care are urgently needed.
C_LI

category: palliative medicine


title: A multi-centre service evaluation of the impact of the COVID-19 pandemic on presentation of newly diagnosed cancers and type 1 diabetes in children in the UK

abstract:
BackgroundThe COVID-19 pandemic led to changes in patterns of presentation to Emergency Departments (ED). Child health professionals were concerned that this could contribute to the delayed diagnosis of life-threatening conditions, including childhood cancer (CC) and type 1 diabetes (T1DM). Our multicentre, UK-based service evaluation assessed diagnostic intervals and disease severity for these conditions.

MethodsWe collected presentation route, timing and disease severity for children with newly diagnosed CC in three principal treatment centres, and T1DM in four centres between 1stJanuary - 31st July 2020 and the corresponding period in 2019. We assessed the impact of lockdown on total diagnostic interval (TDI), patient interval (PI), system interval (SI) and disease severity.

FindingsFor CCs and T1DM, the route to diagnosis and severity of illness at presentation were unchanged across all time periods. Diagnostic intervals for CCs during lockdown were comparable to that in 2019 (TDI 4.6, PI 1.1 and SI 2.1 weeks), except for an increased PI in Jan-Mar 2020 (median 2.7 weeks). Diagnostic intervals for T1DM during lockdown were similar to that in 2019 (TDI 16 vs 15 and PI 14 vs 14 days), except for an increased PI in Jan-Mar 2020 (median 21 days).

InterpretationThere is no evidence of diagnostic delay or increased illness severity for CC or T1DM, during the first phase of the pandemic across the participating centres. This provides reassuring data for children and families with these life-changing conditions.

Research in ContextO_ST_ABSEvidence before this studyC_ST_ABSThis project was initiated after the first national lockdown in March 2020 during COVID-19 pandemic in the UK. At the design stage, Medline was searched (with no language limit), using the keywords ((Cancer) OR (neoplasm) OR (Type 1 diabetes mellitus)) AND ((Covid-19) OR (SARS-CoV-2) OR (Pandemics)) AND ((Emergency department attendances) OR (diabetes ketoacidosis) OR (Delayed diagnosis) OR (interval) OR (wait)) to identify publications reporting the impact of the pandemic and public health measures on both overall and paediatric healthcare services. Significant changes in service utilisation in the UK were reported following the commencement of the first lockdown, including a 49% reduction in emergency department attendances in the week following the lockdown; and two adult studies reported that referral via the urgent two-week wait cancer referral diagnoses decreased by 84% from Mar-May and 60% in June 2020. As for Type 1 diabetes (T1DM), a 30 patient UK-study reported an increase in newly diagnosed T1DM during the first six weeks of lockdown. Increased proportions of severe diabetic ketoacidosis (DKA) at presentation were also reported in an Italian survey involving 53 paediatric diabetes centres. Through the search we identified a need for multi-centre, more thorough assessment on referral pathways, time taken from symptom onset to diagnosis, and its association with severity at presentation for children diagnosed with life-changing conditions during the national lockdown.

Added value of this studyOur findings suggest that the first national lockdown in the UK were not associated with delayed diagnosis of childhood cancer or type 1 diabetes at participating centres. This provides reassuring information for children and families with these life-changing conditions.

ImplicationWe believe that our study can play a key role in allaying parental and professional concern. it is important to establish whether subsequent public health measures have impacted the diagnostic interval in the context of an evolving backlog of patient referrals across the UK.

category: pediatrics


title: Superantigenic TCR Vbeta 21.3 signature in Multisystem Inflammatory Syndrome in Children

abstract:
ObjectivesMultiple Inflammatory Syndrome in Children (MIS-C) is the most severe pediatric form of COVID-19 and occurs in previously healthy children. MIS-C combines features of Kawasaki disease and Toxic Shock Syndrome (TSS).

MethodsChildren with suspected MIS-C were included within the first week of diagnosis and a large scale immunoassay was performed to determein the immunologic signature of these patients.

ResultsWe characterized the immunological profile of 27 MIS-C cases in comparison with 4 KD and 4 TSS cases. Similarly to TSS, an increase of serum inflammatory cytokines (IL-6, TNF-a, CD25s) was observed in MIS-C contrasting with low expression of HLA-DR monocytes, a feature often associated with immune paralysis. Expansions of T cells expressing the V{beta}21.3 T cell receptor {beta} chain variable region were detected in both CD4 and CD8 subsets in almost 50% of patients and V{beta}21.3-positive T cells expressed high level of HLA-DR highlighting their specific activation. TCR sequencing uncovered the polyclonal nature of the V{beta} 21.3+ population. SARS-CoV2 antigene-specific production of interferon gamma in T cells was not increased in MIS-C T cells compared to COVID-19 patients suggesting the antigen-specific immune response in MIS-C patients is not pivotal to the manifestation.

ConclusionsOur findings argue in favor of a strong activation of the immune system related to a superantigenic immune response in MIS-C with a specific polyclonal V{beta}21.3 T cell expansion.

Key messagesWhat is already known about this subject ?

MIS-C occurs 3-5 weeks after acute SARS-CoV2 infection and overlap features of Toxic Shock syndrome and Kawasaki disease.

MIS-C appears different in term of cytokine and autoantibodies generation from KD with subtle signs of T cells activation

What does this study add?

This study demonstrates that V{beta}21.3+ CD4 and CD8 T cells are highly increased in about 50% of MIS-C and distinctive of the V{beta}2+ expansion observed in toxic shock syndrome in This reflects a specific T cell activation and cytokine release syndrome similar to toxic shock syndrome

How mich this impact on clinical practice or future developments?

V{beta}21.3+ signature can be available on a short term basis by flowcytometry and represents a signature of the MIS-C.

As for TSS, immunomodulating therapies may revert the superantigenic activation and resolve this life threatening pediatric condition.


title: Recent and forecast post-COVID trends in hospital activity in England amongst 0 to 24 year olds: analyses using routine hospital administrative data

abstract:
BackgroundIncreasing hospital use in the past decade has placed considerable strain on children and young peoples (CYP) health services in England. Greater integration of healthcare may reduce these increases. We projected CYP healthcare activity out to 2040 and examined the potential impact of integrated care systems on projected activity.

MethodsWe used routine administrative data (Hospital Episode Statistics (HES)) on emergency department (ED) attendances, emergency admissions and outpatient (OP) attendances for England by age-group for 0-24 year olds from 2007 to 2017. Bayesian projections of future activity used projected population and ethnicity and future child poverty rates. Cause data were used to identify ambulatory-care-sensitive-conditions (ACSC).

FindingsED attendances, emergency admissions and OP attendances increased in all age groups from 2007 to 2017. ED and OP attendances increased 60-80% amongst children under 10 years. ACSC and neonatal causes drove the majority of increases in emergency admissions. Activity was projected to increase by 2040 by 50-145% for ED attendances, 20-125% for OP attendances and 4-58% for total admissions. Scenarios of increasing or decreasing child poverty resulted in small changes to forecast activity. Scenarios in which 50% of ACSC were seen outside hospital in integrated care reduced estimated activity in 2040 by 21.2-25.9% for admissions and 23.5-30.1% for ED attendances across poverty scenarios amongst infants.

InterpretationThe rapid increases in CYP healthcare activity seen in the past decade may continue for the next decade given projected changes in population and child poverty, unless some of the drivers of increased activity are addressed. Contrary to these pessimistic scenarios, our findings suggest that development of integrated care for CYP at scale in England has the potential to dramatically reduce or even reverse these forecast increases

FundingNil funding obtained.

Research in contextO_ST_ABSEvidence before this studyC_ST_ABSThere has been marked increases in hospital use (inpatient, outpatient and emergency department (ED)) by children and young people (CYP). Search of the PubMed database using the search terms: ((((("child"[MeSH Major Topic]) OR ("adolescent"[MeSH Major Topic])) OR ("infant"[MeSH Major Topic]))) AND ((healthcare use[Text Word])) OR (emergency admission[Text Word])) AND (united kingdom[Text Word]). Drivers of increased activity include population growth and sociodemographic factors, help-seeking behaviour, growth in medical knowledge and capability, and by factors within the health system. Additional factors in child health include increased survival of premature neonates and those with congenital conditions and rising parental expectations of modern medicine. Previous studies have shown that ambulatory-care-sensitive-conditions (ACSC) are responsible for much of the increase in CYP emergency activity in England and Scotland.

Added value of this studyThis is the first study to use existing data to project possible future scenarios for CYP healthcare activity out to 2030 and 2040 in any country. Our future scenarios are based upon authoritative projections for population, ethnic diversity and child poverty in England and allow us to estimate the potential impact of integrated care scenarios in which ACSC are treated outside hospital. We show that future projected CYP activity is very high if mitigations such as integrated care are not instituted in England.

Implications of all the available evidenceHealthcare activity has grown dramatically over the last decade in CYP, largely due to ACSC and the consequences of premature delivery. Projections to 2040 suggest that similar increases are likely over the next 2 decades without action to reduce child poverty and implementation of integrated care at scale in the NHS.


title: Noncommunicable Diseases, Sociodemographic Vulnerability, and the Risk of Mortality in Hospitalized Children and Adolescents with COVID-19 in Brazil: A Syndemic in Play

abstract:
BackgroundAlthough many studies identify the presence of comorbidities and socioeconomic vulnerabilities as risk factors for worse COVID-19 outcomes, few have addressed this issue in children. We aimed to study how these factors have impacted COVID-19 mortality in Brazilian children and adolescents.

MethodsThis is an observational study using publicly available data from the Brazilian Ministry of Health. We studied 5,857 patients younger than 20 years old, all of them hospitalized with laboratory-confirmed COVID-19. We used multilevel mixed-effects generalized linear models to study mortality, stratifying the analysis by age, region of the country, presence of noncommunicable diseases, ethnicity, and socioeconomic development.

FindingsIndividually, most of the comorbidities included were risk factors. Having more than one comorbidity increased almost tenfold the risk of death (OR 9{middle dot}67 95%CI 6{middle dot}89-13{middle dot}57). Compared to White children, Indigenous, Pardo (mixed), and East Asian had a significantly higher risk of mortality. We also found a regional effect (higher mortality in the North), and a socioeconomic effect (higher mortality among children from less socioeconomically developed municipalities).

InterpretationBesides the impact of comorbidities, we identified ethnic, regional, and socioeconomic effects shaping the mortality of children hospitalized with COVID-19 in Brazil. Putting these findings together, we propose that there is a syndemic among COVID-19 and noncommunicable diseases, driven and fostered by large-scale sociodemographic inequalities. Facing COVID-19 in Brazil must also include addressing these structural issues. Our findings also identify risk groups among children that should be prioritized for public health measures, such as vaccination.

FundingNone.


title: Associations between movement behaviors and emotional changes in toddlers and preschoolers during early stages of the COVID-19 pandemic in Chile

abstract:
BackgroundThere is limited evidence about emotional and behavioral responses in toddlers and preschoolers during the coronavirus disease (COVID-19) pandemic, particularly in Latin America.

ObjectiveTo assess associations between changes in movement behaviors (physical activity, screen time and sleeping) and emotional changes in toddlers and preschoolers during early stages of the pandemic in Chile.

MethodsA cross-sectional study conducted from March 30th to April 27th, 2020. Main caregivers of 1-to 5-year-old children living in Chile answered an online survey that included questions about sociodemographic characteristics, changes in the childs emotions and behaviors, movement behaviors and caregivers stress during the pandemic. Multiple linear regressions were used to assess the association between different factors and emotional changes in toddlers and preschoolers.

ResultsIn total, 1727 caregivers provided complete data on emotional changes for children aged 2.9{+/-}1.36 years old, 47.9% girls. A large proportion of toddlers and preschoolers in Chile experienced emotional and behavioral changes. Most caregivers reported that children were  more affectionate (78.9%),  more restless (65.1%), and  more frustrated (54.1%) compared with pre-pandemic times. Apart from changes in movement behaviors, factors such as child age, caregivers age and stress, and residential area (urban/rural) were consistently associated with changes in emotions and behaviors.

ConclusionThe pandemic substantially affected the emotions and behaviors of toddlers and preschoolers in Chile. Mental health promotion programs should consider multilevel approaches in which the promotion of movement behaviors and support for caregivers should be essential pieces for future responses.


title: Prevalence of cardiovascular risk factors in osteoarthritis patients derived from primary care records: a systematic review of observational studies

abstract:
BackgroundPeople with osteoarthritis are at a high risk of cardiovascular disease (CVD). Detecting CVD risk factors in this high-risk population will help to improve CVD outcomes. Primary care electronic health records (EHRs) provide opportunities for the surveillance of CVD risk factors in the osteoarthritis population. This paper aimed to systematically review evidence of prevalence estimates of CVD risk factors in people with osteoarthritis derived from primary care EHRs.

MethodsEight databases including MEDLINE were systematically searched to January 2019. Observational studies using primary care EHRs data to estimate the prevalence of six CVD risk factors in people with osteoarthritis were included. A narrative review was conducted to summarise study results.

ResultsSix studies were identified. High heterogeneity between studies prevented the calculation of pooled estimates. One study reported the prevalence of smoking (12.5%); five reported hypertension (range: 19.7%-55.5%); four reported obesity (range: 34.4%-51.6%); two reported dyslipidaemia (6.0%, 13.3%); five reported diabetes (range: 5.2%-18.6%); and one reported chronic kidney disease (1.8%) in people with osteoarthritis. One study reported a higher prevalence of hypertension (Odds Ratio (OR) 1.25, 95% confidence interval (CI) 1.19-1.32), obesity (OR 2.44, 95%CI 2.33-2.55), dyslipidaemia (OR 1.24, 95%CI 1.14-1.35) and diabetes (1.11, 95%CI 1.02-1.22) in the osteoarthritis population compared with the matched non-osteoarthritis population.

ConclusionsFrom studies identified in this review that had used primary care EHRs, prevalence estimates of CVD risk factors were higher in people with osteoarthritis compared with those without. These estimates may provide baseline frequency of CVD risk factors in osteoarthritis patients in primary care, although this is limited by the small number of studies and high heterogeneity. Further studies of frequency, using primary care EHRs, will help to answer whether this data source can be used for evaluating approaches to manage CVD risk factors in osteoarthritis patients.

Subject AreaPrimary care research

category: primary care research


title: General Health Checks in Adult Primary Care: A Review

abstract:
ImportanceGeneral health checks--also known as general medical exams, periodic health evaluations, checkups, or wellness visits--to identify and prevent disease are extremely common in adult primary care. Although general health checks are often expected and advocated by patients, clinicians, payers, and health systems, others question their value. The current evidence was updated and recommendations provided for conducting general health checks in adults.

ObservationsRandomized trials and observational studies with control groups from prior systematic reviews and an updated literature review through December 2020 were included. Out of 19 included randomized trials (906 to 59,616 participants; follow-up, 1 to 30 years), 5 evaluated a single general health check and 7 evaluated annual health checks. All of 12 included observational studies (240 to 471,415 participants; follow-up, cross-sectional to 5 years) evaluated a single general health check. General health checks were generally not associated with decreased mortality, cardiovascular events, or cardiovascular disease incidence. For example, in the South-East London Screening Study (n=7,229), adults age 40 to 64 who were invited to two health checks over two years experienced no 8-year mortality benefit (6% overall). However, general health checks were associated with increased detection of chronic diseases, such as depression and hypertension; moderate improvements in controlling risk factors such as blood pressure and cholesterol; increased clinical preventive service uptake, such as colorectal and cervical cancer screening; and improvements in patient-reported outcomes, such as quality of life and self-rated health. General health checks were sometimes associated with modest improvements in health behaviors such as physical activity and diet. For example, in the OXCHECK trial (n=4121), fewer intervention participants exercised less than once per month (68% versus 71%). Potential adverse effects in individual studies included an increased risk of stroke and increased mortality attributed to increased completion of advanced directives.

Conclusions and RelevanceGeneral health checks were not associated with reduced mortality or cardiovascular events, but were associated with increased chronic disease recognition and treatment; risk factor control, preventive service uptake, and patient-reported outcomes. Primary care teams may reasonably offer general health checks, especially for groups at high risk of overdue preventive services, uncontrolled risk factors, low self-rated health, or poor connection to primary care.


title: Scoping into Non Iron Deficiency Anemia: Reflection from the Rural India

abstract:
IntroductionAnaemia is one of the leading public health problems. India accounts for the highest prevalence of anaemia in the world. Anaemia programs in India focus on screening and management of anaemia based on haemoglobin estimation, treatment is being given irrespective of status of iron as well as other micronutrient storage. The present study assesses the prevalence of anaemia and iron deficiency (ID) based on low serum ferritin status among antenatal and postnatal women in Devbhoomi Dwarka District of Gujarat.

MethodsA total of 258 pregnant (AN) and postnatal (PN) women drawn from 27 primary health centres were studied. Anaemia was evaluated based on haemoglobin concentration obtained from venous whole blood, using auto-analyser. Serum ferritin was used to evaluate iron status in the study. Serum ferritin was assessed using the direct chemiluminescence method using MINI VIDAS which is a compact automated immunoassay system based on the Enzyme Linked Fluorescent Assay (ELFA) principles.

ResultsOverall, Anaemia (low Hb) and ID (low s. ferritin) was observed in 65.9% and 27.1% respectively. Out of anaemic participants, about 38.2% reported ID while the remaining 61.8% had normal s. ferritin (i.e. non-iron deficient anaemia). Anaemia was reported 69.1% in AN women and 57.1% in PN women. The ID was reported higher (30.9%) in AN woman than PN women (17.1%). However, the prevalence of anaemia, as well as IDA decreased from the first to the third trimester.

ConclusionTwo out of every three women were anaemic; one out of four were anaemic with depleted iron storage. Importantly, two out of five women had anaemia but iron storage was sufficient. Strategy to prevent and correct anaemia must include screening for iron and non-iron deficiency anaemia and follow appropriate treatment protocol for both types of anaemia.


title: Multi-level Predictors of Depression Symptoms in the Adolescent Brain Cognitive Development (ABCD) Study

abstract:
ObjectiveTo identify multi-level factors that maximize prediction of depression symptoms in a diverse sample of children in the U.S. participating in the Adolescent Brain and Cognitive Development (ABCD) study.

Methods8,507 participants (49.6% female, 75.2% white, ages 9-10) from ABCD provided complete data at baseline and 7,998 of these participants provided one-year follow-up data. Depression symptoms were measured with the Child Behavior Checklist. Predictive features included child demographic, environmental, and structural and resting-state fMRI variables, parental depression symptoms and demographic characteristics, and relevant site and scanner-related covariates. We used linear (elastic net regression, EN) and non-linear (gradient boosted trees, GBT) predictive models to identify which set of features maximized prediction of depression symptoms at baseline and, separately, at one-year follow-up.

ResultsBoth linear and non-linear models achieved comparable results for predicting baseline (EN: MAE=3.628; R2=0.232; GBT: MAE=3.555; R2=0.229) and one-year follow-up (EN: MAE=4.116; R2=0.143; GBT: MAE=4.141; R2=0.1400) depression. Parental depression symptoms, family support, and child sleep duration were among the top predictors of concurrent and future child depression symptoms across both models. Although resting-state fMRI features were relatively weaker predictors, connectivity of the right caudate was consistently the strongest neural feature associated with depression symptoms at both timepoints. In contrast, brain features derived from structural MRI did not significantly predict child depression symptoms.

Conclusions & RelevanceParental mental health and child sleep quality are potentially modifiable risk factors for youth depression. Functional connectivity of the caudate is a relatively weaker predictor of depression symptoms but may represent a biomarker of depression risk.

category: psychiatry and clinical psychology


title: Prevalence of dementia in elderly age population of Barangay Bangkal, City

abstract:
BackgroundDementia, a significant cause of disability and dependency among older adults. The growing population of the elderly in the Philippines is expected to increase the prevalence of dementia in the country.

PurposeThis study aims to determine the prevalence of dementia in the elderly population of Barangay Bangkal, Makati City.

MethodsDescriptive cross-sectional community-based study was conducted to determine the prevalence of dementia in the elderly population of Barangay Bangkal, Makati City, aged 60 years and above over one month from mid-October to mid-November 2019. Data was collected with help of Mini-Mental State Examination - Philippines version (MMSE-P) to determine the cognitive status and diagnose dementia in elderly population.

ResultsA total of 266 elderly adults participated in the study. Representatives of the study population were male (59.0%), married (68.0%), with an income of less than 5,000 peso (51.1%), working (64.3%), and with high school education (42.1%). The average age of the study population was 68.02 (+ 6.76) years. The average MMSE score of the participants was 27.05 (+ 3.94). The prevalence of dementia in the sample was 18.8%. Age, income, and level of education were associated with the MMSE score (r{square} = - 0.26, n = 266, p < 0.001, r{square} = 0.23, n = 266, p < 0.001, and rs = 0.19, n = 266, p = 0.002, respectively). The findings for statistical significance do resonate with clinical significance as evident during administration of MMSE score.

ConclusionAdvancing age increases the risk for cognitive decline while higher income and education level prevent or delays the onset of dementia. Collaborative management between the medical education faculty & students, researchers, and local state health officials might address dementia in the region.


title: How has the COVID-19 pandemic impacted on smoking and nicotine dependence among people with severe mental ill health? Analysis of linked data from a UK Closing the Gap Cohort

abstract: Smoking rates are higher for people who use mental health services which contributes substantially to health inequalities. Smoking can lead to worse COVID-19 outcomes, yet it remains unclear whether smoking has changed for people who use mental health services. We examined smoking patterns in a large clinical cohort of people with SMI before and during the pandemic. We found high levels of nicotine dependence and heavier patterns of smoking. Whilst some people had reported quitting, it is likely that smoking inequalities have become further entrenched. Mental health services should seek to mitigate this modifiable risk and source of poor health.


title: Childhood immunisation coverage in Kenya by socioeconomic, geographic, maternal, child, and place of birth characteristics: equity impact analysis

abstract:
BackgroundThe global Immunisation Agenda 2030 highlights coverage and equity as a strategic priority goal to reach high equitable immunisation coverage at national levels and in all districts. We estimated inequities in full immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics among children aged 12-23 months in Kenya.

MethodsWe analysed full immunisation coverage (1-dose BCG, 3-dose DTP-HepB-Hib (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B), 3-dose polio, 1-dose measles, and 3-dose pneumococcal vaccines) of 3,943 children aged 12-23 months from the 2014 Kenya Demographic and Health Survey. We disaggregated mean coverage by socioeconomic (household wealth, religion, ethnicity), geographic (place of residence, province), maternal (maternal age at birth, maternal education, maternal marital status, maternal household head status), child (sex of child, birth order), and place of birth characteristics, and estimated inequities in full immunisation coverage using bivariate and multivariate logistic regression.

ResultsImmunisation coverage ranged from 82% [81-84] for the third dose of polio to 97.4% [96.7-98.2] for the first dose of DTP-HepB-Hib, while full immunisation coverage was 68% [66-71] in 2014. After controlling for other background characteristics through multivariate logistic regression, children of mothers with primary school education or higher have at least 54% higher odds of being fully immunised compared to children of mothers with no education. Children born in clinical settings had 41% higher odds of being fully immunised compared to children born in home settings. Children in the Coast, Western, Central, and Eastern regions had at least 74% higher odds of being fully immunised compared to children in the North Eastern region, while children in urban areas had 26% lower odds of full immunisation compared to children in rural areas. Children in the middle and richer wealth quintile households were 43-57% more likely to have full immunisation coverage compared to children in the poorest wealth quintile households. Children who were sixth born or higher had 37% lower odds of full immunisation compared to first-born children.

ConclusionsChildren of mothers with no education, born in home settings, in regions with limited health infrastructure, living in poorer households, and of higher birth order are associated with lower rates of full immunisation. Targeted programmes to reach under-immunised children in these subpopulations will lower the inequities in childhood immunisation coverage in Kenya.

category: public and global health


title: Inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics in Kenya


title: Pattern of Severity of Road Traffic Injuries Among Pedestrians in Low- and Middle-Income Countries: A Systematic Review

abstract:
BackgroundLow-and middle-income countries (LMICs) contribute about 93 per cent of road traffic injuries (RTIs) and deaths worldwide with a significant proportion of pedestrians (22 per cent). Various scales are used to assess the pattern of injury severity, which are useful in predicting the outcomes of RTIs. We conducted this systematic review to determine the pattern of RTI severity among pedestrians in LMICs.

MethodsWe searched the electronic databases PubMed, CINHAL, CENTRAL, Web of Science, Scopus, EMBASE, ProQuest and SciELO, and examined the references of the selected studies. Original research articles published on the RTI severity among pedestrians in LMICs during 1997-2016 were eligible for this review. Quality of publications was assessed using an adapted Newcastle-Ottawa Scale of observational studies. Findings of this study were presented as a meta-summary.

ResultsFive articles from 3 LMICs were eligible for the systematic review. Abbreviated Injury Score, Glasgow Coma Scale and Maxillofacial Injury Severity Score were used to assess the injury severity in the selected studies. In a multicentric study from China (2013), 21, 38 and 19 per cent pedestrians with head injuries had AIS scores 1-2, 3-4 and 5-6, respectively. In another study from China (2010), the proportion of AIS score 1-2 and AIS score 3 and above (serious to un-survivable) injuries occurred due to crash with sedan cars were 65 and 35 per cent, respectively. Such injuries due to minivan crashes were 49.5 per cent and 50.5 per cent, respectively. Two studies Ikeja, Nigeria (2014) and Elazig, Turkey (2009) presented, 24.5 and 32.5 per cent injured had a severe head injury (GCS < 8), respectively. In another study from Ibadan, Nigeria (2014), the severe maxillofacial injuries were seen in the victims of car/minibus pedestrian crashes 46 per cent, and 17 per cent had a fatal outcome.

ConclusionA varied percent of pedestrians (24.5 to 57 percent) had road traffic injuries of serious to fatal nature, depending on type of collision and injury severity scale. This study pressed the need to conduct studies with a robust methodology on the pattern of RTI severity among pedestrians to guide the programme managers, researchers and policymakers in LMICs to formulate the policies and programmes to save the pedestrian lives.

African relevanceO_LIPrior RTI research reveals that pedestrians and cyclists were at the highest risk of fatality of in Sub-Saharan Africa, whereas motorcyclists had significantly higher fatality rates in Asian countries such as Malaysia and Thailand (1-3).
C_LIO_LIFifty-seven type of injury severity scoring systems have been developed to assess the injury severity for triage and timely decision making for patient treatment need, outcome prediction, quality of trauma care, and epidemiological research and evaluation (4,5).
C_LIO_LIWe found two studies from sub-Saharan Africa in this review which showed that severe pedestrian injuries ranged from 24.5 to 46 per cent of total pedestrian RTIs.
C_LIO_LIDespite the findings of review affected by limited and variegated sample, it could be useful to guide for future research.
C_LI


title: Fear and death anxiety among Latin American doctors during the Covid-19 pandemic

abstract:
IntroductionA patients death elicits various feelings arise in doctors such as impotence and guilt that could trigger physical or psychological symptoms. Despite its impact, few studies have explored anxiety and fear of death among physicians.

ObjectiveTo evaluate perceptions and responses to ones mortality among Latin American physicians treating COVID-19 patients.

MethodologyThis cross-sectional study utilized the Collet-Lester Modified Fear of Death Scale and the Death Anxiety Scale (DAS) to collect data from physicians in Latin America.

Results219 doctors from Peru, Mexico, Argentina, Colombia, and Bolivia filled out the online questionnaire. Fear of death among the sample population ranged from 56.2% to 90%. Furthermore, the prevalence of "High Anxiety" was 80.8%. A statistically significant association was found between fear according to age and time of graduation (p = 0.010 and p = 0.020, respectively). No differences were found by gender, age, and country of origin or practice.

ConclusionPhysicians experience feelings of helplessness and guilt upon the death of a patient and those feelings can trigger physical or psychological symptoms. For these states of fear and anxiety about death, more frequent in times of pandemic, doctors must be prepared, and institutions must provide them with the necessary means to help them overcome these difficult times.