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1.
Pan Afr Med J ; 47: 5, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38371652

RESUMO

Introduction: self-quarantine was one of the key public health interventions in halting the spread of the coronavirus disease (COVID-19) in Ghana. Despite its success, self-quarantine was bridled with challenges across the country, including in the Eastern Region. Consequently, it was pertinent to ascertain these challenges to inform future self-quarantine interventions in the region and the country. The study aimed to ascertain challenges faced by COVID-19 self-quarantined persons in the Eastern Region of Ghana to inform future policies on self-quarantine in the region and the country in general. Methods: thirty-five (35) participants were interviewed in both Twi and English. Following the thematic content analysis approach, Atlas. ti software was used to analyse the data. Relevant quotes were extracted from the transcripts to back the various sub-themes in presenting the results. Results: three global themes emerged from the analyses: socio-economic challenges of self-quarantine (lack of access to essential goods and services, loss of income, and poor housing conditions), health-related challenges (sedentary lifestyle, non-supply of essential personal protective equipment such as face masks, development of oedema and weight gain), and psychological challenges (loneliness, boredom, and anxiety). Conclusion: COVID-19-related challenges self-quarantined persons faced in the Eastern Region of Ghana were multifaceted, ranging from socio-economic, and health to psychological ones. Consequently, emergency preparedness for future pandemic control using self-quarantine as a tool should bring on board various stakeholders to ensure challenges identified in this study are holistically addressed and do not recur.


Assuntos
COVID-19 , Quarentena , Humanos , Quarentena/psicologia , COVID-19/prevenção & controle , Gana , SARS-CoV-2 , Saúde Pública
3.
Disaster Med Public Health Prep ; 18: e29, 2024 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-38372077

RESUMO

OBJECTIVE: The objective of this study was to describe changes in emergency department volumes after statewide lockdown in a network of hospitals across the United States during the COVID-19 global pandemic. METHODS: A retrospective study was performed utilizing data on daily volumes across multiple emergency departments from a centralized data warehouse from a private for-profit hospital system during the COVID-19 pandemic. The mean daily volumes of 148 emergency departments were evaluated across 16 states in relation to each state's governmental statewide lockdown orders. Comparisons of the same period in the prior year were evaluated for percent changes in volumes. We also compared pre-lockdown to post-lockdown volumes. A separate analysis was made for the pediatric ED volumes. RESULTS: The 2020 post-lockdown volumes compared to the same 2019 dates revealed a mean percent change of -43.09%. The overall post-lockdown volumes compared to the pre-lockdown volumes had a mean percent change of -45.00%. The pediatric data revealed a greater mean percentage change in volumes of -71.52% (post-lockdown compared to 2019) and -69.03% (post-lockdown compared to pre-lockdown). CONCLUSIONS: This study found an overall decrease in volumes among 148 emergency departments across 16 states when compared to the comparable period pre-global pandemic.


Assuntos
COVID-19 , Estados Unidos/epidemiologia , Humanos , Criança , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Pandemias/prevenção & controle , Estudos Retrospectivos , Serviço Hospitalar de Emergência
4.
Disaster Med Public Health Prep ; 18: e27, 2024 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-38372080

RESUMO

OBJECTIVE: The objective of this work was to study mortality increase in Spain during the first and second academic semesters of 2020, coinciding with the first 2 waves of the Covid-19 pandemic; by sex, age, and education. METHODS: An observational study was carried out, using linked populations and deaths' data from 2017 to 2020. The mortality rates from all causes and leading causes other than Covid-19 during each semester of 2020, compared to the 2017-2019 averages for the same semester, was also estimated. Mortality rate ratios (MRR) and differences were used for comparison. RESULTS: All-cause mortality rates increased in 2020 compared to pre-covid, except among working-age, (25-64 years) highly-educated women. Such increases were larger in lower-educated people between the working age range, in both 2020 semesters, but not at other ages. In the elderly, the MMR in the first semester in women and men were respectively, 1.14, and 1.25 among lower-educated people, and 1.28 and 1.23 among highly-educated people. In the second semester, the MMR were 1.12 in both sexes among lower-educated people and 1.13 in women and 1.16 in men among highly-educated people. CONCLUSION: Lower-educated people within working age and highly-educated people at older ages showed the greatest increase in all-cause mortality in 2020, compared to the pre-pandemic period.


Assuntos
COVID-19 , Masculino , Humanos , Feminino , Idoso , Adulto , Pessoa de Meia-Idade , COVID-19/epidemiologia , Pandemias , Espanha/epidemiologia , Escolaridade , Mortalidade
5.
Cell Mol Biol (Noisy-le-grand) ; 70(1): 12-18, 2024 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-38372119

RESUMO

SARS-CoV-2, the virus responsible for COVID-19, enters host cells by binding its spike protein's receptor-binding domain (RBD) to the human angiotensin-converting enzyme 2 (ACE2) receptor's peptidase domain (PD). This interaction plays a crucial role in the virus's ability to invade host cells and establish infection. Numerous studies have identified specific residues crucial for their binding interaction. Our objective was to determine whether natural variations in the ACE2 receptor could impact its affinity for the S-protein RBD. To explore this, we focused on investigating the effects of natural variations in the ACE2 PD residues on its binding affinity to the S-protein RBD interface of SARS-CoV-2. We conducted a genotyping study in the Iraqi Kurdish population and identified significant genetic variations in key binding residues of the ACE2 PD residues, including N330K, K353R, R357Q, P389H, and R393H. These variations suggest a distinct genetic profile specific to the Kurdish population regarding their interaction with the SARS-CoV-2 virus. Understanding the implications of these variations is essential for comprehending the mechanisms of viral infection, developing targeted therapeutics, and refining treatment strategies and vaccine design. Additionally, studying these variations can provide insights into population-specific vulnerabilities, help monitor viral evolution and transmission, and guide the development of effective interventions.


Assuntos
COVID-19 , SARS-CoV-2 , Humanos , SARS-CoV-2/genética , COVID-19/genética , Enzima de Conversão de Angiotensina 2/genética , Sítios de Ligação , Perfil Genético , Iraque , Ligação Proteica
7.
Arch Microbiol ; 206(3): 111, 2024 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-38372809

RESUMO

Coronaviruses are a diverse family of viruses, and new strains can emerge. While the majority of coronavirus strains cause mild respiratory illnesses, a few are responsible for severe diseases such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). SARS-CoV-2, the virus responsible for COVID-19, is an example of a coronavirus that has led to a pandemic. Coronaviruses can mutate over time, potentially leading to the emergence of new variants. Some of these variants may have increased transmissibility or resistance to existing vaccines and treatments. The emergence of the COVID-19 pandemic in the recent past has sparked innovation in curbing virus spread, with sanitizers and disinfectants taking center stage. These essential tools hinder pathogen dissemination, especially for unvaccinated or rapidly mutating viruses. The World Health Organization supports the use of alcohol-based sanitizers and disinfectants globally against pandemics. However, there are ongoing concerns about their widespread usage and their potential impact on human health, animal well-being, and ecological equilibrium. In this ever-changing scenario, metal nanoparticles hold promise in combating a range of pathogens, including SARS-CoV-2, as well as other viruses such as norovirus, influenza, and HIV-1. This review explores their potential as non-alcoholic champions against SARS-CoV-2 and other pandemics of tomorrow. This extends beyond metal nanoparticles and advocates a balanced examination of pandemic control tools, exploring their strengths and weaknesses. The manuscript thus involves the evaluation of metal nanoparticle-based alternative approaches as hand sanitizers and disinfectants, providing a comprehensive perspective on this critical issue.


Assuntos
COVID-19 , Desinfetantes , Nanopartículas Metálicas , Animais , Humanos , SARS-CoV-2/genética , Desinfetantes/farmacologia , COVID-19/prevenção & controle , Pandemias/prevenção & controle
8.
JMIR Hum Factors ; 11: e44258, 2024 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-38373020

RESUMO

BACKGROUND: As the SARS-CoV-2 virus created a global pandemic and rapidly became an imminent threat to the health and lives of people worldwide, the need for a vaccine and its quick distribution among the population was evident. Due to the urgency, and on the back of international collaboration, vaccines were developed rapidly. However, vaccination rollouts showed different success rates in different countries and some also led to increased vaccine hesitancy. OBJECTIVE: The aim of this study was to identify the role of information sharing and context sensitivity in various vaccination programs throughout the initial COVID-19 vaccination rollout in different countries. Moreover, we aimed to identify factors in national vaccination programs related to COVID-19 vaccine hesitancy, safety, and effectiveness. Toward this end, multidisciplinary and multinational opinions from members of the Navigating Knowledge Landscape (NKL) network were analyzed. METHODS: From May to July 2021, 25 completed questionnaires from 27 NKL network members were collected. These contributors were from 17 different countries. The responses reflected the contributors' subjective viewpoints on the status and details of the COVID-19 vaccination rollout in their countries. Contributors were asked to identify strengths, weaknesses, opportunities, and threats (ie, SWOT) of the respective vaccination programs. The responses were analyzed using reflexive thematic analysis, followed by frequency analysis of identified themes according to the represented countries. RESULTS: The perspectives of NKL network members showed a link between organizational elements of the vaccination rollout and the accompanying societal response, both of which were related to strengths and weaknesses of the process. External sociocultural variables, improved public communication around vaccination-related issues, ethical controversies, and the spread of disinformation were the dominant themes related to opportunities and challenges. In the SWOT 2×2 matrix, Availability and Barriers emerged as internal categories, whereas Transparent communication and promotion and Societal divide emerged as key external categories. CONCLUSIONS: Inventory of themes and categories inspired by elements of the SWOT framework provides an informative multidisciplinary perspective for effective implementation of public health strategies in the battle against COVID-19 or any future pandemics of a similar nature.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Humanos , Vacinas contra COVID-19/uso terapêutico , COVID-19/epidemiologia , SARS-CoV-2 , Vacinação , Comunicação
9.
JMIR Ment Health ; 11: e49317, 2024 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-38373030

RESUMO

BACKGROUND: The widespread occurrence and devastating impact of adolescent depression warrant health service research focused on feasible and acceptable digital health tools to supplement evidence-based intervention (EBI) efforts, particularly in the context of shelter-in-place guidelines disrupting youth socialization and service use in the wake of the COVID-19 pandemic. Given the promise of SMS text message interventions to enhance EBI engagement, our team developed the HealthySMS system as an adjunct to one of the most empirically supported interventions for adolescent depression: cognitive behavioral therapy (CBT) group services. The system sends daily SMS text messages requesting responses assessing mood, thoughts, and activities; weekly attendance reminder messages; daily tips about adherence (eg, a prompt for activity completion); and personalized responses based on participants' texts. OBJECTIVE: This study aims to evaluate the feasibility and acceptability of HealthySMS in a real-world setting and explore potential mechanisms of change in EBI engagement, before evaluating the system's impact on adolescents' group CBT engagement and, ultimately, depression outcomes. METHODS: Over the course of 2020, we invited all 20 adolescents receiving CBT group services for depression at an outpatient psychiatry clinic to enroll in our HealthySMS study; ultimately, 17 (85%) adolescents agreed to participate. We tracked participant initiation and engagement with the HealthySMS system as well as the content of SMS text message responses to HealthySMS. We also invited each participant to engage in a semistructured interview to gather additional qualitative inputs on the system. RESULTS: All (n=17, 100%) research participants invited agreed to receive HealthySMS messages, and 94% (16/17) of the participants maintained use during the first month without opting out. We uncovered meaningful qualitative themes regarding the feasibility and acceptability of HealthySMS, as well as its potential impact on EBI engagement. CONCLUSIONS: Taken together, the results of this pilot study suggest that HealthySMS adjunct to adolescent CBT group depression services is feasible and acceptable, as evidenced by high rates of HealthySMS initiation and low rates of dropout, as well as meaningful themes uncovered from participants' qualitative feedback. In addition, the findings provide evidence regarding iterative improvements to the HealthySMS system and research protocol, as well as potential mechanisms of change for enhanced EBI engagement and, ultimately, adolescent depression outcomes, which can be used in future effectiveness research.


Assuntos
COVID-19 , Terapia Cognitivo-Comportamental , Envio de Mensagens de Texto , Humanos , Adolescente , Estudos de Viabilidade , Pandemias , Projetos Piloto
10.
Acta Psychol (Amst) ; 243: 104164, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38309223

RESUMO

BACKGROUND: Loneliness is quickly becoming an enormous problem among individuals of all age groups. The onset of Covid-19 has worsened this situation. Therefore, there is urgent need for a practical intervention, which may improve the social well-being of an individual addressing the root cause of loneliness. AIM: In this study we examine the benefits of Sudarshan Kriya Yoga (SKY), a yogic breathing practice to enhance social connectedness among individuals by reducing stress. METHODOLOGY: 473 participants registering for the SKY program enrolled in the current open feasible trial. Assessment of social connectedness was done using Social Connectedness Scale (SCS). Stress was measured using the Perceived Stress Scale (PSS) pre- and post- SKY intervention. Outcomes were measured at three different time points namely, baseline (pre-program), post-program, and day 40. Day 40 was 40 days after the completion of the Sudarshan Kriya program. RESULTS: Significant increase in SCS scores (p value <0.001) was found immediately after the SKY intervention. The SCS scores improved positively with regular practice of the intervention with a large effect size (p value <0.001, measured on day 40). The Stress scores significantly reduced post-intervention (p value <0.001). CONCLUSION: The study suggested a positive connection between the SKY practice and subsequent improvement in social connectedness. The reduction in stress levels post SKY program as indicated in the study may be a reason of enhanced social connectedness. Large scale studies with inclusion of control group can further affirm the study results.


Assuntos
COVID-19 , Meditação , Testes Psicológicos , Yoga , Adulto , Humanos , COVID-19/epidemiologia , Autorrelato , Estudos de Viabilidade
12.
Cancer Invest ; 42(1): 4-11, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38317281

RESUMO

Multidisciplinary team meeting (MDT) became a standard of care in cancer management. The COVID-19 epidemic induced unprecedented pressure on the health system. The impact of this health crisis on MDTs held within a regional French health structures was analyzed. A decrease in the total number of records discussed in hematological, digestive, thoracic, gynecological and genitourinary MDTs was observed following the 1st wave of the COVID-19 pandemic. This decrease was generally maintained during the 2nd and 3rd wave. MDTs activity back in order from the 4th wave. The COVID-19 pandemic has challenged MDTs settings. The implementation of virtual technologies offers an opportunity to improve MDTs organization.


Assuntos
COVID-19 , Neoplasias , Humanos , Pandemias , Equipe de Assistência ao Paciente , COVID-19/epidemiologia , Neoplasias/epidemiologia , Neoplasias/terapia , Surtos de Doenças
13.
J Clin Immunol ; 44(2): 59, 2024 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-38319477

RESUMO

The long-term effects of SARS-CoV-2 infection represent a relevant global health problem. Long COVID (LC) is defined as a complex of signs and symptoms developed during or after SARS-CoV-2 infection and lasting > 12 weeks. In common variable immunodeficiency (CVID) patients, we previously reported higher risk of hospitalization and death during SARS-CoV-2 infection, as well as prolonged swab positivity and frequent reinfections. The aim of the present study was to assess the risk of LC in an Italian cohort of CVID patients. We used a translated version of the survey proposed by Centers for Disease Control and Prevention (CDC) to collect data on LC. In the enrolled cohort of 175 CVID patients, we found a high prevalence of LC (65.7%). The most frequent LC symptoms were fatigue (75.7%), arthralgia/myalgia (48.7%), and dyspnea (41.7%). The majority of patients (60%) experienced prolonged symptoms, for at least 6 months after infection. In a multivariate analysis, the presence of complicated phenotype (OR 2.44, 95% CI 1.88-5.03; p = 0.015), obesity (OR 11.17, 95% CI 1.37-90.95; p = 0.024), and female sex (OR 2.06, 95% CI 1.09-3.89; p = 0.024) significantly correlated with the development of LC. In conclusion, in this multicenter observational cohort study, we demonstrated that CVID patients present an increased prevalence of LC when compared to the general population. Improved awareness on the risk of LC in CVID patients could optimize management of this new and alarming complication of SARS-CoV-2 infection.


Assuntos
COVID-19 , Imunodeficiência de Variável Comum , Estados Unidos , Humanos , Feminino , Síndrome Pós-COVID-19 Aguda , COVID-19/epidemiologia , Imunodeficiência de Variável Comum/epidemiologia , Prevalência , SARS-CoV-2 , Itália/epidemiologia
14.
J Am Heart Assoc ; 13(4): e030749, 2024 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-38323513

RESUMO

BACKGROUND: The objective of the PERSONAL-CovidBP (Personalised Electronic Record Supported Optimisation When Alone for Patients With Hypertension: Pilot Study for Remote Medical Management of Hypertension During the COVID-19 Pandemic) trial was to assess the efficacy and safety of smartphone-enabled remote precision dosing of amlodipine to control blood pressure (BP) in participants with primary hypertension during the COVID-19 pandemic. METHODS AND RESULTS: This was an open-label, remote, dose titration trial using daily home self-monitoring of BP, drug dose, and side effects with linked smartphone app and telemonitoring. Participants aged ≥18 years with uncontrolled hypertension (5-7 day baseline mean ≥135 mm Hg systolic BP or ≥85 mm Hg diastolic BP) received personalized amlodipine dose titration using novel (1, 2, 3, 4, 6, 7, 8, 9 mg) and standard (5 and 10 mg) doses daily over 14 weeks. The primary outcome of the trial was mean change in systolic BP from baseline to end of treatment. A total of 205 participants were enrolled and mean BP fell from 142/87 (systolic BP/diastolic BP) to 131/81 mm Hg (a reduction of 11 (95% CI, 10-12)/7 (95% CI, 6-7) mm Hg, P<0.001). The majority of participants achieved BP control on novel doses (84%); of those participants, 35% were controlled by 1 mg daily. The majority (88%) controlled on novel doses had no peripheral edema. Adherence to BP recording and reported adherence to medication was 84% and 94%, respectively. Patient retention was 96% (196/205). Treatment was well tolerated with no withdrawals from adverse events. CONCLUSIONS: Personalized dose titration with amlodipine was safe, well tolerated, and efficacious in treating primary hypertension. The majority of participants achieved BP control on novel doses, and with personalization of dose there were no trial discontinuations due to drug intolerance. App-assisted remote clinician dose titration may better balance BP control and adverse effects and help optimize long-term care. REGISTRATION: URL: clinicaltrials.gov. Identifier: NCT04559074.


Assuntos
COVID-19 , Hipertensão , Humanos , Adolescente , Adulto , Anti-Hipertensivos/uso terapêutico , Anlodipino/uso terapêutico , Smartphone , Pandemias , Projetos Piloto , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/induzido quimicamente , Pressão Sanguínea , Hipertensão Essencial/tratamento farmacológico , Resultado do Tratamento
15.
Z Geburtshilfe Neonatol ; 228(1): 65-73, 2024 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-38330961

RESUMO

BACKGROUND: Based on single case reports, the COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS) registry, sponsored by the German Society for Perinatal Medicine (DGPM), investigated the likelihood that SARS-CoV-2 infections of the mother in (early) pregnancy cause embryopathies and/or fetopathies. MATERIAL/METHODS: The CRONOS registry enrolled a total of 8032 women with confirmed SARS-CoV-2 infection during pregnancy at more than 130 participating hospitals from April 2020 to February 2023. Both maternal and fetal data were documented and the anonymized multicenter data were analyzed. RESULTS: Of 7142 fully documented pregnancies (including postnatal data), 140 showed congenital malformations. 8.57% of the mothers had had a SARS-CoV-2-infection in the 1st trimester and 36.43% in the 2nd trimester. In 66 cases with congenital malformations (47.14%), the malformation was only detected after the diagnosis of a maternal SARS-CoV-2 infection. The overall prevalence of congenital malformations in this cohort was 1.96%, compared to a prevalence of 2.39% reported in the EUROCAT (European network of population-based registries for the epidemiological surveillance of congenital anomalies) pre-pandemic registry between 2017-2019. DISCUSSION: Our multicenter data argue against a link between maternal SARS-CoV-2 infection in early pregnancy and congenital malformation.


Assuntos
COVID-19 , Complicações Infecciosas na Gravidez , Feminino , Humanos , Recém-Nascido , Gravidez , COVID-19/epidemiologia , COVID-19/diagnóstico , Incidência , Parto , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Sistema de Registros , SARS-CoV-2 , Estudos Multicêntricos como Assunto
16.
Acta Derm Venereol ; 104: adv18389, 2024 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-38348725

RESUMO

Herpes zoster (HZ) results from reactivation of latent varicella-zoster virus. Recent observations have suggested that HZ is associated with vaccination against COVID-19. To investigate the association between the vaccine and HZ severity, a single-centre, cross-sectional study of all patients diagnosed with HZ and 2 control diagnoses (cellulitis and bone fractures), between 2017 and 2021, was performed. Hospital visits and hospitalization rates were compared. All medical records of patients diagnosed with HZ in the first year after the COVID-19 vaccination campaign began were reviewed, in order to generate a retrospective cohort comparing vaccinated and unvaccinated patients with HZ. All participants had received the Pfizer-BioNTech COVID-19 (BNT162b2) vaccine. During the study period, 2,413 patients were diagnosed with HZ, and when normalized to control diagnoses the number of cases remained stable. The retrospective cohort included 365 patients. A multivariate analysis controlling for sex, age, autoimmune diseases, malignancies, and immunosuppressive therapy showed higher admission rates in vaccinated compared with unvaccinated individuals (odds ratio (OR) 2.75, 95% CI 1.27-5.96, p = 0.01). However, matching techniques and stratification by age, used to better control for confounders, invalidated these findings. No differences were observed in other variables indicative of disease severity (hospital stay length and complications). In conclusion, COVID-19 vaccination was not found to be associated with an increased risk of HZ-related admission and complications.


Assuntos
Vacina BNT162 , Vacinas contra COVID-19 , COVID-19 , Varicela , Herpes Zoster , Humanos , Vacina BNT162/efeitos adversos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Estudos Transversais , Herpes Zoster/epidemiologia , Herpes Zoster/prevenção & controle , Herpesvirus Humano 3 , Estudos Retrospectivos , Vacinação
17.
J Am Heart Assoc ; 13(4): e032143, 2024 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-38348793

RESUMO

Multisystemic inflammatory syndrome in adults is a hyperinflammatory condition following (within 4-12 weeks) SARS-CoV-2 infection. Here, the dysregulation of the immune system leads to a multiorgan involvement often affecting the heart. Cardiac involvement in multisystemic inflammatory syndrome in adults has been described mainly in young men without other comorbidities and may present with different clinical scenarios, including acute heart failure, life-threatening arrhythmias, pericarditis, and myocarditis, with a nonnegligible risk of mortality (up to 7% of all cases). The heterogeneity of its clinical features and the absence of a clear case definition make the differential diagnosis with other postinfectious (eg, infective myocarditis) and hyperinflammatory diseases (eg, adult Still disease and macrophage activation syndrome) challenging. Moreover, the evidence on the efficacy of specific treatments targeting the hyperinflammatory response underlying this clinical condition (eg, glucocorticoids, immunoglobulins, and other immunomodulatory agents) is sparse and not supported by randomized clinical trials. In this review article, we aim to provide an overview of the clinical features and the diagnostic workup of multisystemic inflammatory syndrome in adults with cardiac involvement, highlighting the possible pathogenetic mechanisms and the therapeutic management, along with remaining knowledge gaps in this field.


Assuntos
COVID-19 , Miocardite , Adulto , Masculino , Humanos , Miocardite/complicações , Miocardite/diagnóstico , Miocardite/terapia , Pacientes , Coração , COVID-19/complicações , Diagnóstico Diferencial , Síndrome
19.
BMJ Open ; 14(2): e076194, 2024 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-38367966

RESUMO

INTRODUCTION: Children with chronic medical diseases are at an unacceptable risk of hospitalisation and death from influenza and SARS-CoV-2 infections. Over the past two decades, behavioural scientists have learnt how to design non-coercive 'nudge' interventions to encourage positive health behaviours. Our study aims to evaluate the impact of multicomponent nudge interventions on the uptake of COVID-19 and influenza vaccines in medically at-risk children. METHODS AND ANALYSES: Two separate randomised controlled trials (RCTs), each with 1038 children, will enrol a total of approximately 2076 children with chronic medical conditions who are attending tertiary hospitals in South Australia, Western Australia and Victoria. Participants will be randomly assigned (1:1) to the standard care or intervention group. The nudge intervention in each RCT will consist of three text message reminders with four behavioural nudges including (1) social norm messages, (2) different messengers through links to short educational videos from a paediatrician, medically at-risk child and parent and nurse, (3) a pledge to have their child or themselves vaccinated and (4) information salience through links to the current guidelines and vaccine safety information. The primary outcome is the proportion of medically at-risk children who receive at least one dose of vaccine within 3 months of randomisation. Logistic regression analysis will be performed to determine the effect of the intervention on the probability of vaccination uptake. ETHICS AND DISSEMINATION: The protocol and study documents have been reviewed and approved by the Women's and Children's Health Network Human Research Ethics Committee (HREC/22/WCHN/2022/00082). The results will be published via peer-reviewed journals and presented at scientific meetings and public forums. TRIAL REGISTRATION NUMBER: NCT05613751.


Assuntos
COVID-19 , Vacinas contra Influenza , Influenza Humana , Criança , Feminino , Humanos , COVID-19/prevenção & controle , SARS-CoV-2 , Influenza Humana/prevenção & controle , Vacinação , Vitória , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
BMJ Open ; 14(2): e079627, 2024 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-38367975

RESUMO

OBJECTIVES: The personalised treatment demands of patients with psoriasis did not get significant attention during the pandemic lockdown. This study aimed to investigate the treatment demands of patients with psoriasis with different severities, stratified by COVID-19 pandemic conditions. DESIGN: Cross-sectional study design. SETTING: Multicentre study based on a national psoriasis registry in China. PARTICIPANTS: A total of 22 425 adult patients with psoriasis were enrolled between August 2020 and September 2021. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were patient demands for quick healing of skin lesions and improving mental health, which were collected by questionnaires. Multivariable logistic models were used to examine the impact of disease severity, as measured by Psoriasis Area and Severity Index (PASI), body surface area (BSA) and Investigator's Global Assessment (IGA), on treatment demands, as stratified by COVID-19 pandemic conditions (lockdown vs non-lockdown). RESULTS: Increasing PASI score significantly increased patient demands for rapid healing of skin lesions and improving mental health during non-lockdown periods. The magnitude of both associations further increased during the COVID-19 lockdown from an OR of 1.45 (95% CI 1.27 to 1.65) to 2.19 (95% CI 1.57 to 3.05) and 2.21 (95% CI 2.03 to 2.40) to 2.82 (95% CI 2.24 to 3.55), respectively. The skin lesion healing demand was more triggered by the overall irritation level (measured by IGA, OR 1.64, 95% CI 1.35 to 1.99 during non-lockdown periods vs OR 2.70, 95% CI 1.63 to 4.49 during lockdowns), while the mental health improving demand was more triggered by lesion coverage (measured by BSA, OR 2.01, 95% CI 1.85 to 2.19 vs OR 3.27, 95% CI 2.57 to 4.15). CONCLUSIONS: Psoriasis aggravation significantly increased patients' treatment demands, especially during lockdowns. The used psoriasis severity measures highlighted patients' treatment demands differently. This suggests more accessible and personalised healthcare for patients with psoriasis should be available during future pandemics.


Assuntos
COVID-19 , Psoríase , Adulto , Humanos , Pandemias , Estudos Transversais , Índice de Gravidade de Doença , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Psoríase/epidemiologia , Psoríase/terapia , Psoríase/patologia , Sistema de Registros , Imunoglobulina A
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