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1.
Journal of Obesity & Metabolic Syndrome ; 05:05, 2022.
Artigo em Inglês | MEDLINE | ID: covidwho-2025339

RESUMO

Background: Observational analyses have noted an association between obesity and poor clinical outcome from Coronavirus Disease 2019 (COVID-19). The mechanism for this finding remains unclear. Methods: We analyzed data from 22,915 COVID-19 patients hospitalized in non-intensive care units using the American Heart Association National COVID Registry of adult COVID-19 admissions from March 2020 to April 2021. A multivariable Poisson model adjusted for age, sex, medical history, admission respiratory status, hospitalization characteristics, and select laboratory findings was used to calculate length of stay (LOS) as a function of body mass index (BMI) category. Additionally, 5,327 patients admitted to intensive care units were similarly analyzed for comparison. Results: Relative to normal BMI subjects, overweight, class I obese, and class II obese patients had approximately half-day reductions in LOS (-0.469 days, P<0.01;-0.480 days, P<0.01;-0.578 days, P<0.01, respectively). Conclusion: The model identified a dose-dependent, inverse relationship between BMI category and LOS for COVID-19, which was not seen when the model was applied to critically ill patients.

2.
Virus Evol ; 8(2):veac078, 2022.
Artigo em Inglês | PubMed | ID: covidwho-2018109

RESUMO

The Omicron severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant led to a dramatic global epidemic wave following detection in South Africa in November 2021. The BA.1 Omicron lineage was dominant and responsible for most SARS-CoV-2 outbreaks in countries around the world during December 2021-January 2022, while other Omicron lineages, including BA.2, accounted for the minority of global isolates. Here, we describe the Omicron wave in the Philippines by analysing genomic data. Our results identify the presence of both BA.1 and BA.2 lineages in the Philippines in December 2021, before cases surged in January 2022. We infer that only the BA.2 lineage underwent sustained transmission in the country, with an estimated emergence around 18 November 2021 (95 per cent highest posterior density: 6-28 November), while despite multiple introductions, BA.1 transmission remained limited. These results suggest that the Philippines was one of the earliest areas affected by BA.2 and reiterate the importance of whole genome sequencing for monitoring outbreaks.

3.
Journal of General Internal Medicine ; 37:S269, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1995864

RESUMO

BACKGROUND: COVID-19 continues to be an ongoing problem worldwide, especially for those who are disproportionately affected due to their social determinants of health, as they are often at a socioeconomic disadvantage. We are primarily interested in evaluating how education level, income, race, ethnicity, and obesity are correlated with acute COVID-19 severity, and anxiety, depression, and quality of life ≥ 6 months post-infection. Specifically, obesity (BMI > 30), has been previously identified as a risk factor for COVID- 19 regarding severity and mortality. We found it imperative to further investigate these demographic variables, as they are vital in understanding how social determinants of health are impacting COVID-19 outcomes. Insights from this study can assist with identifying gaps in care for those with poor social determinants of health, as well as help shape care for those who have been disproportionately affected. METHODS: We examined records of COVID-19 patients through the COVID-19 Recovery Clinic at George Washington University in Washington, D.C. that has been collecting data on patient short and long-term COVID-19 outcomes in various domains along with demographic information since November 2020. Using RStudio with calculations of descriptive data, odds ratios, and p-values using Fisher's exact test, we assessed education level, income, race, ethnicity, and obesity and looked at how they correlated with COVID-19 severity at diagnosis, presence of anxiety, depression and quality of life ≥ 6 months after acute infection. RESULTS: From our sample (n=150), we found African Americans had greater acute COVID-19 severity (OR=7.56, 95% CI 2.22, 25.68, p=0.0015) relative to white individuals. We also found that obesity was associated with higher levels of acute COVID-19 severity (OR=4.89, 95% CI 1.36, 17.60, p=0.022).Additionally, during acute COVID-19 infection, 7/32 (21.9%) obese patients compared to 9/112 (8.0%) non-obese patients were hospitalized (OR=3.79, 95%CI=1.23, 11.68, p=0.03).No significant association was found between anxiety, depression, quality of life or COVID- 19 severity and persistent symptoms. CONCLUSIONS: We observed associations between the African American race and more severe acute COVID-19 infection. Further, in the acute phase, we observed that obese patients were more likely than non-obsese patients to have more severe infection and be hospitalized. These findings highlight preexisting gaps in healthcare outcomes regarding social determinants of health. It is essential to analyze many of the potential longer-term effects of COVID-19 infection, as they remain poorly understood. We conclude that larger studies are necessary to better understand the effects of social determinants of health on both short and long-term outcomes of COVID-19.

4.
Journal of General Internal Medicine ; 37:S320, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1995699

RESUMO

BACKGROUND: During the COVID-19 pandemic, most attention has been focused on the acute phase of the disease, but lingering symptoms from the postacute sequelae of COVID-19 (PASC) merit concern. The George Washington University COVID-19 Recovery Clinic is documenting these presentations to better understand PASC and its precipitating factors. The group implemented definitions for six phenotype categories: pulmonary, cardiac, connective tissue, vascular, central nervous system (CNS), and other. This research seeks to identify pre-existing factors that could affect disease severity, understand their effect on PASC symptoms at 6-15 months post-infection, and determine associations between patient history and PASC phenotypes. METHODS: An IRB-approved, retrospective cohort study was performed from charts of adult patients with persistent symptoms after acute COVID-19. Data were ed from clinical history prior to COVID-19 diagnosis, during acute COVID-19, and during the post-acute phase, including laboratory results and responses from mental health assessment tools. PASC phenotypes were determined clinically and hospitalization was used as a proxy for disease severity. Descriptive statistics, unadjusted odds ratios, and significance tests (Fisher's exact test, Chi-square test, and Mann-Whitney U test) were calculated using RStudio (4.1.1). RESULTS: Study participants with persistent symptoms at 6-15 months postinfection (n=116) had a mean age of 45.16 (SD 13.23), of which 70% were female, 60% were Caucasian, 12% were African-American, 9% were Asian, and 3% were Hispanic/Latino. When including all patients who had persistent symptoms at 1-15 months post-infection, those with obesity (BMI ≥30) or type 2 diabetes were much more likely to undergo a severe acute phase of COVID19 (OR 12.75;95% CI 1.91-84.95;p=0.02;n=61 and OR 34.67;95% CI 4.43-271.46;p<0.001;n=61 respectively). At 6-15 months post-infection, those suffering from a pulmonary PASC phenotype were more likely to have smoked (OR 3.27;95% CI 1.18-9.11;p=0.02;n=91). At the same period, those presenting with at least one CNS phenotype had a significantly higher level of C-reactive protein (CRP) than those without a CNS phenotype presentation (Mean 3.70 mg/L, SD 5.19 vs. Mean 1.26 mg/L, SD 2.36;p=0.009;n=53). Additionally, acute phase severity was not significantly associated with the presence of PASC. CONCLUSIONS: Our research further demonstrates the increased risk of severe acute COVID-19 among patients with obesity and type 2 diabetes. Furthermore, we show that those with a smoking history were more likely to continue to have pulmonary symptoms of COVID-19 at 6-15 months postinfection. Additionally, our study suggests that there may be a relationship between CRP and persistent CNS symptoms. A better understanding of these associations can help predict the full burden of COVID-19 and improve clinical guidance.

6.
Annals of Surgical Oncology ; 29(SUPPL 2):S419, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1928245

RESUMO

INTRODUCTION: With the pressure to reduce both cost of care and in-patient hospitalizations, particularly in the COVID era, several groups have reported the feasibility of outpatient mastectomies utilizing enhanced recovery after surgery (ERAS) programs. Having converted most mastectomies to the outpatient setting in 2009, we examined our experience sending patients home the same day, including patient selection, unexpected admission and post-operative complications, to better inform institutions considering their own outpatient mastectomy programs. METHODS: With approval from the Institutional Review Board, we performed a retrospective cohort study of patients undergoing mastectomy at a single academic medical center from 2014-2020. Patient population included all patients undergoing mastectomy for malignant disease or risk reduction and excluded patients having immediate breast reconstruction. RESULTS: Of 1678 patients undergoing mastectomy in this time period, 810 did not have immediate reconstruction. Overall, 428 (53%) were planned as outpatient procedures. This was dependent on the type of procedure;unilateral mastectomy (UM) (70%), modified radical mastectomy (MRM) (50%), bilateral simple mastectomies (BSM) (39%) and MRM with contralateral prophylactic mastectomy (MRM/CPM) (25%). The latter two increased over the time course of the study. Admission was associated with ASA status (34% ASA 1/2 vs 51% ASA 3/4, p< 0.001). The most significant predictor was surgeon, with rates ranging from 85% to 46% for UM, 80% to 13% for MRM, 68% to 18% for BSM and 55% to 9% for MRM/CPM. Overall, 16 (3.7%) same-day surgery patients were admitted while 14 (3.8%) 23-hour admission patients were converted to inpatient admissions. Post-operative hematomas requiring a second operation were more common with planned admission compared to those planned for same day discharge (19 (4.9%) vs. 10 (2.3%), p=0.036). CONCLUSIONS: Mastectomies (including bilateral and modified radical mastectomies) without reconstruction can be safely performed on an outpatient basis. Rates of unexpected hospitalizations and post-operative complications are low and there is no difference between those patients planning on same-day discharge and those planned for admission.

7.
Journal of Managed Care and Specialty Pharmacy ; 27(4-A SUPPL):S128, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1880081

RESUMO

BACKGROUND: Digital therapeutics (DTx) have grown in recent years in terms of market size and influence. Despite increasing interest, managed care organizations face barriers around DTx management. Disparate DTx coverage has led to unequal uptake and discrepancies around utilization management (UM) strategies. Thus, an unmet need exists for elucidating DTx coverage criteria and the evidence that shapes policy development. OBJECTIVE: To understand current DTx payer coverage policy patterns and anticipated future trends. METHODS: DTx medical policy research was conducted August to September 2020 using Canary Insights (Lakewood, CO). Following this surveillance, an online survey was fielded to payers from Xcenda's Managed Care Network. Respondents familiar with DTx were asked about DTx coverage, UM, policy criteria, and COVID-19 implications for DTx management. RESULTS: Fifty respondents (54% represent health plans, 26% pharmacy benefit managers, 20% integrated delivery network) completed the survey, and 88% evaluated ≥ 1 DTx in the past 12 to 18 months. Respondents reported that mobile apps (48%) and medication adherence platforms (40%) were the most reviewed and were expected to have the greatest increase in coverage demand over the next 12 to 18 months. Respondents indicated diabetes as the highest priority (66%) with the greatest impact in addressing unmet needs (52%). For UM, DTx coverage fell under medical benefit (41%) or was product dependent (43%). In evaluating DTx, clinical effectiveness (94%), safety (82%), and FDA-approved or cleared use (78%) were indicated as absolutely needed while clinical benefit (98%), peer-reviewed publications (94%), and return on investment (88%) were most useful for coverage decisions. The most cited rationale for either covering or denying DTx was evaluation of existing efficacy and safety data vs a lack of outcomes and cost data. For reauthorization, most respondents indicated documentation of positive clinical response (80%) and total cost of care reduction (71%) as requirements for re-authorization, while citing lack of long-term clinical data (73%) as the largest barrier for establishing re-authorization criteria, and 52% of respondents were interested in subscription-based or alternative pricing models for re-authorization. Respondents indicated that the COVID-19 pandemic has not impacted DTx coverage (58%), with no changes expected in the next 12 to 18 months (46%). CONCLUSIONS: Inconsistencies in DTx payer evaluation, coverage, and UM highlight the unmet need for establishing a standardized format for DTx appraisal.

8.
Medical Journal of Malaysia ; 77(1):237-240, 2022.
Artigo em Inglês | GIM | ID: covidwho-1864109

RESUMO

Introduction: Isolation of SARS-CoV-2-infected individuals is an important COVID-19 pandemic control measure. While most cases have uncomplicated infection, a small proportion of them has developed life-threatening disease. We set up a retrospective study to determine preadmission triaging tool to predict the development of severe COVID-19. Materials and Methods: A retrospective study was conducted from 1 October 2020 to 31 January 2021 with enrolment of all SARS-CoV-2 PCR-confirmed persons aged 13 years. The disease severity was assessed on admission and daily throughout the hospitalisation. Test-positive individuals were considered as having "severe COVID-19" if they had 1 of the following: room air oxygen saturation 30 breaths/minute, signs of severe respiratory distress, or received mechanical ventilation and/or vasopressor therapy. Uni- and multi-variate analyses using SPSS Statistics Ver. 26 were performed.

9.
Modern Pathology ; 35(SUPPL 2):18-19, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1857815

RESUMO

Background: End-stage kidney disease (ESKD) impacts more than 785,000 Americans and often occurs with multiple comorbid conditions, especially cardiovascular diseases, which are the most common cause of death (COD) in ESKD. Many complications directly arise from ESKD, but its deadly impact can be overlooked. At our institution, the death certificate is completed by clinicians and a majority by clinical house staff. We reviewed the death certificates of ESKD autopsies to understand the clinicians' perspectives on the range of CODs in this clinical setting. Design: We searched our database for autopsies of adult ESKD patients (2012-2021) that had accessible death certificates. COVID-positive cases were excluded. We evaluated the COD section of death certificates and correlated them with autopsy findings. The frequency of autopsy findings directly identifying CODs or resulting in amendments of death certificates was also noted. Results: Of 68 autopsy reports, the majority of CODs reported in death certificates were related to sepsis/infection (30%), and cardiovascular diseases (26%). There was no documentation of ESKD in the majority (78%,53/68) of death certificates. Of these 53 cases, 89% had COD either due to fatal complications of ESKD (98%) or increased mortality of another comorbid condition due to the underlying ESKD. The remaining 11% had COD unrelated to ESKD. Among the fatal complications of ESKD, cardiovascular complications were the most commonly noted (72%) followed by sepsis (20%). Autopsy findings were used to identify the COD on death certificates in only 6% of cases. No amendments were made on any of these death certificates. Conclusions: ESRD is often not mentioned in death certificates, which underestimates its mortality burden. The death certificate is a source for mortality statistics and used by government for public health policy and allocation of research funding. Hence, accurate accounting of death certificates is essential for this complex and silent disease.

10.
Journal of Pain ; 23(5):5-6, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1851619

RESUMO

Chronic pain produces the largest non-fatal burden of disease, yet our understanding of factors that contribute to the transition from acute chronic pain are poorly understood. The Acute to Chronic Pain Signatures Program (A2CPS) is a longitudinal, multi-site observational study to identify biomarkers (individual or biosignature combinations) that predict susceptibility or resilience to the development of chronic pain after surgery (knee replacement or thoracotomy). Due to the COVID-19 pandemic, however, travel between sites was restricted just as the study was preparing to begin enrollment. Here, we present multiple training protocol adaptations that were successfully implemented to facilitate remote research-related training. The A2CPS consortium includes 2 Multisite Clinical Centers (MCCs, 10 recruitment sites), a Clinical Coordinating Center (CCC), a Data Integration and Resource Center (DIRC), 3 Omics Data Generation Centers, and representation from the NIH Pain Consortium, Common Fund, and National Institute of Drug Abuse. The A2CPS is collecting candidate and exploratory biomarkers including pain, fatigue, function, sleep, psychosocial factors, quantitative sensory testing (QST), genomics, proteomics, metabolomics, lipidomics, and brain imaging. The CCC adapted the A2CPS training and evaluation techniques for certifying the MCCs to ensure competency with recruitment, assessments (surveys, QST, function), and data entry across clinical sites using a combination of virtual training sessions, standardized quantitative measurements, video demonstrations, and reliability assessments. Staff at data collection sites have been successfully certified in all psychophysical assessments (QST, function). This included use of stop watches and metronomes to ensure standard application rates, completion of application-rate and inter-rater-reliability worksheets at each clinical site, designation of site-specific master examiners, training rubrics and video demonstration to verify competency was harmonized across sites. Adaptation of training protocols to a remote format enabled initiation of subject enrollment while maintaining documented standards with high data completion rates for surveys and assessments. The A2CPS Consortium is supported by the National Institutes of Health Common Fund, which is managed by the OD/Office of Strategic Coordination (OSC). Consortium components include: Clinical Coordinating Center (UO1NS077179), Data Integration and Resource Center (UO1NS077352), Omics Data Generation Centers (U54DA049116, U54DA049115, U54DA09113), and Multisite Clinical Centers: MCC 1 (UM1NS112874) and MCC 2 (UM1NS118922). Postdoctoral support for GB provided by the National Institutes of Neurological Disease and Stroke (NINDS) of the NIH under Award Number U24NS112873-03S2.

11.
Annals of Behavioral Medicine ; 56(SUPP 1):S282-S282, 2022.
Artigo em Inglês | Web of Science | ID: covidwho-1848447
12.
PubMed; 2021.
Preprint em Inglês | PubMed | ID: ppcovidwho-333816

RESUMO

The global COVID-19 pandemic has sparked intense interest in the rapid development of vaccines as well as animal models to evaluate vaccine candidates and to define immune correlates of protection. We recently reported a mouse-adapted SARS-CoV-2 virus strain (MA10) with the potential to infect wild-type laboratory mice, driving high levels of viral replication in respiratory tract tissues as well as severe clinical and respiratory symptoms, aspects of COVID-19 disease in humans that are important to capture in model systems. We evaluated the immunogenicity and protective efficacy of novel rhesus adenovirus serotype 52 (RhAd52) vaccines against MA10 challenge in mice. Baseline seroprevalence is lower for rhesus adenovirus vectors than for human or chimpanzee adenovirus vectors, making these vectors attractive candidates for vaccine development. We observed that RhAd52 vaccines elicited robust binding and neutralizing antibody titers, which inversely correlated with viral replication after challenge. These data support the development of RhAd52 vaccines and the use of the MA10 challenge virus to screen novel vaccine candidates and to study the immunologic mechanisms that underscore protection from SARS-CoV-2 challenge in wild-type mice. IMPORTANCE: We have developed a series of SARS-CoV-2 vaccines using rhesus adenovirus serotype 52 (RhAd52) vectors, which exhibits a lower seroprevalence than human and chimpanzee vectors, supporting their development as novel vaccine vectors or as an alternative Ad vector for boosting. We sought to test these vaccines using a recently reported mouse-adapted SARS-CoV-2 (MA10) virus to i) evaluate the protective efficacy of RhAd52 vaccines and ii) further characterize this mouse-adapted challenge model and probe immune correlates of protection. We demonstrate RhAd52 vaccines elicit robust SARS-CoV-2-specific antibody responses and protect against clinical disease and viral replication in the lungs. Further, binding and neutralizing antibody titers correlated with protective efficacy. These data validate the MA10 mouse model as a useful tool to screen and study novel vaccine candidates, as well as the development of RhAd52 vaccines for COVID-19.

13.
PubMed; 2021.
Preprint em Inglês | PubMed | ID: ppcovidwho-333803

RESUMO

Global deployment of vaccines that can provide protection across several age groups is still urgently needed to end the COVID-19 pandemic especially for low- and middle-income countries. While vaccines against SARS-CoV-2 based on mRNA and adenoviral-vector technologies have been rapidly developed, additional practical and scalable SARS-CoV-2 vaccines are needed to meet global demand. In this context, protein subunit vaccines formulated with appropriate adjuvants represent a promising approach to address this urgent need. Receptor-binding domain (RBD) is a key target of neutralizing antibodies (Abs) but is poorly immunogenic. We therefore compared pattern recognition receptor (PRR) agonists, including those activating STING, TLR3, TLR4 and TLR9, alone or formulated with aluminum hydroxide (AH), and benchmarked them to AS01B and AS03-like emulsion-based adjuvants for their potential to enhance RBD immunogenicity in young and aged mice. We found that the AH and CpG adjuvant formulation (AH:CpG) demonstrated the highest enhancement of anti-RBD neutralizing Ab titers in both age groups (~80-fold over AH), and protected aged mice from the SARS-CoV-2 challenge. Notably, AH:CpG-adjuvanted RBD vaccine elicited neutralizing Abs against both wild-type SARS-CoV-2 and B.1.351 variant at serum concentrations comparable to those induced by the authorized mRNA BNT162b2 vaccine. AH:CpG induced similar cytokine and chemokine gene enrichment patterns in the draining lymph nodes of both young adult and aged mice and synergistically enhanced cytokine and chemokine production in human young adult and elderly mononuclear cells. These data support further development of AH:CpG-adjuvanted RBD as an affordable vaccine that may be effective across multiple age groups. ONE SENTENCE SUMMARY: Alum and CpG enhance SARS-CoV-2 RBD protective immunity, variant neutralization in aged mice and Th1-polarizing cytokine production by human elder leukocytes.

14.
Osteoarthritis and Cartilage ; 30:S393-S394, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1768340

RESUMO

Purpose: Greater access to smartphones and mobile app technology, coupled with the COVID-19 pandemic, has fueled a growing interest in mobile health apps. Patients with knee and/or hip osteoarthritis (OA) may benefit from mobile apps when seeking additional guidance and advice. Clinicians may leverage these apps for symptom monitoring, activity tracking, and exercise program delivery. Integrating mobile apps into patient care may empower self-management and enhance communication, therapeutic alliance, and treatment adherence. Mobile apps could also facilitate access to healthcare services and reduce costs. However, little is known about the quality of these apps. We aimed to synthesize and evaluate current available mobile apps for adults with knee/hip OA. Methods: We searched Apple App Store, Android Google Play, and Amazon App Store for mobile health apps targeting management of knee/hip OA. Inclusion criteria for appraisal: available in English;containing search terms of “knee”, “knee OA”, “hip”, “hip OA”, “osteoarthritis”, “arthritis”, “physical therapy”, “rehabilitation”, and/or “rehab” in the app description;targeting knee and/or hip OA;and free to download. Exclusion criteria for appraisal: apps specific for rheumatoid arthritis;unavailable for download;could not be opened due to incompatibility;requiring subscription, passwords, institutional accounts, download fees, or additional accessories (e.g. motion sensor) for usage. The search was terminated for each search term when the last 10 apps on a platform did not meet the inclusion criteria, consistent with the methodology used in prior research. Paired reviewers rated apps using the adapted Mobile App Rating Scale (MARS) (score range 0-132, higher is better) that appraises apps by technical aspects, engagement, functionality, aesthetics, information, quality, and relevant information to the subject matter. Disagreements were resolved by discussion between 2 reviewers. Apps that scored ≥3/5 on overall app quality or totaled ≥80/132 were included in the final descriptive summary. Results: Among 797 identified apps, 41 met inclusion/exclusion criteria for MARS appraisal. As shown in Figure 1, 17 apps met the pre-determined score thresholds for final summary. Their key characteristics are summarized in Table 1. The median MARS score was 86 (interquartile range = 23 and ranged from 63 to 115). App features varied. Common app features were exercise recommendations, education, goal setting, and improving well-being. Many apps allowed for social media sharing and included measures to protect privacy. 11 apps demonstrated low to moderate credibility. Jointfully Osteoarthritis (Apple), My Arthritis (Apple), and Jointfully Osteoarthritis (Android) were the top three rated apps. They also were the only apps receiving an overall 5/5 quality rating. Conclusions: While many no-cost apps targeting knee/hip OA management exist, only three were rated highly. Features varied widely in our sample. Future research is needed to identify optimal app designs and functions for self-management strategies tailored to patients with knee/hip OA. Evaluating whether incorporating mobile apps in patient care improves outcome, treatment adherence, and patient satisfaction will help guide clinical practice recommendations. [Formula presented] [Formula presented]

15.
Med J Malaysia ; 77(2):237-240, 2022.
Artigo em Inglês | PubMed | ID: covidwho-1762634

RESUMO

INTRODUCTION: Isolation of SARS-CoV-2-infected individuals is an important COVID-19 pandemic control measure. While most cases have uncomplicated infection, a small proportion of them has developed life-threatening disease. We set up a retrospective study to determine preadmission triaging tool to predict the development of severe COVID-19. MATERIALS AND METHODS: A retrospective study was conducted from 1 October 2020 to 31 January 2021 with enrolment of all SARS-CoV-2 PCR-confirmed persons aged ≥13 years. The disease severity was assessed on admission and daily throughout the hospitalisation. Test-positive individuals were considered as having "severe COVID-19" if they had ≥1 of the following: room air oxygen saturation 30 breaths/minute, signs of severe respiratory distress, or received mechanical ventilation and/or vasopressor therapy. Uni- and multi-variate analyses using SPSS Statistics Ver. 26 were performed. RESULTS: We showed that age ≥ 60 years, BMI ≥ 30.0, presentation on days 7-12 of illness, and ≥1 comorbidity were associated with development of severe COVID-19. A scoring system based on the four variables is a useful COVID-19 risk assessment tool. A total score ≥2 had a sensitivity of 60.9%, specificity of 88.2%, positive predictive value of 37.8% and negative predictive value of 95.0%. CONCLUSION: Development of preadmission triaging tool can help health care providers (HCPs) decide on the placement of test-positive individuals to appropriate isolation facilities according to the risk of developing severe COVID-19.

16.
PubMed; 2022.
Preprint em Inglês | PubMed | ID: ppcovidwho-331011

RESUMO

Background We conducted in-depth interviews to characterize reasons for COVID-19 vaccine hesitancy in emergency department (ED) patients and developed messaging platforms that may address their concerns. In this trial we seek to determine whether provision of these COVID-19 vaccine messaging platforms in EDs will be associated with greater COVID-19 vaccine acceptance and uptake in unvaccinated ED patients. Methods This is a cluster-randomized controlled trial (RCT) evaluating our COVID-19 vaccine messaging platforms in seven hospital EDs (mix of academic, community, and safety-net EDs) in four US cities. Within each study site, we randomized 30 one-week periods to the intervention and 30 one-week periods to the control. Adult patients who have not received a COVID-19 vaccine are eligible with these exclusions: 1) major trauma, intoxication, altered mental status, or critical illness;2) incarceration;3) psychiatric chief complaint;and 4) suspicion of acute COVID-19 illness. Participants receive an orally administered Intake survey. During intervention weeks participants then receive three COVID-19 vaccine messaging platforms (4-minute video, one-page informational flyer and a brief, scripted face-to-face message delivered by ED physicians and nurses);patients enrolled during non-intervention weeks do not receive these platforms. Approximately an hour after intake surveys, participants receive a Vaccine Acceptance survey during which the primary outcome of acceptance of the COVID-19 vaccine in the ED is ascertained. The other primary outcome of receipt of a COVID-19 vaccine within 32 days is ascertained by electronic health record review and phone follow-up. To determine whether provision of vaccine messaging platforms is associated with a 7% increase in vaccine acceptance and uptake, we will need to enroll 1290 patients. Discussion Highlighting the difficulties of trial implementation during the COVID-19 pandemic in acute care settings, our novel trial will lay the groundwork for delivery of public health interventions to vulnerable populations whose only health care access occurs in EDs. Trial Status: We began enrollment in December 2021 and expect to continue through 2022. Conclusions Toward addressing vaccine hesitancy in vulnerable populations who seek care in EDs, our cluster-RCT will determine whether implementation of vaccine messaging platforms is associated with greater COVID-19 vaccine acceptance and uptake in unvaccinated ED patients.

17.
Morbidity and Mortality Weekly Report ; 69(16):496-498, 2020.
Artigo em Inglês | GIM | ID: covidwho-1726994

RESUMO

The objective of the article was to assess whether there might be a possible association between COVID-19 cleaning recommendations from public health agencies and the media and the number of chemical exposures reported to the National Poison Data System. CDC and the American Association of Poison Control Centers surveillance team compared the number of exposures reported for the period January-March 2020 with the number of reports during the same 3-month period in 2018 and 2019. Fifty-five poison centers in the United States provide free, 24-hour professional advice and medical management information regarding exposures to poisons, chemicals, drugs, and medications. During January-March 2020, poison centers received 45,550 exposure calls related to cleaners (28,158) and disinfectants (17,392), representing overall increases of 20.4% and 16.4% from January-March 2019 (37,822) and January-March 2018 (39,122), respectively. Although NPDS data do not provide information showing a definite link between exposures and COVID-19 cleaning efforts, there appears to be a clear temporal association with increased use of these products.

18.
Stroke ; 53(SUPPL 1), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1723999

RESUMO

Introduction: Findings of association between COVID-19 and stroke remain inconsistent, ranging from significant association, absence of association to less than expected ischemic stroke among hospitalized patients with COVID-19. The present study examined the association between COVID19 and risk of acute ischemic stroke (AIS). Methods: We included 19,553 Medicare fee-for-service (FFS) beneficiaries aged ≥65 years diagnosed with COVID-19 between April 1 and November 30, 2020 and AIS hospitalization from January 1, 2019 through November 30, 2020. We used a self-controlled case series design to examine the association between COVID-19 and AIS and estimated the incident rate ratios (IRR) by comparing incidence of AIS in risk periods (0-3, 4-7, 8-14, 15-28 days after diagnosis of COVID-19) vs. control periods. Results: Among 19,553 Medicare FFS beneficiaries with COVID-19 and AIS, the median age at diagnosis of COVID-19 was 80.5 (interquartile range 73.6-87.3) years and 57.5% were women. IRRs at 0-3, 4-7, 8-14, and 15-28 days following COVID-19 diagnosis were 10.97 (95% confidence interval 10.30-11.68), 1.59 (1.35-1.87), 1.23 (1.07-1.41), and 1.06 (0.95-1.18), respectively. The association appeared to be stronger among younger beneficiaries and among beneficiaries without prior history of stroke but largely consistent across sex and race/ethnicities. Conclusions: Risk of AIS among Medicare FFS beneficiaries was ten times as high during the first 3 days after diagnosis of COVID-19 as during the control period and the risk associated with COVID-19 appeared to be stronger among those aged 65-74 years and those without prior history of stroke.

19.
Investigative Ophthalmology & Visual Science ; 62(8):3, 2021.
Artigo em Inglês | Web of Science | ID: covidwho-1628250
20.
Obesity ; 29(SUPPL 2):86, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1616064

RESUMO

Background: Growing interest in very low carbohydrate diets, and in particular the ketogenic diet, has been met with some resistance. Important gaps exist regarding what diet to compare to the ketogenic diet. The objective of this study was to compare a Well Formulated Ketogenic Diet (WFKD) with a Mediterranean-Plus diet (Med-Plus;Mediterranean with emphasis on eliminating added sugars and refined grains), in a crossover study, stratified by diabetes status (T2D vs Prediabetes). Methods: The intervention involved having participants follow the WFKD and Med-Plus, for 12 weeks each, in random order. All meals were provided for the first 4 weeks of each diet phase (food delivery);then participants were responsible for purchasing and preparing their own foods (self-provided). The primary outcome was glycosylated hemoglobin (HbA1c). Secondary outcomes included weight, glucose as measured by continuous glucose monitor (CGM), and cardiometabolic risk factors, such as fasting insulin, glucose, and lipids. Results: Among participants randomized (n = 42), 33 had complete data at both diet phases (some missing data attributable to COVID disruptions). Participants were 60 ± 9 (mean ± sd) years of age, 61% men, with BMI 31 ± 5 kg/m2. Adherence for both diets was higher during the food delivery than the self-provided phase, but similar between diets for both phases. HbA1c concentrations were not significantly different between diets, but average CGM glucose levels were significantly lower during the WFKD compared to Med-Plus (p = 0.03). Additionally, WFKD induced a significantly greater decrease in triglycerides (-16% vs -5%, p = 0.02) and greater increase in LDL-C levels (10% vs -5%, p = 0.01), compared to Med-Plus. Weight change on WFKD vs Med-Plus was -8% vs -7% (p = 0.05). Sensitivity analyses largely confirmed the main findings. Conclusions: Participants improved in glucose control and weight management on both diets relative to baseline;however, glucose control was superior on the WFKD. Some caution is warranted when interpreting these results due to pandemic disruptions and a small sample size. A fair comparison of the two diets should also take into consideration non-glycemic effects.

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