Immunological insights into COVID-19 in Southern Nigeria.

Introduction: One of the unexpected outcomes of the COVID-19 pandemic was the relatively low levels of morbidity and mortality in Africa compared to the rest of the world. Nigeria, Africa's most populous nation, accounted for less than 0.01% of the global COVID-19 fatalities. The factors responsible for Nigeria's relatively low loss of life due to COVID-19 are unknown. Also, the correlates of protective immunity to SARS-CoV-2 and the impact of pre-existing immunity on the outcome of the COVID-19 pandemic in Africa are yet to be elucidated. Here, we evaluated the natural and vaccine-induced immune responses from vaccinated, non-vaccinated and convalescent individuals in Southern Nigeria throughout the three waves of the COVID-19 pandemic in Nigeria. We also examined the pre-existing immune responses to SARS-CoV-2 from samples collected prior to the COVID-19 pandemic. Methods: We used spike RBD and N- IgG antibody ELISA to measure binding antibody responses, SARS-CoV-2 pseudotype assay protocol expressing the spike protein of different variants (D614G, Delta, Beta, Omicron BA1) to measure neutralizing antibody responses and nucleoprotein (N) and spike (S1, S2) direct ex vivo interferon gamma (IFNγ) T cell ELISpot to measure T cell responses. Result: Our study demonstrated a similar magnitude of both binding (N-IgG (74% and 62%), S-RBD IgG (70% and 53%) and neutralizing (D614G (49% and 29%), Delta (56% and 47%), Beta (48% and 24%), Omicron BA1 (41% and 21%)) antibody responses from symptomatic and asymptomatic survivors in Nigeria. A similar magnitude was also seen among vaccinated participants. Interestingly, we revealed the presence of preexisting binding antibodies (N-IgG (60%) and S-RBD IgG (44%)) but no neutralizing antibodies from samples collected prior to the pandemic. Discussion: These findings revealed that both vaccinated, non-vaccinated and convalescent individuals in Southern Nigeria make similar magnitude of both binding and cross-reactive neutralizing antibody responses. It supported the presence of preexisting binding antibody responses among some Nigerians prior to the COVID-19 pandemic. Lastly, hybrid immunity and heterologous vaccine boosting induced the strongest binding and broadly neutralizing antibody responses compared to vaccine or infection-acquired immunity alone.

Measurement of the utilization of an installed electronic health record.

For the past decade, adoption of electronic health records (EHRs) has been proposed as one of the most viable approaches to improving the United States health care system. Although there is evidence that EHR adoption is slowly progressing, current methods of assessing adoption have yielded significant variance in estimates of EHR utilization. We conducted an environmental scan consisting of a review of the literature as well as a series of discussions with health center and health center network representatives and experts in the field to understand the current state of EHR adoption and use in the United States and assess the feasibility of developing a systematic approach to tracking EHR usage.

Health-related Quality of Life and Wound Care Practices Among Patients With Chronic Wounds in a Southwestern Nigerian Community

INTRODUCTION: Chronic wounds (CWs) are a common problem around the world. Although known to affect quality of life, patients' perception may vary among cultures. OBJECTIVE: The purpose of this article is to determine the effects of CWs on health-related quality of life (HRQoL) and identify wound care practices among a select population in southwestern Nigeria. MATERIALS AND METHODS: This is a descriptive study of 60 patients with CWs receiving outpatient care. Adult patients > 18 years of age with a wound duration > 3 months were chosen by convenience nonprobability sampling at the point of care. A pretested, semistructured, interviewer-administered questionnaire and a guided interview was provided to each patient to complete; collected data were coded to ensure confidentiality and input into computer software for statistical analysis. RESULTS: The average respondent age was 48.3 years (range, 18-80 years). Male to female ratio was 1:1.2, with 71.7% married, 96.7% of the Yoruba ethnic group, and 40% traders by occupation. The average wound duration was 23.2 months (range, 3-240 months). Trauma was the most common etiology of CWs followed by infection. There was no relationship between wound duration and patients' gender. Most patients accessed care from more than 1 source simultaneously. The presence of CWs adversely affected the quality of life (R = -.288; P = .025). Many patients had varying degrees of abnormality in their mental health. CONCLUSIONS: Chronic wounds are associated with poorer HRQoL, and simultaneous reception of wound care from multiple sources was common. These findings also suggest a need to pay increased attention to psychological aspects of patients with CWs.

The Effectiveness of a Peer-Staffed Crisis Respite Program as an Alternative to Hospitalization.

OBJECTIVE: This study assessed whether peer-staffed crisis respite centers implemented in New York City in 2013 as an alternative to hospitalization reduced emergency department (ED) visits, hospitalizations, and Medicaid expenditures for individuals enrolled in Medicaid. METHODS: This study used Medicaid claims and enrollment data for January 2009 through April 2016 to estimate impacts on ED visits, hospitalizations, and total Medicaid expenditures by using a difference-in-differences model with a matched comparison group. The study sample included 401 respite center clients and 1,796 members of the comparison group. RESULTS: In the month of crisis respite use and the 11 subsequent months, Medicaid expenditures were on average $2,138 lower per Medicaid-enrolled month and there were 2.9 fewer hospitalizations for crisis respite clients than would have been expected in the absence of the intervention (p<.01). CONCLUSIONS: Peer-staffed crisis respite services resulted in lowered rates of Medicaid-funded hospitalizations and health expenditures for participants compared with a comparison group. The findings suggest that peer-staffed crisis respites can achieve system-level impacts.

Caregiver presence and patient completion of a transitional care intervention.

OBJECTIVES: To evaluate the association between family caregiver presence and patient completion of the Care Transitions Intervention (CTI), a patient activation model that provides transitional care coaching for 30 days following hospital discharge. STUDY DESIGN: A convenience sample of 2747 fee-for-service Medicare patients recruited for the CTI during inpatient medical hospitalizations at 6 hospitals in Rhode Island between January 1, 2009 and June 31, 2011. METHODS: As part of an effectiveness trial of the CTI, Transitions Coaches recruited patients prior to hospital discharge. When a family caregiver was present during recruitment, the patient and family caregiver were coached together or the family caregiver was coached independently. RESULTS: We hypothesized that CTI participation would be equivalent for the 2265 coached patients without a family caregiver present at recruitment, versus the 482 patients with a family caregiver. After adjusting for significant covariates, patients with family caregivers were more than 5 times as likely to complete the intervention as patients without family caregivers (AOR = 5.48; 95% CI = 4.22-7.12). Men with family caregivers were nearly 8 times as likely to complete the intervention as men without family caregivers (AOR = 7.94; 95% CI = 5.26-11.98). CONCLUSIONS: The inclusion of a family caregiver is associated with a greater rate of completing the CTI for post discharge coaching, particularly among men; the inclusion of a family caregiver is a feasible modification to the CTI program.