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47 ud af 47 tidsskrifter valgt, søgeord (covid) valgt, emner højest 180 dage gamle, sorteret efter nyeste først.
1272 emner vises.
BMC Infectious Diseases, 9.11.2023
Tilføjet 9.11.2023
Abstract Background Clinical evidence suggests that pregnant women are more vulnerable to COVID-19, since they are at increased risk for disease progression and for obstetric complications, such as premature labor, miscarriage, preeclampsia, cesarean delivery, fetal growth restriction and perinatal death. Despite this evidence, pregnant women are often excluded from clinical trials, resulting in limited knowledge on COVID-19 management. The aim of this systematic review and meta-analysis is to provide better evidence on the efficacy and safety of available COVID-19 treatment in pregnant women. Methods Four authors searched major electronic databases from inception until 1 st November-2022 for controlled trials/observational studies, investigating outcomes after the administration of anti-SARS-CoV-2 treatments in pregnant women affected by COVID-19. The analyses investigated the cumulative incidence of delivery and maternal outcomes in pregnant women, comparing those taking active medication vs standard care. Risk ratios (RRs) with 95% confidence intervals were calculated. Statistical significance was assessed using the random effects model and inverse-variance method. This systematic review and meta-analysis was conducted in accordance with the updated 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol has been registered in Prospero (number registration: CRD42023397445). Results From initially 937 non duplicate records, we assessed the full texts of 40 articles, finally including ten studies. In six studies, including 1627 patients, the use of casirivimab/imdevimab (CAS/IMD), remdesivir, and IFN-alpha 2b significantly decreased the need of cesarean section ((RR = 0.665; 95%CI: 0.491–0.899; p = 0.008; I 2 = 19.5%;) (Table 1, (Fig. 1). Treatments did not decrease the risk of preterm delivery, admission to neonatal ICU, or stillbirth/perinatal loss (p-values > 0.50 for all these outcomes) and did not prevent the progression of disease towards severe degrees (k = 8; 2,374 pregnant women; RR = 0.778; 95%CI: 0.550–1.099; p = 0.15; I 2 = 0%). Moreover, the use of medications during pregnancy did not modify the incidence of maternal death in two studies (Table 2). Conclusions To our analysis, CAS/IMD, remdesivir, and IFN alpha 2b reduced the number of cesarean sections but demonstrated no effect on disease progression and other obstetric and COVID-19 related outcomes. The inability to evaluate the influence of viral load on illness development in pregnant women was attributed to lack of data. In our systematic review, no major side effects were reported. Though, it is essential for the medical community to focus more on clinical trials and less on episodic case reports and case series, with standardization of fetal and maternal outcomes.
Læs mere Tjek på PubMedBMC Infectious Diseases, 9.11.2023
Tilføjet 9.11.2023
Abstract Background Clinical evidence suggests that pregnant women are more vulnerable to COVID-19, since they are at increased risk for disease progression and for obstetric complications, such as premature labor, miscarriage, preeclampsia, cesarean delivery, fetal growth restriction and perinatal death. Despite this evidence, pregnant women are often excluded from clinical trials, resulting in limited knowledge on COVID-19 management. The aim of this systematic review and meta-analysis is to provide better evidence on the efficacy and safety of available COVID-19 treatment in pregnant women. Methods Four authors searched major electronic databases from inception until 1 st November-2022 for controlled trials/observational studies, investigating outcomes after the administration of anti-SARS-CoV-2 treatments in pregnant women affected by COVID-19. The analyses investigated the cumulative incidence of delivery and maternal outcomes in pregnant women, comparing those taking active medication vs standard care. Risk ratios (RRs) with 95% confidence intervals were calculated. Statistical significance was assessed using the random effects model and inverse-variance method. This systematic review and meta-analysis was conducted in accordance with the updated 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol has been registered in Prospero (number registration: CRD42023397445). Results From initially 937 non duplicate records, we assessed the full texts of 40 articles, finally including ten studies. In six studies, including 1627 patients, the use of casirivimab/imdevimab (CAS/IMD), remdesivir, and IFN-alpha 2b significantly decreased the need of cesarean section ((RR = 0.665; 95%CI: 0.491–0.899; p = 0.008; I 2 = 19.5%;) (Table 1, (Fig. 1). Treatments did not decrease the risk of preterm delivery, admission to neonatal ICU, or stillbirth/perinatal loss (p-values > 0.50 for all these outcomes) and did not prevent the progression of disease towards severe degrees (k = 8; 2,374 pregnant women; RR = 0.778; 95%CI: 0.550–1.099; p = 0.15; I 2 = 0%). Moreover, the use of medications during pregnancy did not modify the incidence of maternal death in two studies (Table 2). Conclusions To our analysis, CAS/IMD, remdesivir, and IFN alpha 2b reduced the number of cesarean sections but demonstrated no effect on disease progression and other obstetric and COVID-19 related outcomes. The inability to evaluate the influence of viral load on illness development in pregnant women was attributed to lack of data. In our systematic review, no major side effects were reported. Though, it is essential for the medical community to focus more on clinical trials and less on episodic case reports and case series, with standardization of fetal and maternal outcomes.
Læs mere Tjek på PubMedBMC Infectious Diseases, 9.11.2023
Tilføjet 9.11.2023
Abstract Background While many studies on the determinants of post-COVID-19 conditions (PCC) have been conducted, little is known about the relationship between SARS-CoV-2 variants and PCC. This study aimed to assess the association between different SARS-CoV-2 variants and the probability of having PCC three months after the infection. Methods This study was a longitudinal cohort study conducted between April 2021 and September 2022 in Belgium. In total, 8,238 adults with a confirmed SARS-CoV-2 infection were followed up between the time of their infection and three months later. The primary outcomes were the PCC status three months post infection and seven PCC symptoms categories (neurocognitive, autonomic, gastrointestinal, respiratory, musculoskeletal, anosmia and/or dysgeusia, and other manifestations). The main exposure variable was the type of SARS-CoV-2 variants (i.e. Alpha, Delta, and Omicron), extracted from national surveillance data. The association between the different SARS-CoV-2 variants and PCC as well as PCC symptoms categories was assessed using multivariable logistic regression. Results The proportion of PCC among participants infected during the Alpha, Delta, and Omicron-dominant periods was significantly different and respectively 50%, 50%, and 37%. Participants infected during the Alpha- and Delta-dominant periods had a significantly higher odds of having PCC than those infected during the Omicron-dominant period (OR = 1.61, 95% confidence interval [CI] = 1.33–1.96 and OR = 1.73, 95%CI = 1.54–1.93, respectively). Participants infected during the Alpha and Delta-dominant periods were more likely to report neurocognitive, respiratory, and anosmia/dysgeusia symptoms of PCC. Conclusions People infected during the Alpha- and Delta-dominant periods had a higher probability of having PCC three months after infection than those infected during the Omicron-dominant period. The lower probability of PCC with the Omicron variant must also be interpreted in absolute figures. Indeed, the number of infections with the Omicron variant being higher than with the Alpha and Delta variants, it is possible that the overall prevalence of PCC in the population increases, even if the probability of having a PCC decreases.
Læs mere Tjek på PubMedBMC Infectious Diseases, 9.11.2023
Tilføjet 9.11.2023
Abstract Background While many studies on the determinants of post-COVID-19 conditions (PCC) have been conducted, little is known about the relationship between SARS-CoV-2 variants and PCC. This study aimed to assess the association between different SARS-CoV-2 variants and the probability of having PCC three months after the infection. Methods This study was a longitudinal cohort study conducted between April 2021 and September 2022 in Belgium. In total, 8,238 adults with a confirmed SARS-CoV-2 infection were followed up between the time of their infection and three months later. The primary outcomes were the PCC status three months post infection and seven PCC symptoms categories (neurocognitive, autonomic, gastrointestinal, respiratory, musculoskeletal, anosmia and/or dysgeusia, and other manifestations). The main exposure variable was the type of SARS-CoV-2 variants (i.e. Alpha, Delta, and Omicron), extracted from national surveillance data. The association between the different SARS-CoV-2 variants and PCC as well as PCC symptoms categories was assessed using multivariable logistic regression. Results The proportion of PCC among participants infected during the Alpha, Delta, and Omicron-dominant periods was significantly different and respectively 50%, 50%, and 37%. Participants infected during the Alpha- and Delta-dominant periods had a significantly higher odds of having PCC than those infected during the Omicron-dominant period (OR = 1.61, 95% confidence interval [CI] = 1.33–1.96 and OR = 1.73, 95%CI = 1.54–1.93, respectively). Participants infected during the Alpha and Delta-dominant periods were more likely to report neurocognitive, respiratory, and anosmia/dysgeusia symptoms of PCC. Conclusions People infected during the Alpha- and Delta-dominant periods had a higher probability of having PCC three months after infection than those infected during the Omicron-dominant period. The lower probability of PCC with the Omicron variant must also be interpreted in absolute figures. Indeed, the number of infections with the Omicron variant being higher than with the Alpha and Delta variants, it is possible that the overall prevalence of PCC in the population increases, even if the probability of having a PCC decreases.
Læs mere Tjek på PubMedBMC Infectious Diseases, 9.11.2023
Tilføjet 9.11.2023
Abstract Background Given the widespread prevalence of the coronavirus disease 2019 (COVID-19), oral and neck examinations tend to be avoided in patients with suspected or confirmed COVID-19. This might delay the diagnosis of conditions such as Lemierre’s syndrome, which involves symptoms resembling COVID-19-related throat manifestations. Case presentation A 24-year-old man without any underlying conditions was diagnosed with COVID-19 7 days before presentation. He was admitted to another hospital 1 day before presentation with severe COVID-19 and suspected bacterial pneumonia; accordingly, he was started on treatment with remdesivir and meropenem. Owing to bacteremic complications, the patient was transferred to our hospital for intensive care. On the sixth day, the patient experienced hemoptysis; further, a computed tomography (CT) scan revealed new pulmonary artery pseudoaneurysms. Successful embolization was performed to achieve hemostasis. In blood cultures conducted at the previous hospital, Fusobacterium nucleatum was isolated, suggesting a cervical origin of the infection. A neck CT scan confirmed a peritonsillar abscess and left internal jugular vein thrombus; accordingly, he was diagnosed with Lemierre’s syndrome. The treatment was switched to ampicillin/sulbactam, based on the drug susceptibility results. After 6 weeks of treatment, the patient completely recovered without complications. Conclusion This case highlights the significance of thorough oral and neck examinations in patients with suspected or diagnosed COVID-19 for the detection of throat and neck symptoms caused by other conditions.
Læs mere Tjek på PubMedBMC Infectious Diseases, 9.11.2023
Tilføjet 9.11.2023
Abstract Background Given the widespread prevalence of the coronavirus disease 2019 (COVID-19), oral and neck examinations tend to be avoided in patients with suspected or confirmed COVID-19. This might delay the diagnosis of conditions such as Lemierre’s syndrome, which involves symptoms resembling COVID-19-related throat manifestations. Case presentation A 24-year-old man without any underlying conditions was diagnosed with COVID-19 7 days before presentation. He was admitted to another hospital 1 day before presentation with severe COVID-19 and suspected bacterial pneumonia; accordingly, he was started on treatment with remdesivir and meropenem. Owing to bacteremic complications, the patient was transferred to our hospital for intensive care. On the sixth day, the patient experienced hemoptysis; further, a computed tomography (CT) scan revealed new pulmonary artery pseudoaneurysms. Successful embolization was performed to achieve hemostasis. In blood cultures conducted at the previous hospital, Fusobacterium nucleatum was isolated, suggesting a cervical origin of the infection. A neck CT scan confirmed a peritonsillar abscess and left internal jugular vein thrombus; accordingly, he was diagnosed with Lemierre’s syndrome. The treatment was switched to ampicillin/sulbactam, based on the drug susceptibility results. After 6 weeks of treatment, the patient completely recovered without complications. Conclusion This case highlights the significance of thorough oral and neck examinations in patients with suspected or diagnosed COVID-19 for the detection of throat and neck symptoms caused by other conditions.
Læs mere Tjek på PubMedBMC Infectious Diseases, 9.11.2023
Tilføjet 9.11.2023
Abstract Background Increasing life expectancy and persistently low fertility levels have led to old population age structures in most high-income countries, and population ageing is expected to continue or even accelerate in the coming decades. While older adults on average have few interactions that potentially could lead to disease transmission, their morbidity and mortality due to infectious diseases, respiratory infections in particular, remain substantial. We aim to explore how population ageing affects the future transmission dynamics and mortality burden of emerging respiratory infections. Methods Using longitudinal individual-level data from population registers, we model the Belgian population with evolving age and household structures, and explicitly consider long-term care facilities (LTCFs). Three scenarios are presented for the future proportion of older adults living in LTCFs. For each demographic scenario, we simulate outbreaks of SARS-CoV-2 and a novel influenza A virus in 2020, 2030, 2040 and 2050 and distinguish between household and community transmission. We estimate attack rates by age and household size/type, as well as disease-related deaths and the associated quality-adjusted life-years (QALYs) lost. Results As the population is ageing, small households and LTCFs become more prevalent. Additionally, families with children become smaller (i.e. low fertility, single-parent families). The overall attack rate slightly decreases as the population is ageing, but to a larger degree for influenza than for SARS-CoV-2 due to differential age-specific attack rates. Nevertheless, the number of deaths and QALY losses per 1,000 people is increasing for both infections and at a speed influenced by the share living in LTCFs. Conclusion Population ageing is associated with smaller outbreaks of COVID-19 and influenza, but at the same time it is causing a substantially larger burden of mortality, even if the proportion of LTCF residents were to decrease. These relationships are influenced by age patterns in epidemiological parameters. Not only the shift in the age distribution, but also the induced changes in the household structures are important to consider when assessing the potential impact of population ageing on the transmission and burden of emerging respiratory infections.
Læs mere Tjek på PubMedBMC Infectious Diseases, 9.11.2023
Tilføjet 9.11.2023
Abstract Background Increasing life expectancy and persistently low fertility levels have led to old population age structures in most high-income countries, and population ageing is expected to continue or even accelerate in the coming decades. While older adults on average have few interactions that potentially could lead to disease transmission, their morbidity and mortality due to infectious diseases, respiratory infections in particular, remain substantial. We aim to explore how population ageing affects the future transmission dynamics and mortality burden of emerging respiratory infections. Methods Using longitudinal individual-level data from population registers, we model the Belgian population with evolving age and household structures, and explicitly consider long-term care facilities (LTCFs). Three scenarios are presented for the future proportion of older adults living in LTCFs. For each demographic scenario, we simulate outbreaks of SARS-CoV-2 and a novel influenza A virus in 2020, 2030, 2040 and 2050 and distinguish between household and community transmission. We estimate attack rates by age and household size/type, as well as disease-related deaths and the associated quality-adjusted life-years (QALYs) lost. Results As the population is ageing, small households and LTCFs become more prevalent. Additionally, families with children become smaller (i.e. low fertility, single-parent families). The overall attack rate slightly decreases as the population is ageing, but to a larger degree for influenza than for SARS-CoV-2 due to differential age-specific attack rates. Nevertheless, the number of deaths and QALY losses per 1,000 people is increasing for both infections and at a speed influenced by the share living in LTCFs. Conclusion Population ageing is associated with smaller outbreaks of COVID-19 and influenza, but at the same time it is causing a substantially larger burden of mortality, even if the proportion of LTCF residents were to decrease. These relationships are influenced by age patterns in epidemiological parameters. Not only the shift in the age distribution, but also the induced changes in the household structures are important to consider when assessing the potential impact of population ageing on the transmission and burden of emerging respiratory infections.
Læs mere Tjek på PubMedBMC Infectious Diseases, 9.11.2023
Tilføjet 9.11.2023
Abstract Background Healthcare workers (HCWs) are at a higher risk of contracting COVID-19 due to their close contact with infected patients. However, the true burden of COVID-19 among HCWs in Yemen is unknown due to the inadequate availability of healthcare and the subclinical nature of the disease. This study aims to estimate the seroprevalence of SARS-CoV-2 infection among HCWs in two Yemeni governorates and identify associated factors using a cross-sectional design. Method A total of 404 HCWs were surveyed from June 2022 to September 2022 in Lahj and AL-Dhalea hospitals. A self-administered questionnaire collected demographic data, COVID-19 infection history, and vaccination status. A total of 404 human sera were tested using a specific electrochemiluminescence immunoassay assay. Association analysis was conducted to identify associations between antibody prevalence and demographic and vaccine-related variables. Result The median age of the HCWs was 31 (Range 20–64) years, with 65.0% being male and 35.0% female. Of all HCWs, 94% were SARS-CoV-2 seropositive and 77.0% had no confirmed test of COVID-19-related symptoms. There was no significant association between seropositivity and demographic factors such as age, gender, occupation, or COVID-19 vaccination (P > 0.05). Conclusion The seroprevalence of SARS-CoV-2 was high among HCWs in Yemen, primarily due to natural infection rather than vaccination. Compliance with infection prevention and control measures did not significantly affect seropositivity. This study highlights the need for improved healthcare systems and resources to reduce the burden of COVID-19 and promote infection prevention and control (IPC) measures among HCWs in Yemen.
Læs mere Tjek på PubMedBMC Infectious Diseases, 9.11.2023
Tilføjet 9.11.2023
Abstract Background Healthcare workers (HCWs) are at a higher risk of contracting COVID-19 due to their close contact with infected patients. However, the true burden of COVID-19 among HCWs in Yemen is unknown due to the inadequate availability of healthcare and the subclinical nature of the disease. This study aims to estimate the seroprevalence of SARS-CoV-2 infection among HCWs in two Yemeni governorates and identify associated factors using a cross-sectional design. Method A total of 404 HCWs were surveyed from June 2022 to September 2022 in Lahj and AL-Dhalea hospitals. A self-administered questionnaire collected demographic data, COVID-19 infection history, and vaccination status. A total of 404 human sera were tested using a specific electrochemiluminescence immunoassay assay. Association analysis was conducted to identify associations between antibody prevalence and demographic and vaccine-related variables. Result The median age of the HCWs was 31 (Range 20–64) years, with 65.0% being male and 35.0% female. Of all HCWs, 94% were SARS-CoV-2 seropositive and 77.0% had no confirmed test of COVID-19-related symptoms. There was no significant association between seropositivity and demographic factors such as age, gender, occupation, or COVID-19 vaccination (P > 0.05). Conclusion The seroprevalence of SARS-CoV-2 was high among HCWs in Yemen, primarily due to natural infection rather than vaccination. Compliance with infection prevention and control measures did not significantly affect seropositivity. This study highlights the need for improved healthcare systems and resources to reduce the burden of COVID-19 and promote infection prevention and control (IPC) measures among HCWs in Yemen.
Læs mere Tjek på PubMedTea, Kevin; Zu, Yuanhao; Chung, Cheng Han; Pagliaro, Jaclyn; Espinoza-Barrera, Diana; Mehta, Prakriti; Grewal, Himmat; Douglas, Ivor S.; Khan, Yasin A.; Shaffer, Jeffrey G.; Denson, Joshua L.
Critical Care Medicine, 9.11.2023
Tilføjet 9.11.2023
Objectives: Metabolic syndrome is known to predict outcomes in COVID-19 acute respiratory distress syndrome (ARDS) but has never been studied in non-COVID-19 ARDS. We therefore aimed to determine the association of metabolic syndrome with mortality among ARDS trial subjects. Design: Retrospective cohort study of ARDS trials’ data. Setting: An ancillary analysis was conducted using data from seven ARDS Network and Prevention and Early Treatment of Acute Lung Injury Network randomized trials within the Biologic Specimen and Data Repository Information Coordinating Center database. Patients: Hospitalized patients with ARDS and metabolic syndrome (defined by obesity, diabetes, and hypertension) were compared with similar patients without metabolic syndrome (those with less than three criteria). Interventions: None. Measurements and Main Results: The primary outcome was 28-day mortality. Among 4288 ARDS trial participants, 454 (10.6%) with metabolic syndrome were compared with 3834 controls (89.4%). In adjusted analyses, the metabolic syndrome group was associated with lower 28-day and 90-day mortality when compared with control (adjusted odds ratio [aOR], 0.70 [95% CI, 0.55–0.89] and 0.75 [95% CI, 0.60–0.95], respectively). With each additional metabolic criterion from 0 to 3, adjusted 28-day mortality was reduced by 18%, 22%, and 40%, respectively. In subgroup analyses stratifying by ARDS etiology, mortality was lower for metabolic syndrome vs. control in ARDS caused by sepsis or pneumonia (at 28 d, aOR 0.64 [95% CI, 0.48–0.84] and 90 d, aOR 0.69 [95% CI, 0.53–0.89]), but not in ARDS from noninfectious causes (at 28 d, aOR 1.18 [95% CI, 0.70–1.99] and 90 d, aOR 1.26 [95% CI, 0.77–2.06]). Interaction p = 0.04 and p = 0.02 for 28- and 90-day comparisons, respectively. Conclusions: Metabolic syndrome in ARDS was associated with a lower risk of mortality in non-COVID-19 ARDS. The relationship between metabolic inflammation and ARDS may provide a novel biological pathway to be explored in precision medicine-based trials.
Læs mere Tjek på PubMedAzoulay, Elie; Pochard, Frédéric; Dumas, Guillaume; Kentish-Barnes, Nancy; FAMIREA Study Group
Critical Care Medicine, 9.11.2023
Tilføjet 9.11.2023
Objectives: To assess COVID-19 vaccination rates in ICU-healthcare providers (HCPs) in France and to identify the typology of those who delayed or declined vaccination. Design: Cross-sectional study. Setting: Twenty-one ICUs in France. Subjects: Members of the nursing and medical staff and other allied professionals. Interventions: None. Measurements and Main Results: Six hundred ninety-six of the 950 respondents (73.3%) had undergone a full vaccination schedule. Other HCPs either declined vaccination (n = 112) or delayed vaccination until it became mandatory (n = 142). Factors independently associated with full vaccination were age older than 50 years (odds ratio, 0.25 [95% CI, 0.12–0.51]), more than 5 years of ICU experience (0.66 [0.47–0.93]), increasing working time during the surge (0.94 [0.88–1.00]), and spending time with the family (0.92 [0.85–0.99]). Conversely, being a nurse (1.94 [1.25–2.99]) or a nurse assistant (2.77 [1.62–4.73]), and feeling not supported by hospital and ICU directors (1.49 [1.01–2.20]) was independently associated with not being vaccinated. Conclusions: These results are important to take into account to better implement vaccination strategies in HCPs for existing or future pandemics.
Læs mere Tjek på PubMedGrapin, Kévin; De Bauchene, Romain; Bonnet, Benjamin; Mirand, Audrey; Cassagnes, Lucie; Calvet, Laure; Thouy, François; Bouzgarrou, Radhia; Henquell, Cécile; Evrard, Bertrand; Adda, Mireille; Souweine, Bertrand; Dupuis, Claire
Critical Care Medicine, 9.11.2023
Tilføjet 9.11.2023
Background: Inconsistent results from COVID-19 studies raise the issue of patient heterogeneity. Objective: The objective of this study was to identify homogeneous subgroups of patients (clusters) using baseline characteristics including inflammatory biomarkers and the extent of lung parenchymal lesions on CT, and to compare their outcomes. Design: Retrospective single-center study. Setting: Medical ICU of the University Hospital of Clermont-Ferrand, France. Patients: All consecutive adult patients aged greater than or equal to 18 years, admitted between March 20, 2020, and August 31, 2021, for COVID-19 pneumonia. Interventions: Characteristics at baseline, during ICU stay, and outcomes at day 60 were recorded. On the chest CT performed at admission the extent of lung parenchyma lesions was established by artificial intelligence software. Measurements and Main Results: Clusters were determined by hierarchical clustering on principal components using principal component analysis of admission characteristics including plasma interleukin-6, human histocompatibility leukocyte antigen-DR expression rate on blood monocytes (HLA-DR) monocytic-expression rate (mHLA-DR), and the extent of lung parenchymal lesions. Factors associated with day 60 mortality were investigated by univariate survival analysis. Two hundred seventy patients were included. Four clusters were identified and three were fully described. Cluster 1 (obese patients, with moderate hypoxemia, moderate extent of lung parenchymal lesions, no inflammation, and no down-regulation of mHLA-DR) had a better prognosis at day 60 (hazard ratio [HR] = 0.27 [0.15–0.46], p < 0.01), whereas cluster 2 (older patients with comorbidities, moderate extent of lung parenchyma lesions but significant hypoxemia, inflammation, and down-regulation of mHLA-DR) and cluster 3 (patients with severe parenchymal disease, hypoxemia, inflammatory reaction, and down-regulation of mHLA-DR) had an increased risk of mortality (HR = 2.07 [1.37–3.13], p < 0.01 and HR = 1.52 [1–2.32], p = 0.05, respectively). In multivariate analysis, only clusters 1 and 2 were independently associated with day 60 death. Conclusions: Three clusters with distinct characteristics and outcomes were identified. Such clusters could facilitate the identification of targeted populations for the next trials.
Læs mere Tjek på PubMedClinical Infectious Diseases, 9.11.2023
Tilføjet 9.11.2023
One night in September 2020, I sat atop my mattress engrossed in work when a buzz from my phone broke the silence. I answered to a gruff male voice who swiftly dove into a conversation about my recent appearance before the House Select Subcommittee on the Coronavirus Crisis, where I had discussed the implementation of coronavirus disease 2019 (COVID-19) precautions to safeguard the upcoming presidential election. He accused me of being politically oriented and blamed me for policies he deemed responsible for the pandemic\'s death toll. He went on to disparage my identity and background and threatened to file a complaint to the medical board. Although the precise details of his tirade have faded, his parting words remain with me even 3 years later: “I hope you die.”
Læs mere Tjek på PubMedAnouk M. I. A. van Alphen, Sandra Sülz, Hester F. Lingsma, Robert J. Baatenburg de Jong
PLoS One Infectious Diseases, 9.11.2023
Tilføjet 9.11.2023
by Anouk M. I. A. van Alphen, Sandra Sülz, Hester F. Lingsma, Robert J. Baatenburg de Jong Introduction During the COVID-19 pandemic, prioritizing certain surgical patients became inevitable due to limited surgical capacity. This study aims to identify which factors patients value in priority setting, and to evaluate their perspective on a decision model for surgical prioritization. Methods We enacted a qualitative exploratory study and conducted semi-structured interviews with N = 15 patients. Vignettes were used as guidance. The interviews were transcribed and iteratively analyzed using thematic analysis. Results We unraveled three themes: 1) general attitude towards surgical prioritization: patients showed understanding for the difficult decisions to be made, but demanded greater transparency and objectivity; 2) patient-related factors that some participants considered should, or should not, influence the prioritization: age, physical functioning, cognitive functioning, behavior, waiting time, impact on survival and quality of life, emotional consequences, and resource usage; and 3) patients’ perspective on a decision model: usage of such a model for prioritization decisions is favorable if the model is simple, uses trustworthy data, and its output is supervised by physicians. The model could also be used as a communication tool to explain prioritization dilemmas to patients. Conclusion Support for the various factors and use of a decision model varied among patients. Therefore, it seems unrealistic to immediately incorporate these factors in decision models. Instead, this study calls for more research to identify feasible avenues and seek consensus.
Læs mere Tjek på PubMedFelipe Martínez, Catalina Tobar, Carla Taramasco
PLoS One Infectious Diseases, 9.11.2023
Tilføjet 9.11.2023
by Felipe Martínez, Catalina Tobar, Carla Taramasco Introduction Telemonitoring involves the transmission of clinical information through digital means, including internet-connected devices such as smartphones, health tracking apps and video conferencing platforms. This strategy could provide a viable alternative to facilitate follow-up in several conditions, including cancer. Objectives To synthesise the available evidence on the effectiveness of internet-based telemonitoring platforms amongst oncological patients. Relevant endpoints include overall quality of life, the ability to detect postoperative complications, severe toxicity reactions attributable to chemotherapy, reducing the frequency of hospitalisations, emergency department visits and mortality. Methods A systematic review of published and unpublished randomised and controlled studies will be carried out. Iterative searches in PubMED/MEDLINE, EMBASE, Epistemonikos, LILACS, and Cochrane CENTRAL repositories from January 2000 to January 2023 will be conducted. Grey literature repositories, such as Clinicaltrials, BioRxiv and MedRxiv will be searched as well. The Cochrane risk of bias tool will be used to assess the quality of the eligible studies. If possible, a meta-analysis based on the random-effects model will be conducted to evaluate changes in any of the aforementioned outcomes. Heterogeneity will be assessed with Cochrane’s Q and I2 statistics. Its exploration will be carried out using subgroup and sensitivity analyses. Relevant subgroups include the proportion of elderly patients in each study, characteristics of each platform, study type, type of funding and moment of conduction (i.e. before or after the COVID-19 pandemic). Publication bias will be assessed using funnel plots and Egger’s test. Registration This systematic review protocol is registered in PROSPERO. Its registration number is CRD42023412705.
Læs mere Tjek på PubMedNabin K. Shrestha, Patrick C. Burke, Amy S. Nowacki, Steven M. Gordon
PLoS One Infectious Diseases, 9.11.2023
Tilføjet 9.11.2023
by Nabin K. Shrestha, Patrick C. Burke, Amy S. Nowacki, Steven M. Gordon Background The CDC recently defined being “up-to-date” on COVID-19 vaccination as having received at least one dose of a COVID-19 bivalent vaccine. The purpose of this study was to compare the risk of COVID-19 among those “up-to-date” and “not up-to-date”. Methods Employees of Cleveland Clinic in Ohio, USA, in employment when the COVID-19 bivalent vaccine first became available, and still employed when the XBB lineages became dominant, were included. Cumulative incidence of COVID-19 since the XBB lineages became dominant was compared across the”up-to-date” and “not up-to-date” states, by treating COVID-19 bivalent vaccination as a time-dependent covariate whose value changed on receipt of the vaccine. Risk of COVID-19 by vaccination status was also evaluated using multivariable Cox proportional hazards regression adjusting for propensity to get tested for COVID-19, age, sex, most recent prior SARS-CoV-2 infection, and number of prior vaccine doses. Results COVID-19 occurred in 1475 (3%) of 48 344 employees during the 100-day study period. The cumulative incidence of COVID-19 was lower in the “not up-to-date” than the “up-to-date” state. On multivariable analysis, being “up-to-date” was not associated with lower risk of COVID-19 (HR, 1.05; 95% C.I., 0.88–1.25; P-value, 0.58). Results were very similar when those 65 years and older were only considered “up-to-date” after 2 doses of the bivalent vaccine. Conclusions Since the XBB lineages became dominant, adults “up-to-date” on COVID-19 vaccination by the CDC definition do not have a lower risk of COVID-19 than those “not up-to-date”, bringing into question the value of this risk classification definition.
Læs mere Tjek på PubMedWan In WEI, Cyrus Lap Kwan LEUNG, Arthur TANG, Edward B. MCNEIL, Samuel Yeung Shan WONG, Kin On KWOK
Clinical Microbiology and Infection, 8.11.2023
Tilføjet 8.11.2023
To investigate the feasibility and performance of ChatGPT in converting symptom narratives into structured symptom labels.
Læs mere Tjek på PubMedAggarwal, M., Katz, A., Kokorelias, K. M., Wong, S. T., Aghajafari, F., Ivers, N. M., Martin-Misener, R., Aubrey-Bassler, K., Breton, M., Upshur, R. E. G., Kwong, J. C.
BMJ Open, 8.11.2023
Tilføjet 8.11.2023
IntroductionThe WHO has stated that vaccine hesitancy is a serious threat to overcoming COVID-19. Vaccine hesitancy among underserved and at-risk communities is an ongoing challenge in Canada. Public confidence in vaccine safety and effectiveness and the principles of equity need to be considered in vaccine distribution. In Canada, governments of each province or territory manage their own healthcare system, providing an opportunity to compare and contrast distribution strategies. The overarching objective of this study is to identify effective vaccine distribution approaches and advance knowledge on how to design and implement various strategies to meet the different needs of underserved communities. Methods and analysisMultiple case studies in seven Canadian provinces will be conducted using a mixed-methods design. The study will be informed by Experience-Based CoDesign techniques and theoretically guided by the Socio-Ecological Model and the Vaccine Hesitancy Matrix frameworks. Phase 1 will involve a policy document review to systematically explore the vaccine distribution strategy over time in each jurisdiction. This will inform the second phase, which will involve (2a) semistructured, in-depth interviews with policymakers, public health officials, researchers, providers, groups representing patients, researchers and stakeholders and (2b) an analysis of population-based administrative health data of vaccine administration. Integration of qualitative and quantitative data will inform the identification of effective vaccine distribution approaches for various populations. Informed by this evidence, phase 3 of the study will involve conducting focus groups with multiple stakeholders to codesign recommendations for the design and implementation of effective vaccine delivery strategies for equity-deserving and at-risk populations. Ethics and disseminationThis study is approved by the University of Toronto’s Health Sciences Research Ethics Board (#42643), University of British Columbia Behavioural Research Ethics Board (#H22-01750-A002), Research Ethics Board of the Nova Scotia Health Authority (#48272), Newfoundland and Labrador Health Research Ethics Board (#2022.126), Conjoint Health Research Ethics Board, University of Calgary (REB22-0207), and University of Manitoba Health Research Board (H2022-239). The outcome of this study will be to produce a series of recommendations for implementing future vaccine distribution approaches from the perspective of various stakeholders, including equity-deserving and at-risk populations.
Læs mere Tjek på PubMedWang, L., Huang, S., Feng, Z., Lin, Y., Zhang, Y.
BMJ Open, 8.11.2023
Tilføjet 8.11.2023
ObjectivesThis study aimed to explore the mediating role of resilience and resignation coping in the relationship between consultation empathy and depression in patients with COVID-19. DesignCross-sectional study. SettingParticipants were recruited from a tertiary hospital in Guangzhou, Guangdong province. ParticipantsA total of 215 patients were recruited for this study. Outcome measuresA total of 215 patients completed the Consultation and Relational Empathy Measure, Connor-Davidson Resilience Scale, Medical Coping Modes Questionnaire and Hospital Anxiety and Depression Scale. PROCESS 4.1 model 6 was used to analyse the moderated mediating effects. ResultsConsultation empathy had a positive correlation with resilience (r=0.34, p
Læs mere Tjek på PubMedXinan Wang, Emma White, Francesca Giacona, Amita Khurana, Yi Li, David C. Christiani, Jehan W. Alladina
PLoS One Infectious Diseases, 8.11.2023
Tilføjet 8.11.2023
by Xinan Wang, Emma White, Francesca Giacona, Amita Khurana, Yi Li, David C. Christiani, Jehan W. Alladina Background Clinical utility of routinely measured serial biomarkers in predicting escalation of inpatient care intensity and mortality among hospitalized patients with COVID-19 remains unknown. Methods This retrospective cohort study included patients with COVID-19 who admitted to the Massachusetts General Hospital between March and June 2020 and January to March 2021. White blood cell (WBC) count, platelet count, C-reactive protein (CRP), and D-dimer values were measured on days 1, 3, and 7 of admission. Clinical outcomes include 30- and 60-day morality, ICU transfer, and overall survival (OS) over a follow-up period of 90 days. The association between serial biomarkers and outcomes were assessed using multivariable logistic regression and Cox proportional hazards models. Measurements and main results Of the 456 patients hospitalized with COVID-19, 199 (43.6%) were ICU, 179 (39.3%) were medical floor, and 78 (17.1%) were initially admitted to the medical floor and then transferred to the ICU. In adjusted analyses, each unit increase in the slope of CRP was associated with a 42% higher odds of ICU transfer after controlling for the initial admission level (OR = 1.42, 95% CI: 1.25–1.65, P < 0.001). Including serial change in CRP levels from initial level on admission achieved the greatest predictive accuracy for ICU transfer (AUC = 0.72, 95% CI: 0.64–0.79). Conclusions Serial change in CRP levels from admission is associated with escalations of inpatient care intensity and mortality among hospitalized patients with COVID-19.
Læs mere Tjek på PubMedNatalie Winter, Kerry McKenzie, Danielle Spence, Katherine Lane, Anna Ugalde
PLoS One Infectious Diseases, 8.11.2023
Tilføjet 8.11.2023
by Natalie Winter, Kerry McKenzie, Danielle Spence, Katherine Lane, Anna Ugalde Background Caring for someone with cancer during end of life care can be a challenging and complex experience. Those living in rural and regional areas are less likely to have local healthcare services and may be physically isolated. Even where support services such as respite do exist, they may be less likely to be accessed due to the time burden in travelling to services. This was compounded by the COVID-19 pandemic. Aim To understand the potential benefits of peer support for bereaved carers of people with cancer from rural and regional locations during the COVID-19 period. Methods Phone interviews were conducted with bereaved cancer carers living in rural and regional areas in Victoria. Semi-structured interviews were used, and participants were asked about their experience as a carer, bereavement and the potential for peer support. Interviews were audio recorded and transcribed verbatim; transcripts were coded and a thematic analysis was conducted. Findings 12 interviews were conducted. Carers were mostly female (85%) and were on average 58 years of age (range 42–71). Interviews lasted an average of 58 minutes (range 53–91 minutes). Three themes were derived from the data; 1) Supportive care needs while caring and the impact of COVID-19; 2) Isolation during bereavement compounded by the COVID-19 pandemic; and 3) Peer support requires flexibility to meet diverse needs. Conclusion Peer support has potential to assist bereaved carers of people with cancer. A co-design approach may be beneficial for developing a flexible model for supporting and linking carers together.
Læs mere Tjek på PubMedRachel Sklar, Elizabeth Noth, Ada Kwan, David Sear, Stefano Bertozzi
PLoS One Infectious Diseases, 8.11.2023
Tilføjet 8.11.2023
by Rachel Sklar, Elizabeth Noth, Ada Kwan, David Sear, Stefano Bertozzi Residents of carceral facilities are exposed to poor ventilation conditions which leads to the spread of communicable diseases such as COVID-19. Indoor ventilation conditions are rarely studied within carceral settings and there remains limited capacity to develop solutions to address the impact of poor ventilation on the health of people who are incarcerated. In this study, we empirically measured ventilation rates within housing units of six adult prisons in the California Department of Corrections and Rehabilitation (CDCR) and compare the measured ventilation rates to recommended standards issued by the World Health Organization (WHO). Findings from the empirical assessment include lower ventilation rates than the recommended ventilation standards with particularly low ventilation during winter months when heating systems were in use. Inadvertent airflows from spaces housing potentially infected individuals to shared common spaces was also observed. The methodology used for this work can be leveraged for routine ventilation monitoring, pandemic preparedness, and disaster response.
Læs mere Tjek på PubMedImoro Nasiratu, Lilian Belole Pencille, Nelisiwe Khuzwayo, Richard Gyan Aboagye, Elvis Enowbeyang Tarkang
PLoS One Infectious Diseases, 8.11.2023
Tilføjet 8.11.2023
by Imoro Nasiratu, Lilian Belole Pencille, Nelisiwe Khuzwayo, Richard Gyan Aboagye, Elvis Enowbeyang Tarkang Background Although the coronavirus disease 2019 (COVID-19) vaccination rollout has been accepted by the population of the Ga North Municipality, a substantial proportion has developed hesitancy to COVID-19 vaccination uptake. This study determined the predictors of COVID-19 vaccine uptake among persons aged 18 years and above in the Ga North Municipality using the Health Belief Model. Methods The study used a cross-sectional study design. Structured questionnaires were used to collect data from a multistage sample of 388 respondents. Multivariable binary logistic regression was used to determine the predictors of COVID-19 vaccination uptake at the level of 0.05 and 95% confidence interval. Results Vaccination uptake was 72.2%. The odds of COVID-19 vaccination uptake were higher among men than women [AOR = 2.02, 95% Cl: 1.13–3.20] and among singles than the married [AOR = 1.90, 95% Cl: 1.07–3.36], but lower among Muslims than Christians [AOR = 0.33, 95%Cl: 0.18–0.60]. Perceived susceptibility [AOR = 2.43, 95% Cl: 1.36–4.35], perceived barriers [AOR = 0.54, 95%Cl: 0.31–0.95], cues to action [AOR = 2.23, 95% Cl: 1.19–4.21] and self-efficacy [AOR = 3.23 95% Cl: 1.82–5.71] were the significant predictors of COVID-19 vaccination uptake. Conclusion The uptake of the COVID-19 vaccine in GA North Municipality is high. Health promotion interventions should focus on increasing perceived susceptibility to COVID-19, minimising barriers to COVID-19 vaccine uptake, and promoting cues and self-confidence for COVID-19 vaccine uptake. It should also target women, the married, and Muslims.
Læs mere Tjek på PubMedBMC Infectious Diseases, 7.11.2023
Tilføjet 7.11.2023
Abstract Background Given the widespread prevalence of the coronavirus disease 2019 (COVID-19), oral and neck examinations tend to be avoided in patients with suspected or confirmed COVID-19. This might delay the diagnosis of conditions such as Lemierre’s syndrome, which involves symptoms resembling COVID-19-related throat manifestations. Case presentation A 24-year-old man without any underlying conditions was diagnosed with COVID-19 7 days before presentation. He was admitted to another hospital 1 day before presentation with severe COVID-19 and suspected bacterial pneumonia; accordingly, he was started on treatment with remdesivir and meropenem. Owing to bacteremic complications, the patient was transferred to our hospital for intensive care. On the sixth day, the patient experienced hemoptysis; further, a computed tomography (CT) scan revealed new pulmonary artery pseudoaneurysms. Successful embolization was performed to achieve hemostasis. In blood cultures conducted at the previous hospital, Fusobacterium nucleatum was isolated, suggesting a cervical origin of the infection. A neck CT scan confirmed a peritonsillar abscess and left internal jugular vein thrombus; accordingly, he was diagnosed with Lemierre’s syndrome. The treatment was switched to ampicillin/sulbactam, based on the drug susceptibility results. After 6 weeks of treatment, the patient completely recovered without complications. Conclusion This case highlights the significance of thorough oral and neck examinations in patients with suspected or diagnosed COVID-19 for the detection of throat and neck symptoms caused by other conditions.
Læs mere Tjek på PubMedBMC Infectious Diseases, 7.11.2023
Tilføjet 7.11.2023
Abstract Background Increasing life expectancy and persistently low fertility levels have led to old population age structures in most high-income countries, and population ageing is expected to continue or even accelerate in the coming decades. While older adults on average have few interactions that potentially could lead to disease transmission, their morbidity and mortality due to infectious diseases, respiratory infections in particular, remain substantial. We aim to explore how population ageing affects the future transmission dynamics and mortality burden of emerging respiratory infections. Methods Using longitudinal individual-level data from population registers, we model the Belgian population with evolving age and household structures, and explicitly consider long-term care facilities (LTCFs). Three scenarios are presented for the future proportion of older adults living in LTCFs. For each demographic scenario, we simulate outbreaks of SARS-CoV-2 and a novel influenza A virus in 2020, 2030, 2040 and 2050 and distinguish between household and community transmission. We estimate attack rates by age and household size/type, as well as disease-related deaths and the associated quality-adjusted life-years (QALYs) lost. Results As the population is ageing, small households and LTCFs become more prevalent. Additionally, families with children become smaller (i.e. low fertility, single-parent families). The overall attack rate slightly decreases as the population is ageing, but to a larger degree for influenza than for SARS-CoV-2 due to differential age-specific attack rates. Nevertheless, the number of deaths and QALY losses per 1,000 people is increasing for both infections and at a speed influenced by the share living in LTCFs. Conclusion Population ageing is associated with smaller outbreaks of COVID-19 and influenza, but at the same time it is causing a substantially larger burden of mortality, even if the proportion of LTCF residents were to decrease. These relationships are influenced by age patterns in epidemiological parameters. Not only the shift in the age distribution, but also the induced changes in the household structures are important to consider when assessing the potential impact of population ageing on the transmission and burden of emerging respiratory infections.
Læs mere Tjek på PubMedRice, Emily; Oakes, Daniel B.; Holland, Charlie; Moore, Hannah C.; Blyth, Christopher C.
Current Opinion in Infectious Diseases, 7.11.2023
Tilføjet 7.11.2023
Purpose of review Respiratory syncytial virus (RSV) remains a leading cause of mortality and morbidity worldwide. RSV seasonality was disrupted by COVID-19-associated nonpharmaceutical interventions (NPIs). We review RSV seasonality, molecular epidemiology, clinical manifestations, and community awareness to inform future prevention strategies. Recent findings An initial reduction of RSV disease observed with NPIs, and subsequent global resurgence was associated with a collapse in genetic diversity. A lack of immunity is suggested to have contributed to the resurgence of RSV cases experienced post COVID-19. The median age of children admitted with RSV increased during the resurgence, likely secondary to the expanded cohort of RSV-immune naive children. The pandemic also played a role in increased community awareness, which can be utilized as part of a coordinated public health effort to introduce prevention strategies. Further education on signs and symptoms of RSV is still required. Summary mAbs and maternal vaccines targeting RSV have the potential to reduce paediatric morbidity, however this new era of RSV prevention will require ongoing research to facilitate community awareness and engagement, and better respiratory surveillance. Tackling the global burden of RSV will require a coordinated effort and measures to ensure access and affordability of new prevention strategies.
Læs mere Tjek på PubMedGuangting Zeng, Zanling Zhang, Linlin Wang, Jianqiang Li
Journal of Medical Virology, 7.11.2023
Tilføjet 7.11.2023
Infection, 7.11.2023
Tilføjet 7.11.2023
Abstract We present a case of an ultimately fatal course of COVID-19 (coronavirus disease-19) in an 81-year-old female patient during the Omicron surge. The patient did not represent the typical patient at risk for severe COVID-19 with significant causes of immunodeficiency. However, she had been skeptical about the vaccination for severe acute respiratory syndrome virus-2 (SARS-CoV-2) and had refused it. Moreover, there had been no previous COVID-19 episodes. Our case report illustrates that with regard to SARS-CoV-2, immunologically naive patients are still at risk for severe and/or even fatal courses of COVID-19. We call to implement both, recommendations for SARS-CoV-2 vaccinations as well as for antiviral treatment.
Læs mere Tjek på PubMedJonathan F Lovell, Kazutoyo Miura, Yeong Ok Baik, Chankyu Lee, Jeong-Yoon Lee, Young-Shin Park, Ingi Hong, Jung Hyuk Lee, Taewoo Kim, Sang Hwan Seo, Jae-Ouk Kim, Manki Song, Chung-Jong Kim, Jae-Ki Choi, Jieun Kim, Eun Ju Choo, Jung-Hyun Choi
International Journal of Infectious Diseases, 7.11.2023
Tilføjet 7.11.2023
These data establish antibody durability of ECV-19, using a framework to analyze COVID-19 vaccine-induced antibodies during periods of high infection.
Læs mere Tjek på PubMedIrene (Tai-Lin) Lee, Po-Jen Lin, Ho-Hsian Yen
International Journal of Infectious Diseases, 7.11.2023
Tilføjet 7.11.2023
Since March 2020, there have been more than 770 million confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19) infection, according to the World Health Organization [1]. SARS-CoV-2 infection usually leads to milder symptoms in children, but about 34% develop a unique life-threatening condition known as Multisystem Inflammatory Syndrome in Children (MIS-C), Pediatric Inflammatory Multisystem Syndrome Temporally associated with COVID-19 (PIMS-TS), Systemic inflammatory syndrome in COVID-19 (SISCoV), and COVID-19-associated Kawasaki-like multisystem inflammatory syndrome (Kawa-COVID-19) 4-6 weeks after infection [2–4].
Læs mere Tjek på PubMedVaughan, A., Duffell, E., Freidl, G. S., Lemos, D. S., Nardone, A., Valenciano, M., Subissi, L., Bergeri, I., K Broberg, E., Penttinen, P., Pebody, R., Keramarou, M.
BMJ Open, 7.11.2023
Tilføjet 7.11.2023
ObjectivesSystematic review of SARS-CoV-2 seroprevalence studies undertaken in the WHO European Region to measure pre-existing and cumulative seropositivity prior to the roll out of vaccination programmes. DesignA systematic review of the literature. Data sourcesWe searched MEDLINE, EMBASE and the preprint servers MedRxiv and BioRxiv in the WHO ‘COVID-19 Global literature on coronavirus disease’ database using a predefined search strategy. Articles were supplemented with unpublished WHO-supported Unity-aligned seroprevalence studies and other studies reported directly to WHO Regional Office for Europe and European Centre for Disease Prevention and Control. Eligibility criteriaStudies published before the widespread implementation of COVID-19 vaccination programmes in January 2021 among the general population and blood donors, at national and regional levels. Data extraction and synthesisAt least two independent researchers extracted the eligible studies; a third researcher resolved any disagreements. Study risk of bias was assessed using a quality scoring system based on sample size, sampling and testing methodologies. ResultsIn total, 111 studies from 26 countries published or conducted between 1 January 2020 and 31 December 2020 across the WHO European Region were included. A significant heterogeneity in implementation was noted across the studies, with a paucity of studies from the east of the Region. Sixty-four (58%) studies were assessed to be of medium to high risk of bias. Overall, SARS-CoV-2 seropositivity prior to widespread community circulation was very low. National seroprevalence estimates after circulation started ranged from 0% to 51.3% (median 2.2% (IQR 0.7–5.2%); n=124), while subnational estimates ranged from 0% to 52% (median 5.8% (IQR 2.3%–12%); n=101), with the highest estimates in areas following widespread local transmission. ConclusionsThe low levels of SARS-CoV-2 antibody in most populations prior to the start of vaccine programmes underlines the critical importance of targeted vaccination of priority groups at risk of severe disease, while maintaining reduced levels of transmission to minimise population morbidity and mortality.
Læs mere Tjek på PubMedDayton Eberwein, J., Edochie, I. N., Newhouse, D., Cojocaru, A., Bopahbe, G. D., Kakietek, J. J., Kim, Y. S., Montes, J.
BMJ Open, 7.11.2023
Tilføjet 7.11.2023
ObjectivesThis study aims to estimate the levels of COVID-19 vaccine hesitancy in 53 low-income and middle-income countries, differences across population groups in hesitancy, and self-reported reasons for being hesitant to take the COVID-19 vaccine. MethodsThis paper presents new evidence on levels and trends of vaccine hesitancy in low-income and middle-income countries based on harmonised high-frequency phone surveys from more than 120 000 respondents in 53 low-income and middle-income countries collected between October 2020 and August 2021. These countries represent a combined 53% of the population of low-income and middle-income countries excluding India and China. ResultsOn average across countries, one in five adults reported being hesitant to take the COVID-19 vaccine, with the most cited reasons for hesitancy being concerns about the safety of the vaccine, followed by concerns about its efficacy. Between late 2020 and the first half of 2021, there tended to be little change in hesitancy rates in 11 of the 14 countries with available data, while hesitancy increased in Iraq, Malawi and Uzbekistan. COVID-19 vaccine hesitancy was higher among female, younger adults and less educated respondents, after controlling for selected observable characteristics. ConclusionsCountry estimates of vaccine hesitancy from the high-frequency phone surveys are correlated with but lower than those from earlier studies, which often relied on less representative survey samples. The results suggest that vaccine hesitancy in low-income and middle-income countries, while less prevalent than previously thought, will be an important and enduring obstacle to recovery from the pandemic.
Læs mere Tjek på PubMedTerefa, D. R., Tesfaye, E., Tolessa, B. E., Desisa, A. E., Olani, W., Fetensa, G., Chego, M., Abdisa, E., Turi, E., Bekuma, T. T., Getachew, M., Tesfaye, L., Tilahun, T.
BMJ Open, 7.11.2023
Tilføjet 7.11.2023
ObjectiveGlobally, around one-third of the population has at least one long-term health condition that could be affected by the COVID-19 pandemic. Despite the fact that studies have revealed the direct impact of COVID-19 on healthcare provision and utilisation, the impact of the pandemic on the cost of chronic disease treatment and care from a patient perspective was scanty. So, the study aimed to determine the impact of the COVID-19 pandemic on cost of chronic diseases treatment and care at public hospitals in Wallaga zones, Oromia Regional State, Ethiopia, from 1 August to 31 August 2020. MethodsAn institutional-based cross-sectional study design was used, and the sample size for the study (n=642) was determined using a single population mean formula. Data were collected using interviews and analysed using SPSS V.25. Descriptive statistics were performed, and the cost of follow-up care before and after the pandemic was compared using a related-samples Wilcoxon signed-rank test, declaring the level of significance of the median cost difference at p
Læs mere Tjek på PubMedBMC Infectious Diseases, 7.11.2023
Tilføjet 7.11.2023
Abstract Background Healthcare workers (HCWs) are at a higher risk of contracting COVID-19 due to their close contact with infected patients. However, the true burden of COVID-19 among HCWs in Yemen is unknown due to the inadequate availability of healthcare and the subclinical nature of the disease. This study aims to estimate the seroprevalence of SARS-CoV-2 infection among HCWs in two Yemeni governorates and identify associated factors using a cross-sectional design. Method A total of 404 HCWs were surveyed from June 2022 to September 2022 in Lahj and AL-Dhalea hospitals. A self-administered questionnaire collected demographic data, COVID-19 infection history, and vaccination status. A total of 404 human sera were tested using a specific electrochemiluminescence immunoassay assay. Association analysis was conducted to identify associations between antibody prevalence and demographic and vaccine-related variables. Result The median age of the HCWs was 31 (Range 20–64) years, with 65.0% being male and 35.0% female. Of all HCWs, 94% were SARS-CoV-2 seropositive and 77.0% had no confirmed test of COVID-19-related symptoms. There was no significant association between seropositivity and demographic factors such as age, gender, occupation, or COVID-19 vaccination (P > 0.05). Conclusion The seroprevalence of SARS-CoV-2 was high among HCWs in Yemen, primarily due to natural infection rather than vaccination. Compliance with infection prevention and control measures did not significantly affect seropositivity. This study highlights the need for improved healthcare systems and resources to reduce the burden of COVID-19 and promote infection prevention and control (IPC) measures among HCWs in Yemen.
Læs mere Tjek på PubMedDailey Garnes, Natalie J.M.; Kontoyiannis, Dimitrios P.
Current Opinion in Infectious Diseases, 6.11.2023
Tilføjet 6.11.2023
Purpose of review Mucormycosis (MCR) is a common opportunistic mold infection, and Mucorales were recently designated by WHO as priority pathogens. The interest in this infection has risen significantly since the major outbreak of MCR in the context of the COVID-19 pandemic, particularly in India. Herein, we summarize recently (last 24 months) published information regarding clinical aspects of MCR. Recent findings The disease remains protean in its clinical presentation, difficult to diagnose, and challenging to treat. In 2021, cases of COVID-19-associated mucormycosis (CAM) exploded in India during COVID-19 and manifested primarily as sino-orbital or sino-cerebral disease. Its classic risk factors included the triad of COVID-19, uncontrolled diabetes mellitus and use of corticosteroids. Despite difficulties in the timely diagnosis of MCR, significant progress has been made with the use of molecular techniques in blood to assist with earlier diagnosis, which can facilitate earlier appropriate therapy and improve outcomes. In addition, advances have been made in the use of imaging to stage the disease, determining what types of multimodal therapy are required depending on staging, and tissue-based identification of Mucorales. Summary Although the outlook for MCR has improved, effective new antifungals, risk stratification, and the optimal multimodality approaches remain an unmet need.
Læs mere Tjek på PubMedYushan Peng, Menglin Ni, Xiaoying Wang
PLoS One Infectious Diseases, 6.11.2023
Tilføjet 6.11.2023
by Yushan Peng, Menglin Ni, Xiaoying Wang This paper uses the test proposed by Generalized Supremum Augmented Dickey-Fuller to identify whether there are multiple bubbles in copper price. The empirical results show that base on market fundamentals, there are seven bubbles existed from January 1980 to March 2023. Through analyses, the first two bubbles can be explained by the demand from Japan by the industry concentration and persistent supply constraint. The third to sixth bubbles are mainly negatively impacted by the global financial crisis and growing demand of China. The last bubble is caused by the economic recovery from Covid-19. The logit regression has stated that aluminum price, copper production, all metals index and GDP have a positive impact on copper bubbles, while China’s copper imports and precious metals price negatively explains copper bubbles. The main contributions are the investigation of the copper price bubbles, its determinants and the different technique of GSADF to detect copper price bubbles. Furthermore, it provides helpful information for those investors to make reasonable investment decisions and thus, avoid potential price risk.
Læs mere Tjek på PubMedInfection, 5.11.2023
Tilføjet 5.11.2023
Abstract Purpose Post-acute sequelae of COVID-19 (PASC) affect approximately 10% of convalescent patients. The spectrum of symptoms is broad and heterogeneous with fatigue being the most often reported sequela. Easily accessible blood biomarkers to determine PASC severity are lacking. Thus, our study aimed to correlate immune phenotypes with PASC across the severity spectrum of COVID-19. Methods A total of 176 originally immunonaïve, convalescent COVID-19 patients from a prospective cohort during the first pandemic phase were stratified by initial disease severity and underwent clinical, psychosocial, and immune phenotyping around 10 weeks after first COVID-19 symptoms. COVID-19-associated fatigue dynamics were assessed and related to clinical and immune phenotypes. Results Fatigue and severe fatigue were commonly reported irrespective of initial COVID-19 severity or organ-specific PASC. A clinically relevant increase in fatigue severity after COVID-19 was detected in all groups. Neutralizing antibody titers were higher in patients with severe acute disease, but no association was found between antibody titers and PASC. While absolute peripheral blood immune cell counts in originally immunonaïve PASC patients did not differ from unexposed controls, peripheral CD3+CD4+ T cell counts were independently correlated with fatigue severity across all strata in multivariable analysis. Conclusions Patients were at similar risk of self-reported PASC irrespective of initial disease severity. The independent correlation between fatigue severity and blood T cell phenotypes indicates a possible role of CD4+ T cells in the pathogenesis of post-COVID-19 fatigue, which might serve as a blood biomarker.
Læs mere Tjek på PubMedInfection, 5.11.2023
Tilføjet 5.11.2023
Abstract Purpose Lung transplant recipients are at increased risk of severe disease following infection with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) due to high-dose immunosuppressive drugs and the lung is the main organ affected by Coronavirus disease 2019 (COVID-19). Several studies have confirmed increased SARS-CoV-2-related mortality and morbidity in patients living with lung allografts; however, detailed immunological studies of patients with SARS-CoV-2 infection in the early phase following transplantation remain scarce. Methods We investigated patients who were infected with SARS-CoV-2 in the early phase (18–103 days) after receiving double-lung allografts (n = 4, LuTx) in comparison to immunocompetent patients who had not received solid organ transplants (n = 88, noTx). We analyzed SARS-CoV-2-specific antibody responses against the SARS-CoV-2 spike and nucleocapsid proteins using enzyme-linked immunosorbent assays (ELISA), chemiluminescence immunoassays (CLIA), and immunoblot assays. T cell responses were investigated using Elispot assays. Results One LuTx patient suffered from persistent infection with fatal outcome 122 days post-infection despite multiple interventions including remdesivir, convalescent plasma, and the monoclonal antibody bamlanivimab. Two patients experienced clinically mild disease with prolonged viral shedding (47 and 79 days), and one patient remained asymptomatic. Antibody and T cell responses were significantly reduced or undetectable in all LuTx patients compared to noTx patients. Conclusion Patients in the early phase following lung allograft transplantation are vulnerable to infection with SARS-CoV-2 due to impaired immune responses. This patient population should be vaccinated before LuTx, protected from infection post–LuTx, and in case of infection treated generously with currently available interventions.
Læs mere Tjek på PubMedInfection, 5.11.2023
Tilføjet 5.11.2023
Abstract Purpose We aimed to assess IgG antibodies against the SARS-CoV-2 spike protein (anti-SARS-CoV-2 S IgG) in vaccinated mothers and their infants at delivery and 2–3 months of age. Methods We conducted a prospective study on mothers who received at least one dose of the COVID-19 vaccine (Pfizer-BNT162b2, Moderna mRNA-1273, or Oxford-AstraZeneca ChAdOx1-S) during pregnancy and on their infants. The baseline was at the time of delivery (n = 93), and the end of follow-up was 2 to 3 months post-partum (n = 53). Serum anti-SARS-CoV-2 S IgG titers and ACE2 binding inhibition levels were quantified by immunoassays. Results Mothers and infants had high anti-SARS-CoV-2 S IgG titers against the B.1 lineage at birth. However, while antibody titers were maintained at 2–3 months post-partum in mothers, they decreased significantly in infants (p 0.8, p
Læs mere Tjek på PubMedInfection, 4.11.2023
Tilføjet 4.11.2023
Abstract Purpose Post-acute sequelae of COVID-19 (PASC) affect approximately 10% of convalescent patients. The spectrum of symptoms is broad and heterogeneous with fatigue being the most often reported sequela. Easily accessible blood biomarkers to determine PASC severity are lacking. Thus, our study aimed to correlate immune phenotypes with PASC across the severity spectrum of COVID-19. Methods A total of 176 originally immunonaïve, convalescent COVID-19 patients from a prospective cohort during the first pandemic phase were stratified by initial disease severity and underwent clinical, psychosocial, and immune phenotyping around 10 weeks after first COVID-19 symptoms. COVID-19-associated fatigue dynamics were assessed and related to clinical and immune phenotypes. Results Fatigue and severe fatigue were commonly reported irrespective of initial COVID-19 severity or organ-specific PASC. A clinically relevant increase in fatigue severity after COVID-19 was detected in all groups. Neutralizing antibody titers were higher in patients with severe acute disease, but no association was found between antibody titers and PASC. While absolute peripheral blood immune cell counts in originally immunonaïve PASC patients did not differ from unexposed controls, peripheral CD3+CD4+ T cell counts were independently correlated with fatigue severity across all strata in multivariable analysis. Conclusions Patients were at similar risk of self-reported PASC irrespective of initial disease severity. The independent correlation between fatigue severity and blood T cell phenotypes indicates a possible role of CD4+ T cells in the pathogenesis of post-COVID-19 fatigue, which might serve as a blood biomarker.
Læs mere Tjek på PubMedTahoora Abdolahi, Gholamali Maamouri, Maryam Behmadi, Sara Mirzaeian, Hassan Boskabadi, Raheleh Faramarzi
Journal of Medical Virology, 4.11.2023
Tilføjet 4.11.2023
Lee, Laurie A.; Foster, Jennifer R.; Nikitovic, Dejana; Garros, Daniel; Ryan, Molly J.; Moghadam, Neda; Slumkoski, Corey; Walls, Martha; Curran, Janet A.; Seabrook, Jamie A.; Burgess, Stacy; Betts, Laura; Barclay, Amanda; Choong, Karen; Fontela, Patricia; Murthy, Srinivas; Nicoll, Jessica; O’Hearn, Katie; Sehgal, Anupam; Tijssen, Janice; for the Canadian Critical Care Trials Group
Critical Care Explorations, 4.11.2023
Tilføjet 4.11.2023
CONTEXT: PICUs across Canada restricted family presence (RFP) in response to the COVID-19 pandemic from allowing two or more family members to often only one family member at the bedside. The objective of this study was to describe the experiences and impact of RFP on families of critically ill children to inform future policy and practice. HYPOTHESIS: RFP policies negatively impacted families of PICU patients and caused moral distress. METHODS AND MODELS: National, cross-sectional, online, self-administered survey. Family members of children admitted to a Canadian PICU between March 2020 and February 2021 were invited to complete the survey. RFP-attributable distress was measured with a modified distress thermometer (0–10). Closed-ended questions were reported with descriptive statistics and multivariable linear regression assessed factors associated with RFP-attributable distress. Open-ended questions were analyzed using inductive content analysis. RESULTS: Of 250 respondents who experienced RFP, 124 (49.6%) were restricted to one family member at the bedside. The median amount of distress that families attributed to RFP policies was 6 (range: 0–10). Families described isolation, removal of supports, and perception of trauma related to RFP. Most families (183, 73.2%) felt that policies were enforced in a way that made them feel valued by PICU clinicians, which was associated with less RFP-attributable distress. Differential impact was seen where families with lower household income indicated higher RFP-attributable distress score (2.35; 95% CI, 0.53–4.17; p = 0.03). Most respondents suggested that future policies should allow at least two family members at the bedside. INTERPRETATIONS AND CONCLUSIONS: Families of children admitted to PICUs during the COVID-19 pandemic described increased distress, trauma, and removal of supports due to RFP policies. Vulnerable families showed an increased odds of higher distress. Healthcare professionals played an important role in mitigating distress. Allowance of at least two family members at the bedside should be considered for future policy.
Læs mere Tjek på PubMedOtto Regalado-Pezúa, Orly Carvache-Franco, Mauricio Carvache-Franco, Wilmer Carvache-Franco, Maribel Ortiz-Soto, Guisell Larregui-Candelaria
PLoS One Infectious Diseases, 4.11.2023
Tilføjet 4.11.2023
by Otto Regalado-Pezúa, Orly Carvache-Franco, Mauricio Carvache-Franco, Wilmer Carvache-Franco, Maribel Ortiz-Soto, Guisell Larregui-Candelaria The research examines the negative consumer emotions generated by the perception of social networks or traditional media with consumer behavior during the covid_19 pandemic. The study was developed in Peru with a sample of 220 consumers; the design is quantitative and structural equations were used for data processing. The results indicate that social networks and traditional media are not related to negative emotions, but are related to the change in consumer behavior in the purchase of more products and new products. The research has theoretical implications since it provides evidence to the literature that the negative emotions generated during the covid_19 pandemic are related to changes in consumer behavior, which affect the purchase of more products and new products. The practical implications of the research is for businessmen on the causes of changes in consumer behavior generated during crises. like the COVID-19 pandemic.
Læs mere Tjek på PubMedFarid Samaan, Rafaela Andrade Penalva Freitas, Renata Viana, Lívia Gâmbaro, Karlla Cunha, Tales Dantas Vieira, Valkercyo Feitosa, Eric Aragão Correa, Alexandre Toledo Maciel, Sylvia Aranha, Eduardo Atsushi Osawa, Roberta Pillar, Elias Marcos da Silva Flato, Renata Cristina da Silva, Elisa Carneiro, Fabrizzio Batista Guimarães de Lima Souza, Paula Regina Gan Rossi, Munira Bittencourt Abud, Henrique Pinheiro Konigsfeld, Riberto Garcia da Silva, Ricardo Barbosa Cintra de Souza, Saurus Mayer Coutinho, Miguel Ângelo Goes, Bárbara Antunes Bruno da Silva, Dirce Maria Trevisan Zanetta, Emmanuel Almeida Burdmann
PLoS One Infectious Diseases, 4.11.2023
Tilføjet 4.11.2023
by Farid Samaan, Rafaela Andrade Penalva Freitas, Renata Viana, Lívia Gâmbaro, Karlla Cunha, Tales Dantas Vieira, Valkercyo Feitosa, Eric Aragão Correa, Alexandre Toledo Maciel, Sylvia Aranha, Eduardo Atsushi Osawa, Roberta Pillar, Elias Marcos da Silva Flato, Renata Cristina da Silva, Elisa Carneiro, Fabrizzio Batista Guimarães de Lima Souza, Paula Regina Gan Rossi, Munira Bittencourt Abud, Henrique Pinheiro Konigsfeld, Riberto Garcia da Silva, Ricardo Barbosa Cintra de Souza, Saurus Mayer Coutinho, Miguel Ângelo Goes, Bárbara Antunes Bruno da Silva, Dirce Maria Trevisan Zanetta, Emmanuel Almeida Burdmann Introduction This study aimed to compare the characteristics and outcomes of critically ill patients with COVID-19-associated acute kidney injury (AKI) who were treated with kidney replacement therapy (KRT) in the first and second waves of the pandemic in the megalopolis of Sao Paulo, Brazil. Methods A multicenter retrospective study was conducted in 10 intensive care units (ICUs). Patients aged ≥18 years, and treated with KRT due to COVID-19-associated AKI were included. We compared demographic, laboratory and clinical data, KRT parameters and patient outcomes in the first and second COVID-19 waves. Results We assessed 656 patients (327 in the first wave and 329 in the second one). Second-wave patients were admitted later (7.1±5.0 vs. 5.6±3.9 days after the onset of symptoms, p
Læs mere Tjek på PubMedInfection, 4.11.2023
Tilføjet 4.11.2023
Abstract Purpose Lung transplant recipients are at increased risk of severe disease following infection with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) due to high-dose immunosuppressive drugs and the lung is the main organ affected by Coronavirus disease 2019 (COVID-19). Several studies have confirmed increased SARS-CoV-2-related mortality and morbidity in patients living with lung allografts; however, detailed immunological studies of patients with SARS-CoV-2 infection in the early phase following transplantation remain scarce. Methods We investigated patients who were infected with SARS-CoV-2 in the early phase (18–103 days) after receiving double-lung allografts (n = 4, LuTx) in comparison to immunocompetent patients who had not received solid organ transplants (n = 88, noTx). We analyzed SARS-CoV-2-specific antibody responses against the SARS-CoV-2 spike and nucleocapsid proteins using enzyme-linked immunosorbent assays (ELISA), chemiluminescence immunoassays (CLIA), and immunoblot assays. T cell responses were investigated using Elispot assays. Results One LuTx patient suffered from persistent infection with fatal outcome 122 days post-infection despite multiple interventions including remdesivir, convalescent plasma, and the monoclonal antibody bamlanivimab. Two patients experienced clinically mild disease with prolonged viral shedding (47 and 79 days), and one patient remained asymptomatic. Antibody and T cell responses were significantly reduced or undetectable in all LuTx patients compared to noTx patients. Conclusion Patients in the early phase following lung allograft transplantation are vulnerable to infection with SARS-CoV-2 due to impaired immune responses. This patient population should be vaccinated before LuTx, protected from infection post–LuTx, and in case of infection treated generously with currently available interventions.
Læs mere Tjek på PubMedInfection, 4.11.2023
Tilføjet 4.11.2023
Abstract Purpose Lung transplant recipients are at increased risk of severe disease following infection with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) due to high-dose immunosuppressive drugs and the lung is the main organ affected by Coronavirus disease 2019 (COVID-19). Several studies have confirmed increased SARS-CoV-2-related mortality and morbidity in patients living with lung allografts; however, detailed immunological studies of patients with SARS-CoV-2 infection in the early phase following transplantation remain scarce. Methods We investigated patients who were infected with SARS-CoV-2 in the early phase (18–103 days) after receiving double-lung allografts (n = 4, LuTx) in comparison to immunocompetent patients who had not received solid organ transplants (n = 88, noTx). We analyzed SARS-CoV-2-specific antibody responses against the SARS-CoV-2 spike and nucleocapsid proteins using enzyme-linked immunosorbent assays (ELISA), chemiluminescence immunoassays (CLIA), and immunoblot assays. T cell responses were investigated using Elispot assays. Results One LuTx patient suffered from persistent infection with fatal outcome 122 days post-infection despite multiple interventions including remdesivir, convalescent plasma, and the monoclonal antibody bamlanivimab. Two patients experienced clinically mild disease with prolonged viral shedding (47 and 79 days), and one patient remained asymptomatic. Antibody and T cell responses were significantly reduced or undetectable in all LuTx patients compared to noTx patients. Conclusion Patients in the early phase following lung allograft transplantation are vulnerable to infection with SARS-CoV-2 due to impaired immune responses. This patient population should be vaccinated before LuTx, protected from infection post–LuTx, and in case of infection treated generously with currently available interventions.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.11.2023
Tilføjet 3.11.2023
Abstract Background The general human immune responses similarity against different coronaviruses may reflect some degree of cross-immunity, whereby exposure to one coronavirus may confer partial immunity to another. The aim was to determine whether previous MERS-CoV infection was associated with a lower risk of subsequent COVID-19 disease and its related outcomes. Methods We conducted a retrospective cohort study among all patients screened for MERS-CoV at a tertiary care hospital in Saudi Arabia between 2012 and early 2020. Both MERS-CoV positive and negative patients were followed up from early 2020 to September 2021 for developing COVID-19 infection confirmed by RT-PCR testing. Results A total of 397 participants followed for an average 15 months during COVID-19 pandemic (4.9 years from MERS-CoV infection). Of the 397 participants, 93 (23.4%) were positive for MERS-CoV at baseline; 61 (65.6%) of the positive cases were symptomatic. Out of 397, 48 (12.1%) participants developed COVID-19 by the end of the follow-up period. Cox regression analysis adjusted for age, gender, and major comorbidity showed a marginally significant lower risk of COVID-19 disease (hazard ratio = 0.533, p = 0.085) and hospital admission (hazard ratio = 0.411, p = 0.061) in patients with positive MERS-CoV. Additionally, the risk of COVID-19 disease was further reduced and became significant in patients with symptomatic MERS-CoV infection (hazard ratio = 0.324, p = 0.034) and hospital admission (hazard ratio = 0.317, p = 0.042). Conclusions The current findings may indicate a partial cross-immunity, where patients with symptomatic MERS-CoV have a lower risk of future COVID-19 infection and related hospitalization. The present results may need further examination nationally using immunity markers.
Læs mere Tjek på PubMedRanjeet S. Mahla
Journal of Medical Virology, 3.11.2023
Tilføjet 3.11.2023
Valerie Percival, Oskar T Thoms, Ben Oppenheim, Dane Rowlands, Carolyn Chisadza, Sara Fewer, Gavin Yamey, Amy C Alexander, Chloe L Allaham, Sara Causevic, François Daudelin, Siri Gloppen, Debarati Guha-Sapir, Maseh Hadaf, Samuel Henderson, Steven J Hoffman, Ana Langer, Toni Joe Lebbos, Luiz Leomil, Minna Lyytikäinen, Anju Malhotra, Paul Mkandawire, Holly A Norris, Ole Petter Ottersen, Jason Phillips, Sigrún Rawet, Alexa Salikova, Idil Shekh Mohamed, Ghazal Zazai, Tarja Halonen, Catherine Kyobutungi, Zulfiqar A Bhutta, Peter Friberg
Lancet, 3.11.2023
Tilføjet 3.11.2023
The multiple and overlapping crises faced by countries, regions, and the world appear unprecedented in their magnitude and complexity. Protracted conflicts continue and new ones emerge, fuelled by geopolitics and social, political, and economic pressures. The legacy of the COVID-19 pandemic, economic uncertainty, climatic events ranging from droughts to fires to cyclones, and rising food insecurity add to these pressures. These crises have exposed the inadequacy of national and global leadership and governance structures.
Læs mere Tjek på PubMed