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Immunosuppression variably impacts outcomes for patients hospitalized with COVID-19: A retrospective cohort study

by Vijeeth Guggilla, Jennifer A. Pacheco, Alexandre M. Carvalho, Grant R. Whitmer, Anna E. Pawlowski, Jodi L. Johnson, Catherine A. Gao, Chad J. Achenbach, Theresa L. Walunas

Background

Adults with immunosuppression are more likely to develop severe COVID-19 than adults without immunosuppression. Less is known about differences in outcomes for adults with immunosuppression who are hospitalized with COVID-19.

Methods

A retrospective cohort study of adults hospitalized with COVID-19 at Northwestern Medicine hospitals between 03/01/2020 and 05/31/2022 was performed. Regression analyses were performed comparing in-hospital mortality, intensive care unit (ICU) admission, oxygenation requirements, and hospital/ICU length of stay among patients without immunosuppression (n = 9079) and patients with immunosuppression (n = 873).

Results

Patients with immunosuppression had significantly higher mortality than patients without immunosuppression (OR: 1.33, 95% CI: 1.11–1.60). This effect was even stronger when controlling for age at admission, diabetes, obesity, SARS-CoV-2 variant era, and COVID-19 medication use (adjusted OR: 1.78, 95% CI: 1.46–2.16). ICU admission (adjusted OR: 1.64, 95% CI: 1.41–1.90) and invasive ventilation (adjusted OR: 1.68, 95% CI: 1.36–2.06) were also significantly higher in patients with immunosuppression. Hospitalization length (median: 7 days) and ICU length of stay (median: 2.5 days) were longer in patients with immunosuppression compared to patients without immunosuppression (median: 5 days, adjusted p  Conclusions

Patients with immunosuppression had worse outcomes than patients without immunosuppression. Subgroup analyses showed that patients with solid organ transplant had the worst outcomes overall. Patients with HIV had similar outcomes as patients without immunosuppression unless CD4 cell count was low.

Bridging the gap in full immunisation coverage with parental awareness and attitudes: a community-based cross-sectional analysis on routine childhood vaccinations in Perambalur district of Tamil Nadu, South India

Por: Mohandas · N. V. · Mohandas · V. · Dinesh · A. · Vijayakumar · K. · Anand · V. · Karve · S. S.
Objectives

To determine the independent predictors of full immunisation coverage (FIC) among children aged 12–23 months along with the parental awareness and attitudes (of children aged ≤23 months) regarding routine childhood vaccinations in Perambalur district of Tamil Nadu, South India.

Design

A community-based cross-sectional analysis.

Setting

Perambalur district situated in the central region of Tamil Nadu state, South India.

Participants

Parents of children aged ≤23 months.

Outcome measures

The primary outcome measured was the FIC and FIC plus in the district along with the parental awareness and attitudes regarding routine childhood vaccinations. The independent predictors of FIC and FIC plus were determined using multivariable logistic regression models.

Results

The study included 652 children, with a mean (±SD) age of 16.47 (±6.37) months and a male-to-female ratio of 60:40. The FIC and FIC plus of children aged 12–23 months were 91.3% (95% CI 88.64 to 93.33) and 79.7% (95% CI 76.15 to 82.80), respectively. The immunisation card retention was 97.9% among the parents of children aged 12–23 months. The independent predictors of FIC included below poverty line families (adjusted OR (AOR) 0.11; 95% CI 0.02 to 0.64), illiteracy among mothers (AOR 0.67; 95% CI 0.32 to 0.87), lack of immunisation card (AOR 0.14; 95% CI 0.03 to 0.55), lack of frequent home visits by healthcare worker (AOR 0.38; 95% CI 0.18 to 0.79) and hesitancy of parents towards vaccination (AOR 0.26; 95% CI 0.12 to 0.87).

Conclusion

This study revealed a high FIC in this specific district. However, achieving full coverage is influenced by factors like socioeconomic status, maternal education and parental attitudes. Understanding these factors is essential for improving immunisation rates and ensuring all children are protected.

Associations of educational level with ECG-derived cardiovascular ageing in a population-based cohort: a mediation analysis from the Tromso Study

Por: Panthalanickal Vijayakumar · A. · Wilsgaard · T. · Schirmer · H. · Lindekleiv · H. · Attia · Z. I. · Lopez-Jimenez · F. · Leon · D. · Iakunchykova · O.
Objective

To assess the association between educational level and cardiovascular age acceleration metric derived from ECG, and to determine whether this association is mediated by established cardiovascular disease (CVD) risk factors.

Design

Prospective population-based cohort study (the Tromsø Study).

Setting

General population of the Tromsø municipality, Norway.

Participants

The study sample consisted of 4367 participants of the Tromsø Study, who took part in both Tromsø6 (2007–2008) and Tromsø7 (2015–2016), had a 12-lead ECG obtained at Tromsø7 and did not report a history of heart attack, stroke or atrial fibrillation.

Primary outcome measures

-age, a biomarker of cardiovascular ageing, is defined as the difference (in years) between an individual’s ECG-predicted heart age and their chronological age. ECG-predicted heart age was estimated using a previously validated deep neural network.

Results

Our findings indicate an inverse association between education and -age, with a regression coefficient per increment increase in education of –0.24 (95% CI –0.41 to –0.07) in the overall sample, –0.38 (95% CI –0.59 to –0.16) for women and –0.04 (95% CI –0.31 to 0.23) for men. Participants with the highest level of education (university/college for 4 or more years) had the lowest estimated -age with a regression coefficient of –0.69 years (95% CI –1.23 to –0.16) compared with the group with primary education for the overall sample, –1.05 years (95% CI –1.73 to –0.37) for women and –0.15 years (95% CI –1.03 to 0.73) for men. CVD risk factors mediated up to 75% of the association between overall education and -age, and 80% of the association among those with the highest education level (university/college for 4 or more years). Among women, 50% of the effect of overall education on -age was mediated by CVD risk factors, rising to 53% in the category with the highest level of education. However, in the subsample of men, there was no significant association between education and -age, and the mediation analysis produced natural direct and indirect effects pointing in opposite directions.

Conclusions

Cardiovascular ageing is inversely associated with educational level, an effect that appears to be largely mediated through established risk factors.

Protocol for a prospective cohort study to determine the multimodal biomarkers of delirium and new dementia after acute illness in older adults: ORCHARD-PS

Por: Gan · J. M. · Elderton · L. · Vijayakumar Sheela · M. · Knight · J. · Louca · J. · Evans · S. · Shahab · K. · Lovett · N. G. · Sneade · M. · Muchenje · N. · Fenchyn · M. · Simonato · D. · McColl · A. · Pendlebury · S. T.
Introduction

Delirium is common in the older hospital population and is often precipitated by acute illness. Delirium is associated with poor outcomes including subsequent cognitive decline and dementia and may therefore be a modifiable risk factor for dementia. However, the mechanisms underpinning the delirium–dementia relationship and the role of coexisting acute illness factors remain uncertain. Current biomarker studies of delirium have limitations including lack of detailed delirium characterisation with few studies on neurodegenerative or neuroimaging biomarkers especially in the acute setting. The Oxford and Reading Cognitive Health After Recovery from acute illness and Delirium—Prospective Study (ORCHARD-PS) aims to elucidate the pathophysiology of delirium and subsequent cognitive decline after acute illness in older adults, through acquisition of multimodal biomarkers for deep phenotyping of delirium and acute illness, and follow-up for incident dementia.

Methods and analysis

ORCHARD-PS is a bi-centre, prospective cohort study. Consecutive eligible patients requiring acute hospital admission or assessment are identified by the relevant acute clinical care team. All patients age >65 years without advanced dementia, nursing home residence, end-stage frailty or terminal illness are eligible. Details of potential participants are communicated to the research team and written informed consent or consultee agreement is obtained. Participants are interviewed as soon as possible after admission/assessment using a structured proforma.

Data are collected on demographics, diagnosis and comorbidities, social and functional background. Delirium is assessed using the 4A’s test, Confusion Assessment Method (long-form), Observational Scale of Level of Arousal, Richmond Agitation-Sedation Scale and Memorial Delirium Assessment Scale and diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Delirium is categorised by time of onset (prevalent vs incident), dementia status, motoric subtype, severity and duration. Cognitive tests include the 10-point Abbreviated Mental Test and Montreal Cognitive Assessment. Participants are reassessed every 48–72 hours if remaining in hospital. Informant questionnaire data and interview are supplemented by hand searching of medical records and linkage to electronic patient records for nursing risk assessments, vital observations, laboratory results and International Classification of Diseases, Tenth Revision diagnostic and procedure codes.

In-person follow-up with more detailed cognitive testing and informant interview is undertaken at 3 months, and 1 and 3 years supplemented with indirect follow-up using medical records. Blood banking is performed at baseline and all follow-ups for future biomarker analyses. CT-brain and MRI-brain imaging acquired as part of standard care is obtained for quantification of brain atrophy and white matter disease/stroke supplemented by research CT-brain imaging. Outcomes include length of hospitalisation, change in care needs, institutionalisation, mortality, readmission, longitudinal changes in cognitive and functional status and incident dementia. Biomarker associations with delirium, and with incident dementia on follow-up, will be determined using logistic or Cox regression as appropriate, unadjusted and adjusted for covariates including demographics, baseline cognition, frailty, comorbidity and apolipoprotein E genotype.

Ethics and dissemination

ORCHARD-PS is approved by the South Central—Berkshire Research Ethics Committee (REC Reference: 23/SC/0199). Results will be disseminated through peer-reviewed publications and conference presentations.

Trial registration number

ISRCTN24171810.

Progress towards prevention of suicide in India by improving print media reporting of suicide news: a repeat content analysis study in Tamil Nadu

Por: Armstrong · G. · Haregu · T. · Jayaseelan · M. · Niederkrotenthaler · T. · Cherian · A. · Menon · V. · Arya · V. · Vijayakumar · L.
Objectives

Suicide rates in India are among the highest in the world, with the most recent suicide death rate estimates ranging between 18 and 21 deaths per 100 000 population (compared with the global average of 11/100 000). Responsible media reporting of suicide is one of the few evidence-based population-level suicide prevention interventions. Reports of recent suicides are a routine daily feature in major newspapers in India, and the reporting style carries many concerning features. In 2019, the Press Council of India adopted the WHO media guidelines, yet there has been no investigation as to whether this guidance is being followed. The aim of this paper was to systematically investigate whether the quality of print media reports of suicides has changed since the adoption of media guidelines for suicide reporting in India.

Design

We used content analysis to assess the quality of suicide reporting against WHO guidelines in nine of the most highly read daily newspapers in the southern state of Tamil Nadu between June and December 2016 and June and December 2023. Our analyses of changes in reporting were based on a sample of 1681 print newspaper articles from 2016 and 512 print newspaper articles from 2023. Two-tailed t-tests and proportion tests on aggregate means and frequencies assessed whether the reporting characteristics had changed between 2016 and 2023.

Results

There were small yet statistically discernible reductions in the proportion of articles containing various potentially harmful reporting characteristics, such as articles placed on the front page (4.9–1.8%, p=0.002) and articles mentioning the suicide method (92.7–86.5%, p

Conclusions

We observed substantial improvements in the reporting quality of some English-language newspapers, with minimal improvements in the quality of reporting in Tamil-language newspapers. The media guidelines in India are supporting the early phases of a culture shift on media reporting of suicide, yet they are just the start of the conversation. Strategies are required to engage and support vernacular language newspapers in India on their reporting of suicide, with media sector leadership as a core component.

Use of 3D printed head and neck models for simulating 10 common ENT emergency procedures: a prospective validation study

Por: Rehman · U. · Colton · D. · Gupta · S. · Kulloo · P. · Vijendren · A. · Howard · J. · Sangwan · P. · Davies-Husband · C. · Rudd · J. · Whittaker · M. · Stephenson · K. · Taylor · C. · Roche · P. · Eynon-Lewis · N. · Bajaj · Y. · Lau · A. · Okhovat · S. · Rollin · M. · Lechner · M.
Objective

This study aims to validate a high-fidelity three-dimensional (3D)-printed head and neck model for training emergency medicine (EM) physicians, primary care physicians and allied health professionals in managing 10 common ear, nose and throat (ENT) emergencies.

Setting

The study was conducted at an ENT Emergencies course in London.

Study design

Prospective validation study.

Participants

All delegates (n=90) were healthcare professionals. Among them, 60% (n=54) were EM residents/trainees, 28% (n=25) were primary care residents/trainees, 4% (n=4) were ENT residents/trainees, 4% (n=4) were emergency nurse practitioners, 2% (n=2) were primary care attending physicians and 1% (n=1) was an EM attending/consultant. All faculty were consultant ENT surgeons (n=11).

Intervention

The 3D models, produced using proprietary 3D printing technology (Fuesetec), were used in a 1-day ENT emergencies course for validating training and confidence of delegates in performing 10 common ENT emergencies.

Results

A total of 86% (n=77) of delegates found the models extremely or very helpful in learning ENT emergencies. Delegates rated the resemblance to real patients as excellent or very good in both haptic feedback (n=58, 64%) and tissue texture (n=67, 74%). Additionally, 74%–96% of delegates felt confident in performing the 10 ENT procedures after using the models.

Conclusions

The 3D models enhanced participant confidence in performing 10 common ENT emergency procedures, demonstrating good face, content and indirect criterion validity. These models could support emergency ENT skill development in local emergency departments.

Association between herpes simplex virus 1 and dementia: a systematic review protocol

Por: Hong · A. T. · Luu · I. Y.-K. · Lin · F. · Vij · A. P. · Lewis · K. A. · Wilson · M. L. · Klausner · J. D.
Introduction

Herpes simplex virus 1 (HSV-1) infects approximately two-thirds of the global population under the age of 50 years. Although widely prevalent, the possible implications of HSV-1 in neurodegenerative diseases, especially dementia and Alzheimer’s disease, remain poorly understood. This review seeks to elucidate this association and explore the potential benefits of preventing or treating herpesvirus infections on dementia risk. The goal is to enhance our understanding of HSV-1’s potential role in dementia, which could inform the development of future therapeutic interventions for these conditions.

Methods and analysis

PubMed, Embase (Elsevier/Ovid), Web of Science, Scopus, Global Health, PsycInfo, Cochrane Library and Clinicaltrials.gov will be searched from the inception of each respective database. Studies that have HSV-1 as an exposure and dementia, or its subtypes, as a primary outcome will be included. Two researchers will independently screen titles, abstracts and full texts, with discrepancies resolved by a third researcher. Systematic data extraction from eligible studies will be performed using a standardised template. Risk of bias of individual studies will be assessed with the Cochrane Collaboration approach. We will assess the overall quality of cumulative evidence using the Grading of Recommendations, Assessment, Development and Evaluations criteria. Statistical analysis will employ a random effects model, and heterogeneity will be determined with Cochrane’s Q test and assessed using I2. Studies will be grouped by population subgroups and dementia subtypes when possible to explore nuances in results. We will consider performing meta-regression if heterogeneity remains after subgroup analyses. All statistical analyses will be conducted using Stata V.18 software (College Station, Texas, USA).

Ethics and dissemination

No ethical approval is required since data will be collected from existing studies. The review will be disseminated through peer-reviewed publication and at national and international conferences.

PROSPERO registration number

CRD42024516789.

Characterizing the services provided by family physicians in Ontario, Canada: A retrospective study using administrative billing data

by David W. Savage, Arunim Garg, Salimur Choudhury, Roger Strasser, Robert Ohle, Vijay Mago

Family physicians in Ontario provide most of the primary care to the healthcare system. However, given their broad scope of practice, they often provide additional services including emergency medicine, hospital medicine, and palliative care. Understanding the spectrum of services provided by family physicians across different regions is important for health human resource planning (HHRP). We investigated the services provided by family physicians in Ontario, Canada using a provincial physician database and administrative physician billing data from 2017. Billing codes were used to define 18 general services that family physicians may provide. We then evaluated variation in the services provided by different physicians based on the physicians’ geographic location (north-urban, north-rural, south-urban, and south-rural) and career stage (i.e., years in practice). Ontario had 14,443 family physicians in 2017, with most practicing in urban communities in southern Ontario and only 6.5% practicing in any setting in northern Ontario. In general, rural physicians provided a greater range of services than their urban colleagues. Their practices most often included clinic medicine, mental health services, emergency medicine, palliative care, and hospital medicine. Physicians in urban southern Ontario and those at a more advanced career stage were more likely to provide a narrower range of services. Overall, our findings have the potential to shape HHRP, medical education curriculum development, and clinical services planning in Ontario and elsewhere. Moreover, our results provide policy- and decision-makers with a basis for integrating knowledge of the specific clinical services delivered by family physicians into their future planning, with the goal of ensuring a fit-for-purpose workforce able to meet community healthcare needs.

HER2-low prevalence among Hispanic/Latino women with breast cancer: A systematic review and meta-analysis

by Daniel Felipe Mendivelso-González, Daniel Clavijo Cabezas, Luisa Montoya, Merideidy Plazas Vargas, Patricia López-Correa, Eugenia Colón, Rafael Parra-Medina

Purpose

HER2-low has garnered significant attention for the treatment of HER2-negative breast cancer. We aimed to determine the prevalence of HER2-low expression in Hispanic/Latino women with breast cancer (BC).

Methods

We searched in Embase, LILACS, and Medline databases for articles reporting the expression of HER2 immunohistochemistry with scores reported as 0, 1+, 2+, or 3+, with equivocal cases (2+) confirmed through in situ hybridization (ISH).

Results

A total of 12 articles were finally included, comprising 73,467 individuals. The prevalence of HER2-zero, HER2-low and HER2 positive cases among all BC (0, 1+, 2+/ISH-, 2+/ISH+ and 3+), was 45.0%, 32.0%, and 23.0%, respectively. The prevalence of HER2-zero and HER2-low expression among negative cases (0, 1+ and 2+/ISH-), was 53.0% and 47.0%, respectively.

Conclusion

There is an important percentage of Hispanic/Latino individuals who would benefit from HER2-targeted therapies, even in HER2 negative cases. Additional research on the prevalence of HER2-low tumors across a wider range of Latin American countries is required to better understand the molecular epidemiology of this biomarker within the Hispanic/Latino population.

Attitude of Indian nurses towards importance of families in nursing care: A cross‐sectional study

Abstract

Aims and Objective

To evaluate the attitudes of Indian nurses towards the importance of family involvement in nursing care and the association between nurse attitudes and sociodemographic characteristics.

Background

Involving the family in the care process is crucial for delivering family- and patient-centred care and ensuring the best possible patient outcomes. Nevertheless, published literature revealed that the nurses may lack clarity regarding the role of family members in the patient's care, which in turn hinders families' participation in care.

Design

Cross-sectional descriptive study. The STROBE checklist was used to report the present study.

Methods

A total of 203 Nurses participated in a prospective cross-sectional study between May 2022 and August 2022. They were recruited through convenience sampling from two tertiary care centres in India. A two-part questionnaire was used to gather the data; the first section contained questions for gathering sociodemographic information, and the second part contained the standardized FINC-NA scale.

Results

The mean age of the nurses was (28.08 ± 4.722) years, and their median professional experience was 2.5 (1–5.5) years. Nurses' attitude regarding family's importance in patient care was found to be significantly associated (p ≤ .05) with education level, marital status, religion and hometown region.

Conclusion

In several items Indian nurses have positive attitudes towards family involvement in care but some of the lower scoring items can present opportunities for focused improvement. Continuing development programmes about family-centered care can constitute important strategies to improve the positive attitudes of nurses towards families in practice.

Patient and public contribution

No patient or public contribution.

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