During the COVID-19 pandemic, many clinical sites shifted towards digital delivery of mental health services. However, there is still much to learn regarding tailoring interventions for trauma-affected populations, including military members, Veterans, and public safety personnel. This study examined perceptions of psychotherapies utilized for trauma-affected populations, as reported by Canadian military members, Veterans, and public safety personnel who completed such interventions and mental health clinicians who provided them. Specifically, we explored the shift to digital health use, what changed with this rapid shift, what needs, problems, and solutions arose, and important future considerations associated with delivering trauma-focused and adjunct treatments digitally. Quantitative survey data were collected from 11 Canadian patients (military members, Veterans, and public safety personnel with post-traumatic stress injury) and 12 Canadian mental health clinicians. Survey questions were adapted from the Alberta Quality Matrix for Health (AQMH) and Unified Theory of Acceptance and Use of Technology (UTAUT) model. As a follow-up, participants were invited to participate in either a semi-structured qualitative interview or focus group to further explore their perspectives on digitally delivered trauma-focused and adjunct therapies. Four clients and 19 clinician participants participated in an interview or focus group. In survey and interview/focus group results, patient and clinician participants reported that digitally delivered trauma and adjunct therapies offered similar treatment effectiveness as in-person delivery while also improving treatment access. Participants indicated unique advantages of digital delivery, including the increased accessibility of treatment, cost effectiveness, and more efficient use of resources. However, some participants struggled with using digital platforms and felt less comfortable working in a digital environment. Further research with a larger, more diverse population is required to corroborate our results and identify other avenues in which psychotherapies utilized for trauma-affected populations can be engaged with and improved upon.
Background The COVID-19 pandemic impacted diabetes mellitus clinical outcomes and chronic care globally. However, little is known about its impact in low-resource settings such as sub-Saharan Africa. Hence, to address this, we systematically conducted a scoping review to explore the COVID-19 impact on diabetes outcomes and care in countries of sub-Saharan Africa. Methods We applied our search strategy to PubMed, Web of Science, CINAHL, African Index Medicus, Google Scholar, Cochrane Library, Scopus, Science Direct, ERIC and Embase to obtain relevant articles published from January 2020 to March 2023. Two independent reviewers were involved in the screening of retrieved articles. Data from eligible articles were extracted from quantitative, qualitative and mixed methods studies. Numerical data were summarised using descriptive statistics, while a thematic framework was used to categorise and identify themes for qualitative data. Results We found 42 of the retrieved 360 articles eligible, mainly from South Africa, Ethiopia and Ghana (73.4%). COVID-19 increased the risk of death (OR 1.30,9.0, 95% CI), hospitalisation (OR 3.30,3.73: 95% CI), and severity (OR: 1.30,4.05, 95% CI) in persons with diabetes mellitus. COVID-19 also increased the risk of developing diabetes mellitus in hospitalised cases. The pandemic, on the other hand, was associated with disruptions in patient self-management routine and diabetes mellitus care service delivery. Three major themes emerged, namely, (i) patient-related health management challenges, (ii) diabetes mellitus care service delivery challenges, and (iii) reorganisation of diabetes mellitus care delivery. Conclusion COVID-19 increased mortality and morbidity among people living with diabetes mellitus. In addition, the COVID-19 pandemic worsened diabetes mellitus care management. Sub-Saharan African countries should, therefore, institute appropriate policy considerations for persons with diabetes mellitus during widespread emergencies.
Effective monitoring of infectious disease incidence remains a major challenge to public health. Difficulties in estimating the trends in disease incidence arise mainly from the time delay between case diagnosis and the reporting of cases to public health databases. However, predictive models usually assume that public data sets faithfully reflect the state of disease transmission. In this paper, we study the effect of delayed case reporting by comparing data reported by the Johns Hopkins Coronavirus Resource Center (CRC) with that of the raw clinical data collected from the San Antonio Metro Health District (SAMHD), San Antonio, Texas. An insight on the subtle effect that such reporting errors potentially have on predictive modeling is presented. We use an exponential distribution model for the regression analysis of the reporting delay. The proposed model for correcting reporting delays was applied to our recently developed SEYAR (Susceptible, Exposed, Symptomatic, Asymptomatic, Recovered) dynamical model for COVID-19 transmission dynamics. Employing data from SAMHD, we demonstrate that the forecasting ability of the SEYAR model is substantially improved when the rectified reporting obtained from our proposed model is utilized. The methods and findings demonstrated in this work have ample applicability in the forecasting of infectious disease outbreaks. Our findings suggest that failure to consider reporting delays in surveillance data can significantly alter forecasts.
Background/Objectives COVID-19 continues to pose a significant burden that impacts public health and the healthcare system as the SARS-CoV-2 virus continues to evolve. Regularly updated vaccines are anticipated to boost waning immunity and provide protection against circulating variants. This study evaluated vaccine effectiveness (VE) of mRNA-1273.815, a 2023-2024 Omicron XBB.1.5-containing mRNA COVID-19 vaccine, at preventing COVID-19-related hospitalizations and any medically attended COVID-19 in adults ≥18 years, overall, and by age and underlying medical conditions. Methods This retrospective cohort study used the Veradigm Network EHR linked to claims data to identify US adults ≥18 years of age who received the mRNA-1273.815 vaccine (exposed) matched 1:1 to individuals who did not receive a 2023-2024 updated COVID-19 vaccine (unexposed). Patients in the unexposed cohort were randomly matched to eligible mRNA-1273.815 recipients. Inverse probability of treatment weighting was used to adjust for differences between the two cohorts. The exposed cohort was vaccinated between September 12, 2023, and December 15, 2023, and individuals in both cohorts were followed up for COVID-19-related hospitalizations and medically attended COVID-19 until December 31, 2023. A Cox regression model was used to estimate the hazard ratio (HR). VE of the mRNA-1273.815 vaccine in preventing COVID-19-related hospitalizations and any medically attended COVID-19 was estimated as 100*(1-HR). Subgroup analyses were performed for adults ≥50, adults ≥65, and individuals with underlying medical conditions associated with severe COVID-19 outcomes. Results Overall, 859,335 matched pairs of mRNA-1273.815 recipients and unexposed adults were identified. The mean age was 63 years, and 80% of the study population was ≥50 years old. 61.5% of the mRNA-1273.815 cohort and 66.4% of the unexposed cohort had an underlying medical condition. Among the overall adult population (≥18 years), VE was 60.2% (53.4-66.0%) against COVID-19-related hospitalization and 33.1% (30.2%-35.9%) against medically attended COVID-19 over a median follow-up of 63 (IQR: 44-78) days. VE estimates by age and underlying medical conditions were similar. Conclusions These results demonstrate the significant protection provided by mRNA-1273.815 against COVID-19-related hospitalizations and any medically attended COVID-19 in adults 18 years and older, regardless of their vaccination history, and support CDC recommendations for vaccination with the 2023-2024 Omicron XBB.1.5-containing COVID-19 vaccine to prevent COVID-19-related outcomes, including hospitalizations.
Background: Phase IIb HIPRA-HH-2 study results showed that PHH-1V as first booster dose elicited a strong and sustained neutralising antibody response against various SARS-CoV-2 variants. Here, we report the safety and immunogenicity of a fourth booster dose of PHH-1V against the most prevalent Omicron SARS-CoV-2 variants in Spain. Methods: The HIPRA-HH-2 open-label extension study (NCT05142553) evaluated the safety and immunogenicity of PHH-1V as a fourth booster dose in subjects aged ≥18 years and followed for 6 months. Subjects received a fourth dose of PHH-1V 6-12 months after a previous regime of either two doses of BNT162b2 plus a third dose of PHH-1V (Cohort 1) or three doses of BNT162b2 (Cohort 2). Primary regulatory endpoint evaluated the neutralisation titres (GMT) against Omicron BA.1 on Day 14 of PHH-1V used as fourth dose in Cohort 2 vs the BNT162b2 used as third dose in initial HIPRA-HH-2 study. The immunogenicity of PHH-1V as fourth dose was also investigated by GMTs against Beta, Delta, and Omicron BA.1, BA.4/5 and XBB.1.5 on Days 14, 98 and 182 post-immunisation in the overall study population and in Cohorts 1 and 2 versus baseline. Safety of the fourth dose was also assessed. Findings: From September 2022, 288 subjects received PHH-1V as a fourth dose (Cohort 1 n=106; Cohort 2 n=182). A significant increase in neutralising antibodies against Omicron BA.1 subvariant at Day 14 was observed from the third homologous booster with mRNA vaccine compared to the fourth heterologous booster with PHH-1V (1739.02 vs 4049.01; GMT ratio 0.43 (95% CI: 0.28; 0.65; p-value < 0.0001). PHH-1V used as fourth booster induced a statistically significant increase in neutralising antibody titres 14 days after immunisation for all variants compared with baseline [GMFR on Day 14 (95%CI) was 6.96 (5.23, 9.25) for Beta variant; 6.27 (4.79, 8.22) for Delta variant; 9.21 (5.57, 15.21) for Omicron BA.1 variant; 11.80 (8.29, 16.80) for Omicron BA.4/5 variant and 5.22 (3.97, 6.87) for Omicron XBB.1.5 variant]. Titres remained significantly higher compared with baseline at 3 and 6 months post-vaccination. Cohort comparison revealed no significant differences at 14 , 98 and 182 days post-vaccination. The most frequent adverse events were injection site pain (Cohort 1: 84.0%; Cohort 2: 77.5%) and fatigue (Cohort 1: 17.9%; Cohort 2: 29.1%). No subjects experienced severe COVID-19 infection. Interpretation: The PHH-1V vaccine as a booster induced a potent and sustained neutralising antibody response against previous circulating Beta, Delta variants and Omicron BA.1, BA.4/5, and XBB.1.5 subvariants in subjects previously vaccinated with three doses regardless of previous regimen. These findings suggest that PHH-1V could be an appropriate strategy for upcoming heterologous vaccination campaigns.
Estimation of transmission and contact rate parameters among individuals in different age groups is a key point in the mathematical modeling of infectious disease transmission. Several approaches exist for this task but, given the complexity of the problem, the obtained values are always approximate estimations that hold in particular conditions. Our goal is to contribute to this task in the event of an emerging disease. We propose a methodology to estimate the contact rate parameters from the fraction of the incidence reported in each age group at the beginning of the epidemic spread. Working with an age-structured SIR model, we obtain an equation that relates the contact parameters to various epidemiological quantities that could be accessible through different sources. We apply the method to obtain information about the contact structure by age during the COVID-19 epidemic spread in Greater Buenos Aires (Argentina) in 2020. As we have the fractions of reported incidence by age but only rough estimations of other quantities involved in the method, we define several epidemiological scenarios based on various hypotheses. Using the different sets of contact parameters obtained, we evaluate control strategies and analyze the dependence of the results on our assumptions. The proposed method could be useful to obtain a fast first insight of a new emergent disease at the beginning of epidemic spread using the accessible information.
We mapped the 2020-2023 daily Covid-19 case data from the World Health Organization (WHO) to the original SIR model of Karmack and McKendrick for multiple pandemic recurrences due to the evolution of the virus to different variants in forty countries worldwide. The aim of the study was to determine how the SIR parameters are changing as the virus evolved into variants. Each peak in cases was analyzed separately for each country and the parameters: reff (pandemic R-parameter), Leff (average number of days an individual is infective) and alpha (the rate of infection for contacts between the set of susceptible persons and the set of infected persons) were computed. Each peak was mapped to circulating variants for each country and the SIR parameters (reff, Leff, alpha) were averaged over each variant using their values in peaks where 70% of the variant sequences identified belonged to a single variant. This analysis showed that on average, compared to the original Wuhan variant (alpha = 0.2), the parameter alpha has increased to alpha = 0.5 for the Omicron variants. The value of reff has decreased from around 3.8 to 2.0 and Leff has decreased from 15 days to 10 days. This is as would be expected of a virus that is coming to equilibrium by evolving to increase its infectivity while reducing the effects of infections on the host.
Introduction: COVID-19 triggers prothrombotic and proinflammatory changes, with thrombotic disease prevalent in up to 30% SARS-CoV-2 infected patients. Early work suggests that aspirin could prevent COVID-19 related thromboembolic disorders in some studies but not others. This study leverages data from the largest integrated healthcare system in the United States to better understand this association. Our objective was to evaluate the incidence and risk of COVID-19 associated acute thromboembolic disorders and the potential impact of aspirin. Methods: This retrospective, observational study utilized national electronic health record data from the Veterans Health Administration. 334,374 Veterans who tested positive for COVID-19 from March 2, 2020, to June 13, 2022, were included, 81,830 of whom had preexisting aspirin prescription prior to their COVID-19 diagnosis. Patients with and without aspirin prescriptions were matched and the odds of post-COVID acute thromboembolic disorders were assessed. Results: 10.1% of Veterans had a documented thromboembolic disorder within 12 months following their COVID-19 diagnosis. Those with specific comorbidities were at greatest risk. Preexisting aspirin prescription was associated with a significant decrease risk of post-COVID-19 thromboembolic disorders, including pulmonary embolism (OR [95% CI]: 0.69 [0.65, 0.74]) and deep vein thrombosis (OR [95% CI]: 0.76 [0.69, 0.83], but an increased risk of acute arterial diseases, including ischemic stroke (OR [95% CI]: 1.54 [1.46, 1.60]) and acute ischemic heart disease (1.33 [1.26, 1.39]). Conclusions: Findings demonstrated that preexisting aspirin prescription prior to COVID-19 diagnosis was associated with significantly decreased risk of venous thromboembolism and pulmonary embolism but increased risk of acute arterial disease. The risk of arterial disease may be associated with increased COVID-19 prothrombotic effects superimposed on preexisting chronic cardiovascular disease for which aspirin was already prescribed. Prospective clinical trials may help to further assess the efficacy of aspirin use prior to COVID-19 diagnosis for the prevention of post-COVID-19 thromboembolic disorders.
Individuals9 perceptions of disease influence their adherence to preventive measures, shaping the dynamics of disease spread. Despite extensive research on the interaction between disease spread, human behaviors, and interventions, few models have incorporated real-world behavioral data on disease perception, limiting their applicability. This study novelly integrates disease perception, represented by perceived severity, as a critical determinant of behavioral change into a data-driven compartmental model to assess its impact on disease spread. Using survey data, we explore scenarios involving a competition between a COVID-19 wave and a vaccination campaign, where individuals9 behaviors vary based on their perceived severity of the disease. Results demonstrate that behavioral heterogeneities influenced by perceived severity affect epidemic dynamics, with high heterogeneity yielding contrasting effects. Longer adherence to protective measures by groups with high perceived severity provides greater protection to vulnerable individuals, while premature relaxation of behaviors by low perceived severity groups facilitates virus spread. Epidemiological curves reveal that differences in behavior among groups can eliminate a second infection peak, resulting in a higher first peak and overall more severe outcomes. The specific modeling approach for how perceived severity modulates behavior parameters does not strongly impact the model9s outcomes. Sensitivity analyses confirm the robustness of our findings, emphasizing the consistent impact of behavioral heterogeneities across various scenarios. Our study underscores the importance of integrating risk perception into infectious disease transmission models and highlights the necessity of extensive data collection to enhance model accuracy and relevance.
Effects of Unsupervised Inspiratory Muscle Training on Ventilation Variability in Post-covid-19 Patients. - Conditions: COVID-19
Interventions: Device: Experimental Group
Sponsors: Universidade Federal do Rio Grande do Norte
Recruiting
A Phase IV Vaccine Study Under the National Cohort Study of Effectiveness and Safety of SARS-CoV-2 (COVID-19) Vaccines. - Conditions: SARS CoV 2 Infection
Interventions: Biological: Johnson & Johnson
Sponsors: Jens D Lundgren, MD; Ministry of the Interior and Health, Denmark
Completed
Detoxification From the Lipid Tract - Conditions: COVID-19 Vaccine Adverse Reaction
Interventions: Device: electroencephalogram biofeedback; Device: electrical brain stimulation; Device: ultra-low frequency transcranial magnetic stimulation; Drug: Sertraline Hydrochloride; Drug: Clonazepam; Drug: Alprazolam; Drug: Metoprolol; Drug: Olanzapine; Drug: Pravastatin Sodium 20 MG; Drug: Sacubitril Valsartan Sodium Hydrate
Sponsors: Pachankis, Yang I., M.D.; First Affiliated Hospital of Chongqing Medical University
Completed
Covid-19 and Influenza Oral Vaccine Study - Conditions: covid19 Infection; Influenza, Human
Interventions: Biological: Covid-19 vaccine; Biological: Influenza vaccine
Sponsors: Vaxine Pty Ltd; Australian Respiratory and Sleep Medicine Institute Ltd
Not yet recruiting
A Study of an Investigational mRNA-1273.815 COVID-19 Vaccine in Previously Vaccinated Adults - Conditions: SARS-CoV-2
Interventions: Biological: Investigational mRNA-1273.815; Biological: Licensed Spikevax Vaccine
Sponsors: ModernaTX, Inc.
Not yet recruiting
A Study of the Efficacy of Troxerutin in Preventing Thrombotic Events in COVID-19 Patients - Conditions: COVID 19 Associated Coagulopathy
Interventions: Drug: Troxerutin; Drug: Placebo; Drug: placebo + low molecular weight heparin; Drug: troxerutin + low molecular weight heparin
Sponsors: Westlake University; Shaoxing Central Hospital
Recruiting
The Use of Isatidis Root and Forsythia Oral Liquid for the Treatment of Mild Cases of COVID-19: A Trial Clinical Study - Conditions: Treatment of Mild Cases of COVID-19
Interventions: Drug: Langenlianqiao; Drug: LianhuaQingWen; Other: placebo control group
Sponsors: Central South University
Completed
Fascial Tissue Response To Manual Therapy: Implications In Long Covid Rehabilitation - Conditions: COVID-19
Interventions: Other: Guidebook; Other: Guidebook and Myofascial Reorganization® (RMF).
Sponsors: University of the State of Santa Catarina; Larissa Sinhorim
Recruiting
Effect of Probiotic Strain Lactobacillus Paracasei PS23 on Brain Fog in People With Long COVID - Conditions: Long COVID; Brain Fog; Cognitive Change
Interventions: Dietary Supplement: Lactobacillus paracasei PS23; Dietary Supplement: microcrystalline cellulose
Sponsors: Taipei Veterans General Hospital, Taiwan
Not yet recruiting
Evaluation of the Impact of Rehabilitation Strategies and Early Discharge After Respiratory Failure - Conditions: Acute Respiratory Failure
Interventions: Behavioral: Standard of Care; Behavioral: Rehabilitation
Sponsors: Hospital Israelita Albert Einstein
Not yet recruiting