The impact of COVID-19 vaccination programme in the Republic of San Marino: Focus on effectiveness of Gam-Covid-Vac

ObjectiveThe adenovirus-based vaccine Gam-COVID-Vac (Sputnik V) showed promising effectiveness in a phase 3 clinical trial; however, data concerning its impact at a population level are scarce. The Republic of San Marino (RSM) conducted a SARS-CoV-2 vaccination programme mainly based (>80%) on Gam-COVID-Vac. Our aims were to investigate the impact of Gam-COVID-Vac vaccination programme and its effectiveness in a retrospective observational study based on the entire RSM population aged ≥12 years.MethodsWe calculated the incidence rate and the vaccine effectiveness (VE) in the entire RSM population not previously infected, against SARS-CoV-2 infection and COVID-19–related hospitalization, from 25 February to 1 October 2021, considering any vaccine and separately according to the vaccine used. Vaccine effectiveness was calculated using a multivariable negative binomial regression model as 1-Incidence Rate Ratio.ResultsDuring the study period, 21 568/28 791 (74.9%) not previously infected subjects received at least one dose of the Gam-COVID-Vac (84%) or BNT162b2, vaccines with 98% completing the vaccination schedule. Overall, 1634 SARS-CoV-2 infections and 166 COVID-19-related hospitalizations were observed with 17 COVID-19-related deaths reported. Incidence rates of SARS-CoV-2 infection and COVID-19-related hospitalization were 7.11 and 0.49/100 000 person-days in the fully vaccinated population, respectively. The adjusted overall VE was 67.6% (95% CI: 61.8–72.5) against SARS-CoV-2 infection and 87.9% (95% CI: 77.4–93.5) against COVID-19-related hospitalizations.Gam-COVID-Vac against SARS-CoV-2 infection VE peaked 91.8% (95% CI: 86.3–95.1) in the first bimester from the second dose, declining to 57.8% (95% CI: 42.2–69.2) at 6 months. Protection against hospitalization with COVID-19 was overall 91.6% (95% CI: 81.5–96.2), with no relevant waning trend over time.DiscussionOur study demonstrated the effectiveness of overall vaccination (Gam-COVID-Vac [84%] and BNT162b2 [16%]) in the prevention SARS-CoV-2 infection (pre-Omicron variant), waning over time but still with sustainable effectiveness against COVID-19-related hospitalization in the Republic of San Marino.     

脐带间充质干细胞在遗传性痉挛性截瘫中的应用

目的观察脐带间充质干细胞（UC-MSC）治疗遗传性痉挛性截瘫（HSP）的临床疗效及安全性。方法2010年9月及2011年4月,分别给予一HSP家系父子2人行UC-MSC鞘内注射治疗,两个疗程,每次1×106 cells/Kg,每周1次,4次为1个疗程。采用改良的Ashworth肌张力分级标准（MAS）、国际合作共济失调评分量表（ICARS）及日常生活量表（ADL）,对患者治疗前后神经功能、日常生活能力进行评定。结果第一疗程结束1个月与治疗前比较,2人MAS分级、ICARS及ADL评分均降低,两人行走站立稳定性及言语流利程度较治疗前改善;第二疗程结束后1个月与该疗程治疗前比较,2人ICARS及ADL评分降低,儿子肌张力进一步降低,父亲双上肢共济失调减轻。2人治疗后均未见明显不良反应发生。末次治疗结束后随访20个月,父、子俩分别于第二疗程治疗结束7个月及8个月后,症状继续加重。结论 UC-MSC鞘内注射治疗是安全的,可在一定时间内一定程度上减轻患者临床症状,提高患者生活质量,延缓疾病进展,但疗效不能持久。     

Effectiveness of Procedural Sedation and Analgesia in Pediatric Emergencies. A Cross-Sectional Study

IntroductionPain is defined as an unpleasant emotional and sensory experience associated with bodily harm or with situations that cause fear and anxiety. However, it is often undertreated in pediatric emergency departments. This study aims to assess the effectiveness of sedation-analgesia techniques, level of satisfaction among health care professionals and relatives, and agreement between the satisfaction of health care professionals and relatives.MethodsA cross-sectional design was conducted. Sociodemographic and clinical variables were recorded, together with those for effectiveness using the Face, Legs, Activity, Cry, and Consolability scale and the Wong-Baker FACES scale, and the satisfaction using the 10-point Likert scale. Stata 16.1 was used for data analysis.ResultsA total of 94 procedures were registered. The results suggested that these techniques were effective or mildly effective in only half of the cases. Satisfaction was considered good across the board, and the agreement between health care professionals (ie, pediatric nurses and pediatricians) was considered substantial. However, the agreement between health care professionals and relatives was moderate.DiscussionOur results suggested that the adequate management of pain in pediatric emergency departments is still a challenge, despite the availability of international guidelines. Future research lines should be focused on analyzing possible causes of the inefficacy of some sedation-analgesia techniques and the causes of the differences between the perspectives of health care professionals and relatives. These research lines may be useful to improve quality of care and pediatric patient comfort.     

The effectiveness of nurse practitioner care for patients with mental health conditions in primary care settings: A systematic review

BackgroundThe nurse practitioner (NP) workforce is key to meeting the demand for mental health services in primary care settings.PurposeThe purpose of this study is to synthesize the evidence focused on the effectiveness of NP care for patients with mental health conditions in primary care settings, particularly focused on primary care NPs and psychiatric mental health NPs and patients with anxiety, depression, and substance use disorders.MethodsStudies published since 2014 in the United States studying NP care of patients with anxiety, depression, or substance use disorders in primary care settings were included.FindingsSeventeen studies were included. Four high-quality studies showed that NP evidence-based care and prescribing were comparable to that of physicians. Seven low-quality studies suggest that NP-led collaborative care is associated with reduced symptoms.DiscussionMore high-quality evidence is needed to determine the effectiveness of NP care for patients with mental health conditions in primary care settings.     

产时个性化基础按摩程序对促进自然分娩的影响

目的：探讨产时个性化基础按摩程序对促进自然分娩的影响。方法选取我院产科自然分娩产妇90例,随机分为观察组和对照组各45例。观察组在传统自然分娩的基础上辅以个性化基础按摩程序;对照组按照传统自然分娩流程进行。对比分析两组孕妇产程中的疼痛评分、镇痛药物使用量、产程时间、产后出血、尿潴留、中转剖宫产率及新生儿窒息情况。结果观察组产时疼痛程度评分及镇痛药物剂量均低于对照组,第一产程及第二产程时间短于对照组,差异均有统计学意义( P<0.05)。观察组中转剖宫产率、尿潴留发生率均低于对照组,差异有统计学意义( P<0.05)。两组在产后出血量、新生儿窒息方面比较,差异均无统计学意义( P﹥0.05)。结论产时个性化基础按摩程序有助于减轻产时疼痛,减少镇痛药物的使用,促进产程,降低中转剖宫产率,具有一定的临床应用和推广价值。     

磺胺嘧啶银不宜用于治疗烧伤

数十年来,含银抗菌剂一直作为非全层皮肤烧伤的标准局部疗法使用,尤其是磺胺嘧啶银（SSD）被普遍用于治疗烧伤,然而,其疗效一直不明确。最近发表的两篇系统评述文章揭示了含银敷料和局部治疗药物治疗烧伤缺乏有效证据。     

Effectiveness of an informative video on reducing anxiety levels in patients undergoing elective coronarography: An RCT

Background

Anxiety levels have a considerable effect on patients during hospitalization. Cardiology Departments are characterized by a high turn-over of patients and it is necessary to give clear and exhaustive information routinely in compliance with legal and deontological requirements.

Aims

The aim of the study was to evaluate the effectiveness of an informative video, devised for patients undergoing coronarography, on reducing anxiety levels and getting more satisfaction from the received information.

Methods

A two arm RCT design was chosen.The patients in both study arms received standard care while the informative video was shown in the treatment group. The Spielberger scale was used to measure anxiety levels before the procedure while satisfaction as to the received information was measured using a scale with semantic indications.

Results

Ninety-three patients accepted to take part in the study. The weighted mean difference (WMD) between the anxiety levels of the treated and controlled groups was − 8.24 (CI 95%: − 12.04/− 4.44; p < 0.00001).The WMD of the level of satisfaction for the received information was + 22.23 (CI 95%: + 12.73 /+ 31.73; p < 0.00001).

Conclusions

The use of the informative video in Cardiology Departments proves to be highly recommended as an instrument to lower anxiety levels and increase significantly the level of satisfaction deriving from the received information.     

Effectiveness of the monovalent AS03-adjuvanted influenza A(H1N1)pdm09 vaccine against hospitalization in children because of influenza

We studied the effectiveness of the AS03-adjuvanted monovalent vaccine (Pandemrix^®) for the prevention of severe pandemic influenza A(H1N1)pdm09 in children, in 2009. All children hospitalized for influenza-like illness in Stockholm County during the peak of the pandemic were included. We compared the frequency of vaccinated children between influenza A(H1N1)pdm09 PCR positive cases and PCR negative controls in a retrospective case–control study.     

Clinical effectiveness of pneumococcal polysaccharide vaccine in men: California Men's Health Study

Objective

To examine the effectiveness of pneumococcal polysaccharide vaccine (PPV) among approximately 40,000 community-dwelling men aged 45 years and older in the California Men's Health Study (CMHS) cohort.

Methods

All participants completed an extensive questionnaire at baseline (2002–2003) and were followed for the occurrence of invasive pneumococcal disease (IPD) or all-cause pneumonia hospitalization through the end of 2009. Immunization status and incident IPD and pneumonia cases were ascertained through electronic medical records. The associations between vaccination and IPD or pneumonia hospitalization were assessed using time-dependent Cox proportional models to account for sociodemographics, time-updated vaccination status, and comorbidities.

Results

The median follow-up period of the 39,222 participants was 7.3 years. Among them, 11,902 (30.3%) had received at least one PPV vaccine at baseline and 7653 (19.5%) received their first PPV vaccine during the follow-up. There were 17 pneumococcal bacteremia cases, 647 hospitalized pneumonia cases, and no pneumococcal meningitis cases. The results suggested a reduced risk of pneumococcal bacteremia among men vaccinated at age ≥65 (adjusted hazard ratio [HR]: 0.35; 95% confidence interval [CI]: 0.06–1.91; p = 0.22). PPV vaccination did not show a protective effect against all-cause pneumonia hospitalization (adjusted HR: 1.18; 95% CI: 1.02–1.37, p = 0.03) among men vaccinated before 65 years old, but a moderate protective effect was suggested among men without chronic obstructive pulmonary diseases who were vaccinated after 65 years old (adjusted HR: 0.84; 95% CI: 0.67–1.06, p = 0.15).

Conclusions

The findings in this large cohort of men in Southern California suggested a benefit of PPV for protection against pneumococcal bacteremia among men vaccinated at age 65 years and older. PPV might not provide adequate protection against all-cause pneumonia hospitalization among men.     

某中小型制药企业工作场所健康促进干预的效果

目的 评估某制药企业在实施工作场所健康促进综合性干预活动后的效果.方法 采用问卷调查、查阅资料、现场观察、满意度调查和访谈等方式进行效果评估.结果 干预后员工对《中华人民共和国职业病防治法》、职业病预防措施、高血压定义、艾滋病传播途径和高血压、冠心病预防措施的知晓率分别从干预前的72.4％、13.8％、67.5％、45.8％、51.7％提高到97.8％、19.9％、82.3％、94.7％、53.1％.员工生活方式得以改善,干预后吸烟改善率为98.5％,饮酒改善率为70.2％,早餐每周4次以上人员较干预前增加30.6％.综合评估47项指标中,41项符合,5项基本符合,无不符合项.结论 开展工作场所健康促进活动,可全面提升该制药企业职业安全卫生管理工作水平,促进员工的身心健康,所制定的综合性干预措施可行有效.