Effects of a New Multicomponent Nutritional Supplement on Muscle Mass and Physical Performance in Adult and Old Patients Recovered from COVID-19: A Pilot Observational Case–Control Study

Objective: The purpose of the present study was to assess the effect of a specific oral nutritional supplement among patients recovered from COVID-19 but suffering symptoms of fatigue. Methods: This is an observational case–control study involving a sample of 66 COVID-19 survivors divided in two groups, 33 subjects in the intervention group who received the nutritional supplement and 33 subjects in the control group. The nutritional supplement received by subjects in the active group was based on amino acids; vitamin B6 and B1; and malic, succinic and citric acids. After an 8-week follow-up, the main outcomes considered were skeletal muscle index (measured by bioelectrical impedance analysis), physical performance measures (handgrip strength, one-minute chair–stand test, six-minute walking test), and quality of life (using EuroQol visual analogue scale). Results: All the considered areas increased significantly in the subjects receiving the active treatment with oral nutritional supplement in comparison with the baseline values. After adjusting for age, gender, and baseline values, skeletal muscle index, handgrip strength test, the one-minute chair–stand test, and six-minute walking test values were higher among participants in the treatment group compared with subjects in control group. The oral nutritional supplement significantly improved the handgrip strength; similarly, participants in the active group showed a higher improvement in skeletal muscle index, the one-minute chair–stand test, the six-minute walking test, and in quality of life. Conclusion: The nutritional supplement containing nine essential amino acids plus cysteine; vitamin B6 and B1; and malic, succinic and citric acids had a positive effect on nutritional status, functional recovery, and quality of life in COVID-19 survivors still suffering from fatigue. Additional controlled clinical trials are required to corroborate these results.     

全球新冠疫苗研发与接种策略进展

WHO于2023年5月5日宣布新型冠状病毒感染(corona virus disease 2019,COVID-19)疫情不再构成国际关注的突发公共卫生事件。全球疫情相对稳定,但是各国仍不能放松对COVID-19的警惕。接种新冠疫苗仍是有效的预防手段。本文主要围绕当前全球新冠疫苗研发进展、不同国家疫苗接种策略调整情况等进行对比分析,并结合WHO推荐对新冠疫苗接种策略的最新指导意见,分析探讨全球新冠疫苗研发及各国疫苗接种策略对我国的启示,提出适合我国国情的针对性疫苗接种建议。     

Postpartum Care Behavior Improvement during COVID-19 Pandemic in Indonesia Using Mobile-Health Interactive Message

BackgroundSince 2018, maternal mortality in Semarang City, Indonesia, has mostly (75%) occurred during the postpartum period. Therefore, a health intervention is necessary to improve safe and effective postpartum care. During the Covid-19 pandemic, a mobile-based health intervention is preferred due to the government''s regulation of COVID-19 safety prevention. This study aimed to determine the effectiveness of the mobile-health interactive message on the postpartum care behavior of mothers and their husbands.MethodsThe study was conducted in a quasi-experimental design. It includes the treatment group and the control group, in which each group consists of 46 pairs of pregnant women in the third trimester and their husbands. The research subjects were chosen through the purposive sampling technique. Data collection was conducted via interviews and observations. The m-health intervention is carried out in the form of text messages, images, videos, and interactive mentoring. The latter was carried out through group messaging via the WhatsApp application for the treatment group. Meanwhile, the control group received regular counseling from the local Community Health Center. Data analysis was performed by Mann-Whitney test, unpaired T-Test, Chi-Square Test dan Fisher Exact Test.ResultsIntervention for 2.5 months increased the knowledge of mothers and husbands. The intervention for 3.5 months improved the mother''s attitude, but not the husband''s attitude. The intervention also improves maternal practices related to postpartum visits, such as Early Initiation of Breastfeeding assistance requests from health workers, iron tablets and nutritious food consumption, personal hygiene, postpartum danger signs monitoring, and the husband''s practice of accompanying mothers during postpartum visits.ConclusionMobile-Health interactive messages effectively improved postpartum care behavior for mothers and their husbands.     

Assessment of knowledge of COVID-19 among health care workers-a questionnaire-based cross-sectional study in a tertiary care hospital of India

BackgroundHealth Care Workers (HCW) are among the primary stakeholders and front liners in the fight against COVID-19. They are in direct contact with the patients as primary caregivers and, therefore, are at a higher risk of infection. This Pandemic offers a unique opportunity to explore the level of knowledge among ground-level HCWs during this global health crisis.ObjectiveWe conducted this study to assess the knowledge and awareness among HCW regarding the COVID-19 Pandemic in a tertiary care hospital.MethodsIt was a cross-sectional study done on HCW comprising faculty, senior residents, junior residents, demonstrators, and nursing staff of various specialties directly involved in the care of suspected/confirmed COVID-19 patients. A pretested questionnaire consisting of 20 questions was used as a study tool and was circulated through the digital platform.ResultsThere were a total of 437 respondents. In the subgroup analysis, the respondents in the age group of 55–64 years had a higher mean knowledge score, followed by the respondents in the age group of 18–24 years. For years of experience, the mean knowledge score varied from 13.89 (10–20 years of experience) to 13.83 (5–10 years of experience). The mean knowledge score was the highest for consultants (14.10), followed by Resident Doctors (13.96).ConclusionsThis study has shed some critical clues for further research and interventions. Firstly, as health care workers are probably learning about COVID-19 from their practical exposure rather than formal teaching, it is pertinent to address this issue through well-planned formal sessions of training workshops and lectures.     

新冠疫情期间社区卫生服务中心职工心理健康状况调查

目的 分析上海市宝山区社区卫生服务中心职工新冠疫情期间的心理健康状况,为促进职工心理健康提供参考.方法 于2020年5月随机抽取宝山区17家社区卫生服务中心中的5家,对其中的在职职工通过问卷星平台,使用躯体化症状自评量表(SSS)、健康自评问卷-9(PHQ9)和广泛性焦虑量表-7(GAD7)进行问卷调查.结果 职工在疫...     

世界卫生组织应对新型冠状病毒肺炎的机制

新型冠状病毒肺炎的大流行是这个时代的全球卫生危机,也是我们目前所面临的最大挑战。在世界范围内,传染病的管理关键在于遵守国际法规,进行国际合作,以追求共同利益和价值。WHO是联合国系统下管理和控制疾病传播的专门性国际组织。本文对WHO应对传染病的防控机制、新型冠状病毒肺炎疫情的应对措施以及努力方向进行综述,以期为全球新型冠状病毒肺炎疫情控制提供参考。     

支援新冠肺炎患者定点收治医院的实践与思考

文章总结了同济大学附属第十人民医院支援新冠肺炎患者定点收治医院的救治工作经验。即根据所支援的病区新冠肺炎患者状况，合理分配医师、护士、药师三方人力资源，明确各自岗位责任，在分工合作基础上，不断优化工作流程，并始终贯彻院感理念。文章认为对新冠肺炎重症患者治疗是支援救治工作的重点与难点，需同时采取多学科协作和心理干预方式，而持续强化重症医学学科的发展是今后应对重大公共卫生事件的重要策略。     

新冠肺炎患者医疗救治体系构建与实施

新冠肺炎疫情暴发后,作为综合医院的华中科技大学同济医学院附属协和医院西院被改造为患者收治定点医院。为做好COVID-19重症和危重症患者的救治工作,医院在原有质量管理体系基础上建立了一个以领导指挥体系为核心,以质量管理体系、诊治标准体系、人员调配体系、院感防控体系、救治与预警体系、后勤保障体系为支撑的患者医疗救治体系,取得了良好效果,为其他定点医院提供了借鉴和参考。     

新冠肺炎疫情下定点医院阶梯式重症医疗救治的探索

通过梳理新冠感染重症患者救治定点医院的规模、功能与人员配置,结合武汉与上海不同场景下定点医院的重症救治管理经验,因地制宜地快速整合有限的重症资源,总结出“重症关口前移-同质化重症救治-高级监护病房”的阶梯式重症延伸工作模式,为相关医院救治新冠感染重症患者提供了参考。     

新冠肺炎疫情下的医学人文精神

新冠肺炎疫情下,医学人文展示出独特的内涵。医务人员以天地般的大德关照生命,是爱国主义的实在表现。义不容辞地走上了抗击新型冠状病毒前线的医务人员,表现出高尚的医学人文情怀。医学人文精神是人类社会与医学发展的珍果,是历史与现实的统一;彰显出特有的社会功能与职业价值观,是社会责任与职业道德的统一;实现着人民的愿望与国家的企盼,是“真善美”的统一。医务人员英勇搏击病毒,鲜明地展现出无私的献身品质,凝聚出医学人文精神的俊美。     

Marketing the COVID-19 vaccine and the implications for public health

COVID-19 vaccines are new brands of consumer health technology being introduced to the market. Considering consumer behaviour approaches in this time of crisis, the risk of vaccine hesitancy, the call for more transparency and effective messaging to gain trust, and equitable distribution of this vaccine, this is unexplored theoretical terrain. This commentary takes a multidisciplinary approach to understand and theoretically explore the marketing, distribution, and acceptance of the COVID-19 vaccine. The paper integrates marketing principles, including advertisement and branding of consumer health technology with supply chain management, public affairs, and public health. A theoretical framework was presented to illustrate this relationship and key areas of concerns. The practical implications relevant to equity, ethics, education, employment, and the economic impact was presented.     

Predictors of In-Hospital Mortality in Older Patients With COVID-19: The COVIDAge Study

ObjectiveTo determine predictors of in-hospital mortality related to COVID-19 in older patients.DesignRetrospective cohort study.Setting and ParticipantsPatients aged 65 years and older hospitalized for a diagnosis of COVID-19.MethodsData from hospital admission were collected from the electronic medical records. Logistic regression and Cox proportional hazard models were used to predict mortality, our primary outcome. Variables at hospital admission were categorized according to the following domains: demographics, clinical history, comorbidities, previous treatment, clinical status, vital signs, clinical scales and scores, routine laboratory analysis, and imaging results.ResultsOf a total of 235 Caucasian patients, 43% were male, with a mean age of 86 ± 6.5 years. Seventy-six patients (32%) died. Nonsurvivors had a shorter number of days from initial symptoms to hospitalization (P = .007) and the length of stay in acute wards than survivors (P < .001). Similarly, they had a higher prevalence of heart failure (P = .044), peripheral artery disease (P = .009), crackles at clinical status (P < .001), respiratory rate (P = .005), oxygen support needs (P < .001), C-reactive protein (P < .001), bilateral and peripheral infiltrates on chest radiographs (P = .001), and a lower prevalence of headache (P = .009). Furthermore, nonsurvivors were more often frail (P < .001), with worse functional status (P < .001), higher comorbidity burden (P < .001), and delirium at admission (P = .007). A multivariable Cox model showed that male sex (HR 4.00, 95% CI 2.08-7.71, P < .001), increased fraction of inspired oxygen (HR 1.06, 95% CI 1.03-1.09, P < .001), and crackles (HR 2.42, 95% CI 1.15-6.06, P = .019) were the best predictors of mortality, while better functional status was protective (HR 0.98, 95% CI 0.97-0.99, P = .001).Conclusions and implicationsIn older patients hospitalized for COVID-19, male sex, crackles, a higher fraction of inspired oxygen, and functionality were independent risk factors of mortality. These routine parameters, and not differences in age, should be used to evaluate prognosis in older patients.     

基于信息化的方舱医院新型冠状病毒肺炎患者收治

华中科技大学同济医学院附属同济医院在方舱医院信息化实施的过程中,一方面利用"云平台"优势实现了系统的快速部署调试,同时将已经在同济医院3个院区使用的系统为此次疫情防控所做的部分关键改造,无缝移植到方舱医院,实现方舱医院与同济医院3个院区的同品质医疗。另一方面,基于现有系统流程,定制方舱医院的业务流程,以满足大量新型冠状病毒肺炎患者的集中收治需求。通过一系列信息化举措,在提高方舱医院患者收治效率的同时,所有医患数据均可纳入医院监管平台的集中管控,实现疫情的科学高效防治。     

基层社区新型冠状病毒肺炎健康教育工作实践

在本次新型冠状病毒肺炎疫情中,基层健康教育机构利用多平台、全方位开展健康教育,同时依托专业机构的力量开展健康科普,组织发动社会各级的作用,利用传统媒体和新媒体平台,针对不同的人群开展健康教育,起到积极的作用。     

Prevention and Treatment of COVID-19 Using Traditional and Folk Medicine: A Content Analysis Study

BackgroundCoronavirus 2019 (COVID-19) is a respiratory disease with no specific and definitive drug treatment. With the COVID-19 outbreak, traditional and folk methods were used for its treatment. This study was conducted to explore people''s experiences of using traditional and folk medicine for the prevention and treatment of COVID-19 in Iran.MethodsThis qualitative study was conducted on 37 people in Arak (Iran) from May to November 2020 using a conventional content analysis approach. The participants were selected using cluster sampling and interviewed using semistructured telephone interviews. After transcribing the interviews, they were analyzed using content analysis. Accordingly, semantic units were identified, related codes were extracted and placed in subcategories and categories based on similarities, and themes were formed. The interviews continued until data saturation.ResultsAfter analyzing the collected data, 116 different codes were extracted and classified into two subcategories of pharmacological and non-pharmacological methods. Then, each of the subcategories was classified into two categories: conventional medicine and traditional medicine. Finally, two main themes were obtained, including prevention methods and self-treatment methods for COVID-19.ConclusionPeople use various traditional and folk methods for COVID-19 prevention and treatment. Such methods can be either useful or lack the necessary effectiveness and have side effects. Thus, necessary training should be provided to the public about using these methods and avoiding unapproved treatments.     

Individual preferences for COVID-19 vaccination in China

BackgroundVaccinations are an effective choice to stop disease outbreaks, including COVID-19. There is little research on individuals' COVID-19 vaccination decision-making.ObjectiveWe aimed to determine individual preferences for COVID-19 vaccinations in China, and to assess the factors influencing vaccination decision-making to facilitate vaccination coverage.MethodsA D-efficient discrete choice experiment was conducted across six Chinese provinces selected by the stratified random sampling method. Vaccine choice sets were constructed using seven attributes: vaccine effectiveness, side-effects, accessibility, number of doses, vaccination sites, duration of vaccine protection, and proportion of acquaintances vaccinated. Conditional logit and latent class models were used to identify preferences.ResultsAlthough all seven attributes were proved to significantly influence respondents’ vaccination decision, vaccine effectiveness, side-effects and proportion of acquaintances vaccinated were the most important. We also found a higher probability of vaccinating when the vaccine was more effective; risks of serious side effects were small; vaccinations were free and voluntary; the fewer the number of doses; the longer the protection duration; and the higher the proportion of acquaintances vaccinated. Higher local vaccine coverage created altruistic herd incentives to vaccinate rather than free-rider problems. The predicted vaccination uptake of the optimal vaccination scenario in our study was 84.77%. Preference heterogeneity was substantial. Individuals who were older, had a lower education level, lower income, higher trust in the vaccine and higher perceived risk of infection, displayed a higher probability to vaccinate.ConclusionsPreference heterogeneity among individuals should lead health authorities to address the diversity of expectations about COVID-19 vaccinations. To maximize COVID-19 vaccine uptake, health authorities should promote vaccine effectiveness; pro-actively communicate the absence or presence of vaccine side effects; and ensure rapid and wide media communication about local vaccine coverage.     

COVID-19 vaccine hesitancy in care home staff: A survey of Liverpool care homes

Uptake of COVID-19 vaccine first doses in UK care homes has been higher among residents compared to staff. We aimed to identify causes of lower COVID-19 vaccine uptake amongst care home staff within Liverpool. An anonymised online survey was distributed to all care home managers, between the 21st and the 29th January 2021. 53 % of 87 care homes responded. The overall COVID-19 vaccination rate was 52.6 % (n = 1119). Reasons, identified by care home managers for staff being unvaccinated included: concerns about lack of vaccine research (37.0 %), staff being off-site during vaccination sessions (36.5 %), pregnancy and fertility concerns (5.6 %), and allergic reactions concerns (3.2 %). Care home managers wanted to tackle vaccine hesitancy through conversations with health professionals, and provision of evidence dispelling vaccine misinformation. Vaccine hesitancy and logistical issues were the main causes for reduced vaccine uptake among care home staff. The former could be addressed by targeted training, and public health communication campaigns to build confidence and acceptance of COVID-19 vaccines.     

COVID-19 in clinical practice: A narrative synthesis

The coronavirus disease 2019 (COVID-19) was first reported in the city of Wuhan, China. The disease rapidly spread to the rest of China, to Southern-East Asia, then to Europe, America, and on to the rest of the world. COVID-19 is associated with a betacoronavirus named SARS-CoV-2. The virus penetrates the organism through the respiratory tract, conveyed by contaminated droplets. The main cell receptor targeted is the surface-bound ACE-2. As of the 26th July 2020, 15,200,000 COVID-19 cases and 650,000 deaths were reported worldwide. The mortality rate is estimated between 1.3 and 18.3%. The reproductive rate without any public health intervention is estimated around 4-5.1 in France. Most hospitalized patients for COVID-19 present respiratory symptoms, which in some cases is associated with fever. Up to 86% of admissions to ICU are related to acute respiratory failure. To date, no anti-viral therapy has proven its efficacy considering randomized trials. Only immunomodulatory treatments such as corticosteroids have shown to cause significant improvement in patient outcome.     

The Cost-Effectiveness of Remdesivir for Hospitalized Patients With COVID-19

ObjectivesThis study aimed to estimate the cost-effectiveness of remdesivir, the first novel therapeutic to receive Emergency Use Authorization for the treatment of hospitalized patients with COVID-19, and identify key drivers of value to guide future pricing and reimbursement efforts.MethodsA Markov model evaluated the cost-effectiveness of remdesivir in patients hospitalized with COVID-19 from a US healthcare sector perspective. A lifetime time horizon captured potential long-term costs and outcomes. Model outcomes included discounted total costs, life-years, and quality-adjusted life-years (QALYs). Remdesivir was modeled as an addition to standard of care and compared with standard of care alone, including dexamethasone for patients requiring respiratory support. COVID-19 hospitalizations were assumed to be reimbursed through a single payment based on the respiratory support received alongside a remdesivir carveout payment in the base case. Sensitivity and scenario analyses identified key drivers.ResultsAt a unit price of $520 per vial and assuming no survival benefit with remdesivir, the incremental cost-effectiveness was $298 200/QALY for patients with moderate to severe COVID-19 and $1 847 000/QALY for patients with mild COVID-19. Although current data do not support a survival benefit, if one was assumed, the cost-effectiveness estimate was $50 100/QALY for the moderate to severe population and $103 400/QALY for the mild population. Another key driver included the hospitalization payment structure (per diem vs bundled payment).ConclusionsWith the current evidence available, remdesivir’s price is too high to align with its expected health gains for hospitalized patients with COVID-19. Results from this study provide a rationale for iterative health technology assessment.