无锡市郊区慢病患病率及主要危险因素现况分析

本文对无锡市郊区慢性非传染性疾病（简称慢病）的患病率及主要危险因素现状进行了调查，结果表明：郊区３５周岁以上人群中高血压、冠心病、脑卒中、糖尿病、主要恶件肿癌合计患病率已超过１／３，达３６．８７％，以高血压患病率最高，达２４．６２％。调查结果还显示出不同慢病病种在性别、年龄、文化程度、职业中的差异。对主要危险因素的调查分析显示：ＢＭＩ和ＷＨＲ超标率较高，分别为１０％和５０％左右；男怀常吸烟率６２．２９％，常饮酒３４．１９％；人群血压平均水平超过１９９１年全国调查水平。本次调查基本摸清了无锡市郊区慢病患病及其危险因素流行状况，为开展慢病监测和干预提供了基础资料。     

新冠肺炎疫情下慢性病患者就医延迟问题调查与分析

目的分析新冠肺炎疫情下慢性病患者就医延迟问题。方法2021年2月,采用网络调查,以321名慢性病患者作为调查对象,采用多种统计方法进行分析。结果调查的慢病患者中,37.1%出现就医延迟。就医延迟最多的疾病是心脑血管疾病(23.5%);就医延迟影响的首位原因是患者出现"医院恐慌"现象,害怕院内交叉感染而不敢去医院(54.6%);未及时就医带来的首位影响的是康复变慢(43.7%)。结论就医延迟发生的主要社会人口学特征是年龄和自评健康状况,患者就医延迟的心理行为特征是风险感知和过度防护,新冠肺炎疫情下,慢性病患者就医延迟现象较高,就医延迟后对患者产生不利影响,建议采取全方位的综合举措以缓解患者疫情期间的就医难题。     

Risk Factors of COVID-19 Critical Outcomes in the Eastern Mediterranean Region: Multicountry Retrospective Study

BackgroundThe establishment of empirical evidence in the Eastern Mediterranean Region necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of patients with COVID-19.ObjectiveThis study aims to assess the patterns of COVID-19 severity and mortality in seven countries, and to determine the risk factors of COVID-19 severity and mortality.MethodsThis multicountry study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study includes data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors.ResultsA total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (n=1021, 24.7%) and diabetes (n=939, 22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity.ConclusionsThe study confirms the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases.     

新冠肺炎疫情期间高校学生风险认知、应对倾向与负性情绪的关系研究*

目的:探究新冠肺炎疫情期间高校学生风险认知、应对倾向与负性情绪之间的关系,为减轻学生应激反应和缓解负性情绪提供科学依据。方法:2020年2—3月,使用风险认知心理测量范式、简易应对方式量表及正性负性情绪量表,通过问卷星系统对477名高校学生进行调查。结果:高校学生对新冠肺炎的风险认知与负性情绪呈正相关(r=0.13,P<0.01),应对倾向在风险认知和负性情绪间发挥中介作用,中介效应占总效应的39.33%。结论:高校学生对新冠肺炎的风险认知水平较高,易产生负性情绪,应对倾向是风险认知与负性情绪之间的中介因素。高校应建立突发事件相关危机心理干预机制,指导学生积极应对突发事件,有效缓解负性情绪,促进学生心理健康。     

昆明市2013年成人慢性病危险因素流行现状分析

目的 了解昆明市慢性病相关危险因素的流行现状和分布特征,为昆明市慢性病防治策略的制定和干预措施的实施提供依据.方法 经多阶段随机抽样,对监测点符合条件的18岁及以上常住居民共11 396人进行问卷调查和体格测量.结果 调查人群中慢性病危险因素：超重率为21.97％,吸烟率为27.53％,饮酒率为18.42％,坚持体育锻炼率为26.68％,每天吃早餐率为64.71％,高盐饮食率为80.06％,危险因素知晓率为23.01％.男性组吸烟、饮酒（57.08％、37.77％）的比例高于女性组（1.37％、1.69％）;女性组高盐饮食率（81.23％）高于男性组（78.71％）.不同年龄和城乡居民之间比较,全部纳入的慢性病相关危险因素分布差异具有统计学意义（P＜0.01）.结论 昆明市部分慢性病相关危险因素处于较高流行水平,应针对不同地区和人群,加强居民慢性病健康教育和相关危险因素的干预.     

Impact of COVID-19 Lockdown on Anthropometric Variables,Blood Pressure,and Glucose and Lipid Profile in Healthy Adults: A before and after Pandemic Lockdown Longitudinal Study

In December 2019, 27 cases of pneumonia were reported in Wuhan. In 2020, the causative agent was identified as a virus called SARS-CoV-2. The disease was called “coronavirus disease 2019” (COVID-19) and was determined as a Public Health Emergency. The main measures taken to cope with this included a state of lockdown. The aim of this study was to assess how the unhealthy lifestyles that ensued influenced different parameters. A prospective study was carried out on 6236 workers in a Spanish population between March 2019 and March 2021. Anthropometric, clinical, and analytical measurements were performed, revealing differences in the mean values of anthropometric and clinical parameters before and after lockdown due to the pandemic, namely increased body weight (41.1 ± 9.9–43.1 ± 9.9), BMI (25.1 ± 4.7–25.9 ± 4.7), and percentage of body fat (24.5 ± 9.1–26.9 ± 8.8); higher total cholesterol levels, with a statistically significant increase in LDL levels and a reduction in HDL; and worse glucose levels (90.5 ± 16.4–95.4 ± 15.8). Lockdown can be concluded to have had a negative effect on health parameters in both sexes in all age ranges, causing a worsening of cardiovascular risk factors.     

北京城区居民慢性病行为危险因素分析及对策研究

目的 通过对慢性病患病现状及行为危险因素分析,探讨预防对策。方法 采用现况研究方法,对北京城区15000名15～69岁的常住居民进行入户调查,了解其慢性病患病情况及行为危险因素等。结果 (1)样本人群慢性病患病率为35.90%(标化率为24.78%),其中男性患病率为33.61%,女性为37.92%,女性患病率高于男性(P<0.001).(2)人群总吸烟率为31.61%,酗酒率11.46%,超重率为31.45%,不运动率33.90%.(3)多因素回归分析显示:年龄,性别,吸烟,饮酒,超重和受教育的年限等是慢性病的主要影响因素。结论 北京城区居民慢性病患病率与危险因素均处于较高水平,慢性病预防控制策略和措施亟待加强。     

Presenting Characteristics,Comorbidities, and Outcomes Among Patients With COVID-19 Hospitalized in Pakistan: Retrospective Observational Study

BackgroundCOVID-19 became a pandemic rapidly after its emergence in December 2019. It belongs to the coronavirus family of viruses, which have struck a few times before in history. Data based on previous research regarding etiology and epidemiology of other viruses from this family helped played a vital role in formulating prevention and precaution strategies during the initial stages of this pandemic. Data related to COVID-19 in Pakistan were not initially documented on a large scale. In addition, due to a weak health care system and low economic conditions, Pakistan’s population, in general, already suffers from many comorbidities, which can severely affect the outcome of patients infected with COVID-19.ObjectiveCOVID-19 infections are coupled with a manifestation of various notable outcomes that can be documented and characterized clinically. The aim of this study was to examine these clinical manifestations, which can serve as indicators for early detection as well as severity prognosis for COVID-19 infections, especially in high-risk groups.MethodsA retrospective observational study involving abstraction of demographic features, presenting symptoms, and adverse clinical outcomes for 1812 patients with COVID-19 was conducted. Patients were admitted to the four major hospitals in the Rawalpindi-Islamabad region of Pakistan, and the study was conducted from February to August 2020. Multivariate regression analysis was carried out to identify significant indicators of COVID-19 severity, intensive care unit (ICU) admission, ventilator aid, and mortality. The study not only relates COVID-19 infection with comorbidities, but also examines other related factors, such as age and gender.ResultsThis study identified fever (1592/1812, 87.9%), cough (1433/1812, 79.1%), and shortness of breath (998/1812, 55.1%) at the time of hospital admission as the most prevalent symptoms for patients with COVID-19. These symptoms were common but not conclusive of the outcome of infection. Out of 1812 patients, 24.4% (n=443) required ICU admission and 21.5% (n=390) required ventilator aid at some point of disease progression during their stay at the hospital; 25.9% (n=469) of the patients died. Further analysis revealed the relationship of the presented symptoms and comorbidities with the progression of disease severity in these patients. Older adult patients with comorbidities, such as hypertension, diabetes, chronic kidney disease, and asthma, were significantly affected in higher proportions, resulting in requirement of ICU admission and ventilator aid in some cases and, in many cases, even mortality.ConclusionsOlder adult patients with comorbidities, such as hypertension, diabetes, asthma, chronic obstructive pulmonary disorder, and chronic kidney disease, are at increased risk of developing severe COVID-19 infections, with an increased likelihood of adverse clinical outcomes.     

The Psychosocial Impact of the COVID-19 Pandemic on Chronic Care Patients

ObjectivesThe COVID-19 pandemic has had a profound and pervasive impact on psychosocial health and disrupted care systems world-wide. Our research aims to assess the psychosocial impact of the pandemic and related changes in chronic care provision on patients with chronic obstructive pulmonary disease (COPD) and heart failure.DesignA qualitative survey using semi-structured interviews was held among patients with COPD and heart failure.Setting and ParticipantsUsing randomized sampling, 23 patients with COPD, heart failure, or both were recruited to participate in semi-structured interviews. Interviews were held by phone or videocall. The survey was held during the summer of 2021, when strict national containment strategies were widely implemented but gradually loosened and vaccination was ongoing.MethodsInductive coding using Gioia's approach was used to analyze the data in Atlas.Ti 9.1 software. Using an iterative approach, the data were synthesized in a data structure and data table, which was analyzed using an interpretative approach.ResultsWe found 3 aggregate dimensions in which the COVID-19 pandemic has a negative impact on psychosocial health of patients with chronic disease: (1) perceived vulnerability to disease, (2) influence of health policy, and (3) a mismatch of supply and demand of health care. In these dimensions, the impact of the COVID-19 crisis was found to have a negative impact on psychosocial well-being, compounded by national strategies to contain the pandemic and a disruption of chronic care for patients.Conclusions and ImplicationsHealth care providers should be aware of a multidimensional nature of psychosocial distress for chronic disease patients due to the COVID-19 crisis. Future practice and health policy could be improved by increasing awareness among health care providers, promote regular attention for psychosocial well-being of patients, provision of clear information related to the pandemic, and strategies to secure continuity of care. Results of this study might be further explored in larger studies.     

Association between Dietary Patterns and Chronic Obstructive Pulmonary Disease in Korean Adults: The Korean Genome and Epidemiology Study

In addition to smoking, dietary habits may contribute to the development of chronic obstructive pulmonary disease (COPD). This study aimed to examine the association between dietary patterns and lung function in a Korean community cohort. A total of 5436 participants were included from the Ansan–Ansung cohort study. To identify the dietary patterns, we performed principal component factor analysis using the results of a semi-quantitative food frequency questionnaire. The forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were measured by spirometry. Multiple logistic regression models were used to evaluate the association between dietary patterns and lung function after adjusting for confounders. We identified four major dietary patterns; ‘prudent’, ‘coffee, fat, and sweet’, ‘westernized’, and ‘white rice’. After adjusting for potential confounders, the ‘coffee, fat, and sweet’ dietary pattern was negatively associated with lung function, particularly the FEV1/FVC ratio. Participants with high scores for the ‘coffee, fat and sweet’ pattern had a higher risk of COPD among men but not women. Therefore, these results indicate that the ‘coffee, fat and sweet’ dietary pattern is inversely related to lung function in Korean adults. Our results indicate that dietary habits may be modifiable risk factors for COPD.     

新冠肺炎疫情下公众风险感知对防控行为的影响:一个有调节的中介模型

目的 探索新冠肺炎流行期间公众风险感知对防控行为的作用机制,考察情绪的中介作用和疾病认知的调节作用。 方法 借助问卷星平台在全国范围内开展网络调查,通过相关分析和中介效应分析探究公众风险感知、情绪和防控行为之间的关系,并采用bootstrap检验分析疾病认知的调节作用。 结果 本研究共收集有效问卷10 846份。相关分析结果显示,公众的风险感知和防控行为之间存在显著的正向影响(P<0.05),情绪和防控行为之间存在显著的负向影响(P<0.05)。风险感知、情绪、疾病认知、防控行为四者之间构成了有调节的中介模型,情绪作为风险感知和防控行为的中介变量,其中介效应对总效应的贡献率为28.75%。调节效应分析结果显示,疾病认知对风险感知和情绪的调节效应显著(β=-0.06,t=-5.28,P<0.001),对风险感知和防控行为的调节效应也显著(β=0.26,t=25.05,P<0.001)。 结论 焦虑、神经衰弱等症状会对公众防控行为造成负面影响,认知过程可以对人的情绪进行控制和调节,对情绪变化起主导作用,因此情绪引导可以从改变认知开始。通过加强正面宣传引导,缓解公众情绪,提高疾病认知水平,可以有效引导公众及时采取有效防控行为。     

The Influence of Obesity on Nutrition and Physical Activity during COVID-19 Pandemic: A Case-Control Study

Obesity is one of the important risk factors for a severe course of COVID-19. Maintaining a healthy body weight through diet and physical activity is a reasonable approach to preventing a SARS-CoV-2 infection or in alleviating its course. The goal of the study was to determine the influence of obesity on nutrition and physical activity during the COVID-19 pandemic. A total of 964 respondents, including 227 individuals with a body mass index (BMI) ≥30 kg/m² were evaluated in this study. In the case of 482 respondents, including 105 individuals (21.8%) with BMI ≥ 30 kg/m², the data were collected during the pandemic period from 1 June to 31 August 2020. The remaining 482 individuals were the “pre-pandemic” group, selected via propensity score matching (PSM) out of the 723 National Health Program study participants whose data was collected in 2017–2019. The evaluated dietary health factors were quantitatively similar in patients with BMI of either <30 kg/m² or ≥30 kg/m² and showed no significant changes during the pandemic. The diets of those who suffered from obesity prior to the pandemic showed the evaluated unhealthy nutritional factors to be less pronounced in comparison with those of individuals with BMI < 30 kg/m². During the pandemic, the BMI ≥ 30 kg/m² group showed a significant increase in the overall calorie intake (by 319 kcal; p = 0.001) and an increased consumption of total carbohydrates 299.3 ± 83.8 vs. 252.0 ± 101.5; p = 0.000), sucrose (51.7 ± 30.0 vs. 71.6 ± 49.9; p = 0.000), plant protein (26.3 ± 12.1 vs. 29.3 ± 8.3; p = 0.040), total fat (73.1 ± 42.6 vs. 84.9 ± 29.6; p = 0.011) and saturated fatty acids (29.5 ± 16.4 vs. 34.3 ± 13.9; p = 0.014) in comparison with the pre-pandemic period. The energy and nutritional value of the diets of BMI < 30 kg/m² individuals did not change between the pre-pandemic and pandemic period. Before the pandemic, the level of leisure physical activity of the BMI ≥ 30 kg/m² group was significantly lower than of those with BMI < 30 kg/m². Such differences were not observed in the levels of physical activity at work or school. The pandemic did not alter the amount of physical activity either during leisure time or at work/school in individuals with BMI ≥ 30 kg/m². However, respondents without obesity exercised significantly less during the pandemic than before. In conclusion, the pandemic altered the diets and levels of physical activity in the Polish population, with dietary changes observed in individuals with BMI ≥ 30 kg/m² and changes in physical activity observed in those with BMI < 30 kg/m².     

Community and Campus COVID-19 Risk Uncertainty Under University Reopening Scenarios: Model-Based Analysis

BackgroundSignificant uncertainty has existed about the safety of reopening college and university campuses before the COVID-19 pandemic is better controlled. Moreover, little is known about the effects that on-campus students may have on local higher-risk communities.ObjectiveWe aimed to estimate the range of potential community and campus COVID-19 exposures, infections, and mortality under various university reopening plans and uncertainties.MethodsWe developed campus-only, community-only, and campus × community epidemic differential equations and agent-based models, with inputs estimated via published and grey literature, expert opinion, and parameter search algorithms. Campus opening plans (spanning fully open, hybrid, and fully virtual approaches) were identified from websites and publications. Additional student and community exposures, infections, and mortality over 16-week semesters were estimated under each scenario, with 10% trimmed medians, standard deviations, and probability intervals computed to omit extreme outliers. Sensitivity analyses were conducted to inform potential effective interventions.ResultsPredicted 16-week campus and additional community exposures, infections, and mortality for the base case with no precautions (or negligible compliance) varied significantly from their medians (4- to 10-fold). Over 5% of on-campus students were infected after a mean of 76 (SD 17) days, with the greatest increase (first inflection point) occurring on average on day 84 (SD 10.2 days) of the semester and with total additional community exposures, infections, and mortality ranging from 1-187, 13-820, and 1-21 per 10,000 residents, respectively. Reopening precautions reduced infections by 24%-26% and mortality by 36%-50% in both populations. Beyond campus and community reproductive numbers, sensitivity analysis indicated no dominant factors that interventions could primarily target to reduce the magnitude and variability in outcomes, suggesting the importance of comprehensive public health measures and surveillance.ConclusionsCommunity and campus COVID-19 exposures, infections, and mortality resulting from reopening campuses are highly unpredictable regardless of precautions. Public health implications include the need for effective surveillance and flexible campus operations.     

Influence of Nutritional Parameters on the Evolution,Severity and Prognosis of Critically Ill Patients with COVID-19

This study evaluated the clinical and nutritional status, the evolution over three days, and the relationship between nutritional, inflammatory, and clinical parameters of critically ill patients with COVID-19. A longitudinal study was conducted in the Intensive Care Unit of the Virgen de las Nieves University Hospital in Granada (Spain). The study population comprised patients with a positive polymerase chain reaction test for COVID-19 presenting critical clinical involvement. Clinical outcomes were collected, and inflammatory and nutritional parameters (albumin, prealbumin, transferrin, transferrin saturation index, cholesterol, triglycerides and Controlling Nutritional Status (CONUT) score) were determined. A total of 202 critical patients with COVID-19 were selected, presenting highly altered clinical-nutritional parameters. The evolution experienced by the patients on the third day of admission was a decrease in albumin (p < 0.001) and an increase in prealbumin (p < 0.001), transferrin (p < 0.002), transferrin saturation index (p < 0.018), and cholesterol (p < 0.001). Low levels of albumin, prealbumin (on the third day) and high CONUT score (on the third day) showed an association with higher mortality. Nutritional variables were inversely correlated with clinical and inflammatory parameters. Critically ill patients with COVID-19 have poor nutritional status related to a poor prognosis of disease severity and mortality.     

Predicting Mortality Risk in Older Hospitalized Persons With COVID-19: A Comparison of the COVID-19 Mortality Risk Score with Frailty and Disability

ObjectivesTo assess the association of pre-morbid functional status [Barthel Index (BI)] and frailty [modified Frailty Index (mFI)] with in-hospital mortality and a risk scoring system developed for COVID-19 in patients ≥75 years diagnosed with COVID-19.DesignRetrospective bicentric observational study.Setting and ParticipantsData on consecutive patients aged ≥75 years admitted with COVID-19 at 2 Italian tertiary care centers were collected from February 22 to May 30, 2020.MethodsOverall, 221 consecutive patients with COVID-19 aged ≥75 years were admitted to 2 hospitals in the study period and were included in the analysis. Clinical, functional (BI), frailty (mFI), laboratory, and imaging data were collected. Mortality risk on admission was assessed with the COVID-19 Mortality Risk Score (COVID-19 MRS), a dedicated score developed for hospital triage.ResultsNinety-seven (43.9%) patients died. BI, frailty, age, dementia, respiratory rate, Pao₂/Fio₂ ratio, creatinine, and platelet count were associated with mortality. Analysis of the area under the receiver operating characteristic (AUC) indicated that the predictivity of age was modest and the combination of BI, mFI, and COVID-19 MRS yielded the highest prediction accuracy (AUC_{COVID-19MRS+BI+mFI} vs AUC_Age: 0.87 vs 0.59; difference: +0.28, lower bound–upper bound: 0.17-0.34, P < .001).Conclusions and ImplicationsPremorbid BI and mFI are associated with mortality and improved the accuracy of the COVID-19 MRS. Functional status may prove useful to guide clinical management of older individuals.     

Assessment of SARS-CoV-2 Infection According to Previous Metabolic Status and Its Association with Mortality and Post-Acute COVID-19

Background. SARS-CoV-2 infection was analyzed according to previous metabolic status and its association with mortality and post-acute COVID-19. Methods. A population-based observational retrospective study was conducted on a cohort of 110,726 patients aged 12 years or more who were diagnosed with COVID-19 infection between June 1st, 2021, and 28 February 2022 on the island of Gran Canaria, Spain. Results. In the 347 patients who died, the combination of advanced age, male sex, cancer, immunosuppressive therapy, coronary heart disease, elevated total cholesterol and reduced high-density lipoprotein cholesterol (HDL-C) was strongly predictive of mortality (p < 0.05). In the 555 patients who developed post-acute COVID-19, the persistence of symptoms was most frequent in women, older subjects and patients with obstructive sleep apnea syndrome, asthma, elevated fasting glucose levels or elevated total cholesterol (p < 0.05). A complete vaccination schedule was associated with lower mortality (incidence rate ratio (IRR) 0.5, 95%CI 0.39–0.64; p < 0.05) and post-acute COVID-19 (IRR 0.37, 95%CI 0.31–0.44; p < 0.05). Conclusions. Elevated HDL-C and elevated total cholesterol were significantly associated with COVID-19 mortality. Elevated fasting glucose levels and elevated total cholesterol were risk factors for the development of post-acute COVID-19.     

Impact of COVID-19 Lockdown on Non-Alcoholic Fatty Liver Disease and Insulin Resistance in Adults: A before and after Pandemic Lockdown Longitudinal Study

Background: Non-alcoholic fatty liver disease is a chronic disease caused by the accumulation of fat in the liver related to overweight and obesity, insulin resistance, hyperglycemia, and high levels of triglycerides and leads to an increased cardiovascular risk. It is considered a global pandemic, coinciding with the pandemic in 2020 caused by the “coronavirus disease 2019” (COVID-19). Due to COVID-19, the population was placed under lockdown. The aim of our study was to evaluate how these unhealthy lifestyle modifications influenced the appearance of metabolic alterations and the increase in non-alcoholic fatty liver disease. Methods: A prospective study was carried out on 6236 workers in a Spanish population between March 2019 and March 2021. Results: Differences in the mean values of anthropometric and clinical parameters before and after lockdown were revealed. There was a statistically significant worsening in non-alcoholic fatty liver disease (NAFLD) and in the insulin resistance scales, with increased body weight, BMI, cholesterol levels with higher LDL levels, and glucose and a reduction in HDL levels. Conclusions: Lockdown caused a worsening of cardiovascular risk factors due to an increase in liver fat estimation scales and an increased risk of presenting with NAFLD and changes in insulin resistance.     

Chronic Disease and Health Risk Behaviors Among Rural Agricultural Workforce in Queensland

Introduction: Little is known of the lifestyle behaviors and prevalence of chronic disease in the Australian agricultural workforce. This study aimed to assess behavioral risk factors and the prevalence of chronic disease among attendees of agricultural events in rural Queensland. Methods: Data on lifestyle risk factors and prevalence of diabetes and cardiovascular diseases were collected from participants in four separate cross-sectional studies in rural southern Queensland. Anthropometric measures, blood pressure, serum cholesterol, and glucose levels of consenting participants were assessed by trained medical students under the supervision of rural clinicians. Data were analyzed using SPSS 22 statistical software package and t-tests and chi-square tests were used to compare differences between groups. Results: A total of 702 attendees participated; the majority were agricultural workers (n = 393). Greater psychological distress was reported among participants from these rural communities (42%) than in the Australian population (31%); however, levels of psychological distress was similar between agricultural workers and others in the sample. Fewer people in these agricultural communities reported smoking (10%), and they reported being more active (86%) than the average Australian, but a greater proportion reported high-risk alcohol consumption (53%) and were found to be hypertensive (31%). These findings were accentuated among agricultural workers. Conclusion: This method of investigation both raises awareness in the community and identifies health risks for further management in a group that has otherwise been poorly defined. Resident agricultural workers have different health risks and behaviors, though psychological distress appears to be borne across these communities.     

Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study

Little information is available on the beneficial effects of cholecalciferol treatment in comorbid patients hospitalized for COVID-19. The aim of this study was to retrospectively examine the clinical outcome of patients receiving in-hospital high-dose bolus cholecalciferol. Patients with a positive diagnosis of SARS-CoV-2 and overt COVID-19, hospitalized from 15 March to 20 April 2020, were considered. Based on clinical characteristics, they were supplemented (or not) with 400,000 IU bolus oral cholecalciferol (200,000 IU administered in two consecutive days) and the composite outcome (transfer to intensive care unit; ICU and/or death) was recorded. Ninety-one patients (aged 74 ± 13 years) with COVID-19 were included in this retrospective study. Fifty (54.9%) patients presented with two or more comorbid diseases. Based on the decision of the referring physician, 36 (39.6%) patients were treated with vitamin D. Receiver operating characteristic curve analysis revealed a significant predictive power of the four variables: (a) low (<50 nmol/L) 25(OH) vitamin D levels, (b) current cigarette smoking, (c) elevated D-dimer levels (d) and the presence of comorbid diseases, to explain the decision to administer vitamin D (area under the curve = 0.77, 95% CI: 0.67–0.87, p < 0.0001). Over the follow-up period (14 ± 10 days), 27 (29.7%) patients were transferred to the ICU and 22 (24.2%) died (16 prior to ICU and six in ICU). Overall, 43 (47.3%) patients experienced the combined endpoint of transfer to ICU and/or death. Logistic regression analyses revealed that the comorbidity burden significantly modified the effect of vitamin D treatment on the study outcome, both in crude (p = 0.033) and propensity score-adjusted analyses (p = 0.039), so the positive effect of high-dose cholecalciferol on the combined endpoint was significantly amplified with increasing comorbidity burden. This hypothesis-generating study warrants the formal evaluation (i.e., clinical trial) of the potential benefit that cholecalciferol can offer in these comorbid COVID-19 patients.