Rehabilitation needs and mortality associated with the Covid-19 pandemic: a population-based study of all hospitalised and home-healthcare individuals in a Swedish healthcare region

Background This first report of the Linköping Covid-19 Study (LinCoS) aimed at determination of Covid-19-associated mortality, impairments, activity and participation limitations denoting rehabilitation needs four months after discharge from hospital. Methods An ambidirectional population-based cohort study including all confirmed Covid-19 cases admitted to hospital during 1/03-31/05 and those living in home healthcare settings identified through a regional registry and evaluated through medical records, including WHO Clinical Progression Scale (CPS). All patients discharged from hospital were followed-up by structured telephone interview at 4 months post-discharge. Respondents indicated any new or aggravated persisting problems in any of 25 body functions and 12 activity/participation items and rated them for impact on daily life. Findings Out of 734 hospitalised patients, 149 were excluded, 125 died, and 460 were alive at 4-month follow-up of whom 433 (94.1%) were interviewed. In total, 40% reported impairments and activity/participation limitations affecting daily life and warranted further multi-professional rehabilitation assessment, predominantly those with severe disease and a considerable proportion of those with moderate disease. Cognitive and affective impairments were equally common in all groups and were reported by 20-40% of cases. Limb weakness was reported by 31%, with CPS 7-9 being four times more likely to report this problem as compared to CPS 4-5. 26% of those working or studying reported difficulties returning to these activities, this being 3.5 times more likely in CPS 7-9 as compared to CPS 4-5. 25% reported problems walking >1 km, with CPS 7-9 over three times more likely to report this as compared to the other two sub-groups. 90-day mortality rate of Covid-19 associated deaths was 15.1%. Interpretation Most rehabilitation needs after Covid-19 involved higher cerebral dysfunction both in patients with moderate and severe disease. This should be considered when designing services aiming at minimizing long-term disability. Funding ALF grant and Region Östergötland.

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Rehabilitation needs and mortality associated with the Covid-19 pandemic: a population-based study of all hospitalised and home-healthcare individuals in a Swedish healthcare region

EClinicalMedicine ◽

10.1016/j.eclinm.2021.100920 ◽

2021 ◽

Vol 36 ◽

pp. 100920

Author(s):

Anestis Divanoglou ◽

Assoc. Prof Kersti Samuelsson ◽

Prof. Emer. Rune Sjödahl ◽

Christer Andersson ◽

Prof. Richard Levi

Keyword(s):

Population Based ◽

Home Healthcare ◽

Population Based Study ◽

Rehabilitation Needs

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Age-Adjusted Associations Between Comorbidity and Outcomes of COVID-19: A Review of the Evidence From the Early Stages of the Pandemic

Frontiers in Public Health ◽

10.3389/fpubh.2021.584182 ◽

2021 ◽

Vol 9 ◽

Author(s):

Kate E. Mason ◽

Gillian Maudsley ◽

Philip McHale ◽

Andy Pennington ◽

Jennifer Day ◽

...

Keyword(s):

Early Stage ◽

Severe Disease ◽

Evidence Base ◽

Population Based ◽

Control Measures ◽

International Evidence ◽

Early Stages ◽

Hospitalised Patients ◽

Adjusted Association ◽

Obesity And Cancer

Objectives: Early in the COVID-19 pandemic, people with underlying comorbidities were overrepresented in hospitalised cases of COVID-19, but the relationship between comorbidity and COVID-19 outcomes was complicated by potential confounding by age. This review therefore sought to characterise the international evidence base available in the early stages of the pandemic on the association between comorbidities and progression to severe disease, critical care, or death, after accounting for age, among hospitalised patients with COVID-19.Methods: We conducted a rapid, comprehensive review of the literature (to 14 May 2020), to assess the international evidence on the age-adjusted association between comorbidities and severe COVID-19 progression or death, among hospitalised COVID-19 patients – the only population for whom studies were available at that time.Results: After screening 1,100 studies, we identified 14 eligible for inclusion. Overall, evidence for obesity and cancer increasing risk of severe disease or death was most consistent. Most studies found that having at least one of obesity, diabetes mellitus, hypertension, heart disease, cancer, or chronic lung disease was significantly associated with worse outcomes following hospitalisation. Associations were more consistent for mortality than other outcomes. Increasing numbers of comorbidities and obesity both showed a dose-response relationship. Quality and reporting were suboptimal in these rapidly conducted studies, and there was a clear need for additional studies using population-based samples.Conclusions: This review summarises the most robust evidence on this topic that was available in the first few months of the pandemic. It was clear at this early stage that COVID-19 would go on to exacerbate existing health inequalities unless actions were taken to reduce pre-existing vulnerabilities and target control measures to protect groups with chronic health conditions.

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Exploring the Willingness to Accept SARS-CoV-2 Vaccine in a University Population in Southern Italy, September to November 2020

Vaccines ◽

10.3390/vaccines9030275 ◽

2021 ◽

Vol 9 (3) ◽

pp. 275

Author(s):

Gabriella Di Giuseppe ◽

Concetta Paola Pelullo ◽

Giorgia Della Polla ◽

Maria Pavia ◽

Italo Francesco Angelillo

Keyword(s):

Public Health ◽

Faculty Member ◽

Perceived Risk ◽

Southern Italy ◽

Severe Disease ◽

Risk Level ◽

Considerable Proportion ◽

Willingness To Accept ◽

University Population ◽

To Receive

Understanding whether members of the university population are willing to receive a future vaccination against COVID-19 and identifying barriers may help public health authorities to develop effective strategies and interventions to contain COVID-19. This cross-sectional study explored the willingness to accept a future SARS-CoV-2 vaccine in a university population in Southern Italy. The perceived risk level of developing COVID-19 was 6.5 and it was significantly higher among females, younger subjects, and those who agreed/strongly agreed that COVID-19 is a severe disease. Only 21.4% of respondents were not worried at all regarding the safety of the vaccine. Males, not being married/cohabitant, being a faculty member, those who perceived a lower risk of developing COVID-19, and those who did not need information regarding the vaccination against COVID-19 were significantly more likely to have no concern at all regarding the safety of the vaccine. The vast majority (84.1%) were willing to receive a future vaccine against COVID-19. Almost coherently with predictors of concern on the safety of the vaccine, being male, not being married/cohabitant, being a faculty member, not being concerned at all that COVID-19 vaccination might not be safe, and agreeing that COVID-19 can have serious health consequences were significant predictors of the willingness to receive the vaccine against COVID-19. A considerable proportion of the population had a positive willingness to receive the future COVID-19 vaccine, although some concerns have been expressed regarding the effectiveness and safety and public health activities seem necessary to achieve the rate that can lead to the protection of the community.

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Epidemiology of systemic sclerosis: a multi-database population-based study in Tuscany (Italy)

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01733-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Alessio Coi ◽

◽

Simone Barsotti ◽

Michele Santoro ◽

Fabio Almerigogna ◽

...

Keyword(s):

Systemic Sclerosis ◽

Rare Diseases ◽

Severe Disease ◽

Pulmonary Involvement ◽

Population Based ◽

Vital Statistics ◽

Drug Prescriptions ◽

Malignant Neoplasms ◽

Lower Survival ◽

Treatment And Prevention

Abstract Background Systemic Sclerosis (SSc) is a chronic autoimmune disease with a complex pathogenesis that includes vascular injury, abnormal immune activation, and tissue fibrosis. We provided a complete epidemiological characterization of SSc in the Tuscany region (Italy), considering prevalence and incidence, survival, comorbidities and drug prescriptions, by using a multi-database population-based approach. Cases of SSc diagnosed between 1st January 2003 and 31st December 2017 among residents in Tuscany were collected from the population-based Rare Diseases Registry of Tuscany. All cases were linked to regional health and demographic databases to obtain information about vital statistics, principal causes of hospitalization, complications and comorbidities, and drug prescriptions. Results The prevalence of SSc in Tuscany population resulted to be 22.2 per 100,000, with the highest prevalence observed for the cases aged ≥ 65 years (33.2 per 100,000, CI 95% 29.6–37.3). In females, SSc was predominant (86.7% on the total) with an overall sex ratio F/M of 6.5. Nevertheless, males presented a more severe disease, with a lower survival and significant differences in respiratory complications and metabolic comorbidities. Complications and comorbidities such as pulmonary involvement (HR = 1.66, CI 95% 1.17–2.35), congestive heart failure (HR = 2.76, CI 95% 1.80–4.25), subarachnoid and intracerebral haemorrhage (HR = 2.33, CI 95% 1.21–4.48) and malignant neoplasms (HR = 1.63, CI 95% 1.06–2.52), were significantly associated to a lower survival, also after adjustment for age, sex and other SSc-related complications. Disease-modifying antirheumatic drugs, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors were the drugs with the more increasing prevalence of use in the 2008–2017 period. Conclusions The multi-database approach is important in the investigation of rare diseases where it is often difficult to provide accurate epidemiological indicators. A population-based registry can be exploited in synergy with health databases, to provide evidence related to disease outcomes and therapies and to assess the burden of disease, relying on a large cohort of cases. Building an integrated archive of data from multiple databases linking a cohort of patients to their comorbidities, clinical outcomes and survival, is important both in terms of treatment and prevention.

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Correlates of Physical Activity Participation in Community-Dwelling Older Adults

Journal of Aging and Physical Activity ◽

10.1123/japa.18.4.375 ◽

2010 ◽

Vol 18 (4) ◽

pp. 375-389 ◽

Cited By ~ 26

Author(s):

Christy Haley ◽

Ross Andel

Keyword(s):

Physical Activity ◽

Population Based ◽

Male Gender ◽

Community Dwelling ◽

Physical Activity Participation ◽

Functional Health ◽

Activity Participation ◽

Future Research ◽

Research Attention ◽

Exercise Participation

The authors examined factors related to participation in walking, gardening or yard work, and sports or exercise in 686 community-dwelling adults 60–95 years of age from Wave IV of the population-based Americans’ Changing Lives Study. Logistic regression revealed that male gender, being married, and better functional health were associated with greater likelihood of participating in gardening or yard work (p < .05). Male gender, better functional health, and lower body-mass index were independently associated with greater likelihood of walking (p < .05). Increasing age, male gender, higher education, and better functional health were associated with greater likelihood of participating in sports or exercise (p < .05). Subsequent analyses yielded an interaction of functional health by gender in sport or exercise participation (p = .06), suggesting a greater association between functional health and participation in men. Gender and functional health appear to be particularly important for physical activity participation, which may be useful in guiding future research. Attention to different subgroups may be needed to promote participation in specific activities.

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A COVID-19 Patient with Simultaneous Renal Infarct, Splenic Infarct and Aortic Thrombosis during the Severe Disease

Healthcare ◽

10.3390/healthcare10010150 ◽

2022 ◽

Vol 10 (1) ◽

pp. 150

Author(s):

Georgios Mavraganis ◽

Sofia Ioannou ◽

Anastasios Kallianos ◽

Gianna Rentziou ◽

Georgia Trakada

Keyword(s):

Abdominal Pain ◽

Severe Disease ◽

Severe Abdominal Pain ◽

Antithrombotic Treatment ◽

Post Discharge ◽

Treatment Information ◽

High Incidence ◽

Thrombotic Complications ◽

Renal Infarct

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a high incidence of arterial and venous thrombotic complications. However, thromboembolic events in unusual sites such as limb and visceral arterial ischemia are reported rarely in the literature. Herein, we describe a rare case of a patient with severe coronavirus disease 2019 (COVID-19) infection who experienced severe abdominal pain during the hospitalization and presented simultaneously renal artery, splenic artery and vein as well as aortic thrombi despite prophylactic antithrombotic treatment. Information about his follow-up post discharge is also provided. This case report raises significant clinical implications regarding the correct dose of antithrombotic treatment during the acute phase of the severe COVID-19 infection and highlights the need for incessant vigilance in order to detect thrombosis at unusual sites as a possible diagnosis when severe abdominal pain is present in severe COVID-19 patients.

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P078 Pediatric onset IBD has a more severe disease course compared to adulthood onset: A population-based study

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000578384.93308.4b ◽

2019 ◽

Vol 114 (1) ◽

pp. S21-S21

Author(s):

Malham Mikkel ◽

Jakobsen Christian ◽

Vind Ida ◽

Vester-Andersen Marianne ◽

Wewer Vibeke

Keyword(s):

Severe Disease ◽

Population Based ◽

Disease Course ◽

Population Based Study ◽

Pediatric Onset

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Critical Illness and Long-Term Outcomes Worldwide

10.1093/med/9780199653461.003.0002 ◽

2014 ◽

Author(s):

Neill KJ Adhikari

Keyword(s):

Critical Care ◽

Critical Illness ◽

Administrative Data ◽

Population Based ◽

Post Discharge ◽

Discharge Care ◽

Modelling Techniques ◽

Global Estimates ◽

The Cost

Interest in the global burden of critical illness and its sequelae are growing, but comprehensive data to describe the burden of acute and post-acute illness and the resources available to provide care are lacking. Challenges to obtaining population-based global estimates of critical illness include the syndrome-based definitions of critical illness, incorrect equating of ‘critical illness’ with ‘admission to an intensive care unit’, lack of reliable case ascertainment in administrative data, and short prodrome and high mortality of critical illness, limiting the number of prevalent cases. Estimates of the burden of post-critical illness morbidity are even less reliable, owing to the limited number of observational studies, inaccurate coding in administrative data, and the unclear attributable risk of these morbidities to critical illness. Modelling techniques will be required to estimate the burden of critical illness and disparities in access to critical care using existing data sources. Demands for critical care and post-discharge care for survivors are likely to increase because of urbanization, an ageing demographic, and ongoing wars, disasters, and pandemics, while the ability to assume the cost of increased critical care may be limited due to economic factors. Major public health questions remain unanswered regarding the worldwide burden of critical illness and its sequelae, variation in resources available for treatment, and strategies that are broadly effective and feasible to prevent and treat critical illness and its consequences.

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Burden and Disease Characteristics of Patients with Psoriatic Arthritis: A Population-based Cross-sectional Study

The Journal of Rheumatology ◽

10.3899/jrheum.180670 ◽

2019 ◽

Vol 46 (7) ◽

pp. 716-720 ◽

Cited By ~ 2

Author(s):

Hasan G. Tekin ◽

Jashin J. Wu ◽

Russel Burge ◽

Julie Birt ◽

Alexander Egeberg

Keyword(s):

Psoriatic Arthritis ◽

Population Based ◽

Cross Sectional Study ◽

Nonsteroidal Antiinflammatory Drugs ◽

Considerable Proportion ◽

Antiinflammatory Drugs ◽

Cross Sectional ◽

Disease Characteristics ◽

Systemic Corticosteroids ◽

Comorbid Diseases

Objective.To describe the prevalence and treatment regimes, disease characteristics, and comorbid diseases among patients with psoriatic arthritis (PsA) in Denmark.Methods.All Danish individuals aged ≥ 18 years with rheumatologist-diagnosed PsA were linked in nationwide administrative registers.Results.Among 4.7 million individuals in Denmark, 10,577 patients with PsA had been diagnosed by a rheumatologist. A female predominance (54.5–59.8%) was seen among patients with PsA, and about half of the patients (53.0%) had received no treatment or treatment only with nonsteroidal antiinflammatory drugs/systemic corticosteroids, while 32.9% had received nonbiological disease-modifying antirheumatic drugs (DMARD) and 14.1% had been treated with biologicals. Cutaneous psoriasis was recorded in 66.2–72.3% of patients with PsA, and patients with severe PsA had the highest prevalences of distal interphalangeal arthropathy, spondylitis, and arthritis mutilans. Smoking and comorbid diseases such as hypertension, diabetes, depression, and anxiety were seen frequently in patients with PsA, but did not significantly differ across severities of PsA.Conclusion.Disease burden appeared to be significant in patients with PsA across all severities. A considerable proportion of patients with PsA did not receive active antipsoriatic treatment, and about 1 out of 3 patients was not diagnosed with psoriasis. Cutaneous symptoms of psoriasis in patients with PsA might be either underreported or undertreated.

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Biomarkers and outcomes of COVID-19 hospitalisations: systematic review and meta-analysis

BMJ evidence-based medicine ◽

10.1136/bmjebm-2020-111536 ◽

2020 ◽

pp. bmjebm-2020-111536

Author(s):

Preeti Malik ◽

Urvish Patel ◽

Deep Mehta ◽

Nidhi Patel ◽

Raveena Kelkar ◽

...

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Clinical Decision Making ◽

Meta Analysis ◽

Severe Disease ◽

Invasive Mechanical Ventilation ◽

Mesh Terms ◽

Hospitalised Patients ◽

Poor Outcomes ◽

D Dimer

ObjectiveTo evaluate association between biomarkers and outcomes in COVID-19 hospitalised patients. COVID-19 pandemic has been a challenge. Biomarkers have always played an important role in clinical decision making in various infectious diseases. It is crucial to assess the role of biomarkers in evaluating severity of disease and appropriate allocation of resources.Design and settingSystematic review and meta-analysis. English full text observational studies describing the laboratory findings and outcomes of COVID-19 hospitalised patients were identified searching PubMed, Web of Science, Scopus, medRxiv using Medical Subject Headings (MeSH) terms COVID-19 OR coronavirus OR SARS-CoV-2 OR 2019-nCoV from 1 December 2019 to 15 August 2020 following Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines.ParticipantsStudies having biomarkers, including lymphocyte, platelets, D-dimer, lactate dehydrogenase (LDH), C reactive protein (CRP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, procalcitonin (PCT) and creatine kinase (CK), and describing outcomes were selected with the consensus of three independent reviewers.Main outcome measuresComposite poor outcomes include intensive care unit admission, oxygen saturation <90%, invasive mechanical ventilation utilisation, severe disease, in-hospital admission and mortality. The OR and 95% CI were obtained and forest plots were created using random-effects models. Publication bias and heterogeneity were assessed by sensitivity analysis.Results32 studies with 10 491 confirmed COVID-19 patients were included. We found that lymphopenia (pooled-OR: 3.33 (95% CI: 2.51–4.41); p<0.00001), thrombocytopenia (2.36 (1.64–3.40); p<0.00001), elevated D-dimer (3.39 (2.66–4.33); p<0.00001), elevated CRP (4.37 (3.37–5.68); p<0.00001), elevated PCT (6.33 (4.24–9.45); p<0.00001), elevated CK (2.42 (1.35–4.32); p=0.003), elevated AST (2.75 (2.30–3.29); p<0.00001), elevated ALT (1.71 (1.32–2.20); p<0.00001), elevated creatinine (2.84 (1.80–4.46); p<0.00001) and LDH (5.48 (3.89–7.71); p<0.00001) were independently associated with higher risk of poor outcomes.ConclusionOur study found a significant association between lymphopenia, thrombocytopenia and elevated levels of CRP, PCT, LDH, D-dimer and COVID-19 severity. The results have the potential to be used as an early biomarker to improve the management of COVID-19 patients, by identification of high-risk patients and appropriate allocation of healthcare resources in the pandemic.

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