scholarly journals Comparative effectiveness of ChAdOx1 versus BNT162b2 vaccines against SARS-CoV-2 infections in England and Wales: A cohort analysis using trial emulation in the Virus Watch community data

2021 ◽  
Author(s):  
Vincent Grigori Nguyen ◽  
Alexei Yavlinsky ◽  
Sarah Beale ◽  
Susan J Hoskins ◽  
Vasileios Lampos ◽  
...  
Keyword(s):  
Comparative Effectiveness ◽  
Positive Polymerase Chain Reaction ◽  
Post Vaccination ◽  
England And Wales ◽  
Multiple Deprivation ◽  
Vaccine Type ◽  
The Impact ◽  
Index Of Multiple Deprivation ◽  
Minority Ethnic

Introduction: Infections of SARS-CoV-2 in vaccinated individuals have been increasing globally. Understanding the associations between vaccine type and a post-vaccination infection could help prevent further COVID-19 waves. In this paper, we use trial emulation to understand the impact of a phased introduction of the vaccine in the UK driven by vulnerability and exposure status. We estimate the comparative effectiveness of COVID-19 vaccines (ChAdOx1 versus BNT162b2) against post-vaccination infections of SARS-CoV-2 in a community setting in England and Wales. Method: Trial emulation was conducted by pooling results from six cohorts whose recruitment was staggered between 1st January 2021 and 31st March 2021 and followed until 12th November 2021. Eligibility for each trial was based upon age (18+ at the time of vaccination), without prior signs of infection or an infection within the first 14 days of the first dose. Time from vaccination of ChAdOx1 or BNT162b2 until SARS-CoV-2 infection (positive polymerase chain reaction or lateral flow test after 14 of the vaccination) was modelled using Cox proportional hazards model for each cohort and adjusted for age at vaccination, gender, minority ethnic status, clinically vulnerable status and index of multiple deprivation quintile. For those without SARS-CoV-2 infection during the study period, follow-up was until loss-of-follow-up or end of study (12th November 2021). Pooled hazard ratios were generated using random-effects meta-analysis. Results: Across six cohorts, there were a total of 21,283 participants who were eligible and vaccinated with either ChAdOx1 (n = 13,813) or BNT162b2 (n = 7,470) with a median follow-up time of 266 days (IQR: 235 - 282). By November 12th 2021, 750 (5.4%) adults who had ChAdOx1 as their vaccine experienced a SARS-CoV-2 infection, compared to 296 (4.0%) who had BNT162b2. We found that people who received ChAdOx1 vaccinations had 10.54 per 1000 people higher cumulative incidence for SARS-CoV-2 infection compared to BNT162b2 for infections during a maximum of 315 days of follow-up. When adjusted for age at vaccination, sex, minority ethnic status, index of multiple deprivation, and clinical vulnerability status, we found a pooled adjusted hazard ratio of 1.35 [HR: 1.35, 95%CI: 1.15 - 1.58], demonstrating a 35% increase in SARS-CoV-2 infections in people who received ChAdOx1 compared to BNT162b2. Discussion: We found evidence of greater effectiveness of receiving BNT162b2 compared to ChAdOx1 vaccines against SARS-CoV-2 infection in England and Wales during a time period when Delta became the most prevalent variant of concern. Our findings demonstrate the importance of booster (third) doses to maintain protection and suggest that these should be prioritised to those who received ChAdOx1 as their primary course.

scholarly journals Effectiveness of COVID-19 Vaccines: Eight Months Post Single Dose Vaccination

2021 ◽  
Author(s):  
Naif Khalaf Alharbi ◽  
Jaffar A. Al-Tawfiq ◽  
Suliman Alghnam ◽  
Amal Alwehaibe ◽  
Abrar Alasmari ◽  
...  
Keyword(s):  
Single Dose ◽  
Medical Records ◽  
Real World Data ◽  
Kingdom Of Saudi Arabia ◽  
Post Vaccination ◽  
Vaccine Type ◽  
National Databases ◽  
Site Pain ◽  
Saudi Male

Objectives: To describe the real-world data on the effectiveness of Pfizer-BioNtech BNT162b2 and AstraZeneca-Oxford AZD1222 vaccines against COVID-19 in a large cohort in the Kingdom of Saudi Arabia (KSA). Methods: A total of 18,543 subjects received a single-dose of either of the vaccines at one vaccination centre in KSA, and were followed up for three to eight months. Clinical data from medical records, adverse events (AEs) from a self-reporting system, and COVID-19 infection data from the national databases were retrieved and analysed. Results: Subjects median age was 33 years old with an average of 27.3 body mass index and the majority were male (60.1%). 92.17% of the subjects had no COVID-19 infection post-vaccination. Diabetes mellitus (p=0.0325), organ transplantation (p=0.0254), and morbid obesity (p=0.0014) were risk factors for infection post-vaccination. Unlike vaccine type, being Saudi, male, or obese was more likely to get the infection earlier. AE reports from 1084 subjects included injection site pain, fatigue, fever, myalgia, headache. Conclusion: Single-dose COVID-19 vaccines in KSA showed an effectiveness rate of 92.17% up to eight months follow-up. The rate for AZD1222 was higher than what have been previously reported. Side effects and AEs were within what has been reported in clinical trials.

scholarly journals Do alternative weighting approaches for an Index of Multiple Deprivation change the association with mortality? A sensitivity analysis from Germany

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028553 ◽  
Author(s):  
Florian Schederecker ◽  
Christoph Kurz ◽  
Jon Fairburn ◽  
Werner Maier
Keyword(s):  
Age Groups ◽  
Total Mortality ◽  
Premature Mortality ◽  
Area Deprivation ◽  
Multiple Deprivation ◽  
The Stability ◽  
Weighting Procedures ◽  
The Impact ◽  
The Relationship ◽  
Index Of Multiple Deprivation

ObjectivesThis study aimed to assess the impact of using different weighting procedures for the German Index of Multiple Deprivation (GIMD) investigating their link to mortality rates.Design and settingIn addition to the original (normative) weighting of the GIMD domains, four alternative weighting approaches were applied: equal weighting, linear regression, maximization algorithm and factor analysis. Correlation analyses to quantify the association between the differently weighted GIMD versions and mortality based on district-level official data from Germany in 2010 were applied (n=412 districts).Outcome measuresTotal mortality (all age groups) and premature mortality (<65 years).ResultsAll correlations of the GIMD versions with both total and premature mortality were highly significant (p<0.001). The comparison of these associations using Williams’s t-test for paired correlations showed significant differences, which proved to be small in respect to absolute values of Spearman’s rho (total mortality: between 0.535 and 0.615; premature mortality: between 0.699 and 0.832).ConclusionsThe association between area deprivation and mortality proved to be stable, regardless of different weighting of the GIMD domains. The theory-based weighting of the GIMD should be maintained, due to the stability of the GIMD scores and the relationship to mortality.

1022 Socioeconomic Deprivation and Colorectal Cancer Survival

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
F Ali ◽  
M Jha
Keyword(s):  
Cancer Survival ◽  
Cox Regression ◽  
Socioeconomic Deprivation ◽  
Tumour Site ◽  
Kaplan Meier ◽  
Similar Survival ◽  
The Impact ◽  
Index Of Multiple Deprivation ◽  
Prospective Database

Abstract Background Factors related to CRC survival include age, tumour site and stage. Other factors that may play a role on survival include race and socioeconomic status(SES).We aim to investigate the impact of SES on CRC survival. Method All patients diagnosed with CRC between January 2006-January 2019 were included. Demographics were collected from a prospective database. SES was defined using the Index of Multiple Deprivation(IMD).Cox-regression was used to investigate the effect of factors on survival and Kaplan-Meier to estimate survival. Results A total of 5,073 patients diagnosed with CRC with a median follow up of 65 months were include. Overall survival was 72.2% (76.0%0-78.4%), 59.6%(58.2%-61.0%) and 50.3% (48.8%-51.8%) at 1 year, 3 years and 5 years, respectively. Colon cancer was associated with worse survival(p = 0.00256,HR = 1.163). On multivariate analysis, socioeconomic deprivation was associated with poorer survival (HR = 1.02,p=0.00302).Male and female sex were associated with similar survival outcomes(HR = 0.9831 and 0.9341,respectively; p = 0.986 and 0.946 respectively). Conclusions SES impact on CRC survival seems to be inconsistent across the literature potentially due to lack of uniformity of indices used to assess SES and the heterogeneity of access to healthcare. This could ultimately impact comparability across different studies investigating the impact SES on CRC survival.

scholarly journals The use of the Scottish Index of Multiple Deprivation as an indicator to evaluate the impact of policy on widening access to higher education

2019 ◽  
Vol 28 (4) ◽  
pp. 414-433 ◽  
Author(s):  
Lindsay Paterson ◽  
Lucy Hunter Blackburn ◽  
Elisabet Weedon
Keyword(s):  
Higher Education ◽  
Household Survey ◽  
Access To Higher Education ◽  
Growing Up ◽  
Multiple Deprivation ◽  
Widening Access ◽  
Education Statistics ◽  
The Impact ◽  
Index Of Multiple Deprivation ◽  
Deprived Areas

Policy on widening access to higher education in Scotland is defined mainly in terms of students who live in deprived areas as defined by the Scottish Index of Multiple Deprivation. Although area measures can be informative, and are convenient because they require only a postcode to classify any person into a deprivation category, they are crude. We use data from the Higher Education Statistics Agency, the Growing Up in Scotland Survey and the Scottish Household Survey to analyse the extent to which neighbourhood measures can be used as the basis of valid indicators of widening access. We conclude that they are flawed, although not wholly useless, and ought to be supplemented by more valid measures of students' social circumstances.

scholarly journals Accuracy of death certification of dementia in population-based samples of older people: analysis over time

2018 ◽  
Vol 47 (4) ◽  
pp. 589-594 ◽  
Author(s):  
Lu Gao ◽  
Rowan Calloway ◽  
Emily Zhao ◽  
Carol Brayne ◽  
Fiona E Matthews ◽  
...  
Keyword(s):  
Death Certificate ◽  
Developed Countries ◽  
Population Based ◽  
Death Certificates ◽  
Death Certification ◽  
England And Wales ◽  
Logistic Regression Models ◽  
The Impact ◽  
Prevalence Of Dementia

Abstract Background death certification data are routinely collected in most developed countries. Coded causes of death are a readily accessible source and have the potential advantage of providing complete follow-up, but with limitations. Objective to investigate the reliability of using death certificates for surveillance of dementia, the time trend of recording dementia on death certificates and predictive factors of recording of dementia. Subjects individuals aged 65 and over in six areas across England and Wales were randomly selected for the Medical Research Council Cognitive Function and Ageing Study (CFAS) and CFAS II with mortality follow-up. Methods prevalence of dementia recorded on death certificates were calculated by year. Reporting of dementia on death certificates compared with the study diagnosis of dementia, with sensitivity, specificity and Cohen’s κ were estimated. Multivariable logistic regression models explored the impact of potential factors on the reporting of dementia on the death certificate. Results the overall unadjusted prevalence of dementia on death certificates rose from 5.3% to 25.9% over the last 26 years. Dementia reported on death certificates was poor with sensitivity 21.0% in earlier cohort CFAS, but it had increased to 45.2% in CFAS II. Dementia was more likely to be recorded on death certificates in individuals with severe dementia, or those living in an institution, yet less likely reported if individuals died in hospital. Conclusion recording dementia on death certificate has improved significantly in the England and Wales. However, such information is still an underestimate and should be used alongside epidemiological estimations.

scholarly journals Comparative effectiveness of ChAdOx1 versus BNT162b2 COVID-19 vaccines in Health and Social Care workers in England: a cohort study using OpenSAFELY

2021 ◽  
Author(s):  
William J Hulme ◽  
Elizabeth J Williamson ◽  
Amelia CA Green ◽  
Krishnan Bhaskaran ◽  
Helen I McDonald ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Cumulative Incidence ◽  
Comparative Effectiveness ◽  
Social Care ◽  
Post Vaccination ◽  
Accident And Emergency ◽  
Care Workers ◽  
Health And Social Care ◽  
Vaccine Type ◽  
Accident And Emergency Attendance

Background: The UK COVID-19 vaccination programme delivered both the BNT162b2 mRNA (Pfizer-BioNTech) and the ChAdOx1 (Oxford-AstraZeneca) vaccines during overlapping periods, providing a rare opportunity to emulate a trial that directly compares both vaccines using routinely-collected NHS data. Frontline Health and Social Care workers comprise a useful population to assess comparative effectiveness due to early vaccine eligibility and relatively high post-vaccination transmission risk due to occupational exposure. Methods: With the approval of NHS England we used the OpenSAFELY-TPP database, covering 40% of GP practices in England and linked to national coronavirus surveillance, hospital episodes, and death registry data, to compare the effectiveness of ChAdOx1 versus BNT162b2 in 1/3 million health and social care workers vaccinated between 4 January and 28 February 2021. Recipients were followed-up for 20 weeks. Second-dose effects were estimated under an intention-to-treat strategy. Primary outcomes were recorded SARS-CoV-2 infection, COVID-19-related accident and emergency attendance, and COVID-19-related hospital admission. Results: The cumulative incidence of each outcome was similar for both vaccines during the first 20 weeks post-vaccination. The cumulative incidence of recorded SARS-CoV-2 infection 6 weeks after vaccination with BNT162b2 was 19.2 per 1000 people (95%CI 18.6 to 19.7) and with ChAdOx1 was 18.9 (95%CI 17.6 to 20.3), representing a difference of -0.24 per 1000 people (95%CI -1.71 to 1.22). The difference in the cumulative incidence of COVID-19 accident and emergency attendance at 6 weeks was 0.01 per 1000 people (95%CI -0.27 to 0.28). For COVID-19 hospital admission, this difference was 0.03 per 1000 people (95%CI -0.22 to 0.27). Conclusion: In this cohort of healthcare workers where we would not anticipate vaccine type to be related to health status, we found no substantial differences in the incidence of SARS-CoV-2 infection or COVID-19 disease up to 20 weeks after vaccination. Incidence dropped sharply after 3-4 weeks and there were very few COVID-19 hospital attendance and admission events after this period. This is in line with expected onset of vaccine-induced immunity, and suggests strong protection against COVID-19 disease for both vaccines.

Sound Production Treatment for Acquired Apraxia of Speech: An Examination of Dosage in Relation to Probe Performance

2020 ◽  
pp. 1-16
Author(s):  
Julie L. Wambaugh ◽  
Lydia Kallhoff ◽  
Christina Nessler
Keyword(s):  
Retrospective Analysis ◽  
Sound Production ◽  
Apraxia Of Speech ◽  
Practice Schedule ◽  
Practice Schedules ◽  
Baseline Performance ◽  
The Mean ◽  
Number Of Treatment ◽  
The Impact

Purpose This study was designed to examine the association of dosage and effects of Sound Production Treatment (SPT) for acquired apraxia of speech. Method Treatment logs and probe data from 20 speakers with apraxia of speech and aphasia were submitted to a retrospective analysis. The number of treatment sessions and teaching episodes was examined relative to (a) change in articulation accuracy above baseline performance, (b) mastery of production, and (c) maintenance. The impact of practice schedule (SPT-Blocked vs. SPT-Random) was also examined. Results The average number of treatment sessions conducted prior to change was 5.4 for SPT-Blocked and 3.9 for SPT-Random. The mean number of teaching episodes preceding change was 334 for SPT-Blocked and 179 for SPT-Random. Mastery occurred within an average of 13.7 sessions (1,252 teaching episodes) and 12.4 sessions (1,082 teaching episodes) for SPT-Blocked and SPT-Random, respectively. Comparisons of dosage metric values across practice schedules did not reveal substantial differences. Significant negative correlations were found between follow-up probe performance and the dosage metrics. Conclusions Only a few treatment sessions were needed to achieve initial positive changes in articulation, with mastery occurring within 12–14 sessions for the majority of participants. Earlier occurrence of change or mastery was associated with better follow-up performance. Supplemental Material https://doi.org/10.23641/asha.12592190

Research Participation Experiences of Informants of Suicide and Control Cases

Crisis ◽  
2010 ◽  
Vol 31 (5) ◽  
pp. 238-246 ◽  
Author(s):  
Paul W. C. Wong ◽  
Wincy S. C. Chan ◽  
Philip S. L. Beh ◽  
Fiona W. S. Yau ◽  
Paul S. F. Yip ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Research Participation ◽  
Self Report ◽  
Initial Contact ◽  
Psychological Autopsy ◽  
Autopsy Study ◽  
The People ◽  
And Control ◽  
The Impact

Background: Ethical issues have been raised about using the psychological autopsy approach in the study of suicide. The impact on informants of control cases who participated in case-control psychological autopsy studies has not been investigated. Aims: (1) To investigate whether informants of suicide cases recruited by two approaches (coroners’ court and public mortuaries) respond differently to the initial contact by the research team. (2) To explore the reactions, reasons for participation, and comments of both the informants of suicide and control cases to psychological autopsy interviews. (3) To investigate the impact of the interviews on informants of suicide cases about a month after the interviews. Methods: A self-report questionnaire was used for the informants of both suicide and control cases. Telephone follow-up interviews were conducted with the informants of suicide cases. Results: The majority of the informants of suicide cases, regardless of the initial route of contact, as well as the control cases were positive about being approached to take part in the study. A minority of informants of suicide and control cases found the experience of talking about their family member to be more upsetting than expected. The telephone follow-up interviews showed that none of the informants of suicide cases reported being distressed by the psychological autopsy interviews. Limitations: The acceptance rate for our original psychological autopsy study was modest. Conclusions: The findings of this study are useful for future participants and researchers in measuring the potential benefits and risks of participating in similar sensitive research. Psychological autopsy interviews may be utilized as an active engagement approach to reach out to the people bereaved by suicide, especially in places where the postvention work is underdeveloped.

Coexistent Osteoarthritis and Parkinson’s Disease: Data from the Parkinson’s Foundation Outcomes Project

2020 ◽  
Vol 10 (4) ◽  
pp. 1601-1610
Author(s):  
Jaimie A. Roper ◽  
Abigail C. Schmitt ◽  
Hanzhi Gao ◽  
Ying He ◽  
Samuel Wu ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Study Data ◽  
Functional Mobility ◽  
Quality Improvement Initiative ◽  
Timed Up And Go ◽  
Mobility Performance ◽  
Risk Of Mortality ◽  
The Impact

Background: The impact of concurrent osteoarthritis on mobility and mortality in individuals with Parkinson’s disease is unknown. Objective: We sought to understand to what extent osteoarthritis severity influenced mobility across time and how osteoarthritis severity could affect mortality in individuals with Parkinson’s disease. Methods: In a retrospective observational longitudinal study, data from the Parkinson’s Foundation Quality Improvement Initiative was analyzed. We included 2,274 persons with Parkinson’s disease. The main outcomes were the effects of osteoarthritis severity on functional mobility and mortality. The Timed Up and Go test measured functional mobility performance. Mortality was measured as the osteoarthritis group effect on survival time in years. Results: More individuals with symptomatic osteoarthritis reported at least monthly falls compared to the other groups (14.5% vs. 7.2% without reported osteoarthritis and 8.4% asymptomatic/minimal osteoarthritis, p = 0.0004). The symptomatic group contained significantly more individuals with low functional mobility (TUG≥12 seconds) at baseline (51.5% vs. 29.0% and 36.1%, p < 0.0001). The odds of having low functional mobility for individuals with symptomatic osteoarthritis was 1.63 times compared to those without reported osteoarthritis (p < 0.0004); and was 1.57 times compared to those with asymptomatic/minimal osteoarthritis (p = 0.0026) after controlling pre-specified covariates. Similar results hold at the time of follow-up while changes in functional mobility were not significant across groups, suggesting that osteoarthritis likely does not accelerate the changes in functional mobility across time. Coexisting symptomatic osteoarthritis and Parkinson’s disease seem to additively increase the risk of mortality (p = 0.007). Conclusion: Our results highlight the impact and potential additive effects of symptomatic osteoarthritis in persons with Parkinson’s disease.

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