scholarly journals Evolving consensus for immunomodulatory therapy in non-infectious uveitis during the COVID-19 pandemic

2020 ◽  
pp. bjophthalmol-2020-316776
Author(s):  
Rupesh Agrawal ◽  
Ilaria Testi ◽  
Cecilia S Lee ◽  
Edmund Tsui ◽  
Marian Blazes ◽  
...  
Keyword(s):  
High Risk ◽  
Immunosuppressive Agents ◽  
Risk Groups ◽  
Immunomodulatory Therapy ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Increased Risk ◽  
Consensus Statements ◽  
Infectious Uveitis

BackgroundImmunomodulatory therapy (IMT) is often considered for systemic treatment of non-infectious uveitis (NIU). During the evolving coronavirus disease-2019 (COVID-19) pandemic, given the concerns related to IMT and the increased risk of infections, an urgent need for guidance on the management of IMT in patients with uveitis has emerged.MethodsA cross-sectional survey of international uveitis experts was conducted. An expert steering committee identified clinical questions on the use of IMT in patients with NIU during the COVID-19 pandemic. Using an interactive online questionnaire, guided by background experience and knowledge, 139 global uveitis experts generated consensus statements for IMT. In total, 216 statements were developed around when to initiate, continue, decrease and stop systemic and local corticosteroids, conventional immunosuppressive agents and biologics in patients with NIU. Thirty-one additional questions were added, related to general recommendations, including the use of non-steroidal anti-inflammatory drugs (NSAIDs) and hydroxychloroquine.ResultsHighest consensus was achieved for not initiating IMT in patients who have suspected or confirmed COVID-19, and for using local over systemic corticosteroid therapy in patients who are at high-risk and very high-risk for severe or fatal COVID-19. While there was a consensus in starting or initiating NSAIDs for the treatment of scleritis in healthy patients, there was no consensus in starting hydroxychloroquine in any risk groups.ConclusionConsensus guidelines were proposed based on global expert opinion and practical experience to bridge the gap between clinical needs and the absence of medical evidence, to guide the treatment of patients with NIU during the COVID-19 pandemic.

scholarly journals Malaria in pregnancy in rural Gabon: a cross-sectional survey on the impact of seasonality in high-risk groups

2013 ◽  
Vol 12 (1) ◽  
pp. 412 ◽  
Author(s):  
Mario J Jäckle ◽  
Christian G Blumentrath ◽  
Rella M Zoleko ◽  
Daisy Akerey-Diop ◽  
Jean-Rodolphe Mackanga ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Groups ◽  
Malaria In Pregnancy ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
The Impact ◽  
In Pregnancy

scholarly journals Impact of corticosteroids and immunosuppressive therapies on symptomatic SARS-CoV-2 infection in a large cohort of patients with chronic inflammatory arthritis

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Ennio Giulio Favalli ◽  
Serena Bugatti ◽  
Catherine Klersy ◽  
Martina Biggioggero ◽  
Silvia Rossi ◽  
...  
Keyword(s):  
Inflammatory Arthritis ◽  
Immunosuppressive Agents ◽  
Large Cohort ◽  
World Health ◽  
Nasopharyngeal Swab ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Chronic Inflammatory Arthritis ◽  
Increased Risk ◽  
The Impact

Abstract Background Prevalence and outcomes of coronavirus disease (COVID)-19 in relation to immunomodulatory medications are still unknown. The aim of the study is to investigate the impact of glucocorticoids and immunosuppressive agents on COVID-19 in a large cohort of patients with chronic immune-mediated inflammatory arthritis. Methods The study was conducted in the arthritis outpatient clinic at two large academic hospitals in the COVID-19 most endemic area of Northern Italy (Lombardy). We circulated a cross-sectional survey exploring the prevalence of severe acute respiratory syndrome-coronavirus-2 nasopharyngeal swab positivity and the occurrence of acute respiratory illness (fever and/or cough and/or dyspnea), administered face-to-face or by phone to consecutive patients from 25 February to 20 April 2020. COVID-19 cases were defined as confirmed or highly suspicious according to the World Health Organization criteria. The impact of medications on COVID-19 development was evaluated. Results The study population included 2050 adults with chronic inflammatory arthritis receiving glucocorticoids, conventional-synthetic (cs), or targeted-synthetic/biological (ts/b) disease-modifying drugs (DMARDs). Laboratory-confirmed COVID-19 and highly suspicious infection were recorded in 1.1% and 1.4% of the population, respectively. Treatment with glucocorticoids was independently associated with increased risk of COVID-19 (adjusted OR [95% CI] ranging from 1.23 [1.04–1.44] to 3.20 [1.97–5.18] depending on the definition used). Conversely, patients treated with ts/bDMARDs were at reduced risk (adjusted OR ranging from 0.46 [0.18–1.21] to 0.47 [0.46–0.48]). No independent effects of csDMARDs, age, sex, and comorbidities were observed. Conclusions During the COVID-19 outbreak, treatment with immunomodulatory medications appears safe. Conversely, glucocorticoids, even at low-dose, may confer increased risk of infection. Trial registration Retrospectively registered. Not applicable.

scholarly journals Impact of corticosteroids and immunosuppressive therapies on symptomatic SARS-CoV-2 infection in a large cohort of patients with chronic inflammatory arthritis

2020 ◽  
Author(s):  
Ennio Giulio Favalli ◽  
Serena Bugatti ◽  
Catherine Klersy ◽  
Martina Biggioggero ◽  
Silvia Rossi ◽  
...  
Keyword(s):  
Inflammatory Arthritis ◽  
Immunosuppressive Agents ◽  
Large Cohort ◽  
World Health ◽  
Nasopharyngeal Swab ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Chronic Inflammatory Arthritis ◽  
Increased Risk ◽  
The Impact

Abstract Background: Prevalence and outcomes of Coronavirus Disease (COVID)-19 in relation to immunomodulatory medications are still unknown. The aim of the study is to investigate the impact of glucocorticoids and immunosuppressive agents on COVID-19 in a large cohort of patients with chronic immune-mediated inflammatory arthritis.Methods: The study was conducted in the arthritis outpatient clinic at two large Academic Hospitals in the COVID-19 most endemic area of Northern Italy (Lombardy). We circulated a cross-sectional survey exploring the prevalence of Severe Acute Respiratory Syndrome-Coronavirus-2 nasopharyngeal swab positivity and the occurrence of acute respiratory illness (fever and/or cough and/or dyspnea), administered face-to-face or by phone to consecutive patients from 25th February to 20th April 2020. COVID-19 cases were defined as confirmed or highly suspicious according to the World Health Organization criteria. The impact of medications on COVID-19 development was evaluated. Results: The study population included 2050 adults with chronic inflammatory arthritis receiving glucocorticoids, conventional-synthetic (cs), or targeted-synthetic/biological (ts/b) disease-modifying drugs (DMARDs). Laboratory-confirmed COVID-19 and highly suspicious infection were recorded in 1.1% and 1.4% of the population, respectively. Treatment with glucocorticoids was independently associated with increased risk of COVID-19 (adjusted OR [95% CI] ranging from 1.23 [1.04-1.44] to 3.20 [1.97-5.18] depending on the definition used). Conversely, patients treated with ts/bDMARDs were at reduced risk (adjusted OR ranging from 0.46 [0.18-1.21] to 0.47 [0.46-0.48]). No independent effects of csDMARDs, age, sex, and comorbidities were observed.Conclusions: During the COVID-19 outbreak, treatment with immunomodulatory medications appears safe. Conversely, glucocorticoids, even at low-dose, may confer increased risk of infection.Trial registration: retrospectively registered

scholarly journals Willingness to receive a COVID-19 vaccine among adults at high-risk of COVID-19: a UK-wide survey

2020 ◽  
Author(s):  
Rachael Thorneloe ◽  
Holly Elizabeth Wilcockson ◽  
Martin Lamb ◽  
Caroline H Jordan ◽  
Madelynne Arden
Keyword(s):  
High Risk ◽  
General Population ◽  
Ethnic Group ◽  
Vaccination Programme ◽  
Online Survey ◽  
Significant Proportion ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Increased Risk ◽  
To Receive

PURPOSE Willingness of adults at high-risk of COVID-19 to receive a COVID-19 vaccine is unknown. There are key disparities in the risk and outcomes from COVID-19 by socio-demographic factors, including age, sex, level of deprivation, and ethnicity. A COVID-19 vaccination programme could inadvertently exacerbate these inequalities if it is not readily received by different population groups. In this UK-wide cross-sectional survey, we examined willingness to receive a COVID-19 vaccine in the general population and evaluated socio-demographic and clinical factors associated with willingness.METHODS Between April and June 2020, individuals in the general population were invited to complete an online survey; 2568 provided informed consent. Willingness to receive a COVID-19 vaccine was reported by 2152 (83.8%).RESULTS In total, 76.9% (1654/2152) reported being willing to receive a COVID-19 vaccine. One in five individuals at increased risk of COVID-19, as defined by UK government guidelines, were unwilling to receive a COVID-19 vaccine (119/589; 20.2%). Individuals from white ethnic group were more likely to be willing to receive a COVID-19 vaccine compared with those from BAME groups (79.9% vs. 55.9%, respectively), OR 2.84, 96% CI = 1.93 – 4.18, p ≤ 0.001. Willingness did not vary among adults at increased risk of COVID-19 compared with those not at increased risk.CONCLUSION A significant proportion of individuals in the general population are unwilling to receive a COVID-19 vaccine, including those at increased risk of COVID-19 morbidity and mortality. There are socio-demographic differences in willingness, especially by ethnic group. Success of a vaccination programme for COVID-19 depends not only on the efficacy of the vaccine but also on its uptake. Research is urgently needed to establish the most effective policy and communications to encourage maximal uptake of the vaccination.

scholarly journals Multiple Physical Symptoms Are Useful to Identify High Risk Individuals for Burnout: A Study on Faculties and Hospital Workers in Japan

2021 ◽  
Vol 18 (6) ◽  
pp. 3246
Author(s):  
Yuki Chatani ◽  
Kyoko Nomura ◽  
Haruko Hiraike ◽  
Akiko Tsuchiya ◽  
Hiroko Okinaga
Keyword(s):  
High Risk ◽  
Healthcare Workers ◽  
Job Strain ◽  
Physical Symptoms ◽  
Hospital Workers ◽  
Work Family Conflict ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Work Related ◽  
Increased Risk

Healthcare workers have a high risk of burnout. This study aimed to investigate if the numbers of physical symptoms are associated with burnout among healthcare workers. We conducted a cross-sectional survey at a large university in Tokyo, Japan, in 2016. Participants were 1080: 525 faculties and 555 hospital workers. We investigated 16 physical symptoms perceived more than once per week and examined the association between the number of physical symptoms and Copenhagen Burnout Inventory (CBI); work-related (WBO), personal (PBO), and client-related (CBO) burnout. All CBI scores were higher among hospital workers than among faculties: WBO (43 vs. 29), PBO (50 vs. 33), CBO (33 vs. 29). Moreover, the higher the number of physical symptoms perceived, the higher the degree of burnout scores became (trend p-values < 0.001), except for CBO among faculties. Job strain (all except for CBO among hospital workers) and work–family conflict were associated with an increased risk of burnout. Being married (WBO and CBO among faculties), having a child (except for PBO and CBO among faculties), and job support (faculty and hospital workers with WBO and faculties with PBO) were associated with a decreased risk of burnout. Multiple physical symptoms might be useful for identifying high risk individuals for burnout.

scholarly journals Impact of Corticosteroids and Immunosuppressive Therapies on Symptomatic SARS-CoV-2 Infection in a Large Cohort of Patients with Chronic Inflammatory Arthritis

2020 ◽  
Author(s):  
Ennio Giulio Favalli ◽  
Serena Bugatti ◽  
Catherine Klersy ◽  
Martina Biggioggero ◽  
Silvia Rossi ◽  
...  
Keyword(s):  
Inflammatory Arthritis ◽  
Immunosuppressive Agents ◽  
Large Cohort ◽  
World Health ◽  
Nasopharyngeal Swab ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Chronic Inflammatory Arthritis ◽  
Increased Risk ◽  
The Impact

Abstract Background: Prevalence and outcomes of Coronavirus Disease (COVID)-19 in relation to immunomodulatory medications are still unknown. The aim of the study is to investigate the impact of glucocorticoids and immunosuppressive agents on COVID-19 in a large cohort of patients with chronic immune-mediated inflammatory arthritis.Methods: The study was conducted in the arthritis outpatient clinic at two large Academic Hospitals in the COVID-19 most endemic area of Northern Italy (Lombardy). We circulated a cross-sectional survey exploring the prevalence of Severe Acute Respiratory Syndrome-Coronavirus-2 nasopharyngeal swab positivity and the occurrence of acute respiratory illness (fever and/or cough and/or dyspnea), administered face-to-face or by phone to consecutive patients from 25th February to 20th April 2020. COVID-19 cases were defined as confirmed or highly suspicious according to the World Health Organization criteria. The impact of medications on COVID-19 incidence was evaluated. Results: The study population included 2050 adults with chronic inflammatory arthritis receiving glucocorticoids, conventional-synthetic (cs), or targeted-synthetic/biological (ts/b) disease-modifying drugs (DMARDs). Laboratory-confirmed COVID-19 and highly suspicious infection were recorded in 1.1% and 1.4% of the population, respectively. Treatment with glucocorticoids was independently associated with increased risk of COVID-19 (adjusted OR [95% CI] ranging from 1.23 [1.04-1.44] to 3.20 [1.97-5.18] depending on the definition used). Conversely, patients treated with ts/bDMARDs were at reduced risk (adjusted OR ranging from 0.46 [0.18-1.21] to 0.47 [0.46-0.48]). No independent effects of csDMARDs were observed.Conclusions: During the COVID-19 outbreak, treatment with immunomodulatory medications appears safe. Conversely, glucocorticoids, even at low-dose, may confer increased risk of infection.Trial registration: retrospectively registered

Victimization of individuals with serious mental illness living in sheltered housing.

2020 ◽  
Author(s):  
Milan Zarchev
Keyword(s):  
Mental Illness ◽  
High Risk ◽  
Serious Mental Illness ◽  
Risk Groups ◽  
Living Alone ◽  
Sheltered Housing ◽  
Crime Victimization ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
High Prevalence

Background – Sheltered housing is associated with positive quality of life improvements for individuals with serious mental illness (SMI). However, there are equivocal findings around safety outcomes related to this type of accommodation, as other reports emphasize severe security concerns described by the tenants. This study aims to examine victimization in sheltered housing by comparing crime victimization rates of SMI patients living in sheltered housing to patients living alone or with family.Methods – A large community-based cross-sectional survey of 956 SMI patients completed the Dutch Crime and Victimization survey to investigate a) raw differences in prevalence and incidence between living conditions and b) to identify groups at high risk for victimization using demographic and clinical factors. We do so by reporting estimated victimization incidents for each risk group.Results - Victimization prevalence was highest among residents in sheltered housing (50.8%) compared to persons living alone (43%) or with family (37.8%). We found that sheltered housing was associated with increased victimization incidence (IRR = 2.80 compared to living with family, 1.87 compared to living alone), especially for some victimization high risk groups like males, patients with comorbid PTSD or those with high levels of education. However, women reported less victimization in sheltered housing than living alone or with family if they also reported drug or alcohol use.Conclusion – The high prevalence and incidence of victimization among residents in sheltered housing provides evidence in support of awareness and surveillance of victimization among residents to facilitate a recovery-enabling environment for these SMI patients.

scholarly journals Uptake of peer-led venue-based HIV testing sites in Sweden aimed at men who have sex with men (MSM) and trans persons: a cross-sectional survey

2019 ◽  
Vol 95 (8) ◽  
pp. 575-579 ◽  
Author(s):  
Susanne Strömdahl ◽  
Jonas Hoijer ◽  
Jaran Eriksen
Keyword(s):  
High Risk ◽  
Hiv Testing ◽  
Healthcare System ◽  
Rapid Test ◽  
Risk Groups ◽  
Healthcare Personnel ◽  
Foreign Born ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Sex With Men

ObjectivesHIV testing among high-risk groups is a key intervention to diagnose persons living unknowingly with HIV to enable linkage to care and effective antiretroviral treatment. This study aimed to evaluate the uptake of Testpoint, the first large-scale HIV testing programme in Sweden where peer, non-healthcare personnel offered venue-based testing. Testing was performed by staff from the Swedish Foundation for Lesbian, Gay, Bisexual and Transgender Rights (RFSL Sweden) and testing was performed at the RFSL offices, gay clubs and gay cruising areas, as well as at various gay festivals. The test was a rapid test using capillary blood from a finger prick.MethodsA cross-sectional survey of all persons aged >18 years who came for HIV testing at one of Testpoint’s locations in Sweden between 1 February and 31 December 2016.Results595 respondents (96% response rate) were included. Five persons were diagnosed with HIV and referred for treatment and care. A fifth of participants had never tested for HIV before. More than half of the participants were foreign born and the median age was 31 years. About one-fifth of participants stated they would not have tested through the healthcare system if Testpoint was not available.ConclusionsTestpoint reached their target population of young, foreign-born men who have sex with men (MSM) as well as first time testers and persons who stated that they would not have tested within the healthcare system. Such peer HIV testing outside the healthcare setting is a possible way of increasing uptake of testing in high-risk groups.

scholarly journals Impact of corticosteroids and immunosuppressive therapies on symptomatic SARS-CoV-2 infection in a large cohort of patients with chronic inflammatory arthritis

2020 ◽  
Author(s):  
Ennio Giulio Favalli ◽  
Serena Bugatti ◽  
Catherine Klersy ◽  
Martina Biggioggero ◽  
Silvia Rossi ◽  
...  
Keyword(s):  
Inflammatory Arthritis ◽  
Immunosuppressive Agents ◽  
Large Cohort ◽  
World Health ◽  
Nasopharyngeal Swab ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Chronic Inflammatory Arthritis ◽  
Increased Risk ◽  
The Impact

Abstract Background: Prevalence and outcomes of Coronavirus Disease (COVID)-19 in relation to immunomodulatory medications are still unknown. The aim of the study is to investigate the impact of glucocorticoids and immunosuppressive agents on COVID-19 in a large cohort of patients with chronic immune-mediated inflammatory arthritis.Methods: The study was conducted in the arthritis outpatient clinic at two large Academic Hospitals in the COVID-19 most endemic area of Northern Italy (Lombardy). We circulated a cross-sectional survey exploring the prevalence of Severe Acute Respiratory Syndrome-Coronavirus-2 nasopharyngeal swab positivity and the occurrence of acute respiratory illness (fever and/or cough and/or dyspnea), administered face-to-face or by phone to consecutive patients from 25th February to 20th April 2020. COVID-19 cases were defined as confirmed or highly suspicious according to the World Health Organization criteria. The impact of medications on COVID-19 development was evaluated. Results: The study population included 2050 adults with chronic inflammatory arthritis receiving glucocorticoids, conventional-synthetic (cs), or targeted-synthetic/biological (ts/b) disease-modifying drugs (DMARDs). Laboratory-confirmed COVID-19 and highly suspicious infection were recorded in 1.1% and 1.4% of the population, respectively. Treatment with glucocorticoids was independently associated with increased risk of COVID-19 (adjusted OR [95% CI] ranging from 1.23 [1.04-1.44] to 3.20 [1.97-5.18] depending on the definition used). Conversely, patients treated with ts/bDMARDs were at reduced risk (adjusted OR ranging from 0.46 [0.18-1.21] to 0.47 [0.46-0.48]). No independent effects of csDMARDs, age, sex, and comorbidities were observed.Conclusions: During the COVID-19 outbreak, treatment with immunomodulatory medications appears safe. Conversely, glucocorticoids, even at low-dose, may confer increased risk of infection.Trial registration: retrospectively registered

Biographic Characteristics and Factors Perceived as Affecting Female and Male Careers in Academic Surgery: The Tenured Gender Battle to Make It to the Top

2016 ◽  
Vol 57 (3-4) ◽  
pp. 139-154 ◽  
Author(s):  
Laura Schwarz ◽  
Sonia Sippel ◽  
Andrew Entwistle ◽  
Anna Kathrin Hell ◽  
Sarah Koenig
Keyword(s):  
Career Guidance ◽  
Work Satisfaction ◽  
Attrition Rate ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Professional Career ◽  
Academic Surgery ◽  
Female Surgeons ◽  
High Degree

Purpose: Given the high attrition rate in the field of academic surgery, we aimed to characterise the professional and personal situations of female and male academic surgeons as well as to gather data on their respective perceptions of career advancement and work satisfaction. Methods: We conducted a cross-sectional survey in Germany, inviting all identifiable academically highly qualified female surgeons and their male counterparts in a 1:2 ratio to participate. An anonymous 103-item online questionnaire was designed and the data collected between July and September 2014. Results: The questionnaire was sent to 93 female and 200 male surgeons, of whom 63 women (67.7%) and 70 men (35.0%) replied. The average age was 47.5 and 47.1 years, respectively. Respondents identified ‘high degree of expertise', ‘ambition', and ‘clarity of one's professional aims' as important factors affecting professional career development. Both groups felt ‘workload', ‘working hours/shifts', and ‘gender' to be a hindrance, the latter of significantly greater importance to female surgeons. The mean work satisfaction scores were high in both female (69.5%) and male (75.7%) surgeons. The predictors ‘support from superiors' (standardised β coefficient = 0.41) and ‘manual aptitude' (β = 0.41) contributed incrementally to the variance in ‘high degree of work satisfaction' (90-100%) observed for female surgeons. However, childcare provided by ‘kindergarten/crèche/after-school care' had the greatest negative predictive value (β = -1.33). Conclusions: Although there are many parallels, female faculty members experience the culture of academic surgery to some extent differently from their male counterparts, especially when impacted by parenthood and childcare. Faculty development programmes need to develop strategies to improve perceived equality in career opportunities by respecting individuals' requirements as well as offering gender-appropriate career guidance.

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