Sex disparities in COVID-19 mortality vary considerably across time: The case of New York State

In order to characterize how sex disparities in COVID-19 mortality evolved over time in New York State (NY), we analyzed sex-disaggregated data from the US Gender/Sex COVID-19 Data Tracker from March 14, 2020 to August 28, 2021. We defined six different time periods and calculated mortality rates by sex and mortality rate ratios, both cumulatively and for each time period separately. As of August 28, 2021, 19 227 (44.2%) women and 24 295 (55.8%) men died from COVID-19 in NY. 72.7% of the cumulative difference in the number of COVID-19 deaths between women and men was accrued between March 14 and May 4, 2020. During this period, the COVID-19 mortality rate ratio for men compared to women was 1.56 (95% CI: 1.52-1.61). In the five subsequent time periods, the corresponding ratio ranged between 1.08 (0.98-1.18) and 1.24 (1.15-1.34). While the cumulative mortality rate ratio of men compared to women was 1.34 (1.31-1.37), the ratio equals 1.19 (1.16-1.22) if deaths during the initial COVID-19 surge are excluded from the analysis. This article shows that in NY the magnitude of sex disparities in COVID-19 mortality was not stable across time. While the initial surge in COVID-19 mortality was characterized by stark sex disparities, these were greatly attenuated after the introduction of public health controls.

Religion as a Protective Factor Against Adolescent Smoking Habits: Evidence from Spain

Background: There are a wide number of assessments suggesting that being a member of a religious community inhibits adolescents’ risky behaviours and, consequently, can act as a protective factor against the consumption of smoking substances. Methods: We have analysed a structured questionnaire answered by 1935 adolescents from Tarragona (Spain). Results: We have found that variables linked to family were the principal explanatory factors of adolescents’ smoking habits. Living with two parents was a protective factor against tobacco and cannabis use since its Incidence Rate Ratio (IRR) was clearly below 1 (p<0.01). So, whereas living with one parent showed an IRR>1 (p<0.05), adolescents that live without parents presented an IRR close 2 (p<0.05 for tobacco and p<0.01 for cannabis). However, having a religious confession also influence smoking substance use in adolescents (IRR close 0.85 with p<0.01). Conclusion: We found a clear preventive effect in belonging to a religious community. Moreover, this protective effect was less intense, but not statistically significant, for Catholics than for members of other confessions.

Heavy metal toxicity and mortality—association between density of heavy metal bands and cause specific hospital admissions and mortality: population based cohort study

Objective To assess the association between area level density of heavy metal bands and cause specific hospital admissions and mortality. Design Longitudinal register based cohort study. Setting 311 municipalities in Finland. Participants 3 644 944 people aged 15 to 70 residing in Finland at the end of 2001. Main outcome measures Hospital admission and mortality from all causes, internal causes, alcohol attributable causes, accidental injury and violence, suicide or self-harm, and mental health related causes. Appendicitis and toxic effects of metals were negative control outcomes. Results During 50.4 million person years of follow-up in 2002-17, 4 237 807 person years with hospital admissions were observed and 221 912 individuals died. Mortality in municipalities with a moderate density of heavy metal bands (<5.7 per 10 000 inhabitants) was lower than in municipalities with no heavy metal bands. Hospital admission rates were lower in municipalities with heavy metal bands compared with those with none. These associations could be explained partly by differences in the sociodemographic characteristics of residents in these municipalities. After adjustment for individual characteristics and area level cultural and economic characteristics—proportion of the population with no religious affiliation, unemployment rate, and per capita expenditure on culture and education—large cities with a high density of heavy metal bands (8.2-11.2 per 10 000) showed a mortality advantage (hazard ratio 0.92, 95% confidence interval 0.88 to 0.96). In contrast, the association for hospital admission was fully attenuated (incidence rate ratio 0.99, 95% confidence interval 0.92 to 1.06). The cause specific analysis showed similar results, with the association most pronounced for alcohol attributable mortality (hazard ratio 0.83, 95% confidence interval 0.75 to 0.93 for cities with a high density of heavy metal bands) and alcohol attributable hospital admissions (incidence rate ratio 0.84, 95% confidence interval 0.74 to 0.97 for cities with a high density of heavy metal bands) in the fully adjusted models. No association with heavy metal band density was found for the analysis using appendicitis as a negative control outcome. Conclusions The study found no evidence for adverse health outcomes with increasing density of heavy metal bands. Cities with a high density of heavy metal bands showed slightly lower rates of mortality and of hospital admissions for alcohol related problems and self-harm. Although residual confounding remains a problem in observational studies, vibrant local heavy metal scenes—comparable to many other forms of cultural capital—might help to promote health through healthier lifestyles, better coping mechanisms, and a stronger sense of community.

Comparisons of the risk of myopericarditis between COVID-19 patients and individuals receiving COVID-19 vaccines: a population-based study

Background: Both COVID-19 infection and COVID-19 vaccines have been associated with the development of myopericarditis. The objective of this study is to 1) analyze the rates of myopericarditis after COVID-19 infection and COVID-19 vaccination in Hong Kong and 2) compare to the background rates, and 3) compare the rates of myopericarditis after COVID-19 vaccination to those reported in other countries. Methods: This was a population-based cohort study from Hong Kong, China. Patients with positive RT-PCR test for COVID-19 between 1st January 2020 and 30th June 2021 or individuals who received COVID-19 vaccination until 31st August were included. The main exposures were COVID-19 positivity or COVID-19 vaccination. The primary outcome was myopericarditis. Results: This study included 11441 COVID-19 patients from Hong Kong, of whom four suffered from myopericarditis (rate per million: 350; 95% confidence interval [CI]: 140-900). The rate was higher than the pre-COVID-19 background rate in 2020 (rate per million: 61, 95% CI: 55-67) with a rate ratio of 5.73 (95% CI: 2.23-14.73. Compared to background rates, the rate of myopericarditis among vaccinated subjects in Hong Kong was substantially lower (rate per million: 8.6; 95% CI: 6.4-11.6) with a rate ratio of 0.14 (95% CI: 0.10-0.19). The rates of myocarditis after vaccination in Hong Kong are comparable to those vaccinated in the United States, Israel, and the United Kingdom. Conclusions: COVID-19 infection is associated with a higher rate of myopericarditis whereas COVID-19 vaccination is associated with a lower rate of myopericarditis compared to the background.

Mothers of children with major congenital anomalies have increased health care utilization over a 20-year post-birth time horizon

Objective This population-based, matched cohort study aimed to evaluate utilization of health care services by mothers of children with major congenital anomalies (MCAs), compared to mothers of children without MCAs over a 20-year post-birth time horizon in Denmark. Methods Our analytic sample included mothers who gave birth to an infant with a MCA (n = 23,927) and a cohort of mothers matched to them by maternal age, parity and infant’s year of birth (n = 239,076). Primary outcomes were period prevalence and mothers’ quantity of health care utilization (primary, inpatient, outpatient, surgical, and psychiatric services) stratified by their child’s age (i.e., ages 0–6 = before school, ages 7–13 = pre-school + primary education, and ages 14–18 = secondary education or higher). The secondary outcome measure was length of hospital stays. Outcome measures were adjusted for maternal age at delivery, parity, marital status, income quartile, level of education in the year prior to the index birth, previous spontaneous abortions, maternal pregnancy complications, maternal diabetes, hypertension, alcohol-related diseases, and maternal smoking. Results In both cohorts the majority of mothers were between 26 and 35 years of age, married, and employed, and 47% were primiparous. Mothers of infants with anomalies had greater utilization of outpatient, inpatient, surgical, and psychiatric services, compared with mothers in the matched cohort. Inpatient service utilization was greater in the exposed cohort up to 13 years after a child’s birth, with the highest risk in the first six years after birth [adjusted risk ratio, 1.13; 95% confidence interval (CI), 1.12–1.14], with a decrease over time. Regarding the quantity of health care utilization, the greatest difference between the two groups was in inpatient service utilization, with a 39% increased rate in the exposed cohort during the first six years after birth (adjusted rate ratio, 1.39; 95% CI, 1.37–1.42). During the first 6 years after birth, mothers of children with anomalies stayed a median of 6 days (interquartile range [IQR], 3–13) in hospital overall, while the comparison cohort stayed a median of 4 days (IQR, 2–7) in hospital overall. Rates of utilization of outpatient clinics (adjusted rate ratio, 1.36; 95% CI, 1.29–1.42), as well as inpatient (adjusted rate ratio, 1.77; 95% CI, 1.68–1.87), and surgical services (adjusted rate ratio, 1.33; 95% CI, 1.26–1.41) was higher in mothers of children with multiple-organ MCAs during 0 to 6 years after birth. Among mothers at the lowest income levels, utilization of psychiatric clinic services increased to 59% and when their child was 7 to 13 years of age (adjusted rate ratio, 1.59; 95% CI, 1.24–2.03). Conclusion Mothers of infants with a major congenital anomaly had greater health care utilization across services. Health care utilization decreased over time or remained stable for outpatient, inpatient, and surgical care services, whereas psychiatric utilization increased for up to 13 years after an affected child’s birth. Healthcare utilization was significantly elevated among mothers of children with multiple MCAs and among those at the lowest income levels.

Safety of Five Tuina Manipulations in Rats with Deep Vein Thrombosis

Objective. To study the effects of five tuina manipulations in rats with deep vein thrombosis (DVT) and to explore how to safely perform tuina in the treatment of thrombotic diseases. Methods. Seventy-two male Sprague-Dawley (SD) rats were randomly divided into the model, pointing manipulation, plucking manipulation, kneading manipulation, pushing manipulation, and pulling manipulation groups (n = 12). DVT model was established by incomplete ligation. The tuina intervention was started on the next day after modeling and applied once a day 10 times by the manipulation simulators. On the 3rd and 10th days after intervention, respectively, the effects of tuina on thrombosis were evaluated based on thrombus elasticity, blood coagulation, fibrinolytic function and blood rheology with the ultrasound elastography, four coagulation tests, enzyme linked immunosorbent assay (ELISA), and hemorheology tests. Results. In the pointing manipulation group, the strain rate ratio, 6-ketoprostaglandin F1α (6-Keto-PGF1α), and high shear rate were decreased, and the thromboxane B2 (TXB2) content was increased ( P < 0.05 ). In the plucking manipulation group, the D-dimer and 6-Keto-PGF1α contents were increased, prothrombin time (PT) was shortened, and activated partial thromboplastin time (APTT) was activated, and the high shear rate and plasma viscosity were decreased ( P < 0.05 ). In the kneading manipulation group, APTT was shortened, and 6-Keto-PGF1α, high shear rate, and plasma viscosity were decreased ( P < 0.05 ). In the pushing manipulation group, the strain rate ratio, low shear rate, and high shear rate were all decreased ( P < 0.05 ). In the pulling manipulation group, both the strain rate ratio and the low shear rate were decreased ( P < 0.05 ). The 6-Keto-PGF1α changes on the 3rd and 10th days after intervention were opposite in the pushing manipulation group and the pulling manipulation group ( P < 0.05 ). Conclusion. The pointing, pushing, and pulling manipulations seem to be safe in the early period of thrombosis, but the risk is likely to be elevated as the treatment course of intervention increases. The plucking and kneading manipulations potentially have certain risks in the treatment of DVT in rats.

Accelerometer-Measured Daily Steps, Physical Function, and Subsequent Fall Risk in Older Women: The OPACH Study

We sought to investigate the association between steps per day (steps/d) and incident fall risk while also assessing the role of physical functioning on this association. Steps/d were measured by accelerometer for 7 days in 5,545 women aged 63 to 97 years between 2012 - 2014. Falls were ascertained from daily fall calendars for 13 months. Median steps/d were 3,216. There were 5,473 falls recorded over 61,564 fall calendar months. The adjusted incidence rate ratio comparing women in the highest vs. lowest step quartiles was 0.71 (95% confidence interval, 0.54 - 0.95; P-trend across quartiles of steps/d = 0.01). After further adjustment for physical function using the Short Physical Performance Battery, the rate ratio was 0.86 (0.64-1.16; P-trend = 0.27). Mediation analysis estimated that 66.7% to 70.2% of the association of steps/d and fall risk may be mediated by physical function. In conclusion, higher steps/d were related to lower incident falls primarily through their beneficial association with physical functioning. Interventions that improve physical function, including those that involve stepping, could reduce falls in older adults.

Collateral effects and mortality of kidney transplant recipients during the COVID-19 pandemic

Background: Collateral effects and consequences of the coronavirus disease 19 (COVID-19) pandemic on kidney transplant recipients remain widely unknown. Methods: This retrospective cohort study examines changes in admission rates, incidences of diseases leading to hospitalization, in-patient procedures, and maintenance medication in long-term kidney transplant recipients with functioning graft during the early COVID-19 pandemic in Germany. Data derived from a nationwide health insurance database. Analysis was performed from March 15th to September 30th and compared the years 2019 and 2020. Effects on mortality and adverse allograft events were compared to COVID-19 attributed effects. Results: 7,725 patients were included in the final analysis. Admissions declined in 2020 by 17% with a main dip during a 3-month lockdown (-31%) but without a subsequent rebound. Incidences for hospitalization did not increase for any investigated disease entities, while decreasing trends were noted for non-COVID-19 pulmonary and urogenital infections (incidence rate ratio 0.8, 95%-CI 0.62-1.03, and 0.82, 95%-CI 0.65-1.04, respectively). Non-COVID-19 hospital stays were 0.6 days shorter (p = 0.034) and not complicated by increased dialysis, ventilation, or intensive care treatment rates. In-hospital and 90-day mortality remained stable. Incidence of severe COVID-19 requiring hospitalization was 0.09 per 1,000 patient-days and in-hospital mortality was 9.2%. 31% of patients with calcineurin-inhibitor medication and without being hospitalized for COVID-19 reduced doses by at least 25%, which was associated with an increased allograft rejection risk (adjusted hazard ratios 1.29, 95%-CI 1.02-1.63). COVID-19 caused 16.9% of all deaths but had no significant association with allograft rejections. All-cause mortality remained stable (rate ratio 1.15, 95%-CI 0.91-1.46), also when restricting analysis to patients with no or outpatient-treated COVID-19 (0.97, 95%-CI 0.76-1.25). Conclusion: Despite significant collateral effects, mortality remained unchanged during the early COVID-19 pandemic. Considerable temporary reductions in admissions are safe whereas reducing immunosuppression results in increased allograft rejection risk.

A multicenter, randomized, double-blind, placebo-controlled phase ii trial of intravenous inflammasome inhibitor (NuSepin) for the treatment of COVID-19 patients

Purpose Here we evaluated whether a novel inflammasome inhibitor targeting GPCR19 (NuSepin) provides greater benefit than placebo in patients with COVID-19 pneumonia. Methods We conducted a double-blind, randomized, placebo-controlled phase ii trial of intravenous NuSepin, which is an NLRP3 inflammasome inhibitor targeting GPCR19, in adults who were hospitalized with COVID-19 pneumoniae in Romania from September 2020 to March 2021. The primary outcome was the time to clinical improvement, defined as a decline of two ordinal scales (OS) from randomization on a six-category OS that ranges from 1 (discharged with normal activity) to 6 (death) (=TTCI_P). In addition, clinical improvement was also assessed by aggregated National Early Warning Score 2 (NEWS2), and TTCI_S was defined by time to NEWS2=0 from randomization, which is maintained for 24 h. Results TTCI_P was different between groups numerically, but not statistically. The median difference in TTCI_S was 3.5 d between the NuSepin group and the placebo group (p = 0.016) in moderate-to-severe patients (with baseline NEWS2 ≥ 5) of the PP set [recovery rate ratio = 2.7, p = 0.02], which favored improved recovery in the NuSepin group. The overall recovery rate ratio was 3.4, which favors the NuSepin group in terms of recovery rate (p = 0.0026) when the effects of covariates (use of anti-viral drugs and baseline NEWS2 ≥ 5) were adjusted. Serious adverse events were reported in a patient who received 0.2 mg/kg NuSepin (4.5%), but this was found to be unrelated to NuSepin treatment. Conclusion Considering that NuSepin has a favorable and tolerable safety profile, clinical improvement of hospitalized moderate-to-severe patients might be achieved with 0.2 mg/kg NuSepin significantly faster than placebo.

Incidence of COVID-19 in Children and Young People Who Play Federated Football

Aim: To determine the incidence of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection in children and young people who play federated football. Methods: Prospective study, from October 2020 to January 2021, in players aged 4 to 19 years from federated football clubs in Galicia, Spain (N = 23,845). Outbreaks and cases of SARS-CoV-2 infection were recorded. The cumulative incidence was compared with the incidence registered in Galicia in the same age range. Results: The cumulative incidence was 29.8 cases per 10,000 licenses in 4 months, lower than the incidence registered in the general population for all ages and both sexes (283.7 per 10,000 inhabitants; rate ratio = 9.5). It was higher in January (40.7 per 10,000), coinciding with the population peak. More cases were registered in futsal (42.9 vs 27.5 per 10,000) and competitions with periodic screenings (127.4 vs 9.1 per 10,000). There were 2 outbreaks in 2389 teams (0.08%). Conclusion: The results support the safety of football practice in children and young people with prevention protocols.