关键词： Influenza   Sickle cell disease   Vaccination   Vaccine coverage   Youth   CHILDREN   CARE  

摘要： Influenza vaccination is critical for children with sickle cell disease (SCD) due to risks of severe influenza infections. Despite declining influenza vaccination among children since the COVID-19 pandemic, less is known about influenza vaccine coverage among youth with SCD during this same period. We compared influenza vaccine uptake among youth with SCD seen by a SCD provider in clinic during the 2019-2020 and 2022-2023 influenza seasons and described infection characteristics. Overall, 85% (n = 220) of children received their influenza vaccine during 2019-2020 compared to 75% (n = 245) in 2022-2023 (p = 0.059). Participants seen during both seasons were more likely to shift from vaccinated in 2019-2020 to unvaccinated in 2022-2023 than vice versa (McNemar's OR = 3.0; p = 0.008). Among 66 documented infections, 25.8% resulted in hospitalization. We found high influenza vaccine uptake but those seen during both seasons were more likely to become unvaccinated. More research is needed to understand influenza vaccine decision-making in this population.

关键词： Non-drug measures   Prone positioning   COVID-19   Oxygen saturation   Traditional Chinese medicine  

摘要： Background The outbreak of coronavirus disease 2019 (COVID-19) infection posed a huge threat and burden to public healthcare in late 2022. Non-drug measures of traditional Chinese medicine (TCM), such as acupuncture, cupping and moxibustion, are commonly used as adjuncts in China to help in severe cases, but their effects remain unclear. Objectives To observe the clinical effect of TCM non-drug measures in improving respiratory function and symptoms among patients with severe COVID-19. Design, setting, participants and interventions This study was designed as a multicenter, assessor-blind, randomized controlled trial. Hospitalized patients with COVID-19 were randomly assigned to the treatment or control group. The treatment group received individualized TCM non-drug measures in combination with prone position ventilation, while the control group received prone position ventilation only for 5 consecutive days. Main outcome measures The primary outcome measures were the percentage of patients with improved oxygen saturation (SpO 2 ) at the end of the 5-day intervention, as well as changes of patients’ respiratory rates. The secondary outcome measures included changes in SpO 2 and total score on the self-made respiratory symptom scale. The improvement rate, defined as a 3-day consecutive increase in SpO 2 , the duration of prone positioning, and adverse events were recorded as well. Results Among the 198 patients included in the intention-to-treat analysis, 159 (80.3%) completed all assessments on day 5, and 39 (19.7%) patients withdrew from the study. At the end of the intervention, 71 (91%) patients in the treatment group had SpO 2 above 93%, while 61 (75.3%) in the control group reached this level. The proportion of participant with improved SpO 2 was significantly greater in the intervention group (mean difference [MD] = 15.7; 95% confidence interval [CI]: 4.4, 27.1; P = 0.008). Compared to the baseline, with daily treatment there were significant daily decreases i

关键词： COVID-19 pandemic   Infant vaccinations   Routine vaccination   Non-routine vaccination   Cohort study   Sociodemographic factors   Childhood immunization   Maternal education   Employment status   Socioeconomic factors   COVERAGE   CHILDREN  

摘要： Objective: This study examines the impact of the COVID-19 pandemic on both routine and non-routine vaccinations in infants during their initial 18 months of life, concurrently exploring the complex influence of sociodemographic factors. Methods: A cohort study was conducted, involving 2007 children in two distinct periods: pre-pandemic (January-June 2018) and pandemic (March 2020-May 2021). Participants were classified into two cohorts: 962 children in the 2018 group and 1045 children in the 2020-21 group. Utilizing unconditional logistic regression, the association between vaccination (complete or non-routine) and socioeconomic factors was examined, with adjustments for potential confounding variables such as age, breastfeeding, gestational age, and twins. Results: The study's analysis reveals that in the post-pandemic period, mothers were three times more likely to opt for non-routine vaccines (95% CI 2.25-4.23). However, no significant alterations were observed in routine vaccination rates. Protective factors for complete vaccination included having an employed mother, higher education, and a medium-to-high income. Conversely, a higher income was associated with a reduced likelihood of complete vaccination (OR 0.34, 95% CI 0.20-0.59). Conclusion: Contrary to initial expectations, this study concludes that the COVID-19 pandemic did not have a substantial impact on childhood complete vaccination rates. Nevertheless, a noticeable increase in the choice of non-routine vaccination was observed. Sociodemographic factors, such as maternal education, income, and employment status, emerged as key influencers, particularly in the context of deciding on non-routine vaccinations.

关键词： Kappa-carrageenan   Oversulfation   COVID-19   Antiviral activity   Spray coating  

摘要： The COVID-19 pandemic caused by SARS-CoV-2 has spurred the urgent need for effective antiviral strategies. In this work, we explored the potential of oversulfated kappa-carrageenan (OSKC) in spray-coated facemasks for SARS-CoV-2 inhibition pathway. The sulfated derivative was synthesized with sulfur trioxide pyridine complex in dimethylformamide solution. The antiviral efficacy of OSKC at different concentrations and spray-coated facemasks was evaluated using betacoronavirus Murine Hepatitis Virus strain 3, revealing a significant reduction in viral load compared to commercial kappa-carrageenan. Furthermore, the characterization techniques assessed the effect of the position of the introduced sulfate groups on the antiviral activity and on the physicochemical characteristics. OSKC is able to bind specific proteins of enveloped viruses, preventing viral attachment into target cells. Overall, this study demonstrates the feasibility and effectiveness of OSKC spray coating for breathable facemasks with antimicrobial properties, offering a promising approach to enhancing personal protective equipment against viral transmission in healthcare and community settings.

关键词： Investment Funds   COVID-19   Redemptions   Outflows   G20   G23   G29  

摘要： This paper examines net redemptions from bond funds domiciled in Ireland at the onset of the COVID-19 pandemic. We analyse various empirical specifications to determine whether factors such as fund leverage, measures of liquidity, portfolio risk and portfolio concentration, among others, explain outflows from Irish-domiciled bond funds in March 2020. The findings indicate that funds with a larger share of short-term securities and riskier bond portfolios experienced higher redemptions. Our analysis also suggests that fund size and age are significant factors affecting outflows. When examining various sub-samples, we find evidence of more reactive behaviour among investors in actively managed funds compared to passively managed funds. We also find that retail bond funds demonstrate greater sensitivity to risk and leverage, while professional funds show evidence of lower risk aversion. These results provide insights that can help inform policymakers’ view of regulatory tools for market-based finance, a key priority internationally.

关键词： Ethnic minority   COVID-19   palliative care   ethnic disparity  

摘要： Context A specialist palliative care service in an acute hospital characterized care patterns during the first wave of the COVID-19 pandemic. There were delayed referrals for minoritized ethnic groups. COVID-19 treatments (dexamethasone, anticoagulation, remdesivir) alongside service changes were introduced in the second wave. Objective To examine changes in care patterns and trends in the context of COVID-19 treatments. A secondary objective is to examine differences in ethnic disparity between the first and second wave of COVID-19. Methods Retrospective cohort study comparing patients referred to an acute hospital palliative care service with confirmed COVID-19 infection either at the peak of the first (Mar-Apr 2020, W1), or second (Dec 2020-Feb 2021, W2) wave of the pandemic. Demographic, clinical characteristics, and outcomes data were compared using statistical tests; generalized linear mixed models for modelling of elapsed time from admission to referral; and survival analysis. Results Data from 165 patients (W1 = 60, W2 =105) were included. Patients in W1 were referred earlier to palliative care than in W2, particularly in the first 10 days from admission. Receiving dexamethasone or anticoagulants, and absence of dementia, hypertension, and fever were associated with longer time to referral to palliative care. Delays in referrals of Black and Asian patients during W1 was no longer observable in W2. There was no association between socioeconomic status and care patterns and trends. The Australian-modified Karnofsky Performance Status (HR < 0.92, 95% CI: 0.88 - 0.95) and phase of illness (HR > 3, 95% CI: 2 - 5) were good predictors of survival. Conclusion Our findings have the potential to inform strategies that improve palliative care response and equity beyond COVID-19, and in future pandemics or crises.

关键词： Medical education   teaching of examination skills   COVID-19 pandemic   online teaching   otorhinolaryngology  

摘要： Background/objectives New teaching methods are warranted to meet the demand for increased flexibility in medical education while making optimal use of the limited resources of educators. The COVID-19 pandemic forced universities to resort to online-only teaching, even for training of psychomotor skills. The objectives of this study were: (I) to investigate the performance of students without previous experience in ear, nose and throat (ENT) examination after completing an asynchronous online teaching course in an objective standardized clinical examination (OSCE) and (II) to evaluate the degree of over- and underestimation of their abilities. Methods The study was designed as a prospective, single-institution medical education cohort study. Medical students (n=54; 3 rd /4 th year, no previous head and neck examination skills) completed a comprehensive online training for basic head and neck examination skills 1-14 days before undergoing an OSCE on 5 different examination items (cervical lymph node examination, oral/oropharyngeal examination, otoscopy, Weber/Rinne hearing test, anterior rhinoscopy). Expert-evaluated theoretical knowledge and practical abilities were measured using Likert scales (1 = high proficiency to 5 = low proficiency). Participants self-evaluated their own skills before and after the OSCE (5-point Likert scales). Results Students achieved an overall good to medium skill level in basic head and neck examination after online training. Increased psychomotor complexity of tasks contributed to worse performance. Expert evaluation of practical skills was better in male participants and those who rated their preparation as thorough. Low/no misjudgment (discrepancy between self- and expert-evaluation) was observed in most participants, while high discrepancy levels (strong misjudgment) were mainly attributable to the students’ underestimation of their own abilities. Conclusions Online training of head and neck examination skills is a cost- and resource-

摘要： Respiratory syncytial virus (RSV) is the most predominant viral pathogen worldwide in children with lower respiratory tract infections. The coronavirus disease 2019 (COVID-19) pandemic and resulting non-pharmaceutical interventions perturbed the transmission pattern of respiratory pathogens in South Africa. A seasonality shift and RSV resurgence was observed in 2020 and 2021, with several infected children observed. Conventional RSV-positive nasopharyngeal swabs were collected from various hospitals in the Free State province, Bloemfontein, South Africa, from children suffering from respiratory distress and severe acute respiratory infection between 2020 to 2021. Overlapping genome fragments were amplified and complete genomes were sequenced using the Illumina MiSeq platform. Maximum likelihood phylogenetic and evolutionary analysis were performed on both RSV-A/-B G-genes with published reference sequences from GISAID and GenBank. Our study strains belonged to the RSV-A GA2.3.2 and RSV-B GB5.0.5a clades. The upsurge of RSV was due to pre-existing strains that predominated in South Africa and circulating globally also driving these off-season RSV outbreaks during the COVID-19 pandemic. The variants responsible for the resurgence were phylogenetically related to pre-pandemic strains and could have contributed to the immune debt resulting from pandemic imposed restrictions. The deviation of the RSV season from the usual pattern affected by the COVID-19 pandemic highlights the need for ongoing genomic surveillance and the identification of genetic variants to prevent unforeseen outbreaks in the future.

关键词： COVID-19 vaccine   SARS-CoV-2   VoCs   antibody kinetics   memory T-cell responses  

摘要： Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) studies usually rely on cross-sectional data of large cohorts but limited repeated samples, overlooking significant inter-individual antibody kinetic differences. By combining Luminex, activation-induced marker (AIM) and IFN-γ/IL-2 Fluorospot assays, we characterized the IgM, IgA, and IgG antibody kinetics using 610 samples from 31 healthy adults over two years after COVID-19 vaccination, and the T-cell responses six months post-booster. Antibody trajectories varied among isotypes: IgG decayed slowly, IgA exhibited an initial sharp decline, which gradually slowed down and stabilized above the seropositivity threshold. Contrarily, IgM rapidly dropped to undetectable levels after primary vaccination. Importantly, three vaccine doses induced higher and more durable anti-spike IgG and IgA levels compared to two doses, whereas infection led to the highest antibody peak and slowest antibody decay rate compared to vaccination. Comparing with ancestral virus, antibody levels recognizing Omicron subvariants had a faster antibody decay. Finally, polyfunctional T cells were positively associated with subsequent IgA responses. These results revealed distinctive antibody patterns by isotype and highlight the benefits of booster doses in enhancing and sustaining antibody responses.

关键词： Indigenous tourism   resilience   crisis   collaborative research   Chile  

摘要： This article discusses the relationship between indigenous tourism, crisis situations and resilience from a theoretical and methodological standpoint. The analysis is based on a research process related to indigenous tourism that was implemented during and in the wake of the COVID-19 pandemic. The process involved theoretical discussion of the relationship between tourism, crises and resilience in indigenous peoples as well as the development of innovative methodologies for collaborative work in conditions of confinement for health reasons and openness of the territories. The work was undertaken in the understanding that indigenous tourism is considered a particular type of tourism in which indigenous individuals, families, organizations and communities exercise control and offer an opportunity for encounters. At the same time, however, it has been seen to be a political proposal put forward by indigenous peoples themselves to strengthen their culture and organization. Historically, indigenous peoples have deployed their own strategies in 'crisis' situations. Based on this research and the experience of indigenous tourism in Chile, the article discusses, analyses and links these three concepts from a theoretical standpoint before concluding with a methodological proposal.