关键词： Policy formulation process   alcohol policy   crisis context   South Africa   HEALTH   COST   FRAMEWORK   LOCKDOWN   OUTCOMES   LESSONS   TRAUMA   SYSTEM   SARS  

摘要： This study contributes to a neglected aspect of health policy analysis: policy formulation processes. Context is central to the policy cycle, yet the influence of crises on policy formulation is underrepresented in the health policy literature in low- and middle-income countries (LMICs). This paper analyses a detailed case study of how the COVID-19 crisis influenced policy formulation processes for the regulation of alcohol in South Africa, as part of COVID-19 control measures, in 2020 and 2021. It provides a picture of the policy context, specifically considering the extent to which the crisis influenced the position and power of actors, and policy content. Qualitative data were collected from nine key informant interviews and 127 documents. Data were analysed using thematic content analysis. A policy formulation conceptual framework was applied as a lens to describe complex policy formulation processes. The study revealed that the perceived urgency of the pandemic prompted a heightened sense of awareness of alcohol-related trauma as a known, preventable threat to public health system capacity. This enabled a high degree of innovation among decision-makers in the generation of alternative alcohol policy content. Within the context of uncertainty, epistemic and experiential policy learning drove rapid, adaptive cycles of policy formulation, demonstrating the importance of historical and emerging public health evidence in crisis-driven decision-making. Within the context of centralization and limited opportunities for stakeholder participation, non-state actors mobilized to influence policy through the public arena. The paper concludes that crisis-driven policy formulation processes are shaped by abrupt redistributions of power among policy actors and the dynamic interplay of evolving economic, political and public health priorities. Understanding the complexity of the local policy context may allow actors to navigate opportunities for public health-oriented alcohol

关键词： Primary care data   Antibiotic prescribing   Antimicrobial stewardship   Respiratory tract infection  

摘要： BackgroundInappropriate or overuse of antibiotic prescribing in primary care highlights an opportunity for antimicrobial stewardship (AMS) programs aimed at reducing unnecessary use of antimicrobials through education, policies and practice audits that optimize antibiotic prescribing. Evidence from the early part of the pandemic indicates a high rate of prescribing of antibiotics for patients with COVID-19. It is crucial to surveil antibiotic prescribing by primary care providers from the start of the pandemic and into its endemic stage to understand the effects of the pandemic and better target effective AMS *** was a matched pair population-based cohort study that used electronic medical record (EMR) data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Participants included all patients that visited their primary care provider and met the inclusion criteria for COVID-19, respiratory tract infection (RTI), or non-respiratory or influenza-like-illness (negative). Four outcomes were evaluated (a) receipt of an antibiotic prescription; (b) receipt of a non-antibiotic prescription; (c) a subsequent primary care visit (for any reason); and (d) a subsequent primary care visit with a bacterial infection diagnosis. Conditional logistic regression was used to evaluate the association between COVID-19 and each of the four outcomes. Each model was adjusted for location (rural or urban), material and social deprivation, smoking status, alcohol use, obesity, pregnancy, HIV, cancer and number of chronic *** odds of a COVID-19 patient receiving an antibiotic within 30 days of their visit is much lower than for patients visiting for RTI or for a non-respiratory or influenza-like-illnesses (AOR = 0.08, 95% CI[0.07, 0.09] compared to RTI, and AOR = 0.43, 95% CI[0.38, 0.48] compared to negatives). It was found that a patient visit for COVID-19 was much less likely to have a subsequent visit for a bacterial infection at all tim

关键词： QUALITATIVE RESEARCH   PROTOCOL  

摘要： IMPORTANCE The COVID-19 pandemic created unprecedented challenges for clinical trials worldwide, threatening premature closure and trial integrity. Every phase of research operations was affected, often requiring modifications to protocol design and implementation. OBJECTIVES To identify the barriers, solutions, and opportunities associated with continuing critical care trials that were interrupted during the pandemic, and to generate suggestions for future trials. DESIGN, SETTING, AND PARTICIPANTS This mixed-methods study performed an explanatory sequential analysis involving a self-administered electronic survey and focus groups of principal investigators (PIs) and project coordinators (PCs) conducting adult and pediatric individual-patient randomized trials of the Canadian Critical Care Trials Group during the COVID-19 pandemic. Eligible trials were actively enrolling patients on March 11, 2020. Data were analyzed between September 2023 and January 2024. MAIN OUTCOMES AND MEASURES Importance ratings of barriers to trial conduct and completion, solutions employed, opportunities arising, and suggested strategies for future trials. Quantitative data examining barriers were analyzed using descriptive statistics. Data addressing solutions, opportunities, and suggestions were analyzed by qualitative content analysis. Integration involved triangulation of data sources and perspectives about 13 trials, synthesized by an interprofessional team incorporating reflexivity and member-checking. RESULTS A total of 13 trials run by 29 PIs and PCs (100% participation rate) were included. The highest-rated barriers (on a 5-point scale) to ongoing conduct during the pandemic were decisions to pause all clinical research (mean [SD] score, 4.7 [0.8]), focus on COVID-19 studies (mean [SD] score, 4.6 [0.8]), and restricted family presence in hospitals (mean [SD] score, 4.1 [0.8]). Suggestions to enable trial progress and completion included providing scientific leadership, implementing

关键词： LOSING TEAMS   PERFORMANCE   ELITE   DISCRIMINATE   HOME  

摘要： The aim of this study was to assess pre-shot combinations and game-location influence, together with the traditional game-related statistics to evaluate their impact in the performance of the teams in the Asociaci & oacute;n de Clubs de Baloncesto (ACB) Spanish basketball league. The COVID-19 season was a great opportunity to better analyse the effect of game-location among ACB-teams to evaluate the differences between winners and losers. A retrospective cross-sectional study of the 2019-2020 ACB season (137 games of the regular season and 33 games of the final stage) was carried out. Game-related statistics were gathered from InStat (https://***/). To evaluate the key performance indicators in this context, a discriminant analysis together with a binary logistic regression were run. The main results revealed that specific variables (normalized per minute played), such as points, field-goal percentage, field goals made, defensive rebounds, assists, and contested field goals made, played a crucial role in classifying winners and losers (p<0.05). Defensive rebounds (0.29 +/- 0.05 vs 0.24 +/- 0.04, p < 0.001), and assists (0.23 +/- 0.05 vs 0.19 +/- 0.04, p = 0.042), were key performance indicators for home-court winners. Defensive rebounds (0.29 +/- 0.05 vs 0.25 +/- 0.04, p < 0.001), and field-goal percentage (48.2 +/- 5.31 vs 42.7 +/- 5.95, p = 0.009) were key performance variables for away-court winners. Neutral-court winners had better isolation efficiency (49.5 +/- 31.6 vs 33.3 +/- 31.4, p < 0.05) and contested shot percentage (48.2 +/- 6.02 vs 44.8 +/- 5.34, p < 0.05) in the context of neutral-court tournaments. Uncontested shots and pick-and-roll efficiency seem not to be so important in the ACB when compared to the (National Basketball Association) NBA. Teams should look for players who assist to good shooters, as well as the presence of specialized players proficient in defensive rebounding. In the context of neutral-court tournaments, th

关键词： Connor-Davidson Resilience Scale   Post-COVID-19 Functional Status Scale   EuroQoL 5D-3L   Quality of life   COVID-19   Mechanical ventilation   Resilience   MENTAL-HEALTH   VALIDATION   SURVIVORS   EQ-5D-3L  

摘要： Background Patients with COVID-19 often experience severe long-term sequelae. This study aimed to assess resilience and Quality of Life (QoL) of patients who underwent mechanical ventilation due to COVID-19, one year after discharge. Methods This cross-sectional study enrolled patients who received mechanical ventilation for severe COVID-19 and were assessed one-year post-discharge. Participants completed a structured questionnaire via telephone comprising the Connor-Davidson Resilience Scale (CD-RISC) and the Post-COVID-19 Functional Status scale (PCFS). To establish the association between QoL and resilience, Spearman correlations were calculated between the PCFS and the CD-RISC. Linear regression models were adjusted to evaluate which factors were associated with QoL, with the total score of PCFS as the dependent variable. Results A total of 225 patients were included in the analysis. The CD-RISC had a median score of 83 (IQR 74-91). The PCFS results showed that 61.3% (n = 138) of the patients were able to resume their daily activities without limitations. Among them, 37.3% (n = 84) were classified as Grade 0 and 24% (n = 54) as Grade 1. Mild and moderate functional limitations were found in 33.7% of the patients, with 24.8% (n = 56) classified as Grade 2 and 8.8% (n = 20) as Grade 3. Severe functional limitations (Grade 4) were observed in 4.8% (n = 11) of the patients. High CD-RISC scores were associated with lower levels of PCFS score (p < 0.001). Conclusions In this cohort of critically ill patients who underwent mechanical ventilation due to COVID-19, 38% of patients experienced a significant decline in their QoL one year after hospital discharge. Finally, a high level of resilience was strongly associated with better QoL one year after discharge.

关键词： Mood disorders   Platelet activation   COVID-19   MATRIX METALLOPROTEINASES   EMMPRIN CD147   EXPRESSION   INFLAMMATION   PREVALENCE   INDUCER   BRAIN  

摘要： Pre-existing mental disorders are considered a risk factor for severe COVID-19 outcomes, possibly because of higher vascular burden. Moreover, an unconventional platelet activation characterizes COVID-19 and contributes to inflammatory and thrombotic manifestations. In the light of the inflammation theory of mental disorders, we hypothesized that patients with mental disorders could be sensitive to the SARS-CoV-2 elicited platelet activation. We investigated platelet activation in 141 COVID-19 survivors at one month after clearance of the virus, comparing subjects with or without an established pre-existing diagnosis of mental disorder according to the DSM-5. We found that platelets from patients with a positive history of psychiatric disorder underwent unconventional activation more frequently than conventional activation or no activation at all. Such preferential activation was not detected when platelets from patients without a previous psychiatric diagnosis were studied. When testing the effects of age, sex, and psychiatric history on the platelet activation, GLZM multivariate analysis confirmed the significant effect of diagnosis only. These findings suggest a preferential platelet activation during acute COVID-19 in patients with a pre-existing psychiatric disorder, mediated by mechanisms associated with thromboinflammation. This event could have contributed to the higher risk of severe outcome in the psychiatric population.