PCOM Library / Hot Topics in Research / Archive for "Internal Medicine"

Category: Internal Medicine

Hot Topics in Research: Evidence-Based Strategies for Clinical Organizations to Address COVID-19 Vaccine Hesitancy.

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Evidence-Based Strategies for Clinical Organizations to Address COVID-19 Vaccine Hesitancy. (requires PCOM login)
Finney Rutten LJ, Zhu X, Leppin AL, Ridgeway JL, Swift MD, Griffin JM, St Sauver JL, Virk A, Jacobson RM.
Mayo Clin Proc. 2021 Mar;96(3):699-707. doi: 10.1016/j.mayocp.2020.12.024. Epub 2020 Dec 30.
Building upon efforts at the policy and community level to ensure population access to COVID-19 vaccination, a strong health care system response is critical to address vaccine hesitancy.
PMID: 33673921 Free PMC article. Review.

Abstract:

The success of vaccination programs is contingent upon irrefutable scientific safety data combined with high rates of public acceptance and population coverage. Vaccine hesitancy, characterized by lack of confidence in vaccination and/or complacency about vaccination that may lead to delay or refusal of vaccination despite the availability of services, threatens to undermine the success of coronavirus disease 2019 (COVID-19) vaccination programs. The rapid pace of vaccine development, misinformation in popular and social media, the polarized sociopolitical environment, and the inherent complexities of large-scale vaccination efforts may undermine vaccination confidence and increase complacency about COVID-19 vaccination. Although the experience of recent lethal surges of COVID-19 infections has underscored the value of COVID-19 vaccines, ensuring population uptake of COVID-19 vaccination will require application of multilevel, evidence-based strategies to influence behavior change and address vaccine hesitancy. Recent survey research evaluating public attitudes in the United States toward the COVID-19 vaccine reveals substantial vaccine hesitancy. Building upon efforts at the policy and community level to ensure population access to COVID-19 vaccination, a strong health care system response is critical to address vaccine hesitancy. Drawing on the evidence base in social, behavioral, communication, and implementation science, we review, summarize, and encourage use of interpersonal, individual-level, and organizational interventions within clinical organizations to address this critical gap and improve population adoption of COVID-19 vaccination.

Hot Topics in Research: Considering Emotion in COVID-19 Vaccine Communication: Addressing Vaccine Hesitancy and Fostering Vaccine Confidence.

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Considering Emotion in COVID-19 Vaccine Communication: Addressing Vaccine Hesitancy and Fostering Vaccine Confidence. (requires PCOM login)
Chou WS, Budenz A.
Health Commun. 2020 Dec;35(14):1718-1722. doi: 10.1080/10410236.2020.1838096. Epub 2020 Oct 30.
There are opportunities to consider the role of emotion in communication efforts. In this commentary, we highlight several ways negative as well as positive emotions may be considered and leveraged.
PMID: 33124475

Abstract:
Long-term control of the COVID-19 pandemic hinges in part on the development and uptake of a preventive vaccine. In addition to a segment of population that refuses vaccines, the novelty of the disease and concerns over safety and efficacy of the vaccine have a sizable proportion of the U.S. indicating reluctance to getting vaccinated against COVID-19. Among various efforts to address vaccine hesitancy and foster vaccine confidence, evidence-based communication strategies are critical. There are opportunities to consider the role of emotion in communication efforts. In this commentary, we highlight several ways negative as well as positive emotions may be considered and leveraged. Examples include attending to negative emotions such as fear and anxiety, raising awareness of emotional manipulations by anti-vaccine disinformation efforts, and activating positive emotions such as altruism and hope as part of vaccine education endeavors.

Hot Topics in Research: Public awareness about coronavirus vaccine, vaccine acceptance, and hesitancy.

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Public awareness about coronavirus vaccine, vaccine acceptance, and hesitancy. (requires PCOM login)
Elgendy MO, Abdelrahim MEA.
J Med Virol. 2021 Jul 13. doi: 10.1002/jmv.27199. Online ahead of print.
PMID: 34255346
Measurement of the population’s general knowledge of the coronavirus vaccine is very important to improve public acceptance and decrease vaccine hesitancy in confronting the disease.

Abstract:

Measurement of the population’s general knowledge of the coronavirus vaccine is very important to improve public acceptance and decrease vaccine hesitancy in confronting the disease. This study aimed to evaluate the knowledge, attitude, and practices of the participants towards the coronavirus vaccine. Data were collected using an online survey, in the form of a structured questionnaire, conducted during April-May 2021 in Egypt, and subjects from all over Egypt participated. The questionnaire was divided into three parts to assess the knowledge and attitude regarding coronavirus. The first part was to assess participants’ experience about coronavirus infection (eight items), the second was to assess the health beliefs about coronavirus and vaccine (16 items) and the third was to assess general knowledge, attitude, and practices of the participants towards vaccine (28 items). A total of 871 (465 females) participants participated, 81% of them were still committed to the precautionary measures for protection. Eighty-eight percent of them accepted to take the vaccine. Eighty-three percent of the participants answered that they will encourage family, friends, and colleagues to get the vaccine. Ninety-four percent knew that the coronavirus vaccine provides immunity against infection for a period of 6-12 months. 91.9% believed that the current infection with coronavirus is one of the main contraindications to vaccination. Eighty-nine percent believed that both pregnant women and chronic disease patients can get vaccinated and also that there is no specific age for a specific type of vaccination. Ninety-four percent of them knew that subjects taking immunosuppressive drugs should be prescribed Sinopharm, not AstraZeneca vaccine. The median score of this survey was 20/22 regarding knowledge about the coronavirus vaccine. Overall, the study participants had good knowledge about the coronavirus vaccine and accepted to take the vaccine, which indicates the highly commendable efforts to confront the coronavirus.
(© 2021 Wiley Periodicals LLC.)

Hot Topics in Research: Anti-Asian discrimination during COVID-19

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Cary Wu, Yue Qian & Rima Wilkes (2021) Anti-Asian discrimination and the Asian-white mental health gap during COVID-19, Ethnic and Racial Studies, 44:5, 819-835, DOI: https://doi.org/10.1080/01419870.2020.1851739

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Abstract:

In this article, we consider how, due to a spike in anti-Asian hate crimes, Asians might face a disproportionate mental health impact of the COVID-19 pandemic. Analyzing data from the University of Southern California’s Center for Economic and Social Research Understanding Coronavirus in America survey, we report several findings. First, since the onset of the pandemic, Asians (Asian Americans in particular) have experienced higher levels of mental disorders than whites. Second, Asian Americans and Asian immigrants are about twice as likely as whites to report having encountered instances of COVID-19-related acute discrimination. Third, experiences of COVID-19-related discrimination increase mental disorders for all Americans. Finally, COVID-19-related discrimination partially explains the disproportionate mental health impact of the pandemic on Asians. In conclusion, we highlight the importance of tackling hate, violence, and discrimination so as to address the disproportionate mental health impacts of COVID-19 on minority populations.

Hot Topics – Remdesivir for Compassionate Use in Severe Covid

jackiewe Covid-19, Hot Topics in Research, Pharmaceutical Sciences

Grein J, Ohmagari N, Shin D, et al. Compassionate use of remdesivir for patients with severe covid-19. N Engl J Med. 2020;382(24):2327-2336. https://doi.org/10.1056/NEJMoa2007016.

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BACKGROUND

Remdesivir, a nucleotide analogue prodrug that inhibits viral RNA polymerases, has shown in vitro activity against SARS-CoV-2.

METHODS

We provided remdesivir on a compassionate-use basis to patients hospitalized with Covid-19, the illness caused by infection with SARS-CoV-2. Patients were those with confirmed SARS-CoV-2 infection who had an oxygen saturation of 94% or less while they were breathing ambient air or who were receiving oxygen support. Patients received a 10-day course of remdesivir, consisting of 200 mg administered intravenously on day 1, followed by 100 mg daily for the remaining 9 days of treatment. This report is based on data from patients who received remdesivir during the period from January 25, 2020, through March 7, 2020, and have clinical data for at least 1 subsequent day.

RESULTS

Of the 61 patients who received at least one dose of remdesivir, data from 8 could not be analyzed (including 7 patients with no post-treatment data and 1 with a dosing error). Of the 53 patients whose data were analyzed, 22 were in the United States, 22 in Europe or Canada, and 9 in Japan. At baseline, 30 patients (57%) were receiving mechanical ventilation and 4 (8%) were receiving extracorporeal membrane oxygenation. During a median follow-up of 18 days, 36 patients (68%) had an improvement in oxygen-support class, including 17 of 30 patients (57%) receiving mechanical ventilation who were extubated. A total of 25 patients (47%) were discharged, and 7 patients (13%) died; mortality was 18% (6 of 34) among patients receiving invasive ventilation and 5% (1 of 19) among those not receiving invasive ventilation.

CONCLUSIONS

In this cohort of patients hospitalized for severe Covid-19 who were treated with compassionate-use remdesivir, clinical improvement was observed in 36 of 53 patients (68%). Measurement of efficacy will require ongoing randomized, placebo-controlled trials of remdesivir therapy.

Hot Topics: Asymptomatic Covid Carriers May Not Infect

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Gao M, Yang L, Chen X, et al. A study on infectivity of asymptomatic SARS-CoV-2 carriers. Respir Med. 2020;169:106026. https://doi.org/10.1016/j.rmed.2020.106026.

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Abstract:

Background: An ongoing outbreak of coronavirus disease 2019 (COVID-19) has spread around the world. It is debatable whether asymptomatic COVID-19 virus carriers are contagious. We report here a case of the asymptomatic patient and present clinical characteristics of 455 contacts, which aims to study the infectivity of asymptomatic carriers.

Material and methods: 455 contacts who were exposed to the asymptomatic COVID-19 virus carrier became the subjects of our research. They were divided into three groups: 35 patients, 196 family members and 224 hospital staffs. We extracted their epidemiological information, clinical records, auxiliary examination results and therapeutic schedules.

Results: The median contact time for patients was four days and that for family members was five days. Cardiovascular disease accounted for 25% among original diseases of patients. Apart from hospital staffs, both patients and family members were isolated medically. During the quarantine, seven patients plus one family member appeared new respiratory symptoms, where fever was the most common one. The blood counts in most contacts were within a normal range. All CT images showed no sign of COVID-19 infection. No severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections was detected in 455 contacts by nucleic acid test.

Conclusion: In summary, all the 455 contacts were excluded from SARS-CoV-2 infection and we conclude that the infectivity of some asymptomatic SARS-CoV-2 carriers might be weak.

Hot Topics: Ivermectin Inhibits Covid in Vitro

jackiewe Covid-19, Hot Topics in Research, Pharmaceutical Sciences

Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Research. 2020;178:104787. https://doi.org/10.1016/j.antiviral.2020.104787.

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Abstract:

Although several clinical trials are now underway to test possible therapies, the worldwide response to the COVID-19 outbreak has been largely limited to monitoring/containment. We report here that Ivermectin, an FDA-approved anti-parasitic previously shown to have broad-spectrum anti-viral activity in vitro, is an inhibitor of the causative virus (SARS-CoV-2), with a single addition to Vero-hSLAM cells 2 h post infection with SARS-CoV-2 able to effect ~5000-fold reduction in viral RNA at 48 h. Ivermectin therefore warrants further investigation for possible benefits in humans.

Hot Topics: Social Distancing + PPE Prevent Covid Transmission

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Chu DK, Akl EA, Duda S, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: A systematic review and meta-analysis. Lancet. 2020;395(10242):1973-1987. https://doi.org/S0140-6736(20)31142-9.

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Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread personto-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye
protection on virus transmission in health-care and non-health-care (eg, community) settings.

Methods We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-toperson virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects metaregressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047.

Findings Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m
(n=10736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] –10·2%, 95% CI –11·5 to –7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk
[RR] 2·02 per m; pinteraction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD –14·3%, –15·9 to –10·7; low certainty), with stronger
associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD –10·6%, 95% CI –12·5 to –7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings.

Interpretation The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual
factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance.