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Martani A, Ulyte A, Menges D, Reeves E, Puhan MA, Heusser R. Emerging Health Care Leaders: Lessons From a Novel Leadership and Community-Building Program. Public Health Rev 2024; 45:1606794. [PMID: 38645794 PMCID: PMC11027198 DOI: 10.3389/phrs.2024.1606794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
Background Although there are guidelines and ideas on how to improve public health education, translating innovative approaches into actual training programs remains challenging. In this article, we provide an overview of some initiatives that tried to put this into action in different parts of the world, and present the Emerging Health Care Leader (EHCL), a novel training program developed in Switzerland. Policy Options and Recommendations Looking at the experience of the EHCL, we propose policymakers and other interested stakeholders who wish to help reform public health education to support these initiatives not only through funding, but by valuing them through the integration of early career healthcare leaders in projects where their developing expertise can be practically applied. Conclusion By openly sharing the experiences, strengths, weaknesses, and lessons learned with the EHCL program, we aim to foster a transparent debate on how novel training programs in public health can be organised.
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Affiliation(s)
- Andrea Martani
- Institute of Biomedical Ethics, University of Basel, Basel, Switzerland
| | | | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Emily Reeves
- Swiss School of Public Health (SSPH+), Zürich, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Rolf Heusser
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Jochems KFT, Menges D, Sanchez D, de Glas NA, Wildiers H, Eberli D, Puhan MA, Bastiaannet E. Outcomes in studies regarding older patients with prostate cancer: A systematic review. J Geriatr Oncol 2024:101763. [PMID: 38575500 DOI: 10.1016/j.jgo.2024.101763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Older patients are often deemed ineligible for clinical research, and many frequently-used endpoints and outcome measures are not as relevant for older patients for younger ones. This systematic review aimed to present an overview of outcomes used in clinical research regarding patients over the age of 65 years with prostate cancer. MATERIALS AND METHODS PubMed and Embase were systematically searched to identify studies on prostate cancer (treatment) in patients aged ≥65 between 2016 and 2023. Data on title, study design, number of participants and age, stage of disease, treatment, and investigated outcomes were synthesized and descriptively analyzed. RESULTS Sixty-eight studies were included. Of these most included patients over 65 years, while others used a higher age. Overall, 39 articles (57.3%) reported on survival-related outcomes, 22 (32.4%) reported on progression of disease and 38 (55.9%) used toxicity or adverse events as an outcome measure. Health-related quality of life and functional outcomes were investigated in 29.4%, and cognition in two studies. The most frequently investigated survival-related outcomes were overall and cancer-specific survival (51.3%); however, 38.5% only studied overall survival. DISCUSSION The main focus of studies included in this review remains survival and disease progression. There is limited attention for health-related quality of life and functional status, although older patients often prioritize the latter. Future research should incorporate outcome measures tailored to the aged population to improve care for older patients with prostate cancer.
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Affiliation(s)
- Kim F T Jochems
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dafne Sanchez
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Nienke A de Glas
- Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Wildiers
- Oncology, University Hospital Leuven, Leuven, Belgium
| | - Daniel Eberli
- Urology, University Hospital Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Esther Bastiaannet
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
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De Bandt D, Haile SR, Devillers L, Bourrion B, Menges D. Prescriptions of antidepressants and anxiolytics in France 2012-2022 and changes with the COVID-19 pandemic: interrupted time series analysis. BMJ Ment Health 2024; 27:e301026. [PMID: 38413052 PMCID: PMC10900346 DOI: 10.1136/bmjment-2024-301026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Depression and anxiety have increased in prevalence since the start of the COVID-19 pandemic. OBJECTIVE To evaluate the consumption of antidepressants and anxiolytics from 2012 to 2022 and the pandemic's potential impact in France. METHODS We conducted an interrupted time series analysis of routine drug sales data (Medic'AM) from all French outpatient pharmacies from 2012 to 2022. We investigated trends in defined daily doses of antidepressants and anxiolytics sold per 1000 inhabitants (DDD/TID) and related expenditures before and after pandemic onset and in relation with stringency of pandemic mitigation measures. Analyses were performed descriptively and using segmented linear regression, autoregressive and autoregressive integrated moving average models. FINDINGS From 2012 to 2019, overall monthly antidepressant sales increased (+0.02 DDD/TID) while monthly anxiolytic sales decreased (-0.07 DDD/TID). With pandemic onset, there was a relevant and persisting trend increase (+0.20 DDD/TID per month) for antidepressant sales overall, with an estimated excess of 112.6 DDD/TID sold from May 2020 until December 2022. Anxiolytic sales were elevated from February 2020 throughout the pandemic but returned to expected levels by December 2022, with an estimated excess of 33.8 DDD/TID. There was no evident association between stringency and antidepressant or anxiolytic sales. CONCLUSIONS This study showed a protracted trend increase in the consumption of antidepressants since pandemic onset, while increases in anxiolytic consumption were temporary. CLINICAL IMPLICATIONS We provide evidence that the COVID-19 pandemic may have had long-lasting consequences on the prevalence and treatment of depression and anxiety disorders, requiring further actions by researchers and policy-makers to address this potential public mental health crisis.
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Affiliation(s)
- David De Bandt
- General Practice, Versailles Saint-Quentin-en-Yvelines University Faculty of Science, Montigny le Bretonneux, France
- Center for Research in Epidemiology and Population Health, The French National Institute of Health and Medical Research, INSERM U1018 Equipe 11, Villejuif, Île-de-France, France
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Louise Devillers
- General Practice, Versailles Saint-Quentin-en-Yvelines University Faculty of Science, Montigny le Bretonneux, France
- Center for Research in Epidemiology and Population Health, The French National Institute of Health and Medical Research, INSERM U1018 Equipe 11, Villejuif, Île-de-France, France
| | - Bastien Bourrion
- General Practice, Versailles Saint-Quentin-en-Yvelines University Faculty of Science, Montigny le Bretonneux, France
- Center for Research in Epidemiology and Population Health, The French National Institute of Health and Medical Research, INSERM U1018 Equipe 11, Villejuif, Île-de-France, France
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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4
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Cervia-Hasler C, Brüningk SC, Hoch T, Fan B, Muzio G, Thompson RC, Ceglarek L, Meledin R, Westermann P, Emmenegger M, Taeschler P, Zurbuchen Y, Pons M, Menges D, Ballouz T, Cervia-Hasler S, Adamo S, Merad M, Charney AW, Puhan M, Brodin P, Nilsson J, Aguzzi A, Raeber ME, Messner CB, Beckmann ND, Borgwardt K, Boyman O. Persistent complement dysregulation with signs of thromboinflammation in active Long Covid. Science 2024; 383:eadg7942. [PMID: 38236961 DOI: 10.1126/science.adg7942] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 11/24/2023] [Indexed: 01/23/2024]
Abstract
Long Covid is a debilitating condition of unknown etiology. We performed multimodal proteomics analyses of blood serum from COVID-19 patients followed up to 12 months after confirmed severe acute respiratory syndrome coronavirus 2 infection. Analysis of >6500 proteins in 268 longitudinal samples revealed dysregulated activation of the complement system, an innate immune protection and homeostasis mechanism, in individuals experiencing Long Covid. Thus, active Long Covid was characterized by terminal complement system dysregulation and ongoing activation of the alternative and classical complement pathways, the latter associated with increased antibody titers against several herpesviruses possibly stimulating this pathway. Moreover, markers of hemolysis, tissue injury, platelet activation, and monocyte-platelet aggregates were increased in Long Covid. Machine learning confirmed complement and thromboinflammatory proteins as top biomarkers, warranting diagnostic and therapeutic interrogation of these systems.
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Affiliation(s)
- Carlo Cervia-Hasler
- Department of Immunology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Sarah C Brüningk
- Department of Biosystems Science and Engineering, ETH Zurich, 4058 Basel, Switzerland
- Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Tobias Hoch
- Department of Immunology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Bowen Fan
- Department of Biosystems Science and Engineering, ETH Zurich, 4058 Basel, Switzerland
- Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Giulia Muzio
- Department of Biosystems Science and Engineering, ETH Zurich, 4058 Basel, Switzerland
- Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Ryan C Thompson
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Laura Ceglarek
- Department of Immunology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Roman Meledin
- Department of Immunology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Patrick Westermann
- Precision Proteomics Center, Swiss Institute of Allergy and Asthma Research, University of Zurich, 7265 Davos, Switzerland
| | - Marc Emmenegger
- Institute of Neuropathology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Patrick Taeschler
- Department of Immunology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Yves Zurbuchen
- Department of Immunology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Michele Pons
- Department of Immunology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
| | - Sara Cervia-Hasler
- Department of Immunology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Sarah Adamo
- Department of Immunology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Miriam Merad
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alexander W Charney
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
| | - Petter Brodin
- Unit for Clinical Pediatrics, Department of Women's and Children's Health, Karolinska Institute, 17165 Solna, Sweden
- Department of Immunology and Inflammation, Imperial College London, London W12 0NN, UK
| | - Jakob Nilsson
- Department of Immunology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Adriano Aguzzi
- Institute of Neuropathology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Miro E Raeber
- Department of Immunology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Christoph B Messner
- Precision Proteomics Center, Swiss Institute of Allergy and Asthma Research, University of Zurich, 7265 Davos, Switzerland
| | - Noam D Beckmann
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Division of Data Driven and Digital Medicine (D3M), Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Karsten Borgwardt
- Department of Biosystems Science and Engineering, ETH Zurich, 4058 Basel, Switzerland
- Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Onur Boyman
- Department of Immunology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
- Faculty of Medicine and Faculty of Science, University of Zurich, 8006 Zurich, Switzerland
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5
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Raineri A, Radtke T, Rueegg S, Haile SR, Menges D, Ballouz T, Ulyte A, Fehr J, Cornejo DL, Pantaleo G, Pellaton C, Fenwick C, Puhan MA, Kriemler S. Persistent humoral immune response in youth throughout the COVID-19 pandemic: prospective school-based cohort study. Nat Commun 2023; 14:7764. [PMID: 38012137 PMCID: PMC10682435 DOI: 10.1038/s41467-023-43330-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
Understanding the development of humoral immune responses of children and adolescents to SARS-CoV-2 is essential for designing effective public health measures. Here we examine the changes of humoral immune response in school-aged children and adolescents during the COVID-19 pandemic (June 2020 to July 2022), with a specific interest in the Omicron variant (beginning of 2022). In our study "Ciao Corona", we assess in each of the five testing rounds between 1874 and 2500 children and adolescents from 55 schools in the canton of Zurich with a particular focus on a longitudinal cohort (n=751). By July 2022, 96.9% (95% credible interval 95.3-98.1%) of children and adolescents have SARS-CoV-2 anti-spike IgG (S-IgG) antibodies. Those with hybrid immunity or vaccination have higher S-IgG titres and stronger neutralising responses against Wildtype, Delta and Omicron BA.1 variants compared to those infected but unvaccinated. S-IgG persist over 18 months in 93% of children and adolescents. During the study period one adolescent was hospitalised for less than 24 hours possibly related to an acute SARS-CoV-2 infection. These findings show that the Omicron wave and the rollout of vaccines boosted S-IgG titres and neutralising capacity. Trial registration number: NCT04448717. https://clinicaltrials.gov/ct2/show/NCT04448717 .
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Affiliation(s)
- Alessia Raineri
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001 Zürich, Zurich, Switzerland
| | - Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001 Zürich, Zurich, Switzerland
| | - Sonja Rueegg
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001 Zürich, Zurich, Switzerland
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001 Zürich, Zurich, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001 Zürich, Zurich, Switzerland
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001 Zürich, Zurich, Switzerland
| | - Agne Ulyte
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001 Zürich, Zurich, Switzerland
| | - Jan Fehr
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001 Zürich, Zurich, Switzerland
| | - Daniel L Cornejo
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001 Zürich, Zurich, Switzerland
| | - Giuseppe Pantaleo
- Service of Immunology and Allergy, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Céline Pellaton
- Service of Immunology and Allergy, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Craig Fenwick
- Service of Immunology and Allergy, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001 Zürich, Zurich, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001 Zürich, Zurich, Switzerland.
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6
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Kerksieck P, Ballouz T, Haile SR, Schumacher C, Lacy J, Domenghino A, Fehr JS, Bauer GF, Dressel H, Puhan MA, Menges D. Post COVID-19 condition, work ability and occupational changes in a population-based cohort. Lancet Reg Health Eur 2023:100671. [PMID: 37366496 PMCID: PMC10287546 DOI: 10.1016/j.lanepe.2023.100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
Background Evidence on the impact of post COVID-19 condition (PCC) on work ability is limited but critical due to its high prevalence among working-age individuals. This study aimed to evaluate the association between PCC, work ability, and occupational changes in a population-based cohort. Methods We used data from working-age adults included in a prospective, longitudinal cohort of a random sample of all individuals infected with SARS-CoV-2 between August 2020 and January 2021 in the Canton of Zurich, Switzerland. We evaluated current work ability, work ability related to physical and mental demands, and estimated future work ability in 2 years (assessed using Work Ability Index), and PCC-related occupational changes one year after infection. Findings Of 672 individuals included in this study, 120 (17.9%) were categorised as having PCC (defined as presence of self-reported COVID-19 related symptoms) at 12 months. There was very strong evidence that current work ability scores were mean 0.62 (95% CI 0.30-0.95) points lower among those with PCC compared to those without in adjusted regression analyses. Similarly, there was very strong evidence for lower odds of reporting higher work ability with respect to physical (adjusted odds ratio (aOR) 0.30, 95% CI 0.20-0.46) and mental (aOR 0.40, 0.27-0.62) demands in individuals with PCC. Higher age and history of psychiatric diagnosis were associated with more substantial reductions in current work ability. 5.8% of those with PCC reported direct effects of PCC on their occupational situation, with 1.6% of those with PCC completely dropping out of the workforce. Interpretation These findings highlight the need for providing support and interdisciplinary interventions to individuals affected by PCC to help them maintain or regain their work ability and productivity. Funding Federal Office of Public Health, Department of Health of the Canton of Zurich, University of Zurich Foundation, Switzerland; Horizon Europe.
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Affiliation(s)
- Philipp Kerksieck
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Hirschengraben 84, Zurich 8001, Switzerland
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Hirschengraben 84, Zurich 8001, Switzerland
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Hirschengraben 84, Zurich 8001, Switzerland
| | - Celine Schumacher
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Hirschengraben 84, Zurich 8001, Switzerland
| | - Joanne Lacy
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Hirschengraben 84, Zurich 8001, Switzerland
| | - Anja Domenghino
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Hirschengraben 84, Zurich 8001, Switzerland
- Department of Visceral and Transplantation Surgery, University Hospital Zurich (USZ), Rämistrasse 100, Zurich 8091, Switzerland
| | - Jan S Fehr
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Hirschengraben 84, Zurich 8001, Switzerland
| | - Georg F Bauer
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Hirschengraben 84, Zurich 8001, Switzerland
| | - Holger Dressel
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Hirschengraben 84, Zurich 8001, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Hirschengraben 84, Zurich 8001, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Hirschengraben 84, Zurich 8001, Switzerland
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7
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Ballouz T, Menges D, Anagnostopoulos A, Domenghino A, Aschmann HE, Frei A, Fehr JS, Puhan MA. Recovery and symptom trajectories up to two years after SARS-CoV-2 infection: population based, longitudinal cohort study. BMJ 2023; 381:e074425. [PMID: 37257891 DOI: 10.1136/bmj-2022-074425] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate longer term symptoms and health outcomes associated with post-covid-19 condition within a cohort of individuals with a SARS-CoV-2 infection. DESIGN Population based, longitudinal cohort. SETTING General population of canton of Zurich, Switzerland. PARTICIPANTS 1106 adults with a confirmed SARS-CoV-2 infection who were not vaccinated before infection and 628 adults who did not have an infection. MAIN OUTCOME MEASURES Trajectories of self-reported health status and covid-19 related symptoms between months six, 12, 18, and 24 after infection and excess risk of symptoms at six months after infection compared with individuals who had no infection. RESULTS 22.9% (95% confidence interval 20.4% to 25.6%) of individuals infected with SARS-CoV-2 did not fully recover by six months. The proportion of individuals who had an infection who reported not having recovered decreased to 18.5% (16.2% to 21.1%) at 12 months and 17.2% (14.0% to 20.8%) at 24 months after infection. When assessing changes in self-reported health status, most participants had continued recovery (68.4% (63.8% to 72.6%)) or had an overall improvement (13.5% (10.6% to 17.2%)) over time. Yet, 5.2% (3.5% to 7.7%) had a worsening in health status and 4.4% (2.9% to 6.7%) had alternating periods of recovery and health impairment. The point prevalence and severity of covid-19 related symptoms also decreased over time, with 18.1% (14.8% to 21.9%) reporting symptoms at 24 months. 8.9% (6.5% to 11.2%) of participants reported symptoms at all four follow-up time points, while in 12.5% (9.8% to 15.9%) symptoms were alternatingly absent and present. Symptom prevalence was higher among individuals who were infected compared with those who were not at six months (adjusted risk difference 17.0% (11.5% to 22.4%)). Excess risk (adjusted risk difference) for individual symptoms among those infected ranged from 2% to 10%, with the highest excess risks observed for altered taste or smell (9.8% (7.7% to 11.8%)), post-exertional malaise (9.4% (6.1% to 12.7%)), fatigue (5.4% (1.2% to 9.5%)), dyspnoea (7.8% (5.2% to 10.4%)), and reduced concentration (8.3% (6.0% to 10.7%)) and memory (5.7% (3.5% to 7.9%)). CONCLUSIONS Up to 18% of individuals who were not vaccinated before infection had post-covid-19 condition up to two years after infection, with evidence of excess symptom risk compared with controls. Effective interventions are needed to reduce the burden of post-covid-19 condition. Use of multiple outcome measures and consideration of the expected rates of recovery and heterogeneity in symptom trajectories are important in the design and interpretation of clinical trials. REGISTRATIONS ISRCTN18181860, .
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Affiliation(s)
- Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Alexia Anagnostopoulos
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Anja Domenghino
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Hélène E Aschmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jan S Fehr
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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8
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Sabatini S, Kaufmann M, Fadda M, Tancredi S, Noor N, Van Der Linden BWA, Cullati S, Frank I, Michel G, Harju E, Luedi C, Frei A, Ballouz T, Menges D, Fehr J, Kohler P, Kahlert CR, Scheu V, Ortega N, Chocano-Bedoya P, Rodondi N, Stringhini S, Baysson H, Lorthe E, Zufferey MC, Suggs LS, Albanese E, Vincentini J, Bochud M, D’Acremont V, Nusslé SG, Imboden M, Keidel D, Witzig M, Probst-Hensch N, von Wyl V. Factors Associated With COVID-19 Non-Vaccination in Switzerland: A Nationwide Study. Int J Public Health 2023; 68:1605852. [PMID: 37284510 PMCID: PMC10239801 DOI: 10.3389/ijph.2023.1605852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023] Open
Abstract
Objectives: We compared socio-demographic characteristics, health-related variables, vaccination-related beliefs and attitudes, vaccination acceptance, and personality traits of individuals who vaccinated against COVID-19 and who did not vaccinate by December 2021. Methods: This cross-sectional study used data of 10,642 adult participants from the Corona Immunitas eCohort, an age-stratified random sample of the population of several cantons in Switzerland. We used multivariable logistic regression models to explore associations of vaccination status with socio-demographic, health, and behavioral factors. Results: Non-vaccinated individuals represented 12.4% of the sample. Compared to vaccinated individuals, non-vaccinated individuals were more likely to be younger, healthier, employed, have lower income, not worried about their health, have previously tested positive for SARS-CoV-2 infection, express lower vaccination acceptance, and/or report higher conscientiousness. Among non-vaccinated individuals, 19.9% and 21.3% had low confidence in the safety and effectiveness of SARS-CoV-2 vaccine, respectively. However, 29.1% and 26.7% of individuals with concerns about vaccine effectiveness and side effects at baseline, respectively vaccinated during the study period. Conclusion: In addition to known socio-demographic and health-related factors, non-vaccination was associated with concerns regarding vaccine safety and effectiveness.
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Affiliation(s)
- Serena Sabatini
- Instutite of Public Health, Università della Svizzera Italiana, Lugano, Switzerland
| | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marta Fadda
- Instutite of Public Health, Università della Svizzera Italiana, Lugano, Switzerland
| | - Stefano Tancredi
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Nazihah Noor
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | | | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Irene Frank
- Clinical Trial Unit, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Gisela Michel
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Erika Harju
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- ZHAW Zurich University of Applied Sciences, School of Health Sciences, Winterthur, Switzerland
| | - Chantal Luedi
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jan Fehr
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Philipp Kohler
- Cantonal Hospital St. Gallen, Division of Infectious Diseases and Hospital Epidemiology, St. Gallen, Switzerland
| | - Christian R. Kahlert
- Cantonal Hospital St. Gallen, Division of Infectious Diseases and Hospital Epidemiology, St. Gallen, Switzerland
- Children’s Hospital of Eastern Switzerland, Division of Infectious Diseases and Hospital Epidemiology, St. Gallen, Switzerland
| | - Victor Scheu
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Natalia Ortega
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Patricia Chocano-Bedoya
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Hélène Baysson
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Elsa Lorthe
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Maria Caiata Zufferey
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - L. Suzanne Suggs
- Instutite of Public Health, Università della Svizzera Italiana, Lugano, Switzerland
- Institute of Communication and Public Policy, Università della Svizzera Italiana, Lugano, Switzerland
| | - Emiliano Albanese
- Instutite of Public Health, Università della Svizzera Italiana, Lugano, Switzerland
| | - Julia Vincentini
- University Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Murielle Bochud
- University Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valérie D’Acremont
- University Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Samira Gonseth Nusslé
- University Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Medea Imboden
- Swiss Tropical and Public Health (TPH) Institute, Allschwil, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Dirk Keidel
- Swiss Tropical and Public Health (TPH) Institute, Allschwil, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Melissa Witzig
- Swiss Tropical and Public Health (TPH) Institute, Allschwil, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health (TPH) Institute, Allschwil, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
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9
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Zens KD, Llanas-Cornejo D, Menges D, Fehr JS, Münz C, Puhan MA, Frei A. Longitudinal Humoral and Cell-Mediated Immune Responses in a Population-Based Cohort in Zurich, Switzerland from March to June 2022 - Evidence for Protection against Omicron SARS-CoV-2 Infection by Neutralizing Antibodies and Spike-specific T cells. Int J Infect Dis 2023; 133:18-26. [PMID: 37149211 PMCID: PMC10159929 DOI: 10.1016/j.ijid.2023.04.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND The correlate(s) of protection against SARS-CoV-2 remain incompletely defined. Additional information regarding the combinations of antibody and T cell-mediated immunity which can protect against (re)infection are needed. METHODS We conducted a population-based, longitudinal cohort study including 1044 individuals of varying SARS-CoV-2 vaccination and infection statuses. We assessed Spike (S)- and Nucleocapsid (N)-IgG and wildtype, delta, and omicron neutralizing antibody (N-Ab) activity. In a subset of 328 individuals, we evaluated S, Membrane (M) and N-specific T cells. 3 months later, we reassessed antibody (n=964) and T cell (n=141) responses and evaluated factors associated with protection from (re)infection. RESULTS At study start, >98% of participants were S-IgG seropositive. N-IgG and M/N-T cell responses increased over time, indicating viral (re)exposure, despite existing S-IgG. Compared to N-IgG, M/N-T cells were a more sensitive measure of viral exposure. High N-IgG titers, omicron-N-Ab activity, and S-specific-T cell responses were all associated with reduced likelihood of (re)infection over time. CONCLUSIONS Population-level SARS-CoV-2 immunity is S-IgG-dominated, but heterogenous. M/N T cell responses can distinguish previous infection from vaccination, and monitoring a combination of N-IgG, omicron-N-Ab and S-T cell responses may help estimate protection against SARS-CoV-2 (re)infection.
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Affiliation(s)
- K D Zens
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland.; Institute for Experimental Immunology, University of Zurich (UZH), Zurich, Switzerland
| | - D Llanas-Cornejo
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - D Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - J S Fehr
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - C Münz
- Institute for Experimental Immunology, University of Zurich (UZH), Zurich, Switzerland
| | - M A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - A Frei
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland..
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10
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Menges D, Piatti MC, Omlin A, Cathomas R, Benamran D, Fischer S, Iselin C, Küng M, Lorch A, Prause L, Rothermundt C, O'Meara Stern A, Zihler D, Lippuner M, Braun J, Cerny T, Puhan MA. Patient and General Population Preferences Regarding the Benefits and Harms of Treatment for Metastatic Prostate Cancer: A Discrete Choice Experiment. EUR UROL SUPPL 2023; 51:26-38. [PMID: 37187724 PMCID: PMC10175729 DOI: 10.1016/j.euros.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 05/17/2023] Open
Abstract
Background Patient preferences for treatment outcomes are important to guide decision-making in clinical practice, but little is known about the preferences of patients with metastatic hormone-sensitive prostate cancer (mHSPC). Objective To evaluate patient preferences regarding the attributed benefits and harms of systemic treatments for mHSPC and preference heterogeneity between individuals and specific subgroups. Design setting and participants We conducted an online discrete choice experiment (DCE) preference survey among 77 patients with metastatic prostate cancer (mPC) and 311 men from the general population in Switzerland between November 2021 and August 2022. Outcome measurements and statistical analysis We evaluated preferences and preference heterogeneity related to survival benefits and treatment-related adverse effects using mixed multinomial logit models and estimated the maximum survival time participants were willing to trade to avert specific adverse effects. We further assessed characteristics associated with different preference patterns via subgroup and latent class analyses. Results and limitations Patients with mPC showed an overall stronger preference for survival benefits in comparison to men from the general population (p = 0.004), with substantial preference heterogeneity between individuals within the two samples (both p < 0.001). There was no evidence of differences in preferences for men aged 45-65 yr versus ≥65 yr, patients with mPC in different disease stages or with different adverse effect experiences, or general population participants with and without experiences with cancer. Latent class analyses suggested the presence of two groups strongly preferring either survival or the absence of adverse effects, with no specific characteristic clearly associated with belonging to either group. Potential biases due to participant selection, cognitive burden, and hypothetical choice scenarios may limit the study results. Conclusions Given the relevant heterogeneity in participant preferences regarding the benefits and harms of treatment for mHSPC, patient preferences should be explicitly discussed during decision-making in clinical practice and reflected in clinical practice guidelines and regulatory assessment regarding treatment for mHSPC. Patient summary We examined the preferences (values and perceptions) of patients and men from the general population regarding the benefits and harms of treatment for metastatic prostate cancer. There were large differences between men in how they balanced the expected survival benefits and potential adverse effects. While some men strongly valued survival, others more strongly valued the absence of adverse effects. Therefore, it is important to discuss patient preferences in clinical practice.
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Affiliation(s)
- Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Corresponding author. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland. Tel. +41 44 6344615.
| | - Michela C. Piatti
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Aurelius Omlin
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Onkozentrum Zürich, Zurich, Switzerland
| | - Richard Cathomas
- Division of Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - Daniel Benamran
- Department of Urology, Hôpitaux Universitaires Genève, Geneva, Switzerland
| | - Stefanie Fischer
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christophe Iselin
- Department of Urology, Hôpitaux Universitaires Genève, Geneva, Switzerland
| | - Marc Küng
- Department of Oncology, Hôpital Cantonal Fribourg, Fribourg, Switzerland
| | - Anja Lorch
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Lukas Prause
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland
| | - Christian Rothermundt
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Alix O'Meara Stern
- Department of Oncology, Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland
| | - Deborah Zihler
- Department of Oncology, Hematology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Max Lippuner
- Europa Uomo Switzerland, Ehrendingen, Switzerland
| | - Julia Braun
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Thomas Cerny
- Foundation Board, Cancer Research Switzerland, Bern, Switzerland
- Human Medicines Expert Committee, Swissmedic, Bern, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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11
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Bürzle O, Menges D, Maier JD, Schams D, Puhan MA, Fehr J, Ballouz T, Frei A. Adverse effects, perceptions and attitudes related to BNT162b2, mRNA-1273 or JNJ-78436735 SARS-CoV-2 vaccines: Population-based cohort. NPJ Vaccines 2023; 8:61. [PMID: 37095137 PMCID: PMC10123463 DOI: 10.1038/s41541-023-00657-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/29/2023] [Indexed: 04/26/2023] Open
Abstract
Long-term control of SARS-CoV-2 requires effective vaccination strategies. This has been challenged by public mistrust and the spread of misinformation regarding vaccine safety. Better understanding and communication of the longer-term and comparative experiences of individuals in the general population following vaccination are required. In this population-based longitudinal study, we included 575 adults, randomly selected from all individuals presenting to a Swiss reference vaccination center, for receipt of BNT162b2, mRNA1273, or JNJ-78436735. We assessed the prevalence, onset, duration, and severity of self-reported adverse effects over 12 weeks following vaccination. We additionally evaluated participants' perceptions of vaccines, trust in public health authorities and pharmaceutical companies, and compliance with public health measures. Most participants reported at least one adverse effect within 12 weeks following vaccination. Adverse effects were mostly mild or moderate, resolved within three days, and rarely resulted in anaphylaxis or hospitalizations. Female sex, younger age, higher education, and receipt of mRNA-1273 were associated with reporting adverse effects. Compared to JNJ-78436735 recipients, a higher proportion of mRNA vaccine recipients agreed that vaccination is important, and trusted public health authorities. Our findings provide real-world estimates of the prevalence of adverse effects following SARS-CoV-2 vaccination and highlight the importance of transparent communication to ensure the success of current or future vaccination campaigns.
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Affiliation(s)
- Oliver Bürzle
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Julian D Maier
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Daniel Schams
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Jan Fehr
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland.
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland.
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12
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Ballouz T, Menges D, Kaufmann M, Amati R, Frei A, von Wyl V, Fehr JS, Albanese E, Puhan MA. Post COVID-19 condition after Wildtype, Delta, and Omicron SARS-CoV-2 infection and prior vaccination: Pooled analysis of two population-based cohorts. PLoS One 2023; 18:e0281429. [PMID: 36812215 PMCID: PMC9946205 DOI: 10.1371/journal.pone.0281429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Post COVID-19 condition (PCC) is an important complication of SARS-CoV-2 infection, affecting millions worldwide. This study aimed to evaluate the prevalence and severity of post COVID-19 condition (PCC) with novel SARS-CoV-2 variants and after prior vaccination. METHODS We used pooled data from 1350 SARS-CoV-2-infected individuals from two representative population-based cohorts in Switzerland, diagnosed between Aug 5, 2020, and Feb 25, 2022. We descriptively analysed the prevalence and severity of PCC, defined as the presence and frequency of PCC-related symptoms six months after infection, among vaccinated and non-vaccinated individuals infected with Wildtype, Delta, and Omicron SARS-CoV-2. We used multivariable logistic regression models to assess the association and estimate the risk reduction of PCC after infection with newer variants and prior vaccination. We further assessed associations with the severity of PCC using multinomial logistic regression. To identify groups of individuals with similar symptom patterns and evaluate differences in the presentation of PCC across variants, we performed exploratory hierarchical cluster analyses. RESULTS We found strong evidence that vaccinated individuals infected with Omicron had reduced odds of developing PCC compared to non-vaccinated Wildtype-infected individuals (odds ratio 0.42, 95% confidence interval 0.24-0.68). The odds among non-vaccinated individuals were similar after infection with Delta or Omicron compared to Wildtype SARS-CoV-2. We found no differences in PCC prevalence with respect to the number of received vaccine doses or timing of last vaccination. The prevalence of PCC-related symptoms among vaccinated, Omicron-infected individuals was lower across severity levels. In cluster analyses, we identified four clusters of diverse systemic, neurocognitive, cardiorespiratory, and musculoskeletal symptoms, with similar patterns across variants. CONCLUSION The risk of PCC appears to be lowered with infection by the Omicron variant and after prior vaccination. This evidence is crucial to guide future public health measures and vaccination strategies.
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Affiliation(s)
- Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Rebecca Amati
- Faculty of Biomedical Sciences, Institute of Public Health (IPH), Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Jan S. Fehr
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Emiliano Albanese
- Faculty of Biomedical Sciences, Institute of Public Health (IPH), Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
- * E-mail:
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13
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Emmenegger M, De Cecco E, Lamparter D, Jacquat RP, Riou J, Menges D, Ballouz T, Ebner D, Schneider MM, Morales IC, Doğançay B, Guo J, Wiedmer A, Domange J, Imeri M, Moos R, Zografou C, Batkitar L, Madrigal L, Schneider D, Trevisan C, Gonzalez-Guerra A, Carrella A, Dubach IL, Xu CK, Meisl G, Kosmoliaptsis V, Malinauskas T, Burgess-Brown N, Owens R, Hatch S, Mongkolsapaya J, Screaton GR, Schubert K, Huck JD, Liu F, Pojer F, Lau K, Hacker D, Probst-Müller E, Cervia C, Nilsson J, Boyman O, Saleh L, Spanaus K, von Eckardstein A, Schaer DJ, Ban N, Tsai CJ, Marino J, Schertler GF, Ebert N, Thiel V, Gottschalk J, Frey BM, Reimann RR, Hornemann S, Ring AM, Knowles TP, Puhan MA, Althaus CL, Xenarios I, Stuart DI, Aguzzi A. Continuous population-level monitoring of SARS-CoV-2 seroprevalence in a large European metropolitan region. iScience 2023; 26:105928. [PMID: 36619367 PMCID: PMC9811913 DOI: 10.1016/j.isci.2023.105928] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/18/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Effective public health measures against SARS-CoV-2 require granular knowledge of population-level immune responses. We developed a Tripartite Automated Blood Immunoassay (TRABI) to assess the IgG response against three SARS-CoV-2 proteins. We used TRABI for continuous seromonitoring of hospital patients and blood donors (n = 72'250) in the canton of Zurich from December 2019 to December 2020 (pre-vaccine period). We found that antibodies waned with a half-life of 75 days, whereas the cumulative incidence rose from 2.3% in June 2020 to 12.2% in mid-December 2020. A follow-up health survey indicated that about 10% of patients infected with wildtype SARS-CoV-2 sustained some symptoms at least twelve months post COVID-19. Crucially, we found no evidence of a difference in long-term complications between those whose infection was symptomatic and those with asymptomatic acute infection. The cohort of asymptomatic SARS-CoV-2-infected subjects represents a resource for the study of chronic and possibly unexpected sequelae.
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Affiliation(s)
- Marc Emmenegger
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - Elena De Cecco
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - David Lamparter
- Health2030 Genome Center, 9 Chemin des Mines, 1202 Geneva, Switzerland
| | - Raphaël P.B. Jacquat
- Centre for Misfolding Diseases, Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge CB2 1EW, UK
- Cavendish Laboratory, Department of Physics, University of Cambridge, JJ Thomson Avenue, Cambridge CB3 0HE, UK
| | - Julien Riou
- Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Daniel Ebner
- Target Discovery Institute, University of Oxford, Oxford OX3 7FZ, England
| | - Matthias M. Schneider
- Centre for Misfolding Diseases, Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge CB2 1EW, UK
| | | | - Berre Doğançay
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - Jingjing Guo
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - Anne Wiedmer
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - Julie Domange
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - Marigona Imeri
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - Rita Moos
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - Chryssa Zografou
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - Leyla Batkitar
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - Lidia Madrigal
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - Dezirae Schneider
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - Chiara Trevisan
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | | | | | - Irina L. Dubach
- Division of Internal Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Catherine K. Xu
- Centre for Misfolding Diseases, Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge CB2 1EW, UK
| | - Georg Meisl
- Centre for Misfolding Diseases, Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge CB2 1EW, UK
| | - Vasilis Kosmoliaptsis
- Department of Surgery, Addenbrooke’s Hospital, University of Cambridge, Hills Road, Cambridge CB2 0QQ, UK
- NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Hills Road, Cambridge CB2 0QQ, UK
| | - Tomas Malinauskas
- Division of Structural Biology, The Wellcome Centre for Human Genetics, University of Oxford, Headington, Oxford OX3 7BN, UK
| | | | - Ray Owens
- Division of Structural Biology, The Wellcome Centre for Human Genetics, University of Oxford, Headington, Oxford OX3 7BN, UK
- The Rosalind Franklin Institute, Harwell Campus, Oxford OX11 0FA, UK
| | - Stephanie Hatch
- Target Discovery Institute, University of Oxford, Oxford OX3 7FZ, England
| | - Juthathip Mongkolsapaya
- Nuffield Department of Medicine, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Gavin R. Screaton
- Nuffield Department of Medicine, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Katharina Schubert
- Department of Biology, Institute of Molecular Biology and Biophysics, ETH Zurich, Zurich, Switzerland
| | - John D. Huck
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Feimei Liu
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Florence Pojer
- Protein Production and Structure Core Facility, EPFL SV PTECH PTPSP, 1015 Lausanne, Switzerland
| | - Kelvin Lau
- Protein Production and Structure Core Facility, EPFL SV PTECH PTPSP, 1015 Lausanne, Switzerland
| | - David Hacker
- Protein Production and Structure Core Facility, EPFL SV PTECH PTPSP, 1015 Lausanne, Switzerland
| | | | - Carlo Cervia
- Department of Immunology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Jakob Nilsson
- Department of Immunology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Onur Boyman
- Department of Immunology, University Hospital Zurich, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
| | - Lanja Saleh
- Institute of Clinical Chemistry, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Katharina Spanaus
- Institute of Clinical Chemistry, University Hospital Zurich, 8091 Zurich, Switzerland
| | | | - Dominik J. Schaer
- Division of Internal Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Nenad Ban
- Department of Biology, Institute of Molecular Biology and Biophysics, ETH Zurich, Zurich, Switzerland
| | - Ching-Ju Tsai
- Department of Biology and Chemistry, Laboratory of Biomolecular Research, Paul Scherrer Institute, 5303 Villigen-PSI, Switzerland
| | - Jacopo Marino
- Department of Biology and Chemistry, Laboratory of Biomolecular Research, Paul Scherrer Institute, 5303 Villigen-PSI, Switzerland
| | - Gebhard F.X. Schertler
- Department of Biology and Chemistry, Laboratory of Biomolecular Research, Paul Scherrer Institute, 5303 Villigen-PSI, Switzerland
- Department of Biology, ETH Zürich, 8093 Zürich, Switzerland
| | - Nadine Ebert
- Institute of Virology and Immunology, 3012 Bern, Switzerland
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, 3012 Bern, Switzerland
| | - Volker Thiel
- Institute of Virology and Immunology, 3012 Bern, Switzerland
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, 3012 Bern, Switzerland
| | - Jochen Gottschalk
- Regional Blood Transfusion Service Zurich, Swiss Red Cross, 8952 Schlieren, Switzerland
| | - Beat M. Frey
- Regional Blood Transfusion Service Zurich, Swiss Red Cross, 8952 Schlieren, Switzerland
| | - Regina R. Reimann
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - Simone Hornemann
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - Aaron M. Ring
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Tuomas P.J. Knowles
- Centre for Misfolding Diseases, Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge CB2 1EW, UK
- Cavendish Laboratory, Department of Physics, University of Cambridge, JJ Thomson Avenue, Cambridge CB3 0HE, UK
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Christian L. Althaus
- Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
| | - Ioannis Xenarios
- Health2030 Genome Center, 9 Chemin des Mines, 1202 Geneva, Switzerland
- Agora Center, University of Lausanne, 25 Avenue du Bugnon, 1005 Lausanne, Switzerland
| | - David I. Stuart
- Division of Structural Biology, The Wellcome Centre for Human Genetics, University of Oxford, Headington, Oxford OX3 7BN, UK
| | - Adriano Aguzzi
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
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Menges D, Yebyo HG, Sivec-Muniz S, Haile SR, Barbier MC, Tomonaga Y, Schwenkglenks M, Puhan MA. Treatments for Metastatic Hormone-sensitive Prostate Cancer: Systematic Review, Network Meta-analysis, and Benefit-harm assessment. Eur Urol Oncol 2022; 5:605-616. [PMID: 35599144 DOI: 10.1016/j.euo.2022.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/22/2022] [Accepted: 04/21/2022] [Indexed: 01/26/2023]
Abstract
CONTEXT Multiple treatments for metastatic, hormone-sensitive prostate cancer (mHSPC) are available, but their effects on health-related quality of life (HRQoL) and benefit-harm balance remain unclear. OBJECTIVE To assess clinical effectiveness regarding survival and HRQoL, safety, and benefit-harm balance of mHSPC treatments. EVIDENCE ACQUISITION We searched MEDLINE, EMBASE, CENTRAL, and ClinicalTrials.gov until March 1, 2022. Randomized controlled trials (RCTs) comparing docetaxel, abiraterone, enzalutamide, apalutamide, darolutamide, and radiotherapy combined with androgen deprivation therapy (ADT) mutually or with ADT alone were eligible. Three reviewers independently performed screening, data extraction, and risk of bias assessment in duplicate. EVIDENCE SYNTHESIS Across ten RCTs, we found relevant survival benefits for ADT + docetaxel (high certainty according to the Grading of Recommendations, Assessment, Development and Evaluation [GRADE]), ADT + abiraterone (moderate certainty), ADT + enzalutamide (low certainty), ADT + apalutamide (high certainty), and ADT + docetaxel + darolutamide (high certainty) compared with ADT alone. ADT + radiotherapy appeared effective only in low-volume de novo mHSPC. We found a short-term HRQoL decrease lasting 3-6 mo for ADT + docetaxel (moderate certainty) and a potential HRQoL benefit for ADT + abiraterone up to 24 mo of follow-up (moderate certainty) compared with ADT alone. There was no difference in HRQoL for ADT + enzalutamide, ADT + apalutamide, or ADT + radiotherapy over ADT alone (low-high certainty). Grade 3-5 adverse effect rates were increased with all systemic combination treatments. A benefit-harm assessment showed high probabilities (>60%) for a net clinical benefit with ADT + abiraterone, ADT + enzalutamide, and ADT + apalutamide, while ADT + docetaxel and ADT + docetaxel + darolutamide appeared unlikely (<40%) to be beneficial. CONCLUSIONS Despite substantial survival benefits, no systemic combination treatment showed a clear HRQoL improvement compared with ADT alone. We found evidence for a short-term HRQoL decline with ADT + docetaxel and a higher net clinical benefit with ADT + abiraterone, ADT + apalutamide and ADT + enzalutamide. While individualized decision-making remains important and economic factors need to be considered, the evidence may support a general preference for the combination of ADT with androgen receptor axis-targeted therapies over docetaxel-containing strategies. PATIENT SUMMARY We assessed different combination treatments for metastatic hormone-sensitive prostate cancer. While survival was better with all systemic combination treatments, there was no clear improvement in health-related quality of life compared with androgen deprivation therapy alone. Novel hormonal combination treatments had a more favorable benefit-harm balance than combination treatments that include chemotherapy.
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Affiliation(s)
- Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland.
| | - Henock G Yebyo
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Sergio Sivec-Muniz
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Michaela C Barbier
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Yuki Tomonaga
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Matthias Schwenkglenks
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland; Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
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15
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Daniore P, Nittas V, Ballouz T, Menges D, Moser A, Höglinger M, Villiger P, Schmitz-Grosz K, Von Wyl V. Performance of the Swiss Digital Contact-Tracing App Over Various SARS-CoV-2 Pandemic Waves: Repeated Cross-sectional Analyses. JMIR Public Health Surveill 2022; 8:e41004. [PMID: 36219833 PMCID: PMC9700234 DOI: 10.2196/41004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/28/2022] [Accepted: 10/09/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Digital proximity-tracing apps have been deployed in multiple countries to assist with SARS-CoV-2 pandemic mitigation efforts. However, it is unclear how their performance and effectiveness were affected by changing pandemic contexts and new viral variants of concern. OBJECTIVE The aim of this study is to bridge these knowledge gaps through a countrywide digital proximity-tracing app effectiveness assessment, as guided by the World Health Organization/European Center for Prevention and Disease Control (WHO/ECDC) indicator framework to evaluate the public health effectiveness of digital proximity-tracing solutions. METHODS We performed a descriptive analysis of the digital proximity-tracing app SwissCovid in Switzerland for 3 different periods where different SARS-CoV-2 variants of concern (ie, Alpha, Delta, and Omicron, respectively) were most prevalent. In our study, we refer to the indicator framework for the evaluation of public health effectiveness of digital proximity-tracing apps of the WHO/ECDC. We applied this framework to compare the performance and effectiveness indicators of the SwissCovid app. RESULTS Average daily registered SARS-CoV-2 case rates during our assessment period from January 25, 2021, to March 19, 2022, were 20 (Alpha), 54 (Delta), and 350 (Omicron) per 100,000 inhabitants. The percentages of overall entered authentication codes from positive tests into the SwissCovid app were 9.9% (20,273/204,741), 3.9% (14,372/365,846), and 4.6% (72,324/1,581,506) during the Alpha, Delta, and Omicron variant phases, respectively. Following receipt of an exposure notification from the SwissCovid app, 58% (37/64, Alpha), 44% (7/16, Delta), and 73% (27/37, Omicron) of app users sought testing or performed self-tests. Test positivity among these exposure-notified individuals was 19% (7/37) in the Alpha variant phase, 29% (2/7) in the Delta variant phase, and 41% (11/27) in the Omicron variant phase compared to 6.1% (228,103/3,755,205), 12% (413,685/3,443,364), and 41.7% (1,784,951/4,285,549) in the general population, respectively. In addition, 31% (20/64, Alpha), 19% (3/16, Delta), and 30% (11/37, Omicron) of exposure-notified app users reported receiving mandatory quarantine orders by manual contact tracing or through a recommendation by a health care professional. CONCLUSIONS In constantly evolving pandemic contexts, the effectiveness of digital proximity-tracing apps in contributing to mitigating pandemic spread should be reviewed regularly and adapted based on changing requirements. The WHO/ECDC framework allowed us to assess relevant domains of digital proximity tracing in a holistic and systematic approach. Although the Swisscovid app mostly worked, as reasonably expected, our analysis revealed room for optimizations and further performance improvements. Future implementation of digital proximity-tracing apps should place more emphasis on social, psychological, and organizational aspects to reduce bottlenecks and facilitate their use in pandemic contexts.
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Affiliation(s)
- Paola Daniore
- Institute for Implementation Science in Healthcare, University of Zurich, Zurich, Switzerland
- Digital Society Initiative, University of Zurich, Zurich, Switzerland
| | - Vasileios Nittas
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - André Moser
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Marc Höglinger
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | | | | | - Viktor Von Wyl
- Institute for Implementation Science in Healthcare, University of Zurich, Zurich, Switzerland
- Digital Society Initiative, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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16
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Barbier MC, Tomonaga Y, Menges D, Yebyo HG, Haile SR, Puhan MA, Schwenkglenks M. Survival modelling and cost-effectiveness analysis of treatments for newly diagnosed metastatic hormone-sensitive prostate cancer. PLoS One 2022; 17:e0277282. [PMID: 36327294 PMCID: PMC9632884 DOI: 10.1371/journal.pone.0277282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In metastatic hormone-sensitive prostate cancer (mHSPC) treatment, survival benefits have been shown by adding docetaxel or recent androgen receptor axis-targeted therapies (ARATs) abiraterone, apalutamide, or enzalutamide to androgen deprivation therapy (ADT). However, the optimal treatment strategy in terms of costs and effects is unclear, not least due to high ARAT costs. METHODS To assess treatment cost-effectiveness, we developed a Markov cohort model with health states of progression-free disease, progressive disease and death for men with newly diagnosed mHSPC, with a 30-year time horizon. Survival data, adverse events and utilities were informed by randomized controlled trial results, our meta-analysis of re-created individual patient survival data, and publicly available sources of unit costs. We applied a Swiss healthcare payer perspective and discounted costs and effects by 3%. RESULTS We found a significant overall survival benefit for ADT+abiraterone versus ADT+docetaxel. The corresponding incremental cost-effectiveness ratio (ICER) was predicted to be EUR 39,814 per quality-adjusted life-year (QALY) gained. ADT+apalutamide and ADT+enzalutamide incurred higher costs and lower QALYs compared to ADT+abiraterone. For all ARATs, drug costs constituted the most substantial cost component. Results were stable except for a large univariable reduction in the pre-progression utility under ADT+abiraterone and very large variations in drug prices. CONCLUSIONS Our model projected ADT+abiraterone to be cost-effective compared to ADT+docetaxel at a willingness-to-pay threshold of EUR 70,400/QALY (CHF 100,000 applying purchasing power parities). Given lower estimated QALYs for ADT+apalutamide and ADT+enzalutamide compared to ADT+abiraterone, the former only became cost-effective (the preferred) treatment option(s) at substantial 75-80% (80-90%) price reductions.
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Affiliation(s)
- Michaela C. Barbier
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
- * E-mail:
| | - Yuki Tomonaga
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Henock G. Yebyo
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Sarah R. Haile
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Matthias Schwenkglenks
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
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17
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Sanchez D, Derks M, Verstijnen J, Menges D, Portielje J, Van den Bos F, Bastiaannet E. Use of frailty measurements in observational studies on older patients with breast cancer: A systematic review. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01604-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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18
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Wulf Hanson S, Abbafati C, Aerts JG, Al-Aly Z, Ashbaugh C, Ballouz T, Blyuss O, Bobkova P, Bonsel G, Borzakova S, Buonsenso D, Butnaru D, Carter A, Chu H, De Rose C, Diab MM, Ekbom E, El Tantawi M, Fomin V, Frithiof R, Gamirova A, Glybochko PV, Haagsma JA, Haghjooy Javanmard S, Hamilton EB, Harris G, Heijenbrok-Kal MH, Helbok R, Hellemons ME, Hillus D, Huijts SM, Hultström M, Jassat W, Kurth F, Larsson IM, Lipcsey M, Liu C, Loflin CD, Malinovschi A, Mao W, Mazankova L, McCulloch D, Menges D, Mohammadifard N, Munblit D, Nekliudov NA, Ogbuoji O, Osmanov IM, Peñalvo JL, Petersen MS, Puhan MA, Rahman M, Rass V, Reinig N, Ribbers GM, Ricchiuto A, Rubertsson S, Samitova E, Sarrafzadegan N, Shikhaleva A, Simpson KE, Sinatti D, Soriano JB, Spiridonova E, Steinbeis F, Svistunov AA, Valentini P, van de Water BJ, van den Berg-Emons R, Wallin E, Witzenrath M, Wu Y, Xu H, Zoller T, Adolph C, Albright J, Amlag JO, Aravkin AY, Bang-Jensen BL, Bisignano C, Castellano R, Castro E, Chakrabarti S, Collins JK, Dai X, Daoud F, Dapper C, Deen A, Duncan BB, Erickson M, Ewald SB, Ferrari AJ, Flaxman AD, Fullman N, Gamkrelidze A, Giles JR, Guo G, Hay SI, He J, Helak M, Hulland EN, Kereselidze M, Krohn KJ, Lazzar-Atwood A, Lindstrom A, Lozano R, Malta DC, Månsson J, Mantilla Herrera AM, Mokdad AH, Monasta L, Nomura S, Pasovic M, Pigott DM, Reiner RC, Reinke G, Ribeiro ALP, Santomauro DF, Sholokhov A, Spurlock EE, Walcott R, Walker A, Wiysonge CS, Zheng P, Bettger JP, Murray CJL, Vos T. Estimated Global Proportions of Individuals With Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021. JAMA 2022; 328:1604-1615. [PMID: 36215063 PMCID: PMC9552043 DOI: 10.1001/jama.2022.18931] [Citation(s) in RCA: 281] [Impact Index Per Article: 140.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/25/2022] [Indexed: 01/14/2023]
Abstract
Importance Some individuals experience persistent symptoms after initial symptomatic SARS-CoV-2 infection (often referred to as Long COVID). Objective To estimate the proportion of males and females with COVID-19, younger or older than 20 years of age, who had Long COVID symptoms in 2020 and 2021 and their Long COVID symptom duration. Design, Setting, and Participants Bayesian meta-regression and pooling of 54 studies and 2 medical record databases with data for 1.2 million individuals (from 22 countries) who had symptomatic SARS-CoV-2 infection. Of the 54 studies, 44 were published and 10 were collaborating cohorts (conducted in Austria, the Faroe Islands, Germany, Iran, Italy, the Netherlands, Russia, Sweden, Switzerland, and the US). The participant data were derived from the 44 published studies (10 501 hospitalized individuals and 42 891 nonhospitalized individuals), the 10 collaborating cohort studies (10 526 and 1906), and the 2 US electronic medical record databases (250 928 and 846 046). Data collection spanned March 2020 to January 2022. Exposures Symptomatic SARS-CoV-2 infection. Main Outcomes and Measures Proportion of individuals with at least 1 of the 3 self-reported Long COVID symptom clusters (persistent fatigue with bodily pain or mood swings; cognitive problems; or ongoing respiratory problems) 3 months after SARS-CoV-2 infection in 2020 and 2021, estimated separately for hospitalized and nonhospitalized individuals aged 20 years or older by sex and for both sexes of nonhospitalized individuals younger than 20 years of age. Results A total of 1.2 million individuals who had symptomatic SARS-CoV-2 infection were included (mean age, 4-66 years; males, 26%-88%). In the modeled estimates, 6.2% (95% uncertainty interval [UI], 2.4%-13.3%) of individuals who had symptomatic SARS-CoV-2 infection experienced at least 1 of the 3 Long COVID symptom clusters in 2020 and 2021, including 3.2% (95% UI, 0.6%-10.0%) for persistent fatigue with bodily pain or mood swings, 3.7% (95% UI, 0.9%-9.6%) for ongoing respiratory problems, and 2.2% (95% UI, 0.3%-7.6%) for cognitive problems after adjusting for health status before COVID-19, comprising an estimated 51.0% (95% UI, 16.9%-92.4%), 60.4% (95% UI, 18.9%-89.1%), and 35.4% (95% UI, 9.4%-75.1%), respectively, of Long COVID cases. The Long COVID symptom clusters were more common in women aged 20 years or older (10.6% [95% UI, 4.3%-22.2%]) 3 months after symptomatic SARS-CoV-2 infection than in men aged 20 years or older (5.4% [95% UI, 2.2%-11.7%]). Both sexes younger than 20 years of age were estimated to be affected in 2.8% (95% UI, 0.9%-7.0%) of symptomatic SARS-CoV-2 infections. The estimated mean Long COVID symptom cluster duration was 9.0 months (95% UI, 7.0-12.0 months) among hospitalized individuals and 4.0 months (95% UI, 3.6-4.6 months) among nonhospitalized individuals. Among individuals with Long COVID symptoms 3 months after symptomatic SARS-CoV-2 infection, an estimated 15.1% (95% UI, 10.3%-21.1%) continued to experience symptoms at 12 months. Conclusions and Relevance This study presents modeled estimates of the proportion of individuals with at least 1 of 3 self-reported Long COVID symptom clusters (persistent fatigue with bodily pain or mood swings; cognitive problems; or ongoing respiratory problems) 3 months after symptomatic SARS-CoV-2 infection.
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Affiliation(s)
- Sarah Wulf Hanson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Cristiana Abbafati
- Department of Juridical and Economic Studies, La Sapienza University, Rome, Italy
| | - Joachim G Aerts
- Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ziyad Al-Aly
- John T. Milliken Department of Internal Medicine, Washington University in St Louis, St Louis, Missouri
- Clinical Epidemiology Center, US Department of Veterans Affairs, St Louis, Missouri
| | - Charlie Ashbaugh
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Tala Ballouz
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zurich, Switzerland
| | - Oleg Blyuss
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
- Department of Pediatrics and Pediatric Infectious Diseases, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Polina Bobkova
- Clinical Medicine (Pediatric Profile), I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Gouke Bonsel
- EuroQol Research Foundation, Rotterdam, the Netherlands
| | - Svetlana Borzakova
- Pirogov Russian National Research Medical University, Moscow
- Research Institute for Healthcare Organization and Medical Management, Moscow Healthcare Department, Moscow, Russia
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Agostino Gemelli University Polyclinic IRCCS, Rome, Italy
- Global Health Research Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Denis Butnaru
- I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Austin Carter
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Helen Chu
- Department of Medicine, University of Washington, Seattle
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Agostino Gemelli University Polyclinic IRCCS, Rome, Italy
| | - Mohamed Mustafa Diab
- Center for Policy Impact in Global Health, Duke University, Durham, North Carolina
- Department of Surgery, Duke University, Durham, North Carolina
| | - Emil Ekbom
- Uppsala University Hospital, Uppsala, Sweden
| | - Maha El Tantawi
- Pediatric Dentistry and Dental Public Health Department, Alexandria University, Alexandria, Egypt
| | - Victor Fomin
- Rector's Office, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Robert Frithiof
- Department of Surgical Sciences, Anesthesiology, and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Aysylu Gamirova
- Clinical Medicine (General Medicine Profile), I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Petr V Glybochko
- Administration Department, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Juanita A Haagsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Shaghayegh Haghjooy Javanmard
- Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Erin B Hamilton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Majanka H Heijenbrok-Kal
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Neurorehabilitation, Rijndam Rehabilitation, Rotterdam, the Netherlands
| | - Raimund Helbok
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Merel E Hellemons
- Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - David Hillus
- Department of Infectious Diseases and Respiratory Medicine, Charité Medical University Berlin, Berlin, Germany
| | - Susanne M Huijts
- Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Michael Hultström
- Department of Surgical Sciences, Anesthesiology, and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Waasila Jassat
- Department of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Florian Kurth
- Department of Infectious Diseases and Respiratory Medicine, Charité University Medical Center Berlin, Berlin, Germany
- Department of Clinical Research and Tropical Medicine, Bernhard-Nocht Institute of Tropical Medicine, Hamburg, Germany
| | - Ing-Marie Larsson
- Department of Surgical Sciences, Anesthesiology, and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Miklós Lipcsey
- Department of Surgical Sciences, Anesthesiology, and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Chelsea Liu
- Department of Epidemiology, Harvard University, Boston, Massachusetts
| | | | | | - Wenhui Mao
- Center for Policy Impact in Global Health, Duke University, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Lyudmila Mazankova
- Russian Medical Academy of Continuous Professional Education, Ministry of Healthcare of the Russian Federation, Moscow
| | | | - Dominik Menges
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zurich, Switzerland
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Daniel Munblit
- Department of Pediatrics and Pediatric Infectious Diseases, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
- National Heart and Lung Institute, Imperial College London, London, England
| | - Nikita A Nekliudov
- Clinical Medicine (General Medicine Profile), I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Osondu Ogbuoji
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Ismail M Osmanov
- Pirogov Russian National Research Medical University, Moscow
- ZA Bashlyaeva Children's Municipal Clinical Hospital, Moscow, Russia
| | - José L Peñalvo
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Maria Skaalum Petersen
- Department of Occupational Medicine and Public Health, Faroese Hospital System, Torshavn, Faroe Islands
- Centre of Health Science, University of Faroe Islands, Torshavn
| | - Milo A Puhan
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zurich, Switzerland
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Mujibur Rahman
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Verena Rass
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Nickolas Reinig
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Antonia Ricchiuto
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sten Rubertsson
- Department of Surgical Sciences, Anesthesiology, and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
- Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden
| | - Elmira Samitova
- Russian Medical Academy of Continuous Professional Education, Ministry of Healthcare of the Russian Federation, Moscow
- ZA Bashlyaeva Children's Municipal Clinical Hospital, Moscow, Russia
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Anastasia Shikhaleva
- Clinical Medicine (Pediatric Profile), I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Kyle E Simpson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Dario Sinatti
- Department of Woman and Child Health and Public Health, Agostino Gemelli University Polyclinic IRCCS, Rome, Italy
| | - Joan B Soriano
- Hospital Universitario de La Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (Center for Biomedical Research in Respiratory Diseases Network), Madrid, Spain
| | - Ekaterina Spiridonova
- Clinical Medicine (General Medicine Profile), I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Fridolin Steinbeis
- Department of Infectious Diseases and Respiratory Medicine, Charité Medical University Berlin, Berlin, Germany
| | - Andrey A Svistunov
- Administration Department, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Agostino Gemelli University Polyclinic IRCCS, Rome, Italy
| | - Brittney J van de Water
- Department of Global Health and Social Medicine, Harvard University, Boston, Massachusetts
- Nursing and Midwifery Department, Seed Global Health, Boston, Massachusetts
| | - Rita van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ewa Wallin
- Department of Surgical Sciences, Anesthesiology, and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité University Medical Center Berlin, Berlin, Germany
- German Center for Lung Research, Berlin
| | - Yifan Wu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Hanzhang Xu
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
| | - Thomas Zoller
- Department of Infectious Diseases and Respiratory Medicine, Charité Medical University Berlin, Berlin, Germany
| | - Christopher Adolph
- Department of Political Science, University of Washington, Seattle
- Center for Statistics and the Social Sciences, University of Washington, Seattle
| | - James Albright
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Joanne O Amlag
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Aleksandr Y Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Applied Mathematics, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Bree L Bang-Jensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Catherine Bisignano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Rachel Castellano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Emma Castro
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Suman Chakrabarti
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
| | - James K Collins
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Carolyn Dapper
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Amanda Deen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Megan Erickson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Samuel B Ewald
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Alize J Ferrari
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Abraham D Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - John R Giles
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Gaorui Guo
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Jiawei He
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Monika Helak
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Erin N Hulland
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
| | - Maia Kereselidze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Kris J Krohn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Alice Lazzar-Atwood
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Akiaja Lindstrom
- School of Public Health, University of Queensland, Brisbane, Australia
- School of Public Health, Queensland Centre for Mental Health Research, Wacol, Australia
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Johan Månsson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Ana M Mantilla Herrera
- School of Public Health, University of Queensland, Brisbane, Australia
- West Moreton Hospital Health Services, Queensland Centre for Mental Health Research, Wacol, Australia
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Shuhei Nomura
- Department of Health Policy and Management, Keio University, Tokyo, Japan
- Department of Global Health Policy, University of Tokyo, Tokyo, Japan
| | - Maja Pasovic
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - David M Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Grace Reinke
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Antonio Luiz P Ribeiro
- Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Centre of Telehealth, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Damian Francesco Santomauro
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- School of Public Health, University of Queensland, Brisbane, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, Australia
| | - Aleksei Sholokhov
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Emma Elizabeth Spurlock
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, Connecticut
| | - Rebecca Walcott
- Evans School of Public Policy and Governance, University of Washington, Seattle
| | - Ally Walker
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Janet Prvu Bettger
- Department of Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
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19
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Menges D, Zens KD, Ballouz T, Caduff N, Llanas-Cornejo D, Aschmann HE, Domenghino A, Pellaton C, Perreau M, Fenwick C, Pantaleo G, Kahlert CR, Münz C, Puhan MA, Fehr JS. Heterogenous humoral and cellular immune responses with distinct trajectories post-SARS-CoV-2 infection in a population-based cohort. Nat Commun 2022; 13:4855. [PMID: 35982045 PMCID: PMC9386650 DOI: 10.1038/s41467-022-32573-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 08/06/2022] [Indexed: 12/14/2022] Open
Abstract
To better understand the development of SARS-CoV-2-specific immunity over time, a detailed evaluation of humoral and cellular responses is required. Here, we characterize anti-Spike (S) IgA and IgG in a representative population-based cohort of 431 SARS-CoV-2-infected individuals up to 217 days after diagnosis, demonstrating that 85% develop and maintain anti-S responses. In a subsample of 64 participants, we further assess anti-Nucleocapsid (N) IgG, neutralizing antibody activity, and T cell responses to Membrane (M), N, and S proteins. In contrast to S-specific antibody responses, anti-N IgG levels decline substantially over time and neutralizing activity toward Delta and Omicron variants is low to non-existent within just weeks of Wildtype SARS-CoV-2 infection. Virus-specific T cells are detectable in most participants, albeit more variable than antibody responses. Cluster analyses of the co-evolution of antibody and T cell responses within individuals identify five distinct trajectories characterized by specific immune patterns and clinical factors. These findings demonstrate the relevant heterogeneity in humoral and cellular immunity to SARS-CoV-2 while also identifying consistent patterns where antibody and T cell responses may work in a compensatory manner to provide protection. The persistence of the immune response to SARS-CoV-2 after recovery from infection is an indicator for subsequent protection against infection. Here the authors follow recovered patients and measure antibody and T cell responses and find that these two parts of the immune response may have different longevity.
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Affiliation(s)
- Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Kyra D Zens
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland.,Institute for Experimental Immunology, University of Zurich (UZH), Zurich, Switzerland
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Nicole Caduff
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland.,Institute for Experimental Immunology, University of Zurich (UZH), Zurich, Switzerland
| | - Daniel Llanas-Cornejo
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Hélène E Aschmann
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Anja Domenghino
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland.,Department of Visceral and Transplantation Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Céline Pellaton
- Service of Immunology and Allergy, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Matthieu Perreau
- Service of Immunology and Allergy, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Craig Fenwick
- Service of Immunology and Allergy, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Giuseppe Pantaleo
- Service of Immunology and Allergy, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Christian R Kahlert
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Christian Münz
- Institute for Experimental Immunology, University of Zurich (UZH), Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland.
| | - Jan S Fehr
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
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20
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Wulf Hanson S, Abbafati C, Aerts JG, Al-Aly Z, Ashbaugh C, Ballouz T, Blyuss O, Bobkova P, Bonsel G, Borzakova S, Buonsenso D, Butnaru D, Carter A, Chu H, De Rose C, Diab MM, Ekbom E, El Tantawi M, Fomin V, Frithiof R, Gamirova A, Glybochko PV, Haagsma JA, Javanmard SH, Hamilton EB, Harris G, Heijenbrok-Kal MH, Helbok R, Hellemons ME, Hillus D, Huijts SM, Hultström M, Jassat W, Kurth F, Larsson IM, Lipcsey M, Liu C, Loflin CD, Malinovschi A, Mao W, Mazankova L, McCulloch D, Menges D, Mohammadifard N, Munblit D, Nekliudov NA, Ogbuoji O, Osmanov IM, Peñalvo JL, Petersen MS, Puhan MA, Rahman M, Rass V, Reinig N, Ribbers GM, Ricchiuto A, Rubertsson S, Samitova E, Sarrafzadegan N, Shikhaleva A, Simpson KE, Sinatti D, Soriano JB, Spiridonova E, Steinbeis F, Svistunov AA, Valentini P, van de Water BJ, van den Berg-Emons R, Wallin E, Witzenrath M, Wu Y, Xu H, Zoller T, Adolph C, Albright J, Amlag JO, Aravkin AY, Bang-Jensen BL, Bisignano C, Castellano R, Castro E, Chakrabarti S, Collins JK, Dai X, Daoud F, Dapper C, Deen A, Duncan BB, Erickson M, Ewald SB, Ferrari AJ, Flaxman AD, Fullman N, Gamkrelidze A, Giles JR, Guo G, Hay SI, He J, Helak M, Hulland EN, Kereselidze M, Krohn KJ, Lazzar-Atwood A, Lindstrom A, Lozano R, Magistro B, Malta DC, Månsson J, Mantilla Herrera AM, Mokdad AH, Monasta L, Nomura S, Pasovic M, Pigott DM, Reiner RC, Reinke G, Ribeiro ALP, Santomauro DF, Sholokhov A, Spurlock EE, Walcott R, Walker A, Wiysonge CS, Zheng P, Bettger JP, Murray CJ, Vos T. A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021. medRxiv 2022. [PMID: 35664995 PMCID: PMC9164454 DOI: 10.1101/2022.05.26.22275532] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance: While much of the attention on the COVID-19 pandemic was directed at the daily counts of cases and those with serious disease overwhelming health services, increasingly, reports have appeared of people who experience debilitating symptoms after the initial infection. This is popularly known as long COVID. Objective: To estimate by country and territory of the number of patients affected by long COVID in 2020 and 2021, the severity of their symptoms and expected pattern of recovery Design: We jointly analyzed ten ongoing cohort studies in ten countries for the occurrence of three major symptom clusters of long COVID among representative COVID cases. The defining symptoms of the three clusters (fatigue, cognitive problems, and shortness of breath) are explicitly mentioned in the WHO clinical case definition. For incidence of long COVID, we adopted the minimum duration after infection of three months from the WHO case definition. We pooled data from the contributing studies, two large medical record databases in the United States, and findings from 44 published studies using a Bayesian meta-regression tool. We separately estimated occurrence and pattern of recovery in patients with milder acute infections and those hospitalized. We estimated the incidence and prevalence of long COVID globally and by country in 2020 and 2021 as well as the severity-weighted prevalence using disability weights from the Global Burden of Disease study. Results: Analyses are based on detailed information for 1906 community infections and 10526 hospitalized patients from the ten collaborating cohorts, three of which included children. We added published data on 37262 community infections and 9540 hospitalized patients as well as ICD-coded medical record data concerning 1.3 million infections. Globally, in 2020 and 2021, 144.7 million (95% uncertainty interval [UI] 54.8–312.9) people suffered from any of the three symptom clusters of long COVID. This corresponds to 3.69% (1.38–7.96) of all infections. The fatigue, respiratory, and cognitive clusters occurred in 51.0% (16.9–92.4), 60.4% (18.9–89.1), and 35.4% (9.4–75.1) of long COVID cases, respectively. Those with milder acute COVID-19 cases had a quicker estimated recovery (median duration 3.99 months [IQR 3.84–4.20]) than those admitted for the acute infection (median duration 8.84 months [IQR 8.10–9.78]). At twelve months, 15.1% (10.3–21.1) continued to experience long COVID symptoms. Conclusions and relevance: The occurrence of debilitating ongoing symptoms of COVID-19 is common. Knowing how many people are affected, and for how long, is important to plan for rehabilitative services and support to return to social activities, places of learning, and the workplace when symptoms start to wane.
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21
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Ballouz T, Menges D, Aschmann HE, Jung R, Domenghino A, Fehr JS, Puhan MA, von Wyl V. Individual-level Evaluation of the Exposure Notification Cascade in the SwissCovid Digital Proximity Tracing App: An Observational Study. JMIR Public Health Surveill 2022; 8:e35653. [PMID: 35476726 PMCID: PMC9122110 DOI: 10.2196/35653] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/03/2022] [Accepted: 04/26/2022] [Indexed: 12/31/2022] Open
Abstract
Background Digital proximity tracing (DPT) aims to complement manual contact tracing (MCT) in identifying exposed contacts and preventing further transmission of SARS-CoV-2 in the population. Although several DPT apps, including SwissCovid, have shown to have promising effects on mitigating the pandemic, several challenges have impeded them from fully achieving the desired results. A key question now relates to how the effectiveness of DPT can be improved, which requires a better understanding of factors influencing its processes. Objective In this study, we aim to provide a detailed examination of the exposure notification (EN) cascade and to evaluate potential contextual influences for successful receipt of an EN and subsequent actions taken by cases and contacts in different exposure settings. Methods We used data from 285 pairs of SARS-CoV-2-infected cases and their contacts within an observational cohort study of cases and contacts identified by MCT and enrolled between August 6, 2020, and January 17, 2021, in the canton of Zurich, Switzerland. We surveyed participants with electronic questionnaires. Data were summarized descriptively and stratified by exposure setting. Results We found that only 79 (58.5%) of 135 contacts using the SwissCovid app whose corresponding cases reported to have triggered the EN also received one. Of these, 18 (22.8%) received the EN before MCT. Compared to those receiving an EN after MCT (61/79, 77.2%), we observed that a higher proportion of contacts receiving an EN before MCT were exposed in nonhousehold settings (11/18, 61.1%, vs 34/61, 55.7%) and their corresponding cases had more frequently reported mild-to-moderate symptoms (14/18, 77.8%, vs 42/61, 68.9%). Of the 18 contacts receiving an EN before MCT, 14 (77.8%) took recommended measures: 12 (66.7%) were tested for SARS-CoV-2, and 7 (38.9%) called the SwissCovid Infoline. In nonhousehold settings, the proportion of contacts taking preventive actions after receiving an EN was higher compared to same-household settings (82%, vs 67%). In addition, 1 (9%) of 11 ENs received in the nonhousehold setting before MCT led to the identification of a SARS-CoV-2-infected case by prompting the contact to get tested. This corresponds to 1 in 85 exposures of a contact to a case in a nonhousehold setting, in which both were app users and the case triggered the EN. Conclusions Our descriptive evaluation of the DPT notification cascade provides further evidence that DPT is an important complementary tool in pandemic mitigation, especially in nonhousehold exposure settings. However, the effect of DPT apps can only be exerted if code generation processes are efficient and exposed contacts are willing to undertake preventive actions. This highlights the need to focus efforts on keeping barriers to efficient code generation as low as possible and promoting not only app adoption but also compliance with the recommended measures upon an EN. Trial Registration International Standard Randomised Controlled Trial Number Registry 14990068; https://doi.org/10.1186/ISRCTN14990068
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Affiliation(s)
- Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, CH
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, CH
| | - Hélène E Aschmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, CH.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, US
| | - Ruedi Jung
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, CH
| | - Anja Domenghino
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, CH.,Department of Visceral and Transplantation Surgery, University Hospital Zurich (USZ), University of Zurich, Zurich, CH
| | - Jan S Fehr
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, CH
| | - Milo Alan Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, CH
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, CH.,Institute for Implementation Science in Health Care, University of Zurich, Zurich, CH
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22
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Domenghino A, Aschmann HE, Ballouz T, Menges D, Strebel D, Derfler S, Fehr JS, Puhan MA. Mental health of individuals infected with SARS-CoV-2 during mandated isolation and compliance with recommendations—A population-based cohort study. PLoS One 2022; 17:e0264655. [PMID: 35294465 PMCID: PMC8926272 DOI: 10.1371/journal.pone.0264655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Isolation is an indispensable measure to contain the SARS-CoV-2 virus, but it may have a negative impact on mental health and overall wellbeing. Evidence on the isolation experience, facilitating and complicating factors is needed to mitigate negative effects. Methods and findings This observational, population-based cohort study enrolled 1547 adults from the general population with SARS-CoV-2 infection reported to authorities between 27 February 2020 and 19 January 2021 in Zurich, Switzerland. We assessed the proportion of individuals reporting symptoms of depression and anxiety before, during and after isolation (by DASS-21), and queried worries, positive experiences, and difficulties. We analyzed the association of these outcomes with socio-demographics using ordinal regression. Additionally, we report free-text statements by participants to capture most important aspects of isolation. The proportion of participants affected by depression or anxiety increased during isolation from 10·0% to 17·1% and 9·1% to 17·6%, respectively. Ordinal regression showed that taking care of children increased the difficulty of isolation (OR 2·10, CI 1·43–3·08) and risk of non-compliance (OR 1·63, CI 1·05–2·53), especially in younger participants. A facilitating factor that individuals commonly expressed was receiving more support during isolation. Conclusion Isolation due to SARS-CoV-2 presents a mental burden, especially for younger individuals and those taking care of children. Public health authorities need to train personnel and draw from community-based resources to provide targeted support, information, and guidance to individuals during isolation. Such efforts could alleviate the negative impact isolation has on the mental and physical health of individuals and ensure compliance of the population with recommendations.
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Affiliation(s)
- Anja Domenghino
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland
| | - Hélène E. Aschmann
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
- Department of Epidemiology and Biostatistics, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Dominique Strebel
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Sandra Derfler
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Jan S. Fehr
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
- * E-mail:
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23
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Nittas V, Gao M, West EA, Ballouz T, Menges D, Wulf Hanson S, Puhan MA. Long COVID Through a Public Health Lens: An Umbrella Review. Public Health Rev 2022; 43:1604501. [PMID: 35359614 PMCID: PMC8963488 DOI: 10.3389/phrs.2022.1604501] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/07/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives: To synthesize existing evidence on prevalence as well as clinical and socio-economic aspects of Long COVID.Methods: An umbrella review of reviews and a targeted evidence synthesis of their primary studies, including searches in four electronic databases, reference lists of included reviews, as well as related article lists of relevant publications.Results: Synthesis included 23 reviews and 102 primary studies. Prevalence estimates ranged from 7.5% to 41% in non-hospitalized adults, 2.3%–53% in mixed adult samples, 37.6% in hospitalized adults, and 2%–3.5% in primarily non-hospitalized children. Preliminary evidence suggests that female sex, age, comorbidities, the severity of acute disease, and obesity are associated with Long COVID. Almost 50% of primary studies reported some degree of Long COVID-related social and family-life impairment, long absence periods off work, adjusted workloads, and loss of employment.Conclusion: Long COVID will likely have a substantial public health impact. Current evidence is still heterogeneous and incomplete. To fully understand Long COVID, well-designed prospective studies with representative samples will be essential.
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Affiliation(s)
- Vasileios Nittas
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zürich, Switzerland
- *Correspondence: Vasileios Nittas,
| | - Manqi Gao
- Department of Environmental Systems Sciences, ETH Zürich, Zürich, Switzerland
| | - Erin A. West
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zürich, Switzerland
| | - Tala Ballouz
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zürich, Switzerland
| | - Dominik Menges
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zürich, Switzerland
| | - Sarah Wulf Hanson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
| | - Milo Alan Puhan
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zürich, Switzerland
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Menges D, Piatti MC, Cerny T, Puhan MA. Patient Preference Studies for Advanced Prostate Cancer Treatment Along the Medical Product Life Cycle: Systematic Literature Review. Patient Prefer Adherence 2022; 16:1539-1557. [PMID: 35789822 PMCID: PMC9250329 DOI: 10.2147/ppa.s362802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient preference studies can inform decision-making across all stages of the medical product life cycle (MPLC). The treatment landscape for advanced prostate cancer (APC) treatment has substantially changed in recent years. However, the most patient-relevant aspects of APC treatment remain unclear. This systematic review of patient preference studies in APC aimed to summarize the evidence on patient preferences and patient-relevant aspects of APC treatments, and to evaluate the potential contribution of existing studies to decision-making within the respective stages of the MPLC. METHODS We searched MEDLINE and EMBASE for studies evaluating patient preferences related to APC treatment up to October 2020. Two reviewers independently performed screening, data extraction and quality assessment in duplicate. We descriptively summarized the findings and analyzed the studies regarding their contribution within the MPLC using an analytical framework. RESULTS Seven quantitative preference studies were included. One study each was conducted in the marketing approval and the health technology assessment (HTA) and reimbursement stage, and five were conducted in the post-marketing stage of the MPLC. While almost all stated to inform clinical practice, the specific contributions to clinical decision-making remained unclear for almost all studies. Evaluated attributes related to benefits, harms, and other treatment-related aspects and their relative importance varied relevantly between studies. All studies were judged of high quality overall, but some methodological issues regarding sample selection and the definition of patient-relevant treatment attributes were identified. CONCLUSION The most patient-relevant aspects regarding the benefits and harms of APC treatment are not yet established, and it remains unclear which APC treatments are preferred by patients. Findings from this study highlight the importance of transparent reporting and discussion of study findings according to their aims and with respect to their stage within the MPLC. Future research may benefit from using the MPLC framework for analyzing or determining the aims and design of patient preference studies.
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Affiliation(s)
- Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
- Correspondence: Dominik Menges, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Hirschengraben 84, Zurich, CH-8001, Switzerland, Tel +41 44 634 46 15, Email
| | - Michela C Piatti
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Thomas Cerny
- Foundation Board, Cancer Research Switzerland (Krebsforschung Schweiz KFS), Bern, Switzerland
- Human Medicines Expert Committee (HMEC), Swissmedic, Bern, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
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Abstract
Digital proximity tracing has been promoted as a major technological innovation for its potential added benefits of greater speed, wider reach and better scalability compared with traditional manual contact tracing. First launched in Switzerland on 25 June 2020, the SwissCovid digital proximity tracing app has now been in use for more than one year. In light of this milestone, we raise the questions: What is currently known about the role of SwissCovid in mitigating the pandemic? Were the expectations fulfilled? In this review, we will summarise the current state of the literature from empirical studies on the adoption, performance and effectiveness of SwissCovid. The review consists of three sections. The first section summarizes findings from effectiveness studies, which suggest that SwissCovid exposure notifications contributed to preventive actions in 76% of exposure notification recipients and were associated with a faster quarantine time in some SwissCovid user groups. The second describes the public perception and current state of adoption of SwissCovid in Switzerland in light of prevalent misconceptions and overemphasised expectations. the third places the evidence on SwissCovid in an international context. Specifically, we compare key performance indicators of SwissCovid, which are of similar magnitude as for digital proximity tracing apps from other European countries. Using findings from Switzerland, we subsequently derive a preliminary measure of the population-level effectiveness of digital proximity tracing apps. We estimate that exposure notifications may have contributed to the notification and identification of 500 to 1000 SARS-CoV-2-positive app users per month. We explore why this effectiveness estimation is somewhat lower when compared with Germany or the United Kingdom. In light of the presented evidence, we conclude that digital proximity tracing works well in specific contexts, such as in mitigating non-household spread. However, future applications of digital proximity tracing should invest into stakeholder onboarding and increased process automatization - without deviating from the principles of voluntariness and user privacy.
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Affiliation(s)
- Paola Daniore
- Institute for Implementation Science in Health Care, University of Zurich, Switzerland .,Digital Society Initiative, University of Zurich, Switzerland
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Viktor von Wyl
- Institute for Implementation Science in Health Care, University of Zurich, Switzerland .,Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
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Ballouz T, Menges D, Aschmann HE, Domenghino A, Fehr JS, Puhan MA, von Wyl V. Adherence and Association of Digital Proximity Tracing App Notifications With Earlier Time to Quarantine: Results From the Zurich SARS-CoV-2 Cohort Study. Int J Public Health 2021; 66:1603992. [PMID: 34471402 PMCID: PMC8404355 DOI: 10.3389/ijph.2021.1603992] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: We aimed to evaluate the effectiveness of the SwissCovid digital proximity tracing (DPT) app in notifying exposed individuals and prompting them to quarantine earlier compared to individuals notified only by manual contact tracing (MCT). Methods: A population-based sample of cases and close contacts from the Zurich SARS-CoV-2 Cohort was surveyed regarding SwissCovid app use and SARS-CoV-2 exposure. We descriptively analyzed app adherence and effectiveness, and evaluated its effects on the time between exposure and quarantine among contacts using stratified multivariable time-to-event analyses. Results: We included 393 SARS-CoV-2 infected cases and 261 close contacts. 62% of cases reported using SwissCovid and among those, 88% received and uploaded a notification code. 71% of close contacts were app users, of which 38% received a warning. Non-household contacts notified by SwissCovid started quarantine 1 day earlier and were more likely to quarantine earlier than those not warned by the app (HR 1.53, 95% CI 1.15-2.03). Conclusion: These findings provide evidence that DPT may reach exposed contacts faster than MCT, with earlier quarantine and potential interruption of SARS-CoV-2 transmission chains.
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Affiliation(s)
- Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, Zürich, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Hélène E Aschmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Anja Domenghino
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland.,Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Jan S Fehr
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, Zürich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland.,Institute for Implementation Science in Health Care, University of Zurich, Zürich, Switzerland
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Yebyo HG, Braun J, Menges D, Ter Riet G, Sadatsafavi M, Puhan MA. Personalising add-on treatment with inhaled corticosteroids in patients with chronic obstructive pulmonary disease: a benefit-harm modelling study. Lancet Digit Health 2021; 3:e644-e653. [PMID: 34452874 DOI: 10.1016/s2589-7500(21)00130-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since the benefit-harm balance of adding inhaled corticosteroids to long-acting β2-agonists (LABA) and long-acting muscarinic antagonists (LAMA) for patients with chronic obstructive pulmonary disease is unclear, we evaluated this addition for a range of patient profiles. METHODS Analyses considered the effects of low-to-moderate doses of inhaled corticosteroids, LABA, and LAMA compared with LABA and LAMA alone, outcome incidences, and preference weights assigned to averted moderate-to-severe exacerbations (benefit) and severe pneumonia, candidiasis, and dysphonia (harm). Using exponential models, we estimated the preference weight-adjusted 2-year net clinical benefit (ie, benefits outweighing harms) indices. Exacerbation risk thresholds for triggering inhaled corticosteroids, LABA, and LAMA were established when the probability of a 2-year net clinical benefit reached 60%. We estimated the proportion of patients benefiting from added inhaled corticosteroids using an externally validated prediction model for acute exacerbations in primary care. FINDINGS Adding low-to-moderate dose inhaled corticosteroids to LABA and LAMA provided a net clinical benefit in patients with a 2-year baseline exacerbation risk of 54-83%. Low-dose inhaled corticosteroids showed a net clinical benefit if the baseline risk was 40-91%, but not at higher doses. The benefit was modified by blood eosinophil count (BEC) and age. Although no net benefit was associated with a BEC of less than 150 cells per μL, patients with a BEC of 150 cells per μL or more had a net benefit from low-dose inhaled corticosteroids with a 2-year exacerbation risk of 32-95% in those aged 40-79 years and 41-93% in those older than 80 years. A moderate dose of inhaled corticosteroids showed a net benefit in patients younger than 80 years with a BEC of 150 cells per μL or more at 52-86% 2-year exacerbation risk. Depending on the subgroups, the proportion of patients with a net benefit from added inhaled corticosteroids ranged from 0 to 68%. INTERPRETATION The net clinical benefit of adding different inhaled corticosteroid doses to LABA and LAMA varies greatly with exacerbation risk, BEC, and age. Personalised treatment decisions based on these factors and predicted exacerbation risks might reduce overtreatment and undertreatment with inhaled corticosteroids. FUNDING None.
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Affiliation(s)
- Henock G Yebyo
- Department of Epidemiology, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Julia Braun
- Department of Epidemiology, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dominik Menges
- Department of Epidemiology, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Gerben Ter Riet
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Urban Vitality Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Programme, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Milo A Puhan
- Department of Epidemiology, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland.
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Menges D, Ballouz T, Anagnostopoulos A, Aschmann HE, Domenghino A, Fehr JS, Puhan MA. Burden of post-COVID-19 syndrome and implications for healthcare service planning: A population-based cohort study. PLoS One 2021; 16:e0254523. [PMID: 34252157 PMCID: PMC8274847 DOI: 10.1371/journal.pone.0254523] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Longer-term consequences after SARS-CoV-2 infection are becoming an important burden to societies and healthcare systems. Data on post-COVID-19 syndrome in the general population are required for the timely planning of healthcare services and resources. The objective of this study was to assess the prevalence of impaired health status and physical and mental health symptoms among individuals at least six months after SARS-CoV-2 infection, and to characterize their healthcare utilization. METHODS This population-based prospective cohort study (Zurich SARS-CoV-2 Cohort) enrolled 431 adults from the general population with polymerase chain reaction-confirmed SARS-CoV-2 infection reported to health authorities between 27 February 2020 and 05 August 2020 in the Canton of Zurich, Switzerland. We evaluated the proportion of individuals reporting not to have fully recovered since SARS-CoV-2 infection, and the proportion reporting fatigue (Fatigue Assessment Scale), dyspnea (mMRC dyspnea scale) or depression (DASS-21) at six to eight months after diagnosis. Furthermore, the proportion of individuals with at least one healthcare contact after their acute illness was evaluated. Multivariable logistic regression models were used to assess factors associated with these main outcomes. RESULTS Symptoms were present in 385 (89%) participants at diagnosis and 81 (19%) were initially hospitalized. At six to eight months, 111 (26%) reported not having fully recovered. 233 (55%) participants reported symptoms of fatigue, 96 (25%) had at least grade 1 dyspnea, and 111 (26%) had DASS-21 scores indicating symptoms of depression. 170 (40%) participants reported at least one general practitioner visit related to COVID-19 after acute illness, and 10% (8/81) of initially hospitalized individuals were rehospitalized. Individuals that have not fully recovered or suffer from fatigue, dyspnea or depression were more likely to have further healthcare contacts. However, a third of individuals (37/111) that have not fully recovered did not seek further care. CONCLUSIONS In this population-based study, a relevant proportion of participants suffered from longer-term consequences after SARS-CoV-2 infection. With millions infected across the world, our findings emphasize the need for the timely planning of resources and patient-centered services for post-COVID-19 care.
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Affiliation(s)
- Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Alexia Anagnostopoulos
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Hélène E. Aschmann
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Anja Domenghino
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland
| | - Jan S. Fehr
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
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Menges D, Aschmann HE, Moser A, Althaus CL, von Wyl V. A Data-Driven Simulation of the Exposure Notification Cascade for Digital Contact Tracing of SARS-CoV-2 in Zurich, Switzerland. JAMA Netw Open 2021; 4:e218184. [PMID: 33929521 PMCID: PMC8087953 DOI: 10.1001/jamanetworkopen.2021.8184] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/10/2021] [Indexed: 12/13/2022] Open
Abstract
Importance Digital contact tracing (DCT) apps have been released in several countries to help interrupt SARS-CoV-2 transmission chains. However, the effect of DCT on pandemic mitigation remains to be demonstrated. Objective To estimate key populations and performance indicators along the exposure notification cascade of the SwissCovid DCT app in a clearly defined regional and temporal context. Design, Setting, and Participants This comparative effectiveness study was based on a simulation informed by measured data from issued quarantine recommendations and positive SARS-CoV-2 test results after DCT exposure notifications in the canton of Zurich. A stochastic model was developed to re-create the DCT notification cascade for Zurich. Population sizes at each cascade step were estimated using triangulation based on publicly available administrative and observational research data for the study duration from September 1 to October 31, 2020. The resultant estimates were checked for internal consistency and consistency with upstream or downstream estimates in the cascade. Stochastic sampling from data-informed parameter distributions was performed to explore the robustness of results. Subsequently, key performance indicators were evaluated to assess the potential contribution of DCT compared with manual contact tracing. Main Outcomes and Measures Receiving a voluntary quarantine recommendation and/or a positive SARS-CoV-2 test result after exposure notification. Results In September 2020, 537 app users received a positive SARS-CoV-2 test result in Zurich, 324 of whom received and entered an upload authorization code. This code triggered an app notification for an estimated 1374 (95% simulation interval [SI], 932-2586) proximity contacts and led to 722 information hotline calls, with an estimated 170 callers (95% SI, 154-186) receiving a quarantine recommendation. An estimated 939 (95% SI, 720-1127) notified app users underwent testing for SARS-CoV-2, of whom 30 (95% SI, 23-36) had positive results after an app notification. Key indicator evaluations revealed that the DCT app triggered quarantine recommendations for the equivalent of 5% of all exposed contacts placed in quarantine by manual contact tracing. For every 10.9 (95% SI, 7.6-15.6) upload authorization codes entered in the app, 1 contact had positive test results for SARS-CoV-2 after app notification. Longitudinal indicator analyses demonstrated bottlenecks in the notification cascade, because capacity limits were reached owing to an increased incidence of SARS-CoV-2 infection in October 2020. Conclusions and Relevance In this simulation study of the notification cascade of the SwissCovid DCT app, receipt of exposure notifications was associated with quarantine recommendations and identification of SARS-CoV-2-positive cases. These findings in notified proximity contacts reflect important intermediary steps toward transmission prevention.
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Affiliation(s)
- Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Hélène E. Aschmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - André Moser
- CTU Bern, University of Bern, Bern, Switzerland
| | - Christian L. Althaus
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
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30
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von Wyl V, Höglinger M, Sieber C, Kaufmann M, Moser A, Serra-Burriel M, Ballouz T, Menges D, Frei A, Puhan MA. Drivers of Acceptance of COVID-19 Proximity Tracing Apps in Switzerland: Panel Survey Analysis. JMIR Public Health Surveill 2021; 7:e25701. [PMID: 33326411 PMCID: PMC7790736 DOI: 10.2196/25701] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Digital proximity tracing apps have been released to mitigate the transmission of SARS-CoV-2, the virus known to cause COVID-19. However, it remains unclear how the acceptance and uptake of these apps can be improved. OBJECTIVE This study aimed to investigate the coverage of the SwissCovid app and the reasons for its nonuse in Switzerland during a period of increasing incidence of COVID-19 cases. METHODS We collected data between September 28 and October 8, 2020, via a nationwide online panel survey (COVID-19 Social Monitor, N=1511). We examined sociodemographic and behavioral factors associated with app use by using multivariable logistic regression, whereas reasons for app nonuse were analyzed descriptively. RESULTS Overall, 46.5% (703/1511) of the survey participants reported they used the SwissCovid app, which was an increase from 43.9% (662/1508) reported in the previous study wave conducted in July 2020. A higher monthly household income (ie, income >CHF 10,000 or >US $11,000 vs income ≤CHF 6000 or CONCLUSIONS Eliminating technical hurdles and communicating the benefits of digital proximity tracing apps are crucial to promote further uptake and adherence of such apps and, ultimately, enhance their effectiveness to aid pandemic mitigation strategies.
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Affiliation(s)
- Viktor von Wyl
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zürich, Switzerland
| | - Marc Höglinger
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Chloé Sieber
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Marco Kaufmann
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
| | - André Moser
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Miquel Serra-Burriel
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Tala Ballouz
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Dominik Menges
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Anja Frei
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Milo Alan Puhan
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
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31
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Menges D, Seiler B, Tomonaga Y, Schwenkglenks M, Puhan MA, Yebyo HG. Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Crit Care 2021; 25:16. [PMID: 33407707 PMCID: PMC7789482 DOI: 10.1186/s13054-020-03446-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/18/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to determine the effectiveness of systematic early mobilization in improving muscle strength and physical function in mechanically ventilated intensive care unit (ICU) patients. METHODS We conducted a two-stage systematic literature search in MEDLINE, EMBASE and the Cochrane Library until January 2019 for randomized controlled trials (RCTs) examining the effects of early mobilization initiated within 7 days after ICU admission compared with late mobilization, standard early mobilization or no mobilization. Priority outcomes were Medical Research Council Sum Score (MRC-SS), incidence of ICU-acquired weakness (ICUAW), 6-min walk test (6MWT), proportion of patients reaching independence, time needed until walking, SF-36 Physical Function Domain Score (PFS) and SF-36 Physical Health Component Score (PCS). Meta-analysis was conducted where sufficient comparable evidence was available. We evaluated the certainty of evidence according to the GRADE approach. RESULTS We identified 12 eligible RCTs contributing data from 1304 participants. Two RCTs were categorized as comparing systematic early with late mobilization, nine with standard early mobilization and one with no mobilization. We found evidence for a benefit of systematic early mobilization compared to late mobilization for SF-36 PFS (MD 12.3; 95% CI 3.9-20.8) and PCS (MD 3.4; 95% CI 0.01-6.8), as well as on the proportion of patients reaching independence and the time needed to walking, but not for incidence of ICUAW (RR 0.62; 95% CI 0.38-1.03) or MRC-SS. For systematic early compared to standard early mobilization, we found no statistically significant benefit on MRC-SS (MD 5.8; 95% CI - 1.4 to 13.0), incidence of ICUAW (RR 0.90; 95% CI 0.63-1.27), SF-36 PFS (MD 8.1; 95% CI - 15.3 to 31.4) or PCS (MD - 2.4; 95% CI - 6.1 to 1.3) or other priority outcomes except for change in 6MWT from baseline. Generally, effects appeared stronger for systematic early compared to late mobilization than to standard early mobilization. We judged the certainty of evidence for all outcomes as very low to low. CONCLUSION The evidence regarding a benefit of systematic early mobilization remained inconclusive. However, our findings indicate that the larger the difference in the timing between the intervention and the comparator, the more likely an RCT is to find a benefit for early mobilization. STUDY REGISTRATION PROSPERO (CRD42019122555).
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Affiliation(s)
- Dominik Menges
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.
| | - Bianca Seiler
- Faculty of Medicine (MeF), University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Yuki Tomonaga
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Matthias Schwenkglenks
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Milo A Puhan
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Henock G Yebyo
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
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Salathé M, Althaus C, Anderegg N, Antonioli D, Ballouz T, Bugnon E, Čapkun S, Jackson D, Kim SI, Larus J, Low N, Lueks W, Menges D, Moullet C, Payer M, Riou J, Stadler T, Troncoso C, Vayena E, von Wyl V. Early evidence of effectiveness of digital contact tracing for SARS-CoV-2 in Switzerland. Swiss Med Wkly 2020; 150:w20457. [PMID: 33327003 DOI: 10.4414/smw.2020.20457] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In the wake of the pandemic of coronavirus disease 2019 (COVID-19), contact tracing has become a key element of strategies to control the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Given the rapid and intense spread of SARS-CoV-2, digital contact tracing has emerged as a potential complementary tool to support containment and mitigation efforts. Early modelling studies highlighted the potential of digital contact tracing to break transmission chains, and Google and Apple subsequently developed the Exposure Notification (EN) framework, making it available to the vast majority of smartphones. A growing number of governments have launched or announced EN-based contact tracing apps, but their effectiveness remains unknown. Here, we report early findings of the digital contact tracing app deployment in Switzerland. We demonstrate proof-of-principle that digital contact tracing reaches exposed contacts, who then test positive for SARS-CoV-2. This indicates that digital contact tracing is an effective complementary tool for controlling the spread of SARS-CoV-2. Continued technical improvement and international compatibility can further increase the efficacy, particularly also across country borders.
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Affiliation(s)
- Marcel Salathé
- Digital Epidemiology Lab, Global Health Institute, School of Life Sciences, EPFL, Geneva, Switzerland / School of Computer and Communication Sciences, EPFL, Switzerland
| | - Christian Althaus
- Institute of Social and Preventive Medicine, University of Bern, Switzerland; Interfaculty Platform for Data and Computational Science (INPUT), University of Bern, Switzerland
| | - Nanina Anderegg
- Institute of Social and Preventive Medicine, University of Bern, Switzerland; Division of infectious diseases, Federal Office of Public Health, Liebefeld, Switzerland
| | | | - Tala Ballouz
- Federal Office of Information Technology, Systems and Telecommunication, Bern, Switzerland
| | - Edouard Bugnon
- School of Computer and Communication Sciences, EPFL, Switzerland
| | - Srdjan Čapkun
- Department of Computer Science, ETH Zurich, Switzerland
| | | | - Sang-Il Kim
- Federal Office of Public Health, Liebefeld, Switzerland
| | - Jim Larus
- School of Computer and Communication Sciences, EPFL, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Wouter Lueks
- School of Computer and Communication Sciences, EPFL, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Cédric Moullet
- Federal Office of Information Technology, Systems and Telecommunication, Bern, Switzerland
| | - Mathias Payer
- School of Computer and Communication Sciences, EPFL, Switzerland
| | - Julien Riou
- Institute of Social and Preventive Medicine, University of Bern, Switzerland; Interfaculty Platform for Data and Computational Science (INPUT), University of Bern, Switzerland
| | - Theresa Stadler
- School of Computer and Communication Sciences, EPFL, Switzerland
| | - Carmela Troncoso
- School of Computer and Communication Sciences, EPFL, Switzerland
| | - Effy Vayena
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zurich, Switzerland
| | - Viktor von Wyl
- Digital and Mobile Health Group, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
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Yebyo HG, Aschmann HE, Menges D, Boyd CM, Puhan MA. Net benefit of statins for primary prevention of cardiovascular disease in people 75 years or older: a benefit-harm balance modeling study. Ther Adv Chronic Dis 2019; 10:2040622319877745. [PMID: 31598209 PMCID: PMC6764041 DOI: 10.1177/2040622319877745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/28/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We determined the risk thresholds above which statin use would be more likely to provide a net benefit for people over the age of 75 years without history of cardiovascular disease (CVD). METHODS An exponential model was used to estimate the differences in expected benefit and harms in people treated with statins over a 10-year horizon versus not treated. The analysis was repeated 100,000 times to consider the statistical uncertainty and produce a distribution of the benefit-harm balance index from which we determined the 10-year CVD risk threshold where benefits outweighed the harms. We considered treatment estimates from trials and observational studies, baseline risks, patient preferences, and competing risks of non-CVD death, and statistical uncertainty. RESULTS Based on average preferences, statins were more likely to provide a net benefit at a 10-year CVD risk of 24% and 25% for men aged 75-79 years and 80-84 years, respectively, and 21% for women in both age groups. However, these thresholds varied significantly depending on differences in individual patient preferences for the statin-related outcomes, with interquartile ranges of 21-33% and 23-36% for men aged 75-79 years and 80-84 years, respectively, as well as 20-32% and 21-32% for women aged 75-79 years and 80-84 years, respectively. CONCLUSIONS Statins would more likely provide a net benefit for primary prevention in older people taking the average preferences if their CVD risk is well above 20%. However, the thresholds could be much higher or lower depending on preferences of individual patients, which suggests more emphasis should be placed on individual-based decision-making, instead of recommending statins for everyone based on a single or a small number of thresholds.
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Affiliation(s)
- Henock G. Yebyo
- Epidemiology, Biostatistics & Prevention
Institute, University of Zurich, Hirschengraben 84, Zurich, CH-8001,
Switzerland
| | - Hélène E. Aschmann
- Department of Epidemiology; Epidemiology,
Biostatistics and Prevention Institute, University of Zurich, Zurich,
Switzerland
| | - Dominik Menges
- Department of Epidemiology; Epidemiology,
Biostatistics and Prevention Institute, University of Zurich, Zurich,
Switzerland
| | - Cynthia M. Boyd
- The Johns Hopkins University, School of
Medicine, Baltimore, MD, USA
| | - Milo A. Puhan
- Department of Epidemiology; Epidemiology,
Biostatistics and Prevention Institute, University of Zurich, Zurich,
Switzerland
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Slomianka L, Drenth T, Cavegn N, Menges D, Lazic SE, Phalanndwa M, Chimimba CT, Amrein I. The hippocampus of the eastern rock sengi: cytoarchitecture, markers of neuronal function, principal cell numbers, and adult neurogenesis. Front Neuroanat 2013; 7:34. [PMID: 24194702 PMCID: PMC3810719 DOI: 10.3389/fnana.2013.00034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/26/2013] [Indexed: 12/04/2022] Open
Abstract
The brains of sengis (elephant shrews, order Macroscelidae) have long been known to contain a hippocampus that in terms of allometric progression indices is larger than that of most primates and equal in size to that of humans. In this report, we provide descriptions of hippocampal cytoarchitecture in the eastern rock sengi (Elephantulus myurus), of the distributions of hippocampal calretinin, calbindin, parvalbumin, and somatostatin, of principal neuron numbers, and of cell numbers related to proliferation and neuronal differentiation in adult hippocampal neurogenesis. Sengi hippocampal cytoarchitecture is an amalgamation of characters that are found in CA1 of, e.g., guinea pig and rabbits and in CA3 and dentate gyrus of primates. Correspondence analysis of total cell numbers and quantitative relations between principal cell populations relate this sengi to macaque monkeys and domestic pigs, and distinguish the sengi from distinct patterns of relations found in humans, dogs, and murine rodents. Calretinin and calbindin are present in some cell populations that also express these proteins in other species, e.g., interneurons at the stratum oriens/alveus border or temporal hilar mossy cells, but neurons expressing these markers are often scarce or absent in other layers. The distributions of parvalbumin and somatostatin resemble those in other species. Normalized numbers of PCNA+ proliferating cells and doublecortin-positive (DCX+) differentiating cells of neuronal lineage fall within the overall ranges of murid rodents, but differed from three murid species captured in the same habitat in that fewer DCX+ cells relative to PCNA+ were observed. The large and well-differentiated sengi hippocampus is not accompanied by correspondingly sized cortical and subcortical limbic areas that are the main hippocampal sources of afferents and targets of efferents. This points to intrinsic hippocampal information processing as the selective advantage of the large sengi hippocampus.
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Affiliation(s)
- Lutz Slomianka
- Institute of Anatomy, University of ZürichZürich, Switzerland
| | - Tanja Drenth
- Institute of Anatomy, University of ZürichZürich, Switzerland
| | - Nicole Cavegn
- Institute of Anatomy, University of ZürichZürich, Switzerland
| | - Dominik Menges
- Institute of Anatomy, University of ZürichZürich, Switzerland
| | - Stanley E. Lazic
- In Silico Lead Discovery, Novartis Institutes for Biomedical ResearchBasel, Switzerland
| | - Mashudu Phalanndwa
- Mammal Research Institute, Department of Zoology and Entomology, University of PretoriaHatfield, South Africa
- Western Cape Nature Conservation Board (CapeNature)Cape Town, South Africa
| | - Christian T. Chimimba
- Mammal Research Institute, Department of Zoology and Entomology, University of PretoriaHatfield, South Africa
- Department of Science and Technology-National Research Foundation Centre of Excellence for Invasion Biology, Department of Zoology and Entomology University of PretoriaHatfield, South Africa
| | - Irmgard Amrein
- Institute of Anatomy, University of ZürichZürich, Switzerland
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Cavegn N, van Dijk RM, Menges D, Brettschneider H, Phalanndwa M, Chimimba CT, Isler K, Lipp HP, Slomianka L, Amrein I. Habitat-specific shaping of proliferation and neuronal differentiation in adult hippocampal neurogenesis of wild rodents. Front Neurosci 2013; 7:59. [PMID: 23616743 PMCID: PMC3629335 DOI: 10.3389/fnins.2013.00059] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 03/31/2013] [Indexed: 11/13/2022] Open
Abstract
Daily life of wild mammals is characterized by a multitude of attractive and aversive stimuli. The hippocampus processes complex polymodal information associated with such stimuli and mediates adequate behavioral responses. How newly generated hippocampal neurons in wild animals contribute to hippocampal function is still a subject of debate. Here, we test the relationship between adult hippocampal neurogenesis (AHN) and habitat types. To this end, we compare wild Muridae species of southern Africa [Namaqua rock mouse (Micaelamys namaquensis), red veld rat (Aethomys chrysophilus), highveld gerbil (Tatera brantsii), and spiny mouse (Acomys spinosissimus)] with data from wild European Muridae [long-tailed wood mice (Apodemus sylvaticus), pygmy field mice (Apodemus microps), yellow-necked wood mice (Apodemus flavicollis), and house mice (Mus musculus domesticus)] from previous studies. The pattern of neurogenesis, expressed in normalized numbers of Ki67- and Doublecortin(DCX)-positive cells to total granule cells (GCs), is similar for the species from a southern African habitat. However, we found low proliferation, but high neuronal differentiation in rodents from the southern African habitat compared to rodents from the European environment. Within the African rodents, we observe additional regulatory and morphological traits in the hippocampus. Namaqua rock mice with previous pregnancies showed lower AHN compared to males and nulliparous females. The phylogenetically closely related species (Namaqua rock mouse and red veld rat) show a CA4, which is not usually observed in murine rodents. The specific features of the southern environment that may be associated with the high number of young neurons in African rodents still remain to be elucidated. This study provides the first evidence that a habitat can shape adult neurogenesis in rodents across phylogenetic groups.
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Affiliation(s)
- Nicole Cavegn
- Institute of Anatomy, University of Zurich Zurich, Switzerland
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Kujath P, Bruch HP, Schmidt E, Menges D. [Biomechanics and histological examinations on the pathogenesis of appendicitis]. Chirurg 1980; 51:589-91. [PMID: 7460684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
After appendectomy 60 appendices were examined for their biomechanical characteristics. The active contraction capability and the relaxation after noradrenaline were registered in Tyrode's solution by a tension recorder, and a length/tension graph was drawn up. After histological examination of the appendices, the findings were classified as the classical inflammation stadium. It was shown that the appendix wall can retain its physiological properties up to an advanced stage of inflammation. Physiological decomposition and paralysis of the appendix wall occur only when gangrene sets. Examination also showed that in the subacute inflammation stage scars are formed which cause motility disorders which, in their turn, also cause inflammation.
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