The severe acute respiratory syndrome coronavirus (SARS‐CoV‐2) disease or COVID‐19 pandemic is associated with more than 230 million cases and has challenged healthcare systems globally. Many ...healthcare workers (HCWs) have acquired the infection, often through their workplace, with a significant number dying. The epidemiology of COVID‐19 infection in HCWs continues to be explored, with manifold exposure risks identified, leading to COVID‐19 being recognised as an occupational disease for HCWs. The physical illness due to COVID‐19 in HCWs is similar to the general population, with some HCWs experiencing a long‐term illness, which may impact their ability to return to work. HCWs have also been affected by the immense workplace and psychosocial disruption caused by the pandemic. The impacts on the psychological well‐being of HCWs globally have been profound, with high prevalence estimates for mental health symptoms, including emotional exhaustion. Globally, governments, healthcare organisations and employers have key responsibilities, including: to be better prepared for crises with comprehensive disaster response management plans, and to protect and preserve the health workforce from the physical and psychological impacts of the pandemic. While prioritising HCWs in vaccine rollouts globally has been critical, managing exposures and outbreaks occurring in healthcare settings remains challenging and continues to lead to substantial disruption to the health workforce. Safeguarding healthcare workforces during crises is critical as we move forward on the new path of ‘COVID normal’.
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The emergence of the Delta variant of SARS-CoV-2 has made Australia’s ‘COVID-zero’ strategy unviable. As signalled by the Australian Government’s National plan to transition Australia’s national ...COVID-19 response, we need to plan a pathway forward for life beyond lockdown. However, this plan must be guided by long overdue discussions on our tolerance for serious illness, and hospital and intensive care unit capacity. The modelling that informs the national transition plan remains relevant, even with increases in case numbers, but one crucial thing that does change if cases continue to escalate is the effectiveness of test, trace and isolate models. As we move into suppression mode with higher rates of the population fully vaccinated, we will no longer need to find every case. This is among the many shifts in approach that will shape our transition by early 2022 to living with – and controlling – the disease.
This article presents a longitudinal analysis of COVID-19 infection and vaccination coverage in Melbourne metropolitan local government areas (LGAs) during the 2021 Delta wave.
COVID-19 vaccination ...and infection data from 12 July to 27 November 2021 were sourced from government websites. Summary statistics and associated 95% confidence intervals (95% CI) were compared by LGA ranked according to socioeconomic status: total “burden” (total infections per thousand), “peak” (highest weekly infection rate), “lag” (interval between peak and 70% double vaccination).
LGAs in the bottom five deciles for social advantage experienced higher infection rates (39.0 per thousand 95% CI: 38.5, 39.5 vs. 14.8 14.7, 14.9), and had lower two-dose vaccination coverage (23.8% 23.6, 23.9 vs. 32.7% 32.6, 32.7) compared with LGAs in the top five deciles. LGAs that achieved 70% coverage two weeks or more after the infection peak experienced nearly twice the total infection burden (27.7 per 1000 27.3, 28.0 compared with 14.9 14.7, 15.0) than LGAs with a shorter lag.
Exposure and transmission risk factors cluster within disadvantaged LGAs. The potential for large local outbreaks is heightened if vaccination uptake trails in these communities.
In a pandemic, decision-makers must prioritise disease control and harm reduction interventions for at-risk LGAs.
Background Partially hydrolyzed whey formula (pHWF) has been recommended for infants with a family history of allergic disease at the cessation of exclusive breast-feeding to promote oral tolerance ...and prevent allergic diseases. Objective To determine whether feeding infants pHWF reduces their risk of allergic disease. Methods A single-blind (participant) randomized controlled trial was conducted to compare allergic outcomes between infants fed a conventional cow’s milk formula, a pHWF, or a soy formula. Before birth, 620 infants with a family history of allergic disease were recruited and randomized to receive the allocated formula at cessation of breast-feeding. Skin prick tests to 6 common allergens (milk, egg, peanut, dust mite, rye grass, and cat dander) were performed at 6, 12, and 24 months. The primary outcome was development of allergic manifestations (eczema and food reactions) measured 18 times in the first 2 years of life. Results Follow-up was complete for 93% (575/620) at 2 years and 80% (495/620) at 6 or 7 years of age. There was no evidence that infants allocated to the pHWF (odds ratio, 1.21; 95% CI, 0.81-1.80) or the soy formula (odds ratio, 1.26; 95% CI, 0.84-1.88) were at a lower risk of allergic manifestations in infancy compared with conventional formula. There was also no evidence of reduced risk of skin prick test reactivity or childhood allergic disease. Conclusion Despite current dietary guidelines, we found no evidence to support recommending the use of pHWF at weaning for the prevention of allergic disease in high-risk infants.
Personalized medicine has emerged as the future of cancer care to ensure that patients receive individualized treatment specific to their needs. In order to provide such care, molecular techniques ...that enable oncologists to diagnose, treat, and monitor tumors are necessary. In the field of lung cancer, cell free DNA (cfDNA) shows great potential as a less invasive liquid biopsy technique, and next-generation sequencing (NGS) is a promising tool for analysis of tumor mutations. In this review, we outline the evolution of cfDNA and NGS and discuss the progress of using them in a clinical setting for patients with lung cancer. We also present an analysis of the role of cfDNA as a liquid biopsy technique and NGS as an analytical tool in studying EGFR and MET, two frequently mutated genes in lung cancer. Ultimately, we hope that using cfDNA and NGS for cancer diagnosis and treatment will become standard for patients with lung cancer and across the field of oncology.
Patients with psychotic disorders have increased rates of medical comorbidities. In this cross-sectional study, we investigated the relationship between antipsychotics and medical comorbidities among ...patients with psychotic disorders in an urban psychiatry clinic in Atlanta, Georgia (n = 860). Each antipsychotic group was compared to a group of patients from the same sample who were not on any antipsychotic, and logistic regression models were constructed for each comorbidity. Ziprasidone was associated with diabetes (aOR 2.56, 95% CI 1.03–6.38) and obesity (aOR 3.19, 95% CI 1.37–7.41). Aripiprazole was associated with obesity (aOR 2.39, 95% CI 1.27–4.51). Clozapine was associated with GERD (aOR 3.59, 95% CI 1.11–11.61), movement disorders (aOR 4.44, 95% CI 1.02–19.32), and arrythmias (4.89, 95% CI 1.44–16.64). Two antipsychotics that are considered weight neutral, ziprasidone and aripiprazole, were associated with cardiometabolic comorbidities. This study suggests that research is warranted to study the association between antipsychotics, medical comorbidity, and psychotic symptom burden.
Objective
Longitudinal evidence of relationships between unhealthy diets and BMI in children is crucial for appropriately targeting obesity prevention activities. The objective was to determine the ...relationship between frequency of consumption of sugar sweetened beverages (SSBs) and high fat foods (HFFs) and body weight in Australian children aged from 4 to 10 years.
Methods
Data from 4,164 children participating in four waves (wave 1, 2004; wave 2, 2006; wave 3, 2008; and wave 4, 2010) of the Longitudinal Study of Australian Children were analyzed. A multi‐level growth model tested relationships between consumption of SSB and HFF and BMI z‐scores.
Results
BMI z‐scores were associated with daily consumption of HFF, SSB and maternal BMI independent of BMI z‐scores at wave 1 (baseline); with each additional occurrence of SSB and HFF consumption intake per day, BMI z‐score increased by 0.015 U (P < 0.01) and 0.014 U (P < 0.001), respectively. With each additional maternal BMI unit, BMI z‐score increased by 0.032 (P < 0.001).
Conclusions
Higher BMI z‐scores were strongly associated with the consumption of SSBs and HFFs. Future efforts to prevent obesity should consider urgent action to address the impact of the consumption of SSBs and HFFs in childhood.
COVID-19 responses have cast a spotlight on the uneven impacts of public health policy with particular populations or sites targeted for intervention. Perhaps the starkest example in Australia was ...the 'hard' lockdown of nine public housing complexes in inner-city Melbourne from 4 to 18 July 2020, where residents were fully confined to their homes. These complexes are home to diverse migrant communities and the lockdown drew public criticism for unfairly stigmatising ethnic minorities. This article draws on media articles published during the lockdown and the Victorian Ombudsman's subsequent investigation to explore the implications of broad, top-down public health measures for culturally and linguistically diverse (CALD) communities. Drawing on Lea's (2020) conceptualisation of policy ecology, we analyse the lockdown measures and community responses to explore the normative assumptions underpinning health policy mechanisms, constituting 'target populations' in narrow, exclusionary terms. We argue that the lockdown measures and use of police as compliance officers positioned tower residents as risky subjects in risky places. Tracing how such subject positions are produced, and resisted at the grassroots level, we highlight how policy instruments are not neutral interventions, but rather instantiate classed and racialised patterns of exclusion, reinforcing pervasive social inequalities in the name of public health.
The emergency phase of the coronavirus disease 2019 (COVID-19) pandemic is over. Still, the work goes on in understanding the SARS-CoV-2 virus and its evolution, infection impacts – acute and long ...term – as well as therapeutics and the lessons for preventing and responding to future pandemics. Research into the long-term post-infection effects and therapeutic interventions also expands as the post-infection period lengthens. We provide an overview of the leading edge of COVID-19 research across clinical, epidemiological and social domains.
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