In a COVID‐19 sero‐surveillance cohort study with predominantly healthy and vaccinated individuals, the objectives were (i) to investigate longitudinally the factors associated with the quantitative ...dynamics of antispike (anti‐S1) IgG antibody levels, (ii) to evaluate whether the levels were associated with protection from SARS‐CoV‐2 infection, and (iii) to assess whether the association was different in the pre‐Omicron compared with the Omicron period. The QuantiVac Euroimmun ELISA test was used to quantify anti‐S1 IgG levels. The entire study period (16 months), the 11‐month pre‐Omicron period and the cross‐sectional analysis before the Omicron surge included 3219, 2310, and 895 reactive serum samples from 949, 919, and 895 individuals, respectively. Mixed‐effect linear, mixed‐effect time‐to‐event, and logistic regression models were used to achieve the objectives. Age and time since infection or vaccination were the only factors associated with a decline of anti‐S1 IgG levels. Higher antibody levels were significantly associated with protection from SARS‐CoV‐2 infection (0.89, 95% confidence interval CI 0.82–0.97), and the association was higher during the time period when Omicron was predominantly circulating compared with the ones when Alpha and Delta variants were predominant (adjusted hazard ratio for interaction 0.66, 95% CI 0.53–0.84). In a prediction model, it was estimated that >8000 BAU/mL anti‐S1 IgG was required to reduce the risk of infection with Omicron variants by approximately 20%–30% for 90 days. Though, such high levels were only found in 1.9% of the samples before the Omicron surge, and they were not durable for 3 months. Anti‐S1 IgG antibody levels are statistically associated with protection from SARS‐CoV‐2 infection. However, the prediction impact of the antibody level findings on infection protection is limited.
Background
Statin therapy in multimorbid older individuals with polypharmacy is controversial, particularly in primary prevention of cardiovascular disease. Thereby, physicians must weigh potential ...benefits against potential side effects, drug-drug interactions, and limited life expectancy.
Aim
To assess the prevalence and determinants of potentially inappropriate statin therapy in multimorbid older patients.
Methods
We conducted a cross-sectional analysis of patients aged ≥70 years with multimorbidity and polypharmacy in the Swiss study center of OPERAM, a cluster-randomized trial on pharmacotherapy optimization to reduce drug-related hospital admissions. We assessed potential underuse (no statin but formal indication) and potential overuse (statin but no formal indication, including predicted >60% one-year mortality based on the Walter Score) based on current guidelines for patients in secondary and primary cardiovascular prevention. We assessed the association of potential statin overuse and underuse with six patient characteristics (age, gender, number of diagnoses, number of medications, mental impairment, being housebound) in LASSO-selection analyses.
Results
Of 715 multimorbid older adults (79.7 ± 6.5 years, 39.9% women), 337 (47%) were on statin. Statin therapy was appropriate in 474 (66.3%), underused in 130 (18.2%), and overused in 111 (15.5%) patients. In participants in secondary cardiovascular prevention (
n
= 437), being female (odds ratio OR 2.65, 95% confidence interval CI 1.67–4.22) was significantly associated with potential underuse while being housebound (OR 3.53, 95%CI 1.32–9.46) and taking ≥10 medications (OR 1.95,95%CI 1.05–3.67) were associated with potential overuse. In participants in primary cardiovascular prevention (
n
= 278), 28.1% were potentially under- (9%) or overusing (19%) a statin, with no identified risk factor.
Conclusion
A third of hospitalized multimorbid older patients with polypharmacy potentially (either) overused or underused statin therapy. Among patients in secondary cardiovascular prevention, women were at risk for potential statin underuse. Housebound patients and those taking ≥10 medications were at risk for potential overuse of a statin. Physicians should carefully evaluate the indication for statin prescription in multimorbid older patients with polypharmacy.
Introduction
To assess the risk for COVID‐19 of police officers, we are studying the seroprevalence in a cohort. The baseline cross‐sectional investigation was performed before a vaccination campaign ...in January/February 2021, and demonstrated a seroprevalence of 12.9%. Here, we demonstrate serosurveillance results after a vaccination campaign.
Methods
The cohort consists of 1022 study participants. The 3‐ and 6‐month follow‐up visits were performed in April/May and September 2021. Data on infection and vaccination rates were obtained via measuring antibodies to the nucleocapsid protein and spike protein and online questionnaires.
Results
The mean age of the population was 41 (SD 8.8) years, 72% were male and 76% had no comorbidity. Seroconversion was identified in 1.05% of the study population at the 3‐month visit and in 0.73% at the 6‐month visit, resulting in an infection rate of 1.8% over a time period of 6 months. In comparison, the infection rate in the general population over the same time period was higher (3.18%, p = .018). At the 6‐month visit, 77.8% of participants reported being vaccinated once and 70.5% twice; 81% had an anti‐S antibody titer of >250 U/ml and 87.1% of ≥2 U/ml. No significant association between infection and job role within the department, working region, or years of experience in the job was found. Anti‐spike antibody titers of vaccinated study participants showed a calculated decreasing trend 150–200 days after the second vaccine dose.
Conclusion
These data confirm the value of the vaccination campaign in an exposed group other than healthcare professionals.
Graphical
In this serosurveillance study, we observed a high vaccination and low infection rate during the delta surge in a police cohort. Anti‐Spike antibody titers of vaccinated study participants showed a calculated decreasing trend 150–200 days after the second vaccine dose.
Subclinical hypothyroidism, which is defined as elevated thyroid-stimulating hormone (TSH) levels with free thyroxine concentrations within the reference range, is a common disorder that increases ...with age and affects up to 18% of the elderly, with a higher prevalence in women compared to men. Prospective data have shown an increased risk of coronary heart disease events, heart failure, and cardiovascular mortality among affected adults. Conflicting results have been found on the association between subclinical hypothyroidism and cognitive impairment, depression and the risk of fractures. Management strategies including screening and treatment of subclinical hypothyroidism are still controversial, while the ongoing European randomised controlled trial "TRUST" targets to solve these uncertainties. This narrative review aims to assess current evidence on the clinical aspects, as well as screening and treatment recommendations in adults with subclinical hypothyroidism.
Abstract
Background
Protests and police fieldwork provide a high-exposure environment for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. In this cross-sectional analysis, we ...investigated the seroprevalence among a police cohort, and sociodemographic, work, and health-related factors associated with seropositivity.
Methods
Study participants were invited for serological testing of SARS-CoV-2 and to complete online questionnaires. Serum neutralization titers toward the wild-type SARS-CoV-2 spike protein (expressing D614G) and the Alpha and Beta variants were measured in seropositive study participants.
Results
A total of 978 police personnel representing 35% of the entire staff participated from February to March 2021. The seroprevalence was 12.9%. It varied by geographic region, ranged from 9% to 13.5% in 3 regions, including the city; and was 22% in Bernese Seeland/Jura with higher odds for seropositivity (odds ratio OR, 2.38 95% confidence interval {CI}, 1.28–4.44, P=.006). Job roles with mainly office activity were associated with a lower risk of seropositivity (OR, 0.33 95% CI, .14–.77, P=.010). Self-reported compliance with mask wearing during working hours was 100%; 45% of seropositive vs 5% of seronegative participants (P<.001) reported having had contact with a proven coronavirus disease 2019 (COVID-19) case living in the same household prior to serological testing. The level of serum antibody titers correlated with neutralization capacity. Antibodies derived from natural SARS-CoV-2 infection effectively neutralized the SARS-CoV-2 spike protein, but were less effective against the Alpha and Beta variants.
Conclusions
The seroprevalence of anti–SARS-CoV-2 antibodies of police officers was comparable to that reported in the general population, suggesting that the personal protective equipment of the police is effective, and that household contacts are the leading transmission venues. The level of serum antibody titers, in particular that of anti-spike antibodies, correlated well with neutralization capacity. Low antibody titers acquired from natural infection were not effective against variants.
Clinical Trials Registration
NCT04643444.
The seroprevalence of anti–SARS-CoV-2 antibodies of police officers was comparable to that reported in the general population. The level of serum antibody titers correlates well with neutralization capacity. Low antibody titers acquired from natural infection are not effective against variants.
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