People of minority ethnic backgrounds may be disproportionately affected by severe COVID-19. Whether this relates to increased infection risk, more severe disease progression, or worse in-hospital ...survival is unknown. The contribution of comorbidities or socioeconomic deprivation to ethnic patterning of outcomes is also unclear.
We conducted a case-control and a cohort study in an inner city primary and secondary care setting to examine whether ethnic background affects the risk of hospital admission with severe COVID-19 and/or in-hospital mortality. Inner city adult residents admitted to hospital with confirmed COVID-19 (n = 872 cases) were compared with 3,488 matched controls randomly sampled from a primary healthcare database comprising 344,083 people residing in the same region. For the cohort study, we studied 1827 adults consecutively admitted with COVID-19. The primary exposure variable was self-defined ethnicity. Analyses were adjusted for socio-demographic and clinical variables.
The 872 cases comprised 48.1% Black, 33.7% White, 12.6% Mixed/Other and 5.6% Asian patients. In conditional logistic regression analyses, Black and Mixed/Other ethnicity were associated with higher admission risk than white (OR 3.12 95% CI 2.63–3.71 and 2.97 2.30–3.85 respectively). Adjustment for comorbidities and deprivation modestly attenuated the association (OR 2.24 1.83–2.74 for Black, 2.70 2.03–3.59 for Mixed/Other). Asian ethnicity was not associated with higher admission risk (adjusted OR 1.01 0.70–1.46). In the cohort study of 1827 patients, 455 (28.9%) died over a median (IQR) of 8 (4–16) days. Age and male sex, but not Black (adjusted HR 1.06 0.82–1.37) or Mixed/Other ethnicity (adjusted HR 0.72 0.47–1.10), were associated with in-hospital mortality. Asian ethnicity was associated with higher in-hospital mortality but with a large confidence interval (adjusted HR 1.71 1.15–2.56).
Black and Mixed ethnicity are independently associated with greater admission risk with COVID-19 and may be risk factors for development of severe disease, but do not affect in-hospital mortality risk. Comorbidities and socioeconomic factors only partly account for this and additional ethnicity-related factors may play a large role. The impact of COVID-19 may be different in Asians.
British Heart Foundation; the National Institute for Health Research; Health Data Research UK.
Background: The increasing aging of the population with the consequent increase of age-associated cognitive disorders pose the challenge of controlling its preventable risk factors, among which ...vitamin D deficit is a putative factor. Thus, our objective is to explore the association between vitamin D and cognitive performance in a cohort study of community-dwelling Chilean older people. Material and Methods: Cohort study of 955 (69.7% female), community-dwelling older Chileans free of cognitive impairment from the Alexandros cohorts, with 25(OH)D measurement at baseline. Cognitive Function was evaluated with the Mini Mental State Examination (MMSE) short-form questionnaire. Plasma levels of 25(OH)D were classified as Normal > 30 ng/mL Insufficiency 20−29 ng/mL, Deficiency 20−12 ng/mL and Severe Deficiency < 12 ng/mL. Penalized regressions models were made to assess associations. Results: Mean age of the sample was 66.6 + 4.5 years, with 8.5 + 4.7 years of education. After a mean follow-up of 9.6 years, 54 new cases of Mild Cognitive Impairment (MCI)were identified (Incidence density rate = 5.9 per 1000 person/years). Mean vitamin D plasma levels were lower in people with MCI than in the normal cognitive ones (23.0 + 12.75 vs. 28.35 + 15.17 ng/mL, p < 0.01). In the fully adjusted model only severe deficiency of vitamin D was associated with MCI (RR = 2.33; 95% CI: (1.03−5.26). Conclusions: In this longitudinal study, our results confirm that low Vitamin D is a risk factor for MCI, and that people with severe deficiency have more than double the risk of MCI people with normal Vitamin D levels. Considering the high frequency of vitamin D deficiency in older people, and its preventability, these results are very valuable for future public health programmes.
Growing evidence about the link between cognitive and physical decline suggests the early changes in physical functioning as a potential biomarker for cognitive impairment. Thus, we compared ...grip-strength trajectories over 12-16 years in three groups classified according to their cognitive status (two stable patterns, normal and impaired cognitive performance, and a declining pattern) in two representative UK and Chilean older adult samples. The samples consisted of 7069 UK (ELSA) and 1363 Chilean participants (ALEXANDROS). Linear Mixed models were performed. Adjustments included socio-demographics and health variables. The Declined and Impaired group had significantly lower grip-strength at baseline when compared to the Non-Impaired. In ELSA, the Declined and Impaired showed a faster decline in their grip strength compared to the Non-Impaired group but differences disappeared in the fully adjusted models. In ALEXANDROS, the differences were only found between the Declined and Non-Impaired and they were partially attenuated by covariates. Our study provides robust evidence of the association between grip strength and cognitive performance and how socio-economic factors might be key to understanding this association and their variability across countries. This has implications for future epidemiological research, as hand-grip strength measurements have the potential to be used as an indicator of cognitive performance.
This study explores the association between cognitive ability in childhood and midlife and bone health outcomes in early old age; and the relationships of these bone measures with contemporaneous and ...subsequent cognitive ability in the MRC National Survey of Health and Development (NSHD). This British birth cohort assessed areal and volumetric bone mineral density (aBMD and vBMD) at age 60-64, derived from peripheral quantitative computed tomography and dual-energy X-ray absorptiometry, and cognitive performance from childhood to age 69, among 866 women and 792 men. Cognitive performance at age 15 was assessed using tests of verbal and non-verbal ability, and mathematics; and memory and search speed tasks were administered at ages 53, 60-64, and 69. Covariates included body size, pubertal timing, smoking, leisure time physical activity, socioeconomic circumstances and menopause timing. Multiple linear regression analyses showed that higher childhood cognitive ability was associated with higher hip aBMD, in women, and greater cortical and trabecular vBMD, in men. For women, there were positive associations between hip aBMD and total vBMD, and contemporaneous cognitive ability with associations also extending to subsequent cognitive ability for total vBMD. For men, some associations with trabecular and total vBMD emerged at ages 60-64 and 69 but only after adjusting for education, occupational class and health behaviors. Our findings highlight that higher cognitive ability in childhood is associated with BMD in early old age and these associations might be explained by social and behavioral pathways. The results suggest that individuals with greater cognitive ability in early life are more likely to engage in healthy behaviors (e.g., leisure time physical activity) in adulthood, which in turn are associated with greater BMD later in life. Associations between bone health and cognitive performance should be considered within a life course framework; and the potential role of smoking and physical activity should be addressed when advising adults at high future risk of osteoporosis and fracture.
Background
Qigong is an ancient form of health maintenance, dating back thousands of years, which is part of Traditional Chinese Medicine. Numerous physical as well as mental benefits have been ...classically ascribed to this traditional mind-body method which integrates slow body movements, breathing, and meditation. Albeit we have already reported an immunomodulatory action of qigong in other investigations, measures were then assessed 1 day after the qigong program ended.
Purpose
The aim of the present study was to assess the acute effects of Taoist qigong practice on immune cell counts in healthy subjects 1 h after training.
Method
Forty-three healthy subjects participated in the study of whom 25 were randomly allocated to the experimental group and 18 to the control group. The experimental subjects underwent daily qigong training for 1 month. Blood samples for the quantification of immune parameters (number and percentage of monocytes, neutrophils, eosinophils, total lymphocytes, B lymphocytes, and natural killer (NK) cells) were taken the day before the experiment commenced and 1 h after the last session of the training program ended. As statistical analysis, analysis of covariance (ANCOVA) was performed.
Results
Statistically significant differences were found between the experimental and control groups, with the experimental group showing higher values in the number (
p
= 0.006) and the percentage (
p
= 0.04) of B lymphocytes, as well as lower values in the percentage of NK cells (
p
= 0.05), as compared to control.
Conclusion
This study demonstrates that Taoist qigong is able to exert acute immunomodulatory effects on components of both innate as well as adaptive immune response.
Inconsistencies in the research findings on
F
-test robustness to variance heterogeneity could be related to the lack of a standard criterion to assess robustness or to the different measures used to ...quantify heterogeneity. In the present paper we use Monte Carlo simulation to systematically examine the Type I error rate of
F
-test under heterogeneity. One-way, balanced, and unbalanced designs with monotonic patterns of variance were considered. Variance ratio (VR) was used as a measure of heterogeneity (1.5, 1.6, 1.7, 1.8, 2, 3, 5, and 9), the coefficient of sample size variation as a measure of inequality between group sizes (0.16, 0.33, and 0.50), and the correlation between variance and group size as an indicator of the pairing between them (1, .50, 0, −.50, and −1). Overall, the results suggest that in terms of Type I error a VR above 1.5 may be established as a rule of thumb for considering a potential threat to
F
-test robustness under heterogeneity with unequal sample sizes.
The robustness of F-test to non-normality has been studied from the 1930s through to the present day. However, this extensive body of research has yielded contradictory results, there being evidence ...both for and against its robustness. This study provides a systematic examination of F-test robustness to violations of normality in terms of Type I error, considering a wide variety of distributions commonly found in the health and social sciences.
We conducted a Monte Carlo simulation study involving a design with three groups and several known and unknown distributions. The manipulated variables were: Equal and unequal group sample sizes; group sample size and total sample size; coefficient of sample size variation; shape of the distribution and equal or unequal shapes of the group distributions; and pairing of group size with the degree of contamination in the distribution.
The results showed that in terms of Type I error the F-test was robust in 100% of the cases studied, independently of the manipulated conditions.
•High performance clinical information extraction supports pertinent clinical research.•Multi-site hospital natural language processing models scale across settings.•Flexible informatics empowers ...fast clinician lead research and analysis.•Fast, scalable, flexible electronic health record information extraction.
Electronic health records (EHR) contain large volumes of unstructured text, requiring the application of information extraction (IE) technologies to enable clinical analysis. We present the open source Medical Concept Annotation Toolkit (MedCAT) that provides: (a) a novel self-supervised machine learning algorithm for extracting concepts using any concept vocabulary including UMLS/SNOMED-CT; (b) a feature-rich annotation interface for customizing and training IE models; and (c) integrations to the broader CogStack ecosystem for vendor-agnostic health system deployment. We show improved performance in extracting UMLS concepts from open datasets (F1:0.448–0.738 vs 0.429–0.650). Further real-world validation demonstrates SNOMED-CT extraction at 3 large London hospitals with self-supervised training over ∼8.8B words from ∼17M clinical records and further fine-tuning with ∼6K clinician annotated examples. We show strong transferability (F1 > 0.94) between hospitals, datasets and concept types indicating cross-domain EHR-agnostic utility for accelerated clinical and research use cases.
Aims
The SARS‐CoV‐2 virus binds to the angiotensin‐converting enzyme 2 (ACE2) receptor for cell entry. It has been suggested that angiotensin‐converting enzyme inhibitors (ACEi) and angiotensin II ...receptor blockers (ARB), which are commonly used in patients with hypertension or diabetes and may raise tissue ACE2 levels, could increase the risk of severe COVID‐19 infection.
Methods and results
We evaluated this hypothesis in a consecutive cohort of 1200 acute inpatients with COVID‐19 at two hospitals with a multi‐ethnic catchment population in London (UK). The mean age was 68 ± 17 years (57% male) and 74% of patients had at least one comorbidity. Overall, 415 patients (34.6%) reached the primary endpoint of death or transfer to a critical care unit for organ support within 21 days of symptom onset. A total of 399 patients (33.3%) were taking ACEi or ARB. Patients on ACEi/ARB were significantly older and had more comorbidities. The odds ratio for the primary endpoint in patients on ACEi and ARB, after adjustment for age, sex and co‐morbidities, was 0.63 (95% confidence interval 0.47–0.84, P < 0.01).
Conclusions
There was no evidence for increased severity of COVID‐19 in hospitalised patients on chronic treatment with ACEi or ARB. A trend towards a beneficial effect of ACEi/ARB requires further evaluation in larger meta‐analyses and randomised clinical trials.
Background: The number of informal caregivers within ageing population is increasing and there is a growing research interest to promote their well-being, and therefore there is a need for adequate ...measurement tools. We aim to provide validity evidence of the Satisfaction with Life Scale (SWLS) in a representative sample of British older adults, including measurement invariance across caregivers and non-caregivers. Method: Data was drawn from English Longitudinal Study of Ageing (ELSA). The sample consisted of 3,754 caregivers and 4,036 non-caregivers. The structure and measurement invariance were tested through a confirmatory factor analysis. Reliability and validity evidence based on relationships with other variables were also analysed. Results: Our results supported the one-factor structure of the SWLS, CFI = .996; NNFI = .993; RMSEA = 0.081, and measurement invariance across caregiving status. McDonald's omega was .93. Scores on the SWLS were positively correlated with quality of life, positive social support, and self-reported health, and negatively with loneliness, depression, negative social support, difficulties in activities and instrumental activities of daily living, and number of health conditions. Conclusions: These findings provide new psychometric evidence to support the use of the SWLS in research which focuses on caregivers and on the comparison with non-caregiver samples. Keywords: Caregiving, ageing, measurement invariance, satisfaction with life, Satisfaction with Life Scale. Invarianza Métrica y Validez de la Escala de Satisfacción Vital en Cuidadores Informales. Antecedentes: el número de cuidadores informales mayores está aumentando y existe un creciente interés en la investigación sobre su bienestar, para lo cual es necesario disponer de instrumentos adecuados de medida. Se pretende proporcionar evidencias de validez de la Escala de Satisfacción Vital (SWLS) en una muestra representativa de mayores de la población británica, incluyendo invarianza factorial entre cuidadores y no cuidadores. Método: los datos se extrajeron del English Longitudinal Study of Ageing (ELSA). Participaron 3.754 cuidadores y 4.036 no cuidadores. La estructura y la invarianza factorial se evaluaron mediante análisis factorial confirmatorio. También se analizaron la fiabilidad y la validez basada en la relación con otras variables. Resultados: los resultados apoyaron la estructura unifactorial del SWLS, CFI = .996; NNFI = .993; RMSEA = 0.081, y su invarianza factorial entre cuidadores y no cuidadores. El omega de McDonald fue .93. Se encontraron correlaciones positivas con calidad de vida, apoyo social positivo y salud percibida, y negativas con soledad, depresión, apoyo social negativo, dificultades en actividades y actividades instrumentales de la vida diaria y problemas de salud. Conclusiones: los hallazgos proporcionan nueva evidencia empírica que apoya el uso del SWLS en investigación centrada en cuidadores. Palabras clave: cuidados, tercera edad, invarianza métrica, satisfacción vital, Escala de Satisfacción con la Vida.
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