Tag: National Library of Medicine

Multidisciplinary Center Care for Long COVID Syndrome – a Retrospective Cohort Study

Mary Pat Campbell

Link:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10200714/

Graphic:

Specialty Utilization Specialty utilization by a total of 1802 patients evaluated at the Comprehensive COVID Center (CCC) during the first 21 months in a total of 2361 initial visits in 12 specialty clinics. The mean number of specialty clinics visited by CCC patients was 1.3 (range 1-6) and multiple clinic consultations accounted for 405 visits.

Excerpt:

Background

Persistent multi-organ symptoms after COVID-19 have been termed “long COVID” or “post-acute sequelae of SARS-CoV-2 infection” (PASC). The complexity of these clinical manifestations posed challenges early in the pandemic as different ambulatory models formed out of necessity to manage the influx of patients. Little is known about the characteristics and outcomes of patients seeking care at multidisciplinary post-COVID centers.

Methods

We performed a retrospective cohort study of patients evaluated at our multidisciplinary Comprehensive COVID-19 Center (CCC) in Chicago, IL, between May 2020 and February 2022. We analyzed specialty clinic utilization and clinical test results according to severity of acute COVID-19.

Results

We evaluated 1802 patients a median of 8 months from acute COVID-19 onset, including 350 post-hospitalization and 1452 non-hospitalized patients. Patients were seen in 2361 initial visits in 12 specialty clinics, with 1151 (48.8%) in neurology, 591 (25%) in pulmonology, and 284 (12%) in cardiology. Among patients tested, 742/878(85%) reported decreased quality of life, 284/553(51%) had cognitive impairment, 195/434(44.9%) had alteration of lung function, 249/299(83.3%) had abnormal CT chest scans, and 14/116(12.1%) had elevated heart rate on rhythm monitoring. Frequency of cognitive impairment and pulmonary dysfunction was associated with severity of acute COVID-19. Non-hospitalized patients with positive SARS-CoV-2 testing had similar findings than those with negative or no test results.

Conclusions

The CCC experience shows common utilization of multiple specialists by long COVID patients, who harbor frequent neurologic, pulmonary, and cardiologic abnormalities. Differences in post-hospitalization and non-hospitalized groups suggest distinct pathogenic mechanisms of long COVID in these populations.

Keywords: Long COVID, Post-Acute Sequelae of SARS-CoV-2 Infection, PASC, Multidisciplinary Care, Health Service Delivery

doi: 10.1016/j.amjmed.2023.05.002 [Epub ahead of print]

Author(s): Joseph Bailey, M.D.,a,⁎ Bianca Lavelle, M.D.,b Janet Miller, B.S.,a Millenia Jimenez, B.S.,c Patrick H. Lim, M.S.,c Zachary S. Orban, B.S.,c Jeffrey R. Clark, B.A.,c Ria Tomar, B.S.,a Amy Ludwig, M.D.,a Sareen T. Ali, B.S.,c Grace K. Lank, B.S.,c Allison Zielinski, M.D.,d Ruben Mylvaganam, M.D.,a Ravi Kalhan, M.D.,a Malek El Muayed, M.D.,e R. Kannan Mutharasan, M.D.,d Eric M. Liotta, M.D. M.S.,c Jacob I Sznajder, M.D.,a Charles Davidson, M.D.,d Igor J. Koralnik, M.D.,c,1 and Marc A. Sala, M.D.a,1, for the Northwestern Medicine Comprehensive COVID Center Investigators

Publication Date: 2023 May 22

Publication Site: National Library of Medicine

State Variation in Underreporting of Alcohol Involvement on Death Certificates: Motor Vehicle Traffic Crash Fatalities as an Example

Mary Pat Campbell

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965684/

Graphic:

Abstract:

Abstract

Objective:

We used motor vehicle traffic (MVT) crash fatalities as an example to examine the extent of underreporting of alcohol involvement on death certificates and state variations.

Method:

We compared MVT-related death certificates identified from national mortality data (Multiple Cause of Death [MCoD] data) with deaths in national traffic census data from the Fatality Analysis Reporting System (FARS). Because MCoD data were not individually linked to FARS data, the comparisons were at the aggregate level. Reporting ratio of alcohol involvement on death certificates was thus computed as the prevalence of any mention of alcohol-related conditions among MVT deaths in MCoD, divided by the prevalence of decedents with blood alcohol concentration (BAC) test results (not imputed) of .08% or greater in FARS. Through bivariate analysis and multiple regression, we explored state characteristics correlated with state reporting ratios.

Results:

Both MCoD and FARS identified about 450,000 MVT deaths in 1999–2009. Reporting ratio was only 0.16 for all traffic deaths and 0.18 for driver deaths nationally, reflecting that death certificates captured only a small percentage of MVT deaths involving BAC of .08% or more. Reporting ratio did not improve over time, even though FARS indicated that the prevalence of BAC of at least .08% in MVT deaths increased from 19.9% in 1999 to 24.2% in 2009. State reporting ratios varied widely, from 0.02 (Nevada and New Jersey) to 0.81 (Delaware).

Conclusions:

The comparison of MCoD with FARS revealed a large discrepancy in reporting alcohol involvement in MVT deaths and considerable state variation in the magnitude of underreporting. We suspect similar underreporting and state variations in alcohol involvement in other types of injury deaths.

Author(s): I-Jen P Castle, Ph.D.,a,* Hsiao-Ye Yi, Ph.D.,a Ralph W Hingson, Sc.D.,b and Aaron M White, Ph.D.b

Publication Date: March 2014

Publication Site: Journal of Studies on Alcohol and Drugs, National Library of Medicine

Characteristics of US Blood Donors Testing Reactive for Antibodies to SARS-CoV-2 Prior to the Availability of Authorized Vaccines

Mary Pat Campbell

Link: https://pubmed.ncbi.nlm.nih.gov/34373145/

Graphic:

Abstract:

In the United States, many blood collection organizations initiated programs to test all blood donors for antibodies to SARS-CoV-2, as a measure to increase donations and to assist in the identification of potential donors of COVID-19 convalescent plasma (CCP). As a result, it was possible to investigate the characteristics of healthy blood donors who had previously been infected with SARS-CoV-2. We report the findings from all blood donations collected by the American Red Cross, representing 40% of the national blood supply covering 44 States, in order to characterize the seroepidemiology of SARS-CoV-2 infection among blood donors in the United States, prior to authorized vaccine availability. We performed an observational cohort study from June 15th to November 30th, 2020 on a population of 1.531 million blood donors tested for antibodies to the S1 spike antigen of SARS-CoV-2 by person, place, time, ABO group and dynamics of test reactivity, with additional information from a survey of a subset of those with reactive test results. The overall seroreactivity was 4.22% increasing from 1.18 to 9.67% (June 2020 – November 2020); estimated incidence was 11.6 per hundred person-years, 1.86-times higher than that based upon reported cases in the general population over the same period. In multivariable analyses, seroreactivity was highest in the Midwest (5.21%), followed by the South (4.43%), West (3.43%) and Northeast (2.90%). Seroreactivity was highest among donors aged 18-24 (Odds Ratio 3.02 [95% Confidence Interval 2.80-3.26] vs age >55), African-Americans and Hispanics (1.50 [1.24-1.80] and 2.12 [1.89-2.36], respectively, vs Caucasian). Group O frequency was 51.5% among nonreactive, but 46.1% among seroreactive donors (P< .0001). Of surveyed donors, 45% reported no COVID-19-related symptoms, but 73% among those unaware of testing. Signal levels of antibody tests were stable over 120 days or more and there was little evidence of reinfection. Evaluation of a large population of healthy, voluntary blood donors provided evidence of widespread and increasing SARS-CoV-2 seroprevalence and demonstrated that at least 45% of those previously infected were asymptomatic. Epidemiologic findings were similar to those among clinically reported cases.

Author(s): Roger Y Dodd, Bryan R Spencer, Meng Xu 1, Gregory A Foster 1, Paula Saá 1, Jaye P Brodsky 2, Susan L Stramer 3

Publication Date: 18 August 2021

Publication Site: National Library of Medicine