COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records

BACKGROUND: Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. METHODS: In this cohort study, we used eight linked National Health Service (NHS) datasets for people in England alive on Jan 23, 2020. Data on COVID-19 testing, vaccination, primary and secondary care records, and death registrations were collected until Nov 30, 2021. We defined ten COVID-19 phenotypes reflecting clinically relevant stages of disease severity and encompassing five categories: positive SARS-CoV-2 test, primary care diagnosis, hospital admission, ventilation modality (four phenotypes), and death (three phenotypes). We constructed patient trajectories illustrating transition frequency and duration between phenotypes. Analyses were stratified by pandemic waves and vaccination status. FINDINGS: Among 57 032 174 individuals included in the cohort, 13 990 423 COVID-19 events were identified in 7 244 925 individuals, equating to an infection rate of 12·7% during the study period. Of 7 244 925 individuals, 460 737 (6·4%) were admitted to hospital and 158 020 (2·2%) died. Of 460 737 individuals who were admitted to hospital, 48 847 (10·6%) were admitted to the intensive care unit (ICU), 69 090 (15·0%) received non-invasive ventilation, and 25 928 (5·6%) received invasive ventilation. Among 384 135 patients who were admitted to hospital but did not require ventilation, mortality was higher in wave 1 (23 485 [30·4%] of 77 202 patients) than wave 2 (44 220 [23·1%] of 191 528 patients), but remained unchanged for patients admitted to the ICU. Mortality was highest among patients who received ventilatory support outside of the ICU in wave 1 (2569 [50·7%] of 5063 patients). 15 486 (9·8%) of 158 020 COVID-19-related deaths occurred within 28 days of the first COVID-19 event without a COVID-19 diagnoses on the death certificate. 10 884 (6·9%) of 158 020 deaths were identified exclusively from mortality data with no previous COVID-19 phenotype recorded. We observed longer patient trajectories in wave 2 than wave 1. INTERPRETATION: Our analyses illustrate the wide spectrum of disease trajectories as shown by differences in incidence, survival, and clinical pathways. We have provided a modular analytical framework that can be used to monitor the impact of the pandemic and generate evidence of clinical and policy relevance using multiple EHR sources. FUNDING: British Heart Foundation Data Science Centre, led by Health Data Research UK

The Gender-Specific Relationship between Nutritional Status, Physical Activity and Functional Mobility in Irish Community-Dwelling Older Adults

Research suggests that both nutrition and physical activity can protect mobility in older adults, but it is yet to be determined whether these relationships are affected by gender. Thus, we investigated the gender-specific relationship between nutritional status, physical activity level and functional mobility in Irish older adults. A cross-sectional study was undertaken in 176 community-dwelling older adults (73.6 ± 6.61 years) living in Cork, Ireland. Nutritional status was measured using the Mini Nutritional Assessment-Short Form (MNA-SF) and physical activity was assessed via the Physical Activity Scale for the Elderly (PASE). Functional mobility was measured using the Timed Up and Go (TUG) test. The gender-stratified relationship between variables was assessed using Pearson’s correlations and multiple linear regression. Partial correlations (p < 0.05) were observed for TUG with PASE score in both genders, and with MNA-SF score in females, only. Multiple regression showed that physical activity was a predictor of TUG in both genders (β = 0.257 for males, β = 0.209 for females, p < 0.05), while nutritional status was a predictor of TUG in females, only (β = −0.168, p = 0.030). Our results suggest that physical activity is associated with functional mobility in both genders, while the relationship between nutritional status and mobility may be specific to older females. These findings may be of interest for the design of functional preservation strategies

An investigation into the classification of injury severity in running-related injury research: A scoping review

Objective: To investigate the how injury severity is measured in running-related injury research and to examine if the measure of injury severity has an effect on the outcomes of a study. Introduction: Despite being an essential aspect of injury surveillance, epidemiological and aetiology research, there is little insight into the measures of injury severity utilised in running-related injury research. Inclusion criteria: Research articles from academic journals which have investigated running-related injury severity in adult running populations were included. Only those which provided a description of the measure of injury severity were included. Prospective and retrospective cohort studies, clinical trials and cross-sectional studies were included. Review papers, conference proceedings, abstracts, opinion pieces or sources of information not published in academic journals were excluded. Studies published in English between January 1980 and December 2023 were included. Methods: PubMed, Scopus, SPORTDiscuss, MEDLINE and Web of Science databases were searched. Two authors conducted the search independently. Title and abstract screening was conducted by one author. Full text assessment was conducted by two authors independently. Data extraction was conducted by two authors independently using a data extraction form. Results were charted, mapped and accompanied by a narrative summary

Definitions and surveillance methods of running-related injuries: A scoping review.

Objective: To investigate the definitions and surveillance methods of running-related injuries in the literature. Introduction: Inconsistent and restricted definitions of injury have contributed to limitations in determining injury rates and identifying risk factors for running-related injuries (RRIs). Inclusion criteria: Research articles from academic journals which have investigated running-related injuries in adult running populations were included. Only those which provided a definition for a running-related injury were included. Prospective and retrospective cohort studies, clinical trials and cross-sectional studies were included. Review papers, conference proceedings, abstracts, opinion pieces or sources of information not published in academic journals were excluded. Studies published in English between January 1980 and June 2023 were included. Methods: PubMed, Scopus, SPORTDiscuss, MEDLINE and Web of Science databases were searched. Two authors conducted the search independently. Title and abstract screening was executed by one author. Full text assessment was executed by two independent authors. Data extraction was executed by two independent authors using a data extraction form. Results were charted, mapped and accompanied by a narrative summary

The Running Injury Continuum: A qualitative examination of recreational runners' description and management of injury.

IntroductionA critical step in understanding and preventing running-related injuries (RRIs) is appropriately defining RRIs. Current definitions of RRIs may not represent the full process of injury development, failing to capture lower levels of injury that many athletes continue to train through. Understanding runners' description and management of the injury development process may allow for a more appropriate examination of all levels of injury. This study aimed to examine recreational runners' description and management of the injury development process.MethodsA qualitative focus group study was undertaken. Seven semi-structured focus groups with male (n = 13) and female (n = 18) recreational runners took place. Focus groups were audio and video recorded, and transcribed verbatim. Transcripts were reflexively thematically analysed. A critical friend approach was taken to data coding. Multiple methods of trustworthiness were executed.ResultsRunners describe injury on a nine-level continuum, ranging from injury-free to career-ending injury. There are lower and higher levels of injury. Each level of injury is described across four categories of descriptors; physical description, outcome (effect on running and daily life), psychological description, and management.ConclusionThe Running Injury Continuum is a tool that can be used for injury surveillance (for healthcare professionals and researchers) and for research investigating RRI risk factors. Healthcare professionals, researchers and coaches must ensure they monitor the development of all levels of RRIs, across all categories of descriptors. Runners need to be educated regarding appropriate self-management strategies for lower level injuries, with access to evidence-based information being a critical management tool

The post-primary school experiences of transgender and gender diverse youth in Ireland

This report details the key findings from a research project that explored the post-primary school experiences of transgender and gender diverse (TGD) youth in Ireland. The study was co-funded by the Irish Research Council and Marie Skłowdowska-Curie Actions as part of the “Collaborative Research Fellowships for a Responsive and Innovative Europe” (CAROLINE) programme. The research was a collaboration between the School of Education, University of Limerick and Transgender Equality Network Ireland (TENI). The project was made possible by, and builds on, the advocacy, education and support work that TENI has been conducting in the education sector since 2013. The project team consisted of Dr Ruari-Santiago McBride (Research Fellow), Dr Aoife Neary (Principal Investigator and Academic Mentor), Dr Breda Gray (Consultative Academic Mentor), and Vanessa Lacey (Secondment Mentor)

Minding the gap: identifying values to enable public and patient involvement at the pre-commencement stage of research projects

Background: The University College Dublin (UCD) Public and Patient Invovlement (PPI) ignite program is focused on embedding PPI in health and social care related research, education and training, professional practice and administration. During a PPI knowledge sharing event challenges were noted during the pre-commencement stage of research projects. This stage includes the time before a research projects/partnership starts or when funding is being applied for. As a response, we agreed there was a need to spend time developing a values-based approach to be used from the pre-commencement of PPI projects and partnerships. Values are deeply held ideals that people consider to be important. They are vital in shaping our attitudes and motivating our choices and behaviours. Methods: Using independent facilitators, we invited a diverse group of participants to a full-day workshop in February. During the workshop, the concept of a values statement and values-based approaches was introduced. The group via a majority consensus, agreed on a core set of values and a shared understanding of them. After the workshop, a draft was shared with participants for further comment and final agreement. Results: The workshop had 22 people representing experts by experience, PPI charity partners, funders, academics and national PPI Ignite partners. The group via consensus identified four values of respect, openness, reciprocity and flexibility for the pre-commencement stage. A frequently reported experience of PPI partners was that some felt that the pre-commencement activities appeared at times like a performance; an act that had to be completed in order to move to the next stage rather than a genuine interest in a mutually beneficial partnership. Being open and transparent with all invovled that the funding application may not be successful was stressed. Another important feature related to 'openness' was the 'spaces' and 'places' in which meetings between partners could occur in an accessible and equitable way. The issue of 'space' is particularly critical for the involvement of seldom heard groups. The benefits of the research are often clear for academics, but for PPI partners, these are often less certain. To achieve reciprocity, academic and PPI partners need to engage in a timely, repeated and transparent dialogue to achieve beneficial outcomes for all stakeholders. Being open to new inputs and differing modes of knowledge and ideas was also stressed. For some, this will require a change in attitudes and behaviours and should result in more collective decision making. Several areas were identified using the four values. Conclusions: This work via majority consensus identified four values of respect, openness, reciprocity, and flexibility for the pre-commencement stage. These values should be used to support inclusive, effective and collective PPI across all stages of involvement. We hope this work will stimulate further action in this area. In particular, we would welcome the evaluation of these values involving diverse PPI groups