Changes in the trajectory of Long Covid symptoms following COVID-19 vaccination: community-based cohort study

OBJECTIVE: To estimate associations between COVID-19 vaccination and Long Covid symptoms in adults who were infected with SARS-CoV-2 prior to vaccination. DESIGN: Observational cohort study using individual-level interrupted time series analysis. SETTING: Random sample from the community population of the UK. PARTICIPANTS: 28,356 COVID-19 Infection Survey participants (mean age 46 years, 56% female, 89% white) aged 18 to 69 years who received at least their first vaccination after test-confirmed infection. MAIN OUTCOME MEASURES: Presence of Long Covid symptoms at least 12 weeks after infection over the follow-up period 3 February to 5 September 2021. RESULTS: Median follow-up was 141 days from first vaccination (among all participants) and 67 days from second vaccination (84% of participants). First vaccination was associated with an initial 12.8% decrease (95% confidence interval: -18.6% to -6.6%, p<0.001) in the odds of Long Covid, with the data being compatible with both increases and decreases in the trajectory (+0.3% per week, 95% CI: -0.6% to +1.2% per week, p=0.51) after this. Second vaccination was associated with an 8.8% decrease (95% CI: -14.1% to -3.1%, p=0.003) in the odds of Long Covid, with the odds subsequently decreasing by 0.8% (-1.2% to -0.4%, p<0.001) per week. There was no statistical evidence of heterogeneity in associations between vaccination and Long Covid by socio-demographic characteristics, health status, whether hospitalised with acute COVID-19, vaccine type (adenovirus vector or mRNA), or duration from infection to vaccination. CONCLUSIONS: : The likelihood of Long Covid symptoms reduced after COVID-19 vaccination, and there was evidence of a sustained improvement after the second dose, at least over the median follow-up time of 67 days. Vaccination may contribute to a reduction in the population health burden of Long Covid, though longer follow-up time is needed

O registro dos limites da cidade: imagens da várzea do Carmo no século XIX

Este trabalho debruça-se sobre a iconografia paulistana do século XIX, em suas pinturas, aquarelas e litografias. Partindo da constatação da existência de um privilegiamento das áreas dos arredores do centro nas representações da cidade, especificamente uma região, a várzea do Carmo, e dessa permanência ainda na virada do século, quando a cidade sofre um processo de urbanização e crescimento grande, e a fotografia já está registrando as áreas centrais, quisemos investigar os sentidos dessas representações, tanto a presença desse espaço - a várzea do Carmo - no imaginário da época (cronistas, legisladores, memorialistas), quanto as imagens da cidade que estão sendo produzidas a partir desse ângulo de registro. Escolhemos analisar algumas imagens dessa região, concentrando-nos no final do século, contrapondo com outros discursos produzidos sobre a área por cronistas, jornalistas e memorialistas, na tentativa de entender um pouco mais a sociedade que as produziu

Community pharmacists' opinions on their palliative care education needs and preferences of delivery of an educational programme, a qualitative study

Background: The provision of medication and pharmaceutical care is an essential component of palliative care (PC). Lack of education in PC is a barrier to some community pharmacists providing care to PC patients. Objective: To explore community pharmacists’ understanding of PC, their opinions of their PC education needs and to determine their preferences regarding delivery of a PC education programme. Method: This study used a qualitative approach by means of semi-structured face-to-face interviews. Convenience and snowball sampling were used to select the sample population. Results: Three main themes were identified when exploring PC education needs; (i) lack of knowledge about palliative care, (ii) role of community pharmacists in palliative care, and (iii) perceived barriers to accessing further education. Community pharmacists’ preferences for the delivery of an education programme were influenced by perceived barriers to accessing further education. Conclusion: Community pharmacists’ understanding of PC highlighted a knowledge deficit which may be improved with further education

Risk of COVID-19 related deaths for SARS-CoV-2 Omicron (B.1.1.529) compared with Delta (B.1.617.2)

Objective: To assess the risk of COVID-19 death following infection from Omicron BA.1 relative to Delta (B.1.617.2). Design: Retrospective cohort study. Setting: England, UK, 1 December 2021 to 30st December 2021. Participants: 1,035,149 people aged 18-100 years who tested positive for SARS-CoV-2 in the national surveillance programme, and had an infection identified as either Omicron BA.1- or Delta compatible. Main outcome measures: COVID-19 death as identified from death certification records. The exposure of interest was the SARS-CoV-2 variant identified from NHS Test and Trace PCR positive tests taken in the community (pillar 2) and analysed by Lighthouse laboratories. Cause-specific Cox proportional hazard regression models (censoring non-COVID-19 deaths) were adjusted for sex, age, vaccination status, previous infection, calendar time, ethnicity, Index of Multiple Deprivation rank, household deprivation, university degree, keyworker status, country of birth, main language, region, disability, and comorbidities. Additionally, we tested for interactions between variant and sex, age, vaccination status and comorbidities. Results: The risk of COVID-19 death was 66% lower (95% CI: 54% to 75%) for Omicron BA.1 compared to Delta. The reduction in the risk of death involving COVID-19 for Omicron compared to Delta was more pronounced in 18-59-year-olds (HR=0.14, 95%CI: 0.07 to 0.27) compared to individuals over 70 years of age (HR=0.44, 95%CI: 0.32 to 0.61) (p < 0.0001). We find no evidence of a difference in risk between variant and number of comorbidities (0, 1-2, 3+). Conclusions: Our results support early work showing the relative reduction in severity of Omicron BA.1 compared to Delta in terms of hospitalisation and extends this research to assess COVID-19 mortality

Menopause is associated with postprandial metabolism, metabolic health and lifestyle : The ZOE PREDICT study

Background: The menopause transition is associated with unfavourable alterations in health. However, postprandial metabolic changes and their mediating factors are poorly understood. Methods: The PREDICT 1 UK cohort (n=1002; pre- n=366, peri- n=55, and post-menopausal females n=206) assessed phenotypic characteristics, anthropometric, diet and gut microbiome data, and fasting and postprandial (0–6 h) cardiometabolic blood measurements, including continuous glucose monitoring (CGM) data. Differences between menopausal groups were assessed in the cohort and in an age-matched subgroup, adjusting for age, BMI, menopausal hormone therapy (MHT) use, and smoking status. Findings: Post-menopausal females had higher fasting blood measures (glucose, HbA1c and inflammation (GlycA), 6%, 5% and 4% respectively), sugar intakes (12%) and poorer sleep (12%) compared with pre-menopausal females (p<0.05 for all). Postprandial metabolic responses for glucose2hiauc and insulin2hiauc were higher (42% and 4% respectively) and CGM measures (glycaemic variability and time in range) were unfavourable post- versus pre-menopause (p<0.05 for all). In age-matched subgroups (n=150), postprandial glucose responses remained higher post-menopause (peak0-2h 4%). MHT was associated with favourable visceral fat, fasting (glucose and insulin) and postprandial (triglyceride6hiauc) measures. Mediation analysis showed that associations between menopause and metabolic health indicators (visceral fat, GlycA360mins and glycaemia (peak0-2h)) were in part mediated by diet and gut bacterial species. Interpretation: Findings from this large scale, in-depth nutrition metabolic study of menopause, support the importance of monitoring risk factors for type-2 diabetes and cardiovascular disease in mid-life to older women to reduce morbidity and mortality associated with oestrogen decline. Funding: Zoe Ltd