Association between Tumor Necrosis Factor Inhibitors and the Risk of Hospitalization or Death among Patients with Immune-Mediated Inflammatory Disease and COVID-19

Importance: Although tumor necrosis factor (TNF) inhibitors are widely prescribed globally because of their ability to ameliorate shared immune pathways across immune-mediated inflammatory diseases (IMIDs), the impact of COVID-19 among individuals with IMIDs who are receiving TNF inhibitors remains insufficiently understood. Objective: To examine the association between the receipt of TNF inhibitor monotherapy and the risk of COVID-19-associated hospitalization or death compared with other commonly prescribed immunomodulatory treatment regimens among adult patients with IMIDs. Design, Setting, and Participants: This cohort study was a pooled analysis of data from 3 international COVID-19 registries comprising individuals with rheumatic diseases, inflammatory bowel disease, and psoriasis from March 12, 2020, to February 1, 2021. Clinicians directly reported COVID-19 outcomes as well as demographic and clinical characteristics of individuals with IMIDs and confirmed or suspected COVID-19 using online data entry portals. Adults (age ≥18 years) with a diagnosis of inflammatory arthritis, inflammatory bowel disease, or psoriasis were included. Exposures: Treatment exposure categories included TNF inhibitor monotherapy (reference treatment), TNF inhibitors in combination with methotrexate therapy, TNF inhibitors in combination with azathioprine/6-mercaptopurine therapy, methotrexate monotherapy, azathioprine/6-mercaptopurine monotherapy, and Janus kinase (Jak) inhibitor monotherapy. Main Outcomes and Measures: The main outcome was COVID-19-associated hospitalization or death. Registry-level analyses and a pooled analysis of data across the 3 registries were conducted using multilevel multivariable logistic regression models, adjusting for demographic and clinical characteristics and accounting for country, calendar month, and registry-level correlations. Results: A total of 6077 patients from 74 countries were included in the analyses; of those, 3215 individuals (52.9%) were from Europe, 3563 individuals (58.6%) were female, and the mean (SD) age was 48.8 (16.5) years. The most common IMID diagnoses were rheumatoid arthritis (2146 patients [35.3%]) and Crohn disease (1537 patients [25.3%]). A total of 1297 patients (21.3%) were hospitalized, and 189 patients (3.1%) died. In the pooled analysis, compared with patients who received TNF inhibitor monotherapy, higher odds of hospitalization or death were observed among those who received a TNF inhibitor in combination with azathioprine/6-mercaptopurine therapy (odds ratio [OR], 1.74; 95% CI, 1.17-2.58; P =.006), azathioprine/6-mercaptopurine monotherapy (OR, 1.84; 95% CI, 1.30-2.61; P =.001), methotrexate monotherapy (OR, 2.00; 95% CI, 1.57-2.56; P <.001), and Jak inhibitor monotherapy (OR, 1.82; 95% CI, 1.21-2.73; P =.004) but not among those who received a TNF inhibitor in combination with methotrexate therapy (OR, 1.18; 95% CI, 0.85-1.63; P =.33). Similar findings were obtained in analyses that accounted for potential reporting bias and sensitivity analyses that excluded patients with a COVID-19 diagnosis based on symptoms alone. Conclusions and Relevance: In this cohort study, TNF inhibitor monotherapy was associated with a lower risk of adverse COVID-19 outcomes compared with other commonly prescribed immunomodulatory treatment regimens among individuals with IMIDs

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Benefits of dietary fibre to human health: study from a multi-country platform

Purpose: Because dietary fibre has been recognized as a major ally to the maintenance of a healthy body as well as to help against the development of some chronic diseases, this work aimed at studying the level of knowledge of a relatively wide range of people about the health effects related to the ingestion of dietary fibre in appropriate dosages. Methodology: A descriptive cross-sectional study was undertaken on a non-probabilistic sample of 6010 participants. The data were collected from 10 countries in 3 different continents (Europe, Africa and America) and measured the level of knowledge regarding different health benefits from dietary fibre. The questionnaires were applied by direct interview after verbal informed consent. Findings: The results obtained considering the general level of knowledge revealed a considerable degree of information about the benefits of fibre (average score of 3.54±0.5, on a scale from 1 to 5). There were significant differences between genders (p<0.001), with higher average score for women, and also for level of education (p<0.001), with higher score for university level. The living environment also showed significant differences (p<0.001), with people living in urban areas showing a higher degree of knowledge. Also for countries the differences were significant (p<0.001), with the highest score obtained for Portugal (3.7), and the lowest for Croatia, Italy, Latvia, Macedonia and Romania (3.5). However, despite these differences, the results showed that for all the countries the degree of knowledge was good (above 3.5), corresponding to a minimum level of knowledge of 70%. Originality/Value: This work is considered important due to the wide coverage, including so many countries inclusive with different social and cultural settings. The study allowed concluding that, in general, the participants in the study were quite well informed about the benefits of dietary fibre for the improvement of human health, regardless of gender, level of education, living environment or country. This finding is very relevant considering the diversity of people that composed the sample and reinforces the necessity of continuing with educational policies aimed at providing the general population with the knowledge that might help them make appropriate food choices.info:eu-repo/semantics/publishedVersio

Knowledge about dietary fibre: a fibre study framework

The objective of this work was to study the degree of knowledge about dietary fibre (DF), as influenced by factors such as gender, level of education, living environment or country. For this, a descriptive cross-sectional study was undertaken on a non-probabilistic sample of 6010 participants from 10 countries in different continents (Europe, Africa and America). The results showed that the participants revealed on average a positive but still low global level of knowledge, which alerts for the need to take some actions to further inform the population about DF and its role as a component of a healthy diet. The results also indicated differences between genders, levels of education, living environments and countries. The highest level of knowledge was revealed by the participants from female gender, with higher education and living in urban areas. Concerning the country, the best informed were the participants from Romania, followed by those from Portugal and Turkey while the least informed were from Egypt

Attitudes towards dietary fibre on a multicultural basis: A fibre study framework

Background: Dietary fibre (DF) has been recognised as having many positive health effects. Hence, the objective of this research was to evaluate the consuming habits relating to DF on people from different countries, as well as their knowledge about the fibre rich foods and their attitudes towards food labelling. Methods: A descriptive cross-sectional study was undertaken on a non-probabilistic sample of 6010 participants from 10 countries. Descriptive statistics and inferential tests were done using SPSS software considering a level of significance of 5%. Results: The results suggested that the ingestion of fibre rich foods like fruit, vegetables and cereals, was low and far from the recommended amounts. It was also concluded that most people did not pay the desired level of attention to food labelling and nutritional information. Furthermore, the level of knowledge about dietary fibre was generally not satisfactory. Conclusion: In view of these findings it becomes important to develop actions to better inform the population and to make them better aware of the importance of dietary fibre in their habitual diet