Transmissibility, hospitalization, and intensive care admissions due to omicron compared to delta variants of SARS-CoV-2 in Catalonia: A cohort study and ecological analysis

The transmissibility of omicron using variant screening data from primary care practices (PCP) and hospital admissions. In addition, we used this data from PCP to establish the two periods when delta and omicron were, respectively, dominant (above 95% of cases). After that, we performed a population-based cohort analysis to calculate the rates of hospital and intensive care unit (ICU) admissions for both periods and to estimate reduction in severity. Rate ratios (RR) and 95% confidence intervals (95% CI) were calculated and stratified by age and vaccination status. In a second analysis, the differential substitution model in primary care vs. hospitals allowed us to obtain a population-level average change in severity.We have included 48,874 cases during the delta period and 560,658 during the omicron period. During the delta period, on average, 3.8% of the detected cases required hospitalization for COVID-19. This percentage dropped to 0.9% with omicron [RR of 0.46 (95% CI: 0.43 to 0.49)]. For ICU admissions, it dropped from 0.8 to 0.1% [RR 0.25 (95% CI: 0.21 to 0.28)]. The proportion of cases hospitalized or admitted to ICU was lower in the vaccinated groups, independently of the variant. Omicron was associated with a reduction in risk of admission to hospital and ICU in all age and vaccination status strata. The differential substitution models showed an average RR between 0.19 and 0.50.Both independent methods consistently show an important decrease in severity for omicron relative to delta. The systematic reduction happens regardless of age. The severity is also reduced for non-vaccinated and vaccinated groups, but it remains always higher in the non-vaccinated population. This suggests an overall reduction in severity, which could be intrinsic to the omicron variant. The fact is that the RR in ICU admission is systematically smaller than in hospitalization points in the same direction.MC received funding from la Caixa Foundation ID 100010434, under agreement LCF/PR/GN17/50300003. MC, CP, and SA received funding from Ministerio de Ciencia, Innovación y Universidades and FEDER, with the project PGC2018-095456- B-I00.Objectius de Desenvolupament Sostenible::3 - Salut i BenestarPostprint (published version

Including information about co-morbidity in estimates of disease burden: results from the World Health Organization World Mental Health Surveys

Background The methodology commonly used to estimate disease burden, featuring ratings of severity of individual conditions, has been criticized for ignoring co-morbidity. A methodology that addresses this problem is proposed and illustrated here with data from the World Health Organization World Mental Health Surveys. Although the analysis is based on self-reports about one's own conditions in a community survey, the logic applies equally well to analysis of hypothetical vignettes describing co-morbid condition profiles. Method Face-to-face interviews in 13 countries (six developing, nine developed; n=31 067; response rate=69.6%) assessed 10 classes of chronic physical and nine of mental conditions. A visual analog scale (VAS) was used to assess overall perceived health. Multiple regression analysis with interactions for co-morbidity was used to estimate associations of conditions with VAS. Simulation was used to estimate condition-specific effects. Results The best-fitting model included condition main effects and interactions of types by numbers of conditions. Neurological conditions, insomnia and major depression were rated most severe. Adjustment for co-morbidity reduced condition-specific estimates with substantial between-condition variation (0.24-0.70 ratios of condition-specific estimates with and without adjustment for co-morbidity). The societal-level burden rankings were quite different from the individual-level rankings, with the highest societal-level rankings associated with conditions having high prevalence rather than high individual-level severity. Conclusions Plausible estimates of disorder-specific effects on VAS can be obtained using methods that adjust for co-morbidity. These adjustments substantially influence condition-specific rating

Post-traumatic stress disorder associated with life-threatening motor vehicle collisions in the WHO World Mental Health Surveys

BACKGROUND: Motor vehicle collisions (MVCs) are a substantial contributor to the global burden of disease and lead to subsequent post-traumatic stress disorder (PTSD). However, the relevant literature originates in only a few countries, and much remains unknown about MVC-related PTSD prevalence and predictors. METHODS: Data come from the World Mental Health Survey Initiative, a coordinated series of community epidemiological surveys of mental disorders throughout the world. The subset of 13 surveys (5 in high income countries, 8 in middle or low income countries) with respondents reporting PTSD after life-threatening MVCs are considered here. Six classes of predictors were assessed: socio-demographics, characteristics of the MVC, childhood family adversities, MVCs, other traumatic experiences, and respondent history of prior mental disorders. Logistic regression was used to examine predictors of PTSD. Mental disorders were assessed with the fully-structured Composite International Diagnostic Interview using DSM-IV criteria. RESULTS: Prevalence of PTSD associated with MVCs perceived to be life-threatening was 2.5 % overall and did not vary significantly across countries. PTSD was significantly associated with low respondent education, someone dying in the MVC, the respondent or someone else being seriously injured, childhood family adversities, prior MVCs (but not other traumatic experiences), and number of prior anxiety disorders. The final model was significantly predictive of PTSD, with 32 % of all PTSD occurring among the 5 % of respondents classified by the model as having highest PTSD risk. CONCLUSION: Although PTSD is a relatively rare outcome of life-threatening MVCs, a substantial minority of PTSD cases occur among the relatively small proportion of people with highest predicted risk. This raises the question whether MVC-related PTSD could be reduced with preventive interventions targeted to high-risk survivors using models based on predictors assessed in the immediate aftermath of the MVCs

¿Qué sabemos de los peces óseos marinos del neógeno en Chile? Diversidad e implicaciones biogeográficas

Durante el Neógeno ocurren intensos eventos, oceanográficos y climáticos, que influyeron sobre la fauna marina de Chile desde el pasado hasta la actualidad. Estudios enfocados en la evaluación del efecto de estos eventos sobre la diversidad de mamíferos, aves y tiburones han sido previamente abordados. Sin embargo, las interacciones de estos eventos con los peces óseos como grupo de estudio no han sido analizados en detalle. Este trabajo compara la diversidad de peces óseos del Neógeno con la actualidad y da a conocer lo que sabemos de su diversidad. Se procesaron los datos disponibles de la presencia de peces óseos marinos en formaciones neógenas de Chile y la actualidad. Se comparó la composición del registro fósil de peces neógenos con el registro de peces actuales a 3 niveles taxonómicos distintos (familia, género y especie). Finalmente, se analizaron los rangos de distribución de los taxa fósiles que sobrevivieron con el objetivo de realizar aproximaciones de las dinámicas paleobiogeográficas. Nuestros resultados muestran que la diversidad actual de peces óseos marinos en Chile es de 624 géneros (1.196 especies), mientras que para el Neógeno se han reportado 65 géneros (46 especies). Comparado con la diversidad actual, el registro fósil de peces es representado por un 3,9% a nivel de especie, 10,4% a nivel de género y 23,4% a nivel de familias, lo que puede ser relacionado con la baja cantidad de estudios enfocados en fósiles de este grupo. Del total de 46 especies fósiles reportadas, sólo una se encuentra actualmente presente en las costas de Chile. A nivel genérico, un 38,5% se encuentra actualmente ausente en la región y un 61,5% sobrevive. En relación a los géneros ausentes actualmente, un 20% corresponde a extinción global y un 80% a extinción regional. Estos cambios en las dinámicas biogeográficas de peces óseos del pasado al reciente, podrían estar relacionadas con los intensos eventos climáticos y oceanográficos que han ocurrido en los últimos 23 millones de años. Los análisis de rarefacción y de extrapolación de especies confirman que a pesar de que han aumentado los trabajos sobre peces óseos en los últimos años, todavía se podrían encontrar un mayor número de taxa si se aplica un mayor esfuerzo de muestreo. Estudios futuros podrían ayudarnos a comprender de mejor manera el efecto de los cambios climáticos y oceanográficos sobre los peces del Neógeno de Chile.Durant el Neogen ocorren intensos esdeveniments, oceanogràfics, i climàtics, que van influir sobre la fauna marina de Xile des del passat fins a l’actualitat. Estudis enfocats en l’avaluació de l’efecte d’aquests esdeveniments sobre la diversitat de mamífers, ocells i taurons han sigut prèviament abordats. No obstant això, les interaccions d’aquests esdeveniments amb els peixos ossis com a grup d’estudi no han sigut analitzats detalladament. Aquest treball analitza la diversitat de peixos ossis del Neogen comparat amb l’actualitat i dona a conéixer que sabem de la seua diversitat. Es van analizar les dades disponibles de la presència de peixos ossis marins en formacions neógenas de Xile i l’actualitat. Es va comparar la composició del registre fòssil de peixos neògens amb el registre de peixos actuals a 3 nivells taxonòmics diferents (família, gènere i espècie). Finalment, es van analizar els rangs de distribució dels taxa fòssils que van sobreviure amb la finalitat de realitzar aproximacions de les dinàmiques paleobiogeográficas. Els nostres resultats mostren que la diversitat actual de peixos ossis marins a Xile és de 624 gèneres (1.196 espècies), mentre que per al Neogen s’han reportat 65 gèneres (46 espècies). Comparat amb la diversitat actual, el registre fòssil de peixos és representat per un 3,9% a nivell d’espècie, 10,4% a nivell de gènere i 23,4% a nivell de famílies, la qual cosa pot ser relacionat amb la baixa quantitat d’estudis enfocats en fòssils d’aquest grup. Del total de 46 espècies fòssils reportades, només un 4% es troba actualment present en les costes de Xile. A nivell genèric, un 38.5% es troba actualment absent a la regió i un 61.5% sobreviu. En relació als gèneres absents actualment, un 20% correspon a extinció global i un 80% a extinció regional. Aquests canvis en les dinàmiques biogeogràfiques de peixos ossis del passat al recent, podrien estar relacionades amb els intensos esdeveniments climàtics i oceanogràfics que han ocorregut en els últims 23 milions d’anys. Les anàlisis de rarefacció i d’extrapolació d’espècies confirmen que a pesar que han augmentat els treballs sobre el grup en els últims anys, encara es podrien trobar un major número de taxa si s’aplica un major esforç de mostreig. Estudis futurs podrien ajudar-nos a comprendre de millor manera l’efecte dels canvis climàtics i oceanogràfics sobre els peixos del Neogen de Xile.During the Neogene occurred intense oceanographic and climatic events which had an effect on the marine fauna from the past to the present. Studies focused on the evaluation of the effect of these events on the diversity of mammals, birds and sharks have been previously addressed. However, the interactions of these events with bony fishes as a study group have not been analyzed in detail. This work analyzes the diversity of bony fishes from the Neogene compared to today and reveals what we know about their diversity. We analyzed the available data on the presence of marine bony fishes from Neogene formations in Chile and today. The composition of the fossil record of Neogene fishes was compared to the current fish record at 3 different taxonomic levels (family, genus, and species). Lastly, the distribution ranges of the surviving fossil taxa were analyzed in order to make approximations of the paleobiogeographic dynamics. Our results show that the current diversity of marine bony fish in Chile is composed of 624 genera (1,196 species), whereas from the Neogene 65 genera (46 species) have been reported. Compared to the current diversity, the fossil record of fishes is represented by 3.9% at the species level, 10.4% at the genus level and 23.4% at the family level, which can be related to the low number of studies focused on fossils of this group. Of the total of 46 fossil species reported, only 4% is currently present along the coast of Chile. At a generic level, 38.5% are currently absent in the region whereas 61.5% survived. In relation to the genera currently absent in the region, 20% are globally extinct and 80% regional extinct. These changes in the biogeographic dynamics of bony fishes from the past to the recent could be related to the intense climatic and oceanographic events that have occurred in the last 23 million years. The rarefaction and extrapolation analyses confirm that although the studies focused on the group have increased in the last years, a higher number of taxa could still be found if the sampling effort is increased. Future studies could help us to a better understanding of the effects of climatic and oceanographic changes on the group during the Neogene of Chile

Cross-national differences in the prevalence and correlates of burden among older family caregivers in the World Health Organization World Mental Health (WMH) Surveys

Background Current trends in population aging affect both recipients and providers of informal family caregiving, as the pool of family caregivers is shrinking while demand is increasing. Epidemiological research has not yet examined the implications of these trends for burdens experienced by aging family caregivers. Method Cross-sectional community surveys in 20 countries asked 13 892 respondents aged 50+ years about the objective (time, financial) and subjective (distress, embarrassment) burdens they experience in providing care to first-degree relatives with 12 broadly defined serious physical and mental conditions. Differential burden was examined by country income category, kinship status and type of condition. Results Among the 26.9-42.5% respondents in high-, upper-middle-, and low-/lower-middle-income countries reporting serious relative health conditions, 35.7-42.5% reported burden. Of those, 25.2-29.0% spent time and 13.5-19.4% money, while 24.4-30.6% felt distress and 6.4-21.7% embarrassment. Mean caregiving hours per week in those giving any time were 16.6-23.6 (169.9-205.8 h/week per 100 people aged 50+ years). Burden in low-/lower-middle-income countries was 2- to 3-fold higher than in higher-income countries, with any financial burden averaging 14.3% of median family income in high-, 17.7% in upper-middle-, and 39.8% in low-/lower-middle-income countries. Higher burden was reported by women than men and for conditions of spouses and children than parents or siblings. Conclusions Uncompensated family caregiving is an important societal asset that offsets rising formal healthcare costs. However, the substantial burdens experienced by aging caregivers across multiple family health conditions and geographic regions threaten the continued integrity of their caregiving capacity. Initiatives supporting older family caregivers are consequently needed, especially in low-/lower-middle-income countrie

A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression among University Students:A Secondary Analysis of a Randomized Clinical Trial

Importance: Guided internet-delivered cognitive behavioral therapy (i-CBT) is a low-cost way to address high unmet need for anxiety and depression treatment. Scalability could be increased if some patients were helped as much by self-guided i-CBT as guided i-CBT. Objective: To develop an individualized treatment rule using machine learning methods for guided i-CBT vs self-guided i-CBT based on a rich set of baseline predictors. Design, Setting, and Participants: This prespecified secondary analysis of an assessor-blinded, multisite randomized clinical trial of guided i-CBT, self-guided i-CBT, and treatment as usual included students in Colombia and Mexico who were seeking treatment for anxiety (defined as a 7-item Generalized Anxiety Disorder [GAD-7] score of ≥10) and/or depression (defined as a 9-item Patient Health Questionnaire [PHQ-9] score of ≥10). Study recruitment was from March 1 to October 26, 2021. Initial data analysis was conducted from May 23 to October 26, 2022. Interventions: Participants were randomized to a culturally adapted transdiagnostic i-CBT that was guided (n = 445), self-guided (n = 439), or treatment as usual (n = 435). Main Outcomes and Measures: Remission of anxiety (GAD-7 scores of ≤4) and depression (PHQ-9 scores of ≤4) 3 months after baseline. Results: The study included 1319 participants (mean [SD] age, 21.4 [3.2] years; 1038 women [78.7%]; 725 participants [55.0%] came from Mexico). A total of 1210 participants (91.7%) had significantly higher mean (SE) probabilities of joint remission of anxiety and depression with guided i-CBT (51.8% [3.0%]) than with self-guided i-CBT (37.8% [3.0%]; P =.003) or treatment as usual (40.0% [2.7%]; P =.001). The remaining 109 participants (8.3%) had low mean (SE) probabilities of joint remission of anxiety and depression across all groups (guided i-CBT: 24.5% [9.1%]; P =.007; self-guided i-CBT: 25.4% [8.8%]; P =.004; treatment as usual: 31.0% [9.4%]; P =.001). All participants with baseline anxiety had nonsignificantly higher mean (SE) probabilities of anxiety remission with guided i-CBT (62.7% [5.9%]) than the other 2 groups (self-guided i-CBT: 50.2% [6.2%]; P =.14; treatment as usual: 53.0% [6.0%]; P =.25). A total of 841 of 1177 participants (71.5%) with baseline depression had significantly higher mean (SE) probabilities of depression remission with guided i-CBT (61.5% [3.6%]) than the other 2 groups (self-guided i-CBT: 44.3% [3.7%]; P =.001; treatment as usual: 41.8% [3.2%]; P &lt;.001). The other 336 participants (28.5%) with baseline depression had nonsignificantly higher mean (SE) probabilities of depression remission with self-guided i-CBT (54.4% [6.0%]) than guided i-CBT (39.8% [5.4%]; P =.07). Conclusions and Relevance: Guided i-CBT yielded the highest probabilities of remission of anxiety and depression for most participants; however, these differences were nonsignificant for anxiety. Some participants had the highest probabilities of remission of depression with self-guided i-CBT. Information about this variation could be used to optimize allocation of guided and self-guided i-CBT in resource-constrained settings. Trial Registration: ClinicalTrials.gov Identifier: NCT04780542.</p