Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study

Purpose: Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods: A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results: Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10-1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00-16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26-46.75, vs 18 days, IQR 16-46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6-15.5) for non-IMV and 49.5 days (IQR 36.8-82.5) for IMV patients. Conclusions: Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19

Modelling human choices: MADeM and decision‑making

Research supported by FAPESP 2015/50122-0 and DFG-GRTK 1740/2. RP and AR are also part of the Research, Innovation and Dissemination Center for Neuromathematics FAPESP grant (2013/07699-0). RP is supported by a FAPESP scholarship (2013/25667-8). ACR is partially supported by a CNPq fellowship (grant 306251/2014-0)

Barriers of Influenza Vaccination Intention and Behavior - A Systematic Review of Influenza Vaccine Hesitancy, 2005 - 2016.

BackgroundInfluenza vaccine hesitancy is a significant threat to global efforts to reduce the burden of seasonal and pandemic influenza. Potential barriers of influenza vaccination need to be identified to inform interventions to raise awareness, influenza vaccine acceptance and uptake.ObjectiveThis review aims to (1) identify relevant studies and extract individual barriers of seasonal and pandemic influenza vaccination for risk groups and the general public; and (2) map knowledge gaps in understanding influenza vaccine hesitancy to derive directions for further research and inform interventions in this area.MethodsThirteen databases covering the areas of Medicine, Bioscience, Psychology, Sociology and Public Health were searched for peer-reviewed articles published between the years 2005 and 2016. Following the PRISMA approach, 470 articles were selected and analyzed for significant barriers to influenza vaccine uptake or intention. The barriers for different risk groups and flu types were clustered according to a conceptual framework based on the Theory of Planned Behavior and discussed using the 4C model of reasons for non-vaccination.ResultsMost studies were conducted in the American and European region. Health care personnel (HCP) and the general public were the most studied populations, while parental decisions for children at high risk were under-represented. This study also identifies understudied concepts. A lack of confidence, inconvenience, calculation and complacency were identified to different extents as barriers to influenza vaccine uptake in risk groups.ConclusionMany different psychological, contextual, sociodemographic and physical barriers that are specific to certain risk groups were identified. While most sociodemographic and physical variables may be significantly related to influenza vaccine hesitancy, they cannot be used to explain its emergence or intensity. Psychological determinants were meaningfully related to uptake and should therefore be measured in a valid and comparable way. A compendium of measurements for future use is suggested as supporting information

Flow Chart of selection process.

<p>Flow Chart of selection process.</p

Barriers to seasonal and pandemic influenza vaccine uptake for each risk group aggregated using the macro-level 4C model of vaccine hesitancy (complacency, convenience, confidence and calculation).

<p>Bars visualize the total number of significant results supporting each reason for hesitancy for each risk group. Grey bars indicate the absolute proportion of results addressing pandemic influenza uptake among the total results. Black bars indicate the absolute proportion of results for seasonal influenza uptake among the total results.</p

Barriers of Influenza Vaccination Intention and Behavior – A Systematic Review of Influenza Vaccine Hesitancy, 2005 – 2016 - Sheet 0

<p>Barriers of Influenza Vaccination Intention and Behavior – A Systematic Review of Influenza Vaccine Hesitancy, 2005 – 2016</p> - Sheet

Exclusion criteria used in selection process for literature review on influenza vaccine hesitancy.

<p>Exclusion criteria used in selection process for literature review on influenza vaccine hesitancy.</p

Micro-level determinants of vaccine hesitancy following an extended version of the Theory of Planned Behavior (TPB).

<p>Determinants are based on empirical and theoretical work from Ajzen [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0170550#pone.0170550.ref023" target="_blank">23</a>], Schmiege et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0170550#pone.0170550.ref025" target="_blank">25</a>], Rhodes & Courneya [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0170550#pone.0170550.ref026" target="_blank">26</a>], Koo et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0170550#pone.0170550.ref027" target="_blank">27</a>], Pomery et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0170550#pone.0170550.ref028" target="_blank">28</a>], Larson et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0170550#pone.0170550.ref010" target="_blank">10</a>]. Significant determinants from 470 research articles are clustered according to the model. Circle size represents the total number of reported incidents.</p

Barriers to influenza vaccine uptake mapped onto the macro-level 4C model of vaccine hesitancy (complacency, convenience, confidence and calculation).

<p>Total numbers of studies reporting the variable as either decreasing (white) or increasing (black) vaccine acceptance or inconclusive (circled number).</p

Keywords used for the literature search.

<p>Keywords used for the literature search.</p