An evidence base for school health policy during the covid-19 pandemic

Objective: Children represent a small fraction of confirmed COVID-19 cases, with a low case fatality rate (CFR). In this paper, we lay out an evidence-based policy for reopening schools. Methods: We gathered age-specific COVID-19 case counts and identified mortality data for 14 countries. Dose-response meta-analysis was used to examine the relationship of the incremental case fatality rate (CFR) to age. In addition, an evidence-to-decision framework (EtD) was used to correlate the dose-response data with other epidemiological characteristics of COVID-19 in childhood. Results: In the dose-response analysis, we found that there was an almost negligible fatality below age 18. CFR rose little between ages 5 to 50 years. The confidence intervals were narrow, suggesting relative homogeneity across countries. Further data suggested decreased childhood transmission from respiratory droplets and a low viral load among children. Conclusions: Opening up schools and kindergartens is unlikely to impact COVID-19 case or mortality rates in both the child and adult populations. We outline a robust plan for schools that recommends that general principles not be micromanaged, with authority left to schools and monitored by public health authorities.SB, SA and SD received support from a Qatar University Emergency Response Grant (QUERG-CENG-2020-1). The funder had no role in the study and the content remains the responsibility of the authors.Scopu

The Odds Ratio is "portable" across baseline risk but not the Relative Risk: Time to do away with the log link in binomial regression

Objectives: In a recent paper we suggest that the relative risk (RR) be replaced with the odds ratio (OR) as the effect measure of choice in clinical epidemiology. In response, Chu, and colleagues raise several points that argue for the status quo. In this paper, we respond to their response. Study designs and Settings: We use the same examples given by Chu and colleagues to recompute estimates of effect and demonstrate the problem with the RR. Results: We reaffirm the following findings: a) the OR and RR measure different things and their numerical difference is only important if misinterpreted b) this potential misinterpretation is a trivial issue compared to the lack of portability of the RR c) the same examples reaffirm non-portability of the RR and demonstrate how misleading the results might be in contrast to the OR, which is independent of the baseline risk d) the concept of non-collapsibility for the OR should be expected in the presence of a non-confounding risk factor, and is not a bias e) the log link in regression models that generate RRs as well as the use of RRs in meta-analysis is shown to be problematic using the same examples. Conclusion: The OR should replace the RR in clinical research and meta-analyses though there should be conversion of the end product into ratios or differences of risk, solely, for interpretation. To this end we provide a Stata module (logittorisk) for this purpose.This work was made possible by Program Grant #NPRP10-0129-170274 from the Qatar National Research Fund (a member of Qatar Foundation). The findings herein reflect the work, and are solely the responsibility of the authors. All authors had full access to all the data in the study and the corresponding author had final responsibility for the decision to submit for publication. LFK is supported by an Australian National Health and Medical Research Council Fellowship ( APP1158469 ).Scopu

Core outcomes in gestational diabetes for treatment trials: The Gestational Metabolic Group treatment set

Aims With the rising number of outcomes being reported following gestational diabetes (GDM), the outcomes in existing studies vary widely making it challenging to compare and contrast the effectiveness of different interventions for GDM. The purpose of this study was to develop a core outcome and measurement set (COS) for GDM treatment trials. Materials & Methods A Delphi study with structured consultation with stakeholders and discussion within a specialist Gestational Metabolic Group (GEM) were combined with a comprehensive systematic search across different databases (PubMed, Cochrane Library, and Embase). Several Delphi rounds over 2 years were conducted culminating in this report. Results The process resulted in a targeted set of outcomes constituting a “GEM treatment set” aligned with expert opinion. The final COS also included a measurement set for the 11 important clinical outcomes from three major domains: maternal metabolic, fetal, and pregnancy related. Conclusions Based on the results of this study, it is recommended that future clinical trials on GDM report outcomes uniformly keeping to the recommended COS outcomes.Members of the GEM Group who did not qualify for authorship but who contributed to the QMI meetings include: Maha Abdulla H I Al?Asmakh, PhD, Department of Biomedical Sciences, Qatar University. Stephen Atkin, Professor of Medicine; Weill Cornell Medicine?Qatar; Senior Consultant in Endocrinology, Hamad Medical Corporation, Doha, Qatar. Ilham Bettahi, PhD, Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar. Odette Chagoury, PhD, Associate Director Clinical Research at Weill Cornell Medicine, Doha, Qatar. Tarik El Hadd, MD, Department of Endocrinology, Qatar Metabolic Institute, Hamad Medical Corporation (Hamad Teaching Hospital), Doha, Qatar. Ibrahim M. Ibrahim, MD, Endocrine Department, Sidra Medicine, Doha, Qatar. Gianfranco Pintus, PhD, College of Health Sciences, Qatar University, Doha, Qatar. Manjunath Ramanjaneya, BPharm, Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar. Hiba Mahmoud Hassan Satti, MD, Department of Obstetrics and Gynecology, Hamad Medical Corporation, Doha, Qatar. Hessa Ibrahim Shahbic, MD, Assistant Director of Women's Health Clinical Affairs Department, Primary Health Care Corporation, Doha, Qatar. Fatin Taha, MD, Department of Obstetrics and Gynecology, Hamad Medical Corporation, Doha, Qatar. Shahrad Taheri, BSc, MSc, MBBS, PhD, FRCP; Professor of Medicine; Weill Cornell Medicine?Qatar Senior Consultant in Endocrinology, Hamad Medical Corporation, Doha, Qatar. This study was made possible by program grant NPRP 10?0129?170274 from Qatar National Research Fund (a member of Qatar Foundation) to Suhail A. Doi. The findings herein reflect the work and are solely the responsibility of the authors. Open Access funding provided by the Qatar National Library.Scopu

Impact of Smoking on COVID-19 Symptoms in Non-Vaccinated Patients: A Matched Observational Study from Qatar

Purpose: Predisposition to acute illness from COVID-19 is suggested to correlate with cigarette smoking as it augments the risk of developing cardiovascular and respiratory illnesses, including infections. However, the effects of smoking on COVID-19 symptoms are not well described and controversial. In this study, we aim to explore the associations between smoking and COVID-19 symptoms. Subjects and Methods: A cross-sectional study using the Ministry of Public Health (MoPH), Qatar database was administered to a Qatari population with confirmed COVID-19 disease who filled in pre-defined phone-call questionnaire between 27th February 2020 and 31st December 2020. We analyzed 11,701 non-vaccinated COVID-19 individuals (2952 smokers and 8749 non-smokers) with confirmed RT-PCR test results. The association of smoking and the presence of symptoms as well as patient characteristics was calculated using Pearson’s Chi-square and Fisher’s exact tests, adjusting for potential covariates. Results: Compared with the non-smokers, symptomatic COVID-19 infection is significantly higher in smokers. In addition, we found fever as the most common symptom developed in COVID-19 patients followed by cough, headache, muscle ache, and sore throat. As compared to other symptoms, association of smoking with chills and abdominal pain was less evident (P < 0.05 and P < 0.001, respectively). However, both groups showed similar rates of developing cough. Conclusion: In conclusion, smoking is associated with COVID-19 symptoms frequency in non-vaccinated patients; nevertheless, further investigations are necessary to understand the mechanism of this association which could generate new targets for the management of COVID-19 in smoker patients.We would like to thank Qatar's Ministry of Public Health for providing the data used in this study. Also, we would like to thank the Department of Population Medicine at College of Medicine, Qatar University for their support provided throughout the study.Scopu