COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Securing jugular central venous access devices with dressings fixed to a liquid adhesive in an intensive care unit population: a randomised controlled trial

BackgroundCentral venous access devices (CVADs) can have high rates of failure due to dressing-related complications. CVADs placed in the internal jugular vein are at particular risk of dressing failure-related complications, including catheter-associated bloodstream infection and medical adhesive-related skin injury. Application of Mastisol liquid adhesive (MLA) may reduce CVAD dressing failure and associated complications, by reducing the frequency of dressing changes. The aim of this study is to investigate whether, in an intensive care unit (ICU) population, standard dressing care with or without the addition of MLA, improves internal jugular CVAD dressing adherence.MethodsThis two-arm, parallel group randomised controlled trial will be conducted in three Australian ICUs. A total of 160 patients (80 per group) will be enrolled in accordance with study inclusion and exclusion criteria. Patients will be randomised to receive either (1) ‘standard’ (in accordance with local hospital policy) CVAD dressings (control) or (2) ‘standard’ dressings in addition to MLA (intervention). Patients will be followed from the time of CVAD insertion to 48 h after CVAD removal. The primary outcome is ‘dressing failure’ defined as requirement for initial CVAD dressing to be replaced prior to seven days (routine replacement).DiscussionThis study will be the first randomised controlled trial to evaluate the clinical effectiveness of MLA in the adult intensive care unit population and will also provide crucial data for patient-important outcomes such as infection and skin injury.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12621001012864. Registered on 2 August 202

Pressure injury prevalence in Australian intensive care units: A secondary analysis

Background: Pressure injuries (PIs) are an enduring problem for patients in the intensive care unit (ICU) because of their vulnerability and numerous risk factors. Method: This study reports Australian data as a subset of data from an international 1-day point prevalence study of ICU-acquired PI in adult patients. Patients aged 18 years or older and admitted to the ICU on the study day were included. The outcome measure was the identification of a PI by direct visual skin assessment on the study day. Data collected included demographic data and clinical risk factors, PI location and stage, and PI prevention strategies used. Descriptive statistics were used to describe PI characteristics, and odds ratios (ORs) were used to identify factors associated with the development of a PI. Results: Data were collected from 288 patients from 16 Australian ICUs. ICU-acquired PI prevalence was 9.7%, with 40 PIs identified on 28 patients. Most PIs were of stage 1 and stage 2 (26/40, 65.0%). Half of the ICU-acquired PIs were found on the head and face. The odds of developing an ICU-acquired PI increased significantly with renal replacement therapy (OR: 4.25, 95% confidence interval [CI]: 1.49–12.11), impaired mobility (OR: 3.13, 95% CI: 1.08–9.12), fastest respiratory rate (OR: 1.05 [per breath per minute], 95% CI: 1.00–1.10), longer stay in the ICU (OR: 1.04 [per day], 95% CI: 1.01–1.06), and mechanical ventilation on admission (OR: 0.36, CI: 0.14–0.91). Conclusion: This study found that Australian ICU-acquired PI prevalence was 9.7% and these PIs were associated with many risk factors. Targeted PI prevention strategies should be incorporated into routine prevention approaches to reduce the burden of PIs in the Australian adult ICU patient population.</p

Socio-econo-engineering: What Is the Right Dose of Capitalism Regarding Fertility? Recommendations How to Use Capitalism for Population Control and How to Avert the Falling Rate of Fertility in Capitalist Territories

Based on a 180 country strong worldwide data set and cross sectional correlation studies, this paper outlines that hallmark pillars of capitalism are all negatively associated with fertility rates. The 2017 Economic Freedom Index is significantly negatively correlated with fertility rates around the globe. Based on a 139 country strong worldwide dataset on industrialization as measured by the UNIDO in the Industrialization Intensity Index of 2014 and fertility rates, a highly significant negative relation is found between industrialization and fertility rates around the world. Urban areas around the world tend to have higher fertility rates and access to markets within rural communities lowers fertility rates measured by the World Bank Rural Access Index for 64 countries around the world. The inverse relation of economic freedom and fertility was also found for 50 U.S. states based on the 2017 Economic Freedom Index and fertility rates in the United States