Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Multnomah County Project Launch Evaluation

Early childhood is a critical time in human development. Any experience, positive or negative, can influence long-term outcomes for physical, emotional, social, and cognitive health (Center on the Developing Child at Harvard University, 2010). To ensure a strong foundation for success in school and in life, efforts designed to promote wellness and identify early learning or mental health challenges must begin well before kindergarten. Strong evidence shows that investing in early childhood can yield large dividends for children. Additionally, the ability of our systems to provide positive outcomes for children can be enhanced through strategic planning, well-developed partnerships, and coordinated family services. Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health), a federally funded United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA) initiative, aims to enhance and improve the way systems function by bringing together all participants in each child’s life including caregivers, primary care providers, early childhood educators, and mental health providers. Project LAUNCH strives to incorporate all participants, at all levels of service provision, to strengthen our ability to achieve the best possible outcomes in social and emotional health and wellness for all children. Project LAUNCH has funded states, local jurisdictions, and tribes interested in achieving these goals since 2008. Under Project LAUNCH, grantees are charged with (1) promoting the healthy development of children from birth to age 8 and their families by harnessing and coordinating existing resources and (2) increasing access to high-quality, evidence-based programs in five childcentric domains: developmental screening and assessment, home visiting, mental health consultation, family strengthening and training, and integration of behavioral health into primary care. By developing an understanding of the landscape of services and supports unique to each state and community and by evaluating strengths and opportunities for change, grantees begin to implement promotion and prevention strategies that best serve the needs of their communities at the child, family, and systems levels. Thus, while there are distinct cultural, geographic, and economic differences across LAUNCH sites in all cohorts, the fundamental components of the LAUNCH model remain the same for all grantees. To date, Project LAUNCH has funded 55 projects across six cohorts. All LAUNCH grantees are expected to demonstrate local policy and practice improvements that can be sustained statewide. Unlike other LAUNCH cohorts, Cohort 3 grantees are distinguished by the fact that they were funded solely at the community level with no state or tribal oversight. This presented the six sites with a unique set of opportunities and challenges as they sought to bring policy and practice improvements to scale, enhance infrastructure, and implement direct services in the five domains or strategies. The uniqueness of the community-based aspect of Cohort 3 grantees provided both challenges and opportunities. Grantees identified the flexibility and ability to control program activities within a community setting as key advantages to the local grants, whereas the ability to replicate successful activities and implement policy change on a statewide basis were limited. Additionally, the uniqueness of Cohort 3 made it challenging to evaluate the success of Cohort 3 grantees by measuring their progress against that of other cohorts. This e-book was developed to highlight and share the experience of the local communities in Cohort 3. This publication is designed to serve as a resource for future early childhood systems development activities implemented by LAUNCH grantees or by other early childhood programs with similar goals and interests. This publication shares the contributions of this unique cohort to the field of young children’s mental health and family wellness by spotlighting accomplishments, evidence, and lessons learned within the context of the LAUNCH strategic framework. Narratives from the six grantees detail the successes and challenges of systems building from the ground up and emphasize the value-added benefits of funding directly at the community level. Recommendations for present and future LAUNCH projects and similar initiatives address strategies to build local, state, and national partnerships to support replication and sustainability. We hope you will find this resource of value for supporting local initiatives that promote young child and family wellnes