Interstitial Lung Diseases in Developing Countries

More than 100 different conditions are grouped under the term interstitial lung disease (ILD). A diagnosis of an ILD primarily relies on a combination of clinical, radiological, and pathological criteria, which should be evaluated by a multidisciplinary team of specialists. Multiple factors, such as environmental and occupational exposures, infections, drugs, radiation, and genetic predisposition have been implicated in the pathogenesis of these conditions. Asbestosis and other pneumoconiosis, hypersensitivity pneumonitis (HP), chronic beryllium disease, and smoking-related ILD are specifically linked to inhalational exposure of environmental agents. The recent Global Burden of Disease Study reported that ILD rank 40th in relation to global years of life lost in 2013, which represents an increase of 86% compared to 1990. Idiopathic pulmonary fibrosis (IPF) is the prototype of fibrotic ILD. A recent study from the United States reported that the incidence and prevalence of IPF are 14.6 per 100,000 person-years and 58.7 per 100,000 persons, respectively. These data suggests that, in large populated areas such as Brazil, Russia, India, and China (the BRIC region), there may be approximately 2 million people living with IPF. However, studies from South America found much lower rates (0.4-1.2 cases per 100,000 per year). Limited access to high-resolution computed tomography and spirometry or to multidisciplinary teams for accurate diagnosis and optimal treatment are common challenges to the management of ILD in developing countries

LICENCIATURA EN GASTRONOMÍA PROYECTO CURRICULAR 2016

PROYECTO CURRICULAR DE LA LICENCIATURA EN GASTRONOMIA 201

Physical activity and self-reported health status among adolescents: A cross-sectional population-based study

Objectives: Little is known about the dose–response relationship between physical activity and health benefits among young people. Our objective was to analyse the association between the frequency of undertaking moderate-to-vigorous physical activity (MVPA) and the self-reported health status of the adolescent population. Design: Cross-sectional study. Setting: All regions of Spain. Participants: Students aged 11–18 years participating in the Spanish Health Behaviour in School-aged Children survey 2006. A total of 375 schools and 21 188 students were selected. Main outcomes: The frequency of undertaking MVPA was measured by a questionnaire, with the following four health indicators: self-rated health, health complaints, satisfaction with life and health-related quality of life. Linear and logistic regression models were used to analyse the association, adjusting for potential confounding variables and the modelling of the dose–response relationship. Results: As the frequency of MVPA increased, the association with health benefits was stronger. A linear trend (p<0.05) was found for self-rated health and health complaints in males and females and for satisfaction with life among females; for health-related quality of life this relationship was quadratic for both sexes ( p<0.05). For self-reported health and health complaints, the effect was found to be of greater magnitude in males than in females and, in all scales, the benefits were observed from the lowest frequencies of MVPA, especially in males. Conclusions: A protective effect of MVPA was found in both sexes for the four health indicators studied, and this activity had a gradient effect. Among males, health benefits were detected from very low levels of physical activity and the magnitude of the relationship was greater than that for females.g This study has been funded by the Consejo Superior de Deportes (National Sports Council) and the Ministerio de Sanidad, Servicios Sociales e Igualdad (Ministry of Health and Social Policy

Morphine for treatment of cough in idiopathic pulmonary fibrosis (PACIFY COUGH):a prospective, multicentre, randomised, double-blind, placebo-controlled, two-way crossover trial

Background: Idiopathic pulmonary fibrosis is a progressive fibrotic lung disease, with most patients reporting cough. Currently, there are no proven treatments. We examined the use of low dose controlled-release morphine compared with placebo as an antitussive therapy in individuals with idiopathic pulmonary fibrosis. Methods: The PACIFY COUGH study is a phase 2, multicentre, randomised, double-blind, placebo-controlled, two-way crossover trial done in three specialist centres in the UK. Eligible patients aged 40–90 years had a diagnosis of idiopathic pulmonary fibrosis within 5 years, self-reported cough (lasting &gt;8 weeks), and a cough visual analogue scale (VAS) score of 30 mm or higher. Patients were randomly assigned (1:1) to placebo twice daily or controlled-release morphine 5 mg orally twice daily for 14 days followed by crossover after a 7-day washout period. Patients were randomised sequentially to a sequence group defining the order in which morphine and placebo were to be given, according to a computer-generated schedule. Patients, investigators, study nurses, and pharmacy personnel were masked to treatment allocation. The primary endpoint was percentage change in objective awake cough frequency (coughs per h) from baseline as assessed by objective digital cough monitoring at day 14 of treatment in the intention-to-treat population, which included all randomised participants. Safety data were summarised for all patients who took at least one study drug and did not withdraw consent. This study was registered at ClinicalTrials.gov, NCT04429516, and has been completed. Findings: Between Dec 17, 2020, and March 21, 2023, 47 participants were assessed for eligibility and 44 were enrolled and randomly allocated to treatment. Mean age was 71 (SD 7·4) years, and 31 (70%) of 44 participants were male and 13 (30%) were female. Lung function was moderately impaired; mean forced vital capacity (FVC) was 2·7 L (SD 0·76), mean predicted FVC was 82% (17·3), and mean predicted diffusion capacity of carbon monoxide was 48% (10·9). Of the 44 patients who were randomised, 43 completed morphine treatment and 41 completed placebo treatment. In the intention-to-treat analysis, morphine reduced objective awake cough frequency by 39·4% (95% CI –54·4 to –19·4; p=0·0005) compared with placebo. Mean daytime cough frequency reduced from 21·6 (SE 1·2) coughs per h at baseline to 12·8 (1·2) coughs per h with morphine, whereas cough rates did not change with placebo (21·5 [SE 1·2] coughs per h to 20·6 [1·2] coughs per h). Overall treatment adherence was 98% in the morphine group and 98% in the placebo group. Adverse events were observed in 17 (40%) of 43 participants in the morphine group and six (14%) of 42 patients in the placebo group. The main side-effects of morphine were nausea (six [14%] of 43 participants) and constipation (nine [21%] of 43). One serious adverse event (death) occurred in the placebo group. Interpretation: In patients with cough related to idiopathic pulmonary fibrosis, low dose controlled-release morphine significantly reduced objective cough counts over 14 days compared with placebo. Morphine shows promise as an effective treatment to palliate cough in patients with idiopathic pulmonary fibrosis, and longer term studies should be the focus of future research. Funding: The Jon Moulton Charity Trust.</p

Morphine for treatment of cough in idiopathic pulmonary fibrosis (PACIFY COUGH): a prospective, multicentre, randomised, double-blind, placebo-controlled, two-way crossover trial

Idiopathic pulmonary fibrosis is a progressive fibrotic lung disease, with most patients reporting cough. Currently, there are no proven treatments. We examined the use of low dose controlled-release morphine compared with placebo as an antitussive therapy in individuals with idiopathic pulmonary fibrosis. The PACIFY COUGH study is a phase 2, multicentre, randomised, double-blind, placebo-controlled, two-way crossover trial done in three specialist centres in the UK. Eligible patients aged 40-90 years had a diagnosis of idiopathic pulmonary fibrosis within 5 years, self-reported cough (lasting &gt;8 weeks), and a cough visual analogue scale (VAS) score of 30 mm or higher. Patients were randomly assigned (1:1) to placebo twice daily or controlled-release morphine 5 mg orally twice daily for 14 days followed by crossover after a 7-day washout period. Patients were randomised sequentially to a sequence group defining the order in which morphine and placebo were to be given, according to a computer-generated schedule. Patients, investigators, study nurses, and pharmacy personnel were masked to treatment allocation. The primary endpoint was percentage change in objective awake cough frequency (coughs per h) from baseline as assessed by objective digital cough monitoring at day 14 of treatment in the intention-to-treat population, which included all randomised participants. Safety data were summarised for all patients who took at least one study drug and did not withdraw consent. This study was registered at ClinicalTrials.gov, NCT04429516, and has been completed. Between Dec 17, 2020, and March 21, 2023, 47 participants were assessed for eligibility and 44 were enrolled and randomly allocated to treatment. Mean age was 71 (SD 7·4) years, and 31 (70%) of 44 participants were male and 13 (30%) were female. Lung function was moderately impaired; mean forced vital capacity (FVC) was 2·7 L (SD 0·76), mean predicted FVC was 82% (17·3), and mean predicted diffusion capacity of carbon monoxide was 48% (10·9). Of the 44 patients who were randomised, 43 completed morphine treatment and 41 completed placebo treatment. In the intention-to-treat analysis, morphine reduced objective awake cough frequency by 39·4% (95% CI -54·4 to -19·4; p=0·0005) compared with placebo. Mean daytime cough frequency reduced from 21·6 (SE 1·2) coughs per h at baseline to 12·8 (1·2) coughs per h with morphine, whereas cough rates did not change with placebo (21·5 [SE 1·2] coughs per h to 20·6 [1·2] coughs per h). Overall treatment adherence was 98% in the morphine group and 98% in the placebo group. Adverse events were observed in 17 (40%) of 43 participants in the morphine group and six (14%) of 42 patients in the placebo group. The main side-effects of morphine were nausea (six [14%] of 43 participants) and constipation (nine [21%] of 43). One serious adverse event (death) occurred in the placebo group. In patients with cough related to idiopathic pulmonary fibrosis, low dose controlled-release morphine significantly reduced objective cough counts over 14 days compared with placebo. Morphine shows promise as an effective treatment to palliate cough in patients with idiopathic pulmonary fibrosis, and longer term studies should be the focus of future research. The Jon Moulton Charity Trust. [Abstract copyright: Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Aprendizaje cooperativo. Un recurso indispensable en la formación universitaria

El Libro “Aprendizaje cooperativo Un recurso indispensable en la formación universitaria”, se enmarca dentro del Proyecto de Innovación docente Finestra Oberta UV_ SFPIE GER 15-314671, bajo la dirección de la Profesora María Elena Cobas Cobiella, del Departamento de Derecho Civil, de la Facultad de Derecho de la Universidad de Valencia. Este libro contiene 19 artículos inéditos de un grupo importante de profesores y especialistas en la temática nacionales e internacionales, así como con la intervención como colaboradores de estudiantes de Grado en Derecho, de la doble titulación Derecho- ADE de la Universidad de Valencia, y de Universidades internacionales. También han intervenido en el mismo estudiantes del Master de Mediación y Arbitraje y solución de conflictos en Derecho Privado 2015/2016 y del Proyecto Unisocietat L’Eliana Curso 2015 – 2016. Constituye una obra que eleva la práctica del aula a la teoría. Altamente recomendable para aquellos que incursionen en el camino de la docencia.The Book "Cooperative learning: an indispensable resource in university education" is part of the Project for teaching innovation "Finestra Oberta,UV_ SFPIE GER 15-314671", under the direction of Professor Maria Elena Cobas Cobiella, from Civil Law department of the Faculty of Law of the University of Valencia. This book contains 19 new articles of a large group of professors and specialists in national and international topics, as well as with the intervention as collaborators of Law degree students from the double degree Law-Business Administration from the University of Valencia, and also from international universities. They have also intervened in the book some students from the Master of Mediation, Arbitration and resolution of conflicts in Private Law 2015/2016 and from the Unisocietat L'Eliana project 2015/2016. It is a work that elevates the classroom practice towards the theory. Highly recommended for those who want to progress in the way of teaching.Los siguientes estudiantes han colaborado en la Parte Especial del Libro, con los resúmenes de sus trabajos de mapas conceptuales y los prezi:Ylenia Martínez, María Gómez Escrivá,Julieta Campora Espí, Blanca Giner Zarranz, Mario Zúñiga Martínez, Alicia Martínez Ruiz, Sandra Gimeno Bascuñana, Héctor Martínez Soler, Amparo García Navarro,Joan De la Haba Herrera,Alberto José Fourrat Calatayud, Juan Ortega Talamantes, Vicente Vila Subiela, Cristina Blázquez Sánchez, Sara Monsalve Alemany, Paula Navarro Román, Carlos Reyes Hernández,Jesús Sanz Carnero,José Guillermo Gil, Aroa Gimeno, José Manuel Aznar, Teresa Pérez, Antonio Fernández, Cristina Martin, Rodrigo Climent, José Ángel Molina Sánchez, Daniel Cabanes Ferrando, David Escobar Haro, Diego Martínez Amor, Mari Carmen Arnau Gil, Raquel Jiménez Gago, Daniel March Quevedo, Laura Alapont Vidal, Gema Canós Ferrandis, Mónica Costa Isabel, Jesús Sanmartín Viturro, Eduardo José Tobio García, Pau Viñuelas LLoria, María del Mar Figueroa Hernández, Minerva Llagunes Picazo, Lucía Olmos, José Olmedo, Brynn De Houwer, Enrique Pla Marcos, Héctor Tabernero Más, Laura Payá González, Blanca Martínez Pons,Alejandro Grima Margarit, Belén Català, Mariam Pérez, David Sánchez, Jorge Seguí ,Sara Tamarit,Fernando Aparisi Escriba, Analía Carballo Quispe,José Luis Moreno Miguel,Candy Priscilla Rojas Campoverde, Ademar Lledó Monfort, Irene Belles Rubio, Clara Calomarde Esteban, Marta Marín de la Dueña, Sergio Pinel Castillo,Maria Simo Martin, Daniel Rocher Camps, Sandra Nicolás Mascarell, Teresa Bartret García, Maria Amparo Monasort Pérez,Joan Vicente Torres Moreno, Belén Cuñat Salavert, Carmen Rodríguez Bertos, Aníbal Sánchez Gómez, Sofía Morant Muñoz, Pedro Ballester Martínez,Akbar Khawar, David Ortíz Soler, Jonathan Pérez Gutiérrez.Jorge Amat Andrés, M.ª Antonia García Juncos, Jenny Maritza González Vergara,Juan José Tocón Torres,Pau Zurita Varela, Manuel Calvo Pereiro, Carolina Luis Tamarit,Beatriz Muñoz Moncholí,Marta Conejero Sarrió, Guillermo Juarez Ginestar, Carolina Más Trullás,Ramón Fernández Pares, Carlos Hervás García,Carolina Tamarit García, Jose Belloch Ortí,Danilo Terán Taborga,Manuel Castillo Martínez, Isabel Martínez Salas, Carlos Javier Castello Domenech, Silvia Juste Frechina, Cristina Barrado Franco, Noemi De Miguel Domingo, Elena Masegosa Laurí, Maryana Seniv, Paula Sanz Perez, Liney Paola Peiró Soriano, José Manuel Zahonero Ferrer,Paula Pons Guillem,Andrea Oviedo Millán,Arnaud Wustefeld, Alba Ruiz-Santa Quiteria Lara,Lydia García Céspedes,Antonio Gomar López,Eva Piqueras García, Claudia Salvador Pérez, Joel David Alvarez Remy, Sheila Jorge Muñoz,Virginia Mendoza Leal,David Benavides Arenas, Mario Perera Sánchez, Vladimir Sarmiento Paizán,Javier Mustelier Armiñán,Diamela Salina Ocaña, Edel Morales Salazar,Fortunato Dong Oñaña,María del Carmen Carvajal Balagué,María del Carmen Daries Coll, Catalina Olmo Brazales,Mª Teresa Sánchez, Julia Serra Figuerola,Mª Nieves Valdearcos Quintín,Carmen Moraga Martín,María José Moragues, Salvador Lluch,Maribel Moreno,José Luis Coello,José Cebriá,Matilde Argente,Consuelo Martínez,Rosi Hernández,Susi García,Graciela Garibotti,Susana Bianchi,Judith Steffan,Susan Humphreys,Jesús Castellano,Ana Preus,Mª José Figueroa,Mª Teresa Carbonell,Lola Lombrera,Luisa Martínez Gordillo,Roberto Soler,Pilar Bezares Martínez, Ramón González Ferrer,Raquel González Sainz,Sacra Martínez Alarcón, Emetério Mirálles Ribot, Ramón Pubill Rocaort,Conchin Ruiz Leal, Isabel Sucarrat Bermejo,Pepa San Román Moñino,InmaTarín Arfella, Maise Tarín Arfella, Pedro Montalban,Carmen Kroebel, Lydia González, Carlos Gómez, Amparo Cuellar,Pilar Navarro,Luisa Vallejo, Encarna Monzó,Carmen Conca,Pilar Alegría, Sonia Almonacil, Inma Fernández, María José García Marcelo,Clara Olivert Pavia, Ana Herrero Martínez, Rosana Crespo Martínez, Carmen Vidal Casañ,José Ramón Villagrasa Tort,Juan Carlos López Cubero,Paco Velayos Sánchez,María de la O Pérez,Carles Montagut Alvarez, José Leopoldo Rodríguez Pla, Amanda Bernat Tinoco,Marta García Montañana, Ioana Roxana Moraru, Jenifer Perujo Plumed,María Ribera Cebolla,Amparo Esteve Cervera, Iris Pla Sempere,Juan Rafael Aranda Perozo,Jesús Collado Mas, Cristina Grimalt Molina,Isabel Rojo Lora, María Teresa Peirats Casanova,Rosana Marin Rausell, Ricardo Mejía Hidalgo,Pablo Pastor Aguilera,Daniel Trujillo Villalba,Yolanda Fuster Llidó, Lucas Lamarca Pedemonte, Gabriel Rosa Felipe

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Outcome of Hospitalization for COVID-19 in Patients with Interstitial Lung Disease. An International Multicenter Study.

Rationale: The impact of coronavirus disease (COVID-19) on patients with interstitial lung disease (ILD) has not been established.Objectives: To assess outcomes in patients with ILD hospitalized for COVID-19 versus those without ILD in a contemporaneous age-, sex-, and comorbidity-matched population.Methods: An international multicenter audit of patients with a prior diagnosis of ILD admitted to the hospital with COVID-19 between March 1 and May 1, 2020, was undertaken and compared with patients without ILD, obtained from the ISARIC4C (International Severe Acute Respiratory and Emerging Infection Consortium Coronavirus Clinical Characterisation Consortium) cohort, admitted with COVID-19 over the same period. The primary outcome was survival. Secondary analysis distinguished idiopathic pulmonary fibrosis from non-idiopathic pulmonary fibrosis ILD and used lung function to determine the greatest risks of death.Measurements and Main Results: Data from 349 patients with ILD across Europe were included, of whom 161 were admitted to the hospital with laboratory or clinical evidence of COVID-19 and eligible for propensity score matching. Overall mortality was 49% (79/161) in patients with ILD with COVID-19. After matching, patients with ILD with COVID-19 had significantly poorer survival (hazard ratio [HR], 1.60; confidence interval, 1.17-2.18; P = 0.003) than age-, sex-, and comorbidity-matched controls without ILD. Patients with an FVC of <80% had an increased risk of death versus patients with FVC ≥80% (HR, 1.72; 1.05-2.83). Furthermore, obese patients with ILD had an elevated risk of death (HR, 2.27; 1.39-3.71).Conclusions: Patients with ILD are at increased risk of death from COVID-19, particularly those with poor lung function and obesity. Stringent precautions should be taken to avoid COVID-19 in patients with ILD

Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK:a prospective multicentre cohort study

BACKGROUND: Sleep disturbance is common following hospital admission both for COVID-19 and other causes. The clinical associations of this for recovery after hospital admission are poorly understood despite sleep disturbance contributing to morbidity in other scenarios. We aimed to investigate the prevalence and nature of sleep disturbance after discharge following hospital admission for COVID-19 and to assess whether this was associated with dyspnoea. METHODS: CircCOVID was a prospective multicentre cohort substudy designed to investigate the effects of circadian disruption and sleep disturbance on recovery after COVID-19 in a cohort of participants aged 18 years or older, admitted to hospital for COVID-19 in the UK, and discharged between March, 2020, and October, 2021. Participants were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Follow-up data were collected at two timepoints: an early time point 2-7 months after hospital discharge and a later time point 10-14 months after hospital discharge. Sleep quality was assessed subjectively using the Pittsburgh Sleep Quality Index questionnaire and a numerical rating scale. Sleep quality was also assessed with an accelerometer worn on the wrist (actigraphy) for 14 days. Participants were also clinically phenotyped, including assessment of symptoms (ie, anxiety [Generalised Anxiety Disorder 7-item scale questionnaire], muscle function [SARC-F questionnaire], dyspnoea [Dyspnoea-12 questionnaire] and measurement of lung function), at the early timepoint after discharge. Actigraphy results were also compared to a matched UK Biobank cohort (non-hospitalised individuals and recently hospitalised individuals). Multivariable linear regression was used to define associations of sleep disturbance with the primary outcome of breathlessness and the other clinical symptoms. PHOSP-COVID is registered on the ISRCTN Registry (ISRCTN10980107). FINDINGS: 2320 of 2468 participants in the PHOSP-COVID study attended an early timepoint research visit a median of 5 months (IQR 4-6) following discharge from 83 hospitals in the UK. Data for sleep quality were assessed by subjective measures (the Pittsburgh Sleep Quality Index questionnaire and the numerical rating scale) for 638 participants at the early time point. Sleep quality was also assessed using device-based measures (actigraphy) a median of 7 months (IQR 5-8 months) after discharge from hospital for 729 participants. After discharge from hospital, the majority (396 [62%] of 638) of participants who had been admitted to hospital for COVID-19 reported poor sleep quality in response to the Pittsburgh Sleep Quality Index questionnaire. A comparable proportion (338 [53%] of 638) of participants felt their sleep quality had deteriorated following discharge after COVID-19 admission, as assessed by the numerical rating scale. Device-based measurements were compared to an age-matched, sex-matched, BMI-matched, and time from discharge-matched UK Biobank cohort who had recently been admitted to hospital. Compared to the recently hospitalised matched UK Biobank cohort, participants in our study slept on average 65 min (95% CI 59 to 71) longer, had a lower sleep regularity index (-19%; 95% CI -20 to -16), and a lower sleep efficiency (3·83 percentage points; 95% CI 3·40 to 4·26). Similar results were obtained when comparisons were made with the non-hospitalised UK Biobank cohort. Overall sleep quality (unadjusted effect estimate 3·94; 95% CI 2·78 to 5·10), deterioration in sleep quality following hospital admission (3·00; 1·82 to 4·28), and sleep regularity (4·38; 2·10 to 6·65) were associated with higher dyspnoea scores. Poor sleep quality, deterioration in sleep quality, and sleep regularity were also associated with impaired lung function, as assessed by forced vital capacity. Depending on the sleep metric, anxiety mediated 18-39% of the effect of sleep disturbance on dyspnoea, while muscle weakness mediated 27-41% of this effect. INTERPRETATION: Sleep disturbance following hospital admission for COVID-19 is associated with dyspnoea, anxiety, and muscle weakness. Due to the association with multiple symptoms, targeting sleep disturbance might be beneficial in treating the post-COVID-19 condition. FUNDING: UK Research and Innovation, National Institute for Health Research, and Engineering and Physical Sciences Research Council

Real-world experience of nintedanib for progressive fibrosing interstitial lung disease in the UK

Background Nintedanib slows progression of lung function decline in patients with progressive fibrosing (PF) interstitial lung disease (ILD) and was recommended for this indication within the United Kingdom (UK) National Health Service in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date, there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting.Methods 26 UK centres were invited to take part in a national service evaluation between 17 November 2021 and 30 September 2022. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability were collected via electronic survey.Results 24 UK prescribing centres responded to the service evaluation invitation. Between 17 November 2021 and 30 September 2022, 1120 patients received a multidisciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298 out of 1120, 26.6%), connective tissue disease associated ILD (197 out of 1120, 17.6%), rheumatoid arthritis associated ILD (180 out of 1120, 16.0%), idiopathic nonspecific interstitial pneumonia (125 out of 1120, 11.1%) and unclassifiable ILD (100 out of 1120, 8.9%). Of these, 54.4% (609 out of 1120) were receiving concomitant corticosteroids, 355 (31.7%) out of 1120 were receiving concomitant mycophenolate mofetil and 340 (30.3%) out of 1120 were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD.Conclusion We have demonstrated the use of nintedanib for the treatment of PF-ILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting