Prevalence of and risk factors for severe cognitive and sleep symptoms in ME/CFS and MS.

BACKGROUND: There are considerable phenotypic and neuroimmune overlaps between myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and multiple sclerosis (MS). While the precise aetiologies of both MS and ME/CFS are unclear, evidence suggests that deterioration in cognitive function is widely prevalent in patients with either condition. Little is known about differing risk factors or exposures, which may lead to severe cognitive or sleep symptoms. This study aims to gauge the extent of cognitive and sleep symptoms in ME/CFS and MS patients participating in the UK ME/CFS Biobank and identify the characteristics of those experiencing severe symptoms. METHODS: This was a cross-sectional study of 395 UK ME/CFS Biobank participants, recruited from primary care and the community, using similar standardised protocols, and matched by age, sex and geographical area. Data were collected from participants using a standardized written questionnaire at clinical visits. Cognitive symptoms included problems with short-term memory, attention, and executive function. Sleep symptoms included unrefreshing sleep and poor quality or inadequate duration of sleep. All participants reported symptoms based on an ordinal severity scale. Multivariable logistic regression was carried out in the ME/CFS group to investigate socio-demographic factors associated with severe symptoms. RESULTS: All cognitive and sleep symptoms were more prevalent in the ME/CFS group, with 'trouble concentrating' (98.3%) the most commonly reported symptom. Severe symptoms were also more commonly reported in the ME/CFS group, with 55% reporting 'severe, unrefreshing sleep'. Similarly, in the MS group, the most commonly reported severe symptoms were sleep-related. Logistic regression analysis revealed that ME/CFS patients aged over 50 years were more than three times as likely to experience severe symptoms than those younger than 30 (OR 3.23, p = 0.031). Current smoking was associated with severe symptoms, increasing the risk by approximately three times (OR 2.93, p = 0.003) and those with household incomes of more than £15,000 per year were less likely to experience severe symptoms compared to those earning less than this (OR 0.31, p = 0.017). CONCLUSIONS: Cognitive and sleep symptoms are more common in ME/CFS patients than in MS patients and healthy controls, providing further support for existing evidence of central nervous system abnormalities in ME/CFS. Our findings suggest that people with ME/CFS who are smokers, or have a low income, are more likely to report severe cognitive and sleep symptoms. Future research should aim to develop strategies to prevent the progression of severe cognitive and sleep symptoms through early interventions that prioritise patients identified as being at highest risk

A public health framework for the equitable global allocation of vaccines: COVID-NEEDS

The equitable global allocation of COVID-19 vaccines has received much attention yet been poorly defined. Understanding equity requires assessing needs for vaccines across countries. Making distinctions is especially challenging when countries perform similarly on traditional epidemiological metrics. This Viewpoint offers a novel conceptual framework (COVID-NEEDS) based on empirical evidence and public health guidance. It encompasses health, social, and economic impacts of COVID-19 and associated non-pharmaceutical interventions. We intend this framework to complement existing needs assessment methods to help identify countries most in need of vaccines. We present factors to consider, but future work will be required to understand how to weight the factors and to determine the practical utility of the framework for supplementing existing COVID-19 vaccine allocation mechanisms

A Rapid Review of COVID-19 Vaccine Prioritization in the U.S.: Alignment between Federal Guidance and State Practice

Background: Population groups to be prioritized for COVID-19 vaccinations in the U.S. have been determined at the Federal level, but there is variation in how States have implemented guidance. This review examines how the position of population groups in vaccine priority lists varies between Federal guidance and State practice. Methods: An online search of State vaccination prioritization plans was conducted. Data were extracted on each population group included and their relative position. A standardized ranking method was applied to provide a directional measure of variability in prioritization between State and Federal guidance, for each population group. Results: Healthcare workers and those in long-term care facilities were largely prioritized in line with Federal guidance. Aside from early education staff, essential workers were often excluded at State level. Almost all States included the 65–74 year age group and most assigned them to a higher position than recommended in Federal guidance. Those with underlying medical conditions were similarly highly prioritized, although there was more variability across States. Some socially vulnerable groups (not included in Federal guidance) were highly prioritized by many States. Conclusions: The prioritization of groups for COVID-19 vaccination has been highly variable despite clear Federal guidance. Future guidance must be relevant to local needs, values, and constraints, to minimize any unwarranted heterogeneity in vaccine access across populations

The association between cigarette smoking and primary open-angle glaucoma: a systematic review.

Glaucoma is one of the most common causes of irreversible blindness, globally. Findings from the Blue Mountain Eye Study suggest a moderate positive association between smoking and increased IOP (a significant risk factor for glaucoma). The previous two reviews investigating the association between smoking and primary open-angle glaucoma (POAG) show inconsistent findings and do not include recent studies investigating the dose-response effect of smoking. The current study aims to conduct an up-to-date, comprehensive evaluation of the existing literature. Identification of relevant existing literature was performed by an online search in MEDLINE for studies published from 1st January 1946 to 5th February 2015. The MESH headings (keywords) included "open-angle glaucoma" and "cigarette" or "smoking" or "tobacco". Two independent reviewers assessed the eligibility of each report based on predefined inclusion criteria. Odds ratios and 95 % confidence intervals (95 % CIs) were obtained from studies, for the change in risk of glaucoma due to both past and current smoking. Of the 26 abstracts reviewed, 17 papers were included in the final analysis. Nine of these were case-control studies, five cohort studies and three cross-sectional in design. Six of the case-control studies found a positive association between smoking and POAG, unlike the remaining studies. However, two relatively recent, large studies (including one prospective cohort study) investigating the effect of smoking dose have found a significant increase in risk of POAG in very heavy smokers. There is limited evidence for a causal association between tobacco smoking and POAG. The evidence for a link between current smoking and POAG appears stronger than that of past smoking, but recent studies suggest that heavy smoking may increase the risk of POAG. Future studies must further investigate the possible positive association between heavy smoking and POAG by stratifying participants by pack years and age

Meta-analysis of predictive symptoms for Ebola virus disease.

IntroductionOne of the leading challenges in the 2013-2016 West African Ebola virus disease (EVD) outbreak was how best to quickly identify patients with EVD, separating them from those without the disease, in order to maximise limited isolation bed capacity and keep health systems functioning.MethodologyWe performed a systematic literature review to identify all published data on EVD clinical symptoms in adult patients. Data was dual extracted, and random effects meta-analysis performed for each symptom to identify symptoms with the greatest risk for EVD infection.ResultsSymptoms usually presenting late in illness that were more than twice as likely to predict a diagnosis of Ebola, were confusion (pOR 3.04, 95% CI 2.18-4.23), conjunctivitis (2.90, 1.92-4.38), dysphagia (1.95, 1.13-3.35) and jaundice (1.86, 1.20-2.88). Early non-specific symptoms of diarrhoea (2.99, 2.00-4.48), fatigue (2.77, 1.59-4.81), vomiting (2.69, 1.76-4.10), fever (1.97, 1.10-4.52), muscle pain (1.65, 1.04-2.61), and cough (1.63, 1.24-2.14), were also strongly associated with EVD diagnosis.ConclusionsThe existing literature fails to provide a unified position on the symptoms most predictive of EVD, but highlights some early and late stage symptoms that in combination will be useful for future risk stratification. Confirmation of these findings across datasets (or ideally an aggregation of all individual patient data) will aid effective future clinical assessment, risk stratification tools and emergency epidemic response planning

Planning for large epidemics and pandemics: challenges from a policy perspective.

PURPOSE OF REVIEW: Less than two decades into the 21st century, the world has already witnessed numerous large epidemics or pandemics. These events have highlighted inadequacies in both national and international capacity for outbreak prevention, detection, and response. Here, we review some of the major challenges from a policy perspective. RECENT FINDINGS: The most important challenges facing policymakers include financing outbreak preparedness and response in a complex political environment with limited resources, coordinating response efforts among a growing and diverse range of national and international actors, accurately assessing national outbreak preparedness, addressing the shortfall in the global biomedical workforce, building surge capacity of both human and material resources, balancing investments in public health and curative services, building capacity for outbreak-related research and development, and reinforcing measures for infection prevention and control. SUMMARY: In recent years, numerous epidemics and pandemics have caused not only considerable loss of life but also billions of dollars of economic loss. Although the events have served as a wake-up call and led to the implementation of relevant policies and counter-measures, such as the Global Health Security Agenda, many questions remain and much work to be done. Wise policies and approaches for outbreak control exist, but will require the political will to implement them