Qualidade de vida das crianças e adolescentes e de seus pais durante a pandemia da COVID-19 no Brasil

Introdução: A doença causada pelo SARS-CoV-2 (COVID-19) foi classificada como pandemia em março de 2020 pela Organização Mundial de Saúde (OMS). Para sua prevenção foram adotadas algumas medidas como isolamento social. Estudos mostram que orientações restritivas e a consequente mudança dos hábitos de vida causaram alterações na saúde mental. Acredita-se que esse cenário possa impactar na qualidade de vida de crianças e adolescentes por influência direta ou indireta dos pais ou simplesmente pela mudança na rotina de vida. Assim como, dos seus responsáveis. Porém, há poucos estudos publicados sobre qualidade de vida durante a pandemia nesta população. Objetivo: Avaliar a qualidade de vida de crianças e adolescentes e seus pais em cidades brasileiras durante a pandemia da COVID-19 no ano de 2020. Metodologia: Trata-se de um estudo transversal envolvendo crianças e adolescentes com a faixa etária entre 2 e 18 anos de idade e seus cuidadores, os quais responderam de forma voluntária e anônima o questionário enviado via internet e disseminado pelo método “snow ball” entre os dias 23 de junho de 2020 e 13 de julho de 2020. Foi utilizado um questionário para crianças e pais para caracterização da população, além dos instrumentos para avaliar qualidade de vida (QV): Pediatric Quality of Life Inventory versão 4.0 (PedsQL 4.0) para crianças e adolescentes e o European Health Interview Survey Quality of Life Index of 8 items (EUROHIS-QOL 8) para os responsáveis. Resultados: Durante a pandemia observamos significativo aumento na média do tempo de tela (2hs para 5hs, p<0,001) que foi associado com pior PedSQL4.0 (75,7+12,6 versus 71,3 +13,7; p<0,001). Alimentação não saudável aumentou de 11% para 34% e se associou a menores escores de QV em relação àqueles que melhoraram ou mantiveram hábitos alimentares (69,7+13,3 versus 72,80+13,4 versus 76,4+12,6; p<0,001). A má qualidade do sono aumentou de 9% para 31,7%. Pior qualidade do sono também apresentou piores escores de QV de vida quando comparado àqueles que melhoraram ou não tiveram alterações relacionadas ao sono durante a pandemia (67,3+13,1 versus 74,5+13,1 versus 76,8+12,2; p<0,05). A manutenção de atividade física ocasionou melhores escores PedSQL4.0 (77,5+12,3 versus 72,5+14,4; p<0,001). Além disso, quem teve suas atividades escolares mantidas tiveram piores índices de QV comparado aos que não mantiveram suas atividades (73,1+ 13,2 versus 77,3 +12,9; p<0,001). Crianças entre 2 e 4 anos tiveram os melhores escores e sua QV foi diretamente proporcional a QV dos pais. Maior nível de escolaridade e socioeconômico dos pais foi associado a escores mais altos da QV das crianças e adolescentes. Conclusão: As medidas de mitigação do COVID-19 causaram mudanças no estilo de vida das crianças e adolescentes aumentando o tempo de exposição a tela, reduzindo a atividade física, piorando hábitos alimentares e qualidade de sono, refletindo-se em piores escores de QV. Também foi visto alteração nas atividades escolares. Fator que pode ter contribuído as alterações encontradas.Introduction: On March 2020, the disease caused by SARS-CoV-2 (COVID-19) was classified as a pandemic by the World Health Organization (WHO). Preventive measures such as social isolation was adopted. Studies showed that restrictive measures who induced modification on life habits affected the mental health. It is believed that this scenario may impact the quality of life of children and adolescents due to the direct or indirect influence of parents or simply by changing their routine. However, there are few studies evaluating the impact of the restrictive measures on the quality of life of this population. Goal: To evaluate the quality of life of Brazilian children and adolescents and their parents during the COVID-19 pandemic in 2020. Methodology: This is a cross-sectional study involving children and adolescents (2- 18 years of age) and their parents/ legal guardians, who responded voluntarily and anonymously to an online survey. Snowball sampling was used to recruit participants between the days June 23, 2020 and July 13, 2020. A questionnaire for children and parents was used to characterize the population. In addition, it was used the instruments to assess quality of life (QoL): Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0) for children and adolescents and the European Health Interview Survey Quality of Life Index of 8 items (EUROHIS-QOL 8) for guardians. Results: Mean screen time increased from 2h pre-pandemic to 5h during the pandemic (p<0.001) which was associated with worse PedSQL4.0 (75.7+12.6 versus 71.3+13.7; p<0.001). Unhealthy eating habits increased from 11% to 34% and were associated with lower QoL scores compared with improved or unchanged eating habits during the pandemic (69.7+13.3 versus 72.80+13.4 versus 76.4+12, 6; p<0.001). Poor sleeping quality increased from 9% to 31.7% and was associated with worse QoL scores compared with improved or unchanged sleeping quality during the pandemic (67.3+13.1 versus 74.5+13.1 versus 76.8+12, 2; p<0.05). Practicing physical exercise was associated with better PedSQL4.0 scores (77.5+12.3 versus 72.5+14.4; p<0.001). School activities maintained had worse QoL indices compared to not having school activities (73.1+13.2 versus 77.3+12.9; p<0.001). Children aged 2-4 years old had the best scores and their QoL was directly proportional to their parents' QoL. Higher education and socioeconomic level of parents was associated with higher QoL scores of children and adolescents. Conclusion: COVID-19 mitigation measures caused changes in the lifestyle of children and adolescents with increased screen time, reduced physical activity, worsening eating habits and sleep quality, reflected in worse QoL scores. Changes in school activities were also seen. Factor that may have contributed to the changes found

Restingas no litoral sul da Bahia: diversidade, estrutura e distribuição da vegetação lenhosa

Studies on the plant diversity of restingas help in conservation and alert to the degradation of this ecosystem. Therefore, the objective of the present study was to describe the structure and distribution of the woody vegetation of the restinga of Ituberá and Serra Grande in Bahia state. Five parallel transects were used, 10 m apart, with 50 points allocated in each area. Woody individuals with PAS &gt; 10 cm were selected, and phytosociological parameters were calculated using FITOPAC. The species with the highest importance value (IV) from each area were selected to analyze the Kernel density distributions. We identified 57 species and 34 families in Ituberá and 30 species and 16 families in Serra Grande. The species with the highest VI were Miconia holosericea, Tapirira guianensis and Terminalia tetraphylla in Ituberá and Manilkara salzmannii, Didymopanax morototoni and Eugenia punicifolia in Serra Grande. The mean diameter ranged from 11.80cm to 8.70cm, between the areas of Ituberá and Serra Grande, respectively. The diversity and evenness indices were H'= 3.319 nat.ind-1 and J'= 0.821 in Ituberá and H'= 2.828 nat.ind-1 and J'= 0.831 in Serra Grande. The maps of the species with the highest VI showed a high concentration of species density on the coast of Bahia, except for the species E. punicifolia, which has a greater distribution in the interior of the Bahia State. It is necessary to expand research on coastal ecosystems to support public policies aimed at maintaining and creating new areas for the protection of restingas in Northeast Brazil.Estudos sobre diversidade vegetal das restingas auxiliam na conservação e alertam para a degradação desse ecossistema. Diante disso, o objetivo do estudo foi descrever a estrutura e a distribuição da vegetação lenhosa da restinga de Ituberá e Serra Grande na Bahia. Para amostragem foram utilizados cinco transectos paralelos, distando 10 m entre si, sendo alocados 50 pontos em cada área. Foram selecionados os indivíduos lenhosos com PAS &gt; 10 cm e os parâmetros fitossociológicos foram calculados utilizando o FITOPAC. Foram selecionadas as espécies de maior valor de importância (VI) de cada área para analisar as distribuições de densidade de Kernel. Foram identificadas 57 espécies e 34 famílias em Ituberá e 30 espécies e 16 famílias em Serra Grande. As espécies com maior VI foram Miconia holosericea, Tapirira guianensis e Terminalia tetraphylla em Ituberá e Manilkara salzmannii, Didymopanax morototoni e Eugenia punicifolia em Serra Grande. A média dos diâmetros variou de 11,80 cm a 8,70 cm, entre as áreas de Ituberá e Serra Grande, respectivamente. Os índices de diversidade e equabilidade foram H' = 3,319 nat.ind-1 e J' = 0,821 em Ituberá, e H' = 2,828 nat.ind-1 e J' = 0,831 em Serra Grande. Os mapas das espécies de maior VI evidenciaram uma alta concentração da densidade das espécies no litoral baiano, exceto para a espécie E. punicifolia que apresenta maior distribuição no interior do Estado. É necessário ampliar as pesquisas nos ecossistemas litorâneos para subsidiar políticas públicas direcionadas para manutenção e criação de novas áreas para proteção das restingas no Nordeste do Brasil

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school&#x2;aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Neotropical freshwater fisheries : A dataset of occurrence and abundance of freshwater fishes in the Neotropics

The Neotropical region hosts 4225 freshwater fish species, ranking first among the world's most diverse regions for freshwater fishes. Our NEOTROPICAL FRESHWATER FISHES data set is the first to produce a large-scale Neotropical freshwater fish inventory, covering the entire Neotropical region from Mexico and the Caribbean in the north to the southern limits in Argentina, Paraguay, Chile, and Uruguay. We compiled 185,787 distribution records, with unique georeferenced coordinates, for the 4225 species, represented by occurrence and abundance data. The number of species for the most numerous orders are as follows: Characiformes (1289), Siluriformes (1384), Cichliformes (354), Cyprinodontiformes (245), and Gymnotiformes (135). The most recorded species was the characid Astyanax fasciatus (4696 records). We registered 116,802 distribution records for native species, compared to 1802 distribution records for nonnative species. The main aim of the NEOTROPICAL FRESHWATER FISHES data set was to make these occurrence and abundance data accessible for international researchers to develop ecological and macroecological studies, from local to regional scales, with focal fish species, families, or orders. We anticipate that the NEOTROPICAL FRESHWATER FISHES data set will be valuable for studies on a wide range of ecological processes, such as trophic cascades, fishery pressure, the effects of habitat loss and fragmentation, and the impacts of species invasion and climate change. There are no copyright restrictions on the data, and please cite this data paper when using the data in publications

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

International audienceBackground: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs).Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support.Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]).Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings

Implementation of Recommendations on the Use of Corticosteroids in Severe COVID-19

Importance: Research diversity and representativeness are paramount in building trust, generating valid biomedical knowledge, and possibly in implementing clinical guidelines. Objectives: To compare variations over time and across World Health Organization (WHO) geographic regions of corticosteroid use for treatment of severe COVID-19; secondary objectives were to evaluate the association between the timing of publication of the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial (June 2020) and the WHO guidelines for corticosteroids (September 2020) and the temporal trends observed in corticosteroid use by region and to describe the geographic distribution of the recruitment in clinical trials that informed the WHO recommendation. Design, setting, and participants: This prospective cohort study of 434 851 patients was conducted between January 31, 2020, and September 2, 2022, in 63 countries worldwide. The data were collected under the auspices of the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC)-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Analyses were restricted to patients hospitalized for severe COVID-19 (a subset of the ISARIC data set). Exposure: Corticosteroid use as reported to the ISARIC-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Main outcomes and measures: Number and percentage of patients hospitalized with severe COVID-19 who received corticosteroids by time period and by WHO geographic region. Results: Among 434 851 patients with confirmed severe or critical COVID-19 for whom receipt of corticosteroids could be ascertained (median [IQR] age, 61.0 [48.0-74.0] years; 53.0% male), 174 307 (40.1%) received corticosteroids during the study period. Of the participants in clinical trials that informed the guideline, 91.6% were recruited from the United Kingdom. In all regions, corticosteroid use for severe COVID-19 increased, but this increase corresponded to the timing of the RECOVERY trial (time-interruption coefficient 1.0 [95% CI, 0.9-1.2]) and WHO guideline (time-interruption coefficient 1.9 [95% CI, 1.7-2.0]) publications only in Europe. At the end of the study period, corticosteroid use for treatment of severe COVID-19 was highest in the Americas (5421 of 6095 [88.9%]; 95% CI, 87.7-90.2) and lowest in Africa (31 588 of 185 191 [17.1%]; 95% CI, 16.8-17.3). Conclusions and relevance: The results of this cohort study showed that implementation of the guidelines for use of corticosteroids in the treatment of severe COVID-19 varied geographically. Uptake of corticosteroid treatment was lower in regions with limited clinical trial involvement. Improving research diversity and representativeness may facilitate timely knowledge uptake and guideline implementation

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60&nbsp;years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death.&nbsp;The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death