Population homogeneity for the antibody response to COVID-19 BNT162b2/Comirnaty vaccine is only reached after the second dose across all adult age ranges

While mRNA vaccines are administrated worldwide in an effort to contain the COVID-19 pandemic, the heterogeneity of the humoral immune response they induce at the population scale remains unclear. Here, in a prospective, longitudinal, cohort-study, including 1245 hospital care workers and 146 nursing home residents scheduled for BNT162b2 vaccination, together covering adult ages from 19 to 99 years, we analyse seroconversion to SARS-CoV-2 spike protein and amount of spike-specific IgG, IgM and IgA before vaccination, and 3-5 weeks after each dose. We show that immunogenicity after a single vaccine dose is biased to IgG, heterogeneous and reduced with increasing age. The second vaccine dose normalizes IgG seroconversion in all age strata. These findings indicate two dose mRNA vaccines is required to reach population scale humoral immunity. The results advocate for the interval between the two doses not to be extended, and for serological monitoring of elderly and immunosuppressed vaccinees.

Length of stay as quality indicator in emergency departments: analysis of determinants in the German Emergency Department Data Registry (AKTIN registry)

Several indicators reflect the quality of care within emergency departments (ED). The length of stay (LOS) of emergency patients represents one of the most important performance measures. Determinants of LOS have not yet been evaluated in large cohorts in Germany. This study analyzed the fixed and influenceable determinants of LOS by evaluating data from the German Emergency Department Data Registry (AKTIN registry). We performed a retrospective evaluation of all adult (age ≥ 18 years) ED patients enrolled in the AKTIN registry for the year 2019. Primary outcome was LOS for the whole cohort; secondary outcomes included LOS stratified by (1) patient-related, (2) organizational-related and (3) structure-related factors. Overall, 304,606 patients from 12 EDs were included. Average LOS for all patients was 3 h 28 min (95% CI 3 h 27 min–3 h 29 min). Regardless of other variables, patients admitted to hospital stayed 64 min longer than non-admitted patients. LOS increased with patients’ age, was shorter for walk-in patients compared to medical referral, and longer for non-trauma presenting complaints. Relevant differences were also found for acuity level, day of the week, and emergency care levels. We identified different factors influencing the duration of LOS in the ED. Total LOS was dependent on patient-related factors (age), disease-related factors (presentation complaint and triage level), and organizational factors (weekday and admitted/non-admitted status). These findings are important for the development of management strategies to optimize patient flow through the ED and thus to prevent overcrowding.

Poliovirus immunity among adults in the Democratic Republic of the Congo: a cross-sectional serosurvey

Background Vaccination efforts to eradicate polio currently focus on children under 5 years of age, among whom most cases of poliomyelitis still occur. However, in the Democratic Republic of the Congo (DRC), an outbreak of wild poliovirus type 1 occurred in 2010–2011 in which 16% of cases occurred among adults; in a related outbreak in the neighboring Republic of Congo, 75% of cases occurred among the same adult age-group. Given that infected adults may transmit poliovirus, this study was designed to assess adult immunity against polioviruses. Methods We assessed poliovirus seroprevalence using dried blood spots from 5,526 adults aged 15–59 years from the 2013–2014 Demographic and Health Survey in the DRC. Results Among adults in the DRC, 74%, 72%, and 57% were seropositive for neutralizing antibodies for poliovirus types 1, 2, and 3, respectively. For all three serotypes, seroprevalence tended to be higher among older age groups, those living in households with more children, and among women. Conclusions Protection against poliovirus is generally low among adults in the DRC, particularly for type 3 poliovirus. The lack of acquired immunity in adults suggests a potentially limited poliovirus circulation over the lifetime of those surveyed (spanning 1954 through 2014) and transmission of vaccine-derived poliovirus in this age group while underscoring the risk of these outbreaks among adults in the DRC.

Experiences of violence in daily life among adults in California: a population-representative survey

Background Research on violence exposure emphasizes discrete acute events such as direct and witnessed victimization. Little is known about the broad range of experiences of violence (EVs) in daily life. This study assesses the prevalence and patterns of distribution of 6 EVs in an adult general population. Methods California state-representative survey administered online (English and Spanish), July 14–27, 2020. Adult (age ≥ 18 years) California resident members of the Ipsos KnowledgePanel were eligible to participate. Two EVs concerned community environments: (1) the occurrence of gunshots and shootings in the neighborhood and (2) encounters with sidewalk memorials where violent deaths occurred. Four concerned social networks: direct personal knowledge of individuals who (1) had purposefully been shot by someone else or (2) had purposefully shot themselves, and direct personal knowledge of individuals whom respondents perceived to be at risk of violence, either (3) to another person or (4) to themselves. Main outcome measures, expressed as weighted percentages with 95% confidence intervals (CIs), were the prevalence and extent (or dose) of each EV and of EVs in combination and associations between EVs and respondents’ sociodemographic characteristics and firearm ownership status. Results Of 2870 respondents (57% completion rate), 52.3% (95% CI 49.5–55.0%) were female; mean [SD] age was 47.9 [16.9] years. Nearly two-thirds (64.6%, 95% CI 61.9–67.3%) reported at least 1 EV; 11.4% (95% CI 9.7–13.2%) reported 3 or more. Gender was not associated with the prevalence of any experience. Non-owners of firearms who lived with owners reported more extensive EVs through social networks than did firearm owners or non-owners in households without firearms. Knowledge of people who had been shot by others was most common among Black respondents, 31.0% (95% CI 20.9–43.3%) of whom knew 2 or more such persons. Knowledge of people who had shot themselves was greatest among respondents aged ≥ 60 years, but knowledge of persons perceived to be at risk of violence to themselves was greatest among respondents aged 18–29 years. Conclusions and relevance Experiences of violence in daily life are widespread. They occur in sociodemographic patterns that differ from those for direct victimization and suggest new opportunities for research and intervention.

“Hard” High-Investment Adult-Age Adventure Play in the Off Hours

Globally, adults engage in various forms of high-investment adventure play in their leisure. Sometimes, these are complementary to their careers, their self-identities, and their social circles. This type of adventure play requires investments in learning, KSA (knowledge, skills, and abilities) development, social network development, time, moneys, reputation, and other costs. It may involve some level of risk-taking. This work explores this niche space of “hard” adventure play as expressed on the Social Web as a type of peer-shared teaching and learning, with a focus on “luxury geocaching” as the activity.

DIAGNOSTIC CRITERIA AND CLINICAL COURSE OF ATOPIC DERMATITIS IN ADULTS

Objective: to analyze Atopic dermatitis (AD) diagnostics criteria routinely used for diagnosis as well as common findings and history in adult patients with different age of onset of the disease. Materials and methods. 123 adult patients aged between 18 and 58 years with AD relapse were examined. The diagnosis was confirmed according to Ukrainian guidelines on AD. The patients were randomized in 2 groups depending on AD age of onset: 67 patients had AD start in early childhood and puberty, 56 patients – in adulthood. Precise medical history of the patients, clinical symptoms were collected. The disease severity was evaluated with SCORAD index and itch severity scale. Results were analyzed using parametric and nonparametric statistical tools. Results. Depending on age of AD onset patients demonstrated some differences in diagnostic criteria positivity, past and actual clinical features of the disease, cooperation with health system specialists. Among major AD diagnostic criteria personal or family history of atopy and flexural lichenification in adults were detected as variable signs of the disease depending on age of onset. Family history of atopy stayed hidden information for part of the patients and could not be verified. The most often minor criteria detected positive and used for AD diagnosis in adults were xerosis, itching when sweating, facial pallor or erythema and white dermographism, with their different frequency among groups. 17,9% of cases in childhood and 25% of cases in adults were not initially recognized as AD and managed as another skin disease for months or years. Skin itch as constant sign of AD is provoked by different triggered with high prevalence of emotional stress in adult-onset AD and different frequency of contact triggers among groups. Emotional trauma was considered by the patients as a major trigger of mild relapses in adult-age AD and moderate relapses in early-age AD. Constant and severe xerosis was more common for patients with AD onset in childhood and was mostly not a significant impacting issue for adult-aged AD. Secondary pyoderma accompanies AD relapses of both groups. 100% of examined patients had experience of self-treatment with topical and systemic medications. Physical modalities of treatment (sunbathing, change of climate etc.) are less often of adult-age AD patients’ choice and provide good results more for early onset AD patients. Steroid-phobia was observed in patients with early disease onset only and is not an issue for adult-age AD patients. Conclusions. Diagnostic criteria stay an important tool for diagnosing AD. Adult patients may demonstrate different set of positive major and minor criteria depending on time of the disease onset. Established diagnosis of AD may not correspond to first manifestation of the disease that is possible both in childhood and adult patients. Prognosing of AD course in adults may depend on general duration of the disease: starting in childhood AD more often has seasonal relation, constant xerosis, irritation by sweeting; patients have long experience of moisturizers and physical treatments use. If started in adulty AD more often aggravates due to emotional and occupational triggers, then others; long-term use of moisturizers more probably would be neglected by the patient.

Inverse association between the anticholinergic burden and hippocampus volume in a population-based cohort across the entire adult age range

Many medications of different indications have a relevant anticholinergic activity. The anticholinergic burden of medication has been shown to have significant effects on the cognition and the risk for cognitive impairment and dementia particularly in older patients. So far, most of the studies used data from geriatric patients and the effect of the anticholinergic burden on brain structures is still unexplored. Our study aimed to analyze possible associations of hippocampus and cholinergic basal forebrain volumes as vulnerable brain structures for the development of dementia and the anticholinergic burden in a population-based cohort of non-demented participants spanning the adult age range from 21 to 80 years. We analyzed associations between medication-related anticholinergic burden and structural MRI volumes from participants (n = 3087, 52.2% female) of the population-based “Study of Health in Pomerania” (SHIP). Anticholinergic burden was obtained from the current medication plan using the Anticholinergic Burden Scale (ACB). All analyses were adjusted for age, sex, education, and total intracranial volume. We found statistically significant associations between the ACB and the left and right hippocampus volume but not for the basal forebrain cholinergic system. Complementary voxel-based analysis across all participants revealed FWE-corrected (p = < 0.05) clusters in the temporo-parietal regions reaching into frontal areas, showing reduced volumes with higher ACB scores. We identified an association between anticholinergic burden of medication on hippocampal volume suggesting a potential inverse effect of such medication. This association highlights the importance of a careful prescription of medication with anticholinergic activity at any adult age.

Proportion and Characteristics of Insomnia among Lecturers Continuing Postgraduate Education at the Faculty of Medicine Udayana University

Fatigue and work stress can trigger insomnia. Insomnia is the most common sleep disorder with a prevalence of 10-30% in the world population. One of the professions that are prone to work burnout are lecturers, especially lecturers who are currently pursuing postgraduate education. These lecturers have two roles, namely as educators and college students, so they have a fairly solid task. This study aims to determine the proportion and characteristics of insomnia in lecturers who continue their postgraduate education at the Faculty of Medicine. This research is a descriptive observational study with a cross-sectional approach. The data collection technique was carried out by total sampling by distributing questionnaires to lecturers who continuing postgraduate education at the Faculty of Medicine. This study involved 41 subjects who met the inclusion and exclusion criteria. Of all subjects, 24.4% had mild insomnia, the rest did not experience insomnia. Mild insomnia is most common in the early adult age group, with more frequent in males than females. Subject have varying stress levels. More obese and do not apply sleep hygiene. All subjects do not smoke, most do not consume coffee and alcohol. In conclusion, the proportion of insomnia among lecturers who continue their postgraduate education at the Faculty of Medicine is 24.4% with mild insomnia category. Mild insomnia is more common in male lecturers in early adulthood with varying levels of stress and most of them are obese and do not apply sleep hygiene. Keywords: [Insomnia, Lecturer, Student, Postgraduate].

Comparison of Timing to Develop Anti-Drug Antibodies to Infliximab and Adalimumab Between Adult and Pediatric Age Groups, Males and Females

OBJECTIVE To compare the timing of serum anti-drug antibodies in adult and pediatric age groups, males and females, treated for inflammatory bowel disease or arthritis with adalimumab or infliximab by retrospectively combining data collected during a 2-year therapeutic drug monitoring period. METHODS Four hundred thirty sera were divided in groups collected at 0, 3, 6, 12, and 24 months (T0, T3, T6, T12, and T24) after initiation of therapy and assayed for drug and relative anti-drug antibodies levels. At each time point, the percentage of sera presenting anti-drug antibodies, as well as the drug concentrations, were calculated and correlated with patient age and sex. RESULTS Anti-drug antibodies were present in 31.5% of sera and were significantly higher in the pediatric age group than in the adult age group, through all time points. The percentages of sera showing anti-drug antibodies were significantly different as early as 3 months and were sera from pediatric female group. The percentages of sera showing anti-drug antibodies reached the highest value at 6 months in the pediatric age group and at 12 months in the adult age group. CONCLUSIONS Sera from pediatric had an earlier presence of anti-drug antibodies than adults. In particular, pediatric females sera showed the fastest anti-drug antibodies development.

Blood Pressure Variability in Fabry Disease Patients

<b><i>Introduction:</i></b> Fabry disease is a rare metabolic, multisystemic, and X-linked lysosomal storage disorder. The involvement of the autonomic nervous system is well defined; however, data on the variability of the blood pressure (BP) and heart rate in Fabry disease are largely missing. In this study, we aimed to examine the circadian variations of BP and heart rate variability in Fabry disease patients. <b><i>Methods:</i></b> We recruited 31 consecutive adult (age &#x3e;18 years) Fabry disease patients (16 males and 15 females) who were regularly followed up in our outpatient clinic between July 2019 and March 2020. We performed ambulatory blood pressure monitoring and echocardiography in all patients. We used standard deviation (SD), coefficient of variation (CV), and average real variability as the measures of variability. We constructed 2 control groups for propensity score matching using age, sex, and eGFR parameters in the first group and adding antihypertensive drug use to the above parameters in the second group. <b><i>Results:</i></b> All BP measurements were significantly lower in the FD group compared to that of the control groups, except the nighttime systolic BP. Regarding nondipping and reverse dipping statuses, FD patients and controls were similar. We found that none of the BP variability measures were higher in FD patients. Regarding heart rate variability data, both the nighttime SD and CV were significantly lower in FD patients compared to those of the controls. <b><i>Conclusion:</i></b> A decrease in heart rate variability, rather than an increase in BP variability, might be an early marker of autonomic involvement in FD.