Risk of new post-COVID mental disorders higher only in older patients, study suggests

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Older woman in distressA study including all Danish adults published yesterday in JAMA Psychiatry suggests an increased risk of new-onset mental illness only in SARS-CoV-2–positive patients aged 70 and older. It also finds that worsened mental health after COVID-19 hospitalization is common but no more so than after other, similarly severe respiratory infections.

A team led by Copenhagen University Hospital researchers used national registry data to compare the risk of new-onset mental disorders and psychotropic drug prescriptions among 526,749 adults who tested positive for COVID-19 with that of 501,119 untested, 3,124,933 COVID-negative, and hospitalized adults living in Denmark from January 1 to March 1, 2020.

Follow-up was conducted until December 31, 2021. About half of the participants were women, and the average age was 48.8 years.

Higher risk among hospitalized patients

The risk of new-onset mental illness was higher in both COVID-positive (hazard rate ratio [HRR], 1.24) and -negative (HRR, 1.42) adults than in those never tested. Relative to COVID-negative participants, the risk of mental illness in infected participants was 25% lower in those aged 18 to 29 years (HRR, 0.75), while those 70 and older were at 25% greater risk (HRR, 1.25).

A comparable trend was seen for first-time psychotropic medication use, with a lower risk in 18- to 29-year-olds (HRR, 0.81) and a higher risk in those 70 and older (HRR, 1.57). The risk of mental disorders was much higher in hospitalized COVID-19 patients than among the general population (HRR, 2.54) but no more so than among those hospitalized for other respiratory infections (HRR, 1.03).

Future studies should include even longer follow-up time.

Compared with COVID-negative participants, COVID-positive adults were at higher risk of filling anti-anxiety medication prescriptions (HRR, 1.22) and lower risk of taking antidepressants (HRR, 0.85), with no significant difference as to antipsychotic and antidementia drugs.

"Future studies should include even longer follow-up time and preferentially include immunological biomarkers to further investigate the impact of infection severity on postinfectious mental disorder sequelae," the study authors wrote.

Group argues for name change for US vaccine safety monitoring system

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Young man getting vaccineThe Vaccine Adverse Event Reporting System (VAERS), the federal spontaneous reporting system for vaccine safety, is poorly named, thus leaving it vulnerable to criticism and misuse argues a new report from the Annenberg Public Policy Center.

With a name change to "Vaccination Safety Monitor" or "Vaccination Safety Watch," the federal government would be able to counter misperceptions that arose during the COVID-19 pandemic.

The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) use VAERS to monitor the safety of all vaccines licensed in the United States, but because anyone in the United States can submit a report to VAERS, the system can be misused, and the public is not aware that any adverse event or death reported to VAERS is not confirmed.

Such misuse and misunderstanding became more common after November of 2020, when COVID-19 vaccines were first being used under emergency authorization in the United States. The report cites national polls conducted in 2022, which show only 27% of US adults knew that VAERS deaths were not confirmed to have been caused by COVID vaccinations.

A lot of coincidental events wind up being submitted.

"The public needs to understand that VAERS includes valuable information that makes it possible for the CDC and FDA to monitor vaccine safety," the report states. "But because these agencies want to know about any possible effects of vaccination and anyone can report any event they consider vaccine-related, a lot of coincidental events wind up being submitted."

To clarify, the report says a name change to "Vaccine Safety Watch" and changing "Adverse Event" to "Incident" signals that the incidents of concern are unverified, relate to safety, and are part of a monitoring system.

Federal officials open National Bio and Agro-Defense Facility

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National bio lab
The new lab in Manhattan, Kansas.
–Starfishprime1989 / Wikimedia Commons

Yesterday federal officials and leaders from Kansas formally opened the National Bio and Agro-Defense Facility (NBAF) in Manhattan, Kansas, marking the culmination of plans that have been in the works since 2006 to replace the 68-year-old Plum Island Animal Disease Facility, a biosafety level 3 (BSL-3) facility in New York.

The NBAF is the nation's only large-animal BSL-4 facility that is designed to handle pathogens that don't have any treatments or countermeasures. When the site was under consideration, environmental impact studies raised concerns about a risk of a pathogen leak in an area located not far from livestock operations. However, factors that tipped the balance toward the Kansas site included its location near research facilities at Kansas State University and animal health companies in the Kansas City area.

In a press release, US Department of Agriculture (USDA) Secretary Tom Vilsack said farmers, ranchers, and consumers depend on federal researchers for their work on better understanding and quickly responding to high-consequence animal pathogens. "This new, innovative facility will give USDA scientists access to cutting-edge, safe, and secure technology so they can continue to lead the world in animal health research, training, and diagnostics to protect our food supply, agricultural economy, and public health."

This new, innovative facility will give USDA scientists access to cutting-edge, safe, and secure technology.

No research has started at the lab yet, and staff are still doing compliance, regulatory work, inspections, development and testing of protocols, equipment preparations, and training, according to the Topeka Capital-Journal. NBAF Director Alfonso Clavijo, DVM, said clearance to start lab work is expected by late 2024.

The Department of Homeland Security led the design and construction of the NBAF, which will be owned and operated by the USDA, with the USDA's Animal Research Service and the Animal Plant Health and Inspection Services sharing operating responsibilities.

Meta-analysis supports shorter antibiotic courses for kids' pneumonia

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Coughing girl in bedA review and meta-analysis of randomized clinical trials suggests shorter antibiotic durations are as safe and effective as longer durations in children with community-acquired pneumonia (CAP), researchers reported today in Pediatrics.

To evaluate the evidence on antibiotic treatment durations for children with CAP, a team of Chinese and Canadian researchers reviewed and analyzed 16 randomized controlled trials conducted in high- and low-income countries comparing shorter (5 days or less) with longer antibiotic durations in 12,774 patients. Guidelines from the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America recommend 7 to 10 days of antibiotics but acknowledge that shorter courses may be just as effective, while the World Health Organization recommends 3 to 5 days for children in low- and middle-income countries.

The meta-analysis found no substantial differences between shorter-duration and longer-duration antibiotics in clinical cure (odds ratio 1.01; 95% confidence interval [CI], 0.87 to 1.17; risk difference [RD] ,0.1%; moderate certainty), treatment failure (relative risk [RR], 1.06; 95% CI, 0.93 to 1.21; RD, 0.3%; moderate certainty), and relapse (RR, 1.12, 95% CI 0.92 to 1.35; RD, 0.5%; moderate certainty). Compared with longer-duration antibiotics, shorter-duration antibiotics do not appreciably increase mortality (RD, 0.0%; 95% CI, −0.2 to 0.1; high certainty), and probably have little or no impact on the need for change in antibiotics (RR, 1.03; 95% CI, 0.72 to 1.47; RD, 0.2%; moderate certainty), need for hospitalization (RD, −0.2%; 95% CI −0.9 to 0.5; moderate certainty), and severe adverse events (RD, 0.0%; 95% CI −0.2 to 0.2; moderate certainty).

We showed with reasonable certainty that shorter-duration therapy appears to be as efficacious and as safe as longer-duration therapy across a range of settings.

The study authors say the review is the most comprehensive yet to show the efficacy and safety of shorter versus longer antibiotic durations in children with CAP.

"Though it may be that there are differences in the typical phenotype of a child with CAP in different regions, and management guidelines are likely to vary, we showed with reasonable certainty that shorter-duration therapy appears to be as efficacious and as safe as longer-duration therapy across a range of settings," they wrote.

Study finds gender makes little difference in acceptance of antibiotic stewardship interventions

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Hallway consultAn analysis conducted at Mayo Clinic sites found that female clinicians were no less likely than their male counterparts to have antimicrobial stewardship recommendations accepted, researchers reported yesterday in Infection Control & Hospital Epidemiology.

For the study, Mayo Clinic researchers conducted a retrospective, multivariable analysis of antimicrobial stewardship program (ASP) prospective audit and feedback outcomes at 17 Mayo Clinic sites in Minnesota, Florida, and Arizona from July 2017 through June 2022. The study included 84 female and 59 male clinicians. The researchers used antimicrobial stewardship rules and associated interventions documented within a prospective audit-and-feedback tool embedded in Mayo's electronic health record system to analyze intervention rates, communication methods, and intervention acceptance by clinician gender, profession, patient age, and intensive care unit (ICU) status.

Of the 71,729 rules that met study inclusion, 18,175 (25%) were associated with an intervention. Of 10,363 interventions with an outcome documented, 8,829 (85.2%) were accepted and 1,534 (14.8%) were rejected. Female clinicians had 6,782 (86.5%) of 7,843 interventions accepted, and male clinicians had 2,047 (81.2%) of 2,520 interventions accepted (odds ratio, [OR], 0.82; 95% confidence interval [CI], 0.53 to 1.28). There was no difference in communication methods used by female versus male interveners. There was also no difference in the staff profession as it related to recommendation acceptance.

Female patients had more interventions than male patients (female vs male: 25.9% vs 24.9%; OR, 1.04; 95% CI, 1.02 to 1.08). Patients in the ICU had a significantly lower intervention acceptance rate (ICU vs non-ICU: 78.2% vs 86.7%; OR, 0.56; 95% CI, 0.45 to 0.7).

We are optimistic that there continues to be an improvement in decreasing gender bias among healthcare workers.

The study authors note that the results contrast with a previous study that found female pharmacist recommendations were less likely to be accepted by hospitalists than those of their male counterparts. They suggest that could be because Mayo's ASP is well established and most of the interventions were conducted by female staff.

"We are optimistic that there continues to be an improvement in decreasing gender bias among healthcare workers, but we acknowledge that much work remains," they wrote.

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