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  1. Article ; Online: Defining the Optimal Duration of Therapy for Hospitalized Patients With Complicated Urinary Tract Infections and Associated Bacteremia.

    McAteer, John / Lee, Jae Hyoung / Cosgrove, Sara E / Dzintars, Kathryn / Fiawoo, Suiyini / Heil, Emily L / Kendall, Ronald E / Louie, Ted / Malani, Anurag N / Nori, Priya / Percival, Kelly M / Tamma, Pranita D

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2023  Volume 76, Issue 9, Page(s) 1604–1612

    Abstract: Background: Limited data are available to guide effective antibiotic durations for hospitalized patients with complicated urinary tract infections (cUTIs).: Methods: We conducted an observational study of patients ≥18 years at 24 US hospitals to ... ...

    Abstract Background: Limited data are available to guide effective antibiotic durations for hospitalized patients with complicated urinary tract infections (cUTIs).
    Methods: We conducted an observational study of patients ≥18 years at 24 US hospitals to identify the optimal treatment duration for patients with cUTI. To increase the likelihood patients experienced true infection, eligibility was limited to those with associated bacteremia. Propensity scores were generated for an inverse probability of treatment weighted analysis. The primary outcome was recurrent infection with the same species ≤30 days of completing therapy.
    Results: 1099 patients met eligibility criteria and received 7 (n = 265), 10 (n = 382), or 14 (n = 452) days of therapy. There was no difference in the odds of recurrent infection for patients receiving 10 days and those receiving 14 days of therapy (aOR: .99; 95% CI: .52-1.87). Increased odds of recurrence was observed in patients receiving 7 days versus 14 days of treatment (aOR: 2.54; 95% CI: 1.40-4.60). When limiting the 7-day versus 14-day analysis to the 627 patients who remained on intravenous beta-lactam therapy or were transitioned to highly bioavailable oral agents, differences in outcomes no longer persisted (aOR: .76; 95% CI: .38-1.52). Of 76 patients with recurrent infections, 2 (11%), 2 (10%), and 10 (36%) in the 7-, 10-, and 14-day groups, respectively, had drug-resistant infections (P = .10).
    Conclusions: Seven days of antibiotics appears effective for hospitalized patients with cUTI when antibiotics with comparable intravenous and oral bioavailability are administered; 10 days may be needed for all other patients.
    MeSH term(s) Humans ; Duration of Therapy ; Reinfection ; Retrospective Studies ; Anti-Bacterial Agents ; Urinary Tract Infections/drug therapy ; Bacteremia/complications ; Bacteremia/drug therapy
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2023-01-11
    Publishing country United States
    Document type Observational Study ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciad009
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Animal models of chronic traumatic encephalopathy.

    McAteer, Kelly M / Turner, Renee J / Corrigan, Frances

    Concussion (London, England)

    2017  Volume 2, Issue 2, Page(s) CNC32

    Abstract: Repeated head impacts have been suggested to be associated with the development of the neurodegenerative disorder, chronic traumatic encephalopathy (CTE). CTE is characterized by the accumulation of hyperphosphorylated tau within the brain, with ... ...

    Abstract Repeated head impacts have been suggested to be associated with the development of the neurodegenerative disorder, chronic traumatic encephalopathy (CTE). CTE is characterized by the accumulation of hyperphosphorylated tau within the brain, with accompanying cognitive and behavioral deficits. How a history of repeated head impacts can lead to the later development of CTE is not yet known, and as such appropriate animal models are required. Over the last decade a number of rodent models of repeated mild traumatic brain injury have been developed that are broadly based on traditional traumatic brain injury models, in controlled cortical impact, fluid percussion and weight drop models, with adaptations to allow for better modeling of the mechanical forces associated with concussion.
    Language English
    Publishing date 2017-05-19
    Publishing country England
    Document type Journal Article ; Review
    ISSN 2056-3299
    ISSN (online) 2056-3299
    DOI 10.2217/cnc-2016-0031
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Short and Long Term Behavioral and Pathological Changes in a Novel Rodent Model of Repetitive Mild Traumatic Brain Injury.

    McAteer, Kelly M / Corrigan, Frances / Thornton, Emma / Turner, Renee Jade / Vink, Robert

    PloS one

    2016  Volume 11, Issue 8, Page(s) e0160220

    Abstract: A history of concussion, particularly repeated injury, has been linked to an increased risk for the development of neurodegenerative diseases, particularly chronic traumatic encephalopathy (CTE). CTE is characterized by abnormal accumulation of ... ...

    Abstract A history of concussion, particularly repeated injury, has been linked to an increased risk for the development of neurodegenerative diseases, particularly chronic traumatic encephalopathy (CTE). CTE is characterized by abnormal accumulation of hyperphosphorylated tau and deficits in learning and memory. As yet the mechanisms associated with the development of CTE are unknown. Accordingly, the aim of the current study was to develop and characterize a novel model of repetitive mTBI that accurately reproduces the key short and long-term functional and histopathological features seen clinically. Forty male Sprague-Dawley rats were randomly assigned to receive 0, 1 or 3x mTBI spaced five days apart using a modified version of the Marmarou impact-acceleration diffuse-TBI model to deliver 110G of linear force. Functional outcomes were assessed six and twelve weeks post-injury, with histopathology assessed twenty-four hours and twelve weeks post-injury. Repetitive mTBI resulted in mild spatial and recognition memory deficits as reflected by increased escape latency on the Barnes maze and decreased time spent in the novel arm of the Y maze. There was a trend towards increased anxiety-like behavior, with decreased time spent in the inner portion of the open field. At 24 hours and 12 weeks post injury, repetitive mTBI animals showed increased tau phosphorylation and microglial activation within the cortex. Increases in APP immunoreactivity were observed in repetitive mTBI animals at 12 weeks indicating long-term changes in axonal integrity. This novel model of repetitive mTBI with its persistent cognitive deficits, neuroinflammation, axonal injury and tau hyperphosphorylation, thus represents a clinically relevant experimental approach to further explore the underlying pathogenesis of CTE.
    MeSH term(s) Animals ; Behavior, Animal ; Brain Concussion/metabolism ; Brain Concussion/pathology ; Brain Concussion/physiopathology ; Cognition ; Disease Models, Animal ; Male ; Rats ; Rats, Sprague-Dawley ; Time Factors
    Language English
    Publishing date 2016
    Publishing country United States
    Document type Journal Article
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0160220
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Short and Long Term Behavioral and Pathological Changes in a Novel Rodent Model of Repetitive Mild Traumatic Brain Injury.

    Kelly M McAteer / Frances Corrigan / Emma Thornton / Renee Jade Turner / Robert Vink

    PLoS ONE, Vol 11, Iss 8, p e

    2016  Volume 0160220

    Abstract: A history of concussion, particularly repeated injury, has been linked to an increased risk for the development of neurodegenerative diseases, particularly chronic traumatic encephalopathy (CTE). CTE is characterized by abnormal accumulation of ... ...

    Abstract A history of concussion, particularly repeated injury, has been linked to an increased risk for the development of neurodegenerative diseases, particularly chronic traumatic encephalopathy (CTE). CTE is characterized by abnormal accumulation of hyperphosphorylated tau and deficits in learning and memory. As yet the mechanisms associated with the development of CTE are unknown. Accordingly, the aim of the current study was to develop and characterize a novel model of repetitive mTBI that accurately reproduces the key short and long-term functional and histopathological features seen clinically. Forty male Sprague-Dawley rats were randomly assigned to receive 0, 1 or 3x mTBI spaced five days apart using a modified version of the Marmarou impact-acceleration diffuse-TBI model to deliver 110G of linear force. Functional outcomes were assessed six and twelve weeks post-injury, with histopathology assessed twenty-four hours and twelve weeks post-injury. Repetitive mTBI resulted in mild spatial and recognition memory deficits as reflected by increased escape latency on the Barnes maze and decreased time spent in the novel arm of the Y maze. There was a trend towards increased anxiety-like behavior, with decreased time spent in the inner portion of the open field. At 24 hours and 12 weeks post injury, repetitive mTBI animals showed increased tau phosphorylation and microglial activation within the cortex. Increases in APP immunoreactivity were observed in repetitive mTBI animals at 12 weeks indicating long-term changes in axonal integrity. This novel model of repetitive mTBI with its persistent cognitive deficits, neuroinflammation, axonal injury and tau hyperphosphorylation, thus represents a clinically relevant experimental approach to further explore the underlying pathogenesis of CTE.
    Keywords Medicine ; R ; Science ; Q
    Subject code 610
    Language English
    Publishing date 2016-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Nonadherence to systemic immune-modifying therapy in people with psoriasis during the COVID-19 pandemic: findings from a global cross-sectional survey.

    Quirke-McFarlane, Sophia / Weinman, John / Cook, Emma S / Yiu, Zenas Z N / Dand, Nick / Langan, Sinead M / Bechman, Katie / Tsakok, Teresa / Mason, Kayleigh J / McAteer, Helen / Meynell, Freya / Coker, Bolaji / Vincent, Alexandra / Urmston, Dominic / Vesty, Amber / Kelly, Jade / Lancelot, Camille / Moorhead, Lucy / Barbosa, Ines A /
    Bachelez, Herve / Capon, Francesca / Contreras, Claudia R / De La Cruz, Claudia / Di Meglio, Paola / Gisondi, Paolo / Jullien, Denis / Lambert, Jo / Naldi, Luigi / Puig, Lluís / Spuls, Phyllis / Torres, Tiago / Warren, Richard B / Waweru, Hoseah / Galloway, James B / Griffiths, Christopher E M / Barker, Jonathan N / Norton, Sam / Smith, Catherine H / Mahil, Satveer K

    The British journal of dermatology

    2023  Volume 188, Issue 5, Page(s) 610–617

    Abstract: Background: Nonadherence to immune-modifying therapy is a complex behaviour which, before the COVID-19 pandemic, was shown to be associated with mental health disorders in people with immune-mediated diseases. The COVID-19 pandemic has led to a rise in ... ...

    Abstract Background: Nonadherence to immune-modifying therapy is a complex behaviour which, before the COVID-19 pandemic, was shown to be associated with mental health disorders in people with immune-mediated diseases. The COVID-19 pandemic has led to a rise in the global prevalence of anxiety and depression, and limited data exist on the association between mental health and nonadherence to immune-modifying therapy during the pandemic.
    Objectives: To assess the extent of and reasons underlying nonadherence to systemic immune-modifying therapy during the COVID-19 pandemic in individuals with psoriasis, and the association between mental health and nonadherence.
    Methods: Online self-report surveys (PsoProtectMe), including validated screens for anxiety and depression, were completed globally during the first year of the pandemic. We assessed the association between anxiety or depression and nonadherence to systemic immune-modifying therapy using binomial logistic regression, adjusting for potential cofounders (age, sex, ethnicity, comorbidity) and country of residence.
    Results: Of 3980 participants from 77 countries, 1611 (40.5%) were prescribed a systemic immune-modifying therapy. Of these, 408 (25.3%) reported nonadherence during the pandemic, most commonly due to concerns about their immunity. In the unadjusted model, a positive anxiety screen was associated with nonadherence to systemic immune-modifying therapy [odds ratio (OR) 1.37, 95% confidence interval (CI) 1.07-1.76]. Specifically, anxiety was associated with nonadherence to targeted therapy (OR 1.41, 95% CI 1.01-1.96) but not standard systemic therapy (OR 1.16, 95% CI 0.81-1.67). In the adjusted model, although the directions of the effects remained, anxiety was not significantly associated with nonadherence to overall systemic (OR 1.20, 95% CI 0.92-1.56) or targeted (OR 1.33, 95% CI 0.94-1.89) immune-modifying therapy. A positive depression screen was not strongly associated with nonadherence to systemic immune-modifying therapy in the unadjusted (OR 1.22, 95% CI 0.94-1.57) or adjusted models (OR 1.14, 95% CI 0.87-1.49).
    Conclusions: These data indicate substantial nonadherence to immune-modifying therapy in people with psoriasis during the pandemic, with attenuation of the association with mental health after adjusting for confounders. Future research in larger populations should further explore pandemic-specific drivers of treatment nonadherence. Clear communication of the reassuring findings from population-based research regarding immune-modifying therapy-associated adverse COVID-19 risks to people with psoriasis is essential, to optimize adherence and disease outcomes.
    MeSH term(s) Humans ; COVID-19/epidemiology ; Cross-Sectional Studies ; Pandemics ; Anxiety/epidemiology ; Anxiety/psychology ; Psoriasis/drug therapy ; Psoriasis/epidemiology ; Depression/epidemiology
    Language English
    Publishing date 2023-02-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 80076-4
    ISSN 1365-2133 ; 0007-0963
    ISSN (online) 1365-2133
    ISSN 0007-0963
    DOI 10.1093/bjd/ljac144
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Vaccine hesitancy and access to psoriasis care during the COVID-19 pandemic: findings from a global patient-reported cross-sectional survey.

    Bechman, Katie / Cook, Emma S / Dand, Nick / Yiu, Zenas Z N / Tsakok, Teresa / Meynell, Freya / Coker, Bolaji / Vincent, Alexandra / Bachelez, Herve / Barbosa, Ines / Brown, Matthew A / Capon, Francesca / Contreras, Claudia R / De La Cruz, Claudia / Meglio, Paola Di / Gisondi, Paolo / Jullien, Denis / Kelly, Jade / Lambert, Jo /
    Lancelot, Camille / Langan, Sinead M / Mason, Kayleigh J / McAteer, Helen / Moorhead, Lucy / Naldi, Luigi / Norton, Sam / Puig, Lluís / Spuls, Phyllis I / Torres, Tiago / Urmston, Dominic / Vesty, Amber / Warren, Richard B / Waweru, Hoseah / Weinman, John / Griffiths, Christopher E M / Barker, Jonathan N / Smith, Catherine H / Galloway, James B / Mahil, Satveer K

    The British journal of dermatology

    2022  Volume 187, Issue 2, Page(s) 254–256

    MeSH term(s) COVID-19/prevention & control ; Cross-Sectional Studies ; Humans ; Pandemics ; Patient Reported Outcome Measures ; Psoriasis/drug therapy ; Vaccination ; Vaccination Hesitancy
    Language English
    Publishing date 2022-05-03
    Publishing country England
    Document type Letter
    ZDB-ID 80076-4
    ISSN 1365-2133 ; 0007-0963
    ISSN (online) 1365-2133
    ISSN 0007-0963
    DOI 10.1111/bjd.21042
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Describing the burden of the COVID-19 pandemic in people with psoriasis: findings from a global cross-sectional study.

    Mahil, S K / Yates, M / Yiu, Z Z N / Langan, S M / Tsakok, T / Dand, N / Mason, K J / McAteer, H / Meynell, F / Coker, B / Vincent, A / Urmston, D / Vesty, A / Kelly, J / Lancelot, C / Moorhead, L / Bachelez, H / Capon, F / Contreras, C R /
    De La Cruz, C / Di Meglio, P / Gisondi, P / Jullien, D / Lambert, J / Naldi, L / Norton, S / Puig, L / Spuls, P / Torres, T / Warren, R B / Waweru, H / Weinman, J / Brown, M A / Galloway, J B / Griffiths, C M / Barker, J N / Smith, C H

    Journal of the European Academy of Dermatology and Venereology : JEADV

    2021  Volume 35, Issue 10, Page(s) e636–e640

    MeSH term(s) COVID-19 ; Cross-Sectional Studies ; Humans ; Pandemics ; Psoriasis/epidemiology ; SARS-CoV-2
    Language English
    Publishing date 2021-08-19
    Publishing country England
    Document type Letter
    ZDB-ID 1128828-0
    ISSN 1468-3083 ; 0926-9959
    ISSN (online) 1468-3083
    ISSN 0926-9959
    DOI 10.1111/jdv.17450
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Risk-mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey.

    Mahil, S K / Yates, M / Langan, S M / Yiu, Z Z N / Tsakok, T / Dand, N / Mason, K J / McAteer, H / Meynell, F / Coker, B / Vincent, A / Urmston, D / Vesty, A / Kelly, J / Lancelot, C / Moorhead, L / Bachelez, H / Bruce, I N / Capon, F /
    Contreras, C R / Cope, A P / De La Cruz, C / Di Meglio, P / Gisondi, P / Hyrich, K / Jullien, D / Lambert, J / Marzo-Ortega, H / McInnes, I / Naldi, L / Norton, S / Puig, L / Sengupta, R / Spuls, P / Torres, T / Warren, R B / Waweru, H / Weinman, J / Griffiths, C E M / Barker, J N / Brown, M A / Galloway, J B / Smith, C H

    The British journal of dermatology

    2021  Volume 185, Issue 1, Page(s) 80–90

    Abstract: Background: Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse coronavirus disease 2019 (COVID-19) outcomes compared with patients receiving no systemic ... ...

    Abstract Background: Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse coronavirus disease 2019 (COVID-19) outcomes compared with patients receiving no systemic treatments.
    Objectives: We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation.
    Methods: Online surveys were completed by individuals with psoriasis (globally) or rheumatic and musculoskeletal diseases (RMDs) (UK only) between 4 May and 7 September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterized international variation in a mixed-effects model.
    Results: Of 3720 participants (2869 psoriasis, 851 RMDs) from 74 countries, 2262 (60·8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term 'shielding'). A greater proportion of those receiving targeted therapies (biologics and Janus Kinase inhibitors) reported shielding compared with those receiving no systemic therapy [adjusted odds ratio (OR) 1·63, 95% confidence interval (CI) 1·35-1·97]. The association between targeted therapy and shielding was preserved when standard systemic therapy was used as the reference group (OR 1·39, 95% CI 1·23-1·56). Shielding was associated with established risk factors for severe COVID-19 [male sex (OR 1·14, 95% CI 1·05-1·24), obesity (OR 1·37, 95% CI 1·23-1·54), comorbidity burden (OR 1·43, 95% CI 1·15-1·78)], a primary indication of RMDs (OR 1·37, 95% CI 1·27-1·48) and a positive anxiety or depression screen (OR 1·57, 95% CI 1·36-1·80). Modest differences in the proportion shielding were observed across nations.
    Conclusions: Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk-mitigation strategies and may help inform updated public health guidelines as the pandemic continues.
    MeSH term(s) COVID-19 ; Cross-Sectional Studies ; Humans ; Joint Diseases ; Male ; Pandemics ; SARS-CoV-2
    Language English
    Publishing date 2021-03-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 80076-4
    ISSN 1365-2133 ; 0007-0963
    ISSN (online) 1365-2133
    ISSN 0007-0963
    DOI 10.1111/bjd.19755
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Describing the burden of the COVID-19 pandemic in people with psoriasis: findings from a global cross-sectional study

    Mahil, Satveer K / Yates, Mark / Yiu, Zenas Z / Langan, Sinead M / Tsakok, Teresa / Dand, Nick / Mason, Kayleigh J / McAteer, Helen / Meynall, Freya / Coker, Bolaji / Vincent, Alexandra / Urmston, Dominic / Vesty, Amber / Kelly, Jade / Lancelot, Camille / Moorhead, Lucy / Bachelez, Herve / Capon, Francesca / Contreras, Claudia R /
    De La Cruz, Claudia / Di Meglio, Paola / Gisondi, Paolo / Jullien, Denis / Lambert, Jo / Naldi, Luigi / Norton, Sam / Puig, Luis / Spuls, Phyllis / Torres, Tiago / Warren, Richard B / Waweru, Hoseah / Weinman, John / Brown, Matt A / Galloway, James B / Griffiths, Christopher M / Barker, Jonathan N / Smith, Catherine H

    medRxiv

    Abstract: Background Indirect excess morbidity has emerged as a major concern in the COVID-19 pandemic. People with psoriasis may be particularly vulnerable to this because of prevalent anxiety and depression, multimorbidity and therapeutic use of ... ...

    Abstract Background Indirect excess morbidity has emerged as a major concern in the COVID-19 pandemic. People with psoriasis may be particularly vulnerable to this because of prevalent anxiety and depression, multimorbidity and therapeutic use of immunosuppression. Objective Characterise the factors associated with worsening psoriasis in the COVID-19 pandemic, using mental health status (anxiety and depression) as the main exposure of interest. Methods Global cross-sectional study using a primary outcome of self-reported worsening of psoriasis. Individuals with psoriasis completed an online self-report questionnaire (PsoProtectMe; Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection Me) between May 2020 and January 2021. Each individual completed a validated screen for anxiety (Generalized Anxiety Disorder-2) and depression (Patient Health Questionnaire-2). Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression. Results 4,043 people with psoriasis (without COVID-19) from 86 countries self-reported to PsoProtectMe (mean age 47.2 years [SD 15.1]; mean BMI 27.6kg/m2 [SD 6.0], 2,684 [66.4%] female and 3,016 [74.6%] of white European ethnicity). 1,728 (42.7%) participants (1322 [77%] female) reported worsening of their psoriasis in the pandemic. A positive screen for anxiety or depression associated with worsening psoriasis in age and gender adjusted (OR 2.04, 95% CI 1.77-2.36), and fully adjusted (OR 2.01, 95% CI 1.72-2.34) logistic regression models. Female sex, obesity, shielding behaviour and systemic immunosuppressant non-adherence also associated with worsening psoriasis. The commonest reason for non-adherence was concern regarding complications related to COVID-19. Conclusions These data indicate an association between poor mental health and worsening psoriasis in the pandemic. Access to holistic care including psychological support may mitigate potentially long-lasting effects of the pandemic on health outcomes in psoriasis. The study also highlights an urgent need to address patient concerns about immunosuppressant-related risks, which may be contributing to non-adherence.
    Keywords covid19
    Language English
    Publishing date 2021-05-06
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2021.05.04.21256507
    Database COVID19

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  10. Article ; Online: Risk mitigating behaviours in people with inflammatory joint and skin disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey

    Mahil, S. K. / Yates, M. / Langan, S. M. / Yiu, Z. Z. / Tsakok, T. / Dand, N. / Mason, K. J. / McAteer, H. / Meynall, F. / Coker, B. / Vincent, A. / Urmston, D. / Vesty, A. / Kelly, J. / Lancelot, C. / Moorhead, L. / Bachelez, H. / Bruce, I. N. / Capon, F. /
    Contreras, C. R. / Cope, A. P. / De La Cruz, C. / Di Meglio, P. / Gisondi, P. / Hyrich, K. / Jullien, D. / Lambert, J. / Waweru, H. / Marzo-Ortega, H. / McInnes, I. / Naldi, L. / Norton, S. / Puig, L. / Spuls, P. / Sengupta, R. / Torres, T. / Warren, R. B. / Weinman, J. / Griffiths, C. E. / Barker, J. N. / Brown, M. A. / Galloway, J. B. / Smith, C. H.

    Abstract: Objectives Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse COVID-19 outcomes compared to patients receiving no systemic treatments. We used international ... ...

    Abstract Objectives Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse COVID-19 outcomes compared to patients receiving no systemic treatments. We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation. Methods Online surveys were completed by individuals with Rheumatic and Musculoskeletal Diseases (RMD) (UK only) or psoriasis (globally) between 4th May and 7th September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterised international variation in a mixed effects model. Results Of 3,720 participants (2,869 psoriasis, 851 RMD) from 74 countries, 2,262 (60.8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term shielding). A greater proportion of those receiving targeted therapies (biologics and JAK inhibitors) reported shielding compared to those receiving no systemic therapy (adjusted odds ratio [OR] 1.63, 95% CI 1.35-1.97) and standard systemic agents (OR 1.39, 95% CI 1.22-1.56). Shielding was associated with established risk factors for severe COVID-19 (male sex [OR 1.14, 95% CI 1.05-1.24], obesity [OR 1.38, 95% CI 1.23-1.54], comorbidity burden [OR 1.43, 95% CI 1.15-1.78]), a primary indication of RMD (OR 1.37, 95% CI 1.27-1.48) and a positive anxiety or depression screen (OR 1.57, 95% CI 1.36-1.80). Modest differences in the proportion shielding were observed across nations. Conclusions Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk mitigation strategies and may help inform updated public health guidelines as the pandemic continues.
    Keywords covid19
    Publisher MedRxiv; WHO
    Document type Article ; Online
    DOI 10.1101/2020.11.05.20226662
    Database COVID19

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