The evidence shows that COVID-19 vaccines can reduce the risks of poor pregnancy outcomes. Yet, reluctance to vaccinate remains high in pregnant populations. In this paper, we take a precision health and patient-centered approach to vaccine hesitancy. We adopted the society-to-cells vaccine hesitancy framework to identify society, community, family, individual, and physiologic factors contributing to COVID-19 vaccine hesitancy in pregnancy. Nurses are particularly well-suited to impact the factors associated with vaccine hesitancy. Because of their proximity to the patient, nurses are positioned to provide individualized, timely health information, and clinical guidelines to assist patients with decision-making related to vaccinations. Recommendations are provided to bolster nurses\' engagement in precision health and patient-centered models of care to mitigate COVID-19 vaccine hesitancy in pregnancy.

暂无摘要。

The success of telemedicine depends on awareness among doctors on how to implement it. We aimed to assess knowledge about national telemedicine guidelines in pediatricians during the coronavirus disease 2019 (COVID-19) pandemic. A cross-sectional study of pediatricians across India was conducted through a structured online questionnaire containing 16 marks. The mean knowledge score (KS) was calculated. Participants were divided into two groups: poor KS (KS <8) and good KS (KS ≥8). The association between factors and KS was assessed using univariate analysis. A total of 503 pediatricians participated (private sector: 80.7% and public sector: 19.3%). Most (61%) belonged to the age group of 31-50 years and were males (75%). The minimum educational qualification was a Doctor of Medicine (MD) in 57% of cases. Despite work experience of more than 5 years in most (70%) of the cases, very few had provided teleconsultation before the pandemic (13.9%). The mean KS was 10.60 ± 2.8, that is, 66.25%. The minimum KS was 1 (6.25%), and the maximum was 16 (100%). Assam, Chandigarh, Himachal Pradesh, Jharkhand, Odisha, Sikkim, and Tamil Nadu showed higher knowledge than other states, although no significant difference was found. The majority (89.1%) had good KS, which is significantly higher among private practitioners as compared to public practitioners. There was no association between KS and age, gender, qualification, and work experience. Pediatricians have good information regarding telemedicine guidelines in India; however, training programs will further empower doctors working in the public sector.

This study proposes a novel approach to studying severe acute respiratory syndrome coronavirus 2 virus mutations through sequencing data comparison. Traditional consensus-based methods, which focus on the most common nucleotide at each position, might overlook or obscure the presence of low-frequency variants. Our method, in contrast, retains all sequenced nucleotides at each position, forming a genomic matrix. Utilizing simulated short reads from genomes with specified mutations, we contrasted our genomic matrix approach with the consensus sequence method. Our matrix methodology, across multiple simulated datasets, accurately reflected the known mutations with an average accuracy improvement of 20% over the consensus method. In real-world tests using data from GISAID and NCBI-SRA, our approach demonstrated an increase in reliability by reducing the error margin by approximately 15%. The genomic matrix approach offers a more accurate representation of the viral genomic diversity, thereby providing superior insights into virus evolution and epidemiology.

BACKGROUND: The importance of building ventilation to protect health has been more widely recognized since the COVID-19 pandemic. Outdoor air ventilation in buildings dilutes indoor-generated air pollutants (including bioaerosols) and reduces resulting occupant exposures. Many countries and organizations have advisory guidelines or mandatory standards for minimum ventilation rates (VRs) to maintain indoor air quality (IAQ). Because directly measuring VRs is often difficult, many IAQ guidelines instead specify indoor concentration limits for carbon dioxide (CO2), using CO2 exhaled by building occupants as an indicator of VR. Although indoor CO2 guidelines are common, the evidence basis for the various CO2 limits has not been clear.
OBJECTIVE: To review current indoor CO2 guidelines worldwide and the supportive evidence provided.
METHODS: We identified worldwide CO2-based guidelines for IAQ or ventilation, along with any supportive evidence provided. We excluded occupational guidelines for CO2 levels ≥5000 ppm.
RESULTS: Among 43 guidelines identified, 35 set single CO2 concentration limits and eight set multi-tiered limits; 16 mentioned no specific human effect to be controlled, 19 specified only odor dissatisfaction, five specified non-infectious health effects, and three specified airborne infectious disease transmission. The most common indoor CO2 limit was 1000 ppm. Thirteen guidelines specified maximum CO2 limits as extended time-weighted averages, none with evidence linking averaged limits to occupant effects. Of only 18 guidelines citing evidence to support limits set, we found this evidence persuasive for eight. Among these eight guidelines, seven set limits to control odor perception. One provided 17 scientifically-based CO2 limits, for specific example space uses and occupancies, to control long-range COVID-19 transmission indoors.
CONCLUSIONS: Many current indoor carbon dioxide (CO2) guidelines for indoor air quality specified no adverse effects intended for control. Odor dissatisfaction was the effect mentioned most frequently, few mentioned health, and three mentioned control of infectious disease. Only one CO2 guideline was developed from scientific models to control airborne transmission of COVID-19. Most guidelines provided no supportive evidence for specified limits; few provided persuasive evidence. No scientific basis is apparent for setting one CO2 limit for IAQ across all buildings, setting a CO2 limit for IAQ as an extended time-weighted average, or using a one-time CO2 measurement to verify a desired VR.

BACKGROUND: It is known that 24-hour movement behaviors, including physical activity (PA), sedentary behavior (SB), and sleep, are crucial components affecting older adults\' health. Canadian 24-hour movement guidelines for older adults were launched in 2020, emphasizing the combined role of these 3 movement behaviors in promoting older adults\' health. However, research on the prevalence and correlates of guideline adherence and its associations with health-related outcomes is limited, especially among Chinese older adults.
OBJECTIVE: This study aimed to investigate the prevalence and correlates of meeting 24-hour movement guidelines among Chinese older adults. Furthermore, this study aimed to examine the associations of guideline adherence with older adults\' physical and mental health outcomes.
METHODS: Using a stratified cluster random sampling approach, a total of 4562 older adults (mean age 67.68 years, SD 5.03 years; female proportion: 2544/4562, 55.8%) were recruited from the latest provincial health surveillance of Hubei China from July 25 to November 19, 2020. Measures included demographics, movement behaviors (PA, SB, and sleep), BMI, waist circumference, waist-hip ratio (WHR), percentage body fat (PBF), systolic and diastolic blood pressure, physical fitness, depressive symptoms, and loneliness. Generalized linear mixed models were employed to examine the associations between variables using SPSS 28.0 (IBM Corp).
RESULTS: Only 1.8% (83/4562) of participants met all 3 movement guidelines, while 32.1% (1466/4562), 3.4% (155/4562), and 66.4% (3031/4562) met the individual behavioral guidelines for PA, SB, and sleep, respectively. Participants who were older, were female, and lived in municipalities with lower economic levels were less likely to meet all 3 movement guidelines. Adhering to individual or combined movement guidelines was associated with greater physical fitness and lower values of BMI, waist circumference, WHR, PBF, depressive symptoms, and loneliness, with the exception of the relationship of SB+sleep guidelines with loneliness. Furthermore, only meeting SB guidelines or meeting both PA and SB guidelines was associated with lower systolic blood pressure.
CONCLUSIONS: This is the first study to investigate adherence to 24-hour movement guidelines among Chinese older adults with regard to prevalence, correlates, and associations with physical and mental health outcomes. The findings emphasize the urgent need for promoting healthy movement behaviors among Chinese older adults. Future interventions to improve older adults\' physical and mental health should involve enhancing their overall movement behaviors and should consider demographic differences.

UNASSIGNED: The spread of Covid-19 and resultant infection prevention strategies have disturbed the life routine of Chinese young adults, led to reduced physical activity (PA), prolonged screen time (ST) and inadequate sleep duration (SP), and made immense influence on their mental health (MH) and quality of life (QoL). E-Health literacy (EHL) can enable citizens to use available online information to respond to the highly complex information environment and make appropriate health decisions.
UNASSIGNED: This study aims to examine associations between adhering to 24-h movement (24HM) guidelines and MH and QoL among young adults, as well as to identify any mediating or moderating role of EHL in these associations.
UNASSIGNED: 1742 young adults (20.03 ± 1.54 years old, 68.6% females) from north and south China completed self-report measures of 24HM (PA, ST and SP), health indicators (MH and QoL), EHL and demographic information through an online survey between 4 Apr and 16 Jun 2022. Generalized linear mixed models were applied for data analysis.
UNASSIGNED: Results showed that adhering to PA, ST and SP guidelines were all positively connected with QoL while MH was associated with adhering ST or SP guidelines. Adhering to more of 24HM guidelines was linked to better MH and QoL. EHL significantly mediated the association of guideline adherence and QoL and moderate that of guideline adherence and MH.
UNASSIGNED: This is the first study to investigate the role of EHL on the associations between 24HM and MH as well as QoL during the Covid-19. The findings may contribute to further empirical research or intervention that aims to promote MH or QoL among young adults more effectively or provide valuable references for developing relevant strategies or policy of health promotion or public health events in China.

BACKGROUND: The Korea Expert Committee on Immunization Practices (KECIP) is a key advisory body the government to develop guidelines and provide technical advisory activities on immunization policies in Korea. A recent policy study, inspired by global best practices, aims to enhance KECIP\'s functionality for providing timely and transparent recommendations in the face of evolving vaccine science and emerging infectious diseases like COVID-19.
METHODS: This study reviewed the current status of KECIP and collected expert opinions through surveys and consultations. Among the 40 panel members who were surveyed, 19 responded to a questionnaire specifically designed to assess the potential areas of improvement within KECIP.
RESULTS: The majority of respondents favored maintaining the current member count and emphasized the need for a subcommittee. Opinions varied on issues such as the length of KECIP\'s term, the representation of vaccine manufacturers\' perspectives, and the chairperson\'s role. However, there was a consensus on the importance of expertise, transparency, and fair proceedings within the committee.
CONCLUSIONS: This study underscores the pivotal role of KECIP in shaping national immunization policies, emphasizing the necessity for informed guidance amidst evolving vaccine science and emerging infectious diseases. Furthermore, it stressed the importance of enhancing KECIP\'s capacity to effectively address evolving public health challenges and maintain successful immunization programs in South Korea.

CONCLUSIONS: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
OBJECTIVE: Introduction of new medications to health-system formularies is often not accompanied by assessments of their clinical impact on the local patient population. The growing availability of electronic health record (EHR) data and advancements in pharmacoepidemiology methods offer institutions the opportunity to monitor the medication implementation process and assess clinical effectiveness in the local clinical context. In this study, we applied novel causal inference methods to evaluate the effects of a formulary policy introducing tocilizumab therapy for critically ill patients with coronavirus disease 2019 (COVID-19).
METHODS: We conducted a medication use evaluation utilizing EHR data from patients admitted to a large medical center during the 6 months before and after implementation of a formulary policy endorsing the use of tocilizumab for treatment of COVID-19. The impact of tocilizumab on 28-day all-cause mortality was assessed using a difference-in-differences analysis, with ineligible patients serving as a nonequivalent control group, and a matched analysis guided by a target trial emulation framework. Safety endpoints assessed included the incidence of secondary infections and liver enzyme elevations. Our findings were benchmarked against clinical trials, an observational study, and a meta-analysis.
RESULTS: Following guideline modification, tocilizumab was administered to 69% of eligible patients. This implementation was associated with a 3.1% absolute risk reduction in 28-day mortality (odds ratio, 0.86; number needed to treat to prevent one death, 32) attributable to the inclusion of tocilizumab in the guidelines and an additional 8.6% absolute risk reduction (odds ratio, 0.65; number needed to treat to prevent one death, 12) linked to its administration. These findings were consistent with estimates from published literature, although the effect estimates from the difference-in-differences analysis exhibited imprecision.
CONCLUSIONS: Evaluating formulary management decisions through novel causal inference approaches offers valuable estimates of clinical effectiveness and the potential to optimize the impact of new medications on population outcomes.

Although COVID-19 no longer constitutes a \"public health emergency of international concern\", which still has being spreading around the world at a low level. Small molecule drugs are the main antiviral treatment for novel coronavirus recommended in China. Although a variety of small-molecule antiviral drugs against COVID-19 have been listed in China, there is no specific drug recommendation for special populations. Society of Bacterial Infection and Resistance of Chinese Medical Association, together with the National Clinical Research Center for Respiratory Disease, and the National Center for Respiratory Medicine, organized domestic experts in various fields such as respiratory, virology, infection, critical care, emergency medicine and pharmacy to release Expert Consensus on the Clinical Application of Oral Small-Molecule Antiviral Drugs against COVID-19. The main content of this consensus includes the introduction of seven small-molecule antiviral drugs against COVID-19, focusing on the drug recommendations for 14 special groups such as the elderly, patients with complicated chronic diseases, tumor patients, pregnant women, and children, and providing suggestions for clinicians to standardize drug use.
新型冠状病毒（新冠病毒）感染虽已不再构成“国际关注的突发公共卫生事件”，但仍在全球范围内处于低水平流行。小分子口服药物是我国目前推荐的针对新冠病毒感染的主要抗病毒治疗方案。虽然国内已上市多种抗新冠病毒小分子药物，但目前尚无针对特殊人群的具体用药推荐。中华医学会细菌感染与耐药防治分会联合国家呼吸医学中心、国家呼吸系统疾病临床医学研究中心组织国内呼吸、病毒学、感染、重症、急诊、药学等各领域专家制订了本共识。本共识的主要内容包括7种抗新冠病毒小分子药物介绍，重点阐述了老年人群、合并慢性疾病人群、肿瘤患者、孕妇、儿童等14种特殊人群用药推荐，为临床医师规范用药提供建议。.