Associations Between Healthy Behaviors and Persistently Favorable Self-Rated Health in a Longitudinal Population-Based Study in Switzerland

BACKGROUND

Self-rated health is a subjective yet valuable indicator of overall health status, influenced by various factors including physical, psychological, and socio-economic elements. Self-rated health could be telling and used by primary care physicians to evaluate overall present and predictive health.

DESIGN

This study investigates the longitudinal evolution of self-rated health in Switzerland during the COVID-19 pandemic, focusing on the association of persistently favorable self-rated health with various predictors.

PARTICIPANTS

This study based on the Specchio cohort, a population-based digital study in Geneva Switzerland, involved participants completing questionnaires from 2021 to 2023.

MAIN MEASURES

Self-rated health was assessed alongside factors like physical and mental health, socio-economic status, and lifestyle behaviors.

KEY RESULTS

The study included 7006 participants in 2021, and 3888 participants who answered all three follow-ups (2021, 2022, and 2023). At baseline, 34.9% of individuals reported very good, 54.6% reported good, 9.6% reported average, and 1.0% reported poor to very poor self-rated health. Overall, 29.1% had a worsening in their self-rated health between 2021 and 2023. A subset of participants (12.1%) maintained very good self-rated health throughout, demonstrating persistently favorable self-rated health during the COVID-19 pandemic. Positive health behaviors were associated with persistently favorable self-rated health (exercise aOR 1.13 [1.03-1.24]; healthy diet aOR 2.14 [1.70-2.68]; less screen time aOR 1.28 [1.03-1.58]; and better sleep quality aOR 2.48 [2.02-3.04]). Mental health and social support also played significant roles.

CONCLUSION

The study underscores the significance of healthy lifestyle choices and social support in maintaining favorable self-rated health, particularly during challenging times like the COVID-19 pandemic. Primary care physicians should focus on promoting these factors, integrating these actions in their routine consultations, and advising patients to undertake in socially engaging activities to improve overall health perceptions and outcomes.

Persistence and emergence of new neuropsychological deficits following SARS-CoV-2 infection: A follow-up assessment of the Geneva COVID-COG cohort

Background

Despite numerous observations of neuropsychological deficits immediately following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, little is known about what happens to these deficits over time and whether they are affected by changes in fatigue and any psychiatric symptoms. We aimed to assess the prevalence of neuropsychological deficits at 6-9 months and again at 12-15 months after coronavirus disease 2019 (COVID-19) and to explore whether it was associated with changes in fatigue and psychiatric symptoms.

Methods

We administered a series of neuropsychological tests and psychiatric questionnaires to 95 patients (mean age = 57.12 years, standard deviation (SD) = 10.68; 35.79% women) 222 (time point 1 (T1)) and 441 (time point 2 (T2)) days on average after infection. Patients were categorised according to the severity of their respiratory COVID-19 symptoms in the acute phase: mild (no hospitalisation), moderate (conventional hospitalisation), and severe (hospitalisation in intensive care unit (ICU) plus mechanical ventilation). We ran Monte-Carlo simulation methods at each time point to generate a simulated population and then compared the cumulative percentages of cognitive disorders displayed by the three patient subgroups with the estimated normative data. We calculated generalised estimating equations for the whole sample to assess the longitudinal associations between cumulative neuropsychological deficits, fatigue, and psychiatric data (anxiety, depressive symptoms, posttraumatic stress disorder, and apathy).

Results

Most participants (>50%) exhibited a decrease in their neuropsychological impairments, while approximately 25% showed an escalation in these cognitive deficits. At T2, patients in the mild subgroup remained free of accumulated neuropsychological impairments. Patients with moderate severity of symptoms displayed a decrease in the magnitude of cumulative deficits in perceptual and attentional functions, a persistence of executive, memory and logical reasoning deficits, and the emergence of language deficits. In patients with severe symptoms, perceptual deficits emerged and executive deficits increased, while attentional and memory deficits remained unchanged. Changes in executive functions were significantly associated with changes in depressive symptoms, but the generalised estimating equations failed to reveal any other significant effect.

Conclusion

While most cumulative neuropsychological deficits observed at T1 persisted and even worsened over time in the subgroups of patients with moderate and severe symptoms, a significant proportion of patients, mainly in the mild subgroup, exhibited improved performances. However, we identified heterogeneous neuropsychological profiles both cross-sectionally and over time, suggesting that there may be distinct patient phenotypes. Predictors of these detrimental dynamics have yet to be identified.

[New developments and perspectives in outpatient general internal medicine]

Several studies have been published in 2023, in the field of general internal medicine, addressing various aspects of health and covering topics ranging from hormonal treatment of menopause to the management of chronic and acute diseases. A selection of articles was chosen for this update in outpatient general internal medicine, showing recent studies on outpatient care of patients (treatment, follow-up). The summary of articles is supplemented this year by a table of medical recommendations published in 2023, modestly proposed, and covering various areas. These guidelines, most of them from North America, show advances in the care and monitoring of outpatients, and should be interpreted in light of the various recommendations in Switzerland.

Use of complementary medicine and its association with SARS-CoV-2 vaccination during the COVID-19 pandemic: a longitudinal cohort study

AIMS OF THE STUDY

Patients are increasingly using and requesting complementary medicine therapies, especially during the COVID-19 pandemic. However, it remains unclear whether they use them in conjunction with conventional medicine or to replace vaccination or other approaches and whether they discuss them with their physicians as part of shared decision-making. This study aimed to evaluate the use and initiation of complementary medicine during the COVID-19 pandemic, focusing on the association between complementary medicine use and COVID-19 vaccination status.

METHODS

This study is a part of the longitudinal cohort of the CoviCare program, which follows all outpatients tested for COVID-19 at the Geneva University Hospitals. Outpatients tested for COVID-19 were contacted 12 months after their positive or negative test between April and December 2021. Participants were asked about their vaccination status and if they had used complementary medicine in the past 12 months. Complementary medicine use was defined based on a specific list of therapies from which participants could choose the options they had used. Logistic regression models adjusting for age, sex, education, profession, severe acute respiratory system coronavirus 2 (SARS-CoV-2) infection, and pre-existing conditions were used to evaluate the association between being unvaccinated and complementary medicine use. SARS-CoV-2 infection status was evaluated for effect modification in the association between being unvaccinated and complementary medicine use.

RESULTS

This study enrolled 12,246 individuals (participation proportion = 17.7%). Their mean age was 42.8 years, 59.4% were women, and 63.7% used complementary medicine. Complementary medicine use was higher in women, the middle-aged, and those with a higher education level, a SARS-CoV-2 infection, or pre-existing comorbidities. A third of cases initiated complementary medicine therapies as prevention against COVID-19. Being unvaccinated was associated with complementary medicine use (adjusted odds ratio [aOR] 1.22 [1.09-1.37]), and more specifically when these therapies were used for COVID-19 prevention (aOR 1.61 [1.22-2.12]). Being unvaccinated was associated with the use of zinc (aOR 2.25 [1.98-2.55]), vitamin D (aOR 1.45 [1.30-1.62]), and vitamin C (aOR 1.59 [1.42-1.78]), and more specifically when these therapies were used for COVID-19 prevention. Only 4% of participants discussed using complementary medicine with their primary care physicians.

CONCLUSION

While complementary medicine is increasingly used, it is rarely discussed with primary care physicians. Complementary medicine use, especially for COVID-19 prevention, is associated with COVID-19 vaccination status. Communication between physicians, patients, and complementary medicine therapists is encouraged to facilitate a truly holistic approach to making a shared decision based on the best available information.

Exercise ventilatory response after COVID-19: comparison between ambulatory and hospitalized patients

Inefficient ventilatory response during cardiopulmonary exercise testing (CPET) has been suggested as a cause of post-COVID-19 dyspnea. It has been described in hospitalized patients (HOSP) with lung parenchymal sequelae but also after mild infection in ambulatory patients (AMBU). We hypothesize that AMBU and HOSP have different ventilatory responses to exercise, due to different etiologies. We analyzed CPET realized between July 2020 and May 2022 of patients with persisting respiratory symptoms 3 mo after COVID-19. Chest computed tomography (CT) scan, pulmonary function tests, quality of life, and respiratory questionnaires were collected. CPET data were specifically explored as a function of ventilation (V̇e) and time. Seventy-nine consecutive patients were included (42 AMBU and 37 HOSP, median: 54 [44-60] yr old, 57% female). Patients were hospitalized for a median of 20 [8-34] days, with pneumonia (41%) or acute respiratory distress syndrome (ARDS; 30%). Among HOSP, 12(32%) patients had abnormal values for spirometry and 18(51%) for carbon monoxide diffusing capacity (P < 0.001). CPET showed no differences between AMBU and HOSP in peak absolute O2 uptake (V̇o2) (1.59 [1.22-2.11] mL·min-1; P = 0.65). Tidal volume (VT) as a function of V̇e, was lower in AMBU than in HOSP (P < 0.01) toward the end of exercise. The slope of the V̇e-CO2 production was higher than normal in both groups (30.9 [26.1-34.3]; P = 0.96). In conclusion, the severity of COVID-19 did not influence the exercise capacity, but AMBU demonstrated a less efficient ventilatory response to exercise as compared with HOSP. CPET with exploration of data as a function of V̇e and throughout the exercise better unveil ventilatory inefficiency.NEW & NOTEWORTHY We evaluated the exercise ventilatory response in patients with persisting dyspnea after severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. We found that despite similar peak power and peak absolute O2 uptake, tidal volume as a function of ventilation was lower in ambulatory than in hospitalized patients toward the end of exercise, reflecting ventilatory inefficiency. We call for evaluation of minute ventilation with the exploration of data throughout the exercise and not only peak data to better unveil ventilatory inefficiency.

The longitudinal study of subjective wellbeing and absenteeism of healthcare workers considering post-COVID condition and the COVID-19 pandemic toll

Experts have warned against the pandemic burden on healthcare workers early on, however little is known about the evolution of this burden with time, in addition to the long-term effects of post-COVID symptoms in healthcare workers. Staff at the Geneva University Hospitals in Switzerland had an online follow-up in July and December 2021, on their physical and mental health, quality of life and functional capacity using validated scales. Descriptive analyses compared the prevalence of symptoms, functional impairment and quality of life in SARS-CoV-2 positive and negative individuals at baseline and at follow-up. Out of the initial n = 3,083 participants that answered at baseline in July 2021, n = 900 (mean age of 46.4 years, 70.1% women) completed the follow-up in December 2021. With time, more individuals reported fatigue (+ 9.4%), headache (+ 9.0%), insomnia (+ 2.3%), cognitive impairment (+ 1.4%), stress/burnout (+ 8.8%), pain (+ 8.3%), digestive symptoms (+ 3.6%), dyspnea (+ 1.0%), and cough (+ 7.7%) compared to baseline, with a differentially larger increase in symptoms in the SARS-CoV-2 negative group. Individuals had more functional impairment (12.7% at baseline and 23.9% at follow-up), with more absenteeism and worsening quality of life. Healthcare workers are potentially suffering from long term consequences of the pandemic burden, calling for urgent action and solutions.

Markers of limbic system damage following SARS-CoV-2 infection

Alterations of the limbic system may be present in the chronic phase of SARS-CoV-2 infection. Our aim was to study the long-term impact of this disease on limbic system-related behaviour and its associated brain functional connectivity, according to the severity of respiratory symptoms in the acute phase. To this end, we investigated the multimodal emotion recognition abilities of 105 patients from the Geneva COVID-COG Cohort 223 days on average after SARS-CoV-2 infection (diagnosed between March 2020 and May 2021), dividing them into three groups (severe, moderate or mild) according to respiratory symptom severity in the acute phase. We used multiple regressions and partial least squares correlation analyses to investigate the relationships between emotion recognition, olfaction, cognition, neuropsychiatric symptoms and functional brain networks. Six to 9 months following SARS-CoV-2 infection, moderate patients exhibited poorer recognition abilities than mild patients for expressions of fear (P = 0.03 corrected), as did severe patients for disgust (P = 0.04 corrected) and irritation (P < 0.01 corrected). In the whole cohort, these performances were associated with decreased episodic memory and anosmia, but not with depressive symptoms, anxiety or post-traumatic stress disorder. Neuroimaging revealed a positive contribution of functional connectivity, notably between the cerebellum and the default mode, somatosensory motor and salience/ventral attention networks. These results highlight the long-term consequences of SARS-Cov-2 infection on the limbic system at both the behavioural and neuroimaging levels.

[Pharmacological trials evaluating treatment options for neuropsychiatric symptoms in post-COVID. A narrative review]

Post-COVID prevalence's is estimated at 10 % in the general population. The neuropsychiatric symptoms, which are frequent (up to 30 %), can severely affect the quality of life of patients affected by this condition, notably by significantly reducing their working ability. To date, no pharmacologic treatment is available for post-COVID, apart from symptomatic treatments. A large number of pharmacological clinical trials for post-COVID are underway since 2021. A number of these trials targets neuropsychiatric symptoms, based on the various underlying pathophysiological hypotheses. The objective of this narrative review is to provide an overview of these ongoing trials targeting neuropsychiatric symptoms in post-COVID.

Prevalence of Post-Coronavirus Disease Condition 12 Weeks After Omicron Infection Compared With Negative Controls and Association With Vaccination Status

BACKGROUND

Post-coronovirus disease (COVID) symptoms can persist several months after severe acute respiratory syndrome coronavirus 2 infection. Little is known, however, about the prevalence of post-COVID condition following infections from Omicron variants and how this varies according to vaccination status. This study evaluates the prevalence of symptoms and functional impairment 12 weeks after an infection by Omicron variants (BA.1 and BA.2) compared with negative controls tested during the same period.

METHODS

Outpatient individuals who tested positive or negative for COVID-19 infection between December 2021 and February 2022 at the Geneva University Hospitals were followed 12 weeks after their test date.

RESULTS

Overall, 11.7% of Omicron cases had symptoms 12 weeks after the infection compared with 10.4% of individuals who tested negative during the same period (P < .001), and symptoms were much less common in vaccinated versus nonvaccinated individuals with Omicron infection (9.7% vs 18.1%; P < .001). There were no significant differences in functional impairment at 12 weeks between Omicron cases and negative controls, even after adjusting for multiple potential confounders.

CONCLUSIONS

The differential prevalence of post-COVID symptoms and functional impairment attributed to Omicron BA.1 and BA.2 infection is low when compared with negative controls. Vaccination is associated with lower prevalence of post-COVID symptoms.

The development of a Chatbot technology to disseminate post-COVID condition information: a descriptive implementation study

BACKGROUND

Post-COVID condition has now affected millions of individuals, resulting in fatigue, neurocognitive symptoms and an impact on daily life. The uncertainty of knowledge around this condition, including its overall prevalence, pathophysiology, and management, along with the growing numbers of affected individuals have created an essential need in information and disease management. This has become even more critical in a time of abundant online misinformation and potential misleading of patients and healthcare professionals.

OBJECTIVE

The RAFAEL platform is an ecosystem created to address the information and management of post-COVID condition, integrating online information, webinars, and chatbot technology to answer to a large number of individuals in a time-limited and resources-limited setting. This paper describes the development and deployment of the RAFAEL platform and chatbot in addressing post-COVID condition in children and adults.

METHODS

The RAFAEL study takes place in Geneva, Switzerland. The RAFAEL platform and chatbot were made available online, and all users were considered participants to this study. The development phase started in December 2020 and consisted of developing the concept, the backend, and the frontend developments as well as beta testing. The specific strategy behind the RAFAEL chatbot balanced an accessible interactive approach with medical safety, aiming to relay correct and verified information in the management of post-COVID condition. Development was followed by deployment with the establishment of partnerships and communication strategies in the French speaking world. The use of the chatbot and the answers provided were continuously monitored by community moderators and healthcare professionals, creating a safe fallback for users.

RESULTS

To date, the RAFAEL chatbot has had 30488 interactions, with n=6471 (79.5%) matching rate and n=1795 positive feedback rate out of the 2 51 users who provided feedback. Overall, 5807 unique users interacted with the chatbot with 5.1 interactions on average per user, and 8061 stories triggered. Use of the chatbot and RAFAEL platform was additionally driven by the monthly thematic webinars as well as communication campaigns, with an average of 250 participants at each webinar. User queries included questions about post-COVID symptoms (n=5612; 69.2%), of which fatigue was the most predominant query (n=1255; 22.4% of symptoms-related stories). Additional queries included questions about consultations (n=598; 7.4%), treatment (n=527; 6.5%), and general information (n=510; 6.3%).

CONCLUSIONS

The RAFAEL chatbot is to our knowledge the first chatbot developed to address post-COVID condition in children and adults. Its innovation lies in the use of a scalable tool to disseminate verified information in a time- and resources-limited environment. Additionally, the use of machine-learning could help professionals gain knowledge about a new condition while concomitantly addressing patients' concerns. Lessons learned from the RAFAEL chatbot will further encourage a participative approach to learning and could potentially be applied to other chronic conditions.

CLINICALTRIAL

Acute TNFα levels predict cognitive impairment 6-9 months after COVID-19 infection

BACKGROUND

A neurocognitive phenotype of post-COVID-19 infection has recently been described that is characterized by a lack of awareness of memory impairment (i.e., anosognosia), altered functional connectivity in the brain's default mode and limbic networks, and an elevated monocyte count. However, the relationship between these cognitive and brain functional connectivity alterations in the chronic phase with the level of cytokines during the acute phase has yet to be identified.

AIM

Determine whether acute cytokine type and levels is associated with anosognosia and functional patterns of brain connectivity 6-9 months after infection.

METHODS

We analyzed the predictive value of the concentration of acute cytokines (IL-1RA, IL-1β, IL-6, IL-8, IFNγ, G-CSF, GM-CSF) (cytokine panel by multiplex immunoassay) in the plasma of 39 patients (mean age 59 yrs, 38-78) in relation to their anosognosia scores for memory deficits via stepwise linear regression. Then, associations between the different cytokines and brain functional connectivity patterns were analyzed by MRI and multivariate partial least squares correlations for the whole group.

RESULTS

Stepwise regression modeling allowed us to show that acute TNFα levels predicted (R² = 0.145; β = -0.38; p = .017) and were associated (r = -0.587; p < .001) with scores of anosognosia for memory deficits observed 6-9 months post-infection. Finally, high TNFα levels were associated with hippocampal, temporal pole, accumbens nucleus, amygdala, and cerebellum connectivity.

CONCLUSION

Increased plasma TNFα levels in the acute phase of COVID-19 predict the presence of long-term anosognosia scores and changes in limbic system functional connectivity.

Brain functional connectivity alterations associated with neuropsychological performance 6-9 months following SARS-CoV-2 infection

Neuropsychological deficits and brain damage following SARS-CoV-2 infection are not well understood. Then, 116 patients, with either severe, moderate, or mild disease in the acute phase underwent neuropsychological and olfactory tests, as well as completed psychiatric and respiratory questionnaires at 223 ± 42 days postinfection. Additionally, a subgroup of 50 patients underwent functional magnetic resonance imaging. Patients in the severe group displayed poorer verbal episodic memory performances, and moderate patients had reduced mental flexibility. Neuroimaging revealed patterns of hypofunctional and hyperfunctional connectivities in severe patients, while only hyperconnectivity patterns were observed for moderate. The default mode, somatosensory, dorsal attention, subcortical, and cerebellar networks were implicated. Partial least squares correlations analysis confirmed specific association between memory, executive functions performances and brain functional connectivity. The severity of the infection in the acute phase is a predictor of neuropsychological performance 6-9 months following SARS-CoV-2 infection. SARS-CoV-2 infection causes long-term memory and executive dysfunctions, related to large-scale functional brain connectivity alterations.

Prevalence and predictors of psychological distress before, during, and after a COVID-19 pandemic wave in Switzerland, 2021

There are concerns about acute and long-term mental health effects of the COVID-19 pandemic. This study examined the prevalence and predictors of psychological distress before, during, and after a pandemic wave in Switzerland, 2021. Prevalence of psychological distress was estimated in adults aged 35-96 years using the General Health Questionnaire-12 administered in June 2021 (Specchio-COVID19 cohort, N = 3965), and compared to values from 2003 to 2006 (CoLaus|PsyCoLaus cohort, N = 5667). Anxiety and depression were assessed from February to June 2021 using the Generalised Anxiety Disorder scale-2 and the Patient Health Questionnaire-2, respectively. Prevalence of psychological distress in June 2021, after the pandemic wave (16.0% [95% CI, 14.6%-17.4%]) was comparable to pre-pandemic levels (15.1% [14.0%-16.2%]). Anxiety and depression were highest at the start of the pandemic wave in February 2021, and declined from February to June with the relaxation of measures. Predictors of psychological distress included being younger, female, a single parent, unemployed, a change in working hours or job loss in the past 6 months, greater perceived severity and contagiousness of COVID-19, and self-reported post COVID-19. By June 2021, following a pandemic wave, prevalence of psychological distress in Switzerland was closer to pre-pandemic levels. These findings highlight the need for additional mental health support during times of stricter government policies relating to COVID-19; yet they also suggest that individuals can adapt relatively quickly to the changing context.

[Post-Covid: 2022 updates and next steps.]

Post-Covid is defined by persistent symptoms following a SARS-CoV-2 infection, after excluding other causes. The prevalence of post-Covid is estimated at around 30% in the general population after an infection. Some of the risk factors include female sex, the number of symptoms in the acute phase, and comorbidities. Vaccination and Omicron infection are associated with a lower prevalence. The pathophysiology of post-Covid is not known to date, with hypotheses including immune dysregulation, viral persistence, endothelial dysfunction, microthrombosis and their consequences. Current management is defined by an adaptation of daily activities, and a symptom-based approach reducing their severity, frequency and impact. Clinical trials are underway to offer potential treatments for those affected.

Persistent symptoms after SARS-CoV-2 infection in children: a cross-sectional population-based serological study

OBJECTIVES

To estimate the prevalence of children and adolescents reporting persistent symptoms after SARS-CoV-2 infection.

DESIGN

A random sample of children and adolescents participated with their family members to a serological survey including a blood drawing for detecting antibodies targeting the SARS-CoV-2 nucleocapsid (N) protein and a questionnaire on COVID-19-related symptoms experienced since the beginning of the pandemic.

SETTING

The study took place in the canton of Geneva, Switzerland, between June and July 2021.

PARTICIPANT

660 children aged between 2 and 17 years old.

PRIMARY AND SECONDARY OUTCOME

The primary outcome was the persistence of symptoms beyond 4 weeks comparing seropositive and seronegative participants. The type of declared symptoms were also studied as well as associated risk factors.

RESULTS

Among seropositive children, the sex-adjusted and age-adjusted prevalence of symptoms lasting longer than 2 weeks was 18.3%, compared with 11.1% among seronegatives (adjusted prevalence difference (ΔaPrev)=7.2%, 95% CI: 1.5% to 13.0%). Among adolescents aged 12-17 years, we estimated the prevalence of experiencing symptoms lasting over 4 weeks to be 4.4% (ΔaPrev,95% CI: -3.8% to 13.6%), whereas no seropositive child aged 2-11 reported symptoms of this duration. The most frequently declared symptoms were fatigue, headache and loss of smell.

CONCLUSIONS

We estimated the prevalence of experiencing persistent symptoms lasting over 4 weeks to be around 4% among adolescents, which represents a large absolute number, and should raise awareness and concern. We did not observe meaningful differences of persistent symptoms between seropositive and seronegative younger children, suggesting that they may be less affected than their older counterparts.

Autoantibodies against apolipoprotein A-1 after COVID-19 predict symptoms persistence

BACKGROUND

SARS-CoV-2 infection triggers different auto-antibodies, including anti-apolipoprotein A-1 IgGs (AAA1), which could be of concern as mediators of persistent symptoms. We determined the kinetics of AAA1 response over after COVID-19 and the impact of AAA1 on the inflammatory response and symptoms persistence.

METHODS

All serologies were assessed at one, three, six and twelve months in 193 hospital employees with COVID-19. ROC curve analyses and logistic regression models (LRM) were used to determine the prognostic accuracy of AAA1 and their association with patient-reported COVID-19 symptoms persistence at 12 months. Interferon (IFN)-α and-γ production by AAA1-stimulated human monocyte-derived macrophages (HMDM) was assessed in vitro.

RESULTS

AAA1 seropositivity was 93% at one month and declined to 15% at 12 months after COVID-19. Persistent symptoms at 12 months were observed in 45.1% of participants, with a predominance of neurological (28.5%), followed by general (15%) and respiratory symptoms (9.3%). Over time, strength of correlations between AAA1 and anti-SARS-COV2 serologies decreased, but remained significant. From the 3^rd month on, AAA1 levels predicted persistent respiratory symptoms (area under the curves 0.72-0.74; p < 0.001), independently of disease severity, age and gender (adjusted odds ratios 4.81-4.94; p = 0.02), while anti-SARS-CoV-2 serologies did not. AAA1 increased IFN-α production by HMDMs (p = 0.03), without affecting the IFN-γ response.

CONCLUSION

COVID-19 induces a marked though transient AAA1 response, independently predicting one-year persistence of respiratory symptoms. By increasing IFN-α response, AAA1 may contribute to persistent symptoms. If and how AAA1 levels assessment could be of use for COVID-19 risk stratification remains to be determined.

Characteristics of long-COVID among older adults: a cross-sectional study

OBJECTIVES

To describe long-COVID symptoms among older adults and to assess the risk factors for two common long-COVID symptoms: fatigue and dyspnea.

METHODS

This is a multicenter, prospective cohort study conducted in Israel, Switzerland, Spain, and Italy. Individuals were included at least 30 days after their COVID-19 diagnosis. We compared long-COVID symptoms between elderly (aged >65 years) and younger individuals (aged 18-65 years) and conducted univariate and multivariable analyses for the predictors of long-COVID fatigue and dyspnea.

RESULTS

A total of 2333 individuals were evaluated at an average of 5 months (146 days [95% confidence interval 142-150]) after COVID-19 onset. The mean age was 51 years, and 20.5% were aged >65 years. Older adults were more likely to be symptomatic, with the most common symptoms being fatigue (38%) and dyspnea (30%); they were more likely to complain of cough and arthralgia and have abnormal chest imaging and pulmonary function tests. Independent risk factors for long-COVID fatigue and dyspnea included female gender, obesity, and closer proximity to COVID-19 diagnosis; older age was not an independent predictor.

CONCLUSION

Older individuals with long-COVID have different persisting symptoms, with more pronounced pulmonary impairment. Women and individuals with obesity are at risk. Further research is warranted to investigate the natural history of long-COVID among the elderly population and to assess possible interventions aimed at promoting rehabilitation and well-being.

The pandemic toll and post-acute sequelae of SARS-CoV-2 in healthcare workers at a Swiss University Hospital

Healthcare workers have potentially been among the most exposed to SARS-CoV-2 infection as well as the deleterious toll of the pandemic. This study has the objective to differentiate the pandemic toll from post-acute sequelae of SARS-CoV-2 infection in healthcare workers compared to the general population.

The study was conducted between April and July 2021 at the Geneva University Hospitals, Switzerland. Eligible participants were all tested staff, and outpatient individuals tested for SARS-CoV-2 at the same hospital. The primary outcome was the prevalence of symptoms in healthcare workers compared to the general population, with measures of COVID-related symptoms and functional impairment, using prevalence estimates and multivariable logistic regression models.

Healthcare workers (n = 3083) suffered mostly from fatigue (25.5 %), headache (10.0 %), difficulty concentrating (7.9 %), exhaustion/burnout (7.1 %), insomnia (6.2 %), myalgia (6.7 %) and arthralgia (6.3 %). Regardless of SARS-CoV-2 infection, all symptoms were significantly higher in healthcare workers than the general population (n = 3556). SARS-CoV-2 infection in healthcare workers was associated with loss or change in smell, loss or change in taste, palpitations, dyspnea, difficulty concentrating, fatigue, and headache. Functional impairment was more significant in healthcare workers compared to the general population (aOR 2.28; 1.76–2.96), with a positive association with SARS-CoV-2 infection (aOR 3.81; 2.59–5.60).

Symptoms and functional impairment in healthcare workers were increased compared to the general population, and potentially related to the pandemic toll as well as post-acute sequelae of SARS-CoV-2 infection. These findings are of concern, considering the essential role of healthcare workers in caring for all patients including and beyond COVID-19.

Frequency of Abnormally Low Neuropsychological Scores in Post-COVID-19 Syndrome: the Geneva COVID-COG Cohort

OBJECTIVE

Several studies have reported poor long-term neuropsychological performances in patients following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but none has yet considered the effect of administering multiple intercorrelated neuropsychological tests and assessed the frequency of cognitive deficits in a normative population. Our aim was therefore to assess the presence of cumulative neuropsychological deficits in an actual post-coronavirus disease of 2019 (COVID-19) comparison group versus one simulated using Monte-Carlo methods.

METHOD

Validated neuropsychological Monte-Carlo simulation methods were applied to scores from a battery of neuropsychological tests (memory, executive, attentional, perceptual, logical reasoning, language, and ideomotor praxis) administered to 121 patients who had had mild, moderate, or severe COVID-19 (mean age: 56.70 years; 32% women), 222 ± 43 days post-infection. The cumulative percentages of the three severity subgroups were compared with the results of a false discovery rate-corrected probability analysis based on normative data.

RESULTS

The cumulative percentages of deficits in memory and executive functions among the severe and moderate patients were significantly higher than those estimated for the normative population. Moderate patients also had significantly more deficits in perception and logical reasoning. In contrast, the mild group did not have significantly more cumulative deficits.

CONCLUSIONS

Moderate and severe forms of COVID-19 cause greater long-term neuropsychological deficits than those that would be found in a normative population, reinforcing the hypothesis of long-term effects of SARS-CoV-2 on cognitive function, independent of the severity of the initial infection.

One-year persistent symptoms and functional impairment in SARS-CoV-2 positive and negative individuals

BACKGROUND

Persistent symptoms of SARS-CoV-2 are prevalent weeks to months following the infection. To date, it is difficult to disentangle the direct from the indirect effects of SARS-CoV-2, including lockdown, social, and economic factors.

OBJECTIVE

The study aims to characterize the prevalence of symptoms, functional capacity, and quality of life at 12 months in outpatient symptomatic individuals tested positive for SARS-CoV-2 compared to individuals tested negative.

METHODS

From 23 April to 27 July 2021, outpatient symptomatic individuals tested for SARS-CoV-2 at the Geneva University Hospitals were followed up 12 months after their test date.

RESULTS

At 12 months, out of the 1447 participants (mean age 45.2 years, 61.2% women), 33.4% reported residual mild to moderate symptoms following SARS-CoV-2 infection compared to 6.5% in the control group. Symptoms included fatigue (16% vs. 3.1%), dyspnea (8.9% vs. 1.1%), headache (9.8% vs. 1.7%), insomnia (8.9% vs. 2.7%), and difficulty concentrating (7.4% vs. 2.5%). When compared to the control group, 30.5% of SARS-CoV-2 positive individuals reported functional impairment at 12 months versus 6.6%. SARS-CoV-2 infection was associated with the persistence of symptoms (adjusted odds ratio [aOR] 4.1; 2.60-6.83) and functional impairment (aOR 3.54; 2.16-5.80) overall, and in subgroups of women, men, individuals younger than 40 years, those between 40-59 years, and in individuals with no past medical or psychiatric history.

CONCLUSION

SARS-CoV-2 infection leads to persistent symptoms over several months, including in young healthy individuals, in addition to the pandemic effects, and potentially more than other common respiratory infections. Symptoms impact functional capacity up to 12 months post infection.

OUP accepted manuscript

Lack of awareness of cognitive impairment (i.e. anosognosia) could be a key factor for distinguishing between neuropsychological post-COVID-19 condition phenotypes. In this context, the 2-fold aim of the present study was to (i) establish the prevalence of anosognosia for memory impairment, according to the severity of the infection in the acute phase and (ii) determine whether anosognosic patients with post-COVID syndrome have a different cognitive and psychiatric profile from nosognosic patients, with associated differences in brain functional connectivity. A battery of neuropsychological, psychiatric, olfactory, dyspnoea, fatigue and quality-of-life tests was administered 227.07 ± 42.69 days post-SARS-CoV-2 infection to 102 patients (mean age: 56.35 years, 65 men, no history of neurological, psychiatric, neuro-oncological or neurodevelopmental disorder prior to infection) who had experienced either a mild (not hospitalized; n = 45), moderate (conventional hospitalization; n = 34) or severe (hospitalization with intensive care unit stay and mechanical ventilation; n = 23) presentation in the acute phase. Patients were first divided into two groups according to the presence or absence of anosognosia for memory deficits (26 anosognosic patients and 76 nosognosic patients). Of these, 49 patients underwent an MRI. Structural images were visually analysed, and statistical intergroup analyses were then performed on behavioural and functional connectivity measures. Only 15.6% of patients who presented mild disease displayed anosognosia for memory dysfunction, compared with 32.4% of patients with moderate presentation and 34.8% of patients with severe disease. Compared with nosognosic patients, those with anosognosia for memory dysfunction performed significantly more poorly on objective cognitive and olfactory measures. By contrast, they gave significantly more positive subjective assessments of their quality of life, psychiatric status and fatigue. Interestingly, the proportion of patients exhibiting a lack of consciousness of olfactory deficits was significantly higher in the anosognosic group. Functional connectivity analyses revealed a significant decrease in connectivity, in the anosognosic group as compared with the nosognosic group, within and between the following networks: the left default mode, the bilateral somatosensory motor, the right executive control, the right salient ventral attention and the bilateral dorsal attention networks, as well as the right Lobules IV and V of the cerebellum. Lack of awareness of cognitive disorders and, to a broader extent, impairment of the self-monitoring brain system, may be a key factor for distinguishing between the clinical phenotypes of post-COVID syndrome with neuropsychological deficits.

COVID-19 vaccination acceptance in the canton of Geneva: a cross-sectional population-based study

OBJECTIVE

This study aimed to assess acceptance of COVID-19 vaccination as well as its sociodemographic and clinical determinants, 3 months after the launch of the vaccination programme in Geneva, Switzerland.

METHODS

In March 2021, an online questionnaire was proposed to adults included in a longitudinal cohort study of previous SARS-CoV-2 serosurveys carried out in the canton of Geneva, which included former participants of a population-based health survey as well as individuals randomly sampled from population registries, and their household members. Questions were asked about COVID-19 vaccination acceptance, reasons for acceptance or refusal and attitudes to vaccination in general. Data on demographic (age, sex, education, income, professional status, living conditions) and health-related characteristics (having a chronic disease, COVID-19 diagnosis, smoking status) were assessed at inclusion in the cohort (December 2020). The overall vaccination acceptance was standardised according to the age, sex, and education distribution in the Geneva population.

RESULTS

Overall, 4067 participants (completion rate of 77.4%) responded to the survey between 17 March and 1 April 2021. The mean age of respondents was 53.3 years and 56.0% were women. At the time of the survey, 17.2% of respondents had already been vaccinated with at least one dose or had made an appointment to get vaccinated, and an additional 58.5% intended or rather intended to get vaccinated. The overall acceptance of COVID-19 vaccination standardised to the age, sex and education distribution of the population of Geneva was 71.8%, with a higher acceptance among men than women, older adults compared with younger adults, high-income individuals compared with those with a low income, and participants living in urban and semi-urban areas compared with rural areas. Acceptance was lower among individuals having completed apprenticeships and secondary education than those with tertiary education. The most common reasons reported by participants intending to get vaccinated were the desire to "get back to normal", to protect themselves, their community and/or society,and their relatives or friends against the risk of infection by SARS-CoV-2, as well as the desire to travel. Less than half (45.6%) of participants having children were willing or rather willing to have their children vaccinated against COVID-19 if it were recommended by public health authorities.

CONCLUSION

Although our study found a 71.8% weighted acceptance of COVID-19 vaccination, there were noticeable sociodemographic disparities in vaccination acceptance. These data will be useful for public health measures targeting hesitant populations when developing health communication strategies.

Cohort profile: Actionable Register of Geneva Outpatients and inpatients with SARS-CoV-2 (ARGOS)

PURPOSE

The Actionable Register of Geneva Outpatients and inpatients with SARS-CoV-2 (ARGOS) is an ongoing prospective cohort created by the Geneva Directorate of Health. It consists of an operational database compiling all SARS-CoV-2 test results recorded in the Geneva area since late February 2020. This article aims at presenting this comprehensive cohort, in light of some of the varying public health measures in Geneva, Switzerland, since March 2020.

PARTICIPANTS

As of 1 June 2021, the database included 360 525 patients, among which 65 475 had at least one positive test result for SARS-CoV-2. Among all positive patients, 37.6% were contacted only once, 10.6% had one follow-up call, 8.5% had two and 27.7% had three or more follow-up calls. Participation rate among positive patients is 94%. Data collection is ongoing.

FINDINGS TO DATE

ARGOS data illustrates the magnitude of COVID-19 pandemic in Geneva, Switzerland, and details a variety of population factors and outcomes. The content of the cohort includes demographic data, comorbidities and risk factors for poor clinical outcome, self-reported COVID-19 symptoms, environmental and socioeconomic factors, prospective and retrospective contact tracing data, travel quarantine data and deaths. The registry has already been used in several publications focusing on symptoms and long COVID-19, infection fatality rate and re-infection.

FUTURE PLANS

The data of this large real-world registry provides a valuable resource for various types of research, such as clinical research, epidemiological research or policy assessment as it illustrates the impact of public health policies and overall disease burden of COVID-19.

Perceptions of vaccination certificates among the general population in Geneva, Switzerland

OBJECTIVE

This study aimed to assess the public perception of COVID-19 vaccination certificates as well as potential differences between individuals.

METHODS

Between 17 March and 1 April 2021, a self-administered online questionnaire was proposed to all persons aged 18 years and older participating in the longitudinal follow-up of SARS-CoV-2 seroprevalence studies in Geneva, Switzerland. The questionnaire covered aspects of individual and collective benefits, and allowed participants to select contexts in which vaccination certificates should be presented. Results were presented as the proportion of persons agreeing or disagreeing with the implementation of vaccination certificates, selecting specific contexts where certificates should be presented, and agreeing or disagreeing with the potential risks related to certificates. Logistic regression was used to calculate odds ratios for factors associated with certificate non-acceptance.

RESULTS

Overall, 4067 individuals completed the questionnaire (response rate 77.4%; mean age 53.3 ± standard deviation 14.4 years; 56.1% were women). About 61.0% of participants agreed or strongly agreed that a vaccination certificate was necessary in certain contexts and 21.6% believed there was no context where vaccination certificates should be presented. Contexts where a majority of participants perceived a vaccination certificate should be presented included jobs where others would be at risk of COVID-related complications (60.7%), jobs where employees would be at risk of getting infected (58.7%), or to be exempt from quarantine when travelling abroad (56.0%). Contexts where fewer individuals perceived the need for vaccination certificates to be presented were participation in large gatherings (36.9%), access to social venues (35.5%), or sharing the same workspace (21.5%). Younger age, no intent for vaccination, and not believing vaccination to be an important step in surmounting the pandemic were factors associated with certificate non-acceptance.

CONCLUSION

This large population-based study showed that the general adult population in Geneva, Switzerland, agreed with the implementation of vaccination certificates in work-related and travel-related contexts. However, this solution was perceived as unnecessary for access to large gatherings or social venues, or to share the same workspace. Differences were seen with age, sex, education, socioeconomic status, and vaccination willingness and perception, highlighting the importance of taking personal and sociodemographic variation into consideration when predicting acceptance of such certificates.

Acceptability of COVID-19 Certificates: A Qualitative Study in Geneva, Switzerland, in 2020

Immunity certificates related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have been under discussion since the beginning of the pandemic with conflicting opinions. In order to identify arguments in favor of and against the possible implementation of documents certifying immunity of an individual based on serological testing, we developed a qualitative study in Geneva, Switzerland. The study took place between two lockdowns with a sense of semi-normalcy during summer 2020 in Switzerland but at a time when no vaccine was available and seroprevalence was below 21%. Eleven focus groups with members of the public and 14 semi-structured interviews with stakeholders were conducted between July and November 2020, with a total of 68 participants with an age range between 24 and 77 years. Interviews and focus groups transcripts were coded with the ATLAS.ti CAQDAS. Few participants considered immunity certificates based on serological testing as an acceptable public health measure. Major concerns included the reliability of scientific data related to COVID-19 immunity and serological testing potential re-infection as well as the possibility that the use of certificates could result in deleterious outcomes. Discrimination, counterfeiting, incitement for self-infection, invasion of the private sphere, violation of personal integrity, and violation of medical secrecy were perceived as the major risks. Benefits of immunity certificates were more perceived when in relation to vaccination, and included gains in medical knowledge and protection in certain contexts involving leisure or work-related activities. The consequences of implementing immunity certificates are numerous, and the acceptability by the general population has to be considered when engaging in such policy. Even if the results provide a snapshot of arguments discussed around immunity certificates based on serological testing before the implementation of the COVID-19 vaccine, most of the issues discussed are central in the current debates about vaccination certificates.

Prevalence of Symptoms More Than Seven Months After Diagnosis of Symptomatic COVID-19 in an Outpatient Setting

BACKGROUND

With millions of SARS-CoV-2 infections worldwide, increasing numbers of patients are coming forward with long-term clinical effects of the disease lasting several weeks to months.

OBJECTIVE

To characterize symptoms 7 to 9 months after diagnosis of COVID-19.

DESIGN

Self-reported surveys and semistructured telephone interviews at enrollment and 30 to 45 days and 7 to 9 months from diagnosis.

SETTING

From 18 March to 15 May 2020, symptomatic persons who tested positive for SARS-CoV-2 at the Geneva University Hospitals were followed by CoviCare, a virtual, clinical, outpatient follow-up program. Persons were contacted again at 30 to 45 days and 7 to 9 months from diagnosis.

PARTICIPANTS

Persons who were a part of the CoviCare program from 18 March to 15 May 2020.

MEASUREMENTS

A standardized interview of symptoms consistent with COVID-19, with grading of intensity.

RESULTS

Of the 629 participants in the study who completed the baseline interviews, 410 completed follow-up at 7 to 9 months after COVID-19 diagnosis; 39.0% reported residual symptoms. Fatigue (20.7%) was the most common symptom reported, followed by loss of taste or smell (16.8%), dyspnea (11.7%), and headache (10.0%).

LIMITATION

Limitations include generalizability and missing data for 34.8% of participants.

CONCLUSION

Residual symptoms after SARS-CoV-2 infection are common among otherwise young and healthy persons followed in an outpatient setting. These findings contribute to the recognition of long-term effects in a disease mostly counted by its death toll to date by promoting communication on postacute sequelae of SARS-CoV-2 and encouraging physicians to continue long-term monitoring of their patients.

PRIMARY FUNDING SOURCE

None.

Impact of peritraumatic dissociation in hospitalized patients with COVID-19 pneumonia: A longitudinal study

OBJECTIVE

Psychiatric impact of COVID-19 is still explored and previous data suggest potential risks of anxiety, depression and PTSD related to COVID-19. We aimed to explore the predictive value of risk factors during hospitalization (T0) for COVID-19 for anxiety, depression and PTSD and at three months (T1) because they could differ over these two time points.

METHODS

We performed a screening of mental suffering in hospitalized patients for COVID-19, as well as specialized care and three months longitudinal follow-up. We evaluated at T0 and at T1 the prevalence of anxiety, depression and PTSD in survivors who benefited from early detection and treatment, and assessed possible risk factors in adults surviving COVID-19 between the 30th March and the 1^st of July 2020.

RESULTS

109 patients were screened at T0 and 61 of these were reassessed at T1. At T0, we found 44.9% pathological score on peritraumatic dissociation experiences questionnaire (PDEQ), 85.4% of post-traumatic stress disorder symptoms (PTSS), 14.6% of pathological rate of post-traumatic stress disorder scale 5 (PCL5) and at T1, 86.9% of PTSS, 10.6% of pathological rate of PCL5. Finally, PDEQ score at T0 during hospitalization was positively correlated to PCL-5 score at T1 (β = 0.26, p = 0.01) and that was confirmed in multivariate analysis (β = 0.04, p = 0.02 for the log of PCL-5 per point on the PDEQ).

CONCLUSION

Screening of psychiatric symptoms during hospitalization for COVID-19 should be systematic, especially peritraumatic dissociation to offer an early treatment and prevent PTSD, which seemed frequent for hospitalized patients for COVID-19 at three months.

Novel outpatient management of mild to moderate COVID-19 spares hospital capacity and safeguards patient outcome: The Geneva PneumoCoV-Ambu study

BACKGROUND

Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2), the novel coronavirus that causes coronavirus disease (COVID-19), is creating an unprecedented burden on health care systems across the world due to its high rate of pneumonia-related hospitalizations. This study presents recommendations for the outpatient management of moderate SARS-CoV-2 pneumonia implemented at the Geneva University Hospital, Switzerland, from April 4 to June 30, 2020 and evaluated the impact of these recommendations on patient safety, patient satisfaction, and overall hospital capacity.

METHODS

Recommendations for the outpatient management of moderate pneumonia implemented in the Geneva University Hospital (PneumoCoV-Ambu) between April 4 and June 30, 2020, were evaluated prospectively. The primary endpoint was hospitalization. Secondary endpoints were: severity of COVID-19 disease based on a 7-points ordinal scale assessed at 1 and 2 months following SARS-CoV-2 infection; patient satisfaction using a satisfaction survey and the analysis of number of beds and costs potentially averted.

RESULTS

A total of 36 patients with COVID-19-related pneumonia were followed between April 4 and May 5, 2020. Five patients (14%) were hospitalized and none died over a median of 30 days follow-up. The majority of patients (n = 31; 86%) were satisfied with the ambulatory care they received. These novel recommendations for outpatient management resulted in sparing an estimated potential 124 hospital bed-nights and CHF 6'826 per capita averted hospitalization costs over the three months period.

CONCLUSIONS

Recommendations developed for the outpatient management of COVID-19-related pneumonia were able to spare hospital capacity without increasing adverse patient outcomes. Widely implementing such recommendations is crucial in preserving hospital capacity during this pandemic.

[COGERIA: coordination of care for the frail elderly]

COGERIA, a cantonal program is the fruit of a close collaboration between the Geneva General Directorate of Health and the major health and social partners in the canton. The program aims to improve inter-professional care for the frail elderly and to adapt their care pathways in close collaboration with their primary care physicians and home healthcare providers. Launched in May 2019, the program includes more than 283 beneficiaries and 152 primary care physicians in collaboration with the home healthcare providers in the Servette and Meyrin areas. Preliminary results show a possible trend towards a decrease in hospitalizations, as well as major satisfaction from beneficiaries and the COGERIA partners.

Perceptions of immunity and vaccination certificates among the general population: a nested study within a serosurvey of anti-SARS-CoV-2 antibodies (SEROCoV-POP)

At a time when COVID-19 immunity certificates are debated and vaccination certificates might potentially be made available if an effective vaccine is established, we conducted a study to elucidate public opinion on this issue. Our objective was to determine social and individual perceptions of COVID-19 immunity certificates through a population-based study. A nested survey within the SEROCoV-POP study, a population-based serosurvey of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland, was conducted with a self-administered questionnaire. The questionnaire was proposed to 1520 SEROCoV-POP participants. Measures included percentage of participants agreeing or disagreeing with statements on immunity and vaccination certificates. Stratification by age, gender, education and work status was used to examine socio-demographic variations. Of the 1520 SEROCoV-POP participants, 1425 completed the questionnaire (response rate 93%; mean age &plusmn; standard deviation 52 &plusmn; 15.1 years; 51.9% women). About 80% of participants agreed that knowing one&rsquo;s serology status would lead to a change in one&rsquo;s behaviour. In the event that the presence of antibodies correlated with immunity, 60% of participants reported that certificates should be offered to the general population. The results showed variations in perceptions of certificates depending on the context (73% agreed on certificates&rsquo; utility for travel, 72% for entering a country, and 32% for the right to work). Provided an effective vaccine was available, 55% of participants agreed that vaccination should be mandatory and 49% agreed that a vaccination certificate should be mandatory. About 68% reported a potential risk of discrimination and 28% a risk of deliberate infection. Differences were seen with age, gender and education level. This study shows that the general adult population in Geneva, Switzerland can envisage scenarios where COVID-19 immunity, and eventually vaccination, certificates would be useful. Seroprevalence estimates of anti-SARS-CoV-2 antibodies remain low to date, and the interpretability of serological testing and immunity remains undefined. However, the information from this study is important, especially the differences based on context and the socio-demographic variations, and should be taken into account if COVID-19-related certificates are to be implemented.

[Telemedicine at the heart of management of the COVID-19 crisis]

During the COVID-19 crisis, telemedicine was at the center of the health management systems in the canton of Geneva. Telemedicine contributed to the triage and follow-up of patients with a suspected or confirmed diagnosis of COVID-19, as well as to the coordination of different healthcare actors in the patient's trajectory. New partnerships and reinforcement of coordination in the Geneva healthcare and social care networks with an unprecedented use of telemedicine tools were able to ensure patient care while preserving frontline healthcare providers. Telemedicine has benefited during this time from a temporary relaxation of measures and regulations governing its practice, encouraging its deployment in a crisis situation. However, for these tools to be effective, they need to become an integral part of our healthcare systems.

Randomised study of the effects of fluoride and time on in situ remineralisation of acid-softened enamel

OBJECTIVES

This single-centre, randomised, crossover study used a short-term in situ dental erosion remineralisation model to explore the remineralisation of acid-softened enamel in the 4-h period immediately following brushing with an anti-erosion, dentin hypersensitivity test dentifrice containing 1150 ppm fluoride (as sodium fluoride [NaF]) or a placebo dentifrice with no fluoride.

MATERIALS AND METHODS

Fifty participants wearing a palatal appliance holding surface-softened bovine enamel specimens brushed their natural teeth with their assigned dentifrice. Specimens were removed at 5-, 10-, 15-, 30-, 60-, 120- and 240-min post brushing. Enamel remineralisation effect was evaluated at each timepoint by percent surface microhardness recovery (%SMHR) and enamel fluoride uptake (EFU). After a second in vitro erosive challenge, the percent relative erosion resistance (%RER) was calculated.

RESULTS

Statistically significant differences in %SMHR were observed for the test dentifrice compared with the placebo dentifrice from the 60-min timepoint onwards (all p < 0.02; mean difference of 8.66 [95% CI 3.46, 13.87] at 60 min). At each specimen removal time, %RER and EFU were statistically significantly higher for the test dentifrice compared with the placebo dentifrice (p < 0.0001 for all). No treatment-related or serious adverse events were reported.

CONCLUSIONS

The NaF-containing anti-erosion, dentin hypersensitivity dentifrice improved remineralisation of acid-softened enamel starting at 60 min of intra-oral exposure. It also improved enamel erosion resistance and fluoride uptake as early as 5 min after exposure to fluoridated dentifrice slurry.

CLINICAL RELEVANCE

Brushing with a NaF-containing dentifrice can rapidly improve remineralisation, enamel erosion resistance and fluoride uptake.