Background rates of 41 adverse events of special interest for COVID-19 vaccines in 10 European healthcare databases - an ACCESS cohort study

BACKGROUND

In May 2020, the ACCESS (The vACCine covid-19 monitoring readinESS) project was launched to prepare real-world monitoring of COVID-19 vaccines. Within this project, this study aimed to generate background incidence rates of 41 adverse events of special interest (AESI) to contextualize potential safety signals detected following administration of COVID-19 vaccines.

METHODS

A dynamic cohort study was conducted using a distributed data network of 10 healthcare databases from 7 European countries (Italy, Spain, Denmark, The Netherlands, Germany, France and United Kingdom) over the period 2017 to 2020. A common protocol (EUPAS37273), common data model, and common analytics programs were applied for syntactic, semantic and analytical harmonization. Incidence rates (IR) for each AESI and each database were calculated by age and sex by dividing the number of incident cases by the total person-time at risk. Age-standardized rates were pooled using random effect models according to the provenance of the events.

FINDINGS

A total number of 63,456,074 individuals were included in the study, contributing to 211.7 million person-years. A clear age pattern was observed for most AESIs, rates also varied by provenance of disease diagnosis (primary care, specialist care). Thrombosis with thrombocytopenia rates were extremely low ranging from 0.06 to 4.53/100,000 person-years for cerebral venous sinus thrombosis (CVST) with thrombocytopenia (TP) and mixed venous and arterial thrombosis with TP, respectively.

INTERPRETATION

Given the nature of the AESIs and the setting (general practitioners or hospital-based databases or both), background rates from databases that show the highest level of completeness (primary care and specialist care) should be preferred, others can be used for sensitivity. The study was designed to ensure representativeness to the European population and generalizability of the background incidence rates.

FUNDING

The project has received support from the European Medicines Agency under the Framework service contract nr EMA/2018/28/PE.

Altered eating: a definition and framework for assessment and intervention

Background

Eating can be a significant challenge for cancer survivors; however, to date there is no systematic way of assessing and addressing food related quality of life in this group. The purpose of our study was to develop a framework for doing so.

Methods

Over the course of 6 years in participant-led food workshops, we worked alongside 25 head and neck cancer (HNC) survivors and their partners, employing video-reflexive ethnographic (VRE) methods. The current study reports on data from the two summative workshops of this series where we worked with participants to cohere the emergent themes. Video and transcripts were reviewed and coded with participants and stakeholders according to domains of life that were affected by food. Three of the authors, one of whom is both survivor and researcher, arrived at the consensus framework.

Results

Seven areas of life were identified as affecting, or being affected by, altered eating. Three were physiological: anatomical, functional and sensory. Two captured the cognitive and behavioural labour of eating. Social life and identity were altered. The foregoing had an enduring emotional impact.

Conclusions

Altered eating has physical, emotional and social consequences. The altered eating framework provides a systematic way of exploring those consequences with individual survivors. This framework has the potential to improve both the assessment and treatment of altered eating, to benefit food-related quality of life.

Risk of ischemic stroke associated with non-steroidal anti-inflammatory drugs and paracetamol: a population-based case-control study

OBJECTIVE

To assess the risk of non-fatal ischemic stroke associated with non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol. The effects of dose, duration of treatment, background cardiovascular (CV) risk and use of concomitant aspirin were studied.

METHODS

We performed a population-based case-control study. Patients were considered exposed if they were on treatment within a 30-day window before the index date. We estimated adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) using logistic regression.

RESULTS

Two thousand eight hundred and eighty-eight cases and 20 000 controls were included. No increased risk was observed with traditional NSAIDs as a group (OR = 1.03; 95% CI, 0.90-1.19), but results varied across individual agents and conditions of use. An increased risk was found with diclofenac (OR = 1.53; 95% CI, 1.19-1.97), in particular when used at high doses (OR = 1.62; 1.06-2.46), over long-term periods (> 365 days; OR = 2.39; 1.52-3.76) and in patients with a high background CV risk (OR = 1.78; 1.23-2.58), as well as with aceclofenac when used at high doses (OR = 1.67; 1.05-2.67), in long-term treatments (OR = 2.00; 1.14-3.53) and in patients with CV risk factors (OR = 2.33; 1.40-3.87). No association was found with ibuprofen (OR = 0.94; 0.76-1.17) or naproxen (OR = 0.68; 0.36-1.29). The concomitant use of aspirin did not show a significant effect modification. Paracetamol did not increase the risk overall (OR = 0.97; 0.85-1.10) or in patients at high CV risk (OR = 0.94; 0.78-1.14).

CONCLUSIONS

Diclofenac and aceclofenac increase the risk of ischemic stroke while ibuprofen and naproxen do not. Dose, duration and baseline CV risk, but not aspirin use, appear to modulate the risk. Paracetamol does not increase the risk, even in patients with a high background CV risk.

Altered patterns of cortical activation in ALS patients during attention and cognitive response inhibition tasks

Since amyotrophic lateral sclerosis (ALS) can be accompanied by executive dysfunction, it is hypothesised that ALS patients will have impaired performance on tests of cognitive inhibition. We predicted that ALS patients would show patterns of abnormal activation in extramotor regions when performing tests requiring the inhibition of prepotent responses (the Stroop effect) and the inhibition of prior negatively primed responses (the negative priming effect) when compared to healthy controls. Functional magnetic resonance imaging was used to measure activation during a sparse sequence block design paradigm investigating the Stroop and negative priming effects in 14 ALS patients and 8 healthy age- and IQ-matched controls. Behavioural measures of performance were collected. Both groups' reaction times (RTs) reflected the Stroop effect during scanning. The ALS and control groups did not differ significantly for any of the behavioural measures but did show significant differences in cerebral activation during both tasks. The ALS group showed increased activation predominantly in the left middle temporal gyrus (BA 20/21), left superior temporal gyrus (BA 22) and left anterior cingulate gyrus (BA 32). Neither group's RT data showed clear evidence of a negative priming effect. However the ALS group showed decreased activation, relative to controls, particularly in the left cingulate gyrus (BA 23/24), left precentral gyrus (BA 4/6) and left medial frontal gyrus (BA 6). Greater cerebral activation in the ALS group accompanying the performance of the Stroop effect and areas of decreased activation during the negative priming comparison suggest altered inhibitory processing in ALS, consistent with other evidence of executive dysfunction in ALS. The current findings require further exploration in a larger study.

The effect of noninvasive ventilation on ALS patients and their caregivers

BACKGROUND

Noninvasive ventilation (NIV) reduces mortality and improves some aspects of quality of life (QoL) in ALS. However, concerns remain that progressive disability may negate these benefits and unnecessarily burden caregivers.

METHODS

Thirty-nine patients requiring NIV were offered treatment. Twenty-six were established on NIV, but 13 declined or could not tolerate NIV. Fifteen patients without respiratory muscle weakness (RMW) but with similar ALS severity and age were studied in parallel. Caregivers of 21 NIV, 7 untreated, and 10 patients without RMW participated. Patients and caregivers had detailed QoL measurements for 12 months. NIV patients underwent cognitive testing before and after treatment.

RESULTS

RMW correlated with lower QoL. The median survival of untreated patients (18 days; 95% CI 11 to 25 days) was shorter than for NIV patients (298 days; 95% CI 192 to 404 days) and non-RMW patients (370 days; 95% CI 278 to 462 days; log rank test [2 df] = 81, p = 0.00001). A wide range of QoL measures improved within 1 month of starting NIV, and improvements were maintained for 12 months. QoL of non-RMW patients declined as RMW progressed. Caregivers of NIV and non-RMW patients showed similar increases in burden, but NIV patient caregivers developed a deterioration in the Short Form-36 Vitality score. No improvements were found on measures of learning and recall in the NIV patients.

CONCLUSIONS

Respiratory muscle weakness has a greater impact on quality of life (QoL) than overall ALS severity. Noninvasive ventilation (NIV) improves QoL despite ALS progression. NIV has no impact on most aspects of caregiver QoL and does not significantly increase caregiver burden or stress.

Prevention of burn injuries to children involving nightwear

The effectiveness of legislative intervention in the New Zealand market for children's nightclothes as an injury prevention strategy has been reassessed by examining those hospital admissions for the period 1980-8 (with emphasis on the 1985-8 period) in which clothing and/or nightclothes were involved. The profiles of the production of children's nightclothes (1977-86) and domestic heating (1984-8) were also examined. Ninety-five cases of burn injury discharges were identified (1985-8), and of those cases involving clothing 42% involved nightwear (49% 1981-4). Some of the 27% unspecified cases may have also involved nightwear (23%, 1981-4). A very strong linear downward trend for nightwear incidents was noted (chi 2 slope = 31.06, p less than 0.001). Forty-eight percent of cases involved children aged 1-6 years, and 68% involved pajamas. Stoves were the main specified ignition agent for nightclothes (36%). Open fires as a form of household heating decreased from 49% to 34% of households (1984-8). Estimated production of nightdresses in New Zealand also decreased (460,000 to 80,000 units, 1973-86). The pronounced decrease in injuries attributable to ignition of children's nightclothes is likely to be the result of mandatory controls on children's nightclothes, increased use of pyjamas, and a steady decrease in use of open fires and portable electric heaters. The typical injury event portrayed to the public of a girl in front of a heater or open fire needs to be corrected.

Further studies on histamine release from rat mast cells in vitro induced by peptides. Characteristics of a synthetic intermediate with potent releasing activity

Previous studies on histamine release by corticotropin peptides and melittin peptides were extended, leading to the identification of a synthetic peptide intermediate, Lys(Z)-Arg(NO2)-Arg(NO2)OMe, (I) as an active non-cytolytic histamine releaser from rat mast cells. However, significant differences in the releasing capacity of optical isomers of this compound, and of Lys-Lys-Arg-ArgOMe [methyl ester of corticotropin-(15-18)-tetrapeptide; 'basic core'] were observed, with the L-forms being markedly more active. A study of various analogues of the tripeptide compound (I) indicated that the structural basis for mast-cell triggering by such peptidic agents was highly specific. The relevance of these observations to the immunologically induced histamine-release processes is discussed.

The distribution of Nematospiroides dubius within the small intestine of laboratory mice

Analyses of primary infections of Nematospiroides dubius in male and female laboratory mice show that on days 4--6 post-infection worms occupy up to 50% of the small intestine but as the age of the infection increases worm populations are highly aggregated in relation to the anterior sections of the small intestine. Individual worms are also shown to be aggregated with respect to each other. Between days 42 and 60 post-infection, although the pattern of distribution of N. dubius along the small intestine does not significantly change, survival of worms is influenced by both age and sex of ASH/CSI S.P.F. mice, reasons for which are discussed in the light of previous work on primary infections of N. dubius in other strains of laboratory mice.

Growth and respiration throughout the life-cycle of Nematospiroides dubius Baylis (1926) (Nematoda: Heligmosomidae): the parasitic stages

The growth of male and female parasitic stages ofNematospiroides dubiusfrom male and female ASH/CS1 mice was measured in terms of dry weight. No sex-linked resistance of mice to infection withN. dubiuswas apparent, as growth was the same in both sexes of host. The growth rate did not alter when moulting occurred.

All parasitic stages ofN. dubiusconsumed oxygenin vitroand oxygen was also shown to be necessary for motility and survival.

The relationship between body size and metabolic rate was established for male and female parasiticN. dubiusand thebvalues indicated that aerobic metabolism is of functional importance to this species.

The size/metabolism relationship for the whole life-cycle was established.

Growth and respiration throughout the life-cycle of Nematospiroides dubius Baylis, 1926 (Nematoda: Heligmosomidae). The free-living stages

The growth of the three free-living stages of N. dubius was measured in terms of dry and fresh weight. Changes in body water content during moulting were demonstrated by variations in dry weight when expressed as a percentage of fresh weight. The respiration rate of the larvae increased until they became infective, after which time it decreased until five days later no oxygen consumption could be recorded. The inability of all larval stages to withstand anaerobic conditions indicated that their metabolism was essentially aerobic. The relationship between body size and metabolic rate was established for each stage and its significance in relation to the life-cycle discussed.

The life cycle of Nematospiroides dubius, Baylis, 1926 (Nematoda: Heligmosomidae)

1. The number and duration of free-living and parasitic stages of N. dubius has been determined.

2. The results have been discussed in relation to previous accounts of the life cycle, and some of the discrepancies explained.