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Understanding the factors associated with disease severity and mortality in Coronavirus disease (COVID-19) is imperative to effectively triage patients. We performed a systematic review to determine the demographic, clinical, laboratory and radiological factors associated with severity and mortality in COVID-19. We searched PubMed, Embase and WHO database for English language articles from inception until May 8, 2020. We included Observational studies with direct comparison of clinical characteristics between a) patients who died and those who survived or b) patients with severe disease and those without severe disease. Data extraction and quality assessment were performed by two authors independently. Among 15680 articles from the literature search, 109 articles were included in the analysis. The risk of mortality was higher in patients with increasing age, male gender (RR 1.45, 95%CI 1.23-1.71), dyspnea (RR 2.55, 95%CI 1.88-2.46), diabetes (RR 1.59, 95%CI 1.41-1.78), hypertension (RR 1.90, 95%CI 1.69-2.15). Congestive heart failure (OR 4.76, 95%CI 1.34-16.97), hilar lymphadenopathy (OR 8.34, 95%CI 2.57-27.08), bilateral lung involvement (OR 4.86, 95%CI 3.19-7.39) and reticular pattern (OR 5.54, 95%CI 1.24-24.67) were associated with severe disease. Clinically relevant cut-offs for leukocytosis(>10.0 x109/L), lymphopenia(< 1.1 x109/L), elevated C-reactive protein(>100mg/L), LDH(>250U/L) and D-dimer(>1mg/L) had higher odds of severe disease and greater risk of mortality. Knowledge of the factors associated of disease severity and mortality identified in our study may assist in clinical decision-making and critical-care resource allocation for patients with COVID-19.

IntroductionThe COVID-19 pandemic caused widespread disruptions to population health, affecting key risk factors such as physical and mental health, smoking status and body weight. While short-term impacts have been studied extensively, long-term trends and recovery patterns remain unclear.MethodsThis study used data from the Behavioural Risk Factor Surveillance System covering 2016–2022. Weighted proportions for health outcomes were calculated, and trends were analysed using locally weighted scatterplot smoothing and Kendall’s tau correlation. Bootstrapping was used to estimate CIs.ResultsDuring the pandemic, individuals reporting 14+not good physical health days increased significantly (τ=0.7238, p<0.0001). Mental health also deteriorated, with 14+not good mental health days increasing (τ=0.7263, p<0.0001). Smoking prevalence declined (τ=−0.5536, p<0.0001) while those who ‘never smoked’ increased (τ=0.6024, p<0.0001). Obesity prevalence rose significantly postpandemic (τ=0.6632, p<0.0001).ConclusionsThe findings highlight the pandemic’s profound and differential impact on physical health and persistent worsening of not good mental health days and body mass index indicating obesity. The decline in smoking prevalence suggests a positive behavioural shift during the early years of the pandemic. Targeted public health interventions are needed to address these challenges and promote recovery.

Background Climate change poses significant risks to human health, particularly for future generations, making it imperative to integrate climate education into school curricula. This study evaluates the feasibility of expanding the Health Effects of Climate Change Curriculum (HECCC) from Baltimore, MD, to urban youth in Providence County, Rhode Island. Developed by the Lung Health Ambassadors Programme (LHAP) at Johns Hopkins University, the HECCC is an interdisciplinary curriculum aimed at educating students on the health impacts of climate change and empowering them to take local action. Methods During the 2023–2024 school year, the HECCC was adapted and piloted in five public schools in Providence County. The curriculum consisted of four lessons: climate science, air quality and heat, food and water, and health equity and environmental justice. Each lesson series discussed mental health impacts and was tailored to meet the unique needs of the participating schools, including a variety of delivery methods, with some schools integrating the curriculum into regular class hours and others as an after-school programme. Evaluation metrics included student reach, engagement, pre-and post survey results, and problem driven iterative adaptation (PDIA). Results The HECCC was taught to 195 students from fourth through twelfth grades in Providence County schools. Students demonstrated engagement via non-verbal cues (e.g. smiling, nodding) and asked questions throughout the lessons. Based on preliminary pilot pre- and post-survey results from students ( N  = 10) and teachers ( N  = 3), the curriculum potentially increased students’ knowledge of climate change, health impacts, and environmental justice, as well as their self-efficacy in addressing these issues. However, the surveys also potentially revealed an increase in students’ climate anxiety. Results from teachers’ surveys preliminarily indicated teachers’ improved confidence in discussing climate change with students, but noted students’ barriers to taking meaningful action, such as limited resources and time. Conclusion This study demonstrates the feasibility of implementing a locally curated HECCC in an urban setting. The study elicited teacher recommendations for further expansion, broader language translations, alignment with local state standards, and increased survey participation, especially to evaluate impact on eco-anxiety. Future plans involve expanding educator resources such as an educator’s toolkit to facilitate the curriculum’s adaptation in other communities, especially in alignment with local state standards. Overall, the HECCC shows promise in fostering climate and health literacy among urban youth, equipping them to be informed advocates for local environmental justice.

IntroductionOver 777 million COVID-19 infections have occurred globally, with data suggesting that 10%–20% of those infected develop Long COVID. Fatigue is one of the most common and disabling symptoms of Long COVID. We aim to assess the feasibility and safety of a new, remotely delivered, multimodal rehabilitation intervention, paced to prevent post-exertional malaise (PEM), to support the conduct of a future, definitive randomised trial.Methods and analysisWe will conduct a randomised, two-arm feasibility trial (COVIDEx intervention vs usual care). Sixty participants with Long COVID will be recruited and randomised prior to giving informed consent under a modified Zelen design using 1:1 allocation with random permuted blocks via central randomisation to receive either the COVIDEx intervention or usual care. The 50-minute, remotely delivered, COVIDEx intervention will occur twice weekly for 8 weeks. All participants will wear a non-invasive device throughout their entire study participation, to track heart rate, blood oxygen saturation, steps, sleep and monitor PEM. The primary feasibility objectives will be recruitment rates, intervention fidelity, adherence, acceptability (intervention and design), retention, blinding success and outcome completeness. Secondary objectives will include refined estimates for the standard deviation and correlation between baseline and follow-up measurements of fatigue. Feasibility and clinical outcomes will be collected at baseline, 4, 8, 12 and 24 weeks. Qualitative interviews with participants and physiotherapists will explore intervention acceptability and barriers/facilitators.Ethics and disseminationEthical approval for this study was obtained by the Western University Health Sciences Research Ethics Board (REB# 123902). Dissemination plans include sharing of trial findings at conferences and through open access publications and patient/community channels.Trial registration numberNCT06156176

[...]the disparities began before the ICU admission and continue after the ICU discharge. [...]what is the responsibility of critical care medicine in regard to population health and medical-community partnerships? In 2015, the Baltimore City Health Department implemented a law allowing a standing order of naloxone to all residents of Baltimore City and thus expanding access to naloxone. [...]if a patient were to survive an opioid overdose and while recovering in the ICU, critical care providers in Baltimore City ICUs could talk with family about having naloxone at home and, further, learn how to use it.

Introduction: Electronic cigarette (e-cigarette) usage use has increased exponentially, especially in youth and young adults. For many, the usage of these products results in a severe addiction, one that is difficult to discontinue. Further, e-cigarette cessation is challenging as there are no specific guidelines directing such medical management for patients and their respective clinicians. Here, we report a case series of patients who we are attempting to wean from e-cigarettes with medical guidance. Methods: Six patients who self-reported daily e-cigarette usage and were enrolled in our Tobacco Treatment Clinic (TTC) were followed for 12-months. An inventory of the e-cigarette product and usage was captured, along with responses to identify when the patients experienced majority of their cravings. Co-morbidities, if present, were documented. Documentation of interventions, counseling with or without pharmacological therapies, were captured. Primary outcome was cessation at 6-months. Results: The 6 patients enrolled in clinic ranged in age from 17 to 31 years, with 4 of the patients identifying as males and 2 as females. Patients were using e-cigarettes for 1 to 6 years prior to enrolling into the TTC. As for interventions, all patients received counseling and pharmacological interventions in the form of nicotine replacement therapies (NRTs). Three of the 6 patients were weaned off e-cigarettes by 6-months, with a fourth patient weaned off at the 8-month mark. Variables identified as barriers to cessation included non-compliance with medical regimen and peer influence. Discussion: Here we present a case series of attempting to wean persons from electronic cigarettes use. Given the lack of international guidelines in e-cigarette addiction management, we believe this case series will be of value for clinicians and their patients. Further studies are warranted to help patients with e-cigarette addiction in their attempt at cessation.

During the pandemic caused by the severe acute respiratory syndrome coronavirus-2, public health instructions were issued with the hope of curbing the virus' spread. In an effort to assure accordance with these instructions, equitable strategies for at-risk and vulnerable populations and communities are warranted. One such strategy was our community conference calls, implemented to disseminate information on the pandemic and allow community leaders to discuss struggles and successes. Over the first 6 weeks, we held 12 calls, averaging 125 (standard deviation 41) participants. Participants were primarily from congregations and faithbased organizations that had an established relationship with the hospital, but also included school leaders, elected officials, and representatives of housing associations. Issues discussed included reasons for quarantining, mental health, social isolation, health disparities, and ethical concerns regarding hospital resources. Concerns identified by the community leaders as barriers to effective quarantining and adherence to precautions included food access, housing density, and access to screening and testing. Through the calls, ways to solve such challenges were addressed, with novel strategies and resources reaching the community. This medical-religious resource has proven feasible and valuable during the pandemic and warrants discussions on reproducing it for other communities during this and future infectious disease outbreaks.

Rationale Racial disparities in sepsis outcomes have been previously reported. However, recently, there have been inconsistencies in identifying which socioeconomic variables, such as race, account for these disparities. The objective of this study was to perform a systematic review in order to examine the impact of race on sepsis-attributable mortality. Methods Systematic searches for English-language articles identified through MEDLINE, EBSCOhost, PubMed, ERIC, and Cochrane Library databases from 1960 to 1 February 2017. Included studies examined sepsis outcomes in the context of sepsis incidence and/or mortality. Two investigators independently extracted data and assessed study quality. The meta-analysis was performed in accordance with the Cochrane Collaboration guidelines. Results Twenty-one studies adhered to the predefined selection criteria and were included in the review. Of the 21 studies, we pooled data from 6 studies comparing African American/Black race as a risk factor for sepsis-related mortality disparities (reference group being Caucasian/White). From the meta-analysis on these six studies, African American/Black race was found to have no statistical significant relationship with sepsis-related mortality (odds ratio 1.20, 95% CI, 0.81 to 1.77). Similar results were found for other races (Native Americans, Asians) and ethnicities (Hispanic/Latinos). Conclusion On the basis of available evidence from a limited number of observation retrospective studies, race alone cannot fully explain sepsis-related disparities, especially sepsis-attributable mortality.

Background Tobacco usage and obesity remain critical public health issues in the United States. This study examined the relationship between smoking behaviors, specifically—cigarettes per day (CPD) and motivations to smoke—and body mass index (BMI). We hypothesized that motivations related to food or stress, as well as a higher CPD, will be positively associated with BMI. Methodology We analyzed the electronic medical records of 204 patients from the Johns Hopkins' Tobacco Treatment and Cancer Screening Clinic (TTCSC) between January and April 2022. Demographic information, smoking behavior, CPD, and motivations to smoke were recorded. Multiple linear regression analysis was performed. Results We found no statistical significance between motivations to smoke, CPD, and BMI. However, the age at a patient’s first visit to the TTCSC was negatively associated with BMI (B = −0.152, P < 0.001). Conclusions Smoking behaviors were not significantly related to BMI in our sample. It is advisable for clinicians working in tobacco cessation clinics to consider the BMI of individuals who present for cessation services, especially for younger individuals who smoke. They may be more likely to have an elevated BMI at presentation.

To the Editor: Members of the Long-Term Oxygen Treatment Trial (LOTT) Research Group (Oct. 27 issue) 1 report that the use of long-term supplemental oxygen had no significant effect on the time until a first hospitalization or death among patients with stable chronic obstructive pulmonary disease (COPD) with either resting or exercise-induced moderate desaturation. Of the 738 patients who were included in the trial, 202 (27%) were current tobacco users at the time of enrollment. According to data provided by the authors in the Supplementary Appendix (available with the full text of the article at NEJM.org), the mean (±SD) number of . . .