To the Editor:The colorectal cancer(CRC)is the fourthmost common cause of cancer deaths in China that was treated as a public health threat,accounting for approximately 10%of all the cancer-caused mortalities each yea...To the Editor:The colorectal cancer(CRC)is the fourthmost common cause of cancer deaths in China that was treated as a public health threat,accounting for approximately 10%of all the cancer-caused mortalities each year.[1]It usually takes decades to develop from a polyp to full CRC,[2]which allows a time window for detecting precancerous lesions and taking early steps for preventions and treatments.展开更多
Background:Data on the immunogenicity and safety of heterologous immunization schedules are inconsistent.This study aimed to evaluate the immunogenicity and safety of homologous and heterologous immunization schedules...Background:Data on the immunogenicity and safety of heterologous immunization schedules are inconsistent.This study aimed to evaluate the immunogenicity and safety of homologous and heterologous immunization schedules.Methods:Multiple databases with relevant studies were searched with an end date of October 31,2021,and a website including a series of Coronavirus disease 2019 studies was examined for studies before March 31,2022.Randomized controlled trials(RCTs)that compared different heterologous and homologous regimens among adults that reported immunogenicity and safety outcomes were reviewed.Primary outcomes included neutralizing antibodies against the original strain and serious adverse events(SAEs).A network meta-analysis(NMA)was conducted using a random-effects model.Results:In all,11 RCTs were included in the systematic review,and nine were ultimately included in the NMA.Among participants who received two doses of CoronaVac,another dose of mRNA or a non-replicating viral vector vaccine resulted in a significantly higher level of neutralizing antibody than a third CoronaVac 600 sino unit(SU);a dose of BNT162b2 induced the highest geometric mean ratio(GMR)of 15.24,95%confidence interval[CI]:9.53–24.39.Following one dose of BNT162b2 vaccination,a dose of mRNA-1273 generated a significantly higher level of neutralizing antibody than BNT162b2 alone(GMR=1.32;95%CI:1.06–1.64),NVX-CoV2373(GMR=1.60;95%CI:1.16–2.21),or ChAdOx1(GMR=1.80;95%CI:1.25–2.59).Following one dose of ChAdOx1,a dose of mRNA-1273 was also more effective for improving antibody levels than ChAdOx1(GMR=11.09;95%CI:8.36–14.71)or NVX-CoV2373(GMR=2.87;95%CI:1.08–3.91).No significant difference in the risk for SAEs was found in any comparisons.Conclusions:Relative to vaccination with two doses of CoronaVac,a dose of BNT162b2 as a booster substantially enhances immunogenicity reactions and has a relatively acceptable risk for SAEs relative to other vaccines.For primary vaccination,schedules including mRNA vaccines induce a greater immune response.However,the comparatively higher risk for local and systemic adverse events introduced by mRNA vaccines should be noted.Registration:PROSPERO;https://www.crd.york.ac.uk/PROSPERO/;No.CRD42021278149.展开更多
Objectives Older individuals with multimorbidity are at an elevated risk of infection and complications from COVID-19.Effectiveness of post-COVID-19 interventions or care models in reducing subsequent adverse outcomes...Objectives Older individuals with multimorbidity are at an elevated risk of infection and complications from COVID-19.Effectiveness of post-COVID-19 interventions or care models in reducing subsequent adverse outcomes in these individuals have rarely been examined.This study aims to examine the effectiveness of attending general outpatient within 30 days after discharge from COVID-19 on 1-year survival among older adults aged 85 years or above with multimorbidity.Design Retrospective cohort study emulating a randomised target trial using electronic health records.Setting We used data from the Hospital Authority and the Department of Health in Hong Kong,which provided comprehensive electronic health records,COVID-19 confirmed case data,population-based vaccination records and other individual characteristics for the study.Participants Adults aged 85 years or above with multimorbidity who were discharged after hospitalisation for COVID-19 between January 2020 and August 2022.Interventions Attending a general outpatient within 30 days of last COVID-19 discharge defined the exposure,compared to no outpatient visit.Main outcome measures Primary outcome was all-cause mortality within one year.Secondary outcomes included mortality from respiratory,cardiovascular and cancer causes.Results A total of 6183 eligible COVID-19 survivors were included in the analysis.The all-cause mortality rate following COVID-19 hospitalisation was lower in the general outpatient visit group(17.1 deaths per 100 person-year)compared with non-visit group(42.8 deaths per 100 person-year).After adjustment,primary care consultations within 30 days after discharge were associated with a significantly greater 1-year survival(difference in 1-year survival:11.2%,95%CI 8.1%to 14.4%).We also observed significantly better survival from respiratory diseases in the general outpatient visit group(difference in 1-year survival:6.3%,95%CI 3.5%to 8.9%).In a sensitivity analysis for different grace period lengths,we found that the earlier participants had a general outpatient visit after COVID-19 discharge,the better the survival.Conclusions Timely primary care consultations after COVID-19 hospitalisation may improve survival following COVID-19 hospitalisation among older adults aged 85 or above with multimorbidity.Expanding primary care services and implementing follow-up mechanisms are crucial to support this vulnerable population’s recovery and well-being.展开更多
基金supported by a grant from the National Natural Science Foundation of China(No.72074011)
文摘To the Editor:The colorectal cancer(CRC)is the fourthmost common cause of cancer deaths in China that was treated as a public health threat,accounting for approximately 10%of all the cancer-caused mortalities each year.[1]It usually takes decades to develop from a polyp to full CRC,[2]which allows a time window for detecting precancerous lesions and taking early steps for preventions and treatments.
基金National Key R&D Program of China(No.2021YFC2301601)
文摘Background:Data on the immunogenicity and safety of heterologous immunization schedules are inconsistent.This study aimed to evaluate the immunogenicity and safety of homologous and heterologous immunization schedules.Methods:Multiple databases with relevant studies were searched with an end date of October 31,2021,and a website including a series of Coronavirus disease 2019 studies was examined for studies before March 31,2022.Randomized controlled trials(RCTs)that compared different heterologous and homologous regimens among adults that reported immunogenicity and safety outcomes were reviewed.Primary outcomes included neutralizing antibodies against the original strain and serious adverse events(SAEs).A network meta-analysis(NMA)was conducted using a random-effects model.Results:In all,11 RCTs were included in the systematic review,and nine were ultimately included in the NMA.Among participants who received two doses of CoronaVac,another dose of mRNA or a non-replicating viral vector vaccine resulted in a significantly higher level of neutralizing antibody than a third CoronaVac 600 sino unit(SU);a dose of BNT162b2 induced the highest geometric mean ratio(GMR)of 15.24,95%confidence interval[CI]:9.53–24.39.Following one dose of BNT162b2 vaccination,a dose of mRNA-1273 generated a significantly higher level of neutralizing antibody than BNT162b2 alone(GMR=1.32;95%CI:1.06–1.64),NVX-CoV2373(GMR=1.60;95%CI:1.16–2.21),or ChAdOx1(GMR=1.80;95%CI:1.25–2.59).Following one dose of ChAdOx1,a dose of mRNA-1273 was also more effective for improving antibody levels than ChAdOx1(GMR=11.09;95%CI:8.36–14.71)or NVX-CoV2373(GMR=2.87;95%CI:1.08–3.91).No significant difference in the risk for SAEs was found in any comparisons.Conclusions:Relative to vaccination with two doses of CoronaVac,a dose of BNT162b2 as a booster substantially enhances immunogenicity reactions and has a relatively acceptable risk for SAEs relative to other vaccines.For primary vaccination,schedules including mRNA vaccines induce a greater immune response.However,the comparatively higher risk for local and systemic adverse events introduced by mRNA vaccines should be noted.Registration:PROSPERO;https://www.crd.york.ac.uk/PROSPERO/;No.CRD42021278149.
基金funded by a research grant from the Health Bureau of the Government of the Hong Kong Special Administrative Region,through the Health and Medical Research Fund Research on COVID-19(COVID19F01)supported by the Laboratory of Data Discovery for Health,funded by the AIR@InnoHK and administered by the Innovation and Technology Commission.
文摘Objectives Older individuals with multimorbidity are at an elevated risk of infection and complications from COVID-19.Effectiveness of post-COVID-19 interventions or care models in reducing subsequent adverse outcomes in these individuals have rarely been examined.This study aims to examine the effectiveness of attending general outpatient within 30 days after discharge from COVID-19 on 1-year survival among older adults aged 85 years or above with multimorbidity.Design Retrospective cohort study emulating a randomised target trial using electronic health records.Setting We used data from the Hospital Authority and the Department of Health in Hong Kong,which provided comprehensive electronic health records,COVID-19 confirmed case data,population-based vaccination records and other individual characteristics for the study.Participants Adults aged 85 years or above with multimorbidity who were discharged after hospitalisation for COVID-19 between January 2020 and August 2022.Interventions Attending a general outpatient within 30 days of last COVID-19 discharge defined the exposure,compared to no outpatient visit.Main outcome measures Primary outcome was all-cause mortality within one year.Secondary outcomes included mortality from respiratory,cardiovascular and cancer causes.Results A total of 6183 eligible COVID-19 survivors were included in the analysis.The all-cause mortality rate following COVID-19 hospitalisation was lower in the general outpatient visit group(17.1 deaths per 100 person-year)compared with non-visit group(42.8 deaths per 100 person-year).After adjustment,primary care consultations within 30 days after discharge were associated with a significantly greater 1-year survival(difference in 1-year survival:11.2%,95%CI 8.1%to 14.4%).We also observed significantly better survival from respiratory diseases in the general outpatient visit group(difference in 1-year survival:6.3%,95%CI 3.5%to 8.9%).In a sensitivity analysis for different grace period lengths,we found that the earlier participants had a general outpatient visit after COVID-19 discharge,the better the survival.Conclusions Timely primary care consultations after COVID-19 hospitalisation may improve survival following COVID-19 hospitalisation among older adults aged 85 or above with multimorbidity.Expanding primary care services and implementing follow-up mechanisms are crucial to support this vulnerable population’s recovery and well-being.
