Overweight and obesity are risk factors for poor COVID-19 outcomes
In this meta-analysis of 208 studies with 3 550 997 participants from over 32 countries, Sawadogo et al (2022) evaluated the association between overweight or obesity and COVID-19-related hospitalisations (including hospital admission, intensive care unit admission, invasive mechanical ventilation and death). This study is the largest and most comprehensive summary of the association between obesity and COVID-19 outcomes to date.
They found that being overweight increases the risk of COVID-19-related hospitalisations but not death, with obesity and extreme obesity increasing the risk of both COVID-19-related hospitalisations and death. Possible mechanisms by which obesity could increase the risk of severe COVID-19 include first, that adipose tissue could be a reservoir for viral production; second, obesity is linked to impaired immune function weakening the body, which fails to contain viral replication; third, obesity increases inflammation, which may affect lung parenchyma and bronchi; and fourth, obesity lowers lung capacity and reserve thus making ventilation more difficult.
However, the authors found that ‘the strength of the association has weakened over time following the pattern of the first wave of COVID-19.’ Nonetheless, they suggest that overweight and obesity remain significant risk factors of poor COVID-19 outcomes and that ‘prompt access to COVID-19 testing and healthcare, prioritisation for COVID-19 vaccination and other preventive measures are warranted for this vulnerable group.’
Improving indoor air quality lessens symptoms associated with chemical intolerance
Citing evidence that 20% of primary care patients report adverse reactions associated with low-level exposures to chemical inhalants, foods, and drugs, Perales et al (2021) note that affected patients often report symptoms like headaches, mood changes, ‘brain fog’, and gastrointestinal problems.
In this American study, they investigated whether environmental house calls (EHCs) that improved indoor air quality (IAQ) effectively reduced symptoms of chemical intolerance (CI) among 59 primary care clinic participants (average age 55 years). Thirty-seven patients assessed as having CI volunteered to allow the EHC team to visit their homes to collect air samples for volatile organic compounds (VOCs); EHC team members discussed indoor air exposures, their effects, and offered guidance for reducing exposures. Twenty-two patients received no EHCs.
Those homes where EHC team recommendations were followed showed the greatest improvements in IAQ, with fewer airborne VOCs, associated with reductions in cleaning chemicals, personal care products, and improvements in patients' symptoms. The authors conclude: ‘Improvements in both IAQ and patients' symptoms occur when families implement an action plan developed and shared with them by a trained EHC team. Indoor air problems simply are not part of most doctors' differential diagnoses, despite relatively high prevalence rates of CI in primary care clinics.’
Factors affecting compliance with COVID-19 guidelines
Using cross-sectional data from 20 947 UK adults in the COVID-19 Social Study collected from 17 November to 23 December 2020, Wright et al (2021) examined patterns on self-reported compliance with six COVID-19 preventive behaviours: mask wearing, hand washing, indoor household mixing, outdoor household mixing, social distancing, and compliance with other guidelines.
The authors found evidence that high compliance was strongly related to older age and to lower risk-taking behaviour, consistent with previous research using the COVID-19 Social Study. Lower self-reported compliance was related to young age, high risk-taking behaviour, low confidence in government, and low empathy, among other factors. In terms of individual behaviours, mask wearing had high compliance while social distancing had low compliance: ‘this may reflect the issue that individuals' capacity to socially distance is constrained by the behaviour of others and the environment (for instance, due to the layout of shops).’
In conclusion, although their results suggest that compliance with some behaviours is higher, Wright et al (2021) found that overall individuals comply consistently across recommended compliance behaviours. This ‘suggests that motivation is a particularly important determinant of compliance behaviour. Interventions that increase or maintain motivation to comply may be particularly effective at reducing transmission of COVID-19.’
Quality of point-of-care testing for urinalysis in general practice
General practice provides around 75% of all antibiotics prescribed in Denmark, with urinary tract infections often indicated, and Escherichia coli accounting for 75–95% of cases. This is cited by Kollerup et al (2022), who evaluated urinalysis performed in general practices in North Denmark during 2013–2018 by point-of-care (POC) microscopy, urine culture and susceptibility testing. Simulated urine samples containing uropathogenic bacteria were distributed by a Danish quality control organisation.
Over 5300 samples were analysed by microscopy (39.7%), culture (66.0%) and/or susceptibility testing (76.5%). For culture, 87.6% gave correct answers, followed by chromogenic agar (85.1%) and 2-plate dipslide (85.2%). Interestingly, susceptibility testing with tablets (range: 76.1–84.6%) was found to be more accurate than discs (range: 72.9–75.5%), and overall, the highest percentage of correct answers were obtained from urine samples containing E. coli: microscopy (78.3%), culture (87.0%) and susceptibility testing (range: 84.3–90.7%).
The quality of POC tests (microscopy, urine culture, susceptibility testing) in general practice was high when examining urine containing E. coli, but difficulties were observed for samples including S. saprophyticus or K. pneumoniae. Susceptibility testing was more often performed than urine culture, indicating a problem ‘as only urine cultures contribute with information about the flora composition and bacterial quantification.’ Further, ‘microscopy was the least used method even though the result may be reached within a few minutes.’