Fourth Wave Research Articles

COVID-19-related temporary disability in healthcare workers in Spain during the four first pandemic waves

Healthcare workers (HCW) have been the professional category most exposed to SARS-CoV-2. The pandemic’s impact on HCW was analyzed in terms of COVID-19-related temporary disability (TD) between February 15th, 2020 and May 1st, 2021. TDs in HCW for COVID-19 infection or quarantine were described. TD quarantine/infection ratios and TDs per 100,000 affiliated HCW were compared with the cumulative incidence (CI) of COVID-19 cases notified to the National Network of Epidemiological Surveillance. TDs rates by economic activity and occupation were computed. A total of 429,127 TDs were recorded, 36,6% for infection. Three-quarters (76%) were women. The median TD quarantine/infection ratio was 2.5 (Interquartile range [IQR] 1.5–3.9). TDs rates in HCW were always above the CI except for the last two months of the fourth wave. Hospital activities accounted for 84% of TDs and showed the highest TD rate for infection (8,279/100,000). Nursing professionals and midwifery, Physicians, and Nursing assistants accounted for 26, 18 and 17 % of the conceded TD respectively, whereas the highest TDs rates were registered among Nursing assistants, Nursing professionals and Physicians: 7,426, 6,925 and 5,508/100,000, respectively. The results indicate the high impact of COVID-19 on HCW in Spain and it’s inequalities. They also confirm that TDs represent a complementary source of information for epidemiological and public health surveillance and could provide an early warning of new emerging infections.

The Impact of Cloud Systems on Enhancing Organizational Performance through Innovative Business Models in the Digitalization Era

Abstract Information technology has massively transformed the world of business over the past fifty years - first individual functional areas within companies (“first wave”), later increasingly also cross-divisional value-added processes and trade (“second wave”), advent of the internet and the World Wide Web marked a transformative shift in how information is accessed, shared, and distributed (“third wave”), mobile computing and smartphone (“fourth wave”) and cloud computing that has emerged as a paradigm for delivering computing resources and services over the internet on-demand, providing scalability, flexibility, and cost-effectiveness (“fifth wave”). This paper investigates the transformative impact of cloud systems on increasing organizational performance through innovative business models in the age of digitalization. By employing a mixed methods approach, the study integrates qualitative and quantitative techniques to provide a comprehensive understanding of the research phenomenon.

Geographical variation in dementia prevalence across China: a geospatial analysis

Dementia poses great health and social challenges in China. Dementia prevalence may vary across geographic areas, while comparable estimations on provincial level is lacking. This study aims to estimate dementia prevalence by provinces across China, taking into account risk factors of individual level and potential spatial correlation of provinces. In this study, 17,176 adults aged 50 years or older were included from the fourth wave of the ChinaHealth and Retirement Longitudinal Study (CHARLS 2018), covering 28 provinces, autonomous regions and municipalities. To improve provincial representativeness, we constructed provincial survey weights based on China 7th census (2020). The prevalence of dementia and 95% Bayesian credible intervals (BCIs) were estimated using a Bayesian conditional autoregressive (CAR) model with spatially varying coefficients of covariates. The weighted prevalence of dementia at provincial level in China in 2018 ranged from 2.62% (95%BCI: 1.70%, 3.91%) to 13.53% (95%BCI: 8.82%, 20.93%). High dementia prevalence was concentrated in North China, with a prominent high-high cluster, while provinces of low prevalence were concentrated on East and South China, characterized by a low-low cluster. Ordered by the median estimation of prevalence, the top 10% of provinces, include Xinjiang, Jilin, and Beijing. Meanwhile, Fujian, Zhejiang, and Guangdong rank among the last. The association between dementia prevalence and drinking, smoking, social isolation, physical inactivity, hearing impairment, hypertension, and diabetes exhibits provincial variation. Our study identifies a geospatial disparity in dementia prevalence and risk factor effects across China's provinces, with high-high and low-low clusters in some northern and southern provinces, respectively. The findings emphasize the need for targeted strategies, such as addressing hypertension and hearing impairment, in specific regions for more effective dementia prevention and treatment. National Science Foundation of China/the Economic and Social Research Council, UK Research and Innovation joint call: Understanding and Addressing Health and Social Challenges for Ageing in the UK and China. UK-China Health And Social Challenges Ageing Project (UKCHASCAP): present and future burden of dementia, and policy responses (grant number 72061137003, ES/T014377/1).

"Coke in the Dope": The Underrecognized Complications of a Cocaine-Adulterated Fentanyl Supply.

The opioid crisis, particularly the "fourth wave" involving fentanyl and stimulants, has been responsible for an alarming increase in overdose deaths in the United States. Although fentanyl contamination in cocaine has gained significant attention, the converse-cocaine-adulterated fentanyl-has been largely overlooked despite its health implications. The rise in concurrent cocaine and fentanyl overdose deaths could be attributed to various factors, from intentional polysubstance use to unintentional adulterations. Cocaine-related health issues may amplify the problem. Four potential pathways for the increased risk of overdose with cocaine-adulterated opioids include enhanced drug reinforcement, potential overdose risk with switching drug samples, altered metabolism of medications used for opioid use disorder, and increased myocardial demand juxtaposed with opioid-induced respiratory depression. With these risks, the importance of drug testing becomes paramount in the unregulated drug market. As polysubstance use overdoses surge, there is an urgent need to understand how drug supplies are changing in order to effectively identify appropriate harm reduction strategies. Specifically, further research is needed evaluating complications of low-level cocaine exposure with chronic/persistent opioid use. The hazards associated with cocaine-adulterated fentanyl emphasize the significance of understanding not only fentanyl's presence in cocaine but also cocaine's role in the fentanyl supply.

Dispersion of SARS-CoV-2 lineage BA.5.1.25 and its descendants in Peru during two COVID-19 waves in 2022

During the third year of the pandemic in Peru, the persistent transmission of SARS-CoV-2 led to the appearance of more transmissible and immune-evasive Omicron sublineages; in that context, the National Genomic Surveillance of SARS-CoV-2 performed by the Peruvian National Institute of Health detected spike mutations in the circulating Omicron BA.5.1.25 sublineage which was later designated as DJ.1 and increased during the fourth COVID-19 wave, this eventually branched into new sublineages. The introduction, emergence, and timing of the most recent common ancestor (tMRCA) of BA.5.1.25 and its descendants (DJ.1, DJ.1.1, DJ.1.2, and DJ.1.3) were investigated in this paper as well as the time lags between their emergence and identification by the Peruvian National Institute of Health. Our findings show that ongoing genomic surveillance of SARS-CoV-2 is critical for understanding its phylogenetic evolution and the emergence of novel variations.

What motivates the intention of seeking confirmed cases' activity trajectory information in public health emergencies? An information ecology theory analysis

PurposeIn public health emergencies, seeking confirmed cases’ activity trajectory information (CCATI) is crucial to the public’s efforts to combat the epidemic. The public can stabilize their sentiments and mitigate the risk of cross-infection by obtaining CCATI. We investigated the factors influencing users' intentions to seek CCATI to enhance the government’s risk communication capabilities and improve information platform services.Design/methodology/approachWe analyzed how information ecological factors affect the intention to seek CCATI through perceived value. Data was collected from 429 Chinese citizens during the fourth wave of the coronavirus disease 2019 (COVID-19) pandemic. We used the structural equation model technology and bootstrap mediation effect test to examine the model.FindingsInformation understandability, information relevance, perceived severity and perceived vulnerability directly and positively affect the intention of seeking CCATI. While, the above relationships are also partially mediated by emotional value and functional value. Social support directly and negatively affects the intention of seeking CCATI, while the relationship is also partially mediated by emotional value and functional value. Curiosity directly and positively affects the intention of seeking CCATI, while the relationship is also partially mediated by emotional value. The relationship between the quality of the search service and the intention of seeking CCATI is not significant, instead, it is fully mediated by functional value. The influence effect of information relevance on the intention of seeking CCATI is the greatest, followed by perceived vulnerability. The mediating effect of functional value is higher than emotional value.Practical implicationsThe findings may help governments enhance their risk communication capabilities and improve epidemic prevention and control measures, enhancing the appeal of information platforms.Originality/valueWe focused on CCATI, an area with limited scholarly attention. We analyzed CCATI-seeking factors using an information ecology theory, introducing perceived value as a mediator, thus offering novel perspectives and models.

Feasibility of Provision and Vaccine Hesitancy at a Central Hospital COVID-19 Vaccination Site in South Africa after Four Waves of the Pandemic.

As mortality declined significantly during the fourth and fifth waves compared to previous waves, the question of the future role of COVID-19 vaccination arose among both experts and the public in South Africa. Turning attention away from the general public, now considered to be at very low risk of severe COVID-19 disease, a commonly held view was that the vaccination campaign should focus only on those who remain highly vulnerable to severe disease and death from COVID-19. Primary amongst this group are patients with common chronic diseases attending hospital outpatient departments. We hypothesized that providing COVID-19 vaccinations on-site at a central hospital will increase uptake for the patients with co-morbid chronic conditions who need them most in the Omicron phase of the pandemic. Evaluate the acceptability, need, and uptake of a hospital-based vaccination site for patients attending the medical hospital outpatient departments. To assess vaccination uptake, coverage, and hesitancy in people attending a central hospital, to determine factors associated with and influencing vaccination uptake, and to document implementation and assess acceptability of the vaccination project among staff and persons attending the hospital. Mixed-methods study using quantitative and qualitative methods. Of the 317 participants enrolled in the study, 229 (72%) had already received at least one dose of the COVID-19 vaccine. A total of 296 participants were eligible for a first vaccination, additional vaccination, or booster vaccination according to the South African Department of Health guidelines. Of those previously vaccinated, 65% opted for an additional dose on the day it was offered (same day). Only 13 previously unvaccinated participants (15% of vaccine naïve participants) opted for vaccination, increasing vaccine coverage with at least one dose from 72% to 76%. Approximately 24% (n = 75) of all participants refused vaccination (vaccine hesitant). Variables tested for an association with vaccination status demonstrated that age reached statistical significance. Emerging themes in the qualitative analysis included perceptions of vulnerability, vaccine safety and efficacy concerns, information gaps regarding vaccinations, the value of convenience in the decision to vaccinate, and the role of health promoters. This study has shown that it is logistically acceptable to provide a vaccination site at a large hospital targeting patients attending outpatient services for chronic medical conditions. This service also benefits accompanying persons and hospital staff. Access and convenience of the vaccination site influence decision-making, increasing the opportunity to vaccinate. However, vaccine hesitancy is widespread with just under one-quarter of all those offered vaccinations remaining unvaccinated. Strengthening health education and patient-clinician engagement about the benefits of vaccination is essential to reach highly vulnerable populations routinely attending hospital outpatient departments with an appropriate vaccination program.

Characterization of antibody response to SARS-CoV-2 Orf8 from three waves of COVID-19 outbreak in Thailand.

A dynamic of virus adaptation and a mass vaccination campaign could significantly reduce the severity of clinical manifestations of COVID-19 and transmission. Hence, COVID-19 may become an endemic disease globally. Moreover, mass infection as the COVID-19 pandemic progressed affected the serology of the patients as a result of virus mutation and vaccination. Therefore, a need exists to acquire accurate serological testing to monitor the emergence of new outbreaks of COVID-19 to promptly prevent and control the disease spreading. In this study, the anti-Orf8 antibodies among samples collected in Thailand's first, fourth, and fifth waves of COVID-19 outbreaks compared with pre-epidemic sera were determined by indirect ELISA. The diagnostic sensitivity and specificity of the anti-Orf8 IgG ELISA for COVID-19 samples from the first, fourth, and fifth waves of outbreaks was found to be 100% compared with pre-epidemic sera. However, the diagnostic sensitivity and specificity of the anti-Orf8 IgG ELISA for a larger number of patient samples and controls from the fifth wave of outbreaks which were collected on day 7 and 14 after an RT-PCR positive result were 58.79 and 58.44% and 89.19 and 58.44%, respectively. Our data indicated that some of the controls might have antibodies from natural past infections. Our study highlighted the potential utility of anti-Orf8 IgG antibody testing for seroprevalence surveys but still warrants further investigations.

The Temporary Incapacity (TI) register as a complementary system to traditional epidemiological surveillance during the COVID-19 pandemic in Spain.

During the COVID-19 pandemic, a set of social measures were adopted for the preservation of business activity and the protection of workers. One of these measures was issuing the Temporary Disability (TD) for COVID-19 cases, close contacts, and especially vulnerable workers. This study analyzes whether the TD registry could be used as a complementary source to traditional epidemiological surveillance. A longitudinal study of time series was carried out with a cross-correlation analysis of TD and COVID-19 cases reported to the National Epidemiological Surveillance Network (RENAVE). The analysis included six pandemic waves between 10/03/2020 and 31/12/2021 in Spain. Cross-correlation coefficients (r) were calculated using a time lag of -14 days. During the study period, 2,253,573 TD processes were recorded in Spain and 4,894,802 COVID-19 cases were reported to RENAVE. Significant positive correlations were observed at time lags of -7, -10, and -14, indicating that TD notification preceded RENAVE notification. In the first and sixth pandemic waves, TD notification preceded RENAVE by 12 and 7 days, respectively. Negative correlations between the two series were observed in the second and fourth waves, coinciding with a lower number of reported cases. In the third and fifth waves, TD notification also preceded RENAVE (lags -1, -5 and -14, -7, respectively). The results confirm the usefulness of TD registry as a complementary system to traditional epidemiological surveillance in Spain, by detecting COVID-19 cases in the 7, 10, and 14 days prior. A better positive correlation is observed in waves where more cases were reported.

Racial/ethnic trends in opioid and polysubstance opioid overdose mortality in adolescents and young adults, 1999–2020

ObjectivesPrevious reports have described variations in opioid overdose mortalities among different race/ethnicity groups. We have analyzed racial/ethnicity trends in opioid and polysubstance opioid overdose mortalities in adolescents and young adults to further characterize differences and potential sub-epidemics within this specific population. MethodsWe used mortality data from the U.S. Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death file from 1999 to 2020. Drug overdose mortalities were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes. Joinpoint regression was used to examine mortality rates for all opioids, opioids with a stimulant, opioids with benzodiazepines, and opioids with alcohol among racial/ethnic groups (non-Hispanic white, non-Hispanic Black, Hispanic, non-Hispanic other) in adolescents and young adults. ResultsThe Average Annual Percent Change (AAPC) for mortality due to opioid and polysubstance opioid overdose increased for all racial/ethnic groups where data was available for analysis from 1999 to 2020. For mortality due to any opioid and any opioid with a stimulant, the greatest AAPC was seen among non-Hispanic Blacks. ConclusionsUnprecedented increases in mortality due to opioid overdose occurred in the last two decades among adolescents and young adults. Heterogenous trends support the notion that the previously defined opioid overdose epidemic “waves” may not accurately depict the effects of the crisis in all race/ethnicity groups. Additionally, alarming increases in opioid-stimulant overdose mortality starting in 2012 further characterize the interrelated effects of the third and fourth waves.

Importance of social inequalities to contact patterns, vaccine uptake, and epidemic dynamics.

Individuals' socio-demographic and economic characteristics crucially shape the spread of an epidemic by largely determining the exposure level to the virus and the severity of the disease for those who got infected. While the complex interplay between individual characteristics and epidemic dynamics is widely recognised, traditional mathematical models often overlook these factors. In this study, we examine two important aspects of human behaviour relevant to epidemics: contact patterns and vaccination uptake. Using data collected during the COVID-19 pandemic in Hungary, we first identify the dimensions along which individuals exhibit the greatest variation in their contact patterns and vaccination uptake. We find that generally higher socio-economic groups of the population have a higher number of contacts and a higher vaccination uptake with respect to disadvantaged groups. Subsequently, we propose a data-driven epidemiological model that incorporates these behavioural differences. Finally, we apply our model to analyse the fourth wave of COVID-19 in Hungary, providing valuable insights into real-world scenarios. By bridging the gap between individual characteristics and epidemic spread, our research contributes to a more comprehensive understanding of disease dynamics and informs effective public health strategies.

Sentiment Analysis of COVID-19 Tweets using Neural Network in Pakistan

Covid-19 is a respiratory infectious disease that spreads from person to person. World Health Organization declared it a pandemic in March 2020. Social distancing and lockdowns during the pandemic affected the lives, sentiments, and mental health of people. They are mentally, physically, and emotionally disturbed. It was observed that the verification of the very first Covid case increased the precariousness and fear in Pakistan because people had no information about the state policies. In this paper, Covid-related tweets from Pakistan for the year 2021 are collected. Pakistan faced two Covid waves in 2021. Dataset is preprocessed and a neural network-based model is applied to analyze the sentiment of the tweet. Sentiments of people are analyzed separately for each Covid wave, moreover, a comparative analysis is presented to discuss the change in people's sentiments with the passage of time. Results show a reduction in the number of tweets from third to fourth wave. Moreover, the %decrease in negative and positive sentiments are 6 and 1 respectively which show that by the passage of time, people started living with the environment and time healed the wounds of fears and uncertainty in their lives.

Burnout and Satisfaction with Work-Life Balance among General Practitioners in Bulgaria during the COVID-19 Pandemic.

The objective of the present study is to analyze the link between the degree of professional burnout among general practitioners in Bulgaria during a pandemic and their satisfaction with the balance between their personal lives and professional lives. A cross-sectional study was conducted during the fourth wave of the COVID-19 pandemic from December 2021 to January 2022 among 377 general practitioners. We identified the presence and level of burnout syndrome among GPs using V. Boyko's method for diagnostics of the severity of symptoms and the phases of formation and completion of the 'occupational burnout' process. Descriptive statistics and parametric and non-parametric tests were used for the analysis. For the significance level of the null hypothesis, we assumed that p < 0.05 at a 95% confidence interval. A total of 96.3% of the GPs had a high level of burnout during the COVID-19 pandemic. They worked more than 8 h a day (74.8%) and more than 5 days a week (69.0%). A total of 86.3% of them were not satisfied with the spare time they had and stated that they could not balance their work and personal lives (67.1%) since the pandemic was announced. A link was found between the level of professional burnout and long working hours (p = 0.022), dissatisfaction with free time (p = 0.028), and the inability to balance work and personal life (p = 0.000), as well as concerns related to safety during the pandemic (p = 0.048). Unrealistically high levels of burnout during the COVID-19 pandemic due to a disturbed work-life balance is a reason to re-evaluate health policies and involve more hospital care doctors at the frontlines to fight against severe infectious diseases. The results of this study could be used to inform policy makers, healthcare managers, and other stakeholders about the factors that have had profound impacts on GPs' stress levels during the COVID-19 pandemic.

Systolic Blood Pressure, Diastolic Blood Pressure and Pulse Pressure and the Risk of Subclinical Myocardial Injury: The HUNT Study.

Subclinical myocardial injury expressed as higher cardiac troponin concentrations may represent an important intermediary between hypertension and the risk of cardiovascular disease. The study aimed to assess the relative strength of associations between systolic blood pressure (BP), diastolic BP, and pulse pressure, and subclinical myocardial injury, and how change in BP variables over time associates with subclinical myocardial injury. cTnl (cardiac troponin I) was measured in 32 968 participants of the fourth wave of the population-based cohort HUNT4 (Trøndelag Health Study) without a history of cardiovascular disease. An additional longitudinal analysis included participants from HUNT4 with BP measurements from HUNT3 (n=18 681). Associations between BP variables and cTnI concentrations were assessed by linear and logistic regression analyses. The median cTnI concentration was 1.6 ng/L (25th-75th percentiles, 0.6-3.1 ng/L), median age was 52 years (39.1-65.6 years), and 57% were female subjects. Cross-sectionally, only systolic BP categories ≥130 mm Hg associated with higher cTnI concentrations, compared with a reference systolic BP of <110 mm Hg. All categories of diastolic BP and pulse pressure were positively associated with higher cTnI concentrations when diastolic BP 70 to 79 mm Hg and pulse pressure <40 mm Hg were used as references, respectively. When comparing systolic BP, diastolic BP, and pulse pressure as continuous variables, cross-sectionally, pulse pressure most strongly associated with cTnI concentrations (P for all comparisons <0.001), whereas longitudinally, change in diastolic BP was most strongly associated with cTnI concentrations (P for all comparisons <0.05). Subjects with high pulse pressure and longitudinal increase in diastolic BP are at higher risk for subclinical myocardial injury.

Sero-epidemiological investigation and cross-neutralization activity against SARS-CoV-2 variants in cats and dogs, Thailand.

Epidemiological data on SARS-CoV-2 infection in companion animals have been thoroughly investigated in many countries. However, information on the neutralizing cross-reactivity against SARS-CoV-2 variants in companion animals is still limited. Here, we explored the neutralizing antibodies against SARS-CoV-2 in cats and dogs between May 2020 and December 2021 during the first wave (a Wuhan-Hu-1-dominant period) and the fourth wave (a Delta-dominant period) of the Thailand COVID-19 outbreak. Archival plasma samples of 1,304 cats and 1,795 dogs (total = 3,099) submitted for diagnosis and health checks were collected at the Prasu-Arthorn Veterinary Teaching Hospital, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom. A microneutralization test was used to detect neutralizing antibodies against the ancestral Wuhan-Hu-1 and the Delta variants. A plasma sample with neutralizing titers ≥10 was considered positive. Our results showed relatively low seroprevalence with seropositive samples detected in 8 out of 3,099 individuals (0.26, 95% CI 0.11-0.51%). Among these cases, SARS-CoV-2 neutralizing antibodies from both the ancestral Wuhan-Hu-1 and the Delta variants were found in three out of eight cases in two cats (n = 2) and one dog (n = 1). Furthermore, neutralizing antibodies specific to only the ancestral Wuhan-Hu-1 variant were exclusively found in one cat (n = 1), while antibodies against only the Delta variant were detected in four dogs (n = 4). Additionally, the neutralizing cross-activities against SARS-CoV-2 variants (Alpha, Beta, and Omicron BA.2) were observed in the seropositive cats with limited capacity to neutralize the Omicron BA.2 variant. In summary, the seropositivity among cats and dogs in households with an unknown COVID-19 status was relatively low in Thailand. Moreover, the neutralizing antibodies against SARS-CoV-2 found in the seropositive cats and dogs had limited or no ability to neutralize the Omicron BA.2 variant. Thus, monitoring SARS-CoV-2 infection and sero-surveillance, particularly in cats, is imperative for tracking virus susceptibility to the emergence of new SARS-CoV-2 variants.

Multicentral Agent-Based Model of Six Epidemic Waves of COVID-19 in the Nizhny Novgorod Region of Russian Federation

Relevance. To investigate the characteristics of the COVID-19 pandemic and introduce timely and effective measures, there is a need for models that can predict the impact of various restrictive actions or characteristics of disease itself on COVID-19 spread dynamics. Employing agent-based models can be attractive because they take into consideration different population characteristics (e.g., age distribution and social activity) and restrictive measures, laboratory testing, etc., as well as random factors that are usually omitted in traditional modifications of the SIR-like dynamic models. Aim. Improvement of the previously proposed agent-based model [23,24] for modeling the spread of COVID-19 in various regions of the Russian Federation. At this stage, six waves of the spread of COVID-19 have been modeled in the Nizhny Novgorod region as a whole region, as well as in its individual cities, taking into account restrictive measures and vaccination of the population. Materials and Methods. In this paper we extend a recently proposed agent-based model for Monte Carlo-based numerical simulation of the spread of COVID-19 with consideration of testing and vaccination strategies. Analysis is performed in MATLAB/ GNU Octave. Results. Developed multicentral model allows for more accurate simulation of the epidemic dynamics within one region, when a patient zero usually arrives at a regional center, after which the distribution chains capture the periphery of the region due to pendulum migration. Furthermore, we demonstrate the application of the developed model to analyze the epidemic spread in the Nizhny Novgorod region of Russian Federation. The simulated dynamics of the daily newly detected cases and COVID-19-related deaths was in good agreement with the official statistical data both for the region as whole and different periphery cities. Conclusions. The results obtained with developed model suggest that the actual number of COVID-19 cases might be 1.5–3.0 times higher than the number of reported cases. The developed model also took into account the effect of vaccination. It is shown that with the same modeling parameters, but without vaccination, the third and fourth waves of the epidemic would be united into one characterized by a huge rise in the morbidity rates and the occurrence of natural individual immunity with the absence of further pandemic waves. Nonetheless, the number of deaths would exceed the real one by about 9–10 times.

Experience of Personal Loss Due to Drug Overdose Among US Adults

Since 1999, over 1 million people have died of a drug overdose in the US. However, little is known about the bereaved, meaning their family, friends, and acquaintances, and their views on the importance of addiction as a policy priority. To quantify the scope of the drug overdose crisis in terms of personal overdose loss (ie, knowing someone who died of a drug overdose) and to assess the policy implications of this loss. This cross-sectional study used data from a nationally representative survey of US adults (age ≥18 years), the fourth wave of the COVID-19 and Life Stressors Impact on Mental Health and Well-Being (CLIMB) study, which was conducted from March to April 2023. Respondents reported whether they knew someone who died of a drug overdose and the nature of their relationship with the decedent(s). They also reported their political party affiliation and rated the importance of addiction as a policy issue. Logistic regression models estimated the associations between sociodemographic characteristics and political party affiliation and the probability of experiencing a personal overdose loss and between the experience of overdose loss and the perceived salience of addiction as a policy issue. Survey weights adjusted for sampling design and nonresponse. Of the 7802 panelists invited to participate, 2479 completed the survey (31.8% response rate); 153 were excluded because they did not know whether they knew someone who died of a drug overdose, resulting in a final analytic sample of 2326 (51.4% female; mean [SD] age, 48.12 [0.48] years). Of these respondents, 32.0% (95% CI, 28.8%-34.3%) reported any personal overdose loss, translating to 82.7 million US adults. A total of 18.9% (95% CI, 17.1%-20.8%) of all respondents, translating to 48.9 million US adults, reported having a family member or close friend die of drug overdose. Personal overdose loss was more prevalent among groups with lower income (<$30 000: 39.9%; ≥$100 000: 26.0%). The experience of overdose loss did not differ across political party groups (Democrat: 29.0%; Republican: 33.0%; independent or none: 34.2%). Experiencing overdose loss was associated with a greater odds of viewing addiction as an extremely or very important policy issue (adjusted odds ratio, 1.37; 95% CI, 1.09-1.72) after adjustment for sociodemographic and geographic characteristics and political party affiliation. This cross-sectional study found that 32% of US adults reported knowing someone who died of a drug overdose and that personal overdose loss was associated with greater odds of endorsing addiction as an important policy issue. The findings suggest that mobilization of this group may be an avenue to facilitate greater policy change.

Predictive Analysis of COVID-19 Epidemic in Thailand: Evaluating Control Lockdown Measures using LSTM Networks

This study addresses the critical objective of evaluating the effectiveness of non-pharmaceutical lockdown measures implemented during COVID-19 outbreaks in Thailand. Assessing the outcome of these measures provides valuable insight that can inform and guide response to future outbreaks. Utilizing a closed-loop forecasting model built on Long Short-Term Memory (LSTM) networks, the research focuses on achieving precise daily forecasts of COVID-19 cases. The methodology involves optimizing hyperparameters through grid-search and incorporating training data from other countries that implemented similar measures. The LSTM, configured with an optimal number of hidden processing units, utilizes past lagged data of daily infected cases as predictors to generate multi-step-ahead predicted values, which are subsequently used as predictors in a recursive approach. As a result, the predicted cases closely align with measured data, facilitating the estimation of the effective reproduction number (Reff) to assess the performance of lockdown measures. The effectiveness of the lockdown measures is quantified at different time intervals: 51%, 41%, and 23% one day after implementation, increasing to 84%, 98%, and 34% after one week, and reaching 96%, 99%, and 73% at the endpoint of the first, second, and fourth waves of infection, respectively. Throughout these waves, the final Reff remains below 1, indicating ongoing but controllable COVID-19, demonstrating the efficacy of the implemented lockdown measures. It is noted that these results are based on specific LSTM model, as the effectiveness of lockdown measures may vary with alternative modeling approaches. Therefore, the findings should be interpreted in the context of this LSTM-framework.

Vigilancia genómica del SARS-CoV-2 en Nayarit, México (verano- invierno 2021-2022)

Background: COVID-19, whose etiologic agent is SARS-CoV-2, an RNA virus, is characterized by a high mutation rate. Therefore, while more subjects are infected, greater probability that the virus will potentially undergo changes that confer evolutionary advantages (immune response evasion, increased virulence, and reduced vaccination efficacy). Efforts to acquire herd immunity through vaccination may be compromised in low- and middle-income countries, where the vaccination process is slow and inequitable. This may lead to new variant outbreaks with greater transmission capacity. Therefore, it is important to surveillance the circulating variants in the populations. Methods: In this sense, in Tepic, Nayarit, Mexico, 100 viral genomes of positive patients were sequenced during the beginning and end of the third (August 4th to September 3rd, 2021) and fourth (January 3rd, to February 2nd, 2022) COVID-19 waves. Results: Sequence analysis revealed the presence of several variants; alpha (B.1.1.7), gamma (P.1), local variant (B.1.1.519), mu (B.1.621), delta (B.1.617.2), and its subtypes (AY.3, AY.4, AY.10, AY.11, AY.20, and AY.23.1) during the third wave. Later, during the fourth wave, delta subtypes were still detected (AY.26 and AY.113), as well as omicron (B.1.1.529) and omicron subtypes (B.A.1 and BA.1.1). Conclusion: Obtained data revealed a progressive shift of the dominant variants, delta, and subtypes in the third wave and omicron and subtypes in the fourth wave.

Understanding and Addressing Widening Racial Inequalities in Drug Overdose.

The fourth wave of the United States overdose crisis-driven by the polysubstance use of fentanyl with stimulants and other synthetic substances-has driven sharply escalating racial/ethnic inequalities in drug overdose death rates. Here the authors present a detailed portrait of the latest overdose trends and synthesize the literature to describe where, how, and why these inequalities are worsening. By 2022 overdose deaths among Native and Black Americans rose to 1.8 and 1.4 times the rate seen among White Americans, respectively. This reflects that Black and Native Americans have been disproportionately affected by fentanyl and the combination of fentanyl and stimulants at the national level and in virtually every state. The highest overdose deaths rates are currently seen among Black Americans 55-64 years of age as well as younger cohorts of Native Americans 25-44 years of age. In 2022-the latest year of data available-deaths among White Americans decreased relative to 2021, whereas rates among all other groups assessed continued to rise. Moving forward, Fundamental Cause Theory shows us a relevant universal truth of implementation science: in socially unequal societies, new technologies typically end up favoring more privileged groups first, thereby widening inequalities unless underlying social inequalities are addressed. Therefore, interventions designed to reduce addiction and overdose death rates that are not explicitly designed to also improve racial/ethnic inequalities will often unintentionally end up worsening them. Well-funded community-based programs, with Black and Native leadership, providing harm reduction resources, naloxone, and medications for opioid use disorder in the context of comprehensive, culturally appropriate healthcare and other services, represent the highest priority interventions to decrease inequalities.