Sixth Wave Research Articles

Differences in leucocytes and inflammation-based indices among critically ill patients owing to SARS-CoV-2 variants during several successive waves of COVID-19 pandemic

Background/AimInflammatory indices are useful informative markers in assessing the severity of the COVID-19 disease course; however, their involvements during series waves of SARS-CoV-2 virus outbreaks in critical patients with COVID-19 remain unclear. Hence, we aimed to ascertain the changing dynamics of the combined inflammatory indices (NLR, dNLR, CLR, LMR, PLR, SII, and SIRI) and their associations with clinical outcomes in severe COVID-19 patients during serial waves of SARS-CoV-2. Patients and methodsWe retrospectively enrolled 163 severe COVID-19 patients admitted to the ICU during six SARS-CoV-2 waves. ResultsWe found that most of patients admitted to the ICU were from the fourth wave. Patients in the fourth wave were considerably younger and had the highest percentage of ARDS than other waves. The highest CRP was found in the first wave, while the lowest in patients admitted in the sixth wave. Although most of the COVID-19 waves were marked with leukocytosis, neutrophilia, and lymphocytopenia, the lowest of both NLR and dNLR were found in the fourth wave “Delta wave” and the lowest of both CLR and SII were observed in “Omicron wave”. Interestingly, during most of the COVID-19 waves, the derived combined inflammatory ratio NLR, dNLR, CLR, SII and SIRI were sustained at high levels in fatal cases at the last day of hospitalization, while these indices declined in the alive group at the end of ICU hospitalization. No major difference was identified in lymphocyte count between admission and the last day of hospitalization in both deceased and recovered COVID-19 patients during Delta and Omicron waves. Moreover, patients admitted in the Omicron wave had less severe disease compared to those admitted in the Delta wave. The Kaplan-Meier analysis revealed no significant difference in survival rates or the probability of respiratory failure between six successive COVID-19 waves. ConclusionTaken together, our results showed marked differences in the alteration of nonspecific inflammation and damage in the adaptive immune response during the six serial SARS-CoV-2 waves. Considering the inflammatory response of infectious diseases, embedding inflammatory indices informative markers into routine clinical testing offers the potential to mitigate the impact of future pandemics of COVID-19 and other infectious diseases.

Are relative educational inequalities in multiple health behaviors widening? A longitudinal study of middle-aged adults in Northern Norway.

Educational inequality in multiple health behaviors is rarely monitored using data from the same individuals as they age. The aim of this study is to research changes in relative educational inequality in multiple variables related to health behavior (smoking, physical activity, alcohol intake, and body mass index), separately and collectively (healthy lifestyle), among middle-aged adults living in Northern Norway. Data from adult respondents aged 32-87 in 2008 with repeated measurements in 2016 (N = 8,906) were drawn from the sixth and seventh waves of the Tromsø Study. Logistic regression was used to assess the relative educational inequality in the variables related to health behavior. The analyses were performed for the total sample and separately for women and men at both baseline and follow-up. Educational inequality was observed in all the variables related to health behavior at baseline and follow-up, in both men and women. Higher levels of educational attainment were associated with healthier categories (non-daily smoking, physical activity, normal body mass index, and a healthy lifestyle), but also with high alcohol intake. The prevalence of daily smoking and physical inactivity decreased during the surveyed period, while high alcohol intake, having a body mass index outside of the normal range and adhering to multiple health recommendations simultaneously increased. The magnitude of relative educational inequality measured at baseline increased at the follow-up in all the variables related to health behavior. Differences were larger among women when compared to men, except in physical inactivity. Persistent and increasing relative disparities in health behavior between the highest education level and lower education levels are found in countries with well-established and comprehensive welfare systems like Norway. Addressing these inequalities is essential for reducing both the chronic disease burden and educational disparities in health.

Tracking community infection dynamics of COVID-19 by monitoring SARS-CoV-2 RNA in wastewater, counting positive reactions by qPCR

Wastewater-based epidemiology has proved useful for monitoring the COVID-19 infection dynamics in communities. However, in regions of low prevalence, low concentrations of SARS-CoV-2 RNA in wastewater make this difficult. Here, we used real-time reverse-transcription PCR (RT-qPCR) to monitor SARS-CoV-2 RNA in wastewater from October 2020 to December 2022 during the third, fourth, fifth, sixth, seventh, and eighth waves of the COVID-19 outbreak in Japan. Viral RNA was below the limit of detection in all samples during the third and fourth waves. However, by counting the number of positive replicates in qPCR of each sample, we found that the positive ratio to all replicates in wastewater was significantly correlated with the number of clinically confirmed cases by the date of symptom onset during the third, fourth, and fifth waves. Time-step analysis indicated that, for 2 days either side of symptom onset, COVID-19 patients excreted in their feces large amounts of virus that wastewater surveillance could detect. We also demonstrated that the viral genome copy number in wastewater, as estimated from the positive ratio of SARSA-CoV-2 RNA, was correlated with the number of clinically confirmed cases. The positive count method is thus useful for tracing COVID-19 dynamics in regions of low prevalence.

Distance in Disconnection: The Varied Impact of Core Network Losses on Loneliness Among Older Europeans.

Research among older adults reveals that the loss of core network members is a risk factor for loneliness. Still, it is not clear whether all such losses induce similar levels of loneliness, particularly as network members are distributed at varied geographic distances. Neither is it clear whether tie addition-the other ubiquitous aspect of network turnover in later life-offsets the loneliness that arises from different network loss scenarios. This paper scrutinized core network losses across multiple relationship-distance scenarios. We used the fourth and sixth waves of data from the Survey of Health, Ageing, and Retirement in Europe and estimated fixed-effect models. The loss of a child from a core network increases feelings of loneliness across variant distances, especially when not complemented by additional connections. Losing relatives or nonkin core connections in proximity (within 1 km and 5 km radius, respectively) is also associated with increased loneliness, yet such effects are also largely mitigated by the addition of new core network members. The relationship between core network member losses and loneliness can significantly differ based on the nature of the lost connection and its geographic distance. Active rebalancing of one's core network following losses and proactive network expansion can serve as pivotal strategies to prevent loneliness for the aging population.

Who Hurt You at Work? Results From a Nationwide Survey of Association Between Absenteeism and Workplace Violence, Stratified by Perpetrator.

This study aimed to determine the association between workplace violence and sickness absenteeism. We analyzed the data from the fifth and sixth waves of the Korean Working Conditions Surveys. Individuals younger than 18 years and self-employed or unpaid family workers were excluded. Descriptive statistics, χ 2 tests, and multiple logistic regression analysis were conducted. After adjusting for sociodemographic, occupational, and job-related characteristics, we found that the workers who had experienced workplace violence had higher rates of sickness absenteeism, especially when the perpetrator of violence was a coworker. Daily contact with the perpetrator at the workplace can cause distress and recollection of painful memories; thus, the aftermath of being harassed inside the workplace can be even more devastating than the event itself. A sensitive approach to recognizing the perpetrators of violence is needed.

The Impact of Environmental Management on Labour Productivity

The green transition and green economic growth are policy priorities in the European Union. In this context, this study estimates the effects of environmental management on firm performance, in particular labour productivity. There is currently a lack of empirical evidence on this topic, although it is of great importance due to the increasing need for environmental practices across the globe. Therefore, to address this gap, we explore the relationship between several environmental variables on labour productivity, through the use of cross-sectional firm-level data. These data were obtained using the sixth wave of the Business Environment and Enterprise Survey (BEEPS VI). This study focuses on ten EU countries. The results obtained from the empirical analysis reveal that firms who employ an environmental manager and firms that are subject to energy taxes or levies both have higher productivity than those who do not; thus, firms that have employed or are subject to certain environmental practices reap the benefits of higher labour productivity. Furthermore, firms that use renewable energy have higher labour productivity than those that do not. Therefore, the results obtained allowed us to draw implications for both policy makers and managers.

The Optimal Control Chart Selection for Monitoring COVID-19 Phases: A Case Study of Daily Deaths in the USA.

Epidemiologists frequently adopt statistical process control tools, like control charts, to detect changes in the incidence or prevalence of a specific disease in real time, thereby protecting against outbreaks and emergent health concerns. Control charts have proven essential in instantly identifying fluctuations in infection rates, spotting emerging patterns, and enabling timely reaction measures in the context of COVID-19 monitoring. This study aims to review and select an optimal control chart in epidemiology to monitor variations in COVID-19 deaths and understand pandemic mortality patterns. An essential aspect of the present study is selecting an appropriate monitoring technique for distinct deaths in the USA in 7 phases, including pre-growth, growth, and post-growth phases. Stage-1 evaluated control chart applications in epidemiology departments of 12 countries between 2000 and 2022. The study assessed various control charts and identified the optimal one based on maximum shift detection using sample data. This study considered at Shewhart (Javid Shabbir2, ) control charts and exponentially weighted moving average (EWMA) control chart with smoothing parameters were all investigated in this study. In Stage-2, we applied the EWMA control chart for monitoring because of its outstanding shift detection capabilities and compatibility with the present data. Daily deaths have been monitored from March 2020 to February 2023. Control charts in epidemiology show growing use, with the United States leading at 42% applications among top countries. During the application on COVID-19 deaths, the EWMA chart accurately depicted mortality dynamics from March 2020 to February 2022, indicating six distinct stages of death. The third and fifth waves were extremely catastrophic, resulting in a considerable loss of life. Significantly, a persistent sixth wave appeared from March 2022 to February 2023. The EWMA map effectively determined the peaks associated with each wave by thoroughly examining the time and amount of deaths, providing vital insights into the pandemic's progression. The severity of each wave was measured by the average number of deaths. The United States entered a seventh phase (6th wave) from March 2022 to February 2023, marked by fewer deaths. While reassuring, it remains crucial to maintain vaccinations and pandemic control measures. Control charts enable early detection of daily COVID-19 deaths, providing a systematic strategy for government and medical staff. Incorporating the EWMA chart for monitoring immunizations, cases, and deaths is recommended.

Modeling of spatial spread of COVID-19 pandemic waves in Russia using a kinetic-advection model

Objectives. COVID-19 has a number of specific characteristics that distinguish it from past pandemics. In addition to the high infection rate, the high spread rate is due to the increased mobility of contemporary populations. The aim of the present work is to construct a mathematical model for the spread of the pandemic and identify patterns under the assumption that Moscow comprises the main source of viral infection in Russia. For this purpose, a twoparameter kinetic model describing the spatial spread of the epidemic is developed. The parameters are determined using theoretical constructions alongside statistical vehicle movement and population density data from various countries, additionally taking into account the development of the first wave on the examples of Russia, Italy and Chile with verification of values obtained from subsequent epidemic waves. This paper studies the development of epidemic events in Russia, starting from the third and including the most recent fifth and sixth waves. Our twoparameter model is based on a kinetic equation. The investigated possibility of predicting the spatial spread of the virus according to the time lag of reaching the peak of infections in Russia as a whole as compared to Moscow is connected with geographical features: in Russia, as in some other countries, the main source of infection can be identified. Moscow represents such a source in Russia due to serving as the largest transport hub in the country.Methods. Mathematical modeling and data analysis methods are used.Results. A predicted time lag between peaks of daily infections in Russia and Moscow is confirmed. Identified invariant parameters for COVID-19 epidemic waves can be used to predict the spread of the disease. The checks were carried out for the wave sequence for which predictions were made about the development of infection for Russia and when the recession following peak would occur. These forecasts for all waves were confirmed from the third to the last sixth waves to confirm the found pattern, which can be important for predicting future events.Conclusions. The confirmed forecasts for the timing and rate of the recession can be used to make good predictions about the fifth and sixth waves of infection of the Omicron variant of the COVID-19 virus. Earlier predictions were confirmed by the statistical data.

Socioeconomic inequalities in COVID-19 incidence during the first six waves in Barcelona.

The emergence of SARS-CoV-2 affected urban areas. In Barcelona, six waves of COVID-19 hit the city between March 2020 and March 2022. Inequalities in the incidence of COVID-19 have been described. However, no studies have examined the daily trends of socioeconomic inequalities and how they changed during the different phases of the pandemic. The aim of this study is to analyse the dynamic socioeconomic inequalities in the incidence of COVID-19 during the six waves in Barcelona. We examined the proportion of daily cases observed in the census tracts in the lower income tercile compared with the proportion of daily cases observed in the sum of the lower and higher income terciles. Daily differences in these proportions were assessed as a function of the epidemic waves, sex, age group, daily incidence and daily change in the incidence. A logistic regression model with an autoregressive term was used for statistical analysis. A time-dynamic effect was found for socioeconomic inequalities in the incidence of COVID-19. In fact, belonging to a lower-income area changed from being a risk factor (Waves 1, 2, 4 and 5) to being a protective factor in the sixth wave of the pandemic. Age also had a significant effect on incidence, which also changed over the different waves of the pandemic. Finally, the lower-income areas showed a comparatively lower incidence during the ascending phase of the epidemic waves. Socioeconomic inequalities in COVID-19 changed by wave, age group and wave phase.

“Globalization and Social Identities at the Individual Level: Populism from Shifting at the Top?”

Abstract This paper reconsiders the proposition that globalization leads to more transnational and less national identities. Providing an argument specifying how these various international processes could shift identities at the individual level, it hypothesizes that globalization should be associated with more transnational/less national identities for people toward the top of society based on their experience with and information about globalization, but not for those at the bottom. Based on the identity shift happening at the top but not at the bottom, globalization should also be associated with a larger identity difference between the elite and the mass public. Using data from the sixth wave of the World Values Survey conducted across fifty-six countries from 2010 to 2014 and the seventh wave across forty-four countries from 2017 to 2020, it presents results consistent with these hypotheses. These results help explain the current “anti-global” backlash, providing evidence consistent with populist theories but inconsistent with rising nationalism.

Assessing the relationship between digital divide and citizens’ political participation in Africa

ABSTRACT The proliferation of access to digital technology has raised remarkable interest regarding its various effects on everyday life, with recent studies largely focusing on financial inclusion. This study examined the influence of digital inequalities on political participation in Africa’s nascent democracies using the sixth wave of Afrobarometer data covering 36 countries and involving 49 896 respondents. The descriptive analysis shows that nearly 70 per cent of the respondents voted, were interested in public affairs, and took part in political discussions. Furthermore, digital inequalities were found to be geographically correlated, with the highest prevalence in Southern Africa. Using the OLS regression technique, we observe that access to the internet and mobile phones and usage thereof have strong positive relationships with various aspects of political participation, among others. Our results suggest the need to promote policies directed towards reducing digital inequalities, including internet usage subsidies, to engage citizens in political participation.

Optimal adaptive nonpharmaceutical interventions to mitigate the outbreak of respiratory infections following the COVID-19 pandemic: a deep reinforcement learning study in Hong Kong, China.

Long-lasting nonpharmaceutical interventions (NPIs) suppressed the infection of COVID-19 but came at a substantial economic cost and the elevated risk of the outbreak of respiratory infectious diseases (RIDs) following the pandemic. Policymakers need data-driven evidence to guide the relaxation with adaptive NPIs that consider the risk of both COVID-19 and other RIDs outbreaks, as well as the available healthcare resources. Combining the COVID-19 data of the sixth wave in Hong Kong between May 31, 2022 and August 28, 2022, 6-year epidemic data of other RIDs (2014-2019), and the healthcare resources data, we constructed compartment models to predict the epidemic curves of RIDs after the COVID-19-targeted NPIs. A deep reinforcement learning (DRL) model was developed to learn the optimal adaptive NPIs strategies to mitigate the outbreak of RIDs after COVID-19-targeted NPIs are lifted with minimal health and economic cost. The performance was validated by simulations of 1000 days starting August 29, 2022. We also extended the model to Beijing context. Without any NPIs, Hong Kong experienced a major COVID-19 resurgence far exceeding the hospital bed capacity. Simulation results showed that the proposed DRL-based adaptive NPIs successfully suppressed the outbreak of COVID-19 and other RIDs to lower than capacity. DRL carefully controlled the epidemic curve to be close to the full capacity so that herd immunity can be reached in a relatively short period with minimal cost. DRL derived more stringent adaptive NPIs in Beijing. DRL is a feasible method to identify the optimal adaptive NPIs that lead to minimal health and economic cost by facilitating gradual herd immunity of COVID-19 and mitigating the other RIDs outbreaks without overwhelming the hospitals. The insights can be extended to other countries/regions.

Análisis de las características de los pacientes mayores que ingresaron en una unidad de cuidados intensivos durante las 6 olas de la pandemia por SARS-CoV-2: implicaciones para la atención médica

ObjectiveTo analyze the characteristics of seriously ill elderly patients during the six waves of the COVID-19 pandemic. MethodRetrospective, observational and analytical study of patients over 70 years of age admitted to the ICU (March-2020 to March-2022). Patients were categorized into three groups based on age: 70-74 years; 75-79 years; and >80 years. A descriptive and comparative analysis of the sample was initially performed; and a 28-, 60- and 90-day survival analysis using the Kaplan–Meier method. Multivariate survival analysis was performed by fitting a Cox model. ResultsOf 301 patients, the lowest number of admissions occurred during the first wave (20 (6%)), compared to the wave with the highest number of admissions: the sixth wave (76 (25%)). The survival curves at 28 days, 60 days and 90 days showed a higher probability of survival in the younger age groups (P<.01 and P=.01, respectively). Troponin at admission (per unit, ng/l) showed a significant association with 28- and 60-day mortality (HR: 1.00; 95% CI: 1.00-1.01; P<.05). Taking the 1st wave of the pandemic as a reference, admission in the 3rd wave behaved as a protective factor against mortality at 28 and 60 days of follow-up (HR: 0.18; 95% CI: 0.02-0.64; P<.05; HR: 0.13; 95% CI: 0.02–0.64; P<.05, respectively). ConclusionsThe time of admission and biomarkers, such as troponin, constitute prognostic markers independent of age in the elderly population.

#5773 URINARY OROSOMUCOID IS ASSOCIATED WITH ALL-CAUSE MORTALITY IN THE GENERAL POPULATION

Abstract Background and Aims Urinary albumin excretion (UAE) is considered a risk factor for cardiovascular (CV) disease and all-cause mortality, but the pathophysiological mechanisms are not known, and studies are not consistent with regards to the effect of pharmacological UAE reduction on endpoints. Another protein, orosomucoid (41-43kDa), is a non-specific acute inflammatory protein and is a part of the glycolax that covers the endothelium. Under normal conditions the concentration in urine is low, but a marked increase is demonstrated under both acute and chronic inflammation and in cardiovascular disease. In patients with diabetes urinary orosomucoid excretion (UOE), was an independent predictor of all-cause and cardiovascular mortality even in normoalbuminuric patients. In this longitudinal study, our aim was to study both UAE and UOE in a middle-aged cohort from the general population. We hypothesized that UOE, but not UAE, is an independent predictor for all-cause mortality. Method The Tromsø Study is a population-based, prospective study with repeated health surveys of inhabitants of Tromsø (Northern Norway), and the first took place in 1974. From the sixth wave (Tromsø6, 2007/2008) we included all participants with urinary samples. Follow-up time was assigned from the attendance date of Tromsø6 until 31.08.2022. The associations between urinary markers and all-cause mortality were assessed by Cox regression analysis. Results The cohort included 7180 subjects (4094 women and 3086 men) with a mean (SD) age 63.5 (±9.2) years. Median urinary orosomucoid to creatinine ratio (UOCR) was 0.44 g/g, median albumin to creatinine ratio (UACR) was 0.36 mg/mmol, mean (SD) eGFR was 88.1 (±14.0) ml/min/1.73m² and 1689 died during follow-up. UOCR was independently associated with all-cause mortality (hazard ratio (HR) per g/g increase 1.02, 95% CI 1.01,1.03, p&amp;lt;0.001) adjusted for sex, age, UACR, eGFR and CV risk factors (diabetes, hypertension, smoke, cholesterol, BMI). The HR for UOCR above vs. below median adjusted for the same variables was 1.13 (95% CI 1.01, 1.27, p = 0.032). UACR above median with the same adjustments was not associated to all-cause mortality (hazard ratio 1.04, 95%CI 0.93, 1.15, p = 0.484). Conclusion In this study, we showed for the first time that UOE, but not UAE, was an independent predictor of all-cause mortality in a large cohort from the general population. Thus, UOE may be an earlier marker of vascular damage than UAE. Whether UOE is clinically useful as an early marker of CV disease should be further studied.

The longitudinal associations between perceived importance of the internet and depressive symptoms among a sample of Chinese adults.

The aim of this study is to examine the extent to which individuals' cognitive evaluation of the importance of the Internet is associated with depressive symptoms, and in what ways. This study utilized a sample of 4,100 participants from the fourth (2016), fifth (2018), and sixth (2020) waves of the China Family Panel Studies. Structural equation modeling was employed for data analysis. The findings of this study reveal that individuals' cognitive evaluation of the importance of the Internet in 2016 was positively linked with the frequency of Internet use and subjective socioeconomic status in 2018. Furthermore, the frequency of Internet use and subjective socioeconomic status in 2018 were found to be negatively associated with depressive symptoms in 2020. These results indicate that the perceived importance of the Internet has an indirect effect on depressive symptoms through the identified pathway. The present findings contribute to the existing literature by highlighting the importance of individuals' perceived importance of the internet as a significant factor that influences depressive symptoms. The results suggest that policy makers should take actions to increase public awareness of the importance of the Internet in the digital era, and to ensure equitable access to the internet, thus facilitating convenient internet use and helping individuals adapt to the digital age.

Comparison of the first and sixth waves of the SARS-COV-2 coronavirus pandemic in patients with immune-mediated disease

IntroductionRecent evidence shows that COVID-19 infection does not have a worse prognosis in patients with immune-mediated inflammatory diseases (IMID), although they develop a worse response to vaccination. ObjectiveTo compare the incidence of COVID-19 and clinical features in patients with IMID between the first and sixth waves. MethodProspective observational study of two cohorts of IMID patients diagnosed with COVID-19. First cohort March to May 2020, and second cohort December/2021 to February/2022.Sociodemographic and clinical variables were collected and, in the second cohort, COVID-19 vaccination status. Statistical analysis established differences in characteristics and clinical course between the two cohorts. ResultsIn total, 1627 patients were followed up, of whom 77 (4.60%) contracted COVID-19 during the first wave and 184 in the sixth wave (11.3%). In the sixth wave, there were fewer hospitalisations, intensive care unit admissions, and deaths than in the first wave (p=.000) and 180 patients (97.8%) had at least one dose of vaccine. ConclusionEarly detection and vaccination have prevented the occurrence of serious complications.

Thinking with Urban Natures

Abstract Since the Enlightenment, cities have been considered as exemplary spaces of human achievement. Technological developments and the constant reorganisation of materials and infrastructures have contributed to a widely shared conception of nature as something outside of urban areas. Our age, framed by the Anthropocene and the sixth wave of extinction, has shattered such vision. Novel reflections across the natural sciences, the arts and the humanities have chosen to focus on relational entanglements instead of separating the city from the environment. In this short collection, we offer a series of reflections about multiple urban natures that often remain unknown or concealed. Each of us does so from a unique disciplinary perspective, ranging from anthropology to history and geography over urban ecology, urban studies and landscape architecture. We hope to point towards a multidisciplinary articulation of urban nature as in itself diverse, complex and de-centred.

Effectiveness of the booster dose of COVID-19 vaccine in the Basque Country during the sixth wave: A nationwide cohort study

The aim of the study was to assess the effect of a booster dose of COVID-19 vaccine on the rates of hospital ward and intensive care unit (ICU) admissions around the time of emergence of the Omicron variant in the Basque Country.A retrospective cohort population-based study was conducted. The population with any records related to COVID-19 vaccination up to 28 February 2022 was classified into four cohorts by vaccination status. For every cohort, the hospital ward and ICU admission rates were calculated for each day between November 2021 and February 2022. Generalized linear models with a negative binomial distribution were used to estimate the age-adjusted hospitalization rate ratio of the cohort of individuals who had received a booster compared to the other cohorts.The age-adjusted rates of hospital ward and ICU admissions were 70.4 % and 72.0 % lower, respectively, in the fully vaccinated plus booster group compared to the fully vaccinated but no booster group. Analysing changes in the 14-day admission incidence rates showed that as the prevalence of the Omicron variant increased, the corresponding rate ratios decreased.The immunity acquired with the booster dose allowed the hospital network to meet all the demand for hospitalization during a period of high incidence of COVID-19, despite the fact that vaccine protection decreased as the prevalence of the Omicron variant increased.

Impact of the COVID-19 pandemic on the trajectory of the number of bronchoscopies performed in a tertiary hospital in Kyoto city.

The coronavirus disease 2019 (COVID-19) pandemic has restricted many medical practices. We aimed to investigate the impact of the COVID-19 pandemic on the number of bronchoscopies, outpatients, and hospital admissions. We retrospectively analyzed the number of outpatients, admissions, and bronchoscopies performed between March 2020 and May 2022. We defined "Peak month of the pandemic," "Wave of the pandemic," "Month in the wave," and "Period of a state of emergency" for each analysis. In the first year of the COVID-19 pandemic, analysis of variance (ANOVA) in linear mixed models indicated significant effects of "month in each wave" on the number of bronchoscopies (P = .003), outpatients (P = .041), and admissions (P = .017). The number of outpatients, admissions, and bronchoscopies was significantly influenced by the first wave of the COVID-19 pandemic. In contrast, in the second year of the COVID-19 pandemic, a mixed-ANOVA indicated significant effects of "month in each wave" only on the number of outpatients (P = .020) but no significant effects on the number of bronchoscopies (P = .407) and admissions (P = .219). During the second year of the pandemic, the number of bronchoscopies and admissions was not significantly affected by the waves of the pandemic. There were no significant differences in the number of admissions and bronchoscopies between the fourth and sixth waves. Although the number of bronchoscopies was found to be significantly affected in the early stages of the COVID-19 pandemic, the impact of the pandemic was much more limited thereafter.

Longitudinal relationships between habitual physical activity and pain tolerance in the general population.

Physical activity (PA) might influence the risk or progression of chronic pain through pain tolerance. Hence, we aimed to assess whether habitual leisure-time PA level and PA change affects pain tolerance longitudinally in the population. Our sample (n = 10,732; 51% women) was gathered from the sixth (Tromsø6, 2007-08) and seventh (Tromsø7, 2015-16) waves of the prospective population-based Tromsø Study, Norway. Level of leisure-time PA (sedentary, light, moderate, or vigorous) was derived from questionnaires; experimental pain tolerance was measured by the cold-pressor test (CPT). We used ordinary, and multiple-adjusted mixed, Tobit regression to assess 1) the effect of longitudinal PA change on CPT tolerance at follow-up, and 2) whether a change in pain tolerance over time varied with level of LTPA. We found that participants with high consistent PA levels over the two surveys (Tromsø6 and Tromsø7) had significantly higher tolerance than those staying sedentary (20.4 s. (95% CI: 13.7, 27.1)). Repeated measurements show that light (6.7 s. (CI 3.4, 10.0)), moderate (CI 14.1 s. (9.9, 18.3)), and vigorous (16.3 s. (CI 6.0, 26.5)) PA groups had higher pain tolerance than sedentary, with non-significant interaction showed slightly falling effects of PA over time. In conclusion, being physically active at either of two time points measured 7-8 years apart was associated with higher pain tolerance compared to being sedentary at both time-points. Pain tolerance increased with higher total activity levels, and more for those who increased their activity level during follow-up. This indicates that not only total PA amount matters but also the direction of change. PA did not significantly moderate pain tolerance change over time, though estimates suggested a slightly falling effect possibly due to ageing. These results support increased PA levels as a possible non-pharmacological pathway towards reducing or preventing chronic pain.