Electronic nudges sent to patients failed to increase influenza vaccine uptake in one randomized clinical trial, while another trial found that slight increases in vaccination rates from letters emailed to patients failed to impact clinical outcomes.
Neither portal nor text messages to remind patients to get an influenza vaccination were effective at a population level at improving vaccination uptake, Peter Szilagyi, MD, MPH, of the UCLA Mattel Children's Hospital at the University of California in Los Angeles, and colleagues reported in JAMA Internal Medicine. Among patients who received care from 79 primary care practices in a large healthcare system, flu shot rates remained at approximately 47% whether patients received portal messages, text messages, or no reminders at all.
And in an analysis of the Danish NUDGE-FLU trial, an about 1% boost in influenza vaccination associated with email letters encouraging patients to get vaccinated did not translate into improvements in cardiovascular, respiratory, or other clinical endpoints, Niklas Johansen, MD, of the Copenhagen University Hospital-Harlev and Gentofte in Denmark, and colleagues wrote in the Annals of Internal Medicine.
Potential Advantage to Text Messages
Szilagyi and investigators found that patient portal messages sent monthly or before scheduled visits did not increase influenza vaccination rates.
However, preappointment reminders sent 24 to 48 hours before a scheduled primary care appointment, by either text or patient portal, had a small positive effect on vaccine uptake (adjusted risk ratio [aRR] 1.04, 95% CI 1.01-1.06, P=0.01) in a subgroup of patients who were unvaccinated but had at least one primary care appointment. This effect seemed to be driven by text preappointment reminders, which were associated with an absolute increase in vaccination rates of 1.6-1.8% (aRR 1.07, P=0.002), whereas the portal preappointment reminders had no significant impact.
"We suspect there are several reasons why text, but not portal, preappointment reminders were effective," Szilagyi and colleagues wrote. "Portal messages require patients to open the portal and find and then read the message, whereas text messages appear instantly and might appear more urgent or important."
Given the results of their study, the authors concluded that "text message preappointment reminders can be effective for patients with scheduled appointments," but health systems might opt for more intensive interventions instead, "such as improving access to vaccinations (e.g., Saturday or after-hours clinics) or communication training for clinicians to address vaccine hesitancy."
The trial included patients 6 months of age or older in the UCLA Health System with either one or two visits to a primary care provider within the past year or who were enrolled in managed care within the system. The trial included 262,085 patients, 9% of whom where children. Mean age was 45 years: females accounted for 57% of participants, 53% were white, 12% were Hispanic or Latino, and 10% were Asian. Most (83.5%) had private health insurance, and 14.9% received Medicare. About 65% had received an influenza vaccination within 2 years.
Patients were randomized equally to receive standard of care, influenza vaccine portal reminders, or vaccine text reminders. Those randomized to the portal reminder group were further randomized to receive fixed or responsive monthly portal reminders, with or without preappointment reminders. Those randomized to the text reminder group received fixed monthly reminders and were further randomized to receive preappointment reminders or no preappointment reminders.
The primary outcome was influenza vaccination, including vaccination at pharmacies and other sites.
NUDGE-FLU Analysis
Previously, the Danish NUDGE-FLU trial found that electronic letters that nudged recipients to get vaccinated for influenza and also provided information on its cardiovascular benefits (so-called "gain-framing") were associated with a small increase of about 1% in flu vaccine uptake.
In this prespecified clinical outcome assessment of that trial, no statistically significant differences in clinical outcomes were found among those who received a letter that incorporated cardiovascular gain-framing or in those who received repeated letters, when compared with the usual care group who received no letters, reported Johansen and co-authors.
Hospitalization for pneumonia or influenza was 1% in the usual care group, 1% in the group that received the letters with cardiovascular gain-framing, and 1.1% in the repeated-letter group. Hospitalization for any cause was approximately 13% in all three groups. Mortality during the study occurred in 1.8% of the usual care group, 1.9% in the gain-framing group, and 1.7% in the repeated-letter group.
Given the modest results of the original NUDGE-FLU trial, the findings of the prespecified analysis came as no surprise to Mark Fendrick, MD, of the University of Michigan Medical School in Ann Arbor.
"It's not that the flu shot doesn't work, it's that an intervention that got a very small [number] of additional people to get the flu shot did not produce a positive outcome effect across the entire population," Fendrick told MedPage Today. "I would not expect an additional 1% of a population getting the flu shot to actually show meaningfully clinical outcome differences."
"There's pretty robust evidence to show that a lot of these [vaccine] reminders are not extraordinarily effective," he added.
Johansen told MedPage Today via email that his group wasn't surprised either. "We were well aware that our nudging letters only resulted in modest increases in influenza vaccination, and we therefore suspected that the difference in vaccination rates would not be enough to drive a difference in clinical outcomes."
In the original NUDGE-FLU trial, approximately 965,000 Danish participants were randomized to usual care or to receive one of nine different electronically delivered behavioral nudging letters during the 2022-2023 flu season. The current analysis included 691,820 participants of that trial who were 65 years of age or older. Since the original NUDGE-FLU trial found that repeated standard letters and cardiovascular gain-framing letters resulted in modest but significantly higher rates of influenza vaccination, the current analysis focused on comparison of the groups that received no letters, letters sent at baseline and 14 days later, and cardiovascular gain-framed letters.
Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.
Disclosures
The study by Szilagyi's group was funded by the National Institute of Allergy and Infectious Diseases.
The study by Johansen's group was funded by Sanofi.
Szilagyi reported no relevant conflicts of interest; other co-authors of the study reported ties to industry.
Johansen reported no relevant conflicts of interest; other co-authors of the study reported ties to industry.
Primary Source
JAMA Internal Medicine
Source Reference: Szilagyi PG, et al "Text vs patient portal messaging to improve influenza vaccination coverage" JAMA Intern Med 2024; DOI: 10.1001/jamainternmed.2024.0001.
Secondary Source
Annals of Internal Medicine
Source Reference: Johansen ND, et al "Clinical outcomes with electronic nudges to increase influenza vaccination" Ann Intern Med 2024; DOI: 10.7326/M23-2638.
Silver Spring (Precision Vaccinations News)
In the United States, influenzais a significant health concern each year, affecting millions of people and leading to hospitalization and death for many.
Flu vaccines have been recommended for over five decades and have been proven to lower the risk of flu and its severe complications in those who receive it.
The composition of U.S. flu vaccines is reviewed annually in time for newer flu vaccines to be manufactured each year.
On March 5, 2024, the U.S.FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC) met to discuss and recommend the viruses for the nextflu season's vaccines.
The VRBPACrecommended that all 2024-2025 U.S. flu vaccines be three-component (trivalent) vaccines and include an influenza A(H1N1), an A(H3N2), and a B/Victoria-lineage vaccine virus.
This decision was made because influenza B/Yamagata viruses are no longer circulating and have not been detected in global surveillance after March 2020.
Therefore, itsinclusion in next season's flu vaccines is no longer warranted.
Initial news from vaccine producers has been very positive, with the intent to deliver the trivalent flu shots on time in 2024.
These types of vaccine changes have been made for many years.
From 1978-1979 through 2012-2013, flu vaccines were trivalent. But, quadrivalent flu vaccines became available in the U.S.during the 2013-2014 flu season.
The newer vaccines contained a fourth componenta second influenza B virusto protect against both influenza B virus lineages.
As of March2024, about158millionquadrivalent flu vaccineshad beendistributedduring the 2023-2024 season.
Furthermore, government agencies have reviewprocesses to determine if the flu vaccines, egg, cell, or nasal-based vaccines actually deliver virus protection.
Regarding flu shot protection, on February 28, 2024,Aaron M. Frutos, Ph.D., MPH, presented to the U.S. CDC's Advisory Committee on Immunization Practices (ACIP), confirming four networksevaluate vaccine effectiveness (VE) against laboratory-confirmed influenza for children, adolescents, and adults in the outpatient and inpatient settings.
According to the ACIP, the aggregated interim VE for this season's flu vaccines is about 50%. The final data is expected during a later CDC meeting.
Investigation of an early signal for stroke associated with COVID-19 bivalent vaccines turned into suspicion of high-dose or adjuvanted flu shots instead, based on a large U.S. population-based study.
When researchers inspected a large Medicare database, they found no evidence of a significantly elevated risk for stroke at 1-21 days or 22-42 days after vaccination with either of the mRNA COVID vaccines distributed for the 2022-2023 respiratory season when compared with the 43-90 day control window, reported researchers led by Yun Lu, PhD, a statistician of the FDA in Silver Spring, Maryland.
There was a significant excess of nonhemorrhagic stroke for people with concomitant administration of Pfizer-BioNTech's bivalent vaccine plus a high-dose or adjuvanted influenza vaccine during the 22-42 days risk window (risk difference of 3.13 out of 100,000 doses); and a significant excess of transient ischemic attack for people with concomitant administration of Moderna's bivalent COVID vaccine plus a high-dose or adjuvanted influenza vaccine during the 1-21 days risk window (risk difference of 3.33 out of 100,000 doses).
But the researchers found that people with administration of a high-dose or adjuvanted influenza vaccine alone (without concomitant COVID vaccination) had an elevated risk for the combined outcome of nonhemorrhagic stroke or transient ischemic attack in both the 1-21 days risk window (risk difference of 1.65 per 100,000 doses) and 22-42 days risk window (risk difference of 1.60 per 100,000 doses).
"This finding suggests that the observed association between vaccination and stroke in the concomitant subgroup was likely driven by a high-dose or adjuvanted influenza vaccination," the investigators reported in JAMA.
COVID-19 bivalent vaccines were made to blend protection against the ancestral COVID strain and the Omicron BA.4/5 subvariants. They were not as widely adopted as the original vaccines but still remained on the market until they were replaced in September 2023 with monovalent vaccines targeting the XBB.1.5 Omicron subvariant alone for the 2023-2024 respiratory virus season.
Lu and colleagues conducted their study as a follow-up to the CDC and FDA's January 2023 warning of an early signal of nonhemorrhagic stroke in older adults who had received Pfizer-BioNTech's bivalent COVID-19 vaccine. That preliminary notice had been based on reports to the Vaccine Safety Datalink during the immediate period after vaccination, though later analyses also suggested a connection with concomitant flu vaccination.
Regarding these now-retired bivalent COVID vaccines, the present data are "reassuring" and consistent with reports from France and Israel, according to vaccine researchers Kathryn Edwards, MD, and Marie Griffin, MD, MPH, both of Vanderbilt University in Nashville, Tennessee.
Edwards and Griffin emphasized the small magnitude of the stroke risk associated with high-dose influenza vaccination identified by Lu's team.
"From a population health perspective, a risk of serious outcomes of 1 per 100,000 vaccinated individuals would be more than balanced by the benefits of most recommended vaccines. For example, influenza virus results in thousands of potentially preventable illnesses, medical care visits, hospitalizations, and deaths among persons aged 65 years or older in the U.S. annually and missed days from school and work in younger persons," they commented in an accompanying editorial.
The duo nevertheless cautioned that the risk-benefit calculus of these vaccines may not be so favorable for some relatively healthy older adults who are at an extremely low risk of serious influenza complications.
"It is encouraging that the current U.S. vaccine safety system can identify small vaccine risks on the order of 1 per 100,000. Importantly, public health professionals should be prepared to effectively communicate the level of certainty about potential risks," Edwards and Griffin urged. "The study by Lu et al illustrates the value of a timely, well-designed analysis and has provided reassurance about the COVID-19 boosters. Ongoing monitoring of influenza vaccines marketed for older adults will provide additional data on stroke risk."
For their study, the authors relied on a large representative database that identified over 5.3 million Medicare beneficiaries (median age 74 years, 56% women) who got either mRNA bivalent COVID vaccine starting from Aug. 31, 2022, the emergency use authorization date for these products, to Feb. 4, 2023. Excluded were people with a recent prior stroke, residents of long-term care facilities, and those in hospice care.
There were ultimately 11,001 individuals recorded as having a stroke after getting a COVID-19 bivalent vaccine. Approximately 10-15% of this case population had a COVID-19 diagnosis claim in the months prior to stroke, and 34-45% had had a concomitant high-dose or adjuvanted influenza vaccination.
"Because the framework of the current self-controlled case series study does not compare the populations who were vaccinated vs those who were unvaccinated, it does not account for the reduced rate of severe influenza after vaccination," Lu's group wrote. "More studies are needed to better understand the association between high-dose or adjuvanted influenza vaccination and stroke."
The study authors also acknowledged that they likely did not capture all cases of SARS-CoV-2 infection among participants due to non-reported at-home tests.
Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow
Disclosures
The study was funded by the FDA and CMS via a contract with Acumen.
Lu had no relevant disclosures.
Edwards reported receiving grant funding from the NIH and the CDC; being a consultant to Bionet, Dynavax, GSK, and IBM; and being a member of data safety and monitoring committees for Sanofi, X-4 Pharma, Seqirus, Moderna, Pfizer, Merck, Roche, Novavax, and CEPI. Griffin disclosed being a member of the CDC's Advisory Committee on Immunization Practices RSV Vaccines Adult Work Group.
Primary Source
JAMA
Source Reference: Lu Y, et al "Stroke risk after COVID-19 bivalent vaccination among US older adults" JAMA 2024; DOI: 10.1001/jama.2024.1059.
Secondary Source
JAMA
Source Reference: Edward KM, Griffin MR "Postmarketing vaccine safety assessments: important work in progress" JAMA 2024; DOI: 10.1001/jama.2023.26630.
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STATUS CODE: 500
SAO PAULO (AP) Former Brazilian President Jair Bolsonaro was formally accused Tuesday of falsifying his COVID-19 vaccination status, marking the first indictment for the embattled far-right leader, with more allegations potentially in store.
The federal police indictment released by the Supreme Court alleged that Bolsonaro and 16 others inserted false information into a public health database to make it appear as though the then-president, his 12-year-old daughter and several others in his circle had received the COVID-19 vaccine.
Police detective Fbio Alvarez Shor, who signed the indictment, said in his report that Bolsonaro and his aides changed their vaccination records in order to issue their respective (vaccination) certificates and use them to cheat current health restrictions.
The investigation found several false insertions between November 2021 and December 2022, and also many actions of using fraudulent documents, Shor added.
The detective said in the indictment that Bolsonaros aide-de-camp, Mauro Cid, told investigators the former president asked him to insert the false data into the system for both himself and his daughter. Cid also said he delivered the vaccination certificates to Bolsonaro personally.
During the pandemic, Bolsonaro was one of the few world leaders who railed against the vaccine. He openly flouted health restrictions and encouraged other Brazilians to follow his example. His administration ignored several offers from pharmaceutical company Pfizer to sell Brazil tens of millions of shots in 2020, and he openly criticized a move by Sao Paulo states governor to buy vaccines from Chinese company Sinovac when no other doses were available.
Brazils prosecutor-generals office will have the final say on whether to use the indictment to file charges against Bolsonaro at the Supreme Court. The case stems from one of several investigations targeting Bolsonaro, who governed from 2019 to 2022.
Bolsonaros lawyer, Fbio Wajngarten, called his clients indictment absurd and said he did not have access to it.
When he was president, he was completely exempted from showing any kind of certificate on his trips. This is political persecution and an attempt to void the enormous political capital that has only grown, Wajngarten said.
The former president denied any wrongdoing during questioning in May 2023.
Gleisi Hoffmann, chairwoman of the Workers Party, whose candidate defeated Bolsonaro, celebrated his indictment on social media. She said she hopes the former president stands trial in many other cases, including for his alleged attempt to sneak $3 million in diamond jewelry into the country and the sale of two luxury watches he received as gifts from Saudi Arabia while in office.
He has lied until this day about his nefarious administration, but now he will have to face the truth in the courts. The federal polices indictment sent to prosecutors is just the first of several, Hoffmann said. What is up now, Big Coward? Are you going to face this or run away to Miami?
Brazils Supreme Court has already seized Bolsonaros passport.
Police accuse Bolsonaro and his aides of tampering with the health ministrys database shortly before he traveled to the U.S. in December 2022, two months after he lost his reelection bid to Luiz Incio Lula da Silva.
Bolsonaro needed a certificate of vaccination to enter the U.S., where he remained for the final days of his term and the first months of Lulas term. The former president has repeatedly said he has never taken a COVID-19 vaccine.
If convicted for falsifying health data, the 68-year-old politician could spend up to 12 years behind bars or as little as two years, according to legal analyst Zilan Costa. The maximum jail time for a charge of criminal association is four years, he said.
What Bolsonaro will argue in this case is whether he did insert the data or enable others to do it, or not. And that is plain and simple: Either you have the evidence or you dont. It is a very serious crime with a very harsh sentence for those convicted, Costa told The Associated Press.
Shor also said he is awaiting information from the U.S. Justice Department to clarify whether those under investigation did make use of the false vaccination certificates upon their arrival and stay in American territory.
If so, further charges could be leveled against Bolsonaro, Shor wrote without specifying in which country.
The indictment sheds new light on a Senate committee inquiry that ended in October 2021 with a recommendation for nine criminal charges against Bolsonaro alleging that he mismanaged the pandemic. Then prosecutor-general Augusto Aras, who was widely seen as a Bolsonaro ally, declined to move the case forward.
Brazilian media reported that Aras successor, Paulo Gonet, was scheduled to meet lawmakers later Tuesday to discuss the possibility of filing charges.
Bolsonaro retains staunch allegiance among his political base, as shown by an outpouring of support last month, when an estimated 185,000 people clogged Sao Paulos main boulevard to decry what they and the former president characterize as political persecution.
The indictment will not turn off his backers and will only confirm his detractors suspicions, said Carlos Melo, a political science professor at Insper University in Sao Paulo.
It is definitely worse for him in courts, Melo said. He could be entering a trend of convictions, and then arrest.
Brazils top electoral court has already ruled Bolsonaro ineligible to run for office until 2030, on the grounds that he abused his power during the 2022 campaign and cast unfounded doubts on the countrys electronic voting system.
Another investigation relates to his alleged involvement in the Jan. 8, 2023, uprising in the capital of Brasilia, soon after Lula took power. The uprising resembled the U.S. Capitol riot in Washington two years prior. Bolsonaro has denied wrongdoing in both cases.
Shor wrote that the indictment will be folded into the investigation of Jan. 8, which is being overseen by Supreme Court Justice Alexandre de Moraes. That justice authorized the unsealing of the indictment.
Four years after the start of the COVID-19 pandemic, researchers are continuing to make strides in their understanding of the relationship between the virus and dermatologic conditions, including psoriasis.
This week,Dermatology Timesis highlighting recent COVID-19 research affecting skin, hair, and nails. Recently-published studies have explored the relationship between COVID-19 infection and psoriatic disease severity, case reports of psoriasis onset and exacerbation following vaccination, and more. We review these studies below.
In one study, researchers investigated psoriasis flare-ups following COVID-19 vaccinations, examining 71 patients with a history of plaque psoriasis who experienced flare-ups post-vaccination.1 They also explored cases of new-onset psoriasis and modifications in psoriasis subtypes. The research delved into various factors including patient characteristics, vaccination details, and exposome traits such as sex, age, comorbidities, and UV exposure. Clinical manifestations aligned with traditional symptoms of psoriasis, with pustular psoriasis being the most frequently reported subtype modification. The study found no significant association between biological treatment and flare occurrence, and timing of flare-ups varied widely. Additionally, there was an analysis of psoriasis flare-ups following non-COVID-19 vaccinations, albeit with fewer cases identified.
In one systematic review, registered on PROSPERO, researchers investigated cases of psoriasis exacerbation or induced psoriasis post-COVID-19 vaccination.2 The review included research articles and correspondence reporting such cases, excluding active psoriasis cases. Through searches in PubMed, Google Scholar, and EBSCOHost until June 2022, 33 relevant articles were identified and analyzed. The included studies detail demographics, vaccine types, onset of psoriasis symptoms, comorbidities, and treatments. Most cases involved individuals with a history of psoriasis, with Pfizer being the most commonly associated vaccine. The onset of symptoms varied from 1 to 90 days post-vaccination, and treatments ranged from topical steroids to monoclonal antibodies, with notable clinical improvement observed in many cases.
Another study explored the rare but potentially life-threatening variant of psoriasis known as generalized pustular psoriasis (GPP) and its interaction with COVID-19 infection, a topic scarcely documented previously.3 The report presented 2 cases of individuals with GPP who experienced fatal outcomes following SARS-CoV-2 infection. The first case involved a 20-year-old male with a history of psoriasis vulgaris who experienced a sudden exacerbation of GPP leading to acute respiratory distress syndrome (ARDS) due to COVID-19 infection. Despite medical intervention, including methotrexate and acitretin treatment, the patient succumbed to the illness. The second case was a 52-year-old female with a history of GPP under treatment with acitretin and cyclosporine, who also developed ARDS following COVID-19 infection and passed away despite medical management. Both cases underscore the potential severity of COVID-19 infection in individuals with GPP and emphasize the importance of awareness among dermatologists regarding the heightened risk of mortality in such patients.
A study conducted at the Second Affiliated Hospital of Zhejiang University aimed to assess the impact of COVID-19 infection on patients with plaque psoriasis, particularly those treated with or without biologic agents.5 Involving 209 patients over 18 years old with confirmed SARS-CoV-2 infection, the research categorized participants into non-biologics, ADA, IXE, and SEC treatment groups. Analysis of demographic data, treatment history, and PASI scores before and after COVID-19 infection revealed a significant increase in median PASI scores across all groups post-infection, indicating exacerbated psoriasis severity. Notably, patients treated with IXE demonstrated a lower likelihood of psoriasis exacerbation following COVID-19 infection compared to those on other biological agents. Additionally, serum analysis showed that biological agents, including ADA, SEC, and IXE, suppressed serum OAS2 and OAS3 levels while elevating OAS1 levels, potentially contributing to the protective effect against psoriasis exacerbation.
A population-based multicenter study investigated the incidence of COVID-19, medical interventions, and COVID-19-associated mortality among patients with psoriasis from December 2022 to February 2023 across 6 hospitals in China.6 Patients receiving psoriasis treatment were included, with those undergoing immunosuppressive therapy for reasons other than psoriasis excluded. Data on COVID-19 diagnoses, interventions, and mortality were collected, along with patient characteristics and treatment details. Statistical analysis revealed significant associations between treatment types, COVID-19 incidence, and outcomes. Specifically, IL-23 inhibitor treatment showed a decreased risk of COVID-19 compared to other treatments, with patients experiencing fewer symptoms and lower COVID-19 mortality. Outdoor work was associated with reduced COVID-19 risk, while vaccination status did not significantly correlate with infection rates. Additionally, patients with other allergic diseases exhibited lower COVID-19 risk.
References
Covid-19 investigations
Former president allegedly inserted false information into public health database to make it appear he received Covid vaccine
Staff and agencies in So Paulo
Tue 19 Mar 2024 10.57 EDT
Brazils federal police have accused Jair Bolsonaro of criminal association and falsifying his own Covid-19 vaccination data, marking the first indictment for the embattled far-right leader with others potentially in store.
The supreme court on Tuesday released the polices indictment which alleges Bolsonaro and 16 others inserted false information into the public health database to make it appear as though the former president, his 12-year-old daughter and several others in his circle had received the Covid-19 vaccine.
During the pandemic, Bolsonaro was one of the few world leaders railing against the vaccine, openly flouting health restrictions and encouraging society to follow his example. His administration ignored several emails from the pharmaceutical company Pfizer offering to sell Brazil tens of millions of shots in 2020 and openly criticized a move by So Paulo states then governor, Joo Doria, to buy vaccines from the Chinese company Sinovac when no jabs were otherwise available.
Brazils prosecutor-generals office will have the final say on whether to use the police indictment to file charges against Bolsonaro at the supreme court. It stems from one of several investigations targeting Bolsonaro, who governed between 2019 and 2022.
The former president reiterated that he had not taken the Covid-19 vaccine and said he was calm. Its a selective investigation. Im calm, I dont owe anything, Bolsonaro told Reuters. The world knows that I didnt take the vaccine.
Police accuse Bolsonaro and his aides of tampering with the health ministrys database shortly before he traveled to the US in December 2022, two months after he lost his re-election bid to Luiz Incio Lula da Silva.
Bolsonaro needed a certificate of vaccination to enter the US, where he remained for the final days of his term and the first months of Lulas term.
If convicted for falsifying health data, the 68-year-old politician could spend up to 12 years behind bars, and as little as two years, according to legal analyst Zilan Costa. The maximum jail time for a charge of criminal association is four years, he said.
Bolsonaro retains staunch allegiance among his base, as shown by an outpouring of support last month, with an estimated 185,000 people clogging So Paulos main boulevard to decry what they and the former president characterize as political persecution.
Brazils top electoral court has already ruled Bolsonaro ineligible until 2030, on the grounds that he abused his power during the 2022 campaign and cast unfounded doubts on the countrys electronic voting system.
Other investigations include one seeking to determine whether Bolsonaro tried to sneak two sets of expensive diamond jewelry into Brazil and prevent them from being incorporated into the presidencys public collection. Another relates to his alleged involvement in the 8 January 2023 uprising in the capital, Braslia, soon after Lula took power, that resembled the Capitol riot in Washington two years earlier. He has denied wrongdoing in both cases.
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A new analysis of data in Influenza and Other Respiratory Viruses finds that the incidence of COVID-19 hospitalization is more than double among patients with any psychiatric disorder compared to adults with no psychiatric disorder.
The longitudinal study is based on electronic health records collected from four health systems and research centers in Indiana, Oregon, Texas, and Utah that partner with the Centers for Disease Control and Prevention (CDC). The study follow-up period lasted from December 2021 to August 2022, after both widespread vaccination campaigns and the Omicron variant became features of the pandemic in the United States.
Among the 2,436,999 adults included in the study, the median age was 47. Women composed 58.3% of the sample, 66.1% were White, 12.9% were Black, 12.0% were Hispanic, and 3.6% were Asian. Among participants, 41.6% were unvaccinated, 35.7% had received two doses, and 22.7% had received three doses.
A total of 538,034 adults had any psychiatric disorder, including 13.6% with anxiety disorders, 12.9% with mood disorders, 3.1% with trauma or stressor-related disorders, 1.9% with attention-deficit hyperactivity disorders, and 1.0% with psychotic disorders.
Adults with psychiatric disorders were hospitalized at a rate of 394 per 100,000 person-years, compared with a rate of 156 per 100,000 person-years for those without psychiatric disorder.
Psychiatric disorder was a significant predictor of COVID-19-associated hospitalization (adjusted hazard ratio, 1.27; 95% confidence interval, 1.18 to 1.37). Mood disorders, anxiety, and psychotic disorders were most associated with hospitalization.
Adjusted hazard ratios for hospitalization among vaccinated and unvaccinated adults with or without psychiatric disorders was the same.
The relative protection associated with mRNA vaccination was similar irrespective of psychiatric disorder status.
"The relative protection associated with mRNA vaccination was similar irrespective of psychiatric disorder status, underscoring the benefit of COVID-19 vaccination in this population," the authors concluded.
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