Background In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov ( NCT04381936 ). Findings Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding UK Research and Innovation (Medical Research Council) and National Institute of Health Research.

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ObjectivesTo identify the prevalence of knowledge of the current UK physical activity guidelines which were introduced in 2011 and prior physical activity guidelines (30 min on 5 days each week) within two large samples of UK adult's. To investigate whether knowledge of physical activity guidelines differs according to demographics such as ethnicity, age, education and employment status.DesignDescriptive cross-sectional study comparing two distinctive adult samples.SettingNational survey and online-administered survey conducted in England.ParticipantsThe 2007 Health Survey for England provides data on knowledge of physical activity guidelines from 2860 UK adults (56% women, 89% white, 63% under 45 years old). In 2013, an online survey was disseminated and data were collected from 1797 UK adults on knowledge of the most recent physical activity guidelines. The 2013 sample was 70% women, 92% white and 57% under 45 years old. All adults in both samples were >18 years old and without illnesses/disorders likely to restrict physical activity.Main outcomesKnowledge of physical activity guidelines in 2007 and 2013. Demographic correlates of knowledge of moderate-to-vigorous physical activity guidelines.Results18% of the 2013 sample accurately recalled the current physical activity guidelines compared with 11% of the 2007 sample who accurately recalled the previous guidelines. The differences in knowledge of physical activity guidelines existed for marital status, gender, age, education and employment status within both 2007 and 2013 samples (p<0.05). Men with lower education and employment status (unemployed including student and retired) and older adults were less likely to know physical activity guidelines (p<0.05). Knowledge of physical activity guidelines remained higher in the 2013 sample after controlling for demographic differences (p<0.05).ConclusionsDisadvantaged population groups are less knowledgeable about physical activity guidelines. Although knowledge of physical activity guidelines appears to have increased in recent years demographic disparities are still evident. Efforts are needed to promote health information among these groups.

BackgroundPhysical activity guidelines state that adults should engage in at least 150 min of moderate to vigorous physical activity (MVPA) per week to benefit health. A high proportion of adults in England fail to reach this target. Accurate knowledge of MVPA guidelines could influence the amount and quality of MVPA engaged in by adults. This study aimed to determine knowledge of the MVPA guideline within a large sample of working adults in England and identify individual and workplace-related predictors of knowledge.Methods10,992 adults completed an online survey which included questions on demographics, knowledge of the MVPA guideline and workplace predictors for physical activity. Multinomial logistic regression identified predictors of underestimating, overestimating or not knowing the MVPA guideline relative to accurately reporting the guideline for males and females separately.ResultsRespondents were 37 % male, 95 % White, 63 % with a degree or higher, and had a mean age of 38.9 ± 11 years. The MVPA guideline was accurately reported by 15 % of adults while 13.8 % overestimated, 8.9 % underestimated and 62.3 % failed to provide any estimate of the guideline. Low education predicted underestimation (females: OR = 0.36, 95 % CI 0.17, 0.80) and not knowing (males: OR = 0.37, 95 % CI 0.14, 0.96; females: OR = 0.36, 95 % CI 0.19, 0.69). Ethnicity was a significant predictor for females only (OR 3.55, 95 % CI 1.46, 8.63; OR 4.03, 95 % CI 1.58, 10.27; OR 3.73, 95 % CI 1.67, 8.33). Employer support for physical activity was a significant predictor of accurate knowledge of the MVPA guideline for both males (underestimation: OR = 0.63, 95 % CI 0.40, 1.00; ‘don’t know’: OR = 0.71, 95 % CI 0.51, 1.00) and females (overestimation: OR = 0.72, 95 % CI 0.53, 0.97; underestimation: OR = 0.66, 95 % CI 0.47, 0.92; ‘don’t know’: OR = 0.60, 95 % CI 0.47, 0.76).ConclusionsKnowledge of the MVPA guideline within working adults in England is low. Employers should play a role in using targeted strategies to increase knowledge as employer support-related factors may influence knowledge of the MVPA guideline. Employers who assert strategies to promote physical activity and encourage employees who have responsibility for promoting health to educate their colleagues may help improve the MVPA knowledge of their employees.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-015-0231-3) contains supplementary material, which is available to authorized users.

Aims The influence of the COVID-19 pandemic on attendance to out-of-hospital cardiac arrest (OHCA) has only been described in city or regional settings. The impact of COVID-19 across an entire country with a high infection rate is yet to be explored. Methods The study uses data from 8629 cases recorded in two time-series (2017/2018 and 2020) of the Spanish national registry. Data from a non-COVID-19 period and the COVID-19 period (February 1st–April 30th 2020) were compared. During the COVID-19 period, data a further analysis comparing non-pandemic and pandemic weeks (defined according to the WHO declaration on March 11th, 2020) was conducted. The chi-squared analysis examined differences in OHCA attendance and other patient and resuscitation characteristics. Multivariate logistic regression examined survival likelihood to hospital admission and discharge. The multilevel analysis examined the differential effects of regional COVID-19 incidence on these same outcomes. Results During the COVID-19 period, the incidence of resuscitation attempts declined and survival to hospital admission (OR = 1.72; 95%CI = 1.46–2.04; p < 0.001) and discharge (OR = 1.38; 95%CI = 1.07–1.78; p = 0.013) fell compared to the non-COVID period. This pattern was also observed when comparing non-pandemic weeks and pandemic weeks. COVID-19 incidence impinged significantly upon outcomes regardless of regional variation, with low, medium, and high incidence regions equally affected. Conclusions The pandemic, irrespective of its incidence, seems to have particularly impeded the pre-hospital phase of OHCA care. Present findings call for the need to adapt out-of-hospital care for periods of serious infection risk. Study registration number ISRCTN10437835.

Physical activity, body mass index, and adherence to the Mediterranean diet are important components to consider when targeting improvements in the health-related quality of life of adolescents, with physical activity representing the component with the greatest influence.