The transmission of SARS-CoV-2 leads to devastating COVID-19 infections around the world, which has affected both human health and the development of industries dependent on social gatherings. Sports events are one of the subgroups facing great challenges. The uncertainty of COVID-19 transmission in large-scale sports events is a great barrier to decision-making with regard to reopening auditoriums. Policymakers and health experts are trying to figure out better policies to balance audience experiences and COVID-19 infection control. In this study, we employed the generalized SEIR model in conjunction with the Wells–Riley model to estimate the effects of vaccination, nucleic acid testing, and face mask wearing on audience infection control during the 2021 Chinese Football Association Super League from 20 April to 5 August. The generalized SEIR modeling showed that if the general population were vaccinated by inactive vaccines at an efficiency of 0.78, the total number of infectious people during this time period would decrease from 43,455 to 6,417. We assumed that the general population had the same odds ratio of entering the sports stadiums and becoming the audience. Their infection probabilities in the stadium were further estimated by the Wells–Riley model. The results showed that if all of the 30,000 seats in the stadium were filled by the audience, 371 audience members would have become infected during the 116 football games in the 2021 season. The independent use of vaccination and nucleic acid testing would have decreased this number to 79 and 118, respectively. The combined use of nucleic acid testing and vaccination or face mask wearing would have decreased this number to 14 and 34, respectively. The combined use of all three strategies could have further decreased this number to 0. According to the modeling results, policymakers can consider the combined use of vaccination, nucleic acid testing, and face mask wearing to protect audiences from infection when holding sports events, which could create a balance between audience experiences and COVID-19 infection control.
Introduction Obesity is a major comorbidity that compounds the health consequences of diabetes. Effective weight control through behavior modification is an effective component for diabetic management, and can easily be counseled and implemented through primary care visits. Setting self-management Support (SMS) goals, which incorporates the needs, goals, and life experiences of patients, may improve clinical outcomes, health status, and quality of life. We hypothesized that setting SMS goals in primary care visits empowers diabetic patients to lose weight. Methods A chart review was conducted on a total of 205 diabetic patients. SMS goals of weight-control plan (diet and/or exercise) were incorporated into patients’ electronic medical records. A total of 115 (56%) patients included SMS goals in their treatment plan, and 90 (44%) patients did not contain SMS goals. Body weights of these patients were assessed at baseline and after 6 months of follow up. Results 35 (17 %) diabetic patients were overweight and 152 (74 %) were obese in our practice. During 6 months of follow up, 64/115 (56%) patients with SMS goals documented lost weight ( ≥ 5 lb weight loss), compared to 9/31 (29 %) in patients with no SMS goal set. When comparing effect of diet only with the combination of diet and exercise, we found that 47/73 (64 %) patients with the combination SMS goal settings lost weight, while only 17/42 (40 %) of patients with the diet only SMS plans lost body weight. Discussion Our study highlights the importance of educating patients to maintain physical activity and healthy diet, but more importantly shows that empowering patients to agree upon and be active in goal setting is a powerful tool for disease management. Setting SMS goals may assist providers in giving patients their self-defined circle of support, so that patients can manage their conditions on a daily basis, and develop the confidence to sustain healthy behaviors for a lifetime. In addition, SMS goal-setting and progress-monitoring during each encounter help providers to assess the motivation and engagement of patients for behavior modification. Last, the dynamic physician-patient relationship during goal setting and assessment facilitates patient compliance and eventually successful weight loss.
4665 Introduction: Multiple sclerosis (MS) is an autoimmune inflammatory and chronic demyelinating disease. Occurrence of hypercoagulable states and breast cancer in patients with multiple sclerosis (MS) has not been extensively reported. We report a case of a female MS patient with recurrent DVTs, elevated factor VIII levels, and advanced breast cancer with aggressive biologic phenotypes. Case report: A 45-year-old Caucasian female with a history of MS had a breast mass diagnosed on a screening mammogram. She was diagnosed with right breast carcinoma (2.5 × 2.5 × 1.6 cm), T2 N3 M0, which correlated to stage IIIC. She underwent a right modified radical mastectomy with 16/25 lymph nodes involved, ER/PR status was positive, HER-2/neu 0 with high Ki67. Her post-surgery treatment plan included 4 cycles of Cyclophosphamide and Taxotere chemotherapy. She also received chest wall radiation as well as tamoxifen and aromatase inhibitor (Femara) therapy. The patient had never been on hormone replacement therapy or oral contraceptives. She had bilateral salpingo-oophorectomy and hysterectomy and pathology was unremarkable. Patient was diagnosed with Multiple Sclerosis at age 27. She was treated with intermittent courses of steroids, Interferon b-1b, Interferon b-1a, and Mitoxantrone (MTX) for relapsing/remitting MS for several years until she developed left hemiparesis, hypoesthesias, and residual visual dysfunction that prompted her to start IVIG therapy and plasmapheresis. Past medical history presents recurrent DVT (in 2006) and elevations of coagulation factor VIII (355%). The patient also developed superior vena cava thrombosis in the presence of Lovenox and coumadin therapy. Discussion: Multiple sclerosis (MS) is an autoimmune inflammatory disease of the central nervous system, frequently complicated by devastating neurologic symptoms and progressive disability. Risks of DVT in bedridden or wheelchair-bound MS patients have been suggested. Previous studies show that the frequency of DVT in late-stage MS may be over 40%. Additionally, in MS patients without risk factors, it has been suggested with an autoimmune inflammatory disease that the inflammatory infiltration in MS plaques located close to small or medium-sized veins could have a role as well. The lumbar puncture could also be one of other thrombophilic factor in MS, since after dural puncture the decrease of cerebrospinal fluid pressure induces a rostrocaudal sagging effect with traumatic damage to the fragile venous endothelial wall and may trigger a venous vasodilatation with resultant stasis. Elevated factor VIII levels are a risk factor for venous thrombosis and may also be associated with the risk of arterial thrombosis in coronary heart disease. Studies show that factor VIII levels may be increased by chronic inflammation. However, elevated factor VIII levels in patients with MS have never been reported. There is no cure for MS, though there are several drugs such as immunomodulatory agents that can slow or stop its progress. However, current data show a small increased risk of breast cancer in women with MS. The size of the breast tumor was also larger for woman with MS. More specifically, the proportions of biologically aggressive phenotypes that can worsen the prognosis of breast cancer incrementally despite the biologic phenotype at diagnosis also were investigated in this group of patients. One hypothesis linking breast cancer and MS involves long-term use of immunomodulatory agents including IFNs and glatiramer. Immunomodulatory therapy may impart immune system alterations that promote enhancement of cancer cells’ ability to evade immune recognition and cancer metastasis by altering the body’s ability to conduce immunosurveillance. However, consistent with previous observations, this remains unexplained and warrants further attention. Conclusion: The Female patient with MS described in this article presents an example of recurrent DVT, Superior Vena Cava thrombosis, elevated factor VIII levels, and breast cancer with stage IIIC and biologically aggressive phenotypes. The authors concern is that there is an increased risk of hypercoagulation states and breast cancer development in patients with MS. The systematic application of long-term preventive DVT may be considered for this group of patients. Disclosures: No relevant conflicts of interest to declare.
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