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BackgroundThere has been considerable international variation in mortality during the COVID-19 pandemic. The objective of this study was to investigate the differences between mortality registered as due to COVID-19 and the excess all-cause mortality reported in countries worldwide during the COVID-19 pandemic.MethodsEcological analysis of 22 countries compared five-year historical all-cause mortality, reported all-cause mortality and expected all-cause mortality (calculated as the historical mortality plus the reported deaths attributed to COVID-19). Data available from the first week of January 2020 to that most recently available were analysed.ResultsCompared to the preceding five years, there was an excess of 716 616 deaths of which 64.3% were attributed to COVID-19. The proportion of deaths registered as COVID-19 related/excess deaths varied markedly between countries, ranging between 30% and 197% in those countries that had an excess of deaths during the period of observation. In most countries where a definite peak in COVID-19 related deaths occurred, the increase in reported all-cause mortality preceded the increase in COVID-19 reported mortality. During the latter period of observation, a few countries reported fewer all-cause deaths than the historical figures.ConclusionThe increases in all-cause mortality preceded the increase in COVID-19 mortality in most countries that had definite spikes in COVID-19 mortality. The number of deaths attributed to COVID-19 was underestimated by at least 35%. Together these findings suggest that calculation of excess all-cause mortality is a better predictor of COVID-19 mortality than the reported rates, in those countries experiencing definite increases in mortality.

The increased risk of falls associated with advancing age has increased demand for methods to improve balance and mobility. The primary purpose of the study was to determine whether wearing Aqua Titan-treated stockings could improve balance and walking performance in an older population; secondary was to elucidate the mechanisms. In a randomized, double-blind crossover, 16 healthy older adults (age, 67.9 ± 4.2 years; BMI, 24.8 ± 3.1 kg/m2) performed two 4-day trials composed of baseline measures and fatiguing exercise on Day 1, with recovery measures at 14, 38 and 62 h post-exercise, wearing Aqua Titan and control stockings. Balance, walking performance, triceps surae stretch reflex, ankle range of motion and gastrocnemius muscle microvascular perfusion, blood flow and oxygen consumption were measured at baseline and during recovery. Aqua Titan had no effect on the microvascular parameters, but increased total ankle range of motion at 38 h (2.4°; 95% CI ± 1.8°) and 62 h (2.7°; ±1.7°), contributed to by increases in dorsiflexion and plantar flexion. There was decreasing persistence in the medial-lateral center of pressure movement at 38 h (q = 0, −0.0635 ± 0.0455), compared to control stockings. Aqua Titan garments hold potential for improving balance and mobility in older adults in the days following a bout of fatiguing exercise. The proposed mechanisms associated with enhanced sensory feedback require further exploration.

The aim of this study was to investigate the effects of acute vibration exercise, at 2 different frequencies, on upper body power output. Muscle activity (EMG) and upper-body peak power was measured in 12 healthy males during ballistic bench press throws at 30% of 1-repetition maximum on a Smith machine. Measures were made prior to, 30 s and 5 min after one of 3 conditions performed for 30 s in a press-up position: side-alternating vibration at 20 Hz, 26 Hz and no vibration. EMG was recorded in the anterior deltoid, triceps brachii and pectoralis major during ballistic bench press throws as well as during application of each condition. While peak power output was higher at 5 min post condition across all conditions, compared to baseline measures (P<0.05), only 20 Hz vibration resulted in a significant increase in peak power output (P<0.05) compared to no vibration. EMG was greater during both vibration conditions, compared to no vibration (P<0.001). However, this difference was not evident during bench press throws when no difference was seen in muscle activity between conditions. These findings suggest that 20 Hz vibration has an ergogenic effect on upper-body power that may be due to peripheral, rather than central, mediated mechanisms.

ObjectiveTo compare bronchodilator response after to salbutamol and budesonide/formoterol in adults with stable asthma.MethodsA double-blind, cross-over, single-centre, placebo-controlled, non-inferiority trial. Adults with stable asthma were randomised to different orders of two treatment regimens: two actuations of placebo via MDI and one actuation of budesonide/formoterol 200/6 µg via turbuhaler; and one actuation of placebo turbuhaler and two actuations of salbutamol 100 µg via MDI. The primary outcome measure was FEV1 after 2 min. Secondary outcome measures included FEV1, mBorg Dyspnoea Scale score and visual analogue score for breathlessness over 30 min.ResultsForty-nine of 50 potential participants were randomised. One participant withdrew following the first intervention visit and another could not be randomised due to COVID-19 restrictions. The mean (SD) change from baseline FEV1 2 min after treatment administration for budesonide/formoterol and salbutamol was 0.08 (0.14) L, n=49, and 0.17 (0.18) L, n=48, respectively, mean (95% CI) paired difference of −0.097 L (−0.147 to −0.047), p=0.07, against a non-inferiority bound of −0.06 L. In the secondary analysis, FEV1 over 30 min was lower for budesonide/formoterol compared with salbutamol, difference (95% CI): −0.10 (−0.12 to −0.08) L, p<0.001. There were no differences in Visual Analogue Scale score or mBorg Dyspnoea Scale score between treatments.ConclusionThe results do not support the primary hypothesis of non-inferiority at the boundary of −0.06 L for the difference between budesonide/formoterol 200/6 µg compared with salbutamol 200 µg for FEV1 at 2 min, and could be consistent with inferiority with a p value of 0.07. For the secondary analysis of FEV1 measurements over time, the FEV1 was higher with salbutamol.Trial registration numberAustralian and New Zealand Clinical Trials Registry (ACTRN 12619001387112).