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This study examined the association of perceived discrimination related to COVID-19 with psychological distress in healthcare workers in the Colombian Caribbean region. The authors designed and conducted a cross-sectional study, recruiting a non-probabilistic sample by email or instant messaging. Participants filled out a questionnaire including scales for perceived discrimination, anxiety, depression, perceived stress related to COVID-19, and suicide risk. Healthcare workers (n = 150) aged 18 to 68 years participated; of these, 72% were women, and the breakdown by occupation was 39.3% nursing assistants, 18.0% nurses, and 42.7% physicians. Perceived discrimination scores showed positive correlations with depressive symptoms among nursing assistants and physicians (rs = 0.34), and suicide risk in nursing assistants (rs = 0.35) and physicians (rs = 0.31). Among nurses, all measurements were independent of perceived discrimination. Nursing assistants scored highest in perceived discrimination. Physicians scored higher for COVID-19 perceived stress than nursing assistants, and nurses showed similar scores to physicians. In conclusion, perceived discrimination is related to depressive symptoms and suicide risk among nursing assistants and physicians. Nursing assistants report more perceived discrimination than nurses and physicians.We report a real-world evaluation of the first commercially approved automated insulin delivery (AID) system, MiniMed 670G (670G), and open source-automated insulin delivery (OS-AID) systems. This was undertaken as a retrospective observational study in adults with type 1 diabetes using AID systems for 6 months or longer in a publicly funded health service using clinically validated data. Sixty-eight adults (38 670G, 30 OS-AID systems) were included. OS-AID system users were younger, had a shorter diabetes duration and a higher education status. OS-AID systems displayed a significantly better change in HbA1c (median -0.9% [-0.4%, -1.1%] vs. -0.1% [IQR -0.7%, 0.2%], P = .004) and time in range 3.9-10 mmol/L (mean 78.5%, SD ± 12.0% vs. 68.2% ± 14.7%, P = .024) compared with 670G. Both systems showed minimal hypoglycaemia, with OS-AID systems revealing significantly improved secondary outcomes of mean glucose and percentage of time more than 10 mmol/L, with a higher percentage of time of less than 3 mmol/L. OS-AID system users displayed improved glycaemic outcomes with no clinical safety concerns compared with 670G, although higher weight-adjusted insulin dose and weight gain were noted. The study highlights key differences in OS-AID system user characteristics that are important for interpreting real-world findings from recent OS-AID system studies.
The alcohol harm paradox (AHP) posits that disadvantaged groups suffer from higher rates of alcohol-related harm compared with advantaged groups, despite reporting similar or lower levels of consumption on average. The causes of this relationship remain unclear. This study aimed to identify explanations proposed for the AHP. Secondary aims were to review the existing evidence for those explanations and investigate whether authors linked explanations to one another.

This was a systematic review. We searched MEDLINE (1946-January 2021), EMBASE (1974-January 2021) and PsycINFO (1967-January 2021), supplemented with manual searching of grey literature. Included papers either explored the causes of the AHP or investigated the relationship between alcohol consumption, alcohol-related harm and socio-economic position. Papers were set in Organization for Economic Cooperation and Development high-income countries. Explanations extracted for analysis could be evidenced in the empirical results or suggested by researchers in their narrative. Inductive thematic analysis was applied to group explanations.

Seventy-nine papers met the inclusion criteria and initial coding revealed that these papers contained 41 distinct explanations for the AHP. Following inductive thematic analysis, these explanations were grouped into 16 themes within six broad domains individual, life-style, contextual, disadvantage, upstream and artefactual. Explanations related to risk behaviours, which fitted within the life-style domain, were the most frequently proposed (n=51) and analysed (n=21).

While there are many potential explanations for the alcohol harm paradox, most research focuses on risk behaviours while other explanations lack empirical testing.
While there are many potential explanations for the alcohol harm paradox, most research focuses on risk behaviours while other explanations lack empirical testing.
Vericiguat reduced the primary composite outcome of cardiovascular death or heart failure (HF) hospitalization in patients with worsening HF with reduced ejection fraction (HFrEF) and a lower limit of baseline estimated glomerular filtration rate (eGFR) of 15 mL/min/1.73 m
. We evaluated the relationship between the efficacy of vericiguat and baseline and subsequent changes in renal function.

In VICTORIA, core laboratory serum creatinine was measured at baseline (n=4956) and weeks 16, 32, and 48. Worsening renal function (WRF), defined as an increase ≥0.3mg/dL in creatinine from baseline to week 16, was assessed via a Cox model with respect to subsequent primary events. APR-246 Mean age was 69 years, 24% were female, and mean baseline eGFR was 61 mL/min/1.73 m
. During 48 weeks of treatment, the trajectories in eGFR and creatinine with vericiguat were similar to placebo (P=0.50 and 0.18). The beneficial effects of vericiguat on the primary outcome were not influenced by baseline eGFR (interaction P=0.48). WRF occurred in 15% of patients and was associated with worse outcomes (adjusted hazard ratio 1.28, 95% confidence interval 1.11-1.47; P < 0.001), but the beneficial effects of vericiguat on the primary outcome were similar in patients with or without WRF (interaction P=0.76).

Renal function trajectories were similar between vericiguat- and placebo-treated patients and the beneficial effects of vericiguat on the primary outcome were consistent across the full range of eGFR and irrespective of WRF.
Renal function trajectories were similar between vericiguat- and placebo-treated patients and the beneficial effects of vericiguat on the primary outcome were consistent across the full range of eGFR and irrespective of WRF.
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