Introduction Little is known about the role played by anticoagulants in COVID-19.Objective The aim of this study was to assess the impact of previous anticoagulant treatment on risk of hospitalization due to COVID-19, progression to severe COVID-19 and susceptibility to COVID-19 infection. Methods We conducted a multiple population-based case-control study in northwest Spain, in 2020, to assess (1) risk of hospitalization: cases were all patients admitted due to COVID-19 with PCR confirmation, and controls were a random matched sample of subjects without a positive PCR; (2) progression: cases were hospitalized COVID-19 subjects, and controls were all non-hospitalized COVID-19 patients; and (3) susceptibility: cases were patients with a positive PCR (hospitalized and non-hospitalized), and the controls were the same as for the hospitalization model. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using a generalized linear mixed model. ResultsThe consumption of antivitamin K and direct-acting anticoagulants apparently was not associated with the risk of progression to severe COVID-19 (OR 0.93 [95% CI 0.74-1.17] and OR 1.04 [95% CI 0.79-1.36], respectively). Antivitamin K anticoagulants were associated with a significantly lower risk of hospitalization (OR 0.77 [95% CI 0.64-0.93]), which, in part, can be explained by a decreased risk of susceptibility to infection (OR 0.83 [95% CI 0.74-0.92]). The use of direct-acting anticoagulants was not associated with the risk of hospitalization, although it also seems to decrease susceptibility (OR 0.85 [95% CI 0.74-0.98]). It has also been observed that low-molecular-weight heparins were associated with an increased risk of progression to severe COVID-19 (OR 1.25 [95% CI 1.01-1.55]). ConclusionThe results of this study have shown that antivitamin K anticoagulants and direct-acting anticoagulants do not increase the risk of progression to more severe stages. Antivitamin K consumption was associated with a lower risk of hospitalization and susceptibility to infection.

Background: Vaccine hesitancy decreases adult vaccination coverage and has been recognized by WHO as a major health threat. Primary care physicians (PCP) play a key role in vaccination by giving vaccine counselling to their patients. The aim of this systematic review is to identify the knowledge, beliefs, attitudes and barriers (KBAB) associated with own vaccination and patient recommendation in primary care physicians. Methods: MEDLINE/PubMed, EMBASE and Cochrane Library databases were used to search and identify relevant studies based on their title and abstract. In the next step, the full text of each previously selected article was read for eligibility. Articles were selected by two independent reviewers and data extraction was performed using tables. The following information was extracted: methodological characteristics, demographic factors, professional characteristics, and intrinsic or extrinsic factors influencing vaccination or recommendation. Results: Our search yielded 41 eligible papers, data-sources, previous practices, belief in the effectiveness or safety of the vaccine, perceived risk, and trust in health authorities were all shown to be related to own vaccination and patient recommendation. Conclusion: Internet is the main source of information for PCP related to vaccine hesitancy. It is therefore essential to increase the presence and access to pro-vaccination content in this area. In addition, involving PCP in the establishment of vaccination recommendations could improve their credibility in the institutions. On the other hand, training in communication skills and establishing reminder systems could reflect higher vaccination coverage among their patients.

Background Readmissions in anorexia nervosa (AN) are a common though understudied outcome. No organic alterations have been related to the likeliness of readmission to date. This study evaluated clinical and laboratory alterations associated to the risk of AN-related hospital readmissions in children and adolescents. Methods A prospective study was performed with every person ≤18 years old admitted due to AN destabilization to the Eating Disorder Ward of a freestanding children's hospital in Madrid (Spain) from November 2018 to October 2019. Both subtypes of AN were included. The participants were evaluated upon admission, at discharge and six months after discharge. T-tests or Mann-Whitney U tests were used for means comparison. Pearson or Spearman correlations were used for measuring the association between two variables. Logistic regression models were developed to evaluate the relationship between scoring methods and readmission. Results 154 persons were admitted during the study period. 131 met the inclusion criteria. Median age was 15.1 years (interquartile range 13.5-16.4). 71% of participants were malnourished at admission. 33 participants (25 %) had been previously admitted due to an eating disorder. Remarkable venous pH decrease and pCO2 elevation remained stable during the follow-up period. Hypercarbia at discharge was associated with readmission being twice more likely. The odds of readmission increased as discharge pCO2 rose. These findings did not depend on the AN subtype or the participant sex. Electrolytes persisted within the normal range. Conclusions Hypercarbia and respiratory acidosis are common alterations in children and adolescents hospitalized due to AN destabilization. Hypercarbia persists for at least 6 months after discharge, despite clinical improvement, and is associated with higher odds of readmission. This is the first study to identify a laboratory alteration as a potential indicator of readmission in AN. Further research is needed to fully understand the consequences of hypercarbia on people diagnosed of AN.