Background Reduced mortality at 28 days in patients treated with corticosteroids was demonstrated, but this result was not confirmed by certain large epidemiological studies. Our aim was to determine whether corticosteroids improve the outcomes of our patients hospitalized with COVID-19 pneumonia. Methods Our retrospective, single centre cohort study included consecutive patients hospitalized for moderate to severe COVID-19 pneumonia between March 15 and April 15 2020. An early short course of corticosteroids was given during the second phase of the study. The primary composite endpoint was the need for mechanical ventilation or mortality within 28 days of admission. A multivariate logistic regression model was used to estimate the propensity score, i.e. the probability of each patient receiving corticosteroid therapy based on the initial variables. Results About 120 consecutive patients were included, 39 in the “corticosteroids group”, 81 in the “no corticosteroids group”; their mean ages (±SD) were 66.4 ± 14.1 and 66.1 ± 15.2 years, respectively. Mechanical ventilation-free survival at 28 days was higher in the “corticosteroids group” than in the “no corticosteroids group” (71% and 29% of cases, respectively, p < .0001). The effect of corticosteroids was confirmed with HR .28 (95%CI .10–.79), p = .02. In older and comorbid patients who were not eligible for intensive care, the effect of corticosteroid therapy was also beneficial (HR .36 (95%CI .16–.80), p = .01). Conclusion A short course of corticosteroids reduced the risks of death or mechanical ventilation in patients with moderate to severe COVID-19 pneumonia in all patients and also in older and comorbid patients not eligible for intensive care.

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RÉSUMÉL'étude des conséquences de la mondialisation sur la santé des populations est au coeur de la santé mondiale. Ce faisant, la mondialisation conditionne également la mise en oeuvre des projets de recherche et des interventions en santé mondiale, et les rapports sociaux inégalitaires qui s'y perpétuent. Le présent commentaire propose des réflexions sur des défis épistémologiques et politiques auxquels se confronte la santé mondiale. Celles-ci sont issues d'observations et de discussions pendant et après la Conférence canadienne sur la santé mondiale, tenue en novembre 2015. Durant cet événement, une volonté affirmée par la communauté internationale de promouvoir l'équité en santé pour tous et un meilleur partage des savoirs et des ressources au sein des partenariats s'est clairement exprimée. Ainsi, nous envisageons un avenir différent, plus intersectionnel et porteur d'espoir, en proposant une déconstruction de la biopolitique hégémonique des institutions du Nord, tout en mettant au coeur de nos actions les communautés et des partenariats francs, solides et susceptibles de perdurer. Pour ce faire, des pistes sont proposées. Celles-ci nous semblent essentielles à considérer, si l'on prône l'équité et la justice sociale et ce, en commençant par nos propres actions. Notre propos s'ancre dans les pratiques et les réflexions d'un groupe de candidates au PhD en santé publique, dans l'option en santé mondiale.MOTS CLÉS : santé mondiale; partenariat; partage des savoirs; justice sociale; intersectionnalité; biopolitiqueThe translation of the Abstract appears at the end of this article.Can J Public Health 2017;108 (4)

Prolonging survival in good health is a fundamental societal goal. However, the leading determinants of disability-free survival in healthy older people have not been well established. Data from ASPREE, a bi-national placebo-controlled trial of aspirin with 4.7 years median follow-up, was analysed. At enrolment, participants were healthy and without prior cardiovascular events, dementia or persistent physical disability. Disability-free survival outcome was defined as absence of dementia, persistent disability or death. Selection of potential predictors from amongst 25 biomedical, psychosocial and lifestyle variables including recognized geriatric risk factors, utilizing a machine-learning approach. Separate models were developed for men and women. The selected predictors were evaluated in a multivariable Cox proportional hazards model and validated internally by bootstrapping. We included 19,114 Australian and US participants aged ≥65 years (median 74 years, IQR 71.6–77.7). Common predictors of a worse prognosis in both sexes included higher age, lower Modified Mini-Mental State Examination score, lower gait speed, lower grip strength and abnormal (low or elevated) body mass index. Additional risk factors for men included current smoking, and abnormal eGFR. In women, diabetes and depression were additional predictors. The biased-corrected areas under the receiver operating characteristic curves for the final prognostic models at 5 years were 0.72 for men and 0.75 for women. Final models showed good calibration between the observed and predicted risks. We developed a prediction model in which age, cognitive function and gait speed were the strongest predictors of disability-free survival in healthy older people.Trial registrationClinicaltrials.gov (NCT01038583)

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