Today's clinicians must not only do a good job in treating diseases and saving people, but also do a good job in medical research and publish academic papers, so as to achieve both theoretical and practical blessings. Clinicians have patient resources and a wealth of clinical data, and if they can be used well, they can easily publish high-quality academic papers.
Today, through an article just published in the sub-journal of The Lancet, a top medical journal, I will talk about how to publish high-quality academic papers using clinical case data.
Research background
Post-re-infection after primary SARS-CoV-2 infection is uncommon in adults, but the risks, characteristics, and severity of re-infection are poorly understood in children. By analyzing national test data from the UK, the researchers assessed the risk of SARS-CoV-2 reinfection in children and compared it with the risk in adults.
Research methodology
This article presents a prospective study of CHILDREN re-infected with SARS-CoV-2 in the UK, which is a type of observational study in clinical studies, i.e. follow-up observation of a group of participants for a period of time from the beginning of the study and collection of data during the study period. In this study, data from children under 16 years of age who met the criteria for reinfection were included.
Using test data from at least 90 days after primary infection with SARS-CoV-2 from 2020.1.27 -2021.7.31, the authors assessed the difference in the proportion of primary infection cases and re-infected cases without any symptoms at the time of detection by a simple χ2 test, and linked reinfection cases to UK National Hospital admission data, intensive care admission data and death registration datasets to assess disease severity.
Research results
During the surveillance period from 2020.1.27-2021.7.31, primary infection cases were fewer in the summer of 2020, then increased from the end of August before the start of the autumn semester and peaked at the end of December 2020, before which, from mid-November 2020, α variants emerged and spread rapidly across the UK (Figure 1).
Figure 1. Cumulative weekly count of SARS-CoV-2 primary infections eligible for re-infection in children under 16 years of age in the UK (90 days apart), weekly count or primary infection (multiplied by 10), weekly count or possible cases of reinfection
Among children, in the week beginning on July 12, 2021, there was an age-related gradient, with the lowest rate of re-infection in children under 5 years of age, at 0-9 per 100,000 population, compared with 1-9 per 100,000 population for children aged 5-11 years and 5-5 per 100,000 population for children aged 12-16 years. These rates are 23,11-fold and 4 times lower than among adults aged 20-29 years, who are unvaccinated and have the highest rates of re-infection at the time (Figure 2).
Figure 2.Weekly incidence of possible SARS-CoV-2 cases per 100,000 people in children of different age groups
During the 19-month surveillance period (2020.1-2021.7), the rate of primary childhood infection in infants (less than 1 year old) was higher than that of those aged 1 and 2 years, and then increased with age until the age of 16 years (Figure 3). However, infants had the lowest rate of re-infection (23 cases), and the rate of re-infection among people aged 1-6 years remained low, averaging 43 cases per group, and then as they age, the 16-year-old population reached 364 cases (Figure 3).
Figure 3. 2020.1.27-2021.7.31Total cases of SARS-CoV-2 suspected reinfection and the rate of primary SARS-CoV-2 infection by age group
In the UK, primary infections in children began to increase in February 2020, with the first child re-infection detected in late July 2020. By the end of July 2021, there were 688418 primary infections and 2343 re-infected children under the age of 16 in the UK. There were no differences in gender and ethnicity between primary and secondary infections (Table 1).
Table 1. Demographic characteristics of primary SARS-CoV-2 infection and reinfection cases in children under 16 years of age in the UK
The total rate of re-infection during this period was 66-88 per 100,000 population, with adults (72-53 per 100,000 population) higher than children (21-53 per 100,000 population). The rate of re-infection after primary infection during the same period is 0-68 per 100 primaryly infected people, 0-73 per 100 primaryly infected adults, and 0-34 per 100 primaryly infected children. Figure 4 summarizes the rate of reinfection by age group.
Figure 4. 2020.1.27-2021.7.31The rate of laboratory-confirmed re-infection by age group is 95%
Conclusions of the study
The risk of SARS-CoV-2 reinfection is closely related to the rate of infection in the community, especially during δ variants. Children have a lower risk of reinfection than adults, but reinfection is not associated with a more serious illness or fatal outcome.
Summarize the analysis
By analyzing the feasibility, innovation and importance of the study, Xiaobian introduces the reference and guidance significance for clinical researchers.
Feasibility studies
In terms of study feasibility: on the one hand, the researchers focused on the current COVID-19 pandemic, recognized the inadequacy of research on child re-infection with SARS-CoV-2, and identified English publications related to SARS-CoV-2 re-infection from January 1, 2020 to November 15, 2021 by searching on PubMed with keywords such as "COVID-19" or "SARS-CoV-2" and "re-infection", No clinical studies of data on child reinfection were found, making the theory feasible.
On the other hand, researchers can make it practical to obtain data and analyse the risk, characteristics and severity of SARS-CoV-2 re-infection in children by retrieving all COVID-19 positive diagnostic test results in the UK and clinical pathology data in a nationwide inpatient electronic database.
Reference significance for clinical researchers: In the determination of clinical research topics, we clinical researchers or doctors may not focus on pandemic diseases like the new crown, but lock in the diseases of interest and some problems found in the clinic, and then determine the research topics through literature retrieval, combined with the feasibility of considering the clinical pathological data of the disease, so that the research is fully feasible and clinically instructive, so as to determine the research topic.
Research innovation
In terms of research innovation: Although the overall data of this study is only a simple data statistics and analysis of the data of children re-infected with SARS-CoV-2 over a period of time, a more detailed classification of data analysis has been made. The test data in the study were derived from children aged 0-16 years and compared with adult data; the test range covered the entire UK region, and the sample size was sufficient, which fully reflected the disease characteristics of child re-infection with SARS-CoV-2. In addition, the study also broke down the data on child re-infection, and analyzed and compared the differences in the rate of child re-infection in different age groups.
Reference significance for clinical researchers: In the collection and analysis of clinical case data, on the basis of the identified disease diseases, the research content and detection indicators can be refined by fully considering the factor characteristics of the research object (children or adults) from the characteristics of the disease itself, so that the study design is rigorous and disease-specific.
Research importance
In terms of the importance of the study: there is no need to say more about it here, I think everyone knows that this study of SARS-CoV-2 reinfection disease in children in the United Kingdom fills the shortcomings of relevant research, and interprets the detection data of SARS-CoV-2 re-infection in children according to the different variants of the virus in the United Kingdom and the local epidemic prevention policy and social environment in the United Kingdom, so that the study has important clinical guidance significance in terms of timeliness and application.
Here, what Xiaobian wants to say is that clinical research has no size, and it is a very important and innovative research to be meticulous and rigorous from scratch. If you want to expand the important impact of the research, either fully refine and increase the depth in the research indicators, or continuously expand and increase the breadth of the research object, so that the research data is more sufficient and rigorous, it is a very good clinical research work!
Returning to the theme, Xiaobian takes you to interpret a clinical research paper of Lancet, and roughly introduces the process of selecting an academic paper from topic selection, research and analysis, hoping to be of certain help to the majority of clinical researchers. Finally, I also wish you all the best in publishing more medical cattle journals as you wish!
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备注：图文均摘自Anna A Mensah, Helen Campbell, Julia Stowe, GiuliaSeghezzo, et al. (2022). Risk of SARS-CoV-2 reinfections in children: aprospective national surveillance study between January, 2020, and July, 2021,in England.https://doi.org/10.1016/S2352-4642(22)00059-1
Written by: Zhao Khanqing
Editor: Elementary school student under Luojia Mountain
Reviewed: Dr. Yongli Gao
Please contact the Metz Academic Administrator for matters such as authorized reprinting