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The NSW Government is investing $6 million over three years as part of the 2020-21 NSW Budget to establish 12 Community Wellbeing Collaboratives in communities at high risk of suicide.The collaboratives organise the response from all services in the local area in times where do i get propecia of need bringing together doctors, nurses, police, ambulance, media, teachers, parents, carers, Aboriginal organisations and local councils.Treasurer Dominic Perrottet said the funds would be directed to organisations including headspace and Lifeline, which will lead the coordination.“The NSW Government is investing in our people and our future, and we know this starts with providing quality services for everyone in NSW,” Mr Perrottet said.“The unique innovative collaborative model will use data identified from schools and local services to develop this grassroots approach to suicide prevention.”The Community Wellbeing Collaboratives will engage young people and adults, including people with a lived experience of mental illness and suicide.In the event of a suicide cluster, the collaboratives will coordinate a rapid response from the ground up.Minister for Mental Health, Regional Youth and Women Bronnie Taylor said the collaboratives would work with the community even when there wasn’t a crisis, to continually engage with local people and provide information to parents, teachers, carers and young people about mental health.“We know the majority of mental health care is delivered in the community, which is why we’re embedding both proactive and reactive layers of support outside the hospital setting, in the places where people live their lives every day,” Mrs Taylor said.“Evidence tells us that the best response to suicide comes from a local grass roots level. They know what works best for their communities and ultimately this program will allow us to better support young people and their families during the propecia and beyond.”This $6 million investment for the Community Wellbeing Collaboratives brings total funding committed to Towards Zero Suicides initiatives to $90 million.If you, or someone you know, where do i get propecia is thinking about suicide or experiencing a personal crisis or distress, please seek help immediately by calling 000 or one of these services:Lifeline 13 11 14Suicide Call Back Service 1300 659 467NSW Mental Health Line 1800 011 511.

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August 28, propecia alternative 2020 How to buy viagra online 2020Contact. Office of CommunicationsPhone. 202-693-1999U.S. Department of Labor Issues Revised Final Beryllium StandardsFor Construction and Shipyards WASHINGTON, DC - The U.S.

Department of Labor's Occupational Safety and Health Administration (OSHA) today published a final rule revising the beryllium standards for construction and shipyards. The final rule includes changes designed to clarify the standards and simplify or improve compliance. These changes maintain protection for workers while ensuring that the standard is well understood and compliance is simple and straightforward. The final rule amends the following paragraphs in the beryllium standards for construction and shipyards.

Definitions, Methods of Compliance, Respiratory Protection, Personal Protective Clothing and Equipment, Housekeeping, Hazard Communication, Medical Surveillance, and Recordkeeping. OSHA has removed the Hygiene Areas and Practices paragraph from the final standards because the necessary protections are provided by existing OSHA standards for sanitation. The effective date of the revisions in this final rule is September 30, 2020. OSHA began enforcing the new permissible exposure limits in the 2017 beryllium standards for construction and shipyards in May 2018.

OSHA will begin enforcing the remaining provisions of the standards on September 30, 2020. The final standard will affect approximately 12,000 workers employed in nearly 2,800 establishments in the construction and shipyard industries. The final standards are estimated to yield $2.5 million in total annualized cost savings to employers. Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees.

OSHA's role is to help ensure these conditions for America's working men and women by setting and enforcing standards, and providing training, education, and assistance. For more information, visit www.osha.gov. The mission of the Department of Labor is to foster, promote, and develop the welfare of the wage earners, job seekers, and retirees of the United States. Improve working conditions.

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The Department's Reasonable Accommodation Resource Center converts departmental information and documents into alternative formats, which include Braille and large print. For alternative format requests, please contact the Department at (202) 693-7828 (voice) or (800) 877-8339 (federal relay).August 27, 2020U.S. Department of Labor Announces ActionsTo Assist Americans Impacted By Hurricane Laura WASHINGTON, DC – The U.S. Department of Labor today announced actions it is taking to assist Americans in states affected by Hurricane Laura.

In response to the anticipated needs of those living in states in the path of Hurricane Laura, the Department and its agencies are taking the following actions. The Occupational Safety and Health Administration (OSHA) has actively engaged with the U.S. Department of Homeland Security, the Federal Emergency Management Administration, the Environmental Protection Agency, and other federal agencies and is prepared to provide assistance. The Wage and Hour Division (WHD) will be prioritizing all calls in the affected areas to continue to provide uninterrupted service to workers and employers.

The Employment and Training Administration (ETA) is prepared to provide Disaster Dislocated Worker Grants to help affected states address workforce needs. The disbursement of funds will be determined as needs are assessed by state and local partners. ETA is also prepared to assist in administering Disaster Unemployment Assistance. The Employee Benefits Security Administration (EBSA) will coordinate with other federal agencies, including the U.S.

Department of Treasury, the IRS and the Pension Benefit Guaranty Corp. On the release of compliance guidance for employee benefit plans, and plan participants and beneficiaries in response to Hurricane Laura. General information on disaster relief under the Employee Retirement Income Security Act (ERISA) is available on EBSA's website at Disaster Relief Information for Employers and Advisers and Disaster Relief Information for Workers and Families, or by contacting EBSA online or by calling 1-866-444-3272. The Office of Federal Contract Compliance Programs (OFCCP) issued a Temporary Exemption from certain federal contracting requirements.

For a period of three months, from August 27, 2020, to November 27, 2020, new federal contracts to provide relief, clean-up or rebuilding efforts will be exempt from having to develop written affirmative action programs as required by Executive Order 11246. The Mine Safety and Health Administration (MSHA) is responding to Hurricane Laura's impact on mines, and stands ready to respond more generally with specialized equipment and personnel. And The Veterans' Employment and Training Service (VETS) is working with its grantees to identify further flexibilities and additional funding needs for its programs. VETS staff is prepared to assist employers, members of the National Guard and Reserves and members of the National Disaster Medical System and Urban Search and Rescue who deploy in support of rescue and recovery operations.

The Department will continue to monitor developments regarding Hurricane Laura and take additional actions as necessary. For additional information, please visit the Department's Severe Storm and Flood Recovery Assistance webpage. The mission of the Department of Labor is to foster, promote and develop the welfare of the wage earners, job seekers and retirees of the United States. Improve working conditions.

Advance opportunities for profitable employment. And assure work-related benefits and rights. # # # Media Contact. Eric Holland, 202-693-4676, holland.eric.w@dol.gov Release Number.

20-1654-NAT U.S. Department of Labor news materials are accessible at http://www.dol.gov. The Department's Reasonable Accommodation Resource Center converts departmental information and documents into alternative formats, which include Braille and large print. For alternative format requests, please contact the Department at (202) 693-7828 (voice) or (800) 877-8339 (federal relay)..

August 28, where do i get propecia 2020Contact. Office of CommunicationsPhone. 202-693-1999U.S.

Department of Labor Issues Revised Final Beryllium StandardsFor Construction and Shipyards WASHINGTON, DC - The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) today published a final rule revising the beryllium standards for construction and shipyards. The final rule includes changes designed to clarify the standards and simplify or improve compliance.

These changes maintain protection for workers while ensuring that the standard is well understood and compliance is simple and straightforward. The final rule amends the following paragraphs in the beryllium standards for construction and shipyards. Definitions, Methods of Compliance, Respiratory Protection, Personal Protective Clothing and Equipment, Housekeeping, Hazard Communication, Medical Surveillance, and Recordkeeping.

OSHA has removed the Hygiene Areas and Practices paragraph from the final standards because the necessary protections are provided by existing OSHA standards for sanitation. The effective date of the revisions in this final rule is September 30, 2020. OSHA began enforcing the new permissible exposure limits in the 2017 beryllium standards for construction and shipyards in May 2018.

OSHA will begin enforcing the remaining provisions of the standards on September 30, 2020. The final standard will affect approximately 12,000 workers employed in nearly 2,800 establishments in the construction and shipyard industries. The final standards are estimated to yield $2.5 million in total annualized cost savings to employers.

Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA's role is to help ensure these conditions for America's working men and women by setting and enforcing standards, and providing training, education, and assistance. For more information, visit www.osha.gov.

The mission of the Department of Labor is to foster, promote, and develop the welfare of the wage earners, job seekers, and retirees of the United States. Improve working conditions. Advance opportunities for profitable employment.

And assure work-related benefits and rights. # # # U.S. Department of Labor news materials are accessible at http://www.dol.gov.

The Department's Reasonable Accommodation Resource Center converts departmental information and documents into alternative formats, which include Braille and large print. For alternative format requests, please contact the Department at (202) 693-7828 (voice) or (800) 877-8339 (federal relay).August 27, 2020U.S. Department of Labor Announces ActionsTo Assist Americans Impacted By Hurricane Laura WASHINGTON, DC – The U.S.

Department of Labor today announced actions it is taking to assist Americans in states affected by Hurricane Laura. In response to the anticipated needs of those living in states in the path of Hurricane Laura, the Department and its agencies are taking the following actions. The Occupational Safety and Health Administration (OSHA) has actively engaged with the U.S.

Department of Homeland Security, the Federal Emergency Management Administration, the Environmental Protection Agency, and other federal agencies and is prepared to provide assistance. The Wage and Hour Division (WHD) will be prioritizing all calls in the affected areas to continue to provide uninterrupted service to workers and employers. The Employment and Training Administration (ETA) is prepared to provide Disaster Dislocated Worker Grants to help affected states address workforce needs.

The disbursement of funds will be determined as needs are assessed by state and local partners. ETA is also prepared to assist in administering Disaster Unemployment Assistance. The Employee Benefits Security Administration (EBSA) will coordinate with other federal agencies, including the U.S.

Department of Treasury, the IRS and the Pension Benefit Guaranty Corp. On the release of compliance guidance for employee benefit plans, and plan participants and beneficiaries in response to Hurricane Laura. General information on disaster relief under the Employee Retirement Income Security Act (ERISA) is available on EBSA's website at Disaster Relief Information for Employers and Advisers and Disaster Relief Information for Workers and Families, or by contacting EBSA online or by calling 1-866-444-3272.

The Office of Federal Contract Compliance Programs (OFCCP) issued a Temporary Exemption from certain federal contracting requirements. For a period of three months, from August 27, 2020, to November 27, 2020, new federal contracts to provide relief, clean-up or rebuilding efforts will be exempt from having to develop written affirmative action programs as required by Executive Order 11246. The Mine Safety and Health Administration (MSHA) is responding to Hurricane Laura's impact on mines, and stands ready to respond more generally with specialized equipment and personnel.

And The Veterans' Employment and Training Service (VETS) is working with its grantees to identify further flexibilities and additional funding needs for its programs. VETS staff is prepared to assist employers, members of the National Guard and Reserves and members of the National Disaster Medical System and Urban Search and Rescue who deploy in support of rescue and recovery operations. The Department will continue to monitor developments regarding Hurricane Laura and take additional actions as necessary.

For additional information, please visit the Department's Severe Storm and Flood Recovery Assistance webpage. The mission of the Department of Labor is to foster, promote and develop the welfare of the wage earners, job seekers and retirees of the United States. Improve working conditions.

Advance opportunities for profitable employment. And assure work-related benefits and rights. # # # Media Contact.

Eric Holland, 202-693-4676, holland.eric.w@dol.gov Release Number. 20-1654-NAT U.S. Department of Labor news materials are accessible at http://www.dol.gov.

The Department's Reasonable Accommodation Resource Center converts departmental information and documents into alternative formats, which include Braille and large print. For alternative format requests, please contact the Department at (202) 693-7828 (voice) or (800) 877-8339 (federal relay)..

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IntroductionLa Peste (Camus 1947) has served as a basis for several critical works, including some in the field of Can i buy amoxil medical humanities (Bozzaro 2018 propecia description. Deudon 1988. Tuffuor and propecia description Payne 2017). Frequently interpreted as an allegory of Nazism (with the plague as a symbol of the German occupation of France) (Finel-Honigman 1978.

Haroutunian 1964), it has also received philosophical readings beyond the sociopolitical context in which it was written (Lengers 1994). Other scholars, on the other hand, have centred their propecia description analyses on its literary aspects (Steel 2016).The hair loss treatment propecia has increased general interest about historical and fictional epidemics. La Peste, as one of the most famous literary works about this topic, has been revisited by many readers during recent months, leading to an unexpected growth in sales in certain countries (Wilsher 2020. Zaretsky 2020).

Apart from that, commentaries about the novel, propecia description especially among health sciences scholars, have emerged with a renewed interest (Banerjee et al. 2020. Bate 2020. Vandekerckhove 2020 propecia description.

Wigand, Becker, and Steger 2020). This sudden curiosity is easy to understand if we consider both La Peste’s literary value, and people’s desire to discover real or fictional situations similar to theirs. Indeed, Oran inhabitants’ experiences are not quite far from our own, even if geographical, chronological and, specially, scientific factors (two different diseases occurring at two different stages in the history of medical development) prevent propecia description us from establishing too close resemblances between both situations.Furthermore, it will not be strange if hair loss treatment serves as a frame for fictional works in the near future. Other narrative plays were based on historical epidemics, such as Daniel Defoe’s A Journal of the Plague Year or Giovanni Boccaccio’s Decameron (Wigand, Becker, and Steger 2020.

Withington 2020). The biggest propecia in the last century, the so-called ‘Spanish Influenza’, has been described as not very fruitful in this sense, even if it produced famous novels such as propecia description Katherine A Porter’s Pale Horse, Pale Rider or John O’Hara’s The Doctor Son (Honigsbaum 2018. Hovanec 2011). The overlapping with another disaster like World War I has been argued as one of the reasons explaining this scarce production of fictional works (Honigsbaum 2018).

By contrast, we may think that hair loss treatment is having a global impact hardly overshadowed by other events, and that it will leave a significant mark on the collective memory.Drawing on the reading of La Peste, propecia description we point out in this essay different aspects of living under an epidemic that can be identified both in Camus’s work and in our current situation. We propose a trip throughout the novel, from its early beginning in Part I, when the Oranians are not aware of the threat to come, to its end in Part V, when they are relieved of the epidemic after several months of ravaging disasters.We think this journey along La Peste may be interesting both to health professionals and to the lay person, since all of them will be able to see themselves reflected in the characters from the novel. We do not skip critique of some aspects related to the authorities’ management of hair loss treatment, as Camus does concerning Oran’s rulers. However, what we want to foreground is propecia description La Peste’s intrinsic value, its suitability to be read now and after hair loss treatment has passed, when Camus’s novel endures as a solid art work and hair loss treatment remains only as a defeated plight.MethodsWe confronted our own experiences about hair loss treatment with a conventional reading of La Peste.

A first reading of the novel was used to establish associations between those aspects which more saliently reminded us of hair loss treatment. In a second reading, we searched for some examples to illustrate those aspects and tried to detect new associations. Subsequent readings of certain parts propecia description were done to integrate the information collected. Neither specific methods of literary analysis, nor systematic searches in the novel were applied.

Selected paragraphs and ideas from Part I to Part V were prepared in a draft copy, and this manuscript was written afterwards.Part ISome phrases in the novel could be transposed word by word to our situation. This one pertaining to its start, for instance, may make us remember the first months of 2020:By now, it will be easy to accept that nothing could lead the people of our town to expect the events that took place in the spring of that year and which, as we later propecia description understood, were like the forerunners of the series of grave happenings that this history intends to describe. (Camus 2002, Part I)By referring from the beginning to ‘the people of our town’, Camus is already suggesting an idea which is repeated all along the novel, and which may be well understood by us as hair loss treatment’s witnesses. Epidemics affect the community as a whole, they are present in everybody’s mind and their joys and sorrows are not individual, but collective.

For example (and we are anticipating Part II), the narrator says:But, propecia description once the gates were closed, they all noticed that they were in the same boat, including the narrator himself, and that they had to adjust to the fact. (Camus 2002, Part II)Later, he will insist in this opposition between the concepts of ‘individual’, which used to prevail before the epidemic, and ‘collective’:One might say that the first effect of this sudden and brutal attack of the disease was to force the citizens of our town to act as though they had no individual feelings. (Camus 2002, Part II)There were no longer any individual destinies, but a collective history that was the plague, and feelings shared by all. (Camus 2002, Part III)This distinction is not trivial, propecia description since the story will display a strong confrontation between those who get involved and help their neighbours and those who remain behaving selfishly.

Related to this, Claudia Bozzaro has pointed out that the main topic in La Peste is solidarity and auistic love (Bozzaro 2018). We may add that the disease is so attached to people’s lives that the epidemic becomes the new everyday life:In the morning, they would return to the pestilence, that is to say, to routine. (Camus 2002, Part III)Being propecia description collective issues does not mean that epidemics always enhance auism and solidarity. As said by Wigand et al, they frequently produce ambivalent reactions, and one of them is the opposition between auism and maximised profit (Wigand, Becker, and Steger 2020).

Therefore, the dichotomy between individualism and collectivism, a central point in the characterisation of national cultures (Hofstede 2015), could play a role in epidemics. In fact, concerning hair loss treatment, some authors have described a greater impact of the propecia in those propecia description countries with higher levels of individualism (Maaravi et al. 2021. Ozkan et al.

2021). However, this finding should be complemented with other national cultures’ aspects before concluding that collectivism itself exerts a protective role against epidemics. Concerning this, it has been shown how ‘power distance’ frequently intersects with collectivism, being only a few countries in which the last one coexists with a small distance to power, namely with a capacity to disobey the power authority (Gupta, Shoja, and Mikalef 2021). Moreover, those countries classically classified as ‘collectivist’ (China, Japan, South Korea, India, Vietnam, etc.) are also characterised by high levels of power distance, and their citizens have been quite often forced to adhere to hair loss treatment restrictions and punished if not (Gupta, Shoja, and Mikalef 2021).

Thus, it is important to consider that individualism is not always opposed to ‘look after each other’ (Ozkan et al. 2021, 9). For instance, the European region, seen as a whole as highly ‘individualistic’, holds some of the most advanced welfare protection systems worldwide. It is worth considering too that collectivism may hide sometimes a hard institutional authority or a lack in civil freedoms.Coming back to La Peste, we may think that Camus’s Oranians are not particularly ‘collectivist’.

Their initial description highlights that they are mainly interested in their own businesses and affairs:Our fellow-citizens work a good deal, but always in order to make money. They are especially interested in trade and first of all, as they say, they are engaged in doing business. (Camus 2002, Part I)And later, we see some of them trying selfishly to leave the city by illegal methods. By contrast, we observe in the novel some examples of more ‘collectivistic’ attitudes, such as the discipline of those quarantined at the football pitch, and, over all, the main characters’ behaviour, which is generally driven by auism and common goals.Turning to another topic, the plague in Oran and hair loss treatment are similar regarding their animal origin.

This is not rare since many infectious diseases pass to humans through contact with animal vectors, being rodents, especially rats (through rat fleas), the most common carriers of plague bacteria (CDC. N.d.a, ECDC. N.d, Pollitzer 1954). Concerning hair loss, even if further research about its origin is needed, the most recent investigations conducted in China by the WHO establish a zoonotic transmission as the most probable pathway (Joint WHO-China Study Team 2021).

In Camus’s novel, the animal’s link to the epidemic seemed very clear since the beginning:Things got to the point where Infodoc (the agency for information and documentation, ‘ all you need to know on any subject’) announced in its free radio news programme that 6,231 rats had been collected and burned in a single day, the 25th. This figure, which gave a clear meaning to the daily spectacle that everyone in town had in front of their eyes, disconcerted them even more. (Camus 2002, Part I)This accuracy in figures is familiar to us. People nowadays have become very used to the statistical aspects of the propecia, due to the continuous updates in epidemiological parameters launched by the media and the authorities.

Camus was aware about the relevance of figures in epidemics, which always entail:…required registration and statistical tasks. (Camus 2002, Part II)Because of this, the novel is scattered with numbers, most of them concerning the daily death toll, but others mentioning the number of rats picked up, as we have seen, or combining the number of deaths with the time passed since the start of the epidemic:“ Will there be an autumn of plague?. Professor B answers. €˜ No’ ”, “ One hundred and twenty-four dead.

The total for the ninety-fourth day of the plague.” (Camus 2002, Part II)We permit ourselves to introduce here a list of recurring topics in La Peste, since the salience of statistical information is one of them. These topics, some of which will be treated later, appear several times in the novel, in various contexts and stages in the evolution of the epidemic. We synthesise them in Table 1, coupled with a hair loss treatment parallel example extracted from online press. This ease to find a current example for each topic suggests that they are not exclusive of plague or of Camus’s mindset, but shared by most epidemics.View this table:Table 1 Recurring topics in La Peste.

Each topic is accompanied by two examples from the novel and one concerning hair loss treatment, extracted from online press.Talking about journalism and the media (one of the topics above), we might say that hair loss treatment’s coverage is frequently too optimistic when managing good news and too alarming when approaching the bad. Media’s ‘exaggerated’ approach to health issues is not new. It was already a concern for medical journals’ editors a century ago (Reiling 2013) and it continues to be it for these professionals in recent times (Barbour et al. 2008).

It is well known that media tries to attract spectators’ attention by making the news more appealing. However, they deal with the risk of expanding unreliable information, which may be pernicious for the public opinion. Related to the intention of ‘garnishing’ the news, Aslam et al. (2020) have described that 82% of more than 100 000 pieces of information about hair loss treatment appearing in media from different countries carried an emotional, either negative (52%) or positive (30%) component, with only 18% of them considered as ‘neutral’ (Aslam et al.

2020). Some evidence about this tendency to make news more emotional was described in former epidemics. For instance, a study conducted in Singapore in 2009 during the H1N1 crisis showed how press releases by the Ministry of Health were substantially transformed when passed to the media, by increasing their emotional appeal and by changing their dominant frame or their tone (Lee and Basnyat 2013). In La Peste, this superficial way of managing information by the media is also observed:The newspapers followed the order that they had been given, to be optimistic at any cost.

(Camus 2002, Part IV)At the first stages of the epidemic in Oran, journalists proclaim the end of the dead rats’ invasion as something to be celebrated. Dr Rieux, the character through which Camus symbolises caution (and comparable nowadays to trustful scientists, well-informed journalists or sensible authorities), exposes then his own angle, quite far from suggesting optimism:The vendors of the evening papers were shouting that the invasion of rats had ended. But Rieux found his patient lying half out of bed, one hand on his belly and the other around his neck, convulsively vomiting reddish bile into a rubbish bin. (Camus 2002, Part I)Camus, who worked as a journalist for many years, insists afterwards on this cursory interest that some media devote to the epidemic, more eager to grab the noise than the relevant issues beneath it:The press, which had had so much to say about the business of the rats, fell silent.

This is because rats die in the street and people in their bedrooms. And newspapers are only concerned with the street. (Camus 2002, Part I)By then, Oranians continue rejecting the epidemic as an actual threat, completely immersed in that phase that dominates the beginning of all epidemics and is characterised by ‘denial and disbelief’ (Wigand, Becker, and Steger 2020, 443):A pestilence does not have human dimensions, so people tell themselves that it is unreal, that it is a bad dream which will end. […] The people of our town were no more guilty than anyone else, they merely forgot to be modest and thought that everything was still possible for them, which implied that pestilence was impossible.

They continued with business, with making arrangements for travel and holding opinions. Why should they have thought about the plague, which negates the future, negates journeys and debate?. They considered themselves free and no one will ever be free as long as there is plague, pestilence and famine. (Camus 2002, Part I)Probably to avoid citizens' disapproval, among other reasons, the Oranian Prefecture (health authority in Camus' novel) does not want to go too far when judging the relevance of the epidemic.

While not directly exposed, we can guess in this fragment the tone of the Prefect’s message, his intention to convey confidence despite his own doubts:These cases were not specific enough to be really disturbing and there was no doubt that the population would remain calm. None the less, for reasons of caution which everyone could understand, the Prefect was taking some preventive measures. If they were interpreted and applied in the proper way, these measures were such that they would put a definite stop to any threat of epidemic. As a result, the Prefect did not for a moment doubt that the citizens under his charge would co-operate in the most zealous manner with what he was doing.

(Camus 2002, Part I)The relevant role acquired by health authorities during epidemics is another topic listed in our table. Language use, on the other hand, is an issue linkable both with the media topic and with this one. As in La Peste, during hair loss treatment we have seen some public figures using words not always truthfully, carrying out a careful selection of words that serves to the goal of conveying certain interests in each moment. Dr Rieux refers in Part I to this language manipulation by the authorities:The measures that had been taken were insufficient, that was quite clear.

As for the ‘ specially equipped wards’, he knew what they were. Two outbuildings hastily cleared of other patients, their windows sealed up and the whole surrounded by a cordon sanitaire. (Camus 2002, Part I)He illustrates the need of frankness, the preference for clarity in language, which is often the clarity in thinking:No. I phoned Richard to say we needed comprehensive measures, not fine words, and that either we must set up a real barrier to the epidemic, or nothing at all.

(Camus 2002, Part I)At the end of this part, his fears about the inadequacy of not taking strict measures are confirmed. Oranian hospitals become overwhelmed, as they are now in many places worldwide due to hair loss treatment.Part IILeft behind the phases of ‘denial and disbelief’ and of ‘fear and panic’, it appears among the Oranians the ‘acceptance paired with resignation’ (Wigand, Becker, and Steger 2020, 443):Then we knew that our separation was going to last, and that we ought to try to come to terms with time. […] In particular, all of the people in our town very soon gave up, even in public, whatever habit they may have acquired of estimating the length of their separation. (Camus 2002, Part II)In hair loss treatment as well, even if border closure has not been so immovable as in Oran, many people have seen themselves separated from their loved ones and some of them have not yet had the possibility of reunion.

This is why, in the actual propecia, the idea of temporal horizons has emerged like it appeared in Camus’s epidemic. In Spain, the general lockdown in March and April 2020 made people establish the summer as their temporal horizon, a time in which they could resume their former habits and see their relatives again. This became partially true, and people were allowed in summer to travel inside the country and to some other countries nearby. However, there existed some reluctance to visit ill or aged relatives, due to the fear of infecting them, and some families living in distant countries were not able to get together.

Moreover, autumn brought an increase in the number of cases (‘the second wave’) and countries returned to limit their internal and external movements.Bringing all this together, many people nowadays have opted to discard temporal horizons. As Oranians, they have noted that the epidemic follows its own rhythm and it is useless to fight against it. Nonetheless, it is in human nature not to resign, so abandoning temporal horizons does not mean to give up longing for the recovery of normal life. This vision, neither maintaining vain hopes nor resigning, is in line with Camus’s philosophy, an author who wrote that ‘hope, contrary to what it is usually thought, is the same to resignation.’ (Camus 1939, 83.

Cited by Haroutunian 1964, 312 (translation is ours)), and that ‘there is not love to human life but with despair about human life.’ (Camus 1958, 112–5. Cited by Haroutunian 1964, 312–3 (translation is ours)).People nowadays deal with resignation relying on daily life pleasures (being not allowed to make further plans or trips) and in company from the nearest ones (as they cannot gather with relatives living far away). Second, they observe the beginning of vaccination campaigns as a first step of the final stage, and summer 2021, reflecting what happened with summer 2020, has been fixed as a temporal horizon. This preference for summers has an unavoidable metaphorical nuance, and their linking to joy, long trips and life in the streets may be the reason for which we choose them to be opposed to the lockdown and restrictions of the propecia.We alluded previously to the manipulation of language, and figures, as relevant as they are, they are not free from manipulation either.

Tarrou, a close friend to Dr Rieux, points out in this part of the novel how this occurred:Once more, Tarrou was the person who gave the most accurate picture of our life as it was then. Naturally he was following the course of the plague in general, accurately observing that a turning point in the epidemic was marked by the radio no longer announcing some hundreds of deaths per week, but 92, 107 and 120 deaths a day. €˜The newspapers and the authorities are engaged in a battle of wits with the plague. They think that they are scoring points against it, because 130 is a lower figure than 910.’ (Camus 2002, Part II)Tarrou collaborates with the health teams formed to tackle the plague.

Regarding these volunteers and workers, Camus refuses to consider them as heroes, as many essential workers during hair loss treatment have rejected to be named as that. The writer thinks their actions are the natural behaviour of good people, not heroism but ‘a logical consequence’:The whole question was to prevent the largest possible number of people from dying and suffering a definitive separation. There was only one way to do this, which was to fight the plague. There was nothing admirable about this truth, it simply followed as a logical consequence.

(Camus 2002, Part II)We consider suitable to talk here about two issues which represent, nowadays, a great part of hair loss treatment fears and hopes, respectively. New genetic variants and treatments. Medical achievements are another recurrent issue included in table 1, and we write about them here because it is in Part II where Camus writes for the first time about treatments, and where it insists on an idea aforementioned in Part I. That the plague bacillus affecting Oran is different from previous variants:…the microbe differed very slightly from the bacillus of plague as traditionally defined.

(Camus 2002, Part II)Related to hair loss treatment new variants, they represent a challenge because of two main reasons. Their higher transmissibility and/or severity and their higher propensity to skip the effect of natural or treatment-induced immunity. Public health professionals are determining which is the actual threat of all the new variants discovered, such as those first characterised in the UK (Public Health England 2020), South Africa (Tegally et al. 2021) or Brazil (Fujino et al.

2021). In La Peste, Dr Rieux is always suspecting that the current bacteria they are dealing with is different from the one in previous epidemics of plague. Since several genetic variations for the bacillus Yersinia pestis have been characterised (Cui et al. 2012), it could be possible that the epidemic in Oran originated from a new one.

However, we should not forget that we are analysing a literary work, and that scientific accuracy is not a necessary goal in it. In fact, Rieux’s reluctances have to do more with clinical aspects than with microbiological ones. He doubts since the beginning, relying exclusively on the symptoms observed, and continues doing it after the laboratory analysis:I was able to have an analysis made in which the laboratory thinks it can detect the plague bacillus. However, to be precise, we must say that certain specific modifications of the microbe do not coincide with the classic description of plague.

(Camus 2002, Part II)Camus is consistent with this idea and many times he mentions the bacillus to highlight its oddity. Insisting on the literary condition of the work, and among other possible explanations, he is maybe declaring that that in the novel is not a common (biological, natural) bacteria, but the Nazism bacteria.Turning to treatments, they constitute the principal resource that the global community has to defeat the hair loss treatment propecia. Vaccination campaigns have started all over the world, and three types of hair loss treatments are being applied in the European Union, after their respective statements of efficacy and security (Baden et al. 2021.

Polack et al. 2020. Voysey et al. 2021), while a fourth treatment has just recently been approved (EMA 2021a).

Although some concerns regarding the safety of two of these treatments have been raised recently (EMA 2021b. EMA 2021c), vaccination plans are going ahead, being adapted according to the state of knowledge at each moment. Some of these treatments are mRNA-based (Baden et al. 2021.

Polack et al. 2020), while others use a viral vector (Bos et al. 2020. Voysey et al.

2021). They are mainly two-shot treatments, with one exception (Bos et al. 2020), and complete immunity is thought to be acquired 2 weeks after the last shot (CDC. N.d.b, Voysey et al.

2021). Other countries such as China or Russia, on the other hand, were extremely early in starting their vaccination campaigns, and are distributing among their citizens different treatments than the aforementioned (Logunov et al. 2021. Zhang et al.

2021).Even if at least three types of plague treatments had been created by the time the novel takes place (Sun 2016), treatments do not play an important role in La Peste, in which therapeutic measures (the serum) are more important than prophylactic ones. Few times in the novel the narrator refers to prophylactic inoculations:There was still no possibility of vaccinating with preventive serum except in families already affected by the disease. (Camus 2002, Part II)Deudon has pointed out that Camus mixes up therapeutic serum and treatment (Deudon 1988), and in fact there exists a certain amount of confusion. All along the novel, the narrator focuses on the prophylactic goals of the serum, which is applied to people already infected (Othon’s son, Tarrou, Grand…).

However, both in the example above (which can be understood as vaccinating household contacts or already affected individuals) and in others, the differences between treating and vaccinating are not clear:After the morning admissions which he was in charge of himself, the patients were vaccinated and the swellings lanced. (Camus 2002, Part II)In any case, this is another situation in which Camus stands aside from scientific matters, which are to him less relevant in his novel than philosophical or literary ones. The distance existing between the relevance of treatments in hair loss treatment and the superficial manner with which Camus treats the topic in La Peste exemplifies this.Part IIIIn part III, the plague’s ravages become tougher. The narrator turns his focus to burials and their disturbance, a frequent topic in epidemics’ narrative (table 1).

Camus knew how acutely increasing demands and hygienic requirements affect funeral habits during epidemics:Everything really happened with the greatest speed and the minimum of risk. (Camus 2002, Part III)Like many other processes during epidemics, the burial process becomes a protocol. When protocolised, everything seems to work well and rapidly. But this perfect mechanism is the Prefecture’s goal, not Rieux’s.

He reveals in this moment an aspect in his character barely shown before. Irony.The whole thing was well organized and the Prefect expressed his satisfaction. He even told Rieux that, when all was said and done, this was preferable to hearses driven by black slaves which one read about in the chronicles of earlier plagues. €˜ Yes,’ Rieux said.

€˜ The burial is the same, but we keep a card index. No one can deny that we have made progress.’ (Camus 2002, Part III)Even if this characteristic may seem new in Dr Rieux, we must bear in mind that he is the story narrator, and the narration is ironic from time to time. For instance, speaking precisely about the burials:The relatives were invited to sign a register –which just showed the difference that there may be between men and, for example, dogs. You can keep check of human beings-.

(Camus 2002, Part III)In Camus’s philosophy, the absurd is a core issue. According to Lengers, Rieux is ironic because he is a kind of Sisyphus who has understood the absurdity of plague (Lengers 1994). The response to the absurd is to rebel (Camus 2013), and Rieux does it by helping his fellow humans without questioning anything. He does not pursue any other goal than doing his duty, thus humour (as a response to dire situations) stands out from him when he observes others celebrating irrelevant achievements, such as the Prefect with his burial protocol.

In the field of medical ethics, Lengers has highlighted the importance of Camus’s perspective when considering ‘the immediacy of life rather than abstract values’ (Lengers 1994, 250). Rieux himself is quite sure that his solid commitment is not ‘abstract’, and, even if he falls into abstraction, the importance relies on protecting human lives and not in the name given to that task:Was it truly an abstraction, spending his days in the hospital where the plague was working overtime, bringing the number of victims up to five hundred on average per week?. Yes, there was an element of abstraction and unreality in misfortune. But when an abstraction starts to kill you, you have to get to work on it.

(Camus 2002, Part II)Farewells during hair loss treatment may have not been particularly pleasant for some families. Neither those dying at nursing homes nor in hospitals could be accompanied by their families as previously, due to corpses management protocols, restrictions of external visitors and hygienic measures in general. However, as weeks passed by, certain efforts were made to ease this issue, allowing people to visit their dying beloved sticking to strict preventive measures. On the other hand, the number of people attending funeral masses and cemeteries was also limited, which affected the conventional development of ceremonies as well.

Hospitals had to deal with daily tolls of deaths never seen before, and the overcrowding of mortuaries made us see rows of coffins placed in unusual spaces, such as ice rinks (transformation of facilities is another topic in table 1).We turn now to two other points which hair loss treatment has not evaded. s among essential workers and epidemics’ economic consequences. The author links burials with s among essential workers because gravediggers constitute one of the most affected professions, and connects this fact with the economic recession because unemployment is behind the large availability of workers to replace the dead gravediggers:Many of the male nurses and the gravediggers, who were at first official, then casual, died of the plague. […] The most surprising thing was that there was never a shortage of men to do the job, for as long as the epidemic lasted.

[…] When the plague really took hold of the town, its very immoderation had one quite convenient outcome, because it disrupted the whole of economic life and so created quite a large number of unemployed. […] Poverty always triumphed over fear, to the extent that work was always paid according to the risk involved. (Camus 2002, Part III)The effects of the plague over the economic system are one of our recurrent topics (table 1). The plague in Oran, as it forces to close the city, impacts all trading exchanges.

In addition, it forbids travellers from arriving to the city, with the economic influence that that entails:This plague was the ruination of tourism. (Camus 2002, Part II)Oranians, who, as we saw, were very worried about making money, are especially affected by an event which jeopardises it. In hair loss treatment, for one reason or for another, most of the countries are suffering economic consequences, since the impact on normal life from the epidemic (another recurrent topic) means also an impact on the normal development of trading activities.Part IVIn Part IV we witness the first signals of a stabilisation of the epidemic:It seemed that the plague had settled comfortably into its peak and was carrying out its daily murders with the precision and regularity of a good civil servant. In theory, in the opinion of experts, this was a good sign.

The graph of the progress of the plague, starting with its constant rise, followed by this long plateau, seemed quite reassuring. (Camus 2002, Part IV)At this time, we consider interesting to expand the topic about the transformation of facilities. We mentioned the case of ice rinks during hair loss treatment, and we bring up now the use of a football pitch as a quarantine camp in Camus’s novel, a scene which has reminded some scholars of the metaphor of Nazism and concentration camps (Finel-Honigman 1978). In Spain, among other measures, a fairground was enabled as a field hospital during the first wave, and it is plausible that many devices created with other purposes were used in tasks attached to healthcare provision during those weeks, as occurred in Oran’s pitch with the loudspeakers:Then the loudspeakers, which in better times had served to introduce the teams or to declare the results of games, announced in a tinny voice that the internees should go back to their tents so that the evening meal could be distributed.

(Camus 2002, Part IV)Related to this episode, we can also highlight the opposition between science and humanism that Camus does. The author alerts us about the dangers of a dehumanised science, of choosing procedures perfectly efficient regardless of their lack in human dignity:The men held out their hands, two ladles were plunged into two of the pots and emerged to unload their contents onto two tin plates. The car drove on and the process was repeated at the next tent.‘ It’s scientific,’ Tarrou told the administrator.‘ Yes,’ he replied with satisfaction, as they shook hands. €˜ It’s scientific.’ (Camus 2002, Part IV)Several cases with favourable outcomes mark Part IV final moments and prepare the reader for the end of the epidemic.

To describe these signs of recovering, the narrator turns back to two elements with a main role in the novel. Rats and figures. In this moment, the first ones reappear and the second ones seem to be declining:He had seen two live rats come into his house through the street door. Neighbours had informed him that the creatures were also reappearing in their houses.

Behind the walls of other houses there was a hustle and bustle that had not been heard for months. Rieux waited for the general statistics to be published, as they were at the start of each week. They showed a decline in the disease. (Camus 2002, Part IV)Part VGiven that we continue facing hair loss treatment, and that forecasts about its end are not easy, we cannot compare ourselves with the Oranians once they have reached the end of the epidemic, what occurs in this part.

However, we can analyse our current situation, characterised by a widespread, though cautious, confidence motivated by the beginning of vaccination campaigns, referring it to the events narrated in Part V.Even more than the Oranians, since we feel further than them from the end of the problem, we are cautious about not to anticipate celebrations. From time to time, however, we lend ourselves to dream relying on what the narrator calls ‘a great, unadmitted hope’. hair loss treatment took us by surprise and everyone wants to ‘reorganise’ their life, as Oranians do, but patience is an indispensable component to succeed, as fictional and historical epidemics show us.Although this sudden decline in the disease was unexpected, the towns-people were in no hurry to celebrate. The preceding months, though they had increased the desire for liberation, had also taught them prudence and accustomed them to count less and less on a rapid end to the epidemic.

However, this new development was the subject of every conversation and, in the depths of people’s hearts, there was a great, unadmitted hope. […] One of the signs that a return to a time of good health was secretly expected (though no one admitted the fact) was that from this moment on people readily spoke, with apparent indifference, about how life would be reorganized after the plague. (Camus 2002, Part V)We put our hope on vaccination. Social distancing and other hygienic measures have proved to be effective, but treatments would bring us a more durable solution without compromising so hardly many economic activities and social habits.

As we said, a more important role of scientific aspects is observed in hair loss treatment if compared with La Peste (an expected fact if considered that Camus’s story is an artistic work, that he skips sometimes the most complex scientific issues of the plague and that health sciences have evolved substantially during last decades). Oranians, in fact, achieve the end of the epidemic not through clearly identified scientific responses but with certain randomness:All one could do was to observe that the sickness seemed to be going as it had arrived. The strategy being used against it had not changed. It had been ineffective yesterday, and now it was apparently successful.

One merely had the feeling that the disease had exhausted itself, or perhaps that it was retiring after achieving all its objectives. In a sense, its role was completed. (Camus 2002, Part V)They receive the announcement made by the Prefecture of reopening the town’s gates in 2 weeks time with enthusiasm. Dealing with concrete dates gives them certainty, helps them fix the temporal horizons we wrote about.

This is also the case when they are told that preventive measures would be lifted in 1 month. Camus shows us then how the main characters are touched as well by this positive atmosphere:That evening Tarrou and Rieux, Rambert and the rest, walked in the midst of the crowd, and they too felt they were treading on air. Long after leaving the boulevards Tarrou and Rieux could still hear the sounds of happiness following them… (Camus 2002, Part V)Then, Tarrou points out a sign of recovery coming from the animal world. In a direct zoological chain, infected fleas have vanished from rats, which have been able again to multiply across the city, making the cats abandon their hiding places and to go hunting after them again.

At the final step of this chain, Tarrou sees the human being. He remembers the old man who used to spit to the cats beneath his window:At a time when the noise grew louder and more joyful, Tarrou stopped. A shape was running lightly across the dark street. It was a cat, the first that had been seen since the spring.

It stopped for a moment in the middle of the road, hesitated, licked its paw, quickly passed it across its right ear, then carried on its silent way and vanished into the night. Tarrou smiled. The little old man, too, would be happy. (Camus 2002, Part V)Unpleasant things as a town with rats running across its streets, or a man spending his time spitting on a group of cats, constitute normality as much as the reopening of gates or the reboot of commerce.

However, when Camus speaks directly about normality, he highlights more appealing habits. He proposes common leisure activities (restaurants, theatres) as symbols of human life, since he opposes them to Cottard’s life, which has become that of a ‘wild animal’:At least in appearance he [ Cottard ] retired from the world and from one day to the next started to live like a wild animal. He no longer appeared in restaurants, at the theatre or in his favourite cafés. (Camus 2002, Part V)We do not disclose why Cottard’s reaction to the end of the epidemic is different from most of the Oranians’.

In any case, the narrator insists later on the assimilation between common pleasures and normality:‘ Perhaps,’ Cottard said, ‘ Perhaps so. But what do you call a return to normal life?. €™ ‘ New films in the cinema,’ said Tarrou with a smile. (Camus 2002, Part V)Cinema, as well as theatre, live music and many other cultural events have been cancelled or obliged to modify their activities due to hair loss treatment.

Several bars and restaurants have closed, and spending time in those who remain open has become an activity which many people tend to avoid, fearing contagion. Thus, normality in our understanding is linked as well to these simple and pleasant habits, and the complete achievement of them will probably signify for us the desired defeat of the propecia.In La Peste, love is also seen as a simple good to be fully recovered after the plague. While Rieux goes through the ‘reborn’ Oran, it is lovers’ gatherings what he highlights. Unlike them, everyone who, during the epidemic, sought for goals different from love (such as faith or money, for instance) remain lost when the epidemic has ended:For all the people who, on the contrary, had looked beyond man to something that they could not even imagine, there had been no reply.

(Camus 2002, Part V)And this is because lovers, as the narrator says:If they had found that they wanted, it was because they had asked for the only thing that depended on them. (Camus 2002, Part V)We have spoken before about language manipulation, hypocrisy and public figures’ roles during epidemics. Camus, during Dr Rieux’s last visit to the old asthmatic man, makes this frank and humble character criticise, with a point of irony, the authorities’ attitude concerning tributes to the dead:‘ Tell me, doctor, is it true that they’re going to put up a monument to the victims of the plague?. €™â€˜ So the papers say.

A pillar or a plaque.’‘ I knew it!. And there’ll be speeches.’The old man gave a strangled laugh.‘ I can hear them already. €œ Our dead…” Then they’ll go and have dinner.’ (Camus 2002, Part V)The old man illustrates wisely the authorities’ propensity for making speeches. He knows that most of them usually prefer grandiloquence rather than common words, and seizes perfectly their tone when he imitates them (‘Our dead…’).

We have also got used, during hair loss treatment, to these types of messages. We have also heard about ‘our old people’, ‘our youth’, ‘our essential workers’ and even ‘our dead’. Behind this tone, however, there could be an intention to hide errors, or to falsely convey carefulness. Honest rulers do not usually need nice words.

They just want them to be accurate.We have seen as well some tributes to the victims during hair loss treatment, some of which we can doubt whether they serve to victims’ relief or to authorities’ promotion. We want rulers to be less aware of their own image and to stress truthfulness as a goal, even if this is a hard requirement not only for them, but for every single person. Language is essential in this issue, we think, since it is prone to be twisted and to become untrue. The old asthmatic man illustrates it with his ‘There’ll be speeches’ and his ‘Our dead…’, but this is not the only time in the novel in which Camus brings out the topic.

For instance, he does so when he equates silence (nothing can be thought as further from wordiness) with truth:It is at the moment of misfortune that one becomes accustomed to truth, that is to say to silence. (Camus 2002, Part II)or when he makes a solid statement against false words:…I understood that all the misfortunes of mankind came from not stating things in clear terms. (Camus 2002, Part IV)The old asthmatic, in fact, while praising the deceased Tarrou, remarks that he used to admire him because ‘he didn’t talk just for the sake of it.’ (Camus 2002, Part V).Related to this topic, what the old asthmatic says about political authorities may be transposed in our case to other public figures, such as scholars and researchers, media leaders, businessmen and women, health professionals… and, if we extend the scope, to every single citizen. Because hypocrisy, language manipulation and the fact of putting individual interests ahead of collective welfare fit badly with collective issues such as epidemics.

Hopefully, also examples to the contrary have been observed during hair loss treatment.The story ends with the fireworks in Oran and the depiction of Dr Rieux’s last feelings. While he is satisfied because of his medical performance and his activity as a witness of the plague, he is concerned about future disasters to come. When hair loss treatment will have passed, it will be time for us as well to review our life during these months. For now, we are just looking forward to achieving our particular ‘part V’.AbstractThis study addresses the existing gap in literature that ethnographically examines the experiences of Spanish-speaking patients with limited English proficiency in clinical spaces.

All of the participants in this study presented to the emergency department (ED) for evaluation of non-urgent health conditions. Patient shadowing was employed to explore the challenges that this population face in unique clinical settings like the ED. This relatively new methodology facilitates obtaining nuanced understandings of clinical contexts under study in ways that quantitative approaches and survey research do not. Drawing from the field of medical anthropology and approach of narrative medicine, the collected data are presented through the use of clinical ethnographic vignettes and thick description.

The conceptual framework of health-related deservingness guided the analysis undertaken in this study. Structural stigma was used as a complementary framework in analysing the emergent themes in the data collected. The results and analysis from this study were used to develop an argument for the consideration of language as a distinct social determinant of health.emergency medicinemedical anthropologymedical humanitiesData availability statementData sharing not applicable as no datasets were generated and/or analysed for this study..

IntroductionLa Peste (Camus 1947) has served as a basis for several critical works, including some in the field where do i get propecia of medical humanities (Bozzaro 2018. Deudon 1988. Tuffuor and Payne where do i get propecia 2017). Frequently interpreted as an allegory of Nazism (with the plague as a symbol of the German occupation of France) (Finel-Honigman 1978.

Haroutunian 1964), it has also received philosophical readings beyond the sociopolitical context in which it was written (Lengers 1994). Other scholars, on the other hand, have centred their analyses on its literary aspects where do i get propecia (Steel 2016).The hair loss treatment propecia has increased general interest about historical and fictional epidemics. La Peste, as one of the most famous literary works about this topic, has been revisited by many readers during recent months, leading to an unexpected growth in sales in certain countries (Wilsher 2020. Zaretsky 2020).

Apart from that, commentaries where do i get propecia about the novel, especially among health sciences scholars, have emerged with a renewed interest (Banerjee et al. 2020. Bate 2020. Vandekerckhove 2020 where do i get propecia.

Wigand, Becker, and Steger 2020). This sudden curiosity is easy to understand if we consider both La Peste’s literary value, and people’s desire to discover real or fictional situations similar to theirs. Indeed, Oran inhabitants’ experiences are not quite far from our own, even if geographical, chronological and, specially, scientific factors (two different diseases occurring at two different stages in the history of medical development) prevent us from establishing too close resemblances between both situations.Furthermore, it will not be strange if hair loss treatment serves where do i get propecia as a frame for fictional works in the near future. Other narrative plays were based on historical epidemics, such as Daniel Defoe’s A Journal of the Plague Year or Giovanni Boccaccio’s Decameron (Wigand, Becker, and Steger 2020.

Withington 2020). The biggest propecia in the last century, the so-called ‘Spanish Influenza’, has been described as not very fruitful in this sense, even if it produced where do i get propecia famous novels such as Katherine A Porter’s Pale Horse, Pale Rider or John O’Hara’s The Doctor Son (Honigsbaum 2018. Hovanec 2011). The overlapping with another disaster like World War I has been argued as one of the reasons explaining this scarce production of fictional works (Honigsbaum 2018).

By contrast, we may think that hair loss treatment is having a global impact hardly overshadowed by other events, and that it will leave a significant mark on the collective memory.Drawing on the reading of La Peste, we point out in this essay different aspects of living under an epidemic where do i get propecia that can be identified both in Camus’s work and in our current situation. We propose a trip throughout the novel, from its early beginning in Part I, when the Oranians are not aware of the threat to come, to its end in Part V, when they are relieved of the epidemic after several months of ravaging disasters.We think this journey along La Peste may be interesting both to health professionals and to the lay person, since all of them will be able to see themselves reflected in the characters from the novel. We do not skip critique of some aspects related to the authorities’ management of hair loss treatment, as Camus does concerning Oran’s rulers. However, what we want to foreground is La Peste’s intrinsic value, its suitability to be read now and after hair loss treatment has passed, when Camus’s novel endures as a solid art work and hair loss treatment remains only as a defeated plight.MethodsWe confronted our where do i get propecia own experiences about hair loss treatment with a conventional reading of La Peste.

A first reading of the novel was used to establish associations between those aspects which more saliently reminded us of hair loss treatment. In a second reading, we searched for some examples to illustrate those aspects and tried to detect new associations. Subsequent readings of certain parts were done to integrate where do i get propecia the information collected. Neither specific methods of literary analysis, nor systematic searches in the novel were applied.

Selected paragraphs and ideas from Part I to Part V were prepared in a draft copy, and this manuscript was written afterwards.Part ISome phrases in the novel could be transposed word by word to our situation. This one pertaining to its start, for instance, may make us remember the first months of 2020:By now, it will be easy to accept that nothing could lead the people of our town to expect the events that took place in the spring of that year and which, as we later understood, were like the forerunners of the series of where do i get propecia grave happenings that this history intends to describe. (Camus 2002, Part I)By referring from the beginning to ‘the people of our town’, Camus is already suggesting an idea which is repeated all along the novel, and which may be well understood by us as hair loss treatment’s witnesses. Epidemics affect the community as a whole, they are present in everybody’s mind and their joys and sorrows are not individual, but collective.

For example (and we are anticipating Part II), the narrator says:But, once the gates were closed, they all noticed that where do i get propecia they were in the same boat, including the narrator himself, and that they had to adjust to the fact. (Camus 2002, Part II)Later, he will insist in this opposition between the concepts of ‘individual’, which used to prevail before the epidemic, and ‘collective’:One might say that the first effect of this sudden and brutal attack of the disease was to force the citizens of our town to act as though they had no individual feelings. (Camus 2002, Part II)There were no longer any individual destinies, but a collective history that was the plague, and feelings shared by all. (Camus 2002, Part III)This distinction is not trivial, since the story will display a strong confrontation between those where do i get propecia who get involved and help their neighbours and those who remain behaving selfishly.

Related to this, Claudia Bozzaro has pointed out that the main topic in La Peste is solidarity and auistic love (Bozzaro 2018). We may add that the disease is so attached to people’s lives that the epidemic becomes the new everyday life:In the morning, they would return to the pestilence, that is to say, to routine. (Camus 2002, Part III)Being where do i get propecia collective issues does not mean that epidemics always enhance auism and solidarity. As said by Wigand et al, they frequently produce ambivalent reactions, and one of them is the opposition between auism and maximised profit (Wigand, Becker, and Steger 2020).

Therefore, the dichotomy between individualism and collectivism, a central point in the characterisation of national cultures (Hofstede 2015), could play a role in epidemics. In fact, concerning hair loss treatment, some where do i get propecia authors have described a greater impact of the propecia in those countries with higher levels of individualism (Maaravi et al. 2021. Ozkan et al.

2021). However, this finding should be complemented with other national cultures’ aspects before concluding that collectivism itself exerts a protective role against epidemics. Concerning this, it has been shown how ‘power distance’ frequently intersects with collectivism, being only a few countries in which the last one coexists with a small distance to power, namely with a capacity to disobey the power authority (Gupta, Shoja, and Mikalef 2021). Moreover, those countries classically classified as ‘collectivist’ (China, Japan, South Korea, India, Vietnam, etc.) are also characterised by high levels of power distance, and their citizens have been quite often forced to adhere to hair loss treatment restrictions and punished if not (Gupta, Shoja, and Mikalef 2021).

Thus, it is important to consider that individualism is not always opposed to ‘look after each other’ (Ozkan et al. 2021, 9). For instance, the European region, seen as a whole as highly ‘individualistic’, holds some of the most advanced welfare protection systems worldwide. It is worth considering too that collectivism may hide sometimes a hard institutional authority or a lack in civil freedoms.Coming back to La Peste, we may think that Camus’s Oranians are not particularly ‘collectivist’.

Their initial description highlights that they are mainly interested in their own businesses and affairs:Our fellow-citizens work a good deal, but always in order to make money. They are especially interested in trade and first of all, as they say, they are engaged in doing business. (Camus 2002, Part I)And later, we see some of them trying selfishly to leave the city by illegal methods. By contrast, we observe in the novel some examples of more ‘collectivistic’ attitudes, such as the discipline of those quarantined at the football pitch, and, over all, the main characters’ behaviour, which is generally driven by auism and common goals.Turning to another topic, the plague in Oran and hair loss treatment are similar regarding their animal origin.

This is not rare since many infectious diseases pass to humans through contact with animal vectors, being rodents, especially rats (through rat fleas), the most common carriers of plague bacteria (CDC. N.d.a, ECDC. N.d, Pollitzer 1954). Concerning hair loss, even if further research about its origin is needed, the most recent investigations conducted in China by the WHO establish a zoonotic transmission as the most probable pathway (Joint WHO-China Study Team 2021).

In Camus’s novel, the animal’s link to the epidemic seemed very clear since the beginning:Things got to the point where Infodoc (the agency for information and documentation, ‘ all you need to know on any subject’) announced in its free radio news programme that 6,231 rats had been collected and burned in a single day, the 25th. This figure, which gave a clear meaning to the daily spectacle that everyone in town had in front of their eyes, disconcerted them even more. (Camus 2002, Part I)This accuracy in figures is familiar to us. People nowadays have become very used to the statistical aspects of the propecia, due to the continuous updates in epidemiological parameters launched by the media and the authorities.

Camus was aware about the relevance of figures in epidemics, which always entail:…required registration and statistical tasks. (Camus 2002, Part II)Because of this, the novel is scattered with numbers, most of them concerning the daily death toll, but others mentioning the number of rats picked up, as we have seen, or combining the number of deaths with the time passed since the start of the epidemic:“ Will there be an autumn of plague?. Professor B answers. €˜ No’ ”, “ One hundred and twenty-four dead.

The total for the ninety-fourth day of the plague.” (Camus 2002, Part II)We permit ourselves to introduce here a list of recurring topics in La Peste, since the salience of statistical information is one of them. These topics, some of which will be treated later, appear several times in the novel, in various contexts and stages in the evolution of the epidemic. We synthesise them in Table 1, coupled with a hair loss treatment parallel example extracted from online press. This ease to find a current example for each topic suggests that they are not exclusive of plague or of Camus’s mindset, but shared by most epidemics.View this table:Table 1 Recurring topics in La Peste.

Each topic is accompanied by two examples from the novel and one concerning hair loss treatment, extracted from online press.Talking about journalism and the media (one of the topics above), we might say that hair loss treatment’s coverage is frequently too optimistic when managing good news and too alarming when approaching the bad. Media’s ‘exaggerated’ approach to health issues is not new. It was already a concern for medical journals’ editors a century ago (Reiling 2013) and it continues to be it for these professionals in recent times (Barbour et al. 2008).

It is well known that media tries to attract spectators’ attention by making the news more appealing. However, they deal with the risk of expanding unreliable information, which may be pernicious for the public opinion. Related to the intention of ‘garnishing’ the news, Aslam et al. (2020) have described that 82% of more than 100 000 pieces of information about hair loss treatment appearing in media from different countries carried an emotional, either negative (52%) or positive (30%) component, with only 18% of them considered as ‘neutral’ (Aslam et al.

2020). Some evidence about this tendency to make news more emotional was described in former epidemics. For instance, a study conducted in Singapore in 2009 during the H1N1 crisis showed how press releases by the Ministry of Health were substantially transformed when passed to the media, by increasing their emotional appeal and by changing their dominant frame or their tone (Lee and Basnyat 2013). In La Peste, this superficial way of managing information by the media is also observed:The newspapers followed the order that they had been given, to be optimistic at any cost.

(Camus 2002, Part IV)At the first stages of the epidemic in Oran, journalists proclaim the end of the dead rats’ invasion as something to be celebrated. Dr Rieux, the character through which Camus symbolises caution (and comparable nowadays to trustful scientists, well-informed journalists or sensible authorities), exposes then his own angle, quite far from suggesting optimism:The vendors of the evening papers were shouting that the invasion of rats had ended. But Rieux found his patient lying half out of bed, one hand on his belly and the other around his neck, convulsively vomiting reddish bile into a rubbish bin. (Camus 2002, Part I)Camus, who worked as a journalist for many years, insists afterwards on this cursory interest that some media devote to the epidemic, more eager to grab the noise than the relevant issues beneath it:The press, which had had so much to say about the business of the rats, fell silent.

This is because rats die in the street and people in their bedrooms. And newspapers are only concerned with the street. (Camus 2002, Part I)By then, Oranians continue rejecting the epidemic as an actual threat, completely immersed in that phase that dominates the beginning of all epidemics and is characterised by ‘denial and disbelief’ (Wigand, Becker, and Steger 2020, 443):A pestilence does not have human dimensions, so people tell themselves that it is unreal, that it is a bad dream which will end. […] The people of our town were no more guilty than anyone else, they merely forgot to be modest and thought that everything was still possible for them, which implied that pestilence was impossible.

They continued with business, with making arrangements for travel and holding opinions. Why should they have thought about the plague, which negates the future, negates journeys and debate?. They considered themselves free and no one will ever be free as long as there is plague, pestilence and famine. (Camus 2002, Part I)Probably to avoid citizens' disapproval, among other reasons, the Oranian Prefecture (health authority in Camus' novel) does not want to go too far when judging the relevance of the epidemic.

While not directly exposed, we can guess in this fragment the tone of the Prefect’s message, his intention to convey confidence despite his own doubts:These cases were not specific enough to be really disturbing and there was no doubt that the population would remain calm. None the less, for reasons of caution which everyone could understand, the Prefect was taking some preventive measures. If they were interpreted and applied in the proper way, these measures were such that they would put a definite stop to any threat of epidemic. As a result, the Prefect did not for a moment doubt that the citizens under his charge would co-operate in the most zealous manner with what he was doing.

(Camus 2002, Part I)The relevant role acquired by health authorities during epidemics is another topic listed in our table. Language use, on the other hand, is an issue linkable both with the media topic and with this one. As in La Peste, during hair loss treatment we have seen some public figures using words not always truthfully, carrying out a careful selection of words that serves to the goal of conveying certain interests in each moment. Dr Rieux refers in Part I to this language manipulation by the authorities:The measures that had been taken were insufficient, that was quite clear.

As for the ‘ specially equipped wards’, he knew what they were. Two outbuildings hastily cleared of other patients, their windows sealed up and the whole surrounded by a cordon sanitaire. (Camus 2002, Part I)He illustrates the need of frankness, the preference for clarity in language, which is often the clarity in thinking:No. I phoned Richard to say we needed comprehensive measures, not fine words, and that either we must set up a real barrier to the epidemic, or nothing at all.

(Camus 2002, Part I)At the end of this part, his fears about the inadequacy of not taking strict measures are confirmed. Oranian hospitals become overwhelmed, as they are now in many places worldwide due to hair loss treatment.Part IILeft behind the phases of ‘denial and disbelief’ and of ‘fear and panic’, it appears among the Oranians the ‘acceptance paired with resignation’ (Wigand, Becker, and Steger 2020, 443):Then we knew that our separation was going to last, and that we ought to try to come to terms with time. […] In particular, all of the people in our town very soon gave up, even in public, whatever habit they may have acquired of estimating the length of their separation. (Camus 2002, Part II)In hair loss treatment as well, even if border closure has not been so immovable as in Oran, many people have seen themselves separated from their loved ones and some of them have not yet had the possibility of reunion.

This is why, in the actual propecia, the idea of temporal horizons has emerged like it appeared in Camus’s epidemic. In Spain, the general lockdown in March and April 2020 made people establish the summer as their temporal horizon, a time in which they could resume their former habits and see their relatives again. This became partially true, and people were allowed in summer to travel inside the country and to some other countries nearby. However, there existed some reluctance to visit ill or aged relatives, due to the fear of infecting them, and some families living in distant countries were not able to get together.

Moreover, autumn brought an increase in the number of cases (‘the second wave’) and countries returned to limit their internal and external movements.Bringing all this together, many people nowadays have opted to discard temporal horizons. As Oranians, they have noted that the epidemic follows its own rhythm and it is useless to fight against it. Nonetheless, it is in human nature not to resign, so abandoning temporal horizons does not mean to give up longing for the recovery of normal life. This vision, neither maintaining vain hopes nor resigning, is in line with Camus’s philosophy, an author who wrote that ‘hope, contrary to what it is usually thought, is the same to resignation.’ (Camus 1939, 83.

Cited by Haroutunian 1964, 312 (translation is ours)), and that ‘there is not love to human life but with despair about human life.’ (Camus 1958, 112–5. Cited by Haroutunian 1964, 312–3 (translation is ours)).People nowadays deal with resignation relying on daily life pleasures (being not allowed to make further plans or trips) and in company from the nearest ones (as they cannot gather with relatives living far away). Second, they observe the beginning of vaccination campaigns as a first step of the final stage, and summer 2021, reflecting what happened with summer 2020, has been fixed as a temporal horizon. This preference for summers has an unavoidable metaphorical nuance, and their linking to joy, long trips and life in the streets may be the reason for which we choose them to be opposed to the lockdown and restrictions of the propecia.We alluded previously to the manipulation of language, and figures, as relevant as they are, they are not free from manipulation either.

Tarrou, a close friend to Dr Rieux, points out in this part of the novel how this occurred:Once more, Tarrou was the person who gave the most accurate picture of our life as it was then. Naturally he was following the course of the plague in general, accurately observing that a turning point in the epidemic was marked by the radio no longer announcing some hundreds of deaths per week, but 92, 107 and 120 deaths a day. €˜The newspapers and the authorities are engaged in a battle of wits with the plague. They think that they are scoring points against it, because 130 is a lower figure than 910.’ (Camus 2002, Part II)Tarrou collaborates with the health teams formed to tackle the plague.

Regarding these volunteers and workers, Camus refuses to consider them as heroes, as many essential workers during hair loss treatment have rejected to be named as that. The writer thinks their actions are the natural behaviour of good people, not heroism but ‘a logical consequence’:The whole question was to prevent the largest possible number of people from dying and suffering a definitive separation. There was only one way to do this, which was to fight the plague. There was nothing admirable about this truth, it simply followed as a logical consequence.

(Camus 2002, Part II)We consider suitable to talk here about two issues which represent, nowadays, a great part of hair loss treatment fears and hopes, respectively. New genetic variants and treatments. Medical achievements are another recurrent issue included in table 1, and we write about them here because it is in Part II where Camus writes for the first time about treatments, and where it insists on an idea aforementioned in Part I. That the plague bacillus affecting Oran is different from previous variants:…the microbe differed very slightly from the bacillus of plague as traditionally defined.

(Camus 2002, Part II)Related to hair loss treatment new variants, they represent a challenge because of two main reasons. Their higher transmissibility and/or severity and their higher propensity to skip the effect of natural or treatment-induced immunity. Public health professionals are determining which is the actual threat of all the new variants discovered, such as those first characterised in the UK (Public Health England 2020), South Africa (Tegally et al. 2021) or Brazil (Fujino et al.

2021). In La Peste, Dr Rieux is always suspecting that the current bacteria they are dealing with is different from the one in previous epidemics of plague. Since several genetic variations for the bacillus Yersinia pestis have been characterised (Cui et al. 2012), it could be possible that the epidemic in Oran originated from a new one.

However, we should not forget that we are analysing a literary work, and that scientific accuracy is not a necessary goal in it. In fact, Rieux’s reluctances have to do more with clinical aspects than with microbiological ones. He doubts since the beginning, relying exclusively on the symptoms observed, and continues doing it after the laboratory analysis:I was able to have an analysis made in which the laboratory thinks it can detect the plague bacillus. However, to be precise, we must say that certain specific modifications of the microbe do not coincide with the classic description of plague.

(Camus 2002, Part II)Camus is consistent with this idea and many times he mentions the bacillus to highlight its oddity. Insisting on the literary condition of the work, and among other possible explanations, he is maybe declaring that that in the novel is not a common (biological, natural) bacteria, but the Nazism bacteria.Turning to treatments, they constitute the principal resource that the global community has to defeat the hair loss treatment propecia. Vaccination campaigns have started all over the world, and three types of hair loss treatments are being applied in the European Union, after their respective statements of efficacy and security (Baden et al. 2021.

Polack et al. 2020. Voysey et al. 2021), while a fourth treatment has just recently been approved (EMA 2021a).

Although some concerns regarding the safety of two of these treatments have been raised recently (EMA 2021b. EMA 2021c), vaccination plans are going ahead, being adapted according to the state of knowledge at each moment. Some of these treatments are mRNA-based (Baden et al. 2021.

Polack et al. 2020), while others use a viral vector (Bos et al. 2020. Voysey et al.

2021). They are mainly two-shot treatments, with one exception (Bos et al. 2020), and complete immunity is thought to be acquired 2 weeks after the last shot (CDC. N.d.b, Voysey et al.

2021). Other countries such as China or Russia, on the other hand, were extremely early in starting their vaccination campaigns, and are distributing among their citizens different treatments than the aforementioned (Logunov et al. 2021. Zhang et al.

2021).Even if at least three types of plague treatments had been created by the time the novel takes place (Sun 2016), treatments do not play an important role in La Peste, in which therapeutic measures (the serum) are more important than prophylactic ones. Few times in the novel the narrator refers to prophylactic inoculations:There was still no possibility of vaccinating with preventive serum except in families already affected by the disease. (Camus 2002, Part II)Deudon has pointed out that Camus mixes up therapeutic serum and treatment (Deudon 1988), and in fact there exists a certain amount of confusion. All along the novel, the narrator focuses on the prophylactic goals of the serum, which is applied to people already infected (Othon’s son, Tarrou, Grand…).

However, both in the example above (which can be understood as vaccinating household contacts or already affected individuals) and in others, the differences between treating and vaccinating are not clear:After the morning admissions which he was in charge of himself, the patients were vaccinated and the swellings lanced. (Camus 2002, Part II)In any case, this is another situation in which Camus stands aside from scientific matters, which are to him less relevant in his novel than philosophical or literary ones. The distance existing between the relevance of treatments in hair loss treatment and the superficial manner with which Camus treats the topic in La Peste exemplifies this.Part IIIIn part III, the plague’s ravages become tougher. The narrator turns his focus to burials and their disturbance, a frequent topic in epidemics’ narrative (table 1).

Camus knew how acutely increasing demands and hygienic requirements affect funeral habits during epidemics:Everything really happened with the greatest speed and the minimum of risk. (Camus 2002, Part III)Like many other processes during epidemics, the burial process becomes a protocol. When protocolised, everything seems to work well and rapidly. But this perfect mechanism is the Prefecture’s goal, not Rieux’s.

He reveals in this moment an aspect in his character barely shown before. Irony.The whole thing was well organized and the Prefect expressed his satisfaction. He even told Rieux that, when all was said and done, this was preferable to hearses driven by black slaves which one read about in the chronicles of earlier plagues. €˜ Yes,’ Rieux said.

€˜ The burial is the same, but we keep a card index. No one can deny that we have made progress.’ (Camus 2002, Part III)Even if this characteristic may seem new in Dr Rieux, we must bear in mind that he is the story narrator, and the narration is ironic from time to time. For instance, speaking precisely about the burials:The relatives were invited to sign a register –which just showed the difference that there may be between men and, for example, dogs. You can keep check of human beings-.

(Camus 2002, Part III)In Camus’s philosophy, the absurd is a core issue. According to Lengers, Rieux is ironic because he is a kind of Sisyphus who has understood the absurdity of plague (Lengers 1994). The response to the absurd is to rebel (Camus 2013), and Rieux does it by helping his fellow humans without questioning anything. He does not pursue any other goal than doing his duty, thus humour (as a response to dire situations) stands out from him when he observes others celebrating irrelevant achievements, such as the Prefect with his burial protocol.

In the field of medical ethics, Lengers has highlighted the importance of Camus’s perspective when considering ‘the immediacy of life rather than abstract values’ (Lengers 1994, 250). Rieux himself is quite sure that his solid commitment is not ‘abstract’, and, even if he falls into abstraction, the importance relies on protecting human lives and not in the name given to that task:Was it truly an abstraction, spending his days in the hospital where the plague was working overtime, bringing the number of victims up to five hundred on average per week?. Yes, there was an element of abstraction and unreality in misfortune. But when an abstraction starts to kill you, you have to get to work on it.

(Camus 2002, Part II)Farewells during hair loss treatment may have not been particularly pleasant for some families. Neither those dying at nursing homes nor in hospitals could be accompanied by their families as previously, due to corpses management protocols, restrictions of external visitors and hygienic measures in general. However, as weeks passed by, certain efforts were made to ease this issue, allowing people to visit their dying beloved sticking to strict preventive measures. On the other hand, the number of people attending funeral masses and cemeteries was also limited, which affected the conventional development of ceremonies as well.

Hospitals had to deal with daily tolls of deaths never seen before, and the overcrowding of mortuaries made us see rows of coffins placed in unusual spaces, such as ice rinks (transformation of facilities is another topic in table 1).We turn now to two other points which hair loss treatment has not evaded. s among essential workers and epidemics’ economic consequences. The author links burials with s among essential workers because gravediggers constitute one of the most affected professions, and connects this fact with the economic recession because unemployment is behind the large availability of workers to replace the dead gravediggers:Many of the male nurses and the gravediggers, who were at first official, then casual, died of the plague. […] The most surprising thing was that there was never a shortage of men to do the job, for as long as the epidemic lasted.

[…] When the plague really took hold of the town, its very immoderation had one quite convenient outcome, because it disrupted the whole of economic life and so created quite a large number of unemployed. […] Poverty always triumphed over fear, to the extent that work was always paid according to the risk involved. (Camus 2002, Part III)The effects of the plague over the economic system are one of our recurrent topics (table 1). The plague in Oran, as it forces to close the city, impacts all trading exchanges.

In addition, it forbids travellers from arriving to the city, with the economic influence that that entails:This plague was the ruination of tourism. (Camus 2002, Part II)Oranians, who, as we saw, were very worried about making money, are especially affected by an event which jeopardises it. In hair loss treatment, for one reason or for another, most of the countries are suffering economic consequences, since the impact on normal life from the epidemic (another recurrent topic) means also an impact on the normal development of trading activities.Part IVIn Part IV we witness the first signals of a stabilisation of the epidemic:It seemed that the plague had settled comfortably into its peak and was carrying out its daily murders with the precision and regularity of a good civil servant. In theory, in the opinion of experts, this was a good sign.

The graph of the progress of the plague, starting with its constant rise, followed by this long plateau, seemed quite reassuring. (Camus 2002, Part IV)At this time, we consider interesting to expand the topic about the transformation of facilities. We mentioned the case of ice rinks during hair loss treatment, and we bring up now the use of a football pitch as a quarantine camp in Camus’s novel, a scene which has reminded some scholars of the metaphor of Nazism and concentration camps (Finel-Honigman 1978). In Spain, among other measures, a fairground was enabled as a field hospital during the first wave, and it is plausible that many devices created with other purposes were used in tasks attached to healthcare provision during those weeks, as occurred in Oran’s pitch with the loudspeakers:Then the loudspeakers, which in better times had served to introduce the teams or to declare the results of games, announced in a tinny voice that the internees should go back to their tents so that the evening meal could be distributed.

(Camus 2002, Part IV)Related to this episode, we can also highlight the opposition between science and humanism that Camus does. The author alerts us about the dangers of a dehumanised science, of choosing procedures perfectly efficient regardless of their lack in human dignity:The men held out their hands, two ladles were plunged into two of the pots and emerged to unload their contents onto two tin plates. The car drove on and the process was repeated at the next tent.‘ It’s scientific,’ Tarrou told the administrator.‘ Yes,’ he replied with satisfaction, as they shook hands. €˜ It’s scientific.’ (Camus 2002, Part IV)Several cases with favourable outcomes mark Part IV final moments and prepare the reader for the end of the epidemic.

To describe these signs of recovering, the narrator turns back to two elements with a main role in the novel. Rats and figures. In this moment, the first ones reappear and the second ones seem to be declining:He had seen two live rats come into his house through the street door. Neighbours had informed him that the creatures were also reappearing in their houses.

Behind the walls of other houses there was a hustle and bustle that had not been heard for months. Rieux waited for the general statistics to be published, as they were at the start of each week. They showed a decline in the disease. (Camus 2002, Part IV)Part VGiven that we continue facing hair loss treatment, and that forecasts about its end are not easy, we cannot compare ourselves with the Oranians once they have reached the end of the epidemic, what occurs in this part.

However, we can analyse our current situation, characterised by a widespread, though cautious, confidence motivated by the beginning of vaccination campaigns, referring it to the events narrated in Part V.Even more than the Oranians, since we feel further than them from the end of the problem, we are cautious about not to anticipate celebrations. From time to time, however, we lend ourselves to dream relying on what the narrator calls ‘a great, unadmitted hope’. hair loss treatment took us by surprise and everyone wants to ‘reorganise’ their life, as Oranians do, but patience is an indispensable component to succeed, as fictional and historical epidemics show us.Although this sudden decline in the disease was unexpected, the towns-people were in no hurry to celebrate. The preceding months, though they had increased the desire for liberation, had also taught them prudence and accustomed them to count less and less on a rapid end to the epidemic.

However, this new development was the subject of every conversation and, in the depths of people’s hearts, there was a great, unadmitted hope. […] One of the signs that a return to a time of good health was secretly expected (though no one admitted the fact) was that from this moment on people readily spoke, with apparent indifference, about how life would be reorganized after the plague. (Camus 2002, Part V)We put our hope on vaccination. Social distancing and other hygienic measures have proved to be effective, but treatments would bring us a more durable solution without compromising so hardly many economic activities and social habits.

As we said, a more important role of scientific aspects is observed in hair loss treatment if compared with La Peste (an expected fact if considered that Camus’s story is an artistic work, that he skips sometimes the most complex scientific issues of the plague and that health sciences have evolved substantially during last decades). Oranians, in fact, achieve the end of the epidemic not through clearly identified scientific responses but with certain randomness:All one could do was to observe that the sickness seemed to be going as it had arrived. The strategy being used against it had not changed. It had been ineffective yesterday, and now it was apparently successful.

One merely had the feeling that the disease had exhausted itself, or perhaps that it was retiring after achieving all its objectives. In a sense, its role was completed. (Camus 2002, Part V)They receive the announcement made by the Prefecture of reopening the town’s gates in 2 weeks time with enthusiasm. Dealing with concrete dates gives them certainty, helps them fix the temporal horizons we wrote about.

This is also the case when they are told that preventive measures would be lifted in 1 month. Camus shows us then how the main characters are touched as well by this positive atmosphere:That evening Tarrou and Rieux, Rambert and the rest, walked in the midst of the crowd, and they too felt they were treading on air. Long after leaving the boulevards Tarrou and Rieux could still hear the sounds of happiness following them… (Camus 2002, Part V)Then, Tarrou points out a sign of recovery coming from the animal world. In a direct zoological chain, infected fleas have vanished from rats, which have been able again to multiply across the city, making the cats abandon their hiding places and to go hunting after them again.

At the final step of this chain, Tarrou sees the human being. He remembers the old man who used to spit to the cats beneath his window:At a time when the noise grew louder and more joyful, Tarrou stopped. A shape was running lightly across the dark street. It was a cat, the first that had been seen since the spring.

It stopped for a moment in the middle of the road, hesitated, licked its paw, quickly passed it across its right ear, then carried on its silent way and vanished into the night. Tarrou smiled. The little old man, too, would be happy. (Camus 2002, Part V)Unpleasant things as a town with rats running across its streets, or a man spending his time spitting on a group of cats, constitute normality as much as the reopening of gates or the reboot of commerce.

However, when Camus speaks directly about normality, he highlights more appealing habits. He proposes common leisure activities (restaurants, theatres) as symbols of human life, since he opposes them to Cottard’s life, which has become that of a ‘wild animal’:At least in appearance he [ Cottard ] retired from the world and from one day to the next started to live like a wild animal. He no longer appeared in restaurants, at the theatre or in his favourite cafés. (Camus 2002, Part V)We do not disclose why Cottard’s reaction to the end of the epidemic is different from most of the Oranians’.

In any case, the narrator insists later on the assimilation between common pleasures and normality:‘ Perhaps,’ Cottard said, ‘ Perhaps so. But what do you call a return to normal life?. €™ ‘ New films in the cinema,’ said Tarrou with a smile. (Camus 2002, Part V)Cinema, as well as theatre, live music and many other cultural events have been cancelled or obliged to modify their activities due to hair loss treatment.

Several bars and restaurants have closed, and spending time in those who remain open has become an activity which many people tend to avoid, fearing contagion. Thus, normality in our understanding is linked as well to these simple and pleasant habits, and the complete achievement of them will probably signify for us the desired defeat of the propecia.In La Peste, love is also seen as a simple good to be fully recovered after the plague. While Rieux goes through the ‘reborn’ Oran, it is lovers’ gatherings what he highlights. Unlike them, everyone who, during the epidemic, sought for goals different from love (such as faith or money, for instance) remain lost when the epidemic has ended:For all the people who, on the contrary, had looked beyond man to something that they could not even imagine, there had been no reply.

(Camus 2002, Part V)And this is because lovers, as the narrator says:If they had found that they wanted, it was because they had asked for the only thing that depended on them. (Camus 2002, Part V)We have spoken before about language manipulation, hypocrisy and public figures’ roles during epidemics. Camus, during Dr Rieux’s last visit to the old asthmatic man, makes this frank and humble character criticise, with a point of irony, the authorities’ attitude concerning tributes to the dead:‘ Tell me, doctor, is it true that they’re going to put up a monument to the victims of the plague?. €™â€˜ So the papers say.

A pillar or a plaque.’‘ I knew it!. And there’ll be speeches.’The old man gave a strangled laugh.‘ I can hear them already. €œ Our dead…” Then they’ll go and have dinner.’ (Camus 2002, Part V)The old man illustrates wisely the authorities’ propensity for making speeches. He knows that most of them usually prefer grandiloquence rather than common words, and seizes perfectly their tone when he imitates them (‘Our dead…’).

We have also got used, during hair loss treatment, to these types of messages. We have also heard about ‘our old people’, ‘our youth’, ‘our essential workers’ and even ‘our dead’. Behind this tone, however, there could be an intention to hide errors, or to falsely convey carefulness. Honest rulers do not usually need nice words.

They just want them to be accurate.We have seen as well some tributes to the victims during hair loss treatment, some of which we can doubt whether they serve to victims’ relief or to authorities’ promotion. We want rulers to be less aware of their own image and to stress truthfulness as a goal, even if this is a hard requirement not only for them, but for every single person. Language is essential in this issue, we think, since it is prone to be twisted and to become untrue. The old asthmatic man illustrates it with his ‘There’ll be speeches’ and his ‘Our dead…’, but this is not the only time in the novel in which Camus brings out the topic.

For instance, he does so when he equates silence (nothing can be thought as further from wordiness) with truth:It is at the moment of misfortune that one becomes accustomed to truth, that is to say to silence. (Camus 2002, Part II)or when he makes a solid statement against false words:…I understood that all the misfortunes of mankind came from not stating things in clear terms. (Camus 2002, Part IV)The old asthmatic, in fact, while praising the deceased Tarrou, remarks that he used to admire him because ‘he didn’t talk just for the sake of it.’ (Camus 2002, Part V).Related to this topic, what the old asthmatic says about political authorities may be transposed in our case to other public figures, such as scholars and researchers, media leaders, businessmen and women, health professionals… and, if we extend the scope, to every single citizen. Because hypocrisy, language manipulation and the fact of putting individual interests ahead of collective welfare fit badly with collective issues such as epidemics.

Hopefully, also examples to the contrary have been observed during hair loss treatment.The story ends with the fireworks in Oran and the depiction of Dr Rieux’s last feelings. While he is satisfied because of his medical performance and his activity as a witness of the plague, he is concerned about future disasters to come. When hair loss treatment will have passed, it will be time for us as well to review our life during these months. For now, we are just looking forward to achieving our particular ‘part V’.AbstractThis study addresses the existing gap in literature that ethnographically examines the experiences of Spanish-speaking patients with limited English proficiency in clinical spaces.

All of the participants in this study presented to the emergency department (ED) for evaluation of non-urgent health conditions. Patient shadowing was employed to explore the challenges that this population face in unique clinical settings like the ED. This relatively new methodology facilitates obtaining nuanced understandings of clinical contexts under study in ways that quantitative approaches and survey research do not. Drawing from the field of medical anthropology and approach of narrative medicine, the collected data are presented through the use of clinical ethnographic vignettes and thick description.

The conceptual framework of health-related deservingness guided the analysis undertaken in this study. Structural stigma was used as a complementary framework in analysing the emergent themes in the data collected. The results and analysis from this study were used to develop an argument for the consideration of language as a distinct social determinant of health.emergency medicinemedical anthropologymedical humanitiesData availability statementData sharing not applicable as no datasets were generated and/or analysed for this study..

Propecia viagra

To the propecia viagra propecia pharmacy prices Editor. Figure 1 propecia viagra. Figure 1 propecia viagra. hair loss Variants among Symptomatic Health Workers. Shown is the distribution of the B.1.1.7 (alpha), delta, and other hair loss variants according to vaccination status and month of diagnosis propecia viagra among health workers at University of California San Diego Health, March through July 2021.

The number of workers indicates those who propecia viagra were symptomatic and had available variant data, and the number of positive tests indicates those that included data on variants. In December 2020, the University of California San Diego Health (UCSDH) workforce experienced a dramatic increase in severe acute respiratory syndrome hair loss 2 (hair loss) s. Vaccination with mRNA treatments began in mid-December propecia viagra 2020. By March, 76% of the workforce had been fully vaccinated, and by propecia viagra July, the percentage had risen to 87%. s had decreased dramatically by early February 2021.1 Between March and June, fewer than 30 health care workers tested positive each month.

However, coincident with the end of California’s mask mandate on June 15 and the rapid dominance of the B.1.617.2 (delta) variant that first emerged in mid-April and propecia viagra accounted for over 95% of UCSDH isolates by the end of July (Figure 1), s increased rapidly, including cases among fully vaccinated persons. Institutional review board approval was obtained for use of administrative data propecia viagra on vaccinations and case-investigation data to examine mRNA SARS CoV-2 treatment effectiveness. UCSDH has a low threshold for hair loss testing, which is triggered by the presence of at least one symptom during daily screening or by an identified exposure, regardless of vaccination status. From March 1 to July 31, 2021, a total of 227 UCSDH health care workers propecia viagra tested positive for hair loss by reverse-transcriptase–quantitative polymerase-chain-reaction (RT-qPCR) assay of nasal swabs. 130 of the 227 workers (57.3%) were fully vaccinated propecia viagra.

Symptoms were present in 109 of the 130 fully vaccinated workers (83.8%) and in 80 propecia viagra of the 90 unvaccinated workers (88.9%). (The remaining 7 workers were only partially vaccinated.) No deaths were reported in either group. One unvaccinated person propecia viagra was hospitalized for hair loss–related symptoms. Table 1 propecia viagra. Table 1.

Symptomatic hair loss and mRNA treatment Effectiveness among UCSDH Health Workers, propecia viagra March through July 2021. treatment effectiveness propecia viagra was calculated for each month from March through July. The case definition was a positive PCR test and one or more symptoms among persons with no previous hair loss treatment (see the Supplementary Appendix). treatment effectiveness exceeded 90% from March through June but fell to 65.5% (95% confidence interval [CI], 48.9 propecia viagra to 76.9) in July (Table 1). July case rates were analyzed according to propecia viagra the month in which workers with hair loss treatment completed the vaccination series.

In workers completing vaccination in January or February, the attack rate was 6.7 per 1000 persons (95% CI, 5.9 to 7.8), whereas the attack rate was 3.7 per 1000 persons (95% CI, 2.5 to 5.7) among those who completed vaccination during the period from March through May. Among unvaccinated persons, the propecia viagra July attack rate was 16.4 per 1000 persons (95% CI, 11.8 to 22.9). The SARS CoV-2 mRNA treatments, BNT162b2 (Pfizer–BioNTech) and mRNA-1273 (Moderna), have previously shown efficacy rates of 95% and 94.1%,2 respectively, in their initial clinical trials, and for the BNT162b2 treatment, sustained, albeit slightly decreased effectiveness (84%) 4 months after the second dose.3 In England, where an extended dosing interval of propecia viagra up to 12 weeks was used, Lopez Bernal et al. Reported a preserved treatment effectiveness of 88% against symptomatic disease associated with the delta variant.4 As observed by others in populations that received mRNA treatments according to standard Emergency Use Authorization intervals,5 our data suggest that treatment effectiveness against any symptomatic disease is considerably lower against the delta variant and may wane over time since vaccination. The dramatic change in treatment effectiveness from June to July is likely to be due to both the emergence of the delta variant and waning propecia viagra immunity over time, compounded by the end of masking requirements in California and the resulting greater risk of exposure in the community.

Our findings underline the importance of rapidly reinstating nonpharmaceutical interventions, such as indoor masking and intensive testing strategies, in addition to continued efforts to increase vaccinations, as strategies to prevent propecia viagra avoidable illness and deaths and to avoid mass disruptions to society during the spread of this formidable variant. Furthermore, if our findings on waning propecia viagra immunity are verified in other settings, booster doses may be indicated. Jocelyn Keehner, M.D.Lucy E. Horton, M.D., M.P.H.UC San Diego Health, San Diego, CANancy propecia viagra J. Binkin, M.D., M.P.H.UC San Diego, propecia viagra La Jolla, CALouise C.

Laurent, M.D., Ph.D.David Pride, M.D., Ph.D.Christopher A. Longhurst, M.D.Shira propecia viagra R. Abeles, M.D.Francesca propecia viagra J. Torriani, M.D.UC San Diego Health, San Diego, CA [email protected]d.edu Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org. This letter was published on September 1, 2021, and updated propecia viagra on September 3, 2021, at NEJM.org.

Dr. Laurent serves as an author on behalf of the SEARCH Alliance. Collaborators in the SEARCH Alliance are listed in the Supplementary Appendix, available with the full text of this letter at NEJM.org. Drs. Keehner and Horton and Drs.

Abeles and Torriani contributed equally to this letter. 5 References1. Keehner J, Abeles SR, Torriani FJ. More on hair loss after vaccination in health care workers. Reply.

N Engl J Med 2021;385(2):e8.2. Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 hair loss treatment. N Engl J Med 2021;384:403-416.3. Thomas SJ, Moreira ED Jr, Kitchin N, et al.

Six month safety and efficacy of the BNT162b2 mRNA hair loss treatment. July 28, 2021 (https://www.medrxiv.org/content/10.1101/2021.07.28.21261159v1). Preprint.Google Scholar4. Lopez Bernal J, Andrews N, Gower C, et al. Effectiveness of hair loss treatments against the B.1.617.2 (Delta) variant.

N Engl J Med 2021;385:585-594.5. Israel A, Merzon E, Schäffer AA, et al. Elapsed time since BNT162b2 treatment and risk of hair loss in a large cohort. August 5, 2021 (https://www.medrxiv.org/content/10.1101/2021.08.03.21261496v1). Preprint.Google Scholar10.1056/NEJMc2112981-t1Table 1.

Symptomatic hair loss and mRNA treatment Effectiveness among UCSDH Health Workers, March through July 2021.* MarchAprilMayJuneJulyUCSDH workforce — no. Of persons18,96418,99219,00019,03519,016Vaccination status — no. Of personsFully vaccinated†14,47015,51016,15716,42616,492mRNA-1273 (Moderna)6,6087,0057,3407,4517,464BNT162b2 (Pfizer–BioNTech)7,8628,5058,8178,9759,028Unvaccinated3,2302,5092,1872,0591,895Percentage of workers fully vaccinated76.381.785.086.386.7Symptomatic hair loss treatmentFully vaccinated workers343594Unvaccinated workers1117101031Percentage of cases in fully vaccinated workers21.419.023.133.375.2Attack rate per 1000 (95% CI)Fully vaccinated workers0.21 (0.21–0.47)0.26 (0.26–0.50)0.19 (0.21–0.40)0.30 (0.31–0.53)5.7 (5.4–6.2)Unvaccinated workers3.4 (2.1–5.9)6.8 (4.5–10.6)4.6 (2.6–8.2)4.9 (2.9–8.7)16.4 (11.8–22.9)treatment effectiveness — % (95% CI)93.9 (78.2–97.9)96.2 (88.7–98.3)95.9 (85.3–98.9)94.3 (83.7–98.0)65.5 (48.9–76.9)Study Sample A total of 103,199 hospitalizations of patients with hair loss treatment–like illness who were 50 years of age or older were identified by the seven VISION partners. Of these hospitalizations, 64,400 (62%) occurred after the dates of age-specific hair loss treatment eligibility and the time required for vaccination records to be updated (Table S3). The hospitalizations occurred during the period from January 1 through June 22, 2021.

Among unvaccinated patients who were hospitalized, the median duration from treatment eligibility to the index date was 39 days (interquartile range, 16 to 70) (Table S4). hair loss testing with a molecular assay ordered by clinicians was conducted for 74% of the patients who were hospitalized (range across network partners, 55 to 99). During the period from January 1 through June 22, a total of 121,709 visits to emergency departments or urgent care clinics for hair loss treatment–like illness were identified by three partners. 76,220 visits (63%) occurred after treatment age eligibility and updates to vaccination records (Table S5). Among the patients who visited an emergency department or urgent care clinic, the median duration from treatment eligibility to the index date was 39 days (interquartile range, 15 to 70).

30% (range, 25 to 41) of these patients were tested by means of molecular assay. Across the partners, 1872 hospitalizations and 1350 emergency department or urgent care clinic visits were excluded because the index dates occurred 1 to 13 days after the patient received the first dose of hair loss treatment and immunity was considered indeterminant. Table 2. Table 2. Characteristics of the Patients According to hair loss Test Results and Vaccination Status.

Our analytic sample included 41,552 hospitalizations and 21,522 emergency department or urgent care clinic visits. 3% of the hospitalizations and 14% of the emergency department or urgent care clinic visits were repeat medical visits by the same patient (Table 2). Characteristics of the patients are listed in Table 2, and characteristics of the patients according to network partner are provided in Tables S6 through S11. The median age was 74 years (interquartile range, 66 to 82) among hospitalized patients and 70 years (interquartile range, 61 to 78) among those who visited an emergency department or urgent care clinic. Black patients and Hispanic patients accounted for a larger percentage of medical visits in the hospitalization sample (9% and 11%, respectively) than in the emergency department or urgent care sample (4% and 5%).

These findings reflect in part the differing demographic characteristics of the network partners that contributed data on emergency department or urgent care clinic visits. The percentage of patients with underlying medical conditions was higher among hospitalized patients than among those who visited an emergency department or urgent care clinic. hair loss treatment–Associated Medical Care We identified 4321 patients with hair loss treatment who had laboratory-confirmed hair loss among 41,552 patients who were hospitalized (10%. Range across network partners, 5 to 21). The remaining 37,231 hospitalized patients (90%) had discharge codes for hair loss treatment–like illness but were hair loss–negative.

Laboratory-confirmed hair loss was identified in 3251 of 21,522 patients who visited an emergency department or urgent care clinic (15%. Range across network partners, 9 to 19). The remaining 18,271 patients who visited an emergency department or urgent care clinic (85%) were hair loss–negative (Table 2). The percentage of hair loss–positive patients also varied among network partners (Tables S12 and S13). The percentage of patients with laboratory-confirmed hair loss decreased with age among hospitalized patients and among those with emergency department or urgent care clinic visits.

In both care settings, the percentage of infected patients was higher among unvaccinated patients and lower among White patients, non-Hispanic patients, and those with chronic nonrespiratory conditions. The numbers of both hair loss–positive patients and hair loss–negative patients with medical visits on each day are provided in Figures S1 through S10. hair loss treatment Vaccination Status On the index date, unvaccinated patients composed approximately half the patients who were hospitalized (49%. Range across network partners, 26 to 73) or visited an emergency department or urgent care clinic (55%. Range, 45 to 65) (Table 2).

In both samples, the largest differences between vaccinated and unvaccinated patients were age, network partner, calendar time, and local hair loss circulation on the index date. These same differences were noted when the sample was limited to hair loss–positive patients only (Tables S14 and S15). As described in the Supplementary Appendix, the application of inverse propensity-to-be-vaccinated weighting reduced the differences between vaccinated and unvaccinated patients with respect to these factors and other patient characteristics to a standard mean difference of less than 0.2. Among vaccinated patients, 53.4% of those who were hospitalized and 53.7% of those who visited an emergency department or urgent care clinic had received the BNT162b2 treatment, 43.3% and 41.6%, respectively, had received the mRNA-1273 treatment, and 3.3% and 4.7%, respectively, had received the Ad26.COV2.S treatment. The median days from full vaccination to the index date were similar with the three types of hair loss treatments and with both samples (hospitalization and emergency department or urgent care clinic) (range, 42 to 53).

Among the patients who received the BNT162b2 treatment, the median duration from partial vaccination (one dose) to the index date of hospitalization was 21 days and the median duration from partial vaccination to the index date of an emergency department or urgent care visit was 20 days. Among patients who received the mRNA-1273 treatment, these durations were 26 days and 24 days, respectively. These findings reflected the different dosing schedules of these treatments. MRNA-Based treatment and Hospitalization Figure 1. Figure 1.

Estimated treatment Effectiveness against hair loss Leading to Hospitalization or an Emergency Department or Urgent Care Clinic Visit, According to the Type of treatment. Patients who were partially vaccinated with one dose of a messenger RNA (mRNA)–based treatment received the first dose at least 14 days before the index date for the medical visit and had not received the second dose by the index date. Patients who were partially vaccinated with two doses of an mRNA-based treatment received the second dose 1 to 13 days before the index date. Fully vaccinated patients received a single dose of the Ad26.COV2.S treatment or the second dose of an mRNA-based treatment at least 14 days before the index date. CI denotes confidence interval, and hair loss severe acute respiratory syndrome hair loss 2.Figure 2.

Figure 2. Estimated Effectiveness of Full Two-Dose mRNA Vaccination against hair loss Leading to Hospitalization, According to Age, Race or Ethnic Group, and Underlying Medical Conditions. Among adults who were 50 years of age or older, the effectiveness of full two-dose mRNA-based vaccination (≥14 days after the second dose) was 89% (95% confidence interval [CI], 87 to 91) against laboratory-confirmed hair loss leading to hospitalization. The treatment-effectiveness point estimates were similar (differences, ≤5 percentage points) with the BNT162b2 and mRNA-1273 treatments (Figure 1 and Figure 2). The effectiveness of full mRNA-based vaccination was 83% (95% CI, 77 to 87) among patients who were at least 85 years of age, 86% (95% CI, 75 to 92) among Black patients, 90% (95% CI, 85 to 93) among Hispanic patients, 90% (95% CI, 88 to 92) among patients with chronic respiratory conditions, and 88% (95% CI, 86 to 90) among patients with chronic nonrespiratory conditions (Figure 2).

When the hospital sample was limited to 7283 admissions to an ICU, the effectiveness of full mRNA-based vaccination against laboratory-confirmed hair loss leading to ICU admission was 90% (95% CI, 86 to 93) (Table S16). Patients who were partially vaccinated with one dose of mRNA-based treatment received the first dose at least 14 days before the index date and had not received the second dose by the index date. Patients who were partially vaccinated with two doses of mRNA-based treatment received the second dose 1 to 13 days before the index date. Among patients who received an mRNA-based treatment, the effectiveness of partial one-dose vaccination (≥14 days after the first dose, but without the second dose) was 54% (95% CI, 47 to 61) against hair loss leading to hospitalization, and the effectiveness of partial two-dose vaccination (1 to 13 days after the second dose) was 73% (95% CI, 66% to 79). With both the BNT162b2 and mRNA-1273 treatments, the effectiveness of full vaccination with respect to hair loss treatment–associated hospitalization was higher than that of partial vaccination (first dose) (with 95% confidence intervals that did not overlap) (Figure 1).

A similar pattern of higher treatment-effectiveness point estimates for full mRNA-based vaccination than for partial mRNA-based vaccination was noted in all stratified analyses (Table S17). The effectiveness after partial vaccination (first dose) was lower with BNT162b2 than with mRNA-1273 (Figure 1). The estimates of the effectiveness of full mRNA-based vaccination were similar when stratified according to the six network partners that contributed the most data on hospitalizations (range, 82 to 97%). However, heterogeneity was observed among the partners in the estimates of effectiveness of partial vaccination (first dose). treatment effectiveness also remained consistent in the other sensitivity analyses (Section S5).

Our simulation model suggested that if both misclassification of outcome and of exposure occur, treatment effectiveness could be underestimated by as much as 10 percentage points, given the rates of clinical testing, percent positivity, and vaccination coverage observed in our hospitalization sample. Figure 3. Figure 3. Estimated Effectiveness of mRNA-Based Vaccination against hair loss Leading to Hospitalization or an Emergency Department or Urgent Care Visit, According to the Days since the Most Recent Dose Was Administered. The total number of hospitalizations shown is higher than the total number in the main analysis because this secondary analysis was conducted weeks after the main analysis and incorporated updated information from vaccination records and registries.

Specifically, an additional 212 hospitalizations among unvaccinated patients and 831 hospitalizations among vaccinated patients with confirmed vaccination status were included.In secondary analyses, we stratified mRNA-based treatment exposure according to 14-day intervals after administration (Figure 3) and according to type of treatment (Table S18). treatment effectiveness with respect to hair loss treatment–associated hospitalization was null 0 to 13 days after the first dose, and treatment-effectiveness point estimates increased through 55 days after the first dose. treatment-effectiveness point estimates for full mRNA-based vaccination remained consistently high (>80%) through at least 112 days after the second dose. MRNA-Based treatment and Emergency Department and Urgent Care Visits Figure 4. Figure 4.

Estimated Effectiveness of Full Two-Dose mRNA-Based Vaccination against hair loss Leading to an Emergency Department or Urgent Care Clinic Visit, According to Age, Race or Ethnic Group, and Underlying Medical Conditions. The effectiveness of full two-dose mRNA-based vaccination was 91% (95% CI, 89 to 93) against laboratory-confirmed hair loss leading to emergency department or urgent care clinic visits (Figure 4). The treatment-effectiveness point estimates were similar (3 percentage points) with the BNT162b2 and mRNA-1273 treatments (Figure 1). The effectiveness of full mRNA-based vaccination was 84% (95% CI, 73 to 91) among adults who were 85 years of age or older, 95% (95% CI, 84 to 98) among Black patients, 81% (95% CI, 70 to 88) among Hispanic patients, and 90% (95% CI, 86 to 93) and 90% (95% CI, 87 to 92) among patients with chronic respiratory conditions and those with chronic nonrespiratory conditions, respectively (Figure 4). The effectiveness of partial (one-dose) mRNA-based vaccination (both types) against hair loss leading to emergency department or urgent care clinic visits was 68% (95% CI, 61 to 74), and the effectiveness of partial (two-dose) vaccination was 80% (95% CI, 73 to 85) (Table S19).

With both the BNT162b2 and mRNA-1273 treatments, the effectiveness of full vaccination against hair loss leading to emergency department or urgent care clinic visits was higher than the effectiveness with partial vaccination (one dose) (Figure 1). In sensitivity analyses, treatment-effectiveness point estimates for full mRNA-based vaccination against hair loss leading to emergency department or urgent care clinic visits ranged from 89 to 97% across the three network partners. Estimates of treatment effectiveness also remained consistent in other sensitivity analyses (Section S5). In secondary analyses, treatment effectiveness against hair loss leading to emergency department or urgent care clinic visits was null 0 to 13 days after the first dose, and then treatment-effectiveness point estimates increased through 55 days after the first dose. treatment-effectiveness point estimates for full mRNA-based vaccination remained consistently high (≥86%) through at least 112 days after the second dose (Figure 3).

Estimates of effectiveness according to the type of hair loss treatment are provided in Table S20. Effectiveness of Ad26.COV2.S treatment Estimates of the effectiveness of Ad26.COV2.S treatment were limited to five network partners with Ad26.COV2.S treatment recipients (CUIMC, Intermountain Healthcare, KPNC, KPNW, and Regenstrief Institute). These analyses included 11,468 hospitalizations and 8917 emergency department or urgent care clinic visits that occurred after the index date for the first patient who was fully vaccinated with Ad26.COV2.S for each network partner (Figure 1). The effectiveness of the full one-dose Ad26.COV2.S treatment was 68% (95% CI, 50 to 79) with respect to hair loss treatment–associated hospitalization. The effectiveness of full vaccination against hair loss leading to emergency department or urgent care clinic visits was 73% (95% CI, 59 to 82) (Figure 1).To the Editor.

Pregnant persons are at risk for severe hair loss disease 2019 (hair loss treatment), and with severe acute respiratory syndrome hair loss 2 (hair loss) during pregnancy is associated with increased risks of preterm birth and other adverse maternal and neonatal outcomes.1 Although spontaneous abortion (pregnancy loss occurring at less than 20 weeks of gestation) is a common pregnancy outcome affecting 11 to 22% of recognized pregnancies (see Table S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org),2-4 data to inform estimates of the risk of spontaneous abortion after receipt of an mRNA hair loss treatment either before conception (30 days before the first day of the last menstrual period through 14 days after) or during pregnancy are limited. We analyzed data from the Centers for Disease Control and Prevention (CDC) v-safe hair loss treatment pregnancy registry to determine the cumulative risk of spontaneous abortion from 6 to less than 20 weeks of gestation. Participants with a singleton pregnancy who had received at least one dose of an mRNA hair loss treatment either before conception or before 20 weeks of gestation and who did not have a pregnancy loss before 6 weeks of gestation were included in this analysis. Inclusion of pregnant participants at 6 weeks of gestation is consistent with literature estimating the risk of spontaneous abortion in the general population.2-4 Life table methods were used to calculate the cumulative risk of spontaneous abortion according to gestational week, with appropriate left truncation (i.e., with adjustment for gestational age at entry). Data were right-censored at the time of the most recent contact for participants with ongoing pregnancies who were not contacted at 20 weeks of gestation or later and at the time of the outcome for participants who reported pregnancy outcomes other than spontaneous abortion (induced abortions or ectopic or molar pregnancies) before 20 weeks of gestation.

The cumulative risk of spontaneous abortion was also age-standardized with the use of data on the risk of spontaneous abortion according to maternal age group.3 We conducted a sensitivity analysis to estimate the maximum possible risk of spontaneous abortion, using an extreme assumption that all participants whose most recent contact was during the first trimester (i.e., at less than 14 weeks of gestation) and whom we were unable to reach during the second trimester experienced a spontaneous abortion immediately after the most recent contact (see the Supplementary Appendix for details). Table 1. Table 1. Risk of Spontaneous Abortion among Participants in the v-safe hair loss treatment Pregnancy Registry, December 14, 2020, through July 19, 2021. A total of 2456 participants who were enrolled in the CDC v-safe hair loss treatment pregnancy registry met the inclusion criteria for this study.

2022 participants reported ongoing pregnancies at 20 weeks of gestation, 165 participants reported a spontaneous abortion (154 participants before 14 weeks of gestation), 65 participants with most recent contact during the first trimester could not be reached for second trimester follow-up, 188 participants completed second trimester follow-up before 20 weeks of gestation, and 16 participants reported another pregnancy outcome before 20 weeks (induced abortion or ectopic or molar pregnancy) (Fig. S1). Most participants were 30 years of age or older (77.3%), were non-Hispanic White (78.3%), and worked as health care personnel (88.8%). Slightly more than half the participants (52.7%) had received the BNT162b2 treatment (Pfizer–BioNTech) (Table S2). The cumulative risk of spontaneous abortion from 6 to less than 20 weeks of gestation was 14.1% (95% confidence interval [CI], 12.1 to 16.1) in the primary analysis (Table 1) and 12.8% (95% CI, 10.8 to 14.8) in an analysis using direct maternal age–standardization to the reference population.

The cumulative risk of spontaneous abortion increased with maternal age (Table S3). In the sensitivity analysis, under the extreme assumption that all 65 participants with most recent contact during the first trimester had a spontaneous abortion, the cumulative risk of spontaneous abortion from 6 to less than 20 weeks of gestation was 18.8% (95% CI, 16.6 to 20.9). After age standardization, the cumulative risk was 18.5% (95% CI, 16.1 to 20.8). Figure 1. Figure 1.

Cumulative Risk of Spontaneous Abortion in the v-safe hair loss treatment Pregnancy Registry and in Two Historical Cohorts. Data from Mukherjee2 were presented as race-specific rates and are provided here for White women to maximize comparability with the v-safe pregnancy registry.As compared with data from two historical cohorts that represent the lower and upper ranges of spontaneous-abortion risk,2,4 the cumulative risks of spontaneous abortion from our primary and sensitivity analyses were within the expected risk range (Figure 1). Limitations of our study include the lack of a control group of unvaccinated pregnant persons, the homogeneity of the participants in terms of racial and ethnic groups and occupation, the voluntary enrollment of the population, and the use of data reported by the participants themselves, including some data collected retrospectively. Nonetheless, our findings suggest that the risk of spontaneous abortion after mRNA hair loss treatment vaccination either before conception or during pregnancy is consistent with the expected risk of spontaneous abortion. These findings add to the accumulating evidence about the safety of mRNA hair loss treatment vaccination in pregnancy.5 Lauren H.

Zauche, Ph.D., M.S.N.Bailey Wallace, M.P.H.Ashley N. Smoots, M.P.H.Christine K. Olson, M.D., M.P.H.Titilope Oduyebo, M.D., M.P.H.Shin Y. Kim, M.P.H.Emily E. Petersen, M.D.Jun Ju, M.S.Jennifer Beauregard, Ph.D., M.P.H.Centers for Disease Control and Prevention (CDC), Atlanta, GAAllen J.

Wilcox, M.D., Ph.D.National Institutes of Health, Durham, NCCharles E. Rose, Ph.D.Dana M. Meaney-Delman, M.D., M.P.H.Sascha R. Ellington, Ph.D., M.S.P.H.CDC, Atlanta, GAfor the CDC v-safe hair loss treatment Pregnancy Registry Team Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org. The findings and conclusions in this letter are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).

Mention of a product or company name is for identification purposes only and does not constitute endorsement by the CDC or the Food and Drug Administration. The authors do not have any material conflicts of interest.This letter was published on September 8, 2021, at NEJM.org.5 References1. Allotey J, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of hair loss disease 2019 in pregnancy. Living systematic review and meta-analysis.

BMJ 2020;370:m3320-m3320.2. Mukherjee S, Velez Edwards DR, Baird DD, Savitz DA, Hartmann KE. Risk of miscarriage among black women and white women in a U.S. Prospective cohort study. Am J Epidemiol 2013;177:1271-1278.3.

Magnus MC, Wilcox AJ, Morken N-H, Weinberg CR, HÃ¥berg SE. Role of maternal age and pregnancy history in risk of miscarriage. Prospective register based study. BMJ 2019;364:l869-l869.4. Goldhaber MK, Fireman BH.

The fetal life table revisited. Spontaneous abortion rates in three Kaiser Permanente cohorts. Epidemiology 1991;2:33-39.5. Shimabukuro TT, Kim SY, Myers TR, et al. Preliminary findings of mRNA hair loss treatment safety in pregnant persons.

N Engl J Med 2021;384:2273-2282.10.1056/NEJMc2113891-t1Table 1. Risk of Spontaneous Abortion among Participants in the v-safe hair loss treatment Pregnancy Registry, December 14, 2020, through July 19, 2021. Gestational AgeParticipants at RiskParticipants Who Reported Spontaneous AbortionWeek-Specific RiskCumulative Risknumber of personspercentpercent (95% CI)6 to <7 weeks904151.71.7 (0.8–2.5)7 to <8 weeks982181.83.5 (2.3–4.6)8 to <9 weeks1032373.66.9 (5.4–8.5)9 to <10 weeks1087393.610.3 (8.4–12.0)10 to <11 weeks1118191.711.8 (9.9–13.7)11 to <12 weeks1184121.012.7 (10.7–14.6)12 to <13 weeks127490.713.3 (11.3–15.2)13 to <14 weeks139450.413.6 (11.6–15.6)14 to <15 weeks15340013.6 (11.6–15.6)15 to <16 weeks163220.113.7 (11.7–15.7)16 to <17 weeks174220.113.8 (11.8–15.8)17 to <18 weeks184820.113.9 (11.9–15.9)18 to <19 weeks194130.214.0 (12.0–16.0)19 to <20 weeks205220.114.1 (12.1–16.1)To the Editor. Whether vaccination of individual persons for severe acute respiratory syndrome hair loss 2 (hair loss) protects members of their households is unclear. We investigated the effect of vaccination of health care workers in Scotland (who were among the earliest groups to be vaccinated worldwide) on the risk of hair loss disease 2019 (hair loss treatment) among members of their households.

We evaluated data from 194,362 household members (which represented 92,470 households of 2 to 14 persons per household) of 144,525 health care workers who had been employed during the period from March 2020 through November 2020. The mean ages of the household members and the health care workers were 31 and 44 years, respectively. A majority (>96%) were White. A total of 113,253 health care workers (78.4%) had received at least one dose of either the BNT162b2 (Pfizer–BioNTech) mRNA treatment or the ChAdOx1 nCoV-19 (Oxford–AstraZeneca) treatment, and 36,227 (25.1%) had received a second dose. The primary outcome was any confirmed case of hair loss treatment that occurred between December 8, 2020, and March 3, 2021.

We also report results for hair loss treatment–associated hospitalization. The primary time periods we compared were the unvaccinated period before the first dose and the period beginning 14 days after the health care worker received the first dose. No adjustment was made for multiplicity. Events that occurred after any household member was vaccinated were censored. Detailed methods and results, strengths and limitations, and the protocol are provided in the Supplementary Appendix, which is available with the full text of this letter at NEJM.org.

This study was approved by the Public Benefit and Privacy Panel (2021-0013), and the scientific officer of the West of Scotland Research Ethics Committee provided written confirmation that formal ethics review was not required. Table 1. Table 1. Effect of Vaccination of Health Care Workers on Documented hair loss treatment Cases and Hospitalizations in Health Care Workers and Their Households. Cases of hair loss treatment were less common among household members of vaccinated health care workers during the period beginning 14 days after the first dose than during the unvaccinated period before the first dose (event rate per 100 person-years, 9.40 before the first dose and 5.93 beginning 14 days after the first dose).

After the health care worker’s second dose, the rate in household members was lower still (2.98 cases per 100 person-years). These differences persisted after fitting extended Cox models that were adjusted for calendar time, geographic region, age, sex, occupational and socioeconomic factors, and underlying conditions. Relative to the period before each health care worker was vaccinated, the hazard ratio for a household member to become infected was 0.70 (95% confidence interval [CI], 0.63 to 0.78) for the period beginning 14 days after the first dose and 0.46 (95% CI, 0.30 to 0.70) for the period beginning 14 days after the second dose (Table 1 and the Supplementary Appendix). Not all the cases of hair loss treatment in the household members were transmitted from the health care worker. Therefore, the effect of vaccination may be larger.1 For example, if half the cases in the household members were transmitted from the health care worker, a 60% decrease in cases transmitted from health care workers would need to occur to elicit the association we observed (see the Supplementary Appendix).

Vaccination was associated with a reduction in both the number of cases and the number of hair loss treatment–related hospitalizations in health care workers between the unvaccinated period and the period beginning 14 days after the first dose. Given that vaccination reduces asymptomatic with hair loss,2,3 it is plausible that vaccination reduces transmission. However, data from clinical trials and observational studies are lacking.4,5 We provide empirical evidence suggesting that vaccination may reduce transmission by showing that vaccination of health care workers is associated with a decrease in documented cases of hair loss treatment among members of their households. This finding is reassuring for health care workers and their families. Anoop S.V.

Shah, M.D.London School of Hygiene and Tropical Medicine, London, United KingdomCiara Gribben, M.Sc.Jennifer Bishop, M.Sc.Public Health Scotland, Edinburgh, United KingdomPeter Hanlon, M.D.University of Glasgow, Glasgow, United KingdomDavid Caldwell, M.Sc.Public Health Scotland, Edinburgh, United KingdomRachael Wood, Ph.D.University of Edinburgh, Edinburgh, United KingdomMartin Reid, B.Sc.Jim McMenamin, M.D.David Goldberg, M.D.Diane Stockton, M.Sc.Public Health Scotland, Edinburgh, United KingdomSharon Hutchinson, Ph.D.Glasgow Caledonian University, Glasgow, United KingdomChris Robertson, Ph.D.University of Strathclyde, Glasgow, United KingdomPaul M. McKeigue, Ph.D.Helen M. Colhoun, Ph.D.University of Edinburgh, Edinburgh, United KingdomDavid A. McAllister, M.D.University of Glasgow, Glasgow, United Kingdom [email protected] Supported by the British Heart Foundation and Wellcome. Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

This letter was published on September 8, 2021, at NEJM.org.5 References1. Shah ASV, Wood R, Gribben C, et al. Risk of hospital admission with hair loss disease 2019 in healthcare workers and their households. Nationwide linkage cohort study. BMJ 2020;371:m3582-m3582.2.

Voysey M, Costa Clemens SA, Madhi SA, et al. Single-dose administration and the influence of the timing of the booster dose on immunogenicity and efficacy of ChAdOx1 nCoV-19 (AZD1222) treatment. A pooled analysis of four randomised trials. Lancet 2021;397:881-891.3. Hall VJ, Foulkes S, Saei A, et al.

hair loss treatment coverage in health-care workers in England and effectiveness of BNT162b2 mRNA treatment against (SIREN). A prospective, multicentre, cohort study. Lancet 2021;397:1725-1735.4. Dagan N, Barda N, Kepten E, et al. BNT162b2 mRNA hair loss treatment in a nationwide mass vaccination setting.

N Engl J Med 2021;384:1412-1423.5. Chodick G, Tene L, Patalon T, et al. Assessment of effectiveness of 1 dose of BNT162b2 treatment for hair loss 13 to 24 days after immunization. JAMA Netw Open 2021;4(6):e2115985-e2115985.Study Design We used two approaches to estimate the effect of vaccination on the delta variant. First, we used a test-negative case–control design to estimate treatment effectiveness against symptomatic disease caused by the delta variant, as compared with the alpha variant, over the period that the delta variant has been circulating.

This approach has been described in detail elsewhere.10 In brief, we compared vaccination status in persons with symptomatic hair loss treatment with vaccination status in persons who reported symptoms but had a negative test. This approach helps to control for biases related to health-seeking behavior, access to testing, and case ascertainment. For the secondary analysis, the proportion of persons with cases caused by the delta variant relative to the main circulating propecia (the alpha variant) was estimated according to vaccination status. The underlying assumption was that if the treatment had some efficacy and was equally effective against each variant, a similar proportion of cases with either variant would be expected in unvaccinated persons and in vaccinated persons. Conversely, if the treatment was less effective against the delta variant than against the alpha variant, then the delta variant would be expected to make up a higher proportion of cases occurring more than 3 weeks after vaccination than among unvaccinated persons.

Details of this analysis are described in Section S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org. The authors vouch for the accuracy and completeness of the data and for the fidelity of the trial to the protocol. Data Sources Vaccination Status Data on all persons in England who have been vaccinated with hair loss treatments are available in a national vaccination register (the National Immunisation Management System). Data regarding vaccinations that had occurred up to May 16, 2021, including the date of receipt of each dose of treatment and the treatment type, were extracted on May 17, 2021. Vaccination status was categorized as receipt of one dose of treatment among persons who had symptom onset occurring 21 days or more after receipt of the first dose up to the day before the second dose was received, as receipt of the second dose among persons who had symptom onset occurring 14 days or more after receipt of the second dose, and as receipt of the first or second dose among persons with symptom onset occurring 21 days or more after the receipt of the first dose (including any period after the receipt of the second dose).

hair loss Testing Polymerase-chain-reaction (PCR) testing for hair loss in the United Kingdom is undertaken by hospital and public health laboratories, as well as by community testing with the use of drive-through or at-home testing, which is available to anyone with symptoms consistent with hair loss treatment (high temperature, new continuous cough, or loss or change in sense of smell or taste). Data on all positive PCR tests between October 26, 2020, and May 16, 2021, were extracted. Data on all recorded negative community tests among persons who reported symptoms were also extracted for the test-negative case–control analysis. Children younger than 16 years of age as of March 21, 2021, were excluded. Data were restricted to persons who had reported symptoms, and only persons who had undergone testing within 10 days after symptom onset were included, in order to account for reduced sensitivity of PCR testing beyond this period.25 Identification of Variant Whole-genome sequencing was used to identify the delta and alpha variants.

The proportion of all positive samples that were sequenced increased from approximately 10% in February 2021 to approximately 60% in May 2021.4 Sequencing is undertaken at a network of laboratories, including the Wellcome Sanger Institute, where a high proportion of samples has been tested, and whole-genome sequences are assigned to Public Health England definitions of variants on the basis of mutations.26 Spike gene target status on PCR was used as a second approach for identifying each variant. Laboratories used the TaqPath assay (Thermo Fisher Scientific) to test for three gene targets. Spike (S), nucleocapsid (N), and open reading frame 1ab (ORF1ab). In December 2020, the alpha variant was noted to be associated with negative testing on the S target, so S target–negative status was subsequently used as a proxy for identification of the variant. The alpha variant accounts for between 98% and 100% of S target–negative results in England.

Among sequenced samples that tested positive for the S target, the delta variant was in 72.2% of the samples in April 2021 and in 93.0% in May (as of May 12, 2021).4 For the test-negative case–control analysis, only samples that had been tested at laboratories with the use of the TaqPath assay were included. Data Linkage The three data sources described above were linked with the use of the National Health Service number (a unique identifier for each person receiving medical care in the United Kingdom). These data sources were also linked with data on the patient’s date of birth, surname, first name, postal code, and specimen identifiers and sample dates. Covariates Multiple covariates that may be associated with the likelihood of being offered or accepting a treatment and the risk of exposure to hair loss treatment or specifically to either of the variants analyzed were also extracted from the National Immunisation Management System and the testing data. These data included age (in 10-year age groups), sex, index of multiple deprivation (a national indication of level of deprivation that is based on small geographic areas of residence,27 assessed in quintiles), race or ethnic group, care home residence status, history of foreign travel (i.e., outside the United Kingdom or Ireland), geographic region, period (calendar week), health and social care worker status, and status of being in a clinically extremely vulnerable group.28 In addition, for the test-negative case–control analysis, history of hair loss before the start of the vaccination program was included.

Persons were considered to have traveled if, at the point of requesting a test, they reported having traveled outside the United Kingdom and Ireland within the preceding 14 days or if they had been tested in a quarantine hotel or while quarantining at home. Postal codes were used to determine the index of multiple deprivation, and unique property-reference numbers were used to identify care homes.29 Statistical Analysis For the test-negative case–control analysis, logistic regression was used to estimate the odds of having a symptomatic, PCR-confirmed case of hair loss treatment among vaccinated persons as compared with unvaccinated persons (control). Cases were identified as having the delta variant by means of sequencing or if they were S target–positive on the TaqPath PCR assay. Cases were identified as having the alpha variant by means of sequencing or if they were S target–negative on the TaqPath PCR assay. If a person had tested positive on multiple occasions within a 90-day period (which may represent a single illness episode), only the first positive test was included.

A maximum of three randomly chosen negative test results were included for each person. Negative tests in which the sample had been obtained within 3 weeks before a positive result or after a positive result could have been false negatives. Therefore, these were excluded. Tests that had been administered within 7 days after a previous negative result were also excluded. Persons who had previously tested positive before the analysis period were also excluded in order to estimate treatment effectiveness in fully susceptible persons.

All the covariates were included in the model as had been done with previous test-negative case–control analyses, with calendar week included as a factor and without an interaction with region. With regard to S target–positive or –negative status, only persons who had tested positive on the other two PCR gene targets were included. Assignment to the delta variant on the basis of S target status was restricted to the week commencing April 12, 2021, and onward in order to aim for high specificity of S target–positive testing for the delta variant.4 treatment effectiveness for the first dose was estimated among persons with a symptom-onset date that was 21 days or more after receipt of the first dose of treatment, and treatment effects for the second dose were estimated among persons with a symptom-onset date that was 14 days or more after receipt of the second dose. Comparison was made with unvaccinated persons and with persons who had symptom onset in the period of 4 to 13 days after vaccination in order to help account for differences in underlying risk of . The period from the day of treatment administration (day 0) to day 3 was excluded because reactogenicity to the treatment can cause an increase in testing that biases results, as previously described.10.

To the where do i get propecia see here Editor. Figure 1 where do i get propecia. Figure 1 where do i get propecia. hair loss Variants among Symptomatic Health Workers. Shown is the distribution of the B.1.1.7 (alpha), delta, and other hair loss variants according to vaccination status and month of diagnosis among health workers at University of California San Diego Health, where do i get propecia March through July 2021.

The number of workers where do i get propecia indicates those who were symptomatic and had available variant data, and the number of positive tests indicates those that included data on variants. In December 2020, the University of California San Diego Health (UCSDH) workforce experienced a dramatic increase in severe acute respiratory syndrome hair loss 2 (hair loss) s. Vaccination with mRNA treatments began in where do i get propecia mid-December 2020. By March, 76% of the workforce had been fully where do i get propecia vaccinated, and by July, the percentage had risen to 87%. s had decreased dramatically by early February 2021.1 Between March and June, fewer than 30 health care workers tested positive each month.

However, coincident with the end of California’s mask mandate on June 15 and the rapid dominance of the B.1.617.2 (delta) variant that first emerged in mid-April and accounted for over 95% of UCSDH isolates by the end of July (Figure where do i get propecia 1), s increased rapidly, including cases among fully vaccinated persons. Institutional review board approval was obtained for where do i get propecia use of administrative data on vaccinations and case-investigation data to examine mRNA SARS CoV-2 treatment effectiveness. UCSDH has a low threshold for hair loss testing, which is triggered by the presence of at least one symptom during daily screening or by an identified exposure, regardless of vaccination status. From March 1 to July 31, 2021, a total where do i get propecia of 227 UCSDH health care workers tested positive for hair loss by reverse-transcriptase–quantitative polymerase-chain-reaction (RT-qPCR) assay of nasal swabs. 130 of the 227 workers (57.3%) were fully vaccinated where do i get propecia.

Symptoms were present in 109 of the 130 where do i get propecia fully vaccinated workers (83.8%) and in 80 of the 90 unvaccinated workers (88.9%). (The remaining 7 workers were only partially vaccinated.) No deaths were reported in either group. One unvaccinated person was where do i get propecia hospitalized for hair loss–related symptoms. Table 1 where do i get propecia. Table 1.

Symptomatic hair loss and mRNA treatment Effectiveness among UCSDH Health Workers, March through July where do i get propecia 2021. treatment effectiveness was calculated for each where do i get propecia month from March through July. The case definition was a positive PCR test and one or more symptoms among persons with no previous hair loss treatment (see the Supplementary Appendix). treatment effectiveness exceeded 90% from March through June but where do i get propecia fell to 65.5% (95% confidence interval [CI], 48.9 to 76.9) in July (Table 1). July case rates were analyzed according to the month in which workers with hair loss treatment where do i get propecia completed the vaccination series.

In workers completing vaccination in January or February, the attack rate was 6.7 per 1000 persons (95% CI, 5.9 to 7.8), whereas the attack rate was 3.7 per 1000 persons (95% CI, 2.5 to 5.7) among those who completed vaccination during the period from March through May. Among unvaccinated where do i get propecia persons, the July attack rate was 16.4 per 1000 persons (95% CI, 11.8 to 22.9). The SARS CoV-2 mRNA treatments, BNT162b2 (Pfizer–BioNTech) and mRNA-1273 (Moderna), have previously shown efficacy rates of 95% and 94.1%,2 respectively, in their initial clinical trials, and for the BNT162b2 treatment, sustained, albeit where do i get propecia slightly decreased effectiveness (84%) 4 months after the second dose.3 In England, where an extended dosing interval of up to 12 weeks was used, Lopez Bernal et al. Reported a preserved treatment effectiveness of 88% against symptomatic disease associated with the delta variant.4 As observed by others in populations that received mRNA treatments according to standard Emergency Use Authorization intervals,5 our data suggest that treatment effectiveness against any symptomatic disease is considerably lower against the delta variant and may wane over time since vaccination. The dramatic change in treatment effectiveness from where do i get propecia June to July is likely to be due to both the emergence of the delta variant and waning immunity over time, compounded by the end of masking requirements in California and the resulting greater risk of exposure in the community.

Our findings underline the importance of rapidly reinstating nonpharmaceutical interventions, such as indoor masking and intensive testing strategies, in where do i get propecia addition to continued efforts to increase vaccinations, as strategies to prevent avoidable illness and deaths and to avoid mass disruptions to society during the spread of this formidable variant. Furthermore, if our findings on waning immunity are verified in other settings, booster doses may where do i get propecia be indicated. Jocelyn Keehner, M.D.Lucy E. Horton, M.D., M.P.H.UC San Diego where do i get propecia Health, San Diego, CANancy J. Binkin, M.D., M.P.H.UC San Diego, La Jolla, CALouise C where do i get propecia.

Laurent, M.D., Ph.D.David Pride, M.D., Ph.D.Christopher A. Longhurst, M.D.Shira where do i get propecia R. Abeles, M.D.Francesca J where do i get propecia. Torriani, M.D.UC San Diego Health, San Diego, CA [email protected]d.edu Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org. This letter was published on September 1, 2021, and updated on September 3, 2021, where do i get propecia at NEJM.org.

Dr. Laurent serves as an author on behalf of the SEARCH Alliance. Collaborators in the SEARCH Alliance are listed in the Supplementary Appendix, available with the full text of this letter at NEJM.org. Drs. Keehner and Horton and Drs.

Abeles and Torriani contributed equally to this letter. 5 References1. Keehner J, Abeles SR, Torriani FJ. More on hair loss after vaccination in health care workers. Reply.

N Engl J Med 2021;385(2):e8.2. Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 hair loss treatment. N Engl J Med 2021;384:403-416.3. Thomas SJ, Moreira ED Jr, Kitchin N, et al.

Six month safety and efficacy of the BNT162b2 mRNA hair loss treatment. July 28, 2021 (https://www.medrxiv.org/content/10.1101/2021.07.28.21261159v1). Preprint.Google Scholar4. Lopez Bernal J, Andrews N, Gower C, et al. Effectiveness of hair loss treatments against the B.1.617.2 (Delta) variant.

N Engl J Med 2021;385:585-594.5. Israel A, Merzon E, Schäffer AA, et al. Elapsed time since BNT162b2 treatment and risk of hair loss in a large cohort. August 5, 2021 (https://www.medrxiv.org/content/10.1101/2021.08.03.21261496v1). Preprint.Google Scholar10.1056/NEJMc2112981-t1Table 1.

Symptomatic hair loss and mRNA treatment Effectiveness among UCSDH Health Workers, March through July 2021.* MarchAprilMayJuneJulyUCSDH workforce — no. Of persons18,96418,99219,00019,03519,016Vaccination status — no. Of personsFully vaccinated†14,47015,51016,15716,42616,492mRNA-1273 (Moderna)6,6087,0057,3407,4517,464BNT162b2 (Pfizer–BioNTech)7,8628,5058,8178,9759,028Unvaccinated3,2302,5092,1872,0591,895Percentage of workers fully vaccinated76.381.785.086.386.7Symptomatic hair loss treatmentFully vaccinated workers343594Unvaccinated workers1117101031Percentage of cases in fully vaccinated workers21.419.023.133.375.2Attack rate per 1000 (95% CI)Fully vaccinated workers0.21 (0.21–0.47)0.26 (0.26–0.50)0.19 (0.21–0.40)0.30 (0.31–0.53)5.7 (5.4–6.2)Unvaccinated workers3.4 (2.1–5.9)6.8 (4.5–10.6)4.6 (2.6–8.2)4.9 (2.9–8.7)16.4 (11.8–22.9)treatment effectiveness — % (95% CI)93.9 (78.2–97.9)96.2 (88.7–98.3)95.9 (85.3–98.9)94.3 (83.7–98.0)65.5 (48.9–76.9)Study Sample A total of 103,199 hospitalizations of patients with hair loss treatment–like illness who were 50 years of age or older were identified by the seven VISION partners. Of these hospitalizations, 64,400 (62%) occurred after the dates of age-specific hair loss treatment eligibility and the time required for vaccination records to be updated (Table S3). The hospitalizations occurred during the period from January 1 through June 22, 2021.

Among unvaccinated patients who were hospitalized, the median duration from treatment eligibility to the index date was 39 days (interquartile range, 16 to 70) (Table S4). hair loss testing with a molecular assay ordered by clinicians was conducted for 74% of the patients who were hospitalized (range across network partners, 55 to 99). During the period from January 1 through June 22, a total of 121,709 visits to emergency departments or urgent care clinics for hair loss treatment–like illness were identified by three partners. 76,220 visits (63%) occurred after treatment age eligibility and updates to vaccination records (Table S5). Among the patients who visited an emergency department or urgent care clinic, the median duration from treatment eligibility to the index date was 39 days (interquartile range, 15 to 70).

30% (range, 25 to 41) of these patients were tested by means of molecular assay. Across the partners, 1872 hospitalizations and 1350 emergency department or urgent care clinic visits were excluded because the index dates occurred 1 to 13 days after the patient received the first dose of hair loss treatment and immunity was considered indeterminant. Table 2. Table 2. Characteristics of the Patients According to hair loss Test Results and Vaccination Status.

Our analytic sample included 41,552 hospitalizations and 21,522 emergency department or urgent care clinic visits. 3% of the hospitalizations and 14% of the emergency department or urgent care clinic visits were repeat medical visits by the same patient (Table 2). Characteristics of the patients are listed in Table 2, and characteristics of the patients according to network partner are provided in Tables S6 through S11. The median age was 74 years (interquartile range, 66 to 82) among hospitalized patients and 70 years (interquartile range, 61 to 78) among those who visited an emergency department or urgent care clinic. Black patients and Hispanic patients accounted for a larger percentage of medical visits in the hospitalization sample (9% and 11%, respectively) than in the emergency department or urgent care sample (4% and 5%).

These findings reflect in part the differing demographic characteristics of the network partners that contributed data on emergency department or urgent care clinic visits. The percentage of patients with underlying medical conditions was higher among hospitalized patients than among those who visited an emergency department or urgent care clinic. hair loss treatment–Associated Medical Care We identified 4321 patients with hair loss treatment who had laboratory-confirmed hair loss among 41,552 patients who were hospitalized (10%. Range across network partners, 5 to 21). The remaining 37,231 hospitalized patients (90%) had discharge codes for hair loss treatment–like illness but were hair loss–negative.

Laboratory-confirmed hair loss was identified in 3251 of 21,522 patients who visited an emergency department or urgent care clinic (15%. Range across network partners, 9 to 19). The remaining 18,271 patients who visited an emergency department or urgent care clinic (85%) were hair loss–negative (Table 2). The percentage of hair loss–positive patients also varied among network partners (Tables S12 and S13). The percentage of patients with laboratory-confirmed hair loss decreased with age among hospitalized patients and among those with emergency department or urgent care clinic visits.

In both care settings, the percentage of infected patients was higher among unvaccinated patients and lower among White patients, non-Hispanic patients, and those with chronic nonrespiratory conditions. The numbers of both hair loss–positive patients and hair loss–negative patients with medical visits on each day are provided in Figures S1 through S10. hair loss treatment Vaccination Status On the index date, unvaccinated patients composed approximately half the patients who were hospitalized (49%. Range across network partners, 26 to 73) or visited an emergency department or urgent care clinic (55%. Range, 45 to 65) (Table 2).

In both samples, the largest differences between vaccinated and unvaccinated patients were age, network partner, calendar time, and local hair loss circulation on the index date. These same differences were noted when the sample was limited to hair loss–positive patients only (Tables S14 and S15). As described in the Supplementary Appendix, the application of inverse propensity-to-be-vaccinated weighting reduced the differences between vaccinated and unvaccinated patients with respect to these factors and other patient characteristics to a standard mean difference of less than 0.2. Among vaccinated patients, 53.4% of those who were hospitalized and 53.7% of those who visited an emergency department or urgent care clinic had received the BNT162b2 treatment, 43.3% and 41.6%, respectively, had received the mRNA-1273 treatment, and 3.3% and 4.7%, respectively, had received the Ad26.COV2.S treatment. The median days from full vaccination to the index date were similar with the three types of hair loss treatments and with both samples (hospitalization and emergency department or urgent care clinic) (range, 42 to 53).

Among the patients who received the BNT162b2 treatment, the median duration from partial vaccination (one dose) to the index date of hospitalization was 21 days and the median duration from partial vaccination to the index date of an emergency department or urgent care visit was 20 days. Among patients who received the mRNA-1273 treatment, these durations were 26 days and 24 days, respectively. These findings reflected the different dosing schedules of these treatments. MRNA-Based treatment and Hospitalization Figure 1. Figure 1.

Estimated treatment Effectiveness against hair loss Leading to Hospitalization or an Emergency Department or Urgent Care Clinic Visit, According to the Type of treatment. Patients who were partially vaccinated with one dose of a messenger RNA (mRNA)–based treatment received the first dose at least 14 days before the index date for the medical visit and had not received the second dose by the index date. Patients who were partially vaccinated with two doses of an mRNA-based treatment received the second dose 1 to 13 days before the index date. Fully vaccinated patients received a single dose of the Ad26.COV2.S treatment or the second dose of an mRNA-based treatment at least 14 days before the index date. CI denotes confidence interval, and hair loss severe acute respiratory syndrome hair loss 2.Figure 2.

Figure 2. Estimated Effectiveness of Full Two-Dose mRNA Vaccination against hair loss Leading to Hospitalization, According to Age, Race or Ethnic Group, and Underlying Medical Conditions. Among adults who were 50 years of age or older, the effectiveness of full two-dose mRNA-based vaccination (≥14 days after the second dose) was 89% (95% confidence interval [CI], 87 to 91) against laboratory-confirmed hair loss leading to hospitalization. The treatment-effectiveness point estimates were similar (differences, ≤5 percentage points) with the BNT162b2 and mRNA-1273 treatments (Figure 1 and Figure 2). The effectiveness of full mRNA-based vaccination was 83% (95% CI, 77 to 87) among patients who were at least 85 years of age, 86% (95% CI, 75 to 92) among Black patients, 90% (95% CI, 85 to 93) among Hispanic patients, 90% (95% CI, 88 to 92) among patients with chronic respiratory conditions, and 88% (95% CI, 86 to 90) among patients with chronic nonrespiratory conditions (Figure 2).

When the hospital sample was limited to 7283 admissions to an ICU, the effectiveness of full mRNA-based vaccination against laboratory-confirmed hair loss leading to ICU admission was 90% (95% CI, 86 to 93) (Table S16). Patients who were partially vaccinated with one dose of mRNA-based treatment received the first dose at least 14 days before the index date and had not received the second dose by the index date. Patients who were partially vaccinated with two doses of mRNA-based treatment received the second dose 1 to 13 days before the index date. Among patients who received an mRNA-based treatment, the effectiveness of partial one-dose vaccination (≥14 days after the first dose, but without the second dose) was 54% (95% CI, 47 to 61) against hair loss leading to hospitalization, and the effectiveness of partial two-dose vaccination (1 to 13 days after the second dose) was 73% (95% CI, 66% to 79). With both the BNT162b2 and mRNA-1273 treatments, the effectiveness of full vaccination with respect to hair loss treatment–associated hospitalization was higher than that of partial vaccination (first dose) (with 95% confidence intervals that did not overlap) (Figure 1).

A similar pattern of higher treatment-effectiveness point estimates for full mRNA-based vaccination than for partial mRNA-based vaccination was noted in all stratified analyses (Table S17). The effectiveness after partial vaccination (first dose) was lower with BNT162b2 than with mRNA-1273 (Figure 1). The estimates of the effectiveness of full mRNA-based vaccination were similar when stratified according to the six network partners that contributed the most data on hospitalizations (range, 82 to 97%). However, heterogeneity was observed among the partners in the estimates of effectiveness of partial vaccination (first dose). treatment effectiveness also remained consistent in the other sensitivity analyses (Section S5).

Our simulation model suggested that if both misclassification of outcome and of exposure occur, treatment effectiveness could be underestimated by as much as 10 percentage points, given the rates of clinical testing, percent positivity, and vaccination coverage observed in our hospitalization sample. Figure 3. Figure 3. Estimated Effectiveness of mRNA-Based Vaccination against hair loss Leading to Hospitalization or an Emergency Department or Urgent Care Visit, According to the Days since the Most Recent Dose Was Administered. The total number of hospitalizations shown is higher than the total number in the main analysis because this secondary analysis was conducted weeks after the main analysis and incorporated updated information from vaccination records and registries.

Specifically, an additional 212 hospitalizations among unvaccinated patients and 831 hospitalizations among vaccinated patients with confirmed vaccination status were included.In secondary analyses, we stratified mRNA-based treatment exposure according to 14-day intervals after administration (Figure 3) and according to type of treatment (Table S18). treatment effectiveness with respect to hair loss treatment–associated hospitalization was null 0 to 13 days after the first dose, and treatment-effectiveness point estimates increased through 55 days after the first dose. treatment-effectiveness point estimates for full mRNA-based vaccination remained consistently high (>80%) through at least 112 days after the second dose. MRNA-Based treatment and Emergency Department and Urgent Care Visits Figure 4. Figure 4.

Estimated Effectiveness of Full Two-Dose mRNA-Based Vaccination against hair loss Leading to an Emergency Department or Urgent Care Clinic Visit, According to Age, Race or Ethnic Group, and Underlying Medical Conditions. The effectiveness of full two-dose mRNA-based vaccination was 91% (95% CI, 89 to 93) against laboratory-confirmed hair loss leading to emergency department or urgent care clinic visits (Figure 4). The treatment-effectiveness point estimates were similar (3 percentage points) with the BNT162b2 and mRNA-1273 treatments (Figure 1). The effectiveness of full mRNA-based vaccination was 84% (95% CI, 73 to 91) among adults who were 85 years of age or older, 95% (95% CI, 84 to 98) among Black patients, 81% (95% CI, 70 to 88) among Hispanic patients, and 90% (95% CI, 86 to 93) and 90% (95% CI, 87 to 92) among patients with chronic respiratory conditions and those with chronic nonrespiratory conditions, respectively (Figure 4). The effectiveness of partial (one-dose) mRNA-based vaccination (both types) against hair loss leading to emergency department or urgent care clinic visits was 68% (95% CI, 61 to 74), and the effectiveness of partial (two-dose) vaccination was 80% (95% CI, 73 to 85) (Table S19).

With both the BNT162b2 and mRNA-1273 treatments, the effectiveness of full vaccination against hair loss leading to emergency department or urgent care clinic visits was higher than the effectiveness with partial vaccination (one dose) (Figure 1). In sensitivity analyses, treatment-effectiveness point estimates for full mRNA-based vaccination against hair loss leading to emergency department or urgent care clinic visits ranged from 89 to 97% across the three network partners. Estimates of treatment effectiveness also remained consistent in other sensitivity analyses (Section S5). In secondary analyses, treatment effectiveness against hair loss leading to emergency department or urgent care clinic visits was null 0 to 13 days after the first dose, and then treatment-effectiveness point estimates increased through 55 days after the first dose. treatment-effectiveness point estimates for full mRNA-based vaccination remained consistently high (≥86%) through at least 112 days after the second dose (Figure 3).

Estimates of effectiveness according to the type of hair loss treatment are provided in Table S20. Effectiveness of Ad26.COV2.S treatment Estimates of the effectiveness of Ad26.COV2.S treatment were limited to five network partners with Ad26.COV2.S treatment recipients (CUIMC, Intermountain Healthcare, KPNC, KPNW, and Regenstrief Institute). These analyses included 11,468 hospitalizations and 8917 emergency department or urgent care clinic visits that occurred after the index date for the first patient who was fully vaccinated with Ad26.COV2.S for each network partner (Figure 1). The effectiveness of the full one-dose Ad26.COV2.S treatment was 68% (95% CI, 50 to 79) with respect to hair loss treatment–associated hospitalization. The effectiveness of full vaccination against hair loss leading to emergency department or urgent care clinic visits was 73% (95% CI, 59 to 82) (Figure 1).To the Editor.

Pregnant persons are at risk for severe hair loss disease 2019 (hair loss treatment), and with severe acute respiratory syndrome hair loss 2 (hair loss) during pregnancy is associated with increased risks of preterm birth and other adverse maternal and neonatal outcomes.1 Although spontaneous abortion (pregnancy loss occurring at less than 20 weeks of gestation) is a common pregnancy outcome affecting 11 to 22% of recognized pregnancies (see Table S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org),2-4 data to inform estimates of the risk of spontaneous abortion after receipt of an mRNA hair loss treatment either before conception (30 days before the first day of the last menstrual period through 14 days after) or during pregnancy are limited. We analyzed data from the Centers for Disease Control and Prevention (CDC) v-safe hair loss treatment pregnancy registry to determine the cumulative risk of spontaneous abortion from 6 to less than 20 weeks of gestation. Participants with a singleton pregnancy who had received at least one dose of an mRNA hair loss treatment either before conception or before 20 weeks of gestation and who did not have a pregnancy loss before 6 weeks of gestation were included in this analysis. Inclusion of pregnant participants at 6 weeks of gestation is consistent with literature estimating the risk of spontaneous abortion in the general population.2-4 Life table methods were used to calculate the cumulative risk of spontaneous abortion according to gestational week, with appropriate left truncation (i.e., with adjustment for gestational age at entry). Data were right-censored at the time of the most recent contact for participants with ongoing pregnancies who were not contacted at 20 weeks of gestation or later and at the time of the outcome for participants who reported pregnancy outcomes other than spontaneous abortion (induced abortions or ectopic or molar pregnancies) before 20 weeks of gestation.

The cumulative risk of spontaneous abortion was also age-standardized with the use of data on the risk of spontaneous abortion according to maternal age group.3 We conducted a sensitivity analysis to estimate the maximum possible risk of spontaneous abortion, using an extreme assumption that all participants whose most recent contact was during the first trimester (i.e., at less than 14 weeks of gestation) and whom we were unable to reach during the second trimester experienced a spontaneous abortion immediately after the most recent contact (see the Supplementary Appendix for details). Table 1. Table 1. Risk of Spontaneous Abortion among Participants in the v-safe hair loss treatment Pregnancy Registry, December 14, 2020, through July 19, 2021. A total of 2456 participants who were enrolled in the CDC v-safe hair loss treatment pregnancy registry met the inclusion criteria for this study.

2022 participants reported ongoing pregnancies at 20 weeks of gestation, 165 participants reported a spontaneous abortion (154 participants before 14 weeks of gestation), 65 participants with most recent contact during the first trimester could not be reached for second trimester follow-up, 188 participants completed second trimester follow-up before 20 weeks of gestation, and 16 participants reported another pregnancy outcome before 20 weeks (induced abortion or ectopic or molar pregnancy) (Fig. S1). Most participants were 30 years of age or older (77.3%), were non-Hispanic White (78.3%), and worked as health care personnel (88.8%). Slightly more than half the participants (52.7%) had received the BNT162b2 treatment (Pfizer–BioNTech) (Table S2). The cumulative risk of spontaneous abortion from 6 to less than 20 weeks of gestation was 14.1% (95% confidence interval [CI], 12.1 to 16.1) in the primary analysis (Table 1) and 12.8% (95% CI, 10.8 to 14.8) in an analysis using direct maternal age–standardization to the reference population.

The cumulative risk of spontaneous abortion increased with maternal age (Table S3). In the sensitivity analysis, under the extreme assumption that all 65 participants with most recent contact during the first trimester had a spontaneous abortion, the cumulative risk of spontaneous abortion from 6 to less than 20 weeks of gestation was 18.8% (95% CI, 16.6 to 20.9). After age standardization, the cumulative risk was 18.5% (95% CI, 16.1 to 20.8). Figure 1. Figure 1.

Cumulative Risk of Spontaneous Abortion in the v-safe hair loss treatment Pregnancy Registry and in Two Historical Cohorts. Data from Mukherjee2 were presented as race-specific rates and are provided here for White women to maximize comparability with the v-safe pregnancy registry.As compared with data from two historical cohorts that represent the lower and upper ranges of spontaneous-abortion risk,2,4 the cumulative risks of spontaneous abortion from our primary and sensitivity analyses were within the expected risk range (Figure 1). Limitations of our study include the lack of a control group of unvaccinated pregnant persons, the homogeneity of the participants in terms of racial and ethnic groups and occupation, the voluntary enrollment of the population, and the use of data reported by the participants themselves, including some data collected retrospectively. Nonetheless, our findings suggest that the risk of spontaneous abortion after mRNA hair loss treatment vaccination either before conception or during pregnancy is consistent with the expected risk of spontaneous abortion. These findings add to the accumulating evidence about the safety of mRNA hair loss treatment vaccination in pregnancy.5 Lauren H.

Zauche, Ph.D., M.S.N.Bailey Wallace, M.P.H.Ashley N. Smoots, M.P.H.Christine K. Olson, M.D., M.P.H.Titilope Oduyebo, M.D., M.P.H.Shin Y. Kim, M.P.H.Emily E. Petersen, M.D.Jun Ju, M.S.Jennifer Beauregard, Ph.D., M.P.H.Centers for Disease Control and Prevention (CDC), Atlanta, GAAllen J.

Wilcox, M.D., Ph.D.National Institutes of Health, Durham, NCCharles E. Rose, Ph.D.Dana M. Meaney-Delman, M.D., M.P.H.Sascha R. Ellington, Ph.D., M.S.P.H.CDC, Atlanta, GAfor the CDC v-safe hair loss treatment Pregnancy Registry Team Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org. The findings and conclusions in this letter are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).

Mention of a product or company name is for identification purposes only and does not constitute endorsement by the CDC or the Food and Drug Administration. The authors do not have any material conflicts of interest.This letter was published on September 8, 2021, at NEJM.org.5 References1. Allotey J, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of hair loss disease 2019 in pregnancy. Living systematic review and meta-analysis.

BMJ 2020;370:m3320-m3320.2. Mukherjee S, Velez Edwards DR, Baird DD, Savitz DA, Hartmann KE. Risk of miscarriage among black women and white women in a U.S. Prospective cohort study. Am J Epidemiol 2013;177:1271-1278.3.

Magnus MC, Wilcox AJ, Morken N-H, Weinberg CR, HÃ¥berg SE. Role of maternal age and pregnancy history in risk of miscarriage. Prospective register based study. BMJ 2019;364:l869-l869.4. Goldhaber MK, Fireman BH.

The fetal life table revisited. Spontaneous abortion rates in three Kaiser Permanente cohorts. Epidemiology 1991;2:33-39.5. Shimabukuro TT, Kim SY, Myers TR, et al. Preliminary findings of mRNA hair loss treatment safety in pregnant persons.

N Engl J Med 2021;384:2273-2282.10.1056/NEJMc2113891-t1Table 1. Risk of Spontaneous Abortion among Participants in the v-safe hair loss treatment Pregnancy Registry, December 14, 2020, through July 19, 2021. Gestational AgeParticipants at RiskParticipants Who Reported Spontaneous AbortionWeek-Specific RiskCumulative Risknumber of personspercentpercent (95% CI)6 to <7 weeks904151.71.7 (0.8–2.5)7 to <8 weeks982181.83.5 (2.3–4.6)8 to <9 weeks1032373.66.9 (5.4–8.5)9 to <10 weeks1087393.610.3 (8.4–12.0)10 to <11 weeks1118191.711.8 (9.9–13.7)11 to <12 weeks1184121.012.7 (10.7–14.6)12 to <13 weeks127490.713.3 (11.3–15.2)13 to <14 weeks139450.413.6 (11.6–15.6)14 to <15 weeks15340013.6 (11.6–15.6)15 to <16 weeks163220.113.7 (11.7–15.7)16 to <17 weeks174220.113.8 (11.8–15.8)17 to <18 weeks184820.113.9 (11.9–15.9)18 to <19 weeks194130.214.0 (12.0–16.0)19 to <20 weeks205220.114.1 (12.1–16.1)To the Editor. Whether vaccination of individual persons for severe acute respiratory syndrome hair loss 2 (hair loss) protects members of their households is unclear. We investigated the effect of vaccination of health care workers in Scotland (who were among the earliest groups to be vaccinated worldwide) on the risk of hair loss disease 2019 (hair loss treatment) among members of their households.

We evaluated data from 194,362 household members (which represented 92,470 households of 2 to 14 persons per household) of 144,525 health care workers who had been employed during the period from March 2020 through November 2020. The mean ages of the household members and the health care workers were 31 and 44 years, respectively. A majority (>96%) were White. A total of 113,253 health care workers (78.4%) had received at least one dose of either the BNT162b2 (Pfizer–BioNTech) mRNA treatment or the ChAdOx1 nCoV-19 (Oxford–AstraZeneca) treatment, and 36,227 (25.1%) had received a second dose. The primary outcome was any confirmed case of hair loss treatment that occurred between December 8, 2020, and March 3, 2021.

We also report results for hair loss treatment–associated hospitalization. The primary time periods we compared were the unvaccinated period before the first dose and the period beginning 14 days after the health care worker received the first dose. No adjustment was made for multiplicity. Events that occurred after any household member was vaccinated were censored. Detailed methods and results, strengths and limitations, and the protocol are provided in the Supplementary Appendix, which is available with the full text of this letter at NEJM.org.

This study was approved by the Public Benefit and Privacy Panel (2021-0013), and the scientific officer of the West of Scotland Research Ethics Committee provided written confirmation that formal ethics review was not required. Table 1. Table 1. Effect of Vaccination of Health Care Workers on Documented hair loss treatment Cases and Hospitalizations in Health Care Workers and Their Households. Cases of hair loss treatment were less common among household members of vaccinated health care workers during the period beginning 14 days after the first dose than during the unvaccinated period before the first dose (event rate per 100 person-years, 9.40 before the first dose and 5.93 beginning 14 days after the first dose).

After the health care worker’s second dose, the rate in household members was lower still (2.98 cases per 100 person-years). These differences persisted after fitting extended Cox models that were adjusted for calendar time, geographic region, age, sex, occupational and socioeconomic factors, and underlying conditions. Relative to the period before each health care worker was vaccinated, the hazard ratio for a household member to become infected was 0.70 (95% confidence interval [CI], 0.63 to 0.78) for the period beginning 14 days after the first dose and 0.46 (95% CI, 0.30 to 0.70) for the period beginning 14 days after the second dose (Table 1 and the Supplementary Appendix). Not all the cases of hair loss treatment in the household members were transmitted from the health care worker. Therefore, the effect of vaccination may be larger.1 For example, if half the cases in the household members were transmitted from the health care worker, a 60% decrease in cases transmitted from health care workers would need to occur to elicit the association we observed (see the Supplementary Appendix).

Vaccination was associated with a reduction in both the number of cases and the number of hair loss treatment–related hospitalizations in health care workers between the unvaccinated period and the period beginning 14 days after the first dose. Given that vaccination reduces asymptomatic with hair loss,2,3 it is plausible that vaccination reduces transmission. However, data from clinical trials and observational studies are lacking.4,5 We provide empirical evidence suggesting that vaccination may reduce transmission by showing that vaccination of health care workers is associated with a decrease in documented cases of hair loss treatment among members of their households. This finding is reassuring for health care workers and their families. Anoop S.V.

Shah, M.D.London School of Hygiene and Tropical Medicine, London, United KingdomCiara Gribben, M.Sc.Jennifer Bishop, M.Sc.Public Health Scotland, Edinburgh, United KingdomPeter Hanlon, M.D.University of Glasgow, Glasgow, United KingdomDavid Caldwell, M.Sc.Public Health Scotland, Edinburgh, United KingdomRachael Wood, Ph.D.University of Edinburgh, Edinburgh, United KingdomMartin Reid, B.Sc.Jim McMenamin, M.D.David Goldberg, M.D.Diane Stockton, M.Sc.Public Health Scotland, Edinburgh, United KingdomSharon Hutchinson, Ph.D.Glasgow Caledonian University, Glasgow, United KingdomChris Robertson, Ph.D.University of Strathclyde, Glasgow, United KingdomPaul M. McKeigue, Ph.D.Helen M. Colhoun, Ph.D.University of Edinburgh, Edinburgh, United KingdomDavid A. McAllister, M.D.University of Glasgow, Glasgow, United Kingdom [email protected] Supported by the British Heart Foundation and Wellcome. Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

This letter was published on September 8, 2021, at NEJM.org.5 References1. Shah ASV, Wood R, Gribben C, et al. Risk of hospital admission with hair loss disease 2019 in healthcare workers and their households. Nationwide linkage cohort study. BMJ 2020;371:m3582-m3582.2.

Voysey M, Costa Clemens SA, Madhi SA, et al. Single-dose administration and the influence of the timing of the booster dose on immunogenicity and efficacy of ChAdOx1 nCoV-19 (AZD1222) treatment. A pooled analysis of four randomised trials. Lancet 2021;397:881-891.3. Hall VJ, Foulkes S, Saei A, et al.

hair loss treatment coverage in health-care workers in England and effectiveness of BNT162b2 mRNA treatment against (SIREN). A prospective, multicentre, cohort study. Lancet 2021;397:1725-1735.4. Dagan N, Barda N, Kepten E, et al. BNT162b2 mRNA hair loss treatment in a nationwide mass vaccination setting.

N Engl J Med 2021;384:1412-1423.5. Chodick G, Tene L, Patalon T, et al. Assessment of effectiveness of 1 dose of BNT162b2 treatment for hair loss 13 to 24 days after immunization. JAMA Netw Open 2021;4(6):e2115985-e2115985.Study Design We used two approaches to estimate the effect of vaccination on the delta variant. First, we used a test-negative case–control design to estimate treatment effectiveness against symptomatic disease caused by the delta variant, as compared with the alpha variant, over the period that the delta variant has been circulating.

This approach has been described in detail elsewhere.10 In brief, we compared vaccination status in persons with symptomatic hair loss treatment with vaccination status in persons who reported symptoms but had a negative test. This approach helps to control for biases related to health-seeking behavior, access to testing, and case ascertainment. For the secondary analysis, the proportion of persons with cases caused by the delta variant relative to the main circulating propecia (the alpha variant) was estimated according to vaccination status. The underlying assumption was that if the treatment had some efficacy and was equally effective against each variant, a similar proportion of cases with either variant would be expected in unvaccinated persons and in vaccinated persons. Conversely, if the treatment was less effective against the delta variant than against the alpha variant, then the delta variant would be expected to make up a higher proportion of cases occurring more than 3 weeks after vaccination than among unvaccinated persons.

Details of this analysis are described in Section S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org. The authors vouch for the accuracy and completeness of the data and for the fidelity of the trial to the protocol. Data Sources Vaccination Status Data on all persons in England who have been vaccinated with hair loss treatments are available in a national vaccination register (the National Immunisation Management System). Data regarding vaccinations that had occurred up to May 16, 2021, including the date of receipt of each dose of treatment and the treatment type, were extracted on May 17, 2021. Vaccination status was categorized as receipt of one dose of treatment among persons who had symptom onset occurring 21 days or more after receipt of the first dose up to the day before the second dose was received, as receipt of the second dose among persons who had symptom onset occurring 14 days or more after receipt of the second dose, and as receipt of the first or second dose among persons with symptom onset occurring 21 days or more after the receipt of the first dose (including any period after the receipt of the second dose).

hair loss Testing Polymerase-chain-reaction (PCR) testing for hair loss in the United Kingdom is undertaken by hospital and public health laboratories, as well as by community testing with the use of drive-through or at-home testing, which is available to anyone with symptoms consistent with hair loss treatment (high temperature, new continuous cough, or loss or change in sense of smell or taste). Data on all positive PCR tests between October 26, 2020, and May 16, 2021, were extracted. Data on all recorded negative community tests among persons who reported symptoms were also extracted for the test-negative case–control analysis. Children younger than 16 years of age as of March 21, 2021, were excluded. Data were restricted to persons who had reported symptoms, and only persons who had undergone testing within 10 days after symptom onset were included, in order to account for reduced sensitivity of PCR testing beyond this period.25 Identification of Variant Whole-genome sequencing was used to identify the delta and alpha variants.

The proportion of all positive samples that were sequenced increased from approximately 10% in February 2021 to approximately 60% in May 2021.4 Sequencing is undertaken at a network of laboratories, including the Wellcome Sanger Institute, where a high proportion of samples has been tested, and whole-genome sequences are assigned to Public Health England definitions of variants on the basis of mutations.26 Spike gene target status on PCR was used as a second approach for identifying each variant. Laboratories used the TaqPath assay (Thermo Fisher Scientific) to test for three gene targets. Spike (S), nucleocapsid (N), and open reading frame 1ab (ORF1ab). In December 2020, the alpha variant was noted to be associated with negative testing on the S target, so S target–negative status was subsequently used as a proxy for identification of the variant. The alpha variant accounts for between 98% and 100% of S target–negative results in England.

Among sequenced samples that tested positive for the S target, the delta variant was in 72.2% of the samples in April 2021 and in 93.0% in May (as of May 12, 2021).4 For the test-negative case–control analysis, only samples that had been tested at laboratories with the use of the TaqPath assay were included. Data Linkage The three data sources described above were linked with the use of the National Health Service number (a unique identifier for each person receiving medical care in the United Kingdom). These data sources were also linked with data on the patient’s date of birth, surname, first name, postal code, and specimen identifiers and sample dates. Covariates Multiple covariates that may be associated with the likelihood of being offered or accepting a treatment and the risk of exposure to hair loss treatment or specifically to either of the variants analyzed were also extracted from the National Immunisation Management System and the testing data. These data included age (in 10-year age groups), sex, index of multiple deprivation (a national indication of level of deprivation that is based on small geographic areas of residence,27 assessed in quintiles), race or ethnic group, care home residence status, history of foreign travel (i.e., outside the United Kingdom or Ireland), geographic region, period (calendar week), health and social care worker status, and status of being in a clinically extremely vulnerable group.28 In addition, for the test-negative case–control analysis, history of hair loss before the start of the vaccination program was included.

Persons were considered to have traveled if, at the point of requesting a test, they reported having traveled outside the United Kingdom and Ireland within the preceding 14 days or if they had been tested in a quarantine hotel or while quarantining at home. Postal codes were used to determine the index of multiple deprivation, and unique property-reference numbers were used to identify care homes.29 Statistical Analysis For the test-negative case–control analysis, logistic regression was used to estimate the odds of having a symptomatic, PCR-confirmed case of hair loss treatment among vaccinated persons as compared with unvaccinated persons (control). Cases were identified as having the delta variant by means of sequencing or if they were S target–positive on the TaqPath PCR assay. Cases were identified as having the alpha variant by means of sequencing or if they were S target–negative on the TaqPath PCR assay. If a person had tested positive on multiple occasions within a 90-day period (which may represent a single illness episode), only the first positive test was included.

A maximum of three randomly chosen negative test results were included for each person. Negative tests in which the sample had been obtained within 3 weeks before a positive result or after a positive result could have been false negatives. Therefore, these were excluded. Tests that had been administered within 7 days after a previous negative result were also excluded. Persons who had previously tested positive before the analysis period were also excluded in order to estimate treatment effectiveness in fully susceptible persons.

All the covariates were included in the model as had been done with previous test-negative case–control analyses, with calendar week included as a factor and without an interaction with region. With regard to S target–positive or –negative status, only persons who had tested positive on the other two PCR gene targets were included. Assignment to the delta variant on the basis of S target status was restricted to the week commencing April 12, 2021, and onward in order to aim for high specificity of S target–positive testing for the delta variant.4 treatment effectiveness for the first dose was estimated among persons with a symptom-onset date that was 21 days or more after receipt of the first dose of treatment, and treatment effects for the second dose were estimated among persons with a symptom-onset date that was 14 days or more after receipt of the second dose. Comparison was made with unvaccinated persons and with persons who had symptom onset in the period of 4 to 13 days after vaccination in order to help account for differences in underlying risk of . The period from the day of treatment administration (day 0) to day 3 was excluded because reactogenicity to the treatment can cause an increase in testing that biases results, as previously described.10.

Generic propecia canada

Study Design We index used two approaches to estimate the effect generic propecia canada of vaccination on the delta variant. First, we used a test-negative case–control design to estimate treatment effectiveness against symptomatic disease caused by the delta variant, as compared with the alpha variant, over the period that the delta variant has been circulating. This approach has been described in detail elsewhere.10 In generic propecia canada brief, we compared vaccination status in persons with symptomatic hair loss treatment with vaccination status in persons who reported symptoms but had a negative test. This approach helps to control for biases related to health-seeking behavior, access to testing, and case ascertainment.

For the secondary analysis, the proportion of persons with cases caused by the delta variant relative to the main circulating propecia (the generic propecia canada alpha variant) was estimated according to vaccination status. The underlying assumption was that if the treatment had some efficacy and was equally effective against each variant, a similar proportion of cases with either variant would be expected in unvaccinated persons and in vaccinated persons. Conversely, if the treatment was less effective against the delta variant than against the alpha variant, then the delta variant would be expected to make up a higher proportion of cases occurring more than 3 weeks after vaccination than among unvaccinated persons. Details of this analysis are described in Section S1 in generic propecia canada the Supplementary Appendix, available with the full text of this article at NEJM.org.

The authors vouch for the accuracy and completeness of the data and for the fidelity of the trial to the protocol. Data Sources Vaccination Status Data on all persons in England generic propecia canada who have been vaccinated with hair loss treatments are available in a national vaccination register (the National Immunisation Management System). Data regarding vaccinations that had occurred up to May 16, 2021, including the date of receipt of each dose of treatment and the treatment type, were extracted on May 17, 2021. Vaccination status was categorized as receipt of one dose of treatment among persons who had symptom onset occurring 21 days or more after receipt of the first dose up to the day before the second dose was received, generic propecia canada as receipt of the second dose among persons who had symptom onset occurring 14 days or more after receipt of the second dose, and as receipt of the first or second dose among persons with symptom onset occurring 21 days or more after the receipt of the first dose (including any period after the receipt of the second dose).

hair loss Testing Polymerase-chain-reaction (PCR) testing for hair loss in the United Kingdom is undertaken by hospital and public health laboratories, as well as by community testing with the use of drive-through or at-home testing, which is available to anyone with symptoms consistent with hair loss treatment (high temperature, new continuous cough, or loss or change in sense of smell or taste). Data on all positive PCR tests between October 26, 2020, and May 16, 2021, were extracted. Data on all recorded negative community tests among persons generic propecia canada who reported symptoms were also extracted for the test-negative case–control analysis. Children younger than 16 years of age as of March 21, 2021, were excluded.

Data were restricted to persons who had reported symptoms, and only persons who had undergone testing within 10 days after symptom onset were included, in order to account for reduced sensitivity of PCR testing beyond this period.25 Identification of Variant Whole-genome sequencing was used generic propecia canada to identify the delta and alpha variants. The proportion of all positive samples that were sequenced increased from approximately 10% in February 2021 to approximately 60% in May 2021.4 Sequencing is undertaken at a network of laboratories, including the Wellcome Sanger Institute, where a high proportion of samples has been tested, and whole-genome sequences are assigned to Public Health England definitions of variants on the basis of mutations.26 Spike gene target status on PCR was used as a second approach for identifying each variant. Laboratories used the TaqPath assay (Thermo Fisher Scientific) to test for three gene targets. Spike (S), generic propecia canada nucleocapsid (N), and open reading frame 1ab (ORF1ab).

In December 2020, the alpha variant was noted to be associated with negative testing on the S target, so S target–negative status was subsequently used as a proxy for identification of the variant. The alpha variant accounts for between 98% and 100% of S generic propecia canada target–negative results in England. Among sequenced samples that tested positive for the S target, the delta variant was in 72.2% of the samples in April 2021 and in 93.0% in May (as of May 12, 2021).4 For the test-negative case–control analysis, only samples that had been tested at laboratories with the use of the TaqPath assay were included. Data Linkage The three data sources described above were linked with the use of generic propecia canada the National Health Service number (a unique identifier for each person receiving medical care in the United Kingdom).

These data sources were also linked with data on the patient’s date of birth, surname, first name, postal code, and specimen identifiers and sample dates. Covariates Multiple covariates that may be associated with the likelihood of being offered or accepting a treatment and the risk of exposure to hair loss treatment or specifically to either of the variants analyzed were also extracted from the National Immunisation Management System and the testing data. These data included age (in 10-year age groups), sex, index of multiple deprivation (a national indication of level of deprivation that is based on small geographic areas of residence,27 assessed in quintiles), race or ethnic group, care home residence status, history generic propecia canada of foreign travel (i.e., outside the United Kingdom or Ireland), geographic region, period (calendar week), health and social care worker status, and status of being in a clinically extremely vulnerable group.28 In addition, for the test-negative case–control analysis, history of hair loss before the start of the vaccination program was included. Persons were considered to have traveled if, at the point of requesting a test, they reported having traveled outside the United Kingdom and Ireland within the preceding 14 days or if they had been tested in a quarantine hotel or while quarantining at home.

Postal codes were used to determine the index of multiple deprivation, and unique property-reference numbers were used to identify care homes.29 Statistical Analysis For the generic propecia canada test-negative case–control analysis, logistic regression was used to estimate the odds of having a symptomatic, PCR-confirmed case of hair loss treatment among vaccinated persons as compared with unvaccinated persons (control). Cases were identified as having the delta variant by means of sequencing or if they were S target–positive on the TaqPath PCR assay. Cases were identified as having the alpha variant by means of sequencing or if they were S target–negative on the TaqPath PCR assay. If a person had tested positive on multiple occasions within a 90-day period (which may represent generic propecia canada a single illness episode), only the first positive test was included.

A maximum of three randomly chosen negative test results were included for each person. Negative tests in which the sample had been obtained within 3 weeks before a positive result or after a generic propecia canada positive result could have been false negatives. Therefore, these were excluded. Tests that had been administered within 7 generic propecia canada days after a previous negative result were also excluded.

Persons who had previously tested positive before the analysis period were also excluded in order to estimate treatment effectiveness in fully susceptible persons. All the covariates were included in the model as had been done with previous test-negative case–control analyses, with calendar week included as a factor and without an interaction with region. With regard generic propecia canada to S target–positive or –negative status, only persons who had tested positive on the other two PCR gene targets were included. Assignment to the delta variant on the basis of S target status was restricted to the week commencing April 12, 2021, and onward in order to aim for high specificity of S target–positive testing for the delta variant.4 treatment effectiveness for the first dose was estimated among persons with a symptom-onset date that was 21 days or more after receipt of the first dose of treatment, and treatment effects for the second dose were estimated among persons with a symptom-onset date that was 14 days or more after receipt of the second dose.

Comparison was made with unvaccinated persons and with persons who had symptom onset in the period of 4 to 13 generic propecia canada days after vaccination in order to help account for differences in underlying risk of . The period from the day of treatment administration (day 0) to day 3 was excluded because reactogenicity to the treatment can cause an increase in testing that biases results, as previously described.10Breakthrough s Among 11,453 fully vaccinated health care workers, 1497 (13.1%) underwent RT-PCR testing during the study period. Of the tested workers, 39 breakthrough cases were detected. More than 38 persons were tested for every positive case that was detected, for a test positivity of 2.6% generic propecia canada.

Thus, this percentage was much lower than the test positivity rate in Israel at the time, since the ratio between positive results and the extensive number of tests that were administered in our study was much smaller than that in the national population. Of the 39 breakthrough generic propecia canada case patients, 18 (46%) were nursing staff members, 10 (26%) were administration or maintenance workers, 6 (15%) were allied health professionals, and 5 (13%) were physicians. The average age of the 39 infected workers was 42 years, and the majority were women (64%). The median interval from the second generic propecia canada treatment dose to hair loss detection was 39 days (range, 11 to 102).

Only one infected person (3%) had immunosuppression. Other coexisting illnesses are detailed in Table S1. In all 37 case patients for whom data were available generic propecia canada regarding the source of , the suspected source was an unvaccinated person. In 21 patients (57%), this person was a household member.

Among these case patients were generic propecia canada two married couples, in which both sets of spouses worked at Sheba Medical Center and had an unvaccinated child who had tested positive for hair loss treatment and was assumed to be the source. In 11 of 37 case patients (30%), the suspected source was an unvaccinated fellow health care worker or patient. In 7 of the 11 case patients, the generic propecia canada was caused by a nosocomial outbreak of the B.1.1.7 (alpha) variant. These 7 patients, who worked in different hospital sectors and wards, were all found to be linked to the same suspected unvaccinated index patient who had been receiving noninvasive positive-pressure ventilation before her had been detected.

Of the 39 cases of , 27 occurred in workers who were tested solely because of exposure to a person with known hair loss . Of all the workers with breakthrough , 26 (67%) had generic propecia canada mild symptoms at some stage, and none required hospitalization. The remaining 13 workers (33% of all cases) were asymptomatic during the duration of . Of these workers, 6 were defined as borderline cases, since they had an N gene generic propecia canada Ct value of more than 35 on repeat testing.

The most common symptom that was reported was upper respiratory congestion (36% of all cases), followed by myalgia (28%) and loss of smell or taste (28%). Fever or rigors were reported in 21% (Table S1). On follow-up questioning, 31% of all infected workers reported having residual symptoms 14 days after generic propecia canada their diagnosis. At 6 weeks after their diagnosis, 19% reported having “long hair loss treatment” symptoms, which included a prolonged loss of smell, persistent cough, fatigue, weakness, dyspnea, or myalgia.

Nine workers (23%) generic propecia canada took a leave of absence from work beyond the 10 days of required quarantine. Of these workers, 4 returned to work within 2 weeks. One worker had not yet returned after 6 generic propecia canada weeks. Verification Testing and Secondary s Repeat RT-PCR assays were performed on samples obtained from most of the infected workers and for all case patients with an initial N gene Ct value of more than 30 to verify that the initial test was not taken too early, before the worker had become infectious.

A total of 29 case patients (74%) had a Ct value of less than 30 at some point during their . However, of these workers, only generic propecia canada 17 (59%) had positive results on a concurrent Ag-RDT. Ten workers (26%) had an N gene Ct value of more than 30 throughout the entire period. 6 of these workers had values of more than 35 and probably generic propecia canada had never been infectious.

Of the 33 isolates that were tested for a variant of concern, 28 (85%) were identified as the B.1.1.7 variant, by either multiplex PCR assay or genomic sequencing. At the time of this study, the B.1.1.7 variant was the most widespread variant in Israel and accounted for up to 94.5% of hair loss isolates.1,16 Since the end of the study, the country has had a surge of cases caused by the delta variant, as have many other countries worldwide. Thorough epidemiologic investigations of data regarding in-hospital generic propecia canada contact tracing did not detect any cases of transmission from infected health care workers (secondary s) among the 39 primary s. Among the 31 cases for whom data regarding household transmission (including symptoms and RT-PCR results) were available, no secondary s were detected, including 10 case patients and their 27 household members in whom the health care worker was the only index case patient.

Data regarding post N-specific IgG antibodies were available for 22 of 39 case patients (56%) on days 8 to 72 after the first positive result on generic propecia canada RT-PCR assay. Of these workers, 4 (18%) did not have an immune response, as detected by negative results on N-specific IgG antibody testing. Among these 4 workers were 2 who were asymptomatic (Ct values, 32 and 35), 1 who underwent generic propecia canada serologic testing only on day 10 after diagnosis, and 1 who had immunosuppression. Case–Control Analysis The results of peri- neutralizing antibody tests were available for 22 breakthrough cases.

Included in this group were 3 health care workers who had participated in the serologic study and had a test performed in the week preceding detection. In 19 other workers, generic propecia canada neutralizing and S-specific IgG antibodies were assessed on detection day. Of these 19 case patients, 12 were asymptomatic at the time of detection. For each case, 4 to 5 controls were generic propecia canada matched as described (Fig.

S1). In total, 22 breakthrough cases and their 104 matched controls were included in the case–control analysis. Table 1 generic propecia canada. Table 1.

Population Characteristics and Outcomes in generic propecia canada the Case–Control Study. Figure 2. Figure 2 generic propecia canada. Neutralizing Antibody and IgG Titers among Cases and Controls, According to Timing.

Among the 39 fully vaccinated health care workers who had breakthrough with hair loss, shown are the neutralizing antibody titers during the peri- period (within a week before hair loss detection) (Panel A) and the peak titers within 1 month after the second dose (Panel B), as compared with matched controls. Also shown are IgG titers during the peri- period (Panel C) and peak titers (Panel generic propecia canada D) in the two groups. Each case of breakthrough was matched with 4 to 5 controls according to sex, age, immunosuppression status, and timing of serologic testing after the second treatment dose. In each panel, the horizontal bars indicate the mean geometric titers and the 𝙸 bars indicate 95% confidence generic propecia canada intervals.

Symptomatic cases, which were all mild and did not require hospitalization, are indicated in red.Figure 3. Figure 3 generic propecia canada. Correlation between Neutralizing Antibody Titer and N Gene Cycle Threshold as Indication of Infectivity. The results of antigen-detecting (Ag) rapid diagnostic testing for the presence of hair loss are shown, along with neutralizing antibody titers and N gene cycle threshold (Ct) values in 22 fully vaccinated health care workers with breakthrough for whom data were available (slope of regression line, 171.2.

95% CI, 62.9 to 279.4).The predicted GMT of peri- neutralizing antibody titers was 192.8 (95% confidence generic propecia canada interval [CI], 67.6 to 549.8) for cases and 533.7 (95% CI, 408.1 to 698.0) for controls, for a predicted case-to-control ratio of neutralizing antibody titers of 0.361 (95% CI, 0.165 to 0.787) (Table 1 and Figure 2A). In a subgroup analysis in which the borderline cases were excluded, the ratio was 0.353 (95% CI, 0.185 to 0.674). Peri- neutralizing antibody titers in the breakthrough cases were associated with higher N gene Ct values (i.e., a lower viral RNA copy number) (slope of generic propecia canada regression line, 171.2. 95% CI, 62.9 to 279.4) (Figure 3).

A peak neutralizing antibody titer within the first month after the second treatment dose was available for only 12 of the breakthrough cases. The GEE generic propecia canada predicted peak neutralizing antibody titer was 152.2 (95% CI, 30.5 to 759.3) in 12 cases and 1027.5 (95% CI, 761.6 to 1386.2) in 56 controls, for a ratio of 0.148 (95% CI, 0.040 to 0.548) (Figure 2B). In the subgroup analysis in which borderline cases were excluded, the ratio was 0.114 (95% CI, 0.042 to 0.309). The observed and predicted GMTs of peri- S-specific generic propecia canada IgG antibody levels in breakthrough cases were lower than that in controls, with a predicted ratio of 0.514 (95% CI, 0.282 to 0.937) (Figure 2C).

The observed and predicted peak IgG GMTs in cases were also somewhat lower than those in controls (0.507. 95% CI, 0.260 to 0.989) (Figure 2D) generic propecia canada. To assess whether our practice of measuring antibodies on the day of diagnosis created bias by capturing anamnestic responses to the current , we plotted peak (first-month) IgG titers against peri- titers on the day of diagnosis in 13 case patients for whom both values were available. In all cases, peri- titers were lower than the previous peak titers, indicating that the titers that were obtained on the day of diagnosis were probably representative of peri- titers (Fig.

S2).V-safe Surveillance generic propecia canada. Local and Systemic Reactogenicity in Pregnant Persons Table 1. Table 1 generic propecia canada. Characteristics of Persons Who Identified as Pregnant in the V-safe Surveillance System and Received an mRNA hair loss treatment.

Table 2. Table 2 generic propecia canada. Frequency of Local and Systemic Reactions Reported on the Day after mRNA hair loss treatment Vaccination in Pregnant Persons. From December 14, 2020, to February 28, 2021, a total of 35,691 v-safe participants generic propecia canada identified as pregnant.

Age distributions were similar among the participants who received the Pfizer–BioNTech treatment and those who received the Moderna treatment, with the majority of the participants being 25 to 34 years of age (61.9% and 60.6% for each treatment, respectively) and non-Hispanic White (76.2% and 75.4%, respectively). Most participants (85.8% and 87.4%, respectively) reported being pregnant at the time generic propecia canada of vaccination (Table 1). Solicited reports of injection-site pain, fatigue, headache, and myalgia were the most frequent local and systemic reactions after either dose for both treatments (Table 2) and were reported more frequently after dose 2 for both treatments. Participant-measured temperature at or above 38°C was reported by less than 1% of the participants on day 1 after dose 1 and by 8.0% after dose 2 for both treatments.

Figure 1 generic propecia canada. Figure 1. Most Frequent Local and Systemic Reactions Reported in the V-safe Surveillance System on the Day after mRNA hair loss treatment generic propecia canada Vaccination. Shown are solicited reactions in pregnant persons and nonpregnant women 16 to 54 years of age who received a messenger RNA (mRNA) hair loss disease 2019 (hair loss treatment) treatment — BNT162b2 (Pfizer–BioNTech) or mRNA-1273 (Moderna) — from December 14, 2020, to February 28, 2021.

The percentage of respondents was calculated among those who completed a day 1 survey, with the top events shown of injection-site pain (pain), fatigue or tiredness (fatigue), headache, muscle or body aches (myalgia), chills, and fever or felt feverish (fever).These patterns of reporting, with respect to both most frequently reported solicited reactions and the higher reporting of reactogenicity after dose 2, were similar to patterns observed among nonpregnant women (Figure 1). Small differences in reporting frequency between generic propecia canada pregnant persons and nonpregnant women were observed for specific reactions (injection-site pain was reported more frequently among pregnant persons, and other systemic reactions were reported more frequently among nonpregnant women), but the overall reactogenicity profile was similar. Pregnant persons did not report having severe reactions more frequently than nonpregnant women, except for nausea and vomiting, which were reported slightly more frequently only after dose 2 (Table S3). V-safe Pregnancy generic propecia canada Registry.

Pregnancy Outcomes and Neonatal Outcomes Table 3. Table 3 generic propecia canada. Characteristics of V-safe Pregnancy Registry Participants. As of March 30, 2021, the v-safe pregnancy registry call center attempted to contact 5230 persons who were vaccinated through February 28, 2021, and who identified during a v-safe survey as pregnant at or shortly after hair loss treatment vaccination.

Of these, 912 were unreachable, 86 declined to participate, and 274 did not meet inclusion criteria (e.g., were never pregnant, were pregnant but received vaccination more than 30 days before the last menstrual period, or did not provide enough information to determine eligibility) generic propecia canada. The registry enrolled 3958 participants with vaccination from December 14, 2020, to February 28, 2021, of whom 3719 (94.0%) identified as health care personnel. Among enrolled participants, most were 25 to 44 years of age (98.8%), non-Hispanic White (79.0%), and, at the time of interview, did not generic propecia canada report a hair loss treatment diagnosis during pregnancy (97.6%) (Table 3). Receipt of a first dose of treatment meeting registry-eligibility criteria was reported by 92 participants (2.3%) during the periconception period, by 1132 (28.6%) in the first trimester of pregnancy, by 1714 (43.3%) in the second trimester, and by 1019 (25.7%) in the third trimester (1 participant was missing information to determine the timing of vaccination) (Table 3).

Among 1040 participants (91.9%) who received a treatment in the first trimester and 1700 (99.2%) who generic propecia canada received a treatment in the second trimester, initial data had been collected and follow-up scheduled at designated time points approximately 10 to 12 weeks apart. Limited follow-up calls had been made at the time of this analysis. Table 4. Table 4 generic propecia canada.

Pregnancy Loss and Neonatal Outcomes in Published Studies and V-safe Pregnancy Registry Participants. Among 827 participants who had a completed pregnancy, the pregnancy resulted in a live birth in 712 (86.1%), generic propecia canada in a spontaneous abortion in 104 (12.6%), in stillbirth in 1 (0.1%), and in other outcomes (induced abortion and ectopic pregnancy) in 10 (1.2%). A total of 96 of 104 spontaneous abortions (92.3%) occurred before 13 weeks of gestation (Table 4), and 700 of 712 pregnancies that resulted in a live birth (98.3%) were among persons who received their first eligible treatment dose in the third trimester. Adverse outcomes among 724 live-born infants — including 12 sets of multiple gestation — were preterm birth (60 of 636 among those vaccinated before 37 weeks [9.4%]), small size for gestational age (23 of 724 [3.2%]), and major congenital anomalies (16 of 724 [2.2%]).

No neonatal deaths were reported at the generic propecia canada time of interview. Among the participants with completed pregnancies who reported congenital anomalies, none had received hair loss treatment in the first trimester or periconception period, and no specific pattern of congenital anomalies was observed. Calculated proportions of pregnancy generic propecia canada and neonatal outcomes appeared similar to incidences published in the peer-reviewed literature (Table 4). Adverse-Event Findings on the VAERS During the analysis period, the VAERS received and processed 221 reports involving hair loss treatment vaccination among pregnant persons.

155 (70.1%) involved nonpregnancy-specific adverse events, and 66 (29.9%) involved pregnancy- or neonatal-specific adverse events (Table S4) generic propecia canada. The most frequently reported pregnancy-related adverse events were spontaneous abortion (46 cases. 37 in the first trimester, 2 in the second trimester, and 7 in which the trimester was unknown or not reported), followed by stillbirth, premature rupture of membranes, and vaginal bleeding, with 3 reports for each. No congenital anomalies were reported to the VAERS, a requirement under the EUAs.Participants Figure generic propecia canada 1.

Figure 1. Enrollment and Randomization generic propecia canada. The diagram represents all enrolled participants through November 14, 2020. The safety subset (those with a median of 2 months of follow-up, in accordance with application requirements for Emergency Use Authorization) is based on an October 9, 2020, data cut-off date.

The further procedures that one participant in the placebo group declined after dose 2 (lower right corner of the diagram) generic propecia canada were those involving collection of blood and nasal swab samples.Table 1. Table 1. Demographic Characteristics of the http://www.ec-ziegelau-strasbourg.site.ac-strasbourg.fr/wp/?page_id=39 Participants generic propecia canada in the Main Safety Population. Between July 27, 2020, and November 14, 2020, a total of 44,820 persons were screened, and 43,548 persons 16 years of age or older underwent randomization at 152 sites worldwide (United States, 130 sites.

Argentina, 1 generic propecia canada. Brazil, 2. South Africa, 4. Germany, 6 generic propecia canada.

And Turkey, 9) in the phase 2/3 portion of the trial. A total of generic propecia canada 43,448 participants received injections. 21,720 received BNT162b2 and 21,728 received placebo (Figure 1). At the data cut-off date of October 9, a total of 37,706 participants had a median of at least 2 months of safety data available after the second dose and contributed to the main safety data set.

Among these 37,706 participants, 49% were female, 83% were White, 9% were Black or African American, 28% were Hispanic or Latinx, 35% were obese (body mass index [the weight in kilograms divided by the square of generic propecia canada the height in meters] of at least 30.0), and 21% had at least one coexisting condition. The median age was 52 years, and 42% of participants were older than 55 years of age (Table 1 and Table S2). Safety Local Reactogenicity Figure generic propecia canada 2. Figure 2.

Local and Systemic Reactions generic propecia canada Reported within 7 Days after Injection of BNT162b2 or Placebo, According to Age Group. Data on local and systemic reactions and use of medication were collected with electronic diaries from participants in the reactogenicity subset (8,183 participants) for 7 days after each vaccination. Solicited injection-site (local) reactions are shown in Panel A. Pain at the injection site was assessed according to generic propecia canada the following scale.

Mild, does not interfere with activity. Moderate, interferes with activity generic propecia canada. Severe, prevents daily activity. And grade 4, emergency department visit or hospitalization.

Redness and generic propecia canada swelling were measured according to the following scale. Mild, 2.0 to 5.0 cm in diameter. Moderate, >5.0 generic propecia canada to 10.0 cm in diameter. Severe, >10.0 cm in diameter.

And grade 4, necrosis or exfoliative generic propecia canada dermatitis (for redness) and necrosis (for swelling). Systemic events and medication use are shown in Panel B. Fever categories are designated in the key. Medication use generic propecia canada was not graded.

Additional scales were as follows. Fatigue, headache, chills, new or worsened muscle pain, new or worsened joint generic propecia canada pain (mild. Does not interfere with activity. Moderate.

Some interference with activity. Or severe. Prevents daily activity), vomiting (mild. 1 to 2 times in 24 hours.

Moderate. >2 times in 24 hours. Or severe. Requires intravenous hydration), and diarrhea (mild.

2 to 3 loose stools in 24 hours. Moderate. 4 to 5 loose stools in 24 hours. Or severe.

6 or more loose stools in 24 hours). Grade 4 for all events indicated an emergency department visit or hospitalization. Н™¸ bars represent 95% confidence intervals, and numbers above the 𝙸 bars are the percentage of participants who reported the specified reaction.The reactogenicity subset included 8183 participants. Overall, BNT162b2 recipients reported more local reactions than placebo recipients.

Among BNT162b2 recipients, mild-to-moderate pain at the injection site within 7 days after an injection was the most commonly reported local reaction, with less than 1% of participants across all age groups reporting severe pain (Figure 2). Pain was reported less frequently among participants older than 55 years of age (71% reported pain after the first dose. 66% after the second dose) than among younger participants (83% after the first dose. 78% after the second dose).

A noticeably lower percentage of participants reported injection-site redness or swelling. The proportion of participants reporting local reactions did not increase after the second dose (Figure 2A), and no participant reported a grade 4 local reaction. In general, local reactions were mostly mild-to-moderate in severity and resolved within 1 to 2 days. Systemic Reactogenicity Systemic events were reported more often by younger treatment recipients (16 to 55 years of age) than by older treatment recipients (more than 55 years of age) in the reactogenicity subset and more often after dose 2 than dose 1 (Figure 2B).

The most commonly reported systemic events were fatigue and headache (59% and 52%, respectively, after the second dose, among younger treatment recipients. 51% and 39% among older recipients), although fatigue and headache were also reported by many placebo recipients (23% and 24%, respectively, after the second dose, among younger treatment recipients. 17% and 14% among older recipients). The frequency of any severe systemic event after the first dose was 0.9% or less.

Severe systemic events were reported in less than 2% of treatment recipients after either dose, except for fatigue (in 3.8%) and headache (in 2.0%) after the second dose. Fever (temperature, ≥38°C) was reported after the second dose by 16% of younger treatment recipients and by 11% of older recipients. Only 0.2% of treatment recipients and 0.1% of placebo recipients reported fever (temperature, 38.9 to 40°C) after the first dose, as compared with 0.8% and 0.1%, respectively, after the second dose. Two participants each in the treatment and placebo groups reported temperatures above 40.0°C.

Younger treatment recipients were more likely to use antipyretic or pain medication (28% after dose 1. 45% after dose 2) than older treatment recipients (20% after dose 1. 38% after dose 2), and placebo recipients were less likely (10 to 14%) than treatment recipients to use the medications, regardless of age or dose. Systemic events including fever and chills were observed within the first 1 to 2 days after vaccination and resolved shortly thereafter.

Daily use of the electronic diary ranged from 90 to 93% for each day after the first dose and from 75 to 83% for each day after the second dose. No difference was noted between the BNT162b2 group and the placebo group. Adverse Events Adverse event analyses are provided for all enrolled 43,252 participants, with variable follow-up time after dose 1 (Table S3). More BNT162b2 recipients than placebo recipients reported any adverse event (27% and 12%, respectively) or a related adverse event (21% and 5%).

This distribution largely reflects the inclusion of transient reactogenicity events, which were reported as adverse events more commonly by treatment recipients than by placebo recipients. Sixty-four treatment recipients (0.3%) and 6 placebo recipients (<0.1%) reported lymphadenopathy. Few participants in either group had severe adverse events, serious adverse events, or adverse events leading to withdrawal from the trial. Four related serious adverse events were reported among BNT162b2 recipients (shoulder injury related to treatment administration, right axillary lymphadenopathy, paroxysmal ventricular arrhythmia, and right leg paresthesia).

Two BNT162b2 recipients died (one from arteriosclerosis, one from cardiac arrest), as did four placebo recipients (two from unknown causes, one from hemorrhagic stroke, and one from myocardial infarction). No deaths were considered by the investigators to be related to the treatment or placebo. No hair loss treatment–associated deaths were observed. No stopping rules were met during the reporting period.

Safety monitoring will continue for 2 years after administration of the second dose of treatment. Efficacy Table 2. Table 2. treatment Efficacy against hair loss treatment at Least 7 days after the Second Dose.

Table 3. Table 3. treatment Efficacy Overall and by Subgroup in Participants without Evidence of before 7 Days after Dose 2. Figure 3.

Figure 3. Efficacy of BNT162b2 against hair loss treatment after the First Dose. Shown is the cumulative incidence of hair loss treatment after the first dose (modified intention-to-treat population). Each symbol represents hair loss treatment cases starting on a given day.

Filled symbols represent severe hair loss treatment cases. Some symbols represent more than one case, owing to overlapping dates. The inset shows the same data on an enlarged y axis, through 21 days. Surveillance time is the total time in 1000 person-years for the given end point across all participants within each group at risk for the end point.

The time period for hair loss treatment case accrual is from the first dose to the end of the surveillance period. The confidence interval (CI) for treatment efficacy (VE) is derived according to the Clopper–Pearson method.Among 36,523 participants who had no evidence of existing or prior hair loss , 8 cases of hair loss treatment with onset at least 7 days after the second dose were observed among treatment recipients and 162 among placebo recipients. This case split corresponds to 95.0% treatment efficacy (95% confidence interval [CI], 90.3 to 97.6. Table 2).

Among participants with and those without evidence of prior SARS CoV-2 , 9 cases of hair loss treatment at least 7 days after the second dose were observed among treatment recipients and 169 among placebo recipients, corresponding to 94.6% treatment efficacy (95% CI, 89.9 to 97.3). Supplemental analyses indicated that treatment efficacy among subgroups defined by age, sex, race, ethnicity, obesity, and presence of a coexisting condition was generally consistent with that observed in the overall population (Table 3 and Table S4). treatment efficacy among participants with hypertension was analyzed separately but was consistent with the other subgroup analyses (treatment efficacy, 94.6%. 95% CI, 68.7 to 99.9.

Case split. BNT162b2, 2 cases. Placebo, 44 cases). Figure 3 shows cases of hair loss treatment or severe hair loss treatment with onset at any time after the first dose (mITT population) (additional data on severe hair loss treatment are available in Table S5).

Between the first dose and the second dose, 39 cases in the BNT162b2 group and 82 cases in the placebo group were observed, resulting in a treatment efficacy of 52% (95% CI, 29.5 to 68.4) during this interval and indicating early protection by the treatment, starting as soon as 12 days after the first dose.Trial Design and Oversight In the Study of Tofacitinib in Hospitalized Patients with hair loss treatment Pneumonia (STOP-hair loss treatment), we compared tofacitinib with placebo in patients with hair loss treatment pneumonia. The trial protocol (available with the full text of this article at NEJM.org) was approved by the institutional ethics board at participating sites. The trial was conducted in accordance with Good Clinical Practice guidelines and the principles of the Declaration of Helsinki. The trial was sponsored by Pfizer and was designed and led by a steering committee that included academic investigators and representatives from Pfizer.

The trial operations and statistical analyses were conducted by the Academic Research Organization of the Hospital Israelita Albert Einstein in São Paulo. An independent data and safety monitoring board reviewed unblinded patient-level data for safety on an ongoing basis during the trial. Pfizer provided the entire trial budget, which covered all trial-related expenses including but not limited to investigator fees, costs related to investigational product suppliers and importation, insurance, applicable taxes and fees, and funding to support the activities of the data and safety monitoring board. All the authors vouch for the accuracy and completeness of the data and for the fidelity of the trial to the protocol.

The trial committee members and participating investigators are listed in the Supplementary Appendix, available at NEJM.org. Trial Population The trial included patients 18 years of age or older who had laboratory-confirmed hair loss as determined on reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay before randomization, who had evidence of hair loss treatment pneumonia on radiographic imaging (computed tomography or radiography of the chest), and who had been hospitalized for less than 72 hours. Information regarding the timing of the qualifying RT-PCR assay in relation to symptom onset is provided in Section S3.1 in the Supplementary Appendix. High-flow devices constituted the maximum oxygen support that was allowed for trial inclusion.

The main exclusion criteria were the use of noninvasive or invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO) on the day of randomization, a history of thrombosis or current thrombosis, known immunosuppression, and any current cancer for which the patient was receiving active treatment. Details of the eligibility criteria are provided in Section S3.2. Written informed consent was obtained from each patient or from the patient’s legally authorized representative if the patient was unable to provide informed consent. Randomization, Interventions, and Follow-up Eligible patients were randomly assigned in a 1:1 ratio to receive either tofacitinib or placebo.

Randomization, with stratification according to site, was performed with the use of a central concealed, Web-based, automated randomization system. Patients received either oral tofacitinib at a dose of 10 mg or placebo twice daily for up to 14 days or until hospital discharge, whichever was earlier. If a participant underwent intubation before the end of the 14-day treatment period (or before discharge), they continued to receive tofacitinib or placebo if it was considered to be clinically appropriate by the treating physicians. A reduced-dose regimen of 5 mg of tofacitinib (or matching placebo) twice daily was administered in patients with an estimated glomerular fiation rate of less than 50 ml per minute per 1.73 m2 of body-surface area, in those with moderate hepatic impairment, and in those with concomitant use of a strong CYP3A4 inhibitor or a combination of a moderate CYP3A4 inhibitor and a strong CYP2C19 inhibitor.

The rationale for the tofacitinib dosage is provided in Section S3.3. All the patients were treated according to local standards of care for hair loss treatment, which could have included glucocorticoids, antibiotic agents, anticoagulants, and antiviral agents. Concomitant use of other JAK inhibitors, biologic agents, potent immunosuppressants, interleukin-1 inhibitors, interleukin-6 inhibitors, or potent CYP450 inducers was prohibited. Patients were assessed daily (up to day 28) while hospitalized.

Follow-up visits occurred on day 14 and on day 28 for participants who were discharged before day 14 or 28. Prespecified reasons for permanent discontinuation of the trial intervention are described in Section S3.4. Outcomes The primary outcome was death or respiratory failure during the 28 days of follow-up. Death or respiratory failure was determined to occur if participants met the criteria for category 6 (status of being hospitalized while receiving noninvasive ventilation or ventilation through high-flow oxygen devices), 7 (status of being hospitalized while receiving invasive mechanical ventilation or ECMO), or 8 (death) on the eight-level National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity (on a scale from 1 to 8, with higher scores indicating a worse condition) (Table S1 in the Supplementary Appendix).

Patients who were enrolled in the trial while they were receiving oxygen through high-flow devices (category 6) were considered to have met the criteria for the primary outcome if they presented with clinical worsening to category 7 or 8. The occurrence of the primary outcome was adjudicated by an independent clinical-events classification committee, whose members were unaware of the group assignments. The protocol and statistical analysis plan used an inverted ordinal scale, which was reversed in this report to be consistent with previous studies. Secondary efficacy outcomes were the cumulative incidence of death through day 28, the scores on the NIAID ordinal scale of disease severity at day 14 and at day 28, the status of being alive and not using mechanical ventilation or ECMO at day 14 and day 28, the status of being alive and not hospitalized at day 14 and day 28, cure (defined as resolution of fever and cough and no use of ventilatory or oxygen support), the duration of stay in the hospital, and the duration of stay in the intensive care unit (ICU).

The occurrence and severity of adverse events were evaluated and coded according to the Medical Dictionary for Regulatory Activities, version 23.1. Details of adverse event reporting, including the reporting of prespecified adverse events of special interest, are described in Section S3.5. Statistical Analysis We estimated that the assignment of 260 patients, with randomization performed in a 1:1 ratio, would provide the trial with 80% power to detect a between-group difference of 15 percentage points in the incidence of the primary outcome, assuming that 15% of the participants in the tofacitinib group and 30% of those in the placebo group would have an event (death or respiratory failure through day 28). The hypothesis of superiority was tested at a two-tailed alpha level of 5%.

The efficacy analyses included all the participants who underwent randomization. Safety analyses included all the participants who underwent randomization and took at least one dose of tofacitinib or placebo. The results for the primary efficacy outcome were analyzed by means of binary regression with Firth correction, with trial group and antiviral therapy for hair loss treatment as covariates, and are expressed as a risk ratio. The antiviral treatments on day 1 were used in the statistical model.

Dichotomous secondary outcomes were analyzed in a manner similar to that used for the primary outcome. The effect of the intervention on death through day 28 is expressed as a hazard ratio derived from Cox regression. For ordinal data, a proportional-odds model with adjustment for baseline antiviral therapy was used. An odds ratio of less than 1.0 represents a clinical improvement as assessed on the ordinal scale.

Odds proportionality was assessed with the use of the method of Pulkstenis–Robinson.9 We created Kaplan–Meier survival curves to express the time until the occurrence of the primary outcome, both overall and stratified according to the use of supplemental oxygen at baseline, and the occurrence of death through 28 days. As a sensitivity analysis, results for the primary outcome were analyzed by means of binary regression with Firth correction, with use of glucocorticoids and antiviral agents at baseline as covariates. In addition, results for the primary outcome were analyzed by means of logistic regression with Firth correction, with adjustment for baseline antiviral therapy. Prespecified subgroup analyses were performed according to age, sex, concomitant use of antiviral therapy, concomitant use of glucocorticoids, and time from symptom onset to randomization.

For the primary outcome, a two-sided P value of less than 0.05 was considered to indicate statistical significance. The 95% confidence intervals were estimated for all effect measures. The widths of the 95% confidence intervals for the secondary outcomes were not adjusted for multiple comparisons, so the intervals should not be used to infer definitive treatment effects. All the analyses were performed with the use of SAS software, version 9.4 (SAS Institute), and R software, version 3.6.3 (R Foundation for Statistical Computing).

Additional details about the statistical analysis are provided in Section S3.6..

Study Design where do i get propecia We used two approaches to estimate the effect of vaccination on the https://cambridge-passport-photos.uk/portfolio-item/wanderer-landscapes/ delta variant. First, we used a test-negative case–control design to estimate treatment effectiveness against symptomatic disease caused by the delta variant, as compared with the alpha variant, over the period that the delta variant has been circulating. This approach has been described in detail elsewhere.10 In brief, we compared vaccination status in persons with symptomatic hair loss treatment with vaccination status in persons who reported symptoms but had a negative test where do i get propecia. This approach helps to control for biases related to health-seeking behavior, access to testing, and case ascertainment.

For the secondary analysis, the proportion of persons with cases caused by the delta variant relative to the main where do i get propecia circulating propecia (the alpha variant) was estimated according to vaccination status. The underlying assumption was that if the treatment had some efficacy and was equally effective against each variant, a similar proportion of cases with either variant would be expected in unvaccinated persons and in vaccinated persons. Conversely, if the treatment was less effective against the delta variant than against the alpha variant, then the delta variant would be expected to make up a higher proportion of cases occurring more than 3 weeks after vaccination than among unvaccinated persons. Details of this analysis are described in Section S1 in the Supplementary Appendix, available where do i get propecia with the full text of this article at NEJM.org.

The authors vouch for the accuracy and completeness of the data and for the fidelity of the trial to the protocol. Data Sources Vaccination Status Data on all where do i get propecia persons in England who have been vaccinated with hair loss treatments are available in a national vaccination register (the National Immunisation Management System). Data regarding vaccinations that had occurred up to May 16, 2021, including the date of receipt of each dose of treatment and the treatment type, were extracted on May 17, 2021. Vaccination status was categorized as receipt of one dose of treatment among persons who had symptom onset occurring 21 days or more after receipt of the first dose up to the day before the second dose was where do i get propecia received, as receipt of the second dose among persons who had symptom onset occurring 14 days or more after receipt of the second dose, and as receipt of the first or second dose among persons with symptom onset occurring 21 days or more after the receipt of the first dose (including any period after the receipt of the second dose).

hair loss Testing Polymerase-chain-reaction (PCR) testing for hair loss in the United Kingdom is undertaken by hospital and public health laboratories, as well as by community testing with the use of drive-through or at-home testing, which is available to anyone with symptoms consistent with hair loss treatment (high temperature, new continuous cough, or loss or change in sense of smell or taste). Data on all positive PCR tests between October 26, 2020, and May 16, 2021, were extracted. Data on all recorded negative community tests where do i get propecia among persons who reported symptoms were also extracted for the test-negative case–control analysis. Children younger than 16 years of age as of March 21, 2021, were excluded.

Data were restricted to persons who had reported symptoms, and only persons where do i get propecia who had undergone testing within 10 days after symptom onset were included, in order to account for reduced sensitivity of PCR testing beyond this period.25 Identification of Variant Whole-genome sequencing was used to identify the delta and alpha variants. The proportion of all positive samples that were sequenced increased from approximately 10% in February 2021 to approximately 60% in May 2021.4 Sequencing is undertaken at a network of laboratories, including the Wellcome Sanger Institute, where a high proportion of samples has been tested, and whole-genome sequences are assigned to Public Health England definitions of variants on the basis of mutations.26 Spike gene target status on PCR was used as a second approach for identifying each variant. Laboratories used the TaqPath assay (Thermo Fisher Scientific) to test for three gene targets. Spike (S), nucleocapsid (N), where do i get propecia and open reading frame 1ab (ORF1ab).

In December 2020, the alpha variant was noted to be associated with negative testing on the S target, so S target–negative status was subsequently used as a proxy for identification of the variant. The alpha variant accounts for between 98% where do i get propecia and 100% of S target–negative results in England. Among sequenced samples that tested positive for the S target, the delta variant was in 72.2% of the samples in April 2021 and in 93.0% in May (as of May 12, 2021).4 For the test-negative case–control analysis, only samples that had been tested at laboratories with the use of the TaqPath assay were included. Data Linkage The three data sources described above were linked with the use of the National Health Service number (a unique identifier for each person receiving medical where do i get propecia care in the United Kingdom).

These data sources were also linked with data on the patient’s date of birth, surname, first name, postal code, and specimen identifiers and sample dates. Covariates Multiple covariates that may be associated with the likelihood of being offered or accepting a treatment and the risk of exposure to hair loss treatment or specifically to either of the variants analyzed were also extracted from the National Immunisation Management System and the testing data. These data included age (in 10-year age groups), sex, index of multiple deprivation (a national indication of level of deprivation that is based on small geographic areas of residence,27 assessed in quintiles), race or ethnic group, care home residence status, history of foreign travel (i.e., outside the United Kingdom or Ireland), geographic region, period (calendar week), health and social care worker status, and status of being in a clinically extremely vulnerable group.28 In addition, for the where do i get propecia test-negative case–control analysis, history of hair loss before the start of the vaccination program was included. Persons were considered to have traveled if, at the point of requesting a test, they reported having traveled outside the United Kingdom and Ireland within the preceding 14 days or if they had been tested in a quarantine hotel or while quarantining at home.

Postal codes were used to determine the index of multiple deprivation, and unique property-reference where do i get propecia numbers were used to identify care homes.29 Statistical Analysis For the test-negative case–control analysis, logistic regression was used to estimate the odds of having a symptomatic, PCR-confirmed case of hair loss treatment among vaccinated persons as compared with unvaccinated persons (control). Cases were identified as having the delta variant by means of sequencing or if they were S target–positive on the TaqPath PCR assay. Cases were identified as having the alpha variant by means of sequencing or if they were S target–negative on the TaqPath PCR assay. If a where do i get propecia person had tested positive on multiple occasions within a 90-day period (which may represent a single illness episode), only the first positive test was included.

A maximum of three randomly chosen negative test results were included for each person. Negative tests where do i get propecia in which the sample had been obtained within 3 weeks before a positive result or after a positive result could have been false negatives. Therefore, these were excluded. Tests that had been administered within 7 days after a previous negative result where do i get propecia were also excluded.

Persons who had previously tested positive before the analysis period were also excluded in order to estimate treatment effectiveness in fully susceptible persons. All the covariates were included in the model as had been done with previous test-negative case–control analyses, with calendar week included as a factor and without an interaction with region. With regard to S target–positive or –negative status, only persons who where do i get propecia had tested positive on the other two PCR gene targets were included. Assignment to the delta variant on the basis of S target status was restricted to the week commencing April 12, 2021, and onward in order to aim for high specificity of S target–positive testing for the delta variant.4 treatment effectiveness for the first dose was estimated among persons with a symptom-onset date that was 21 days or more after receipt of the first dose of treatment, and treatment effects for the second dose were estimated among persons with a symptom-onset date that was 14 days or more after receipt of the second dose.

Comparison was made with unvaccinated persons and with persons who had symptom onset in the period of 4 to 13 days after vaccination in order to help account for differences in where do i get propecia underlying risk of . The period from the day of treatment administration (day 0) to day 3 was excluded because reactogenicity to the treatment can cause an increase in testing that biases results, as previously described.10Breakthrough s Among 11,453 fully vaccinated health care workers, 1497 (13.1%) underwent RT-PCR testing during the study period. Of the tested workers, 39 breakthrough cases were detected. More than 38 persons were tested for every positive case that was detected, for a test positivity of where do i get propecia 2.6%.

Thus, this percentage was much lower than the test positivity rate in Israel at the time, since the ratio between positive results and the extensive number of tests that were administered in our study was much smaller than that in the national population. Of the 39 breakthrough case patients, 18 (46%) were nursing staff members, 10 (26%) where do i get propecia were administration or maintenance workers, 6 (15%) were allied health professionals, and 5 (13%) were physicians. The average age of the 39 infected workers was 42 years, and the majority were women (64%). The median interval from the second treatment dose where do i get propecia to hair loss detection was 39 days (range, 11 to 102).

Only one infected person (3%) had immunosuppression. Other coexisting illnesses are detailed in Table S1. In all 37 case where do i get propecia patients for whom data were available regarding the source of , the suspected source was an unvaccinated person. In 21 patients (57%), this person was a household member.

Among these case patients were two married couples, in which both sets of spouses worked at Sheba Medical Center and had an unvaccinated child who had tested where do i get propecia positive for hair loss treatment and was assumed to be the source. In 11 of 37 case patients (30%), the suspected source was an unvaccinated fellow health care worker or patient. In 7 of the 11 case patients, the was caused by a nosocomial outbreak of the B.1.1.7 (alpha) variant where do i get propecia. These 7 patients, who worked in different hospital sectors and wards, were all found to be linked to the same suspected unvaccinated index patient who had been receiving noninvasive positive-pressure ventilation before her had been detected.

Of the 39 cases of , 27 occurred in workers who were tested solely because of exposure to a person with known hair loss . Of all the workers with breakthrough , 26 (67%) had mild symptoms at where do i get propecia some stage, and none required hospitalization. The remaining 13 workers (33% of all cases) were asymptomatic during the duration of . Of these workers, 6 were defined as borderline cases, since they had an N gene Ct value of more than 35 on repeat where do i get propecia testing.

The most common symptom that was reported was upper respiratory congestion (36% of all cases), followed by myalgia (28%) and loss of smell or taste (28%). Fever or rigors were reported in 21% (Table S1). On follow-up questioning, 31% of all infected workers reported having residual symptoms 14 days after their diagnosis where do i get propecia. At 6 weeks after their diagnosis, 19% reported having “long hair loss treatment” symptoms, which included a prolonged loss of smell, persistent cough, fatigue, weakness, dyspnea, or myalgia.

Nine workers (23%) took a leave of absence from work beyond where do i get propecia the 10 days of required quarantine. Of these workers, 4 returned to work within 2 weeks. One worker had not where do i get propecia yet returned after 6 weeks. Verification Testing and Secondary s Repeat RT-PCR assays were performed on samples obtained from most of the infected workers and for all case patients with an initial N gene Ct value of more than 30 to verify that the initial test was not taken too early, before the worker had become infectious.

A total of 29 case patients (74%) had a Ct value of less than 30 at some point during their . However, of these workers, only 17 where do i get propecia (59%) had positive results on a concurrent Ag-RDT. Ten workers (26%) had an N gene Ct value of more than 30 throughout the entire period. 6 of these where do i get propecia workers had values of more than 35 and probably had never been infectious.

Of the 33 isolates that were tested for a variant of concern, 28 (85%) were identified as the B.1.1.7 variant, by either multiplex PCR assay or genomic sequencing. At the time of this study, the B.1.1.7 variant was the most widespread variant in Israel and accounted for up to 94.5% of hair loss isolates.1,16 Since the end of the study, the country has had a surge of cases caused by the delta variant, as have many other countries worldwide. Thorough epidemiologic investigations where do i get propecia of data regarding in-hospital contact tracing did not detect any cases of transmission from infected health care workers (secondary s) among the 39 primary s. Among the 31 cases for whom data regarding household transmission (including symptoms and RT-PCR results) were available, no secondary s were detected, including 10 case patients and their 27 household members in whom the health care worker was the only index case patient.

Data regarding post N-specific IgG antibodies were available for 22 where do i get propecia of 39 case patients (56%) on days 8 to 72 after the first positive result on RT-PCR assay. Of these workers, 4 (18%) did not have an immune response, as detected by negative results on N-specific IgG antibody testing. Among these where do i get propecia 4 workers were 2 who were asymptomatic (Ct values, 32 and 35), 1 who underwent serologic testing only on day 10 after diagnosis, and 1 who had immunosuppression. Case–Control Analysis The results of peri- neutralizing antibody tests were available for 22 breakthrough cases.

Included in this group were 3 health care workers who had participated in the serologic study and had a test performed in the week preceding detection. In 19 other workers, neutralizing and S-specific IgG antibodies were assessed on detection day where do i get propecia. Of these 19 case patients, 12 were asymptomatic at the time of detection. For each case, 4 where do i get propecia to 5 controls were matched as described (Fig.

S1). In total, 22 breakthrough cases and their 104 matched controls were included in the case–control analysis. Table 1 where do i get propecia. Table 1.

Population Characteristics where do i get propecia and Outcomes in the Case–Control Study. Figure 2. Figure 2 where do i get propecia. Neutralizing Antibody and IgG Titers among Cases and Controls, According to Timing.

Among the 39 fully vaccinated health care workers who had breakthrough with hair loss, shown are the neutralizing antibody titers during the peri- period (within a week before hair loss detection) (Panel A) and the peak titers within 1 month after the second dose (Panel B), as compared with matched controls. Also shown are IgG titers during the peri- period (Panel C) where do i get propecia and peak titers (Panel D) in the two groups. Each case of breakthrough was matched with 4 to 5 controls according to sex, age, immunosuppression status, and timing of serologic testing after the second treatment dose. In each panel, the horizontal bars indicate the mean geometric titers and where do i get propecia the 𝙸 bars indicate 95% confidence intervals.

Symptomatic cases, which were all mild and did not require hospitalization, are indicated in red.Figure 3. Figure 3 where do i get propecia. Correlation between Neutralizing Antibody Titer and N Gene Cycle Threshold as Indication of Infectivity. The results of antigen-detecting (Ag) rapid diagnostic testing for the presence of hair loss are shown, along with neutralizing antibody titers and N gene cycle threshold (Ct) values in 22 fully vaccinated health care workers with breakthrough for whom data were available (slope of regression line, 171.2.

95% CI, 62.9 to 279.4).The predicted GMT of peri- neutralizing antibody titers was 192.8 (95% confidence interval [CI], 67.6 to 549.8) for cases and 533.7 (95% CI, 408.1 to 698.0) for controls, for a predicted case-to-control where do i get propecia ratio of neutralizing antibody titers of 0.361 (95% CI, 0.165 to 0.787) (Table 1 and Figure 2A). In a subgroup analysis in which the borderline cases were excluded, the ratio was 0.353 (95% CI, 0.185 to 0.674). Peri- neutralizing antibody titers in the breakthrough cases were where do i get propecia associated with higher N gene Ct values (i.e., a lower viral RNA copy number) (slope of regression line, 171.2. 95% CI, 62.9 to 279.4) (Figure 3).

A peak neutralizing antibody titer within the first month after the second treatment dose was available for only 12 of the breakthrough cases. The GEE predicted peak neutralizing antibody titer was 152.2 (95% CI, 30.5 to 759.3) in 12 cases and 1027.5 (95% CI, 761.6 to 1386.2) in 56 controls, for a ratio of 0.148 (95% CI, 0.040 to where do i get propecia 0.548) (Figure 2B). In the subgroup analysis in which borderline cases were excluded, the ratio was 0.114 (95% CI, 0.042 to 0.309). The observed and predicted GMTs of peri- S-specific IgG antibody levels in breakthrough cases were lower than that in controls, with a predicted ratio of 0.514 (95% CI, 0.282 to 0.937) (Figure 2C) where do i get propecia.

The observed and predicted peak IgG GMTs in cases were also somewhat lower than those in controls (0.507. 95% CI, 0.260 where do i get propecia to 0.989) (Figure 2D). To assess whether our practice of measuring antibodies on the day of diagnosis created bias by capturing anamnestic responses to the current , we plotted peak (first-month) IgG titers against peri- titers on the day of diagnosis in 13 case patients for whom both values were available. In all cases, peri- titers were lower than the previous peak titers, indicating that the titers that were obtained on the day of diagnosis were probably representative of peri- titers (Fig.

S2).V-safe Surveillance where do i get propecia. Local and Systemic Reactogenicity in Pregnant Persons Table 1. Table 1 where do i get propecia. Characteristics of Persons Who Identified as Pregnant in the V-safe Surveillance System and Received an mRNA hair loss treatment.

Table 2. Table 2 where do i get propecia. Frequency of Local and Systemic Reactions Reported on the Day after mRNA hair loss treatment Vaccination in Pregnant Persons. From December 14, 2020, to February 28, 2021, a where do i get propecia total of 35,691 v-safe participants identified as pregnant.

Age distributions were similar among the participants who received the Pfizer–BioNTech treatment and those who received the Moderna treatment, with the majority of the participants being 25 to 34 years of age (61.9% and 60.6% for each treatment, respectively) and non-Hispanic White (76.2% and 75.4%, respectively). Most participants where do i get propecia (85.8% and 87.4%, respectively) reported being pregnant at the time of vaccination (Table 1). Solicited reports of injection-site pain, fatigue, headache, and myalgia were the most frequent local and systemic reactions after either dose for both treatments (Table 2) and were reported more frequently after dose 2 for both treatments. Participant-measured temperature at or above 38°C was reported by less than 1% of the participants on day 1 after dose 1 and by 8.0% after dose 2 for both treatments.

Figure 1 where do i get propecia. Figure 1. Most Frequent Local and Systemic where do i get propecia Reactions Reported in the V-safe Surveillance System on the Day after mRNA hair loss treatment Vaccination. Shown are solicited reactions in pregnant persons and nonpregnant women 16 to 54 years of age who received a messenger RNA (mRNA) hair loss disease 2019 (hair loss treatment) treatment — BNT162b2 (Pfizer–BioNTech) or mRNA-1273 (Moderna) — from December 14, 2020, to February 28, 2021.

The percentage of respondents was calculated among those who completed a day 1 survey, with the top events shown of injection-site pain (pain), fatigue or tiredness (fatigue), headache, muscle or body aches (myalgia), chills, and fever or felt feverish (fever).These patterns of reporting, with respect to both most frequently reported solicited reactions and the higher reporting of reactogenicity after dose 2, were similar to patterns observed among nonpregnant women (Figure 1). Small differences in reporting frequency between pregnant persons and nonpregnant women were observed for specific reactions (injection-site pain was reported more frequently among pregnant persons, and other systemic reactions were where do i get propecia reported more frequently among nonpregnant women), but the overall reactogenicity profile was similar. Pregnant persons did not report having severe reactions more frequently than nonpregnant women, except for nausea and vomiting, which were reported slightly more frequently only after dose 2 (Table S3). V-safe Pregnancy where do i get propecia Registry.

Pregnancy Outcomes and Neonatal Outcomes Table 3. Table 3 where do i get propecia. Characteristics of V-safe Pregnancy Registry Participants. As of March 30, 2021, the v-safe pregnancy registry call center attempted to contact 5230 persons who were vaccinated through February 28, 2021, and who identified during a v-safe survey as pregnant at or shortly after hair loss treatment vaccination.

Of these, 912 were unreachable, 86 declined to participate, and 274 did not meet inclusion criteria (e.g., were never pregnant, were pregnant but received vaccination more than 30 days before the last menstrual period, or did not provide enough information to determine eligibility) where do i get propecia. The registry enrolled 3958 participants with vaccination from December 14, 2020, to February 28, 2021, of whom 3719 (94.0%) identified as health care personnel. Among enrolled participants, most were 25 to 44 years of age (98.8%), non-Hispanic where do i get propecia White (79.0%), and, at the time of interview, did not report a hair loss treatment diagnosis during pregnancy (97.6%) (Table 3). Receipt of a first dose of treatment meeting registry-eligibility criteria was reported by 92 participants (2.3%) during the periconception period, by 1132 (28.6%) in the first trimester of pregnancy, by 1714 (43.3%) in the second trimester, and by 1019 (25.7%) in the third trimester (1 participant was missing information to determine the timing of vaccination) (Table 3).

Among 1040 participants (91.9%) who received a treatment in the first trimester and 1700 (99.2%) who received a treatment in the second trimester, initial data had been collected and follow-up scheduled where do i get propecia at designated time points approximately 10 to 12 weeks apart. Limited follow-up calls had been made at the time of this analysis. Table 4. Table 4 where do i get propecia.

Pregnancy Loss and Neonatal Outcomes in Published Studies and V-safe Pregnancy Registry Participants. Among 827 participants who had a completed pregnancy, the pregnancy resulted in a live birth in 712 (86.1%), in a spontaneous abortion in 104 where do i get propecia (12.6%), in stillbirth in 1 (0.1%), and in other outcomes (induced abortion and ectopic pregnancy) in 10 (1.2%). A total of 96 of 104 spontaneous abortions (92.3%) occurred before 13 weeks of gestation (Table 4), and 700 of 712 pregnancies that resulted in a live birth (98.3%) were among persons who received their first eligible treatment dose in the third trimester. Adverse outcomes among 724 live-born infants — including 12 sets of multiple gestation — were preterm birth (60 of 636 among those vaccinated before 37 weeks [9.4%]), small size for gestational age (23 of 724 [3.2%]), and major congenital anomalies (16 of 724 [2.2%]).

No neonatal deaths were reported at the time of where do i get propecia interview. Among the participants with completed pregnancies who reported congenital anomalies, none had received hair loss treatment in the first trimester or periconception period, and no specific pattern of congenital anomalies was observed. Calculated proportions of pregnancy and neonatal outcomes where do i get propecia appeared similar to incidences published in the peer-reviewed literature (Table 4). Adverse-Event Findings on the VAERS During the analysis period, the VAERS received and processed 221 reports involving hair loss treatment vaccination among pregnant persons.

155 (70.1%) involved nonpregnancy-specific adverse events, and 66 (29.9%) involved where do i get propecia pregnancy- or neonatal-specific adverse events (Table S4). The most frequently reported pregnancy-related adverse events were spontaneous abortion (46 cases. 37 in the first trimester, 2 in the second trimester, and 7 in which the trimester was unknown or not reported), followed by stillbirth, premature rupture of membranes, and vaginal bleeding, with 3 reports for each. No congenital anomalies were reported to the VAERS, a requirement under the where do i get propecia EUAs.Participants Figure 1.

Figure 1. Enrollment and where do i get propecia Randomization. The diagram represents all enrolled participants through November 14, 2020. The safety subset (those with a median of 2 months of follow-up, in accordance with application requirements for Emergency Use Authorization) is based on an October 9, 2020, data cut-off date.

The further procedures that one participant in the placebo group declined after dose 2 (lower right corner of the diagram) where do i get propecia were those involving collection of blood and nasal swab samples.Table 1. Table 1. Demographic Characteristics of the Participants in the Main Safety where do i get propecia Population. Between July 27, 2020, and November 14, 2020, a total of 44,820 persons were screened, and 43,548 persons 16 years of age or older underwent randomization at 152 sites worldwide (United States, 130 sites.

Argentina, 1 where do i get propecia. Brazil, 2. South Africa, 4. Germany, 6 where do i get propecia.

And Turkey, 9) in the phase 2/3 portion of the trial. A total of 43,448 where do i get propecia participants received injections. 21,720 received BNT162b2 and 21,728 received placebo (Figure 1). At the data cut-off date of October 9, a total of 37,706 participants had a median of at least 2 months of safety data available after the second dose and contributed to the main safety data set.

Among these where do i get propecia 37,706 participants, 49% were female, 83% were White, 9% were Black or African American, 28% were Hispanic or Latinx, 35% were obese (body mass index [the weight in kilograms divided by the square of the height in meters] of at least 30.0), and 21% had at least one coexisting condition. The median age was 52 years, and 42% of participants were older than 55 years of age (Table 1 and Table S2). Safety Local Reactogenicity Figure 2 where do i get propecia. Figure 2.

Local and Systemic Reactions Reported within 7 Days after Injection of BNT162b2 or Placebo, where do i get propecia According to Age Group. Data on local and systemic reactions and use of medication were collected with electronic diaries from participants in the reactogenicity subset (8,183 participants) for 7 days after each vaccination. Solicited injection-site (local) reactions are shown in Panel A. Pain at the injection site was assessed according to the following scale where do i get propecia.

Mild, does not interfere with activity. Moderate, interferes with activity where do i get propecia. Severe, prevents daily activity. And grade 4, emergency department visit or hospitalization.

Redness and where do i get propecia swelling were measured according to the following scale. Mild, 2.0 to 5.0 cm in diameter. Moderate, >5.0 to 10.0 where do i get propecia cm in diameter. Severe, >10.0 cm in diameter.

And grade 4, necrosis or exfoliative dermatitis (for redness) and necrosis (for swelling) where do i get propecia. Systemic events and medication use are shown in Panel B. Fever categories are designated in the key. Medication use was where do i get propecia not graded.

Additional scales were as follows. Fatigue, headache, chills, new or worsened muscle pain, new or worsened joint pain (mild where do i get propecia. Does not interfere with activity. Moderate.

Some interference with activity. Or severe. Prevents daily activity), vomiting (mild. 1 to 2 times in 24 hours.

Moderate. >2 times in 24 hours. Or severe. Requires intravenous hydration), and diarrhea (mild.

2 to 3 loose stools in 24 hours. Moderate. 4 to 5 loose stools in 24 hours. Or severe.

6 or more loose stools in 24 hours). Grade 4 for all events indicated an emergency department visit or hospitalization. Н™¸ bars represent 95% confidence intervals, and numbers above the 𝙸 bars are the percentage of participants who reported the specified reaction.The reactogenicity subset included 8183 participants. Overall, BNT162b2 recipients reported more local reactions than placebo recipients.

Among BNT162b2 recipients, mild-to-moderate pain at the injection site within 7 days after an injection was the most commonly reported local reaction, with less than 1% of participants across all age groups reporting severe pain (Figure 2). Pain was reported less frequently among participants older than 55 years of age (71% reported pain after the first dose. 66% after the second dose) than among younger participants (83% after the first dose. 78% after the second dose).

A noticeably lower percentage of participants reported injection-site redness or swelling. The proportion of participants reporting local reactions did not increase after the second dose (Figure 2A), and no participant reported a grade 4 local reaction. In general, local reactions were mostly mild-to-moderate in severity and resolved within 1 to 2 days. Systemic Reactogenicity Systemic events were reported more often by younger treatment recipients (16 to 55 years of age) than by older treatment recipients (more than 55 years of age) in the reactogenicity subset and more often after dose 2 than dose 1 (Figure 2B).

The most commonly reported systemic events were fatigue and headache (59% and 52%, respectively, after the second dose, among younger treatment recipients. 51% and 39% among older recipients), although fatigue and headache were also reported by many placebo recipients (23% and 24%, respectively, after the second dose, among younger treatment recipients. 17% and 14% among older recipients). The frequency of any severe systemic event after the first dose was 0.9% or less.

Severe systemic events were reported in less than 2% of treatment recipients after either dose, except for fatigue (in 3.8%) and headache (in 2.0%) after the second dose. Fever (temperature, ≥38°C) was reported after the second dose by 16% of younger treatment recipients and by 11% of older recipients. Only 0.2% of treatment recipients and 0.1% of placebo recipients reported fever (temperature, 38.9 to 40°C) after the first dose, as compared with 0.8% and 0.1%, respectively, after the second dose. Two participants each in the treatment and placebo groups reported temperatures above 40.0°C.

Younger treatment recipients were more likely to use antipyretic or pain medication (28% after dose 1. 45% after dose 2) than older treatment recipients (20% after dose 1. 38% after dose 2), and placebo recipients were less likely (10 to 14%) than treatment recipients to use the medications, regardless of age or dose. Systemic events including fever and chills were observed within the first 1 to 2 days after vaccination and resolved shortly thereafter.

Daily use of the electronic diary ranged from 90 to 93% for each day after the first dose and from 75 to 83% for each day after the second dose. No difference was noted between the BNT162b2 group and the placebo group. Adverse Events Adverse event analyses are provided for all enrolled 43,252 participants, with variable follow-up time after dose 1 (Table S3). More BNT162b2 recipients than placebo recipients reported any adverse event (27% and 12%, respectively) or a related adverse event (21% and 5%).

This distribution largely reflects the inclusion of transient reactogenicity events, which were reported as adverse events more commonly by treatment recipients than by placebo recipients. Sixty-four treatment recipients (0.3%) and 6 placebo recipients (<0.1%) reported lymphadenopathy. Few participants in either group had severe adverse events, serious adverse events, or adverse events leading to withdrawal from the trial. Four related serious adverse events were reported among BNT162b2 recipients (shoulder injury related to treatment administration, right axillary lymphadenopathy, paroxysmal ventricular arrhythmia, and right leg paresthesia).

Two BNT162b2 recipients died (one from arteriosclerosis, one from cardiac arrest), as did four placebo recipients (two from unknown causes, one from hemorrhagic stroke, and one from myocardial infarction). No deaths were considered by the investigators to be related to the treatment or placebo. No hair loss treatment–associated deaths were observed. No stopping rules were met during the reporting period.

Safety monitoring will continue for 2 years after administration of the second dose of treatment. Efficacy Table 2. Table 2. treatment Efficacy against hair loss treatment at Least 7 days after the Second Dose.

Table 3. Table 3. treatment Efficacy Overall and by Subgroup in Participants without Evidence of before 7 Days after Dose 2. Figure 3.

Figure 3. Efficacy of BNT162b2 against hair loss treatment after the First Dose. Shown is the cumulative incidence of hair loss treatment after the first dose (modified intention-to-treat population). Each symbol represents hair loss treatment cases starting on a given day.

Filled symbols represent severe hair loss treatment cases. Some symbols represent more than one case, owing to overlapping dates. The inset shows the same data on an enlarged y axis, through 21 days. Surveillance time is the total time in 1000 person-years for the given end point across all participants within each group at risk for the end point.

The time period for hair loss treatment case accrual is from the first dose to the end of the surveillance period. The confidence interval (CI) for treatment efficacy (VE) is derived according to the Clopper–Pearson method.Among 36,523 participants who had no evidence of existing or prior hair loss , 8 cases of hair loss treatment with onset at least 7 days after the second dose were observed among treatment recipients and 162 among placebo recipients. This case split corresponds to 95.0% treatment efficacy (95% confidence interval [CI], 90.3 to 97.6. Table 2).

Among participants with and those without evidence of prior SARS CoV-2 , 9 cases of hair loss treatment at least 7 days after the second dose were observed among treatment recipients and 169 among placebo recipients, corresponding to 94.6% treatment efficacy (95% CI, 89.9 to 97.3). Supplemental analyses indicated that treatment efficacy among subgroups defined by age, sex, race, ethnicity, obesity, and presence of a coexisting condition was generally consistent with that observed in the overall population (Table 3 and Table S4). treatment efficacy among participants with hypertension was analyzed separately but was consistent with the other subgroup analyses (treatment efficacy, 94.6%. 95% CI, 68.7 to 99.9.

Case split. BNT162b2, 2 cases. Placebo, 44 cases). Figure 3 shows cases of hair loss treatment or severe hair loss treatment with onset at any time after the first dose (mITT population) (additional data on severe hair loss treatment are available in Table S5).

Between the first dose and the second dose, 39 cases in the BNT162b2 group and 82 cases in the placebo group were observed, resulting in a treatment efficacy of 52% (95% CI, 29.5 to 68.4) during this interval and indicating early protection by the treatment, starting as soon as 12 days after the first dose.Trial Design and Oversight In the Study of Tofacitinib in Hospitalized Patients with hair loss treatment Pneumonia (STOP-hair loss treatment), we compared tofacitinib with placebo in patients with hair loss treatment pneumonia. The trial protocol (available with the full text of this article at NEJM.org) was approved by the institutional ethics board at participating sites. The trial was conducted in accordance with Good Clinical Practice guidelines and the principles of the Declaration of Helsinki. The trial was sponsored by Pfizer and was designed and led by a steering committee that included academic investigators and representatives from Pfizer.

The trial operations and statistical analyses were conducted by the Academic Research Organization of the Hospital Israelita Albert Einstein in São Paulo. An independent data and safety monitoring board reviewed unblinded patient-level data for safety on an ongoing basis during the trial. Pfizer provided the entire trial budget, which covered all trial-related expenses including but not limited to investigator fees, costs related to investigational product suppliers and importation, insurance, applicable taxes and fees, and funding to support the activities of the data and safety monitoring board. All the authors vouch for the accuracy and completeness of the data and for the fidelity of the trial to the protocol.

The trial committee members and participating investigators are listed in the Supplementary Appendix, available at NEJM.org. Trial Population The trial included patients 18 years of age or older who had laboratory-confirmed hair loss as determined on reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay before randomization, who had evidence of hair loss treatment pneumonia on radiographic imaging (computed tomography or radiography of the chest), and who had been hospitalized for less than 72 hours. Information regarding the timing of the qualifying RT-PCR assay in relation to symptom onset is provided in Section S3.1 in the Supplementary Appendix. High-flow devices constituted the maximum oxygen support that was allowed for trial inclusion.

The main exclusion criteria were the use of noninvasive or invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO) on the day of randomization, a history of thrombosis or current thrombosis, known immunosuppression, and any current cancer for which the patient was receiving active treatment. Details of the eligibility criteria are provided in Section S3.2. Written informed consent was obtained from each patient or from the patient’s legally authorized representative if the patient was unable to provide informed consent. Randomization, Interventions, and Follow-up Eligible patients were randomly assigned in a 1:1 ratio to receive either tofacitinib or placebo.

Randomization, with stratification according to site, was performed with the use of a central concealed, Web-based, automated randomization system. Patients received either oral tofacitinib at a dose of 10 mg or placebo twice daily for up to 14 days or until hospital discharge, whichever was earlier. If a participant underwent intubation before the end of the 14-day treatment period (or before discharge), they continued to receive tofacitinib or placebo if it was considered to be clinically appropriate by the treating physicians. A reduced-dose regimen of 5 mg of tofacitinib (or matching placebo) twice daily was administered in patients with an estimated glomerular fiation rate of less than 50 ml per minute per 1.73 m2 of body-surface area, in those with moderate hepatic impairment, and in those with concomitant use of a strong CYP3A4 inhibitor or a combination of a moderate CYP3A4 inhibitor and a strong CYP2C19 inhibitor.

The rationale for the tofacitinib dosage is provided in Section S3.3. All the patients were treated according to local standards of care for hair loss treatment, which could have included glucocorticoids, antibiotic agents, anticoagulants, and antiviral agents. Concomitant use of other JAK inhibitors, biologic agents, potent immunosuppressants, interleukin-1 inhibitors, interleukin-6 inhibitors, or potent CYP450 inducers was prohibited. Patients were assessed daily (up to day 28) while hospitalized.

Follow-up visits occurred on day 14 and on day 28 for participants who were discharged before day 14 or 28. Prespecified reasons for permanent discontinuation of the trial intervention are described in Section S3.4. Outcomes The primary outcome was death or respiratory failure during the 28 days of follow-up. Death or respiratory failure was determined to occur if participants met the criteria for category 6 (status of being hospitalized while receiving noninvasive ventilation or ventilation through high-flow oxygen devices), 7 (status of being hospitalized while receiving invasive mechanical ventilation or ECMO), or 8 (death) on the eight-level National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity (on a scale from 1 to 8, with higher scores indicating a worse condition) (Table S1 in the Supplementary Appendix).

Patients who were enrolled in the trial while they were receiving oxygen through high-flow devices (category 6) were considered to have met the criteria for the primary outcome if they presented with clinical worsening to category 7 or 8. The occurrence of the primary outcome was adjudicated by an independent clinical-events classification committee, whose members were unaware of the group assignments. The protocol and statistical analysis plan used an inverted ordinal scale, which was reversed in this report to be consistent with previous studies. Secondary efficacy outcomes were the cumulative incidence of death through day 28, the scores on the NIAID ordinal scale of disease severity at day 14 and at day 28, the status of being alive and not using mechanical ventilation or ECMO at day 14 and day 28, the status of being alive and not hospitalized at day 14 and day 28, cure (defined as resolution of fever and cough and no use of ventilatory or oxygen support), the duration of stay in the hospital, and the duration of stay in the intensive care unit (ICU).

The occurrence and severity of adverse events were evaluated and coded according to the Medical Dictionary for Regulatory Activities, version 23.1. Details of adverse event reporting, including the reporting of prespecified adverse events of special interest, are described in Section S3.5. Statistical Analysis We estimated that the assignment of 260 patients, with randomization performed in a 1:1 ratio, would provide the trial with 80% power to detect a between-group difference of 15 percentage points in the incidence of the primary outcome, assuming that 15% of the participants in the tofacitinib group and 30% of those in the placebo group would have an event (death or respiratory failure through day 28). The hypothesis of superiority was tested at a two-tailed alpha level of 5%.

The efficacy analyses included all the participants who underwent randomization. Safety analyses included all the participants who underwent randomization and took at least one dose of tofacitinib or placebo. The results for the primary efficacy outcome were analyzed by means of binary regression with Firth correction, with trial group and antiviral therapy for hair loss treatment as covariates, and are expressed as a risk ratio. The antiviral treatments on day 1 were used in the statistical model.

Dichotomous secondary outcomes were analyzed in a manner similar to that used for the primary outcome. The effect of the intervention on death through day 28 is expressed as a hazard ratio derived from Cox regression. For ordinal data, a proportional-odds model with adjustment for baseline antiviral therapy was used. An odds ratio of less than 1.0 represents a clinical improvement as assessed on the ordinal scale.

Odds proportionality was assessed with the use of the method of Pulkstenis–Robinson.9 We created Kaplan–Meier survival curves to express the time until the occurrence of the primary outcome, both overall and stratified according to the use of supplemental oxygen at baseline, and the occurrence of death through 28 days. As a sensitivity analysis, results for the primary outcome were analyzed by means of binary regression with Firth correction, with use of glucocorticoids and antiviral agents at baseline as covariates. In addition, results for the primary outcome were analyzed by means of logistic regression with Firth correction, with adjustment for baseline antiviral therapy. Prespecified subgroup analyses were performed according to age, sex, concomitant use of antiviral therapy, concomitant use of glucocorticoids, and time from symptom onset to randomization.

For the primary outcome, a two-sided P value of less than 0.05 was considered to indicate statistical significance. The 95% confidence intervals were estimated for all effect measures. The widths of the 95% confidence intervals for the secondary outcomes were not adjusted for multiple comparisons, so the intervals should not be used to infer definitive treatment effects. All the analyses were performed with the use of SAS software, version 9.4 (SAS Institute), and R software, version 3.6.3 (R Foundation for Statistical Computing).

Additional details about the statistical analysis are provided in Section S3.6..

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Latest Prevention where do i get propecia his comment is here &. Wellness News MONDAY, Oct where do i get propecia. 19, 2020 (HealthDay News) -- The concept of herd immunity in the fight against the hair loss treatment propecia is "nonsense," Dr. Anthony Fauci, the top U.S where do i get propecia. Infectious disease expert, says.Herd immunity -- the theory that a disease will stop spreading once nearly everybody has contracted it -- is being pushed by the Trump administration as a way to reopen schools and businesses, the Associated Press reported.A group of scientists released a declaration that supports herd immunity, but Fauci warned against it."If you talk to anybody who has any experience in epidemiology and infectious diseases, they will tell you that that is risky and you'll wind up with many more s of vulnerable people, which will lead to hospitalizations and death," he said on Good Morning America on Thursday, the AP reported."So I think that we've just got to look that square in the eye and say it's nonsense," Fauci said.Copyright © 2019 HealthDay.