Reinfection Covid-19 Absolute Risk Reduction From 2020 To 2024 In A General Medicine Office in Toledo (Spain)

Research Article | DOI: https://doi.org/10.31579/2578-8949/186

Reinfection Covid-19 Absolute Risk Reduction From 2020 To 2024 In A General Medicine Office in Toledo (Spain)

  • Jose Luis Turabian *

Specialist in Family and Community Medicine, Health Center Santa Maria de Benquerencia. Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain.

*Corresponding Author: Specialist in Family and Community Medicine, Health Center Santa Maria de Benquerencia. Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain.

Citation: Jose L. Turabia, (2025), Please let us know what are the Prebiotics and Probiotics and their effect on Public Health, Dermatology and Dermatitis, 12(1); DOI:10.31579/2578-8949/186

Copyright: © 2025, Jose Luis Turabian. This is an open-access article distributed under the terms of The Creative Commons. Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 11 February 2025 | Accepted: 25 February 2025 | Published: 05 March 2025

Keywords: COVID-19; sars-cov-2; risk and benefit data; population surveillance/methods; epidemiological characteristic; public health practice; general practice

Abstract

Background

Absolute risk reduction is one of the most useful data to know the clinical importance of an intervention. But its evolution for covid-19 reinfection is unknown.

Objective

To compare the absolute risk reduction of SARS-CoV-2 reinfections, associated with acquired immunity (vaccination and/or infection) during 2020-2022 period versus 2023 and 2024 versus 2024.

Methodology

Comparison of secondary data among covid-19 reinfection cases in 2020-2022 period, 2023 and 2024 years of previous studies, all of them carried out in the same population of patients treated in a general medicine office in Toledo, Spain. The intervention groups (hybrid immunity: vaccination and/or infection) were considered reinfection cases from 2023 [compared with 2020-2022 period (control)] and from 2024 [compared with 2023 (control)].

Results

There are no reductions in reinfection absolute risk from 2024 to 2023 when they are compared to reductions in reinfection absolute risk from 2023 to 2020-2022, neither in the total, nor in 14-65 years, nor in women, nor in men, nor in cases with moderate severe severity, nor in deaths. This trend does not occur in those over 65 years of age and in cases with the presence of chronic diseases where einfection absolute risk is slightly reduced, and especially in socio-health workers with a very significant reduction.

Conclusion

The vaccination and hybrid immunity intervention were very useful for reinfection absolute risk reduction from 2023 to 2020-2022, but its effect is attenuated from 2024 to 2023, except in those over 65 years of age, in cases with chronic diseases, and especially in socio-health workers.

Introduction

Although scientific papers often provide results indicating their statistical significance, they are less likely to provide data on their clinical importance. The Absolute Risk Reduction (ARR) calculation is probably one of the most useful and intuitive data in this regard (1). The ARR is most useful for understanding the individual benefit of an intervention. The Relative Risk Reduction (RRR) is often used in marketing or the media because it tends to produce a larger, more eye-catching number. However, the ARR can provide guidance on the benefit that an individual patient can expect (2-6).

Not only is this RRR biased impact perceived by the public, but a similar effect has been reported in the interpretation of risk data by primary care physicians (7).

Thus, in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, it may be more intuitive to give the results of the intervention (vaccination and natural immunity from having had the infection) in the form of ARR. Measuring the ARR and the number of people to be treated or vaccinated are more appropriate for prioritizing vaccination of vulnerable populations than relative measures, such as RRR (8).

It should be noted that vaccination efficacy, estimated by the ARR rate, may vary in population subgroups with different background risks (8) and with different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants throughout the pandemic and in the current endemic phase (9), and this information can facilitate policies on vaccine distribution (10).

Most people have some degree of protection due to underlying immunity. By the third quarter of 2023, 98% had antibodies against SARS-CoV-2, with 14% due to vaccination alone, 26% due to infection alone, and 58% due to both (hybrid immunity) (11). Seroprevalence surveys suggest that more than a third and possibly more than half of the global population has been infected with SARS-CoV-2 by early 2022. As large numbers of people continue to be infected (12). Studies have shown a decrease in the immunity provided by the vaccine. But, the temporal evolution of natural and hybrid immunity is unknown (13).

In this scenario, information on the evolution of community ARR measures for covid-19 reinfection from 2020 to 2024 is not clearly known. We present a comparative study based on previously published data, to evaluate the trend of ARR of reinfections covid-19 in the period 2020-2022 (with alpha, delta and omicron SARS-CoV-2 variants; and in 2020 without vaccination, in 2021 with 1 or 2 dose vaccination and in 2022 with first booster), in 2023 (omicron variant and with second booster -4th dose), and in 2024 (omicron variant with third booster -5th doses- of vaccine), from the same population attended in a general medicine consultation in these time periods.

Material And Methods

Design and emplacement

This study compares data from previous observational, longitudinal and prospective studies of covid-19 reinfections from March, 2020 to October, 2024, already published (14-18). All studies were conducted on the same population: patients saw in a general medicine office in Toledo, Spain, which has a list of 2,000 patients > 14 years of age (in Spain, general practitioner (GP) care for people > 14 years of age, except for exceptions). The GPs in Spain work within the National Health System, which is public in nature, and are the gateway for all patients to the system, and each person is assigned a GP. The methodology of all studies has been previously published, but the main elements will be repeated here to facilitate understanding of the current study.

Outcome of interest

To compare ARR of SARS-CoV-2 reinfections, associated with acquired immunity (vaccination and/or infection), comparing ARR from 2023 to 2020-2022 with ARR from 2024 to 2023.

Calculation of the numerators

Cumulative incidence rates were calculated at the GP's office by dividing the number of reinfection events during the study period by the individuals that could develop the event at the start of the study (population at risk) (19). That is, the incidence rate was calculated by dividing the number of cases of covid-19 reinfections by people on the list of patients dependent on the consultation object of the study (N=2,000 people), from the period 2020-2022, in 2023 and 2024 years (20, 21).

Calculation of rate denominators

Data of variables of people in the clinic object of the study were obtained by extrapolating the neighborhood served by the health center to population served in clinic office (22, 23). Data regarding some variables of interest (as complex family, and chronic diseases) were previously published (24-27). The denominator data for prevalence of chronic diseases were taken from previous studies carried out in the same population treated in that general medicine consultation (28-31). The number of social-health workers was obtained as an extrapolation of the total number for Castilla la Mancha in 2020 for the list of 2000 inhabitants attended in the consultation object of the study (32). The ethnic minority data was obtained by extrapolating the data of foreigners in the municipality of Toledo to the population attended at the clinic (33). The data on vaccination with a complete schedule (1, 2 or 3 dose) was obtained by extrapolating the data from Spain to the population of the clinic (34). Likewise, for 2023 the number of people with the 1st booster dose was extrapolated for the population of the clinic from the data for Spain (35).

Calculation of ARR

The absolute risk reduction ARR is the opposite diference del attriutable risk: control minus treated (19).

Absolute risk (AR) = (number of events in the treated or control group) / (number of people in that group)

ARC = Absolute risk of events in the control group

ART = Absolute risk of events in the treatment group

ARR = ARC - ART

Thus, ARR was calculated as the arithmetic difference between 2 event rates: the event rate in the control group minus the event rate in the intervention group. ARR should be interpreted in the context of the baseline risk (36). Thus, the following were considered as intervention groups: 1) the incidence rates in 2023 (immunity by vaccination and/or infection: omicron SARS-CoV-2 variant and 4th booster doses of vaccine) compared with period 2020-2022; and 2) the incidence rates of 2024 (immunity by vaccination and/or infection: omicron SARS-CoV-2 variant and 5th booster doses of vaccine) compared with 2023. Therefore, the following were considered as control or baseline risk group: 1) the period 2020-2022 (successively alpha, delta and omicron SARS-CoV-2 variants, and in 2020 without vaccination, in 2021 with 1 or 2 dose vaccination and in 2022 with third dose -first booster) as a control compared with 2023 (omicron SARS-CoV-2 variants and 4th booster dose of vaccine); and 2) the year 2023 as a control compared to 2024 (5th dose -second booster of vaccine).

Definition of reinfection

SARS-CoV-2 reinfection was defined as a documented infection occurring at least 90 days after a previous infection (37-39).

Diagnosis of covid-19

The diagnosis was performed with reverse transcriptase polymerase chain reaction oropharyngeal swab tests or antigen testing (40) performed in health services or at home.

Covid-19 vaccination 

Patients could have received 1, 2 doses of vaccine, first booster for fall-winter 2021, fourth dose (second booster) for fall-winter 2022 (41) and fifth dose (third booster) for fall-winter 2023. In our study, only Pizfer / BioNTech, Spikevax (mRNA-1273- Moderna), Vaxzevria, Oxford / AstraZeneca and Janssen (Johnson & Johnson) vaccines were used for the first and second doses. For the first booster, only messenger RNA (mRNA) was used. And only Moderna and Pfizer-BioNTech's bivalent covid-19 vaccines were used for the second booster. Omicron XBB.1.5 adapted vaccines Pfizer / BioNTech y Spikevax (Moderna) were used for the third booster in autumn-winter 2023-2024 (42-45).

Collected variables

The following variables were collected:

-Age and sex

-Chronic diseases (defined as "any alteration or deviation from normal that has one or more of the following characteristics: is permanent, leaves residual impairment, is caused by a non-reversible pathological alteration, requires special training of the patient for rehabilitation, and / or can be expected to require a long period of control, observation or treatment” (46)

-Social-occupancy class (according to the Registrar General's classification of occupations and social status code) (47)

-If they were Health Care Workers

-Problems in the family context based on the genogram. It was understood that "complex" genograms present families with psychosocial problems) (48, 49)

-Ethnic minority (defined as a “human group with cultural, linguistic, racial values and geographical origin, numerically inferior compared to the majority group”) (50)

-Disease severity (classified according to: 1. mild cases: clinical symptoms are mild and no manifestation of pneumonia can be found on images; 2. moderate cases: with symptoms such as fever and respiratory tract symptoms and the manifestation of pneumonia can be seen on the imaging tests; and 3. severe cases: respiratory distress, respiratory rate ≥ 30 breaths / min., pulse oxygen saturation ≤ 93% with room air at rest, arterial partial pressure of oxygen / oxygen concentration ≤ 300 mmHg.) (51); to simplify comparison, moderate and severe cases were counted together

-Vaccination status against covid-19 at the date of reinfection: vaccinated with 2 doses of vaccine (40), vaccinated with first booster for fall-winter 2021 (52), vaccinated with fourth dose (second booster) for fall-winter 2022 (53) and vaccinated with fifth dose (third booster) for fall-winter 2023 (54, 55).

Epidemiological analysis

The calculation of ARR as explained above (subsection “Calculation of ARR”). The age of 65 years was used as the beginning of old age (56).  Figures with decimals were rounded to facilitate a more intuitive comparison. Similarly, to facilitate understanding of the data, the periods compared were rounded to full years: the period from March 1, 2020 to September 1, 2022 was labeled 2020-2022; from October 1, 2022 to September 30, 2023 was labeled 2023; and from October 1, 2023 to September 30, 2024 was labeled 2024.

Ethical issues

No personal data of the patients were used, but only group results, which were taken from the clinical history.

Results

There are no ARR from 2024 to 2023 when compared to ARR from 2023 to 2020-2022, both in the total (ARR of 8% from 2023 to 2020-2022 and ARR of 1% from 2024 to 2023); in 14-65 years (ARR of 10% from 2023 to 2020-2022 and ARR of 1% from 2024 to 2023); in women (ARR of 6% from 2023 to 2020-2022 and ARR of 2% from 2024 to 2023); in men (ARR of 10% from 2023 to 2020-2022; and ARR of 1% from 2024 to 2023); in cases with moderate severe severity (RRA of 0.9% from 2023 to 2020-2022 and ARR of 0% from 2024 to 2023); and in deaths (RRA of 0.2% from 2023 to 2020-2022 and RRA of 0% from 2024 to 2023).

This trend does not occur in those over 65 years of age (ARR of 0% from 2023 to 2020-2022 and ARR of 1% from 2024 to 2023) or in cases with the presence of chronic diseases (ARR of -1% from 2023 to 2020-2022 and ARR of 0% from 2024 to 2023) where the absolute risk is slightly reduced from 2024 to 2023 compared with the figure from 2023 to 2020-2022, and especially in socio-health workers where ARR from 2024 to 2023 is very significant when compared with ARR from 2023 to 2020-2022 (ARR of -49% from 2023 to 2020-2022 and ARR of 29% from 2024 to 2023). (TABLE 1, FIGURE 1, FIGURE 2, FIGURE 3, FIGURE 4).

VARIABLES

COVID-19 INCIDENCE RATES IN THE PERIOD OF 2020-2022

(control)

COVID-19 INCIDENCE RATES IN 2023

(intervention group for 2020-2022 period, and control group for 2024)

ABSOLUTE RISK REDUCTION

(INCIDENCE IN 2020-2022 MINUS INCIDENCE IN 2023

COVID-19 INCIDENCE RATES IN 2024

(intervention group regarding 2023)

ABSOLUTE RISK REDUCTION

(INCIDENCE IN 2023 MINUS INCIDENCE IN 2024

Total (>=14 years)

36% x 3 years

[12% average x 1 year]

4% x 1 year8%3% x 1 year1%
> 65 years

19% x 3 years

[6% average x 1 year]

6% x 1 year0%5% x 1 year1%
14-65 years

39% x 3 years

[13% average x 1 year]

3% x 1 year10%2% x 1 year1%
Women

33% x 3 years

[11% average x 1 year]

5% x 1 year6%3% x 1 year2%
Men

38% x 3 years

[13% average x 1 year]

3% x 1 year10%2% x 1 year1%
Socio-health workers

16% x 3 years

[5% average x 1 year]

54% x 1 year-49%25% x 1 year29%

Moderate

severe severity

4% x 3 years

[1% average x 1 year]

0.1% x 1 year0.9%0.1% x 1 year0%
Exitus

0.5% x 3 years

[0.2% average x 1 year]

0 % x 1 year0.2%0 % x 1 year0%
Presence of chronic diseases

7% x 3 years

[2% average x 1 year]

3% x 1 year-1%3 % x 1 year0%

Table 1: Absolute Reduction Covid-19 Risk From 2023 To 2020-2022, And From 2024 To 2023

Figure 1: Absolute Reduction Covid-19 Total Risk From 2023 To 2020-2022, And From 2024 To 2023

Figure 2: Absolute Reduction Covid-19 Risk In Selected Variables From 2023 To 2020-2022, And From 2024 To 2023

Figure 3: Absolute Reduction Covid-19 Risk In Selected Variables From 2023 To 2020-2022, And From 2024 To 2023

Figure 4: Absolute Reduction Covid-19 Risk In Socio-Health Workers From 2023 To 2020-2022, And From 2024 To 2023

Results

There are no ARR from 2024 to 2023 when compared to ARR from 2023 to 2020-2022, both in the total (ARR of 8% from 2023 to 2020-2022 and ARR of 1% from 2024 to 2023); in 14-65 years (ARR of 10% from 2023 to 2020-2022 and ARR of 1% from 2024 to 2023); in women (ARR of 6% from 2023 to 2020-2022 and ARR of 2% from 2024 to 2023); in men (ARR of 10% from 2023 to 2020-2022; and ARR of 1% from 2024 to 2023); in cases with moderate severe severity (RRA of 0.9% from 2023 to 2020-2022 and ARR of 0% from 2024 to 2023); and in deaths (RRA of 0.2% from 2023 to 2020-2022 and RRA of 0% from 2024 to 2023).

This trend does not occur in those over 65 years of age (ARR of 0% from 2023 to 2020-2022 and ARR of 1% from 2024 to 2023) or in cases with the presence of chronic diseases (ARR of -1% from 2023 to 2020-2022 and ARR of 0% from 2024 to 2023) where the absolute risk is slightly reduced from 2024 to 2023 compared with the figure from 2023 to 2020-2022, and especially in socio-health workers where ARR from 2024 to 2023 is very significant when compared with ARR from 2023 to 2020-2022 (ARR of -49% from 2023 to 2020-2022 and ARR of 29% from 2024 to 2023). (TABLE 1, FIGURE 1, FIGURE 2, FIGURE 3, FIGURE 4).

VARIABLES

COVID-19 INCIDENCE RATES IN THE PERIOD OF 2020-2022

(control)

COVID-19 INCIDENCE RATES IN 2023

(intervention group for 2020-2022 period, and control group for 2024)

ABSOLUTE RISK REDUCTION

(INCIDENCE IN 2020-2022 MINUS INCIDENCE IN 2023

COVID-19 INCIDENCE RATES IN 2024

(intervention group regarding 2023)

ABSOLUTE RISK REDUCTION

(INCIDENCE IN 2023 MINUS INCIDENCE IN 2024

Total (>=14 years)

36% x 3 years

[12% average x 1 year]

4% x 1 year8%3% x 1 year1%
> 65 years

19% x 3 years

[6% average x 1 year]

6% x 1 year0%5% x 1 year1%
14-65 years

39% x 3 years

[13% average x 1 year]

3% x 1 year10%2% x 1 year1%
Women

33% x 3 years

[11% average x 1 year]

5% x 1 year6%3% x 1 year2%
Men

38% x 3 years

[13% average x 1 year]

3% x 1 year10%2% x 1 year1%
Socio-health workers

16% x 3 years

[5% average x 1 year]

54% x 1 year-49%25% x 1 year29%

Moderate

severe severity

4% x 3 years

[1% average x 1 year]

0.1% x 1 year0.9%0.1% x 1 year0%
Exitus

0.5% x 3 years

[0.2% average x 1 year]

0 % x 1 year0.2%0 % x 1 year0%
Presence of chronic diseases

7% x 3 years

[2% average x 1 year]

3% x 1 year-1%3 % x 1 year0%

Table 1: Absolute Reduction Covid-19 Risk From 2023 To 2020-2022, And From 2024 To 2023

Figure 1: Absolute Reduction Covid-19 Total Risk From 2023 To 2020-2022, And From 2024 To 2023

Figure 2: Absolute Reduction Covid-19 Risk In Selected Variables From 2023 To 2020-2022, And From 2024 To 2023

Figure 3: Absolute Reduction Covid-19 Risk In Selected Variables From 2023 To 2020-2022, And From 2024 To 2023

Figure 4: Absolute Reduction Covid-19 Risk In Socio-Health Workers From 2023 To 2020-2022, And From 2024 To 2023

Discussion

1. Main findings

Our main findings were:

1. There are no ARR from 2024 to 2023 when compared with ARR from 2023 to 2020-2022, neither in the total, nor in 14-65 years, nor in women, nor in men, nor in cases with moderate severe severity, nor in deaths

2. There are ARR from 2024 to 2023 when compared with ARR from 2023 to 2020-2022 in people over 65 years of age and in cases with the presence of chronic diseases, and especially in socio-health workers.

In the period 2020-2022 SARS-CoV-2 variants were successively alpha, delta and omicron, and the population had received only 1, 2 or 3 doses of vaccine (57). In Spain, in April 2022, the population vaccinated with the complete regimen (2 or 3 doses) was 85.27% (34). In November 2022, more than 60% of people over 80 years of age, and 37% of people over 60 years of age, already had the second booster dose of the covid-19 vaccine (58, 59); this situation was considered in our study as an expression of the baseline rates. The ARR should be interpreted in the context of the baseline risk (36). In 2023, the omicron SARS-CoV-2 variant predominated and the population received the 4th booster dose of the vaccine. By June 2023, the number of people with the 1st booster dose was 56% of the population (35). In 2024, the omicron SARS-CoV-2 variant predominated and the population received the 5th booster dose of the vaccine. 60% of the population over 80 years of age has received the vaccine adapted against the covid-19 subvariants of the 2023/2024 campaign (60).

In any case, the results must be evaluated with caution. In Spain, since April 28, 2022 there was a new "Surveillance and Control Strategy Against Covid-19" that include the non-performance of diagnostic tests, except on over 60 years of age (61). This means that positive cases have been counted with tests carried out in health services and with tests carried out at home and later reported to the GP. Thus, there is probably an underreporting.

2. Comparison with other studies

Five years after the pandemic began, new SARS-CoV-2 infections continue to occur despite advances in vaccines (62). It has been reported that SARS-CoV-2 reinfections were rare until late 2021, but became common with the arrival of omicron (63-66). The human host of SARS-CoV-2 in 2023 and 2024 is different from that of 2020 in terms of vaccination status. Vaccines have been shown to be effective in reducing the severity of SARS-CoV-2 infection (67-69). However, waning immunity as a result of new variants must be taken into account. The efficacy of prior SARS-CoV-2 infection in preventing reinfection varies along the spectrum spanning alpha, beta, delta, and omicron (9). There is increasing scientific evidence showing that the protection generated by vaccination decreases over time, although it is restored with booster dose inoculation (70, 71). Furthermore, the protection conferred by natural immunity, vaccination, and both against SARS-CoV-2 infection with the omicron variant is unclear (38, 72, 73).

When a patient is considering undergoing a preventive service such as vaccination, relevant information to guide a decision includes the likelihood of risk and benefit. Some have argued that all patients considering preventive services should be given this information in the form of absolute probabilities (6). Any quantitative data can be described in many ways, and research shows that the approach to that information has significant effects on patient understanding (74, 75). One of the most intuitive ways to describe the risks and benefits of a medical intervention is the ARR. However, patients are rarely given such absolute measures of potential benefit (74).

While randomized controlled trials and population-based evaluations do not routinely report ARR, their primary effect measure for vaccine effectiveness is RRR. Some researchers have subsequently calculated ARR using data from large studies, but none have assessed the metrics in subpopulations, including socioeconomic groups, with different baseline risks of disease (8). Clinical trials for covid-19 vaccines by 2021 reported impressive efficacy in preventing symptomatic disease: 95% RRR for the Pfizer-BioNTech vaccine and 94% for the Moderna vaccine. But these figures did not imply that 94% to 95% of people were protected from the disease with these vaccines, a common misconception among patients and even some health care professionals. This means that the number of cases of covid-19 disease would be reduced by 94% to 95% compared to what would occur without vaccination. If ARR were calculated in the same population of these two clinical trials, this reduction provided by the vaccines would be much less striking: 0.84% for the Pfizer-BioNTech vaccine (0.88% in the placebo group minus 0.04% in the vaccinated group) and 1.23% for the Moderna vaccine (1.31% minus 0.08%) (76, 77).

In a systematic review for 2021, vaccination in people who have recovered from covid-19 provided an extremely small absolute risk difference for the prevention of subsequent SARS-CoV-2 infection (AR = 0.004 person-years). At that time, the authors concluded that the net benefit is marginal in absolute terms. Therefore, vaccination of people who have recovered from covid-19 should be subject to clinical criteria and individual preferences (78). However, current trends in reported cases of covid-19 are underestimates of the true number of infections and reinfection (79).

In summary, In general practice setting in Toledo, Spain, the hybrid immunity intervention (natural infection and/or vaccination) from 2024 to 2023 compared with 2023 to 2020-2022 only shows reinfection ARR in people over 65 years of age, in cases with chronic diseases and especially in healthcare workers. That is, the vaccination and hybrid immunity intervention that was probably very useful from 2023 to 2020-2022, has a lower effect from 2024 to 2023, except in those over 65 years of age, in cases with chronic diseases, and especially in healthcare workers. These absolute data can more intuitively show information on the protection of hybrid immunity against covid-19 reinfections and suggest which population groups should be predominantly targeted by the vaccination intervention. In any case figures for 2023 and 2024 may have a bias due to underreporting.

Study limitations and strengths

1. The sample was small, so some data may cause misinterpretation.

2. Asymptomatic cases were missing because they did not attend GP consultation, as no surveillance or systematic screening was done.

3. There may be an underreporting of infections to GP of patients with a positive test at home.

4. The great accessibility of patients to the GP, and the fact of continuity of care that characterizes family medicine, have important epidemiological connotations, presenting a unique opportunity to study incidence rates of diseases in small geographical bases.

Conclusion

In a general practice setting in Toledo, Spain, the hybrid immunity (natural infection and/or vaccination) intervention from 2024 to 2023 compared with 2020-2022 only shows reinfection ARR in people over 65 years of age, in cases with chronic diseases and especially in healthcare workers. That is, the vaccination and hybrid immunity intervention was probably very useful from 2023 to 2020-2022, but its effect is attenuated from 2024 to 2023, except in people over 65 years of age, in cases with chronic diseases, and especially in healthcare workers. It is suggested that covid-19 vaccination intervention is especially useful for healthcare workers and people over 65 years of age and those with chronic diseases

References

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Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

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Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

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Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

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Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

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Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

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Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

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Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

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Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

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Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

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Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

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Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

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Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

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S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

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Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

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George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

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Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

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Gomez Barriga Maria Dolores

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

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Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

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Maria Dolores Gomez Barriga

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

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Dr Maria Dolores Gomez Barriga

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

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Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.

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Dr Marcelo Flavio Gomes Jardim Filho

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

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Zsuzsanna Bene

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

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Dr Susan Weiner

My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.

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Lin-Show Chin

My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.

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Sonila Qirko

My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.

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Luiz Sellmann

I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.

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Zhao Jia

Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."

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Thomas Urban

I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.

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Cristina Berriozabal

To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.

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Dr Tewodros Kassahun Tarekegn

"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".

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Dr Shweta Tiwari

I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.

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Dr Farooq Wandroo

Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.

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Dr Anyuta Ivanova

We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.

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Dr David Vinyes

My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.

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Gertraud Teuchert-Noodt

To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina

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Dr Elvira Farina

Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.

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Dr Oleg Golyanovski