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1.
Heart Lung ; 66: 94-102, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38598979

RESUMO

BACKGROUND: Iron Deficiency (ID) is common in Heart Failure (HF) and associated with poor outcomes. Replacement with intravenous (IV) iron can improve functional status, quality of life and risk of unplanned admission. In 2015/16 a local service evaluation was performed which found that of people admitted with HF, only 27.5 % had assessment of iron status, and when identified, replacement occurred in fewer than half. Education strategies were employed to increase awareness of the importance of assessment and correction. OBJECTIVES: To assess if practice had improved following education strategies. METHODS: A review of 220 patient records for people admitted with HF in 2020/21 to establish if iron status assessed, presence of ID, and whether if ID identified it was treated, and by which route. Trends in 2020/21 data were explored in sub-groups by age, sex, type of HF, anaemia status, input from HF specialists and type of ID. RESULTS: Compared to 2015/16, more assessments of iron status were performed (45% vs 27.5 %), ID was corrected more frequently (57% vs 46 %) and increased use of the IV route for replacement (83% vs 58 %) CONCLUSIONS: Despite the impact of COVID-19 on usual care in 2020/21, improvement was seen in proportion of assessment and treatment of ID following simple education strategies for key stakeholders. There may be scope to improve practice further if the findings remain similar post pandemic. If so, a formal Quality Improvement approach may be helpful.


Assuntos
Anemia Ferropriva , Insuficiência Cardíaca , Humanos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Masculino , Feminino , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/terapia , Reino Unido/epidemiologia , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Hospitalização/estatística & dados numéricos , Estudos Retrospectivos , Qualidade de Vida , Ferro/administração & dosagem , COVID-19/epidemiologia , COVID-19/complicações
2.
J Hazard Mater ; 471: 134264, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38640675

RESUMO

SARS-CoV-2 pandemic affected lifestyle habits, and the mental health and wellbeing of people around the world. In this manuscript, two towns (Paulton and Radstock) and two cities (Bath and Bristol) in Southwest England (> 1 million people) were monitored for two years using Wastewater-Based Epidemiology to assess impacts of COVID (including management measures such as lockdowns and movement restrictions) on community lifestyle choices: illicit drugs, legal stimulants, abused pharmaceuticals and pain pharma usage. Results were triangulated with key dates captured during the pandemic (national lockdowns, restrictions and social distancing measures, etc.). This highlighted a reduction in cocaine intake (as benzoylecgonine) (community average: -36 %) during the first lockdown and an increase in illicit drugs usage after the 3rd national lockdown (community averages for amphetamine: +8 %, cocaine/benzoylecgonine: +39 %, ketamine:+70 %) when restrictions were removed, and social interaction and recreational activities increased. There was a reduction in the intake of caffeine (as 1,7-dimethylxanthine) (community average:-39 %) after 3rd national lockdown coinciding with pubs reopening while nicotine intake (via cotinine) remained stable indicating lack of impact of COVID on smoking habits. Pain pharma often used in pain management resulting from injuries linked with sport activities (naproxen and diclofenac) showed decrease in usage due to lockdown restrictions in physical exercise and access to gyms/sport facilities.


Assuntos
COVID-19 , Drogas Ilícitas , Estilo de Vida , Águas Residuárias , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Inglaterra/epidemiologia , Vigilância Epidemiológica Baseada em Águas Residuárias , SARS-CoV-2 , Uso Recreativo de Drogas , Pandemias , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
3.
Front Public Health ; 12: 1333081, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38566790

RESUMO

Introduction: Many researchers have focused their studies on hypertension due to its over-representation among COVID-19 patients. Both retrospective and observational studies conducted close to the Wuhan area have reported that hypertension is the most common comorbidity observed in patients affected by COVID-19. Objective: Our objective is that patients with arterial hypertension have a worse prognosis in terms of evolution leading to higher costs. Methods: A retrospective cross-sectional study was conducted. A total of 3,581 patients from La Paz University Hospital (LPUH) during the period between 15 July 2020 and 31 July 2020 were included in this study. Results: It should be noted that 40.71% of the patients were hypertensive. As expected, hypertension was associated with men, among whom we observed a higher prevalence and a higher age (median age of 77 years (IQI: 65-85) versus 52 years (IQI: 37-64), p-value < 0.001). Hypertensive patients had a higher prevalence of dyspnea (52.14% vs. 47.15%, p-value = 0.004) and altered awareness (14.89% vs. 4.30%, p-value <0.001). The non-parametric Kaplan-Meier curve estimates the survival of patients in the two study groups. We can see how patients with hypertension have a higher associated mortality, with the difference being statistically significant, p-value (log-rank) = 0.004. Only for the appearance of complications during hospitalization, the group of hypertensive patients reached the figure of €1,355,901.71 compared to the total of 421,403.48 € for normotensive patients. Conclusion: Our study shows the worse clinical evolution of patients with COVID-19 in terms of associated morbidity and mortality. It also shows that the cost of managing patients with hypertension is greater than that of managing normotensive patients.


Assuntos
COVID-19 , Hipertensão , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , COVID-19/epidemiologia , Estudos Transversais , Atenção à Saúde , Hipertensão/epidemiologia , Estudos Retrospectivos , Adulto , Idoso de 80 Anos ou mais , Feminino
4.
Front Public Health ; 12: 1338677, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38566793

RESUMO

Objective: To quantitatively assess the impact of COVID-19 pandemic on public health, as well as its economic and social consequences in major economies, which is an international public health concern. The objective is to provide a scientific basis for policy interventions. Subject and methods: This study utilizes a multi-country, multi-sector CGE-COVID-19 model to analyze the repercussions of the pandemic in 2022. The re-search focuses on quantifying the effects of COVID-19 on the macroeconomy and various industry sectors within six economies: the United States, China, the EU, the United Kingdom, Japan, and South Korea. Results: The COVID-19 pandemic shock had the most significant impact on China and the EU, followed by notable effects observed in the United States and the United Kingdom. In contrast, South Korea and Japan experienced relatively minimal effects. The reduction in output caused by the pandemic has affected major economies in multiple sectors, including real industries such as forestry and fisheries, and the services such as hotels and restaurants. Conclusion: The overall negative macroeconomic impact of the epidemic on major economies has been significant. Strategic interventions encompassing initiatives like augmenting capital supply, diminishing corporate taxes and fees, offering individual subsidies, and nurturing international cooperation held the potential to mitigate the detrimental economic consequences and enhance the global-economic amid the pan-demic. Consequently, this study contributes to the advancement of global anti-epidemic policies targeting economic recovery. Moreover, using the CGE-COVID-19 model has enriched the exploration of general equilibrium models in PHEIC events.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , Pandemias , China , Pesqueiros , Indústrias
5.
J Affect Disord ; 356: 707-714, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38608771

RESUMO

OBJECTIVE: To examine socio-demographic disparities in food insecurity during the COVID-19 pandemic and the association between food insecurity and mental health among US adults overall and communities vulnerable to food insecurity. METHODS: A cross-sectional study was conducted using the 2020-2021 National Health Interview Survey of 57,456 US adults. Weighted multivariable logistic regression models were used to estimate the association between food insecurity and anxiety or depression symptoms in overall US adults and subgroups including young adults (18-34 years), females, Hispanic people, non-Hispanic Black people, individuals with prior COVID-19 infection, the unemployed, low-income participants, participants with children, and Supplemental Nutrition Assistance Program (SNAP) participants. RESULTS: Young or middle age, female sex, Hispanic/non-Hispanic Black/other race/ethnicity, lower education level, unmarried/other marital status, unemployment, being below the federal poverty level, and greater number of persons in the household were associated with food insecurity (AOR ranged from 1.35 to 2.70, all p < 0.05). Food insecurity was independently associated with anxiety (AOR = 2.67, 99 % CI: 2.33, 3.06) or depression (AOR = 3.04, 99 % CI: 2.60, 3.55) symptoms in the overall adults. Significant associations between food insecurity and anxiety or depression symptoms were also observed in all subgroups (AOR ranged from 1.95 to 3.28, all p < 0.0001). Compared with overall adults, the magnitude of the association was greater for participants with children, females (for depression only), and non-Hispanic Black people (for depression only). LIMITATIONS: The cross-sectional design prevents inference of causality. CONCLUSIONS: Comprehensive policies are needed to ensure accessible and affordable food resources to reduce disparities in food insecurity and improve mental health, especially for those socioeconomically disadvantaged communities.


Assuntos
Ansiedade , COVID-19 , Depressão , Insegurança Alimentar , Saúde Mental , Humanos , Feminino , COVID-19/epidemiologia , Masculino , Adulto , Estudos Transversais , Estados Unidos/epidemiologia , Adulto Jovem , Adolescente , Pessoa de Meia-Idade , Saúde Mental/estatística & dados numéricos , Depressão/epidemiologia , Ansiedade/epidemiologia , Inquéritos Epidemiológicos , Pobreza/estatística & dados numéricos , SARS-CoV-2 , Fatores Socioeconômicos , Assistência Alimentar/estatística & dados numéricos
6.
PLoS One ; 19(4): e0302072, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38630700

RESUMO

The aim of the paper is to provide an ex-post assessment of the impact of the COVID-19 pandemic on food insecurity in the EU-27 countries expressed by physical and economic food access. We analysed trade and price effects, together with food insecurity and malnutrition indicators. Actual levels of the indicators were compared with their pre-pandemic magnitudes and/or with counterfactual levels derived from predictive models. We also aimed to compare the objective statistics with the subjective consumers' perception of their households' food security. Our research indicates that the EU food trade was more resilient to COVID-19 impacts than the trade in non-food products, while food trade decreases were of a temporary nature. This did not affect the trade balance significantly; however, the import reduction threatened the physical food access in most EU countries. Regarding economic food access, the results indicate that the increase in food prices was offset by the increase in disposable income. It may suggest that the COVID-19 pandemic did not significantly affect the deterioration of economic access to food in the EU countries. However, the prevalence of severe food insecurity in the total population or the proportion of households reporting inability to afford a meal with meat, chicken, fish, or a vegetarian equivalent increased in 2020-2021 compared to 2019. This means that the comparative analysis of the real data on prices and households' income, as well as consumer financial situation and food consumption affordability, does not offer a clear answer concerning the impact of the COVID-19 pandemic on the food security of EU households.


Assuntos
COVID-19 , Humanos , Pandemias , Abastecimento de Alimentos , Refeições , Segurança Alimentar
7.
PLoS One ; 19(4): e0301009, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38630742

RESUMO

The world's health, economic, and social systems have been adversely impacted by the COVID-19 pandemic. With lockdown measures being a common response strategy in most countries, many individuals were faced with financial and mental health challenges. The current study explored the effect of the COVID-19 pandemic on the psychological well-being, perception of risk factors and coping strategies of two vulnerable groups in Malaysia, namely women and older adults from low-income households (USD592). A purposive sample of 30 women and 30 older adults was interviewed via telephone during Malaysia's Movement Control Order (MCO) regarding the challenges they faced throughout the pandemic. Thematic analysis was subsequently conducted to identify key themes. The themes identified from the thematic analysis indicated a degree of overlap between both groups. For women, seven themes emerged: 1) Psychological challenges due to COVID-19 pandemic, 2) Family violence, 3) Finance and employment related stress and anxiety, 4) Women's inequality and prejudice, 5) Coping strategies, 6) Professional support, and 7) Women's empowerment. Similarly, there were six themes for the older adults: 1) Adverse emotional experiences from COVID-19, 2) Threats to health security, 3) Loss of social connections, 4) Government aid to improve older adults' psychological well-being, 5) Psychological support from family members and pets, and 6) Self-reliance, religion, and spirituality. The findings provide valuable information on the specific burdens faced by these groups, and support psychological interventions and mitigations that would be appropriate to improve well-being during the recovery phase.


Assuntos
COVID-19 , Capacidades de Enfrentamento , Humanos , Feminino , Idoso , Pandemias , Controle de Doenças Transmissíveis , Ansiedade
8.
Sci Rep ; 14(1): 8853, 2024 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-38632289

RESUMO

Individual testing of samples is time- and cost-intensive, particularly during an ongoing pandemic. Better practical alternatives to individual testing can significantly decrease the burden of disease on the healthcare system. Herein, we presented the clinical validation of Segtnan™ on 3929 patients. Segtnan™ is available as a mobile application entailing an AI-integrated personalized risk assessment approach with a novel data-driven equation for pooling of biological samples. The AI was selected from a comparison between 15 machine learning classifiers (highest accuracy = 80.14%) and a feed-forward neural network with an accuracy of 81.38% in predicting the rRT-PCR test results based on a designed survey with minimal clinical questions. Furthermore, we derived a novel pool-size equation from the pooling data of 54 published original studies. The results demonstrated testing capacity increase of 750%, 60%, and 5% at prevalence rates of 0.05%, 22%, and 50%, respectively. Compared to Dorfman's method, our novel equation saved more tests significantly at high prevalence, i.e., 28% (p = 0.006), 40% (p = 0.00001), and 66% (p = 0.02). Lastly, we illustrated the feasibility of the Segtnan™ usage in clinically complex settings like emergency and psychiatric departments.


Assuntos
COVID-19 , Humanos , Prevalência , Redução de Custos , Aprendizado de Máquina , Medição de Risco
9.
BMJ Open ; 14(4): e078852, 2024 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-38631825

RESUMO

OBJECTIVE: Diagnostic testing is an important tool to combat the COVID-19 pandemic, yet access to and uptake of testing vary widely 3 years into the pandemic. The WHO recommends the use of COVID-19 self-testing as an option to help expand testing access. We aimed to calculate the cost of providing COVID-19 self-testing across countries and distribution modalities. DESIGN: We estimated economic costs from the provider perspective to calculate the total cost and the cost per self-test kit distributed for three scenarios that differed by costing period (pilot, annual), the number of tests distributed (actual, planned, scaled assuming an epidemic peak) and self-test kit costs (pilot purchase price, 50% reduction). SETTING: We used data collected between August and December 2022 in Brazil, Georgia, Malaysia, Ethiopia and the Philippines from pilot implementation studies designed to provide COVID-19 self-tests in a variety of settings-namely, workplace and healthcare facilities. RESULTS: Across all five countries, 173 000 kits were distributed during pilot implementation with the cost/test distributed ranging from $2.44 to $12.78. The cost/self-test kit distributed was lowest in the scenario that assumed implementation over a longer period (year), with higher test demand (peak) and a test kit price reduction of 50% ($1.04-3.07). Across all countries and scenarios, test procurement occupied the greatest proportion of costs: 58-87% for countries with off-site self-testing (outside the workplace, for example, home) and 15-50% for countries with on-site self-testing (at the workplace). Staffing was the next key cost driver, particularly for distribution modalities that had on-site self-testing (29-35%) versus off-site self-testing (7-27%). CONCLUSIONS: Our results indicate that it is likely to cost between $2.44 and $12.78 per test to distribute COVID-19 self-tests across common settings in five heterogeneous countries. Cost-effectiveness analyses using these results will allow policymakers to make informed decisions on optimally scaling up COVID-19 self-test distribution programmes across diverse settings and evolving needs.


Assuntos
COVID-19 , Infecções por HIV , Humanos , SARS-CoV-2 , Etiópia , Infecções por HIV/epidemiologia , Georgia , Malásia , Pandemias , Brasil , Filipinas , Autoteste , COVID-19/epidemiologia
10.
BMC Health Serv Res ; 24(1): 464, 2024 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-38614980

RESUMO

BACKGROUND: The COVID-19 pandemic has impacted peoples' health-related behaviors, especially those of older adults, who have restricted their activities in order to avoid contact with others. Moreover, the pandemic has caused concerns in long-term care insurance (LTCI) providers regarding management and financial issues. This study aimed to examine the changes in revenues among LTCI service providers in Japan during the pandemic and analyze its impact on different types of services. METHODS: In this study, we used anonymized data from "Kaipoke," a management support platform for older adult care operators provided by SMS Co., Ltd. Kaipoke provides management support services to more than 27,400 care service offices nationwide and has been introduced in many home-care support offices. The data used in this study were extracted from care plans created by care managers on the Kaipoke platform. To examine the impact of the pandemic, an interrupted time-series analysis was conducted in which the date of the beginning of the pandemic was set as the prior independent variable. RESULTS: The participating providers were care management providers (n = 5,767), home-visit care providers (n = 3,506), home-visit nursing providers (n = 971), and adult day care providers (n = 4,650). The results revealed that LTCI revenues decreased significantly for care management providers, home-visit nursing providers, and adult day care providers after the COVID-19 pandemic began. The largest decrease was an average base of USD - 1668.8 in adult day care. CONCLUSION: The decrease in revenue among adult day care providers was particularly concerning in terms of the sustainability of their business. This decrease in revenue may have made it difficult to retain personnel, and staff may have needed to be laid off as a result. Although this study has limitations, it may provide useful suggestions for countermeasures in such scenarios, in addition to support conducted measures.


Assuntos
COVID-19 , Gerentes de Casos , Humanos , Idoso , COVID-19/epidemiologia , Seguro de Assistência de Longo Prazo , Pandemias , Comércio
11.
Front Public Health ; 12: 1170628, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38584913

RESUMO

Background: In the context of the COVID-19 pandemic, limited research has focused on socioeconomic disparities in Local Healthcare System Efficiency (LHSE) among Japanese prefectures. This study seeks to investigate the moderating impact of vaccination on the relationship between LHSE and socioeconomic characteristics and endowments. Methods: To explore these relationships, we first utilized the Data Envelopment Analysis with Slack-Based Measure to measure the LHSE, based on data from Japanese prefectures during waves 2 to 5 of the pandemic. Then estimating the impact of socioeconomic variables on LHSE. Finally, we assessed the changes in the way socioeconomic variables affect LHSE before and after vaccine deployment using the Seemingly Unrelated Estimation t-test methodology. Results: The research findings suggest an overall reduction in LHSE disparities across various regions due to the utilization of vaccines. Particularly in areas with relatively nsufficient bed resources, a significant improvement in LHSE was observed in most regions. However, there was no evidence supporting the role of vaccine deployment in mitigating socioeconomic inequalities in LHSE. Conversely, the utilization of vaccines showed a positive correlation between the improvement in LHSE and the proportion of older adult population in regions with sufficient bed resources. In regions facing bed shortages, the enhancement of LHSE became more reliant on reducing the occupancy rate of secured beds for severe cases after the introduction of vaccination. Discussion: In regions facing bed shortages, the enhancement of LHSE became more reliant on reducing the occupancy rate of secured beds for severe cases. This underscores the importance for policymakers and implementers to prioritize the treatment of severe cases and ensure an effective supply of medical resources, particularly secured beds for severe cases, in their efforts to improve LHSE, in the post-COVID-19 era with rising vaccine coverage.


Assuntos
COVID-19 , Vacinas , Humanos , Idoso , Japão/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Pandemias , Vacinação , Disparidades em Assistência à Saúde , Fatores Socioeconômicos
12.
Sci Total Environ ; 927: 172278, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38583631

RESUMO

The Wells-Riley model is extensively used for retrospective and prospective modelling of the risk of airborne transmission of infection in indoor spaces. It is also used when examining the efficacy of various removal and deactivation methods for airborne infectious aerosols in the indoor environment, which is crucial when selecting the most effective infection control technologies. The problem is that the large variation in viral load between individuals makes the Wells-Riley model output very sensitive to the input parameters and may yield a flawed prediction of risk. The absolute infection risk estimated with this model can range from nearly 0 % to 100 % depending on the viral load, even when all other factors, such as removal mechanisms and room geometry, remain unchanged. We therefore propose a novel method that removes this sensitivity to viral load. We define a quanta-independent maximum absolute before-after difference in infection risk that is independent of quanta factors like viral load, physical activity, or the dose-response relationships. The input data needed for a non-steady-state calculation are just the removal rates, room volume, and occupancy duration. Under steady-state conditions the approach provides an elegant solution that is only dependent on removal mechanisms before and after applying infection control measures. We applied this method to compare the impact of relative humidity, ventilation rate and its effectiveness, filtering efficiency, and the use of ultraviolet germicidal irradiation on the infection risk. The results demonstrate that the method provides a comprehensive understanding of the impact of infection control strategies on the risk of airborne infection, enabling rational decisions to be made regarding the most effective strategies in a specific context. The proposed method thus provides a practical tool for mitigation of airborne infection risk.


Assuntos
Microbiologia do Ar , Poluição do Ar em Ambientes Fechados , Humanos , Poluição do Ar em Ambientes Fechados/prevenção & controle , Aerossóis/análise , COVID-19/prevenção & controle , COVID-19/transmissão , Ventilação , Carga Viral , Modelos Teóricos , Controle de Infecções/métodos , Medição de Risco
13.
BMC Public Health ; 24(1): 1006, 2024 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-38605406

RESUMO

BACKGROUND: The COVID-19 disrupted the provision of essential health services in numerous countries, potentially leading to outbreaks of deadly diseases. This study aims to investigate the effect of the COVID-19 pandemic on the utilization of essential health services in Iran. METHODS: An analytical cross-sectional study was conducted using interrupted time series (ITS) analysis. Data about five indicators, including 'childhood vaccination, infant care, hypertension screening, diabetes screening, and breast cancer screening,' were obtained from the electronic health record System in two-time intervals: 15 months before (November 2018 to January 2020) and 15 months after (January 2020 to May 2021) the onset of the COVID-19 pandemic. The data were analyzed by utilizing ITS. In addition, a Poisson model was employed due to the usage of count data. The Durbin-Watson (DW) test was used to identify the presence of lag-1 autocorrelation in the time series data. All statistical analysis was performed using R 4.3.1 software, considering a 5% significance level. RESULTS: The ITS analysis showed that the COVID-19 pandemic significantly affected the utilization of all essential health services (P < 0.0001). The utilization of hypertension screening (RR = 0.51, p < 0.001), diabetes screening (RR = 0.884, p < 0.001), breast cancer screening (RR = 0.435, p < 0.001), childhood vaccination (IRR = 0.947, p < 0.001), and infant care (RR = 1.666, p < 0.001), exhibited a significant decrease in the short term following the pandemic (P < 0.0001). However, the long-term trend for all service utilization, except breast cancer screening (IRR = 0.952, p < 0.001), demonstrated a significant increase. CONCLUSIONS: The COVID-19 pandemic affected utilization of essential health care in Iran. It is imperative to utilize this evidence to develop policies that will be translated into targeted planning and implementation to sustain provision and utilization of essential health services during public health emergencies. It is also vital to raise awareness and public knowledge regarding the consequences of interruptions in essential health services. In addition, it is important to identify the supply- and demand-side factors contributing to these disruptions.


Assuntos
Neoplasias da Mama , COVID-19 , Diabetes Mellitus , Hipertensão , Humanos , Feminino , Análise de Séries Temporais Interrompida , COVID-19/epidemiologia , Pandemias/prevenção & controle , Estudos Transversais , Irã (Geográfico)/epidemiologia , Serviços de Saúde
14.
J Environ Manage ; 358: 120940, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38652994

RESUMO

The digital economy (DIE), a new economic form with digitalization at its core, has become an important driving force for promoting regional economy development. In the context of the COVID-19 pandemic, exploring the impact path of the DIE on carbon emission efficiency (CEE) is conducive to giving full play to the "carbon-reduction-and-efficiency-enhancement" role of the DIE, and to promoting the realization the "dual carbon" goal of carbon peak and carbon neutrality. In this paper, the Yellow River Basin (YRB) and the Yangtze River Economic Belt (YREB) are taken as study areas, the panel Tobit model is used to explore the impact of the DIE on CEE, and the intermediary-effect model and threshold-effect model are constructed to test the intermediary and threshold effects of technological innovation, respectively. The results show that the DIE has a U-shaped nonlinear impact on CEE in both the YRB and the YREB and that the impact has regional heterogeneity. Technological innovation can play a mediating effect between the DIE and CEE, whereas the mediating effect in the YRB is stronger than that in the YREB. Technological innovation has a threshold effect on the DIE to improve CEE, while the threshold value in the YREB is higher than that in the YRB. Furthermore, this paper proposes some suggestions to guide regional low-carbon and sustainable development.


Assuntos
COVID-19 , Carbono , Invenções , Desenvolvimento Econômico , China
15.
Artigo em Alemão | MEDLINE | ID: mdl-38587641

RESUMO

BACKGROUND: Earlier mortality in socioeconomically disadvantaged population groups represents an extreme manifestation of health inequity. This study examines the extent, time trends, and mitigation potentials of area-level socioeconomic inequalities in premature mortality in Germany. METHODS: Nationwide data from official cause-of-death statistics were linked at the district level with official population data and the German Index of Socioeconomic Deprivation (GISD). Age-standardized mortality rates before the age of 75 were calculated stratified by sex and deprivation quintile. A what-if analysis with counterfactual scenarios was applied to calculate how much lower premature mortality would be overall if socioeconomic mortality inequalities were reduced. RESULTS: Men and women in the highest deprivation quintile had a 43% and 33% higher risk of premature death, respectively, than those in the lowest deprivation quintile of the same age. Higher mortality rates with increasing deprivation were found for cardiovascular and cancer mortality, but also for other causes of death. Socioeconomic mortality inequalities had started to increase before the COVID-19 pandemic and further exacerbated in the first years of the pandemic. If all regions had the same mortality rate as those in the lowest deprivation quintile, premature mortality would be 13% lower overall. DISCUSSION: The widening gap in premature mortality between deprived and affluent regions emphasizes that creating equivalent living conditions across Germany is also an important field of action for reducing health inequity.


Assuntos
Causas de Morte , Mortalidade Prematura , Humanos , Mortalidade Prematura/tendências , Alemanha/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Disparidades nos Níveis de Saúde , COVID-19/mortalidade , Pré-Escolar , Adulto Jovem , Fatores Socioeconômicos , Adolescente , Criança , Lactente , Recém-Nascido , SARS-CoV-2
17.
BMC Public Health ; 24(1): 1129, 2024 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-38654172

RESUMO

BACKGROUND: In China, enhancing the pooling levels of basic health insurance has consistently been regarded as a pivotal measure to promote the refinement of the healthcare insurance system. From 2020 to 2022, the widespread outbreak of COVID-19 posed new challenges to China's basic health insurance. METHODS: The research utilizes Data Envelopment Analysis (DEA), Malmquist index assessment, and fixed-effects panel Tobit models to analyze panel data from 2020 to 2022, assessing the efficiency of basic health insurance in Gansu Province. RESULTS: From 2020 to 2022, the average overall efficiency of the municipal pooling of Basic Medical Insurance for Urban and Rural Residents was 0.941, demonstrating a stable trend with a modest increase. The efficiency frontier regions have expanded from 5 (35.71%) to 7 (50%). Operational efficiency exhibited a negative correlation with per capita hospitalization expenses and per capita fund balance but a positive correlation with per capita accumulated fund balance and reimbursement rates for hospitalized patients. In 2021, compared to 2020, the county-pooling Basic Medical Insurance for Urban Employees saw a decline of 0.126 in overall efficiency, reducing the efficiency frontier regions from 8 to 3. However, from 2021 to 2022, the municipal-coordinated Basic Medical Insurance for Urban Employees experienced a 0.069 increase in overall efficiency, with the efficiency frontier regions expanding from 3 to 5. Throughout 2020 to 2022, the operational efficiency of the Urban Employee Basic Medical Insurance showed a consistent negative correlation with per capita fund balance. CONCLUSION: From 2020 to 2022, the overall operational performance of basic health insurance in Gansu Province was satisfactory, and enhancing the pooling level is beneficial in addressing the impact of unforeseen events on the health insurance system.


Assuntos
COVID-19 , Seguro Saúde , China , Humanos , Seguro Saúde/estatística & dados numéricos , COVID-19/epidemiologia , Eficiência Organizacional , População Rural/estatística & dados numéricos
18.
Front Public Health ; 12: 1386110, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38660365

RESUMO

Purpose: Artificial intelligence has led to significant developments in the healthcare sector, as in other sectors and fields. In light of its significance, the present study delves into exploring deep learning, a branch of artificial intelligence. Methods: In the study, deep learning networks ResNet101, AlexNet, GoogLeNet, and Xception were considered, and it was aimed to determine the success of these networks in disease diagnosis. For this purpose, a dataset of 1,680 chest X-ray images was utilized, consisting of cases of COVID-19, viral pneumonia, and individuals without these diseases. These images were obtained by employing a rotation method to generate replicated data, wherein a split of 70 and 30% was adopted for training and validation, respectively. Results: The analysis findings revealed that the deep learning networks were successful in classifying COVID-19, Viral Pneumonia, and Normal (disease-free) images. Moreover, an examination of the success levels revealed that the ResNet101 deep learning network was more successful than the others with a 96.32% success rate. Conclusion: In the study, it was seen that deep learning can be used in disease diagnosis and can help experts in the relevant field, ultimately contributing to healthcare organizations and the practices of country managers.


Assuntos
Inteligência Artificial , COVID-19 , Aprendizado Profundo , Humanos , COVID-19/diagnóstico por imagem , SARS-CoV-2 , Setor de Assistência à Saúde , Radiografia Torácica/estatística & dados numéricos , Redes Neurais de Computação
19.
Health Expect ; 27(2): e14037, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38634418

RESUMO

BACKGROUND AND AIM: Long Covid is often stigmatised, particularly in people who are disadvantaged within society. This may prevent them from seeking help and could lead to widening health inequalities. This coproduced study with a Community Advisory Board (CAB) of people with Long Covid aimed to understand healthcare and wider barriers and stigma experienced by people with probable Long Covid. METHODS: An active case finding approach was employed to find adults with probable, but not yet clinically diagnosed, Long Covid in two localities in London (Camden and Merton) and Derbyshire, England. Interviews explored the barriers to care and the stigma faced by participants and were analysed thematically. This study forms part of the STIMULATE-ICP Collaboration. FINDINGS: Twenty-three interviews were completed. Participants reported limited awareness of what Long Covid is and the available pathways to management. There was considerable self-doubt among participants, sometimes reinforced by interactions with healthcare professionals (HCPs). Participants questioned their deservedness in seeking healthcare support for their symptoms. Hesitancy to engage with healthcare services was motivated by fear of needing more investigation and concerns regarding judgement about the ability to carry out caregiving responsibilities. It was also motivated by the complexity of the clinical presentation and fear of all symptoms being attributed to poor mental health. Participants also reported trying to avoid overburdening the health system. These difficulties were compounded by experiences of stigma and discrimination. The emerging themes reaffirmed a framework of epistemic injustice in relation to Long Covid, where creating, interpreting and conveying knowledge has varied credibility based on the teller's identity characteristics and/or the level of their interpretive resources. CONCLUSION: We have codeveloped recommendations based on the findings. These include early signposting to services, dedicating protected time to listening to people with Long Covid, providing a holistic approach in care pathways, and working to mitigate stigma. Regardless of the diagnosis, people experiencing new symptoms must be encouraged to seek timely medical help. Clear public health messaging is needed among communities already disadvantaged by epistemic injustice to raise awareness of Long Covid, and to share stories that encourage seeking care and to illustrate the adverse effects of stigma. PATIENT OR PUBLIC CONTRIBUTION: This study was coproduced with a CAB made up of 23 members including HCPs, people with lived experience of Long Covid and other stakeholders.


Assuntos
COVID-19 , Síndrome de COVID-19 Pós-Aguda , Adulto , Humanos , Estigma Social , Saúde Mental , Acessibilidade aos Serviços de Saúde
20.
J Health Commun ; 29(4): 265-273, 2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38651616

RESUMO

Public health communication campaign planners must carefully consider whether misinformation beliefs are important to target and, ideally, correct. Guided by the reasoned action approach, we hypothesized that behavior-specific beliefs regarding COVID-19 vaccination would account for any observed relationship between general coronavirus misinformation beliefs (misinformation beliefs that are not specific to the anticipated consequences of COVID-19 vaccination) and subsequent vaccine uptake. To test our hypothesis, we used panel data from a two-wave nationally representative sample of U.S. adults pre- and post-vaccine availability (T1: July 2020, T2: April/June 2021, analytic sample: n = 665). Contrary to our hypothesis, we find a residual observed relationship between general coronavirus misinformation beliefs and subsequent vaccine uptake (AOR = 0.40, SE = 0.10). Intriguingly, our post-hoc analyses do show that after also adjusting for T2 behavioral beliefs, this association was no longer significant. With this and other justifications, we recommend that messages promoting vaccination prioritize targeting relevant behavioral beliefs.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Comunicação , Comunicação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estados Unidos , Adulto , Masculino , Feminino , Comunicação em Saúde/métodos , Estudos Longitudinais , Pessoa de Meia-Idade , COVID-19/prevenção & controle , Promoção da Saúde/métodos , Adulto Jovem , Vacinação/estatística & dados numéricos , Vacinação/psicologia , Idoso , Inquéritos e Questionários , Adolescente
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