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1.
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
2.
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
3.
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
4.
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
5.
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
6.
Front Public Health ; 12: 1380723, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38655520

RESUMO

Background: After COVID-19, more and more travelers are more inclined to walk in cities, and the sensory elements of streets can have a significant impact on urban tourism. Local residents and travelers have different perceptions of the street and preferences for its use. The purpose of this study is to evaluate and analyse the streets from the perspective of locals and travelers. Method: In this study, a questionnaire was designed to obtain local residents' and travelers' evaluations of the sensory elements of the street and a quadrant analysis of the street's sensory elements was carried out using the IPA-Kano model. Results: The results of the study show that travelers are particularly concerned about maps and signage guidance, while local residents are more concerned about the green environment of the surroundings and how well it is maintained. Conclusion: There is a difference in the indicators chosen by the two groups in the results of the comparison between locals and travelers, and this study is hoped to provide some data support for future urban managers and designers to learn from and refer to for street improvements and renewal.


Assuntos
COVID-19 , Cidades , Turismo , Humanos , Inquéritos e Questionários , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , População Urbana , Planejamento Ambiental , SARS-CoV-2 , Caminhada , Viagem
7.
Front Public Health ; 12: 1223362, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38655523

RESUMO

Background: The emergence of COVID-19 pandemic has led to heightened fear and uncertainty among parents of children with cancer. This study was conducted to evaluate the parental perceptions toward effects of COVID-19 infection to children with cancer, determine their stress level and factors contributing to high stress level during the pandemic. Methods: This cross-sectional study was conducted in three paediatric oncology centres in Malaysia from September 2020 until December 2022. A total of 167 parents were recruited. Parents completed a set of questionnaires to assess their perception on effect of COVID-19 infection to children with cancer and COVID Stress Scale (CSS) to assess the parents' stress level. Results: Patients' mean age at study entry was 8.75 years (SD 4.38). Ninety-one (54.5%) patients were still on active treatment. More than 80% of the parents obtained information regarding COVID-19 infection from mass media and social networking. Fear of their children contracting COVID-19 infection was high especially among patients who were still on treatment. Forty-nine (29.3%) parents were significantly affected by the pandemic leading to loss of job or monthly income. Twenty-nine (17.4%) patients required treatment modification during the pandemic. The median total score for CSS was 78.0 (IQR 25th 64.0; 75th 95.0). Ninety-one (54.5%) respondents were very/extremely stressed based on the CSS scores. Components with high scores were xenophobia (median score 18.0; IQR 25th 13.0, 75th 22.0), fear of danger (median score 17.0; IQR 25th 14.0, 75th 20.0) and contamination fears (median score 16.0; IQR 25th 12.0, 75th 19.0). Lower household income was associated with higher stress level (p = 0.006). Conclusion: Our study demonstrated high awareness regarding risk of COVID-19 infection among parents of oncology children. Half of the parents had high stress level, with low household income identified as a factor associated with high stress level.


Assuntos
COVID-19 , Neoplasias , Pais , Estresse Psicológico , Humanos , COVID-19/psicologia , COVID-19/epidemiologia , Pais/psicologia , Estudos Transversais , Feminino , Masculino , Neoplasias/psicologia , Criança , Malásia/epidemiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários , Adulto , Pré-Escolar , SARS-CoV-2 , Pandemias , Adolescente , Medo/psicologia , Percepção
8.
Front Public Health ; 12: 1379481, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38645440

RESUMO

Introduction: Differences in control measures and response speeds between regions may be responsible for the differences in the number of infections of global infectious diseases. Therefore, this article aims to examine the decay stage of global infectious diseases. We demonstrate our method by considering the first wave of the COVID-19 epidemic in 2020. Methods: We introduce the concept of the attenuation rate into the varying coefficient SEIR model to measure the effect of different cities on epidemic control, and make inferences through the integrated adjusted Kalman filter algorithm. Results: We applied the varying coefficient SEIR model to 136 cities in China where the total number of confirmed cases exceeded 20 after the implementation of control measures and analyzed the relationship between the estimated attenuation rate and local factors. Subsequent analysis and inference results show that the attenuation rate is significantly related to the local annual GDP and the longitude and latitude of a city or a region. We also apply the varying coefficient SEIR model to other regions outside China. We find that the fitting curve of the average daily number of new confirmed cases simulated by the variable coefficient SEIR model is consistent with the real data. Discussion: The results show that the cities with better economic development are able to control the epidemic more effectively to a certain extent. On the other hand, geographical location also affected the effectiveness of regional epidemic control. In addition, through the results of attenuation rate analysis, we conclude that China and South Korea have achieved good results in controlling the epidemic in 2020.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , China/epidemiologia , Saúde Global , Cidades , SARS-CoV-2 , Algoritmos , Doenças Transmissíveis/epidemiologia , Epidemias/prevenção & controle , Controle de Doenças Transmissíveis
9.
Soc Sci Med ; 348: 116849, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38581815

RESUMO

OBJECTIVE: This study examines whether individualism weakens the effectiveness of the COVID-19 vaccine eligibility expansions in the United States in 2021, and assesses the associated social benefits or costs associated with individualism. METHODS: We construct a county-level composite individualism index as a proxy of culture and the fraction of vaccine eligible population as a proxy of vaccination campaign (mean: 41.34%). We estimate whether the COVID-19 vaccine eligibility policy is less effective in promoting vaccine coverage, reducing in COVID-19 related hospitalization and death using a linear two-way fixed effect model in a sample of 2866 counties for the period between early December 2020 and July 1, 2021. We also test whether individualism shapes people's attitudes towards vaccine using a linear probability model in a sample of 625,308 individuals aged 18-65 (mean age: 43.3; 49% male; 59.1% non-Hispanic white, 19.1% Hispanic, 12% African American; 5.9% Asian) from the Household Pulse Survey. RESULTS: The effects of expanded vaccine eligibility are diminished in counties with greater individualism, as evidenced by lower effectiveness in increasing vaccination rates and reducing outpatient doctor visits primarily for COVID-related symptoms and COVID deaths. Moreover, our results show that this cultural influence on attitudes towards vaccine is more pronounced among the less educated, but unrelated to race. CONCLUSION: Assuming an average level of vaccine eligibility policies and an average intensity of individualism across the nation, we calculate that the average social cost associated with an individualistic culture amid the pandemic is approximately $50.044 billion, equivalent to 1.32% of the total U.S. health care spending in 2019. Our paper suggests that strategies to promote public policy compliance should be tailored to accommodate cultural and social contexts.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Humanos , Vacinas contra COVID-19/economia , Vacinas contra COVID-19/administração & dosagem , Masculino , COVID-19/prevenção & controle , COVID-19/epidemiologia , Adulto , Estados Unidos , Feminino , Pessoa de Meia-Idade , Idoso , Adolescente , Adulto Jovem , Saúde Pública , SARS-CoV-2 , Individualidade
10.
BMC Health Serv Res ; 24(1): 526, 2024 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-38664700

RESUMO

BACKGROUND: Individuals experiencing homelessness face unique physical and mental health challenges, increased morbidity, and premature mortality. COVID -19 creates a significant heightened risk for those living in congregate sheltering spaces. In March 2020, the COVID-19 Community Response Team formed at Women's College Hospital, to support Toronto shelters and congregate living sites to manage and prevent outbreaks of SARS-CoV-2 using a collaborative model of onsite mobile testing and infection prevention. From this, the Women's College COVID-19 vaccine program emerged, where 14 shelters were identified to co-design and support the administration of vaccine clinics within each shelter. This research seeks to evaluate the impact of this partnership model and its future potential in community-centered integrated care through three areas of inquiry: (1) vaccine program evaluation and lessons learned; (2) perceptions on hospital/community partnership; (3) opportunities to advance hospital-community partnerships. METHODS: Constructivist grounded theory was used to explore perceptions and experiences of this partnership from the voices of shelter administrators. Semi-structured interviews were conducted with administrators from 10 shelters using maximum variation purposive sampling. A constructivist-interpretive paradigm was used to determine coding and formation of themes: initial, focused, and theoretical. RESULTS: Data analysis revealed five main categories, 16 subcategories, and one core category. The core category "access to healthcare is a human right; understand our communities" emphasizes access to healthcare is a consistent barrier for the homeless population. The main categories revealed during a time of confusion, the hospital was seen as credible and trustworthy. However, the primary focus of many shelters lies in housing, and attention is often not placed on health resourcing, solidifying partnerships, accountability, and governance structures therein. Health advocacy, information sharing tables, formalized partnerships and educating health professionals were identified by shelter administrators as avenues to advance intersectoral relationship building. CONCLUSION: Hospital-community programs can alleviate some of the ongoing health concerns faced by shelters - during a time of COVID-19 or not. In preparation for future pandemics, access to care and cohesion within the health system requires the continuous engagement in relationship-building between hospitals and communities to support co-creation of innovative models of care, to promote health for all.


Assuntos
COVID-19 , Acessibilidade aos Serviços de Saúde , Pessoas Mal Alojadas , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Acessibilidade aos Serviços de Saúde/organização & administração , Ontário , Feminino , SARS-CoV-2 , Vacinas contra COVID-19 , Relações Comunidade-Instituição , Teoria Fundamentada , Avaliação de Programas e Projetos de Saúde
12.
Glob Public Health ; 19(1): 2341403, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38659107

RESUMO

The COVID-19 pandemic has significantly impacted China's economic and social development. Understanding the direct and indirect effects of the epidemic on the economy is vital for formulating scientifically grounded epidemic management policies. This study assesses the economic losses and influence paths of a large-scale epidemic in China. We proposed three COVID-19 scenarios - serious, normal, and mild - to evaluate the direct economic impact on China's GDP from a demand perspective. An input-output model was used to estimate the indirect impact. Our findings show that China's GDP could lose 94,206, 75,365, and 56,524 hundred million yuan under serious, normal, and mild scenarios, respectively, with corresponding GDP decline rates of 9.27%, 7.42%, and 5.56%. Under the normal scenario, indirect economic loss and total loss are projected at 75,364 and 489,386 hundred million yuan, respectively. Additionally, the pandemic led to a reduction in carbon emissions: direct emissions decreased by 1,218.69 million tons, indirect emissions by 9,594.32 million tons, and total emissions by 10,813.01 million tons across various industries. This study provides a comprehensive analysis of the economic and environmental impacts of the pandemic.


Assuntos
COVID-19 , SARS-CoV-2 , COVID-19/epidemiologia , Humanos , China/epidemiologia , Pandemias/economia , Produto Interno Bruto
14.
Prog Community Health Partnersh ; 18(1): 79-89, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38661829

RESUMO

BACKGROUND: Youth experiencing homelessness (YEH) face a wide range of complex barriers to COVID-19 vaccine confidence and access. OBJECTIVES: Describe our process for engaging a cross-sector team centering equity and youth voice; outline our intervention strategies to enhance COVID-19 vaccine confidence and access among YEH; and discuss lessons learned through this community-engaged process. METHODS: We engaged partners from across sectors, including youth-serving agencies, healthcare organizations, public health organizations, and YEH. We used focus groups, key informant interviews, and other community engagement strategies to develop and implement a series of interventions aimed to increase COVID-19 vaccine confidence and access among YEH. RESULTS: We identified youths' key concerns about vaccine confidence and access. To address these concerns, we implemented four community-driven interventions: youth-friendly messaging, health events, vaccine aftercare kits, and staff training. CONCLUSIONS: This community-engaged project highlighted the value of cross-sector partnership and consistent youth engagement in addressing vaccine confidence among YEH.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Acessibilidade aos Serviços de Saúde , Jovens em Situação de Rua , Humanos , Adolescente , COVID-19/prevenção & controle , Acessibilidade aos Serviços de Saúde/organização & administração , Jovens em Situação de Rua/psicologia , Pesquisa Participativa Baseada na Comunidade , SARS-CoV-2 , Feminino , Prática de Saúde Pública , Adulto Jovem , Masculino
15.
Econ Hum Biol ; 53: 101378, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38593608

RESUMO

This paper evaluates the effects of economic shocks to current and expected income reduction on mental wellbeing. We use individual-level data from three East Asian countries; China, Japan, and South Korea, during the early phases of the pandemic when the COVID-induced economic shocks were severe. The findings reveal significant causal effects from current and expected income reduction on different aspects of mental health deterioration, including anxiety, trouble sleeping, boredom, and loneliness. Interestingly, we found that expectations of future income loss have a significantly larger effect on people's mental wellbeing compared to current falls in income. This has significant implications for the design of policies to support income during pandemics.


Assuntos
Ansiedade , COVID-19 , Renda , Saúde Mental , SARS-CoV-2 , Humanos , COVID-19/psicologia , COVID-19/economia , COVID-19/epidemiologia , Masculino , Feminino , Renda/estatística & dados numéricos , Adulto , Ansiedade/epidemiologia , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Solidão/psicologia , Pandemias/economia , China/epidemiologia , Japão/epidemiologia , Idoso , Adulto Jovem , População do Leste Asiático
16.
BMJ Open ; 14(4): e075928, 2024 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-38604636

RESUMO

OBJECTIVE: Conflicting evidence for the association between COVID-19 and adverse perinatal outcomes exists. This study examined the associations between maternal COVID-19 during pregnancy and adverse perinatal outcomes including preterm birth (PTB), low birth weight (LBW), small-for-gestational age (SGA), large-for-gestational age (LGA) and fetal death; as well as whether the associations differ by trimester of infection. DESIGN AND SETTING: The study used a retrospective Mexican birth cohort from the Instituto Mexicano del Seguro Social (IMSS), Mexico, between January 2020 and November 2021. PARTICIPANTS: We used the social security administrative dataset from IMSS that had COVID-19 information and linked it with the IMSS routine hospitalisation dataset, to identify deliveries in the study period with a test for SARS-CoV-2 during pregnancy. OUTCOME MEASURES: PTB, LBW, SGA, LGA and fetal death. We used targeted maximum likelihood estimators, to quantify associations (risk ratio, RR) and CIs. We fit models for the overall COVID-19 sample, and separately for those with mild or severe disease, and by trimester of infection. Additionally, we investigated potential bias induced by missing non-tested pregnancies. RESULTS: The overall sample comprised 17 340 singleton pregnancies, of which 30% tested positive. We found that those with mild COVID-19 had an RR of 0.89 (95% CI 0.80 to 0.99) for PTB and those with severe COVID-19 had an RR of 1.53 (95% CI 1.07 to 2.19) for LGA. COVID-19 in the first trimester was associated with fetal death, RR=2.36 (95% CI 1.04, 5.36). Results also demonstrate that missing non-tested pregnancies might induce bias in the associations. CONCLUSIONS: In the overall sample, there was no evidence of an association between COVID-19 and adverse perinatal outcomes. However, the findings suggest that severe COVID-19 may increase the risk of some perinatal outcomes, with the first trimester potentially being a high-risk period.


Assuntos
COVID-19 , Nascimento Prematuro , Gravidez , Feminino , Recém-Nascido , Humanos , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , México/epidemiologia , COVID-19/epidemiologia , SARS-CoV-2 , Retardo do Crescimento Fetal/epidemiologia , Morte Fetal , Resultado da Gravidez/epidemiologia
17.
Front Med ; 18(1): 19-30, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38561563

RESUMO

The pneumonia caused by novel coronavirus SARS-CoV-2 infection in early December 2019, which was later named coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO), rapidly spread across the world. China has made extraordinary efforts to this unprecedented pandemic, put its response and control at a very high level of infectious disease management (Category B but with measures for Category A), given top priority to the people and their lives, and balanced the pandemic control and socio-economic development. After more than three years' fighting against this disease, China downgraded the management of COVID-19 to Category B infectious disease on January 8, 2023 and the WHO declared the end of public health emergency on May 5, 2023. However, the ending of pandemic does not mean that the disease is no longer a health threat. Experiences against COVID-19 from China and the whole world should be learned to prepare well for the future public health emergencies. This article gives a systematic review of the trajectory of COVID-19 development in China, summarizes the critical policy arrangements and provides evidence for the adjustment during policy making process, so as to share experiences with international community and contribute to the global health for all humanity.


Assuntos
COVID-19 , Humanos , SARS-CoV-2 , Saúde Pública , Organização Mundial da Saúde , China/epidemiologia
18.
Comput Biol Med ; 173: 108344, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38574531

RESUMO

Mobile Health (mHealth) services typically make use of customized software architectures, leading to development-dependent fragmentation. Nevertheless, irrespective of their specific purpose, most mHealth services share common functionalities, where standard pieces could be reused or adapted to expedite service deployment and even extend the follow-up of appearing conditions under the same service. To harness compatibility and reuse, this article presents a data fusion architecture proposing a common design framework for mHealth services. An exhaustive mapping of mHealth functionalities identified in the literature serves as starting point. The architecture is then conceptualized making use of the Joint Directors of Laboratories (JDL) data fusion model. The aim of the architecture is to exploit the multi-source data acquisition capabilities supported by smartphones and Internet of Things devices, and artificial intelligence-enabled feature fusion. A series of interconnected fusion layers ensure streamlined data management; each layer is composed of microservices which may be implemented or omitted depending on the specific goals of the healthcare service. Moreover, the architecture considers essential features related to authentication mechanisms, data sharing protocols, practitioner-patient communication, context-based notifications and tailored visualization interfaces. The effectiveness of the architecture is underscored by its instantiation for four real cases, encompassing risk assessment for youth with mental health issues, remote monitoring for SARS-CoV-2 patients, liquid intake control for kidney disease patients, and peritoneal dialysis treatment support. This breadth of applications exemplifies how the architecture can effectively serve as a guidance framework to accelerate the design of mHealth services.


Assuntos
Aplicativos Móveis , Telemedicina , Adolescente , Humanos , Inteligência Artificial , Telemedicina/métodos , Serviços de Saúde , Smartphone , SARS-CoV-2
19.
JAMA Netw Open ; 7(4): e248519, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38669019

RESUMO

Importance: To meet increasing demand for mental health and substance use services, the Centers for Medicare & Medicaid Services launched the 5-year Comprehensive Primary Care Plus (CPC+) demonstration in 2017, requiring primary care practices to integrate behavioral health services. Objective: To examine the association of CPC+ with access to mental health and substance use treatment before and during the COVID-19 pandemic. Design, Setting, and Participants: Using difference-in-differences analyses, this retrospective cohort study compared adults attributed to CPC+ and non-CPC+ practices, from January 1, 2018, to June 30, 2022. The study included adults aged 19 to 64 years who had depression, anxiety, or opioid use disorder (OUD) and were enrolled with a private health insurer in Pennsylvania. Data were analyzed from January to June 2023. Exposure: Receipt of care at a practice participating in CPC+. Main Outcomes and Measures: Total cost of care and the number of primary care visits for evaluation and management, community mental health center visits, psychiatric hospitalizations, substance use treatment visits (residential and nonresidential), and prescriptions filled for antidepressants, anxiolytics, buprenorphine, naltrexone, or methadone. Results: The 188 770 individuals in the sample included 102 733 adults (mean [SD] age, 49.5 [5.6] years; 57 531 women [56.4%]) attributed to 152 CPC+ practices and 86 037 adults (mean [SD] age, 51.6 [6.6] years; 47 321 women [54.9%]) attributed to 317 non-CPC+ practices. Among patients diagnosed with OUD, compared with patients attributed to non-CPC+ practices, attribution to a CPC+ practice was associated with filling more prescriptions for buprenorphine (0.117 [95% CI, 0.037 to 0.196] prescriptions per patient per quarter) and anxiolytics (0.162 [95% CI, 0.005 to 0.319] prescriptions per patient per quarter). Among patients diagnosed with depression or anxiety, attribution to a CPC+ practice was associated with more prescriptions for buprenorphine (0.024 [95% CI, 0.006 to 0.041] prescriptions per patient per quarter). Conclusions and Relevance: Findings of this cohort study suggest that individuals with an OUD who received care at a CPC+ practice filled more buprenorphine and anxiolytics prescriptions compared with patients who received care at a non-CPC+ practice. As the Centers for Medicare & Medicaid Innovation invests in advanced primary care demonstrations, it is critical to understand whether these models are associated with indicators of high-quality primary care.


Assuntos
COVID-19 , Acessibilidade aos Serviços de Saúde , Atenção Primária à Saúde , Humanos , Feminino , Adulto , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , COVID-19/epidemiologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Pennsylvania , SARS-CoV-2 , Estados Unidos , Transtornos Relacionados ao Uso de Substâncias/terapia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Assistência Integral à Saúde , Transtornos Relacionados ao Uso de Opioides/terapia , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Pandemias , Adulto Jovem , Buprenorfina/uso terapêutico
20.
Front Public Health ; 12: 1294340, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38655511

RESUMO

Introduction: Children and youth with disabilities and special healthcare needs, and their families, have been uniquely affected by the COVID-19 pandemic. However, the voices of children themselves are still not well represented in the existing literature. Methods: This qualitative descriptive study used a combination of visual methods and interviews to learn about the experiences of Canadian children with disabilities (n=18) and their parents (n=14) during the COVID pandemic and into the post-pandemic period. Data collection was carried out between January and July 2023. The aim was to identify the supports and services children and families need at present and moving forward. Results: Families' pandemic experiences were complex and nuanced. For many, the pandemic complicated and disrupted everyday activities and supports. These disruptions were largely buffered by parents. However, some families also identified unexpected benefits. Key themes pertaining to present and future needs included the need for services that are flexible; consistent; conducive to relationship-building; comprehensive; coordinated across sectors; and designed to support the needs of the whole family. Discussion: Implications for policy and practice are outlined.


Assuntos
COVID-19 , Crianças com Deficiência , Pais , Pesquisa Qualitativa , Humanos , COVID-19/epidemiologia , Criança , Pais/psicologia , Canadá/epidemiologia , Feminino , Masculino , Adolescente , Necessidades e Demandas de Serviços de Saúde , SARS-CoV-2 , Adulto , Pré-Escolar , Apoio Social , Pandemias
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