Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 40.251
Filtrar
1.
Hawaii J Health Soc Welf ; 79(9): 268-271, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32914093

RESUMO

Infections with the SARS-CoV-2 virus are increasing in Hawai'i at alarming rates. In the absence of a SARS-CoV-2 virus vaccine, the options for control include social distancing, improved hygiene, and face mask use. There is evidence that mask use may decrease the rates of viral transmission. The rate of effective face mask use has not yet been established in Hawai'i. The authors performed an observational study at 2 locations in Honolulu and evaluated outdoor face mask use compliance in 200 people. Simultaneous observations were performed in a downtown Honolulu business area and in Waikiki, an area focusing on tourism. Overall, 77% of all subjects used face masks in an appropriate fashion, covering their nose and mouth, while 23% were either incorrectly masked or not masked. The rate of compliance with correct public mask use in downtown Honolulu (88%) was significantly higher than in Waikiki (66%) (P=.0003, Odds Ratio [95% Confidence Interval]=3.78 [1.82, 7.85]) These findings suggest that there are opportunities for improvement in rates of public face mask use and a potential decrease in the spread of COVID-19 in our population. Four proposed actions are suggested, including a reassessment of the face mask exemption requirements, enhanced mask compliance education, non-threatening communication for non-compliance, and centralization of information of the public compliance with face mask use.


Assuntos
Infecções por Coronavirus/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Máscaras/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Política Pública , Infecções por Coronavirus/epidemiologia , Geografia , Hawaii/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
2.
J Transl Med ; 18(1): 338, 2020 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-32878627

RESUMO

BACKGROUND: Severe acute respiratory syndrome CoV-2 (SARS-CoV-2) caused the first coronavirus disease 2019 (COVID-19) outbreak in China and has become a public health emergency of international concern. SARS-CoV-2 outbreak has been declared a pandemic by WHO on March 11th, 2020 and the same month several Countries put in place different lockdown restrictions and testing strategies in order to contain the spread of the virus. METHODS: The calculation of the Case Fatality Rate of SARS-CoV-2 in the Countries selected was made by using the data available at https://github.com/owid/covi-19-data/tree/master/public/data . Case fatality rate was calculated as the ratio between the death cases due to COVID-19, over the total number of SARS-CoV-2 reported cases 14 days before. Standard Case Fatality Rate values were normalized by the Country-specific ρ factor, i.e. the number of PCR tests/1 million inhabitants over the number of reported cases/1 million inhabitants. Case-fatality rates between Countries were compared using proportion test. Post-hoc analysis in the case of more than two groups was performed using pairwise comparison of proportions and p value was adjusted using Holm method. We also analyzed 487 genomic sequences from the GISAID database derived from patients infected by SARS-CoV-2 from January 2020 to April 2020 in Italy, Spain, Germany, France, Sweden, UK and USA. SARS-CoV-2 reference genome was obtained from the GenBank database (NC_045512.2). Genomes alignment was performed using Muscle and Jalview software. We, then, calculated the Case Fatality Rate of SARS-CoV-2 in the Countries selected. RESULTS: In this study we analyse how different lockdown strategies and PCR testing capability adopted by Italy, France, Germany, Spain, Sweden, UK and USA have influenced the Case Fatality Rate and the viral mutations spread. We calculated case fatality rates by dividing the death number of a specific day by the number of patients with confirmed COVID-19 infection observed 14 days before and normalized by a ρ factor which takes into account the diagnostic PCR testing capability of each Country and the number of positive cases detected. We notice the stabilization of a clear pattern of mutations at sites nt241, nt3037, nt14408 and nt23403. A novel nonsynonymous SARS-CoV-2 mutation in the spike protein (nt24368) has been found in genomes sequenced in Sweden, which enacted a soft lockdown strategy. CONCLUSIONS: Strict lockdown strategies together with a wide diagnostic PCR testing of the population were correlated with a relevant decline of the case fatality rate in different Countries. The emergence of specific patterns of mutations concomitant with the decline in case fatality rate needs further confirmation and their biological significance remains unclear.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Mutação/genética , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Europa (Continente)/epidemiologia , Genoma Viral , Geografia , Humanos , América do Norte/epidemiologia , Pandemias , Análise de Sequência de DNA
3.
J Transl Med ; 18(1): 329, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32867854

RESUMO

BACKGROUND: The new Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which was first detected in Wuhan (China) in December of 2019 is responsible for the current global pandemic. Phylogenetic analysis revealed that it is similar to other betacoronaviruses, such as SARS-CoV and Middle-Eastern Respiratory Syndrome, MERS-CoV. Its genome is ∼ 30 kb in length and contains two large overlapping polyproteins, ORF1a and ORF1ab that encode for several structural and non-structural proteins. The non-structural protein 1 (nsp1) is arguably the most important pathogenic determinant, and previous studies on SARS-CoV indicate that it is both involved in viral replication and hampering the innate immune system response. Detailed experiments of site-specific mutagenesis and in vitro reconstitution studies determined that the mechanisms of action are mediated by (a) the presence of specific amino acid residues of nsp1 and (b) the interaction between the protein and the host's small ribosomal unit. In fact, substitution of certain amino acids resulted in reduction of its negative effects. METHODS: A total of 17,928 genome sequences were obtained from the GISAID database (December 2019 to July 2020) from patients infected by SARS-CoV-2 from different areas around the world. Genomes alignment was performed using MAFFT (REFF) and the nsp1 genomic regions were identified using BioEdit and verified using BLAST. Nsp1 protein of SARS-CoV-2 with and without deletion have been subsequently modelled using I-TASSER. RESULTS: We identified SARS-CoV-2 genome sequences, from several Countries, carrying a previously unknown deletion of 9 nucleotides in position 686-694, corresponding to the AA position 241-243 (KSF). This deletion was found in different geographical areas. Structural prediction modelling suggests an effect on the C-terminal tail structure. CONCLUSIONS: Modelling analysis of a newly identified deletion of 3 amino acids (KSF) of SARS-CoV-2 nsp1 suggests that this deletion could affect the structure of the C-terminal region of the protein, important for regulation of viral replication and negative effect on host's gene expression. In addition, substitution of the two amino acids (KS) from nsp1 of SARS-CoV was previously reported to revert loss of interferon-alpha expression. The deletion that we describe indicates that SARS-CoV-2 is undergoing profound genomic changes. It is important to: (i) confirm the spreading of this particular viral strain, and potentially of strains with other deletions in the nsp1 protein, both in the population of asymptomatic and pauci-symptomatic subjects, and (ii) correlate these changes in nsp1 with potential decreased viral pathogenicity.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/virologia , Pneumonia Viral/virologia , Deleção de Sequência , Proteínas não Estruturais Virais/genética , Sequência de Aminoácidos , Sequência de Bases , Betacoronavirus/patogenicidade , Doenças Transmissíveis Emergentes/virologia , Infecções por Coronavirus/epidemiologia , Frequência do Gene , Genoma Viral , Geografia , Humanos , Lisina/genética , Modelos Moleculares , Pandemias/estatística & dados numéricos , Fenilalanina/genética , Pneumonia Viral/epidemiologia , Domínios Proteicos/genética , Serina/genética , Proteínas não Estruturais Virais/química , Virulência/genética , Replicação Viral/genética
4.
Nat Commun ; 11(1): 4155, 2020 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-32814776

RESUMO

Declines in animal body sizes are widely reported and likely impact ecological interactions and ecosystem services. For harvested species subject to multiple stressors, limited understanding of the causes and consequences of size declines impedes prediction, prevention, and mitigation. We highlight widespread declines in Pacific salmon size based on 60 years of measurements from 12.5 million fish across Alaska, the last largely pristine North American salmon-producing region. Declines in salmon size, primarily resulting from shifting age structure, are associated with climate and competition at sea. Compared to salmon maturing before 1990, the reduced size of adult salmon after 2010 has potentially resulted in substantial losses to ecosystems and people; for Chinook salmon we estimated average per-fish reductions in egg production (-16%), nutrient transport (-28%), fisheries value (-21%), and meals for rural people (-26%). Downsizing of organisms is a global concern, and current trends may pose substantial risks for nature and people.


Assuntos
Tamanho Corporal , Ecossistema , Pesqueiros/estatística & dados numéricos , Salmão/crescimento & desenvolvimento , Fatores Etários , Alaska , Animais , Clima , Mudança Climática , Peixes/classificação , Peixes/crescimento & desenvolvimento , Geografia , Dinâmica Populacional , Fatores de Risco , Salmão/classificação , Especificidade da Espécie
5.
J Transl Med ; 18(1): 321, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32831104

RESUMO

BACKGROUND: The outbreak of coronavirus disease (COVID-19) was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), through its surface spike glycoprotein (S-protein) recognition on the receptor Angiotensin-converting enzyme 2 (ACE2) in humans. However, it remains unclear how genetic variations in ACE2 may affect its function and structure, and consequently alter the recognition by SARS-CoV-2. METHODS: We have systemically characterized missense variants in the gene ACE2 using data from the Genome Aggregation Database (gnomAD; N = 141,456). To investigate the putative deleterious role of missense variants, six existing functional prediction tools were applied to evaluate their impact. We further analyzed the structural flexibility of ACE2 and its protein-protein interface with the S-protein of SARS-CoV-2 using our developed Legion Interfaces Analysis (LiAn) program. RESULTS: Here, we characterized a total of 12 ACE2 putative deleterious missense variants. Of those 12 variants, we further showed that p.His378Arg could directly weaken the binding of catalytic metal atom to decrease ACE2 activity and p.Ser19Pro could distort the most important helix to the S-protein. Another seven missense variants may affect secondary structures (i.e. p.Gly211Arg; p.Asp206Gly; p.Arg219Cys; p.Arg219His, p.Lys341Arg, p.Ile468Val, and p.Ser547Cys), whereas p.Ile468Val with AF = 0.01 is only present in Asian. CONCLUSIONS: We provide strong evidence of putative deleterious missense variants in ACE2 that are present in specific populations, which could disrupt the function and structure of ACE2. These findings provide novel insight into the genetic variation in ACE2 which may affect the SARS-CoV-2 recognition and infection, and COVID-19 susceptibility and treatment.


Assuntos
Betacoronavirus/fisiologia , Mutação de Sentido Incorreto , Peptidil Dipeptidase A/genética , Domínios e Motivos de Interação entre Proteínas/genética , Glicoproteína da Espícula de Coronavírus/metabolismo , Substituição de Aminoácidos , Betacoronavirus/metabolismo , Sítios de Ligação/genética , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/genética , Infecções por Coronavirus/virologia , Análise Mutacional de DNA/métodos , Bases de Dados Genéticas , Predisposição Genética para Doença/etnologia , Variação Genética , Geografia , Humanos , Modelos Moleculares , Simulação de Acoplamento Molecular , Pandemias , Peptidil Dipeptidase A/química , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/etnologia , Pneumonia Viral/genética , Pneumonia Viral/virologia , Polimorfismo de Nucleotídeo Único , Ligação Proteica , Estrutura Secundária de Proteína/genética , Glicoproteína da Espícula de Coronavírus/química , Internalização do Vírus
6.
Nat Commun ; 11(1): 4229, 2020 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-32843631

RESUMO

Scarlet fever has resurged in China starting in 2011, and the environment is one of the potential reasons. Nationwide data on 655,039 scarlet fever cases and six air pollutants were retrieved. Exposure risks were evaluated by multivariate distributed lag nonlinear models and a meta-regression model. We show that the average incidence in 2011-2018 was twice that in 2004-2010 [RR = 2.30 (4.40 vs. 1.91), 95% CI: 2.29-2.31; p < 0.001] and generally lower in the summer and winter holiday (p = 0.005). A low to moderate correlation was seen between scarlet fever and monthly NO2 (r = 0.21) and O3 (r = 0.11). A 10 µg/m3 increase of NO2 and O3 was significantly associated with scarlet fever, with a cumulative RR of 1.06 (95% CI: 1.02-1.10) and 1.04 (95% CI: 1.01-1.07), respectively, at a lag of 0 to 15 months. In conclusion, long-term exposure to ambient NO2 and O3 may be associated with an increased risk of scarlet fever incidence, but direct causality is not established.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/análise , Exposição Ambiental/análise , Escarlatina/diagnóstico , Poluição do Ar/efeitos adversos , China/epidemiologia , Exposição Ambiental/efeitos adversos , Geografia , Humanos , Incidência , Dióxido de Nitrogênio/análise , Dinâmica não Linear , Ozônio/análise , Material Particulado/análise , Fatores de Risco , Escarlatina/epidemiologia , Escarlatina/etiologia , Estações do Ano , Análise Espaço-Temporal
7.
Nat Commun ; 11(1): 4264, 2020 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-32848152

RESUMO

The pressing need to restart socioeconomic activities locked-down to control the spread of SARS-CoV-2 in Italy must be coupled with effective methodologies to selectively relax containment measures. Here we employ a spatially explicit model, properly attentive to the role of inapparent infections, capable of: estimating the expected unfolding of the outbreak under continuous lockdown (baseline trajectory); assessing deviations from the baseline, should lockdown relaxations result in increased disease transmission; calculating the isolation effort required to prevent a resurgence of the outbreak. A 40% increase in effective transmission would yield a rebound of infections. A control effort capable of isolating daily  ~5.5% of the exposed and highly infectious individuals proves necessary to maintain the epidemic curve onto the decreasing baseline trajectory. We finally provide an ex-post assessment based on the epidemiological data that became available after the initial analysis and estimate the actual disease transmission that occurred after weakening the lockdown.


Assuntos
Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Número Básico de Reprodução , Betacoronavirus , Controle de Doenças Transmissíveis/tendências , Infecções por Coronavirus/transmissão , Previsões , Geografia , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Itália/epidemiologia , Modelos Teóricos , Pneumonia Viral/transmissão , Isolamento Social
8.
Nat Commun ; 11(1): 3870, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32747621

RESUMO

Soils harbor a substantial fraction of the world's biodiversity, contributing to many crucial ecosystem functions. It is thus essential to identify general macroecological patterns related to the distribution and functioning of soil organisms to support their conservation and consideration by governance. These macroecological analyses need to represent the diversity of environmental conditions that can be found worldwide. Here we identify and characterize existing environmental gaps in soil taxa and ecosystem functioning data across soil macroecological studies and 17,186 sampling sites across the globe. These data gaps include important spatial, environmental, taxonomic, and functional gaps, and an almost complete absence of temporally explicit data. We also identify the limitations of soil macroecological studies to explore general patterns in soil biodiversity-ecosystem functioning relationships, with only 0.3% of all sampling sites having both information about biodiversity and function, although with different taxonomic groups and functions at each site. Based on this information, we provide clear priorities to support and expand soil macroecological research.


Assuntos
Biodiversidade , Ecossistema , Microbiologia do Solo , Solo/parasitologia , Animais , Bactérias/classificação , Bactérias/metabolismo , Biomassa , Clima , Fungos/classificação , Fungos/metabolismo , Geografia , Concentração de Íons de Hidrogênio , Nematoides/classificação , Nematoides/metabolismo , Oligoquetos/classificação , Oligoquetos/metabolismo , Solo/química , Temperatura
9.
Nat Commun ; 11(1): 3868, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32747648

RESUMO

Archaeological research documents major technological shifts among people who have lived in the southern tip of South America (South Patagonia) during the last thirteen millennia, including the development of marine-based economies and changes in tools and raw materials. It has been proposed that movements of people spreading culture and technology propelled some of these shifts, but these hypotheses have not been tested with ancient DNA. Here we report genome-wide data from 20 ancient individuals, and co-analyze it with previously reported data. We reveal that immigration does not explain the appearance of marine adaptations in South Patagonia. We describe partial genetic continuity since ~6600 BP and two later gene flows correlated with technological changes: one between 4700-2000 BP that affected primarily marine-based groups, and a later one impacting all <2000 BP groups. From ~2200-1200 BP, mixture among neighbors resulted in a cline correlated to geographic ordering along the coast.


Assuntos
DNA Antigo/análise , Fósseis , Fluxo Gênico , Genoma Humano/genética , Migração Humana , Arqueologia/métodos , Argentina , Osso e Ossos/metabolismo , Chile , DNA Mitocondrial/classificação , DNA Mitocondrial/genética , Variação Genética , Geografia , Humanos , Filogenia , Datação Radiométrica/métodos , Análise de Sequência de DNA/métodos , Dente/metabolismo
10.
Proc Biol Sci ; 287(1932): 20201065, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32752986

RESUMO

Temperature is widely known to influence the spatio-temporal dynamics of vector-borne disease transmission, particularly as temperatures vary across critical thermal thresholds. When temperature conditions exhibit such 'transcritical variation', abrupt spatial or temporal discontinuities may result, generating sharp geographical or seasonal boundaries in transmission. Here, we develop a spatio-temporal machine learning algorithm to examine the implications of transcritical variation for West Nile virus (WNV) transmission in the Los Angeles metropolitan area (LA). Analysing a large vector and WNV surveillance dataset spanning 2006-2016, we found that mean temperatures in the previous month strongly predicted the probability of WNV presence in pools of Culex quinquefasciatus mosquitoes, forming distinctive inhibitory (10.0-21.0°C) and favourable (22.7-30.2°C) mean temperature ranges that bound a narrow 1.7°C transitional zone (21-22.7°C). Temperatures during the most intense months of WNV transmission (August/September) were more strongly associated with infection probability in Cx. quinquefasciatus pools in coastal LA, where temperature variation more frequently traversed the narrow transitional temperature range compared to warmer inland locations. This contributed to a pronounced expansion in the geographical distribution of human cases near the coast during warmer-than-average periods. Our findings suggest that transcritical variation may influence the sensitivity of transmission to climate warming, and that especially vulnerable locations may occur where present climatic fluctuations traverse critical temperature thresholds.


Assuntos
Temperatura , Febre do Nilo Ocidental/transmissão , Vírus do Nilo Ocidental , Animais , California , Culex , Culicidae , Geografia , Humanos , Los Angeles/epidemiologia , Mosquitos Vetores , Febre do Nilo Ocidental/epidemiologia
11.
Nat Commun ; 11(1): 4353, 2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32859908

RESUMO

Continental-scale models of malaria climate suitability typically couple well-established temperature-response models with basic estimates of vector habitat availability using rainfall as a proxy. Here we show that across continental Africa, the estimated geographic range of climatic suitability for malaria transmission is more sensitive to the precipitation threshold than the thermal response curve applied. To address this problem we use downscaled daily climate predictions from seven GCMs to run a continental-scale hydrological model for a process-based representation of mosquito breeding habitat availability. A more complex pattern of malaria suitability emerges as water is routed through drainage networks and river corridors serve as year-round transmission foci. The estimated hydro-climatically suitable area for stable malaria transmission is smaller than previous models suggest and shows only a very small increase in state-of-the-art future climate scenarios. However, bigger geographical shifts are observed than with most rainfall threshold models and the pattern of that shift is very different when using a hydrological model to estimate surface water availability for vector breeding.


Assuntos
Mudança Climática , Hidrologia/métodos , Malária/transmissão , África/epidemiologia , Animais , Anopheles/fisiologia , Ecologia , Ecossistema , Mapeamento Geográfico , Geografia , Malária/epidemiologia , Mosquitos Vetores/fisiologia , Rios , Estações do Ano , Temperatura
12.
BMC Public Health ; 20(1): 1226, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787830

RESUMO

BACKGROUND: Diabetes is a leading cause of death and disability in the United States, and its precursor, pre-diabetes, is estimated to occur in one-third of American adults. Understanding the geographic disparities in the distribution of these conditions and identifying high-prevalence areas is critical to guiding control and prevention programs. Therefore, the objective of this study was to investigate clusters of pre-diabetes and diabetes risk in Florida and identify significant predictors of the conditions. METHODS: Data from the 2013 Behavioral Risk Factor Surveillance System were obtained from the Florida Department of Health. Spatial scan statistics were used to identify and locate significant high-prevalence local clusters. The county prevalence proportions of pre-diabetes and diabetes and the identified significant clusters were displayed in maps. Logistic regression was used to identify significant predictors of the two conditions for individuals living within and outside high-prevalence clusters. RESULTS: The study included a total of 34,186 respondents. The overall prevalence of pre-diabetes and diabetes were 8.2 and 11.5%, respectively. Three significant (p < 0.05) local, high-prevalence spatial clusters were detected for pre-diabetes, while five were detected for diabetes. The counties within the high-prevalence clusters had prevalence ratios ranging from 1.29 to 1.85. There were differences in the predictors of the conditions based on whether respondents lived within or outside high-prevalence clusters. Predictors of both pre-diabetes and diabetes regardless of region or place of residence were obesity/overweight, hypertension, and hypercholesterolemia. Income and physical activity level were significant predictors of diabetes but not pre-diabetes. Arthritis, sex, and marital status were significant predictors of diabetes only among residents of high-prevalence clusters, while educational attainment and smoking were significant predictors of diabetes only among residents of non-cluster counties. CONCLUSIONS: Geographic disparities of pre-diabetes and diabetes exist in Florida. Information from this study is useful for guiding resource allocation and targeting of intervention programs focusing on identified modifiable predictors of pre-diabetes and diabetes so as to reduce health disparities and improve the health of all Floridians.


Assuntos
Diabetes Mellitus/epidemiologia , Disparidades nos Níveis de Saúde , Estado Pré-Diabético/epidemiologia , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Florida/epidemiologia , Geografia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
13.
Eur Rev Med Pharmacol Sci ; 24(15): 8187-8193, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32767348

RESUMO

The ongoing worldwide pandemic of Coronavirus disease 2019 (COVID-19), raised the urgency to address knowledge gaps and to establish evidence for improving management and control of this viral infection. Throughout a keen analysis of the World Health Organization (WHO) most updated data, a gender-specific difference in the occurrence of infection was determined, which seems to correlate with patient's vitamin D status. Therefore, our purpose is to provide insights into the nutritional importance of vitamin D for its immunomodulatory effect, in order to help counteracting the COVID-19 pandemic. Novel interesting findings suggest that vitamin D, by inducing progesterone-induced blocking factor (PIBF), might regulate the immune response and also modulate cytokine IL-6, which appears to be increased in COVID-19 infections. Therefore, in addition to the standard recommendations to prevent the infection, supplementation of vitamin D might be considered an approach to help counteracting this global epidemic.


Assuntos
Infecções por Coronavirus/imunologia , Interleucina-6/imunologia , Pneumonia Viral/imunologia , Proteínas da Gravidez/imunologia , Fatores Supressores Imunológicos/imunologia , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/imunologia , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Geografia , Humanos , Inflamação , Itália/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Raios Ultravioleta , Deficiência de Vitamina D/imunologia
14.
Artigo em Inglês | MEDLINE | ID: mdl-32756513

RESUMO

Background and Objective: COVID-19 has engulfed the entire world, with many countries struggling to contain the pandemic. In order to understand how each country is impacted by the virus compared with what would have been expected prior to the pandemic and the mortality risk on a global scale, a multi-factor weighted spatial analysis is presented. Method: A number of key developmental indicators across three main categories of demographics, economy, and health infrastructure were used, supplemented with a range of dynamic indicators associated with COVID-19 as independent variables. Using normalised COVID-19 mortality on 13 May 2020 as a dependent variable, a linear regression (N = 153 countries) was performed to assess the predictive power of the various indicators. Results: The results of the assessment show that when in combination, dynamic and static indicators have higher predictive power to explain risk variation in COVID-19 mortality compared with static indicators alone. Furthermore, as of 13 May 2020 most countries were at a similar or lower risk level than what would have been expected pre-COVID, with only 44/153 countries experiencing a more than 20% increase in mortality risk. The ratio of elderly emerges as a strong predictor but it would be worthwhile to consider it in light of the family makeup of individual countries. Conclusion: In conclusion, future avenues of data acquisition related to COVID-19 are suggested. The paper concludes by discussing the ability of various factors to explain COVID-19 mortality risk. The ratio of elderly in combination with the dynamic variables associated with COVID-19 emerge as more significant risk predictors in comparison to socio-economic and demographic indicators.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Idoso , Infecções por Coronavirus/virologia , Geografia , Humanos , Motivação , Pneumonia Viral/virologia , Fatores de Risco
15.
Rev Saude Publica ; 54: 77, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32756736

RESUMO

OBJECTIVE To present a methodology for apportioning Union resources to the federative units (FU - 26 states and one federal district) within the Brazilian Unified Health System (SUS) based on health needs measured by demographic, socioeconomic, epidemiological and geographical dimensions. METHODS The apportionment methodology proposal prioritizes the health needs axis, based on Law 141/2012. We adopted a proxy of needs that measures relative inequalities between, socioeconomic, geographic demographic and epidemiological conditions of the populations of the Brazilian Federative Units (FU) for 2015. We first used an adjustment so that the populations of the 27 FU are corrected by their relative needs regarding age and gender. To calculate the health needs axis, the multivariate techniques factorial analysis and principal components were used, and, based on such correction, we applied the health needs index. Subsequently, this index was applied to simulate the resources that should be transferred by the Ministry of Health to states in 2015. RESULTS As we made the methodological choice of transferring a single per capita amount to all states, so the proposal required population correction. Thus, in the analysis of health needs, the FUs that had their population corrected by a factor higher than the national average because of their greater relative need, were the states of: Maranhão, Piauí, Alagoas, Paraíba, Ceará, Pará, Bahia, Acre, Pernambuco, Rio Grande do Norte, Sergipe, Amazonas, Tocantins and Roraima. For the simulation aggregating all the financing blocks, without reducing the resources already distributed to the remaining states in 2015, indicated the additional need of R$ 4.6 billion. CONCLUSIONS The proposal addresses the absence of studies presenting quantitative simulations of federal resources distribution within the scope of SUS to the FUs, based on the apportionment criteria defined by Law 141/2012, in order to contribute to the reduction health inequalities and mitigate the effects of the economic crisis.


Assuntos
Recursos em Saúde , Brasil , Geografia , Fatores Socioeconômicos
16.
J Korean Med Sci ; 35(30): e280, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32743995

RESUMO

BACKGROUND: The fatality rate of patients with coronavirus disease 2019 (COVID-19) varies among countries owing to demographics, patient comorbidities, surge capacity of healthcare systems, and the quality of medical care. We assessed the clinical outcomes of patients with COVID-19 during the first wave of the epidemic in Korea. METHODS: Using a modified World Health Organization clinical record form, we obtained clinical data for 3,060 patients with COVID-19 treated at 55 hospitals in Korea. Disease severity scores were defined as: 1) no limitation of daily activities; 2) limitation of daily activities but no need for supplemental oxygen; 3) supplemental oxygen via nasal cannula; 4) supplemental oxygen via facial mask; 5) non-invasive mechanical ventilation; 6) invasive mechanical ventilation; 7) multi-organ failure or extracorporeal membrane oxygenation therapy; and 8) death. Recovery was defined as a severity score of 1 or 2, or discharge and release from isolation. RESULTS: The median age of the patients was 43 years of age; 43.6% were male. The median time from illness onset to admission was 5 days. Of the patients with a disease severity score of 3-4 on admission, 65 (71.5%) of the 91 patients recovered, and 7 (7.7%) died due to illness by day 28. Of the patients with disease severity scores of 5-7, 7 (19.5%) of the 36 patients recovered, and 8 (22.2%) died due to illness by day 28. None of the 1,324 patients who were < 50 years of age died; in contrast, the fatality rate due to illness by day 28 was 0.5% (2/375), 0.9% (2/215), 5.8% (6/104), and 14.0% (7/50) for the patients aged 50-59, 60-69, 70-79, and ≥ 80 years of age, respectively. CONCLUSION: In Korea, almost all patients of < 50 years of age with COVID-19 recovered without supplemental oxygen. In patients of ≥ 50 years of age, the fatality rate increased with age, reaching 14% in patients of ≥ 80 years of age.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Infecções por Coronavirus/diagnóstico , Coleta de Dados , Progressão da Doença , Feminino , Geografia , Hospitalização , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mortalidade , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Isolamento de Pacientes , Pneumonia Viral/diagnóstico , República da Coreia/epidemiologia , Respiração Artificial , Índice de Gravidade de Doença , Capacidade de Resposta ante Emergências , Resultado do Tratamento , Organização Mundial da Saúde , Adulto Jovem
17.
Lancet Glob Health ; 8(8): e1038-e1060, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32710861

RESUMO

BACKGROUND: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. METHODS: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. FINDINGS: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. INTERPRETATION: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Países em Desenvolvimento , Diarreia/terapia , Hidratação/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Teorema de Bayes , Pré-Escolar , Geografia , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Modelos Estatísticos
18.
BMC Med ; 18(1): 218, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32664927

RESUMO

BACKGROUND: School closures have been enacted as a measure of mitigation during the ongoing coronavirus disease 2019 (COVID-19) pandemic. It has been shown that school closures could cause absenteeism among healthcare workers with dependent children, but there remains a need for spatially granular analyses of the relationship between school closures and healthcare worker absenteeism to inform local community preparedness. METHODS: We provide national- and county-level simulations of school closures and unmet child care needs across the USA. We develop individual simulations using county-level demographic and occupational data, and model school closure effectiveness with age-structured compartmental models. We perform multivariate quasi-Poisson ecological regressions to find associations between unmet child care needs and COVID-19 vulnerability factors. RESULTS: At the national level, we estimate the projected rate of unmet child care needs for healthcare worker households to range from 7.4 to 8.7%, and the effectiveness of school closures as a 7.6% and 8.4% reduction in fewer hospital and intensive care unit (ICU) beds, respectively, at peak demand when varying across initial reproduction number estimates by state. At the county level, we find substantial variations of projected unmet child care needs and school closure effects, 9.5% (interquartile range (IQR) 8.2-10.9%) of healthcare worker households and 5.2% (IQR 4.1-6.5%) and 6.8% (IQR 4.8-8.8%) reduction in fewer hospital and ICU beds, respectively, at peak demand. We find significant positive associations between estimated levels of unmet child care needs and diabetes prevalence, county rurality, and race (p<0.05). We estimate costs of absenteeism and child care and observe from our models that an estimated 76.3 to 96.8% of counties would find it less expensive to provide child care to all healthcare workers with children than to bear the costs of healthcare worker absenteeism during school closures. CONCLUSIONS: School closures are projected to reduce peak ICU and hospital demand, but could disrupt healthcare systems through absenteeism, especially in counties that are already particularly vulnerable to COVID-19. Child care subsidies could help circumvent the ostensible trade-off between school closures and healthcare worker absenteeism.


Assuntos
Absenteísmo , Cuidado da Criança/economia , Infecções por Coronavirus/epidemiologia , Pessoal de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Instituições Acadêmicas , Betacoronavirus , Criança , Simulação por Computador , Estudos de Viabilidade , Previsões , Geografia , Mão de Obra em Saúde , Humanos , Unidades de Terapia Intensiva , Determinação de Necessidades de Cuidados de Saúde , Pandemias , Estados Unidos/epidemiologia
19.
Emerg Microbes Infect ; 9(1): 1824-1834, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32726185

RESUMO

The recent emergence of a coronavirus (SARS-CoV-2), first identified in the Chinese city of Wuhan in December 2019, has had major public health and economic consequences. Although 61,888 confirmed cases were reported in Brazil by 28 April 2020, little is known about the SARS-CoV-2 epidemic in this country. To better understand the recent epidemic in the second most populous state in southeast Brazil - Minas Gerais (MG) - we sequenced 40 complete SARS-CoV-2 genomes from MG cases and examined epidemiological data from three Brazilian states. Both the genome analyses and the geographical distribution of reported cases indicate for multiple independent introductions into MG. Epidemiological estimates of the reproductive number (R) using different data sources and theoretical assumptions suggest the potential for sustained virus transmission despite a reduction in R from the first reported case to the end of April 2020. The estimated date of SARS-CoV-2 introduction into Brazil was consistent with epidemiological data from the first case of a returned traveller from Lombardy, Italy. These findings highlight the nature of the COVID-19 epidemic in MG and reinforce the need for real-time and continued genomic surveillance strategies to better understand and prepare for the epidemic spread of emerging viral pathogens..


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Genoma Viral , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Adulto , Idoso , Brasil/epidemiologia , Feminino , Geografia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Sequenciamento Completo do Genoma , Adulto Jovem
20.
Proc Natl Acad Sci U S A ; 117(30): 17688-17694, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32661145

RESUMO

Studies on geographic inequalities in life expectancy in the United States have exclusively focused on single-level analyses of aggregated data at state or county level. This study develops a multilevel perspective to understanding variation in life expectancy by simultaneously modeling the geographic variation at the levels of census tracts (CTs), counties, and states. We analyzed data from 65,662 CTs, nested within 3,020 counties and 48 states (plus District of Columbia). The dependent variable was age-specific life expectancy observed in each of the CTs. We also considered the following CT-level socioeconomic and demographic characteristics as independent variables: population density; proportions of population who are black, who are single parents, who are below the federal poverty line, and who are aged 25 or older who have a bachelor's degree or higher; and median household income. Of the total geographic variation in life expectancy at birth, 70.4% of the variation was attributed to CTs, followed by 19.0% for states and 10.7% for counties. The relative importance of CTs was greater for life expectancy at older ages (70.4 to 96.8%). The CT-level independent variables explained 5 to 76.6% of between-state variation, 11.1 to 58.6% of between-county variation, and 0.7 to 44.9% of between-CT variation in life expectancy across different age groups. Our findings indicate that population inequalities in longevity in the United States are primarily a local phenomenon. There is a need for greater precision and targeting of local geographies in public policy discourse aimed at reducing health inequalities in the United States.


Assuntos
Variação Biológica da População , Censos , Expectativa de Vida , Feminino , Geografia , Humanos , Masculino , Estados Unidos/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA