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1.
Sci Total Environ ; 741: 140515, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32887014

RESUMO

An ecologic analysis was conducted to explore the correlation between air pollution, and COVID-19 cases and fatality rates in London. The analysis demonstrated a strong correlation (R2 > 0.7) between increment in air pollution and an increase in the risk of COVID-19 transmission within London boroughs. Particularly, strong correlations (R2 > 0.72) between the risk of COVID-19 fatality and nitrogen dioxide and particulate matter pollution concentrations were found. Although this study assumed the same level of air pollution across a particular London borough, it demonstrates the possibility to employ air pollution as an indicator to rapidly identify the city's vulnerable regions. Such an approach can inform the decisions to suspend or reduce the operation of different public transport modes within a city. The methodology and learnings from the study can thus aid in public transport's response to COVID-19 outbreak by adopting different levels of human-mobility reduction strategies based on the vulnerability of a given region.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/análise , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Betacoronavirus , Cidades , Humanos , Londres , Dióxido de Nitrogênio/análise , Material Particulado/análise
2.
Cancer Control ; 27(3): 1073274820950844, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32885663

RESUMO

COVID-19 has forced governments to make drastic changes to healthcare systems. To start making informed decisions about cancer care, we need to understand the scale of COVID-19 infection. Therefore, we introduced swab testing for patients visiting Guy's Cancer Centre. Our Centre is one of the largest UK Cancer Centers at the epicenter of the UK COVID-19 epidemic. The first COVID-19 positive cancer patient was reported on 29 February 2020. We analyzed data from 7-15 May 2020 for COVID-19 tests in our cancer patients. 2,647 patients attended for outpatient, chemotherapy, or radiotherapy appointments. 654 were swabbed for COVID-19 (25%). Of those tested, 9 were positive for COVID-19 (1.38%) of which 7 were asymptomatic. Cancer service providers will need to understand their local cancer population prevalence. The absolute priority is that cancer patients have the confidence to attend hospitals and be reassured that they will be treated in a COVID-19 managed environment.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Neoplasias/epidemiologia , Pneumonia Viral/epidemiologia , Adulto , Idoso , Betacoronavirus/isolamento & purificação , Institutos de Câncer , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Pandemias , Pneumonia Viral/diagnóstico , Prevalência
6.
PLoS One ; 15(8): e0236857, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760081

RESUMO

Recent outbreaks of coronavirus disease 2019 (COVID-19) has led a global pandemic cross the world. Most countries took two main interventions: suppression like immediate lockdown cities at epicenter or mitigation that slows down but not stopping epidemic for reducing peak healthcare demand. Both strategies have their apparent merits and limitations; it becomes extremely hard to conduct one intervention as the most feasible way to all countries. Targeting at this problem, this paper conducted a feasibility study by defining a mathematical model named SEMCR, it extended traditional SEIR (Susceptible-Exposed-Infectious-Recovered) model by adding two key features: a direct connection between Exposed and Recovered populations, and separating infections into mild and critical cases. It defined parameters to classify two stages of COVID-19 control: active contain by isolation of cases and contacts, passive contain by suppression or mitigation. The model was fitted and evaluated with public dataset containing daily number of confirmed active cases including Wuhan and London during January 2020 and March 2020. The simulated results showed that 1) Immediate suppression taken in Wuhan significantly reduced the total exposed and infectious populations, but it has to be consistently maintained at least 90 days (by the middle of April 2020). Without taking this intervention, we predict the number of infections would have been 73 folders higher by the middle of April 2020. Its success requires efficient government initiatives and effective collaborative governance for mobilizing of corporate resources to provide essential goods. This mode may be not suitable to other countries without efficient collaborative governance and sufficient health resources. 2) In London, it is possible to take a hybrid intervention of suppression and mitigation for every 2 or 3 weeks over a longer period to balance the total infections and economic loss. While the total infectious populations in this scenario would be possibly 2 times than the one taking suppression, economic loss and recovery of London would be less affected. 3) Both in Wuhan and London cases, one important issue of fitting practical data was that there were a portion (probably 62.9% in Wuhan) of self-recovered populations that were asymptomatic or mild symptomatic. This finding has been recently confirmed by other studies that the seroprevalence in Wuhan varied between 3.2% and 3.8% in different sub-regions. It highlights that the epidemic is far from coming to an end by means of herd immunity. Early release of intervention intensity potentially increased a risk of the second outbreak.


Assuntos
Infecções por Coronavirus/patologia , Pneumonia Viral/patologia , Doenças Assintomáticas , Betacoronavirus/isolamento & purificação , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Surtos de Doenças , Estudos de Viabilidade , Humanos , Londres/epidemiologia , Modelos Teóricos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia
7.
BMJ Health Care Inform ; 27(3)2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32796085

RESUMO

BACKGROUND: The COVID-19 crisis forced hospitals in the UK dramatically to reduce outpatient activity. To provide continuity of care and to assist patients reluctant or unable to leave their homes, video consultations were rapidly implemented across routine and emergency ophthalmology services. OBJECTIVE: To describe the deployment and scaling to a large volume of teleophthalmology using a video consultation platform 'Attend Anywhere' in Moorfields Eye Hospital's accident and emergency (A&E) department (London, UK). METHOD: Patient satisfaction, waiting time, consultation duration, outcome and management were audited following the launch of the new virtual A&E service. RESULTS: In the 12 days following the service launch, 331 patients were seen by video consultation. 78.6% of patients (n=260) were determined not to need hospital A&E review and were managed with advice (n=126), remote prescription (n=57), general practitioner referral (n=27), direct referral to hospital subspecialty services (n=26) or diversion to a local eye unit (n=24). Mean patient satisfaction was 4.9 of 5.0 (n=62). The mean consultation duration was 12 min (range 5-31 min) and the wait time was 6 min (range 0-37 min). CONCLUSION: Video consultations showed greater than expected usefulness in the remote management of eye disease and supported a substantial reduction in the number of people visiting the hospital.


Assuntos
Serviços Médicos de Emergência , Serviço Hospitalar de Emergência/organização & administração , Oftalmopatias , Oftalmologia , Encaminhamento e Consulta/estatística & dados numéricos , Telemedicina/organização & administração , Infecções por Coronavirus , Serviços Médicos de Emergência/estatística & dados numéricos , Serviços Médicos de Emergência/tendências , Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Feminino , Humanos , Londres , Masculino , Pandemias , Satisfação do Paciente , Pneumonia Viral
8.
Emerg Med J ; 37(9): 567-570, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32669319

RESUMO

For many of us in emergency medicine, rising to the challenge of the COVID-19 crisis will be the single most exciting and challenging episode of our careers. Lessons have been learnt on how to make quick and effective changes without being hindered by the normal restraints of bureaucracy. Changes that would normally have taken months to years to implement have been successfully introduced over a period of several weeks. Although we have managed these changes largely by command and control, compassionate leadership has identified leaders within our team and paved the way for the future. This article covers the preparation and changes made in response to COVID-19 in a London teaching hospital.


Assuntos
Defesa Civil , Infecções por Coronavirus , Serviço Hospitalar de Emergência , Inovação Organizacional , Pandemias , Pneumonia Viral , Planejamento Estratégico , Capacidade de Resposta ante Emergências , Betacoronavirus , Gestão de Mudança , Defesa Civil/métodos , Defesa Civil/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Eficiência Organizacional , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/tendências , Humanos , Liderança , Londres , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
9.
PLoS One ; 15(7): e0235350, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32663203

RESUMO

BACKGROUND: Skin and soft tissue infections (SSTI) are a common but preventable cause of morbidity and mortality among people who inject drugs (PWID). They can be severe, and hospitalisations of PWID with SSTI are rising. The most common SSTI presentations are abscesses and cellulitis. METHODS: We used data from Care & Prevent, a cross-sectional community survey of PWID in London. We reported the lifetime prevalence of SSTI, severity of infections, key risk factors, and associated sequelae. Pictorial questions were used to assess SSTI severity. RESULTS: We recruited 455 PWID. SSTI lifetime prevalence was high: 64% reported an abscess and/or cellulitis. Over one-third (37%) reported a severe infection, 137 (47%) reported hospitalisation. SSTIrisk factors were: aged 35+ years, injecting once or more times a day, subcutaneous or intra-muscular injections, and making four or more attempts to achieve an injection. Those who reported having other health conditions were at higher odds of having an abscess or cellulitis, with risk tending to increase with number of reported conditions. Half (46%) employed self-care for their worst SSTI, and 43% waited for ten or more days before seeking medical care or not seeking medical care at all. CONCLUSIONS: Abscess and cellulitis are very common among PWID in London. We corroborate findings indicating SSTIs are associated with risks, e.g. venous access problems, as well as other co-morbid conditions: septicaemia, endocarditis, DVT, and kidney disease. These co-morbidities may impact SSTIs severity and outcomes. Delayed healthcare seeking potentially exacerbates infection severity, which in turn increases poorer health outcomes and complications.


Assuntos
Abscesso/epidemiologia , Celulite (Flegmão)/epidemiologia , Dermatopatias Infecciosas/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abscesso/complicações , Abscesso/fisiopatologia , Adulto , Celulite (Flegmão)/complicações , Celulite (Flegmão)/fisiopatologia , Feminino , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Prevalência , Fatores de Risco , Sepse/complicações , Sepse/epidemiologia , Sepse/fisiopatologia , Dermatopatias Infecciosas/complicações , Dermatopatias Infecciosas/fisiopatologia , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/fisiopatologia , Reino Unido/epidemiologia
11.
Clin Med (Lond) ; 20(4): e87-e90, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32628128

RESUMO

COVID-19 and diabetes are both pandemics with major impacts on global public health. While the response to COVID-19 has been rapid and progressive to reduce risk of harm, the response to the diabetes pandemic has been somewhat more muted. People with diabetes have been disproportionately affected by COVID-19, with growing evidence of higher mortality and morbidity. In this article, we discuss the impact of COVID-19 on our diabetes service in an urban area in the UK. We discuss the impact on our patients and ourselves, and the possible lessons we can carry into the future.


Assuntos
Assistência Ambulatorial/organização & administração , Infecções por Coronavirus/epidemiologia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Pandemias , Pneumonia Viral/epidemiologia , Betacoronavirus , Comorbidade , Complicações do Diabetes/terapia , Hospitais Urbanos , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/terapia , Londres/epidemiologia , Telemedicina
12.
Eur J Obstet Gynecol Reprod Biol ; 252: 444-446, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32731057

RESUMO

OBJECTIVE: To explore the prevalence of asymptomatic SARS-CoV-2 in the maternity population. STUDY DESIGN: Newham University Hospital based in East London serving a population with the highest death rate secondary to SARS-CoV-2 in the UK, commenced universal screening of all admissions to the Maternity Unit from 22nd April to 5th May, 2020. A proforma was created to capture key patient demographics, indication for admission and presence of SARS-CoV-2 related symptoms at the point of presentation. RESULTS: A total of 180 women with a mean age of 29.9 (SD 7.4) years, at a median gestation of 39 (IQR 37 + 1-40 + 3) weeks underwent universal screening with nasopharyngeal PCR swabs during the two-week period of the study. BAME identity or parity was not associated with the likelihood of a positive result. Seven women (3.9 %, 1.6-7.8) were tested positive for SARS-CoV-2, of whom 6 (3.3 %, 1.2-7.1) were asymptomatic; 85.7 % (42.1-99.6) of the SARS-CoV-2 positive women were asymptomatic. The sensitivity of symptom-driven testing was 14.3 % (0.36-57.87) and specificity was 91.86 % (86.72-95.48) with a positive predictive value of 6.67 % (1.08-31.95) and a negative predictive value of 96.34 % (95.10-97.28). CONCLUSION: The prevalence of SARS-CoV-2 in the maternity population served by Newham University Hospital was 3.9 %, four weeks after lockdown. Of the women who were found to be SARS-CoV-2 positive, a high proportion (87.9 %) were asymptomatic. These findings support the need for universal testing to enable targeted isolation and robust infectious control measures to mitigate outbreaks of SARS-CoV-2 in maternity units.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Diagnóstico Pré-Natal/métodos , Adulto , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Salas de Parto , Feminino , Humanos , Londres/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Prevalência , Adulto Jovem
14.
J Am Soc Nephrol ; 31(8): 1815-1823, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32561681

RESUMO

BACKGROUND: During the coronavirus disease 2019 (COVID-19) epidemic, many countries have instituted population-wide measures for social distancing. The requirement of patients on dialysis for regular treatment in settings typically not conducive to social distancing may increase their vulnerability to COVID-19. METHODS: Over a 6-week period, we recorded new COVID-19 infections and outcomes for all adult patients receiving dialysis in a large dialysis center. Rapidly introduced control measures included a two-stage routine screening process at dialysis entry (temperature and symptom check, with possible cases segregated within the unit and tested for SARS-CoV-2), isolated dialysis in a separate unit for patients with infection, and universal precautions that included masks for dialysis nursing staff. RESULTS: Of 1530 patients (median age 66 years; 58.2% men) receiving dialysis, 300 (19.6%) developed COVID-19 infection, creating a large demand for isolated outpatient dialysis and inpatient beds. An analysis that included 1219 patients attending satellite dialysis clinics found that older age was a risk factor for infection. COVID-19 infection was substantially more likely to occur among patients on in-center dialysis compared with those dialyzing at home. We observed clustering in specific units and on specific shifts, with possible implications for aspects of service design, and high rates of nursing staff illness. A predictive epidemic model estimated a reproduction number of 2.2; cumulative cases deviated favorably from the model from the fourth week, suggesting that the implemented measures controlled transmission. CONCLUSIONS: The COVID-19 epidemic affected a large proportion of patients at this dialysis center, creating service pressures exacerbated by nursing staff illness. Details of the control strategy and characteristics of this epidemic may be useful for dialysis providers and other institutions providing patient care.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Controle de Infecções/métodos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Idoso , Betacoronavirus , Registros Eletrônicos de Saúde , Feminino , Febre/complicações , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Pandemias , Isolamento de Pacientes , Modelos de Riscos Proporcionais , Quarentena , Diálise Renal/efeitos adversos , Fatores de Risco , Serviços Urbanos de Saúde/organização & administração
17.
Eur J Orthop Surg Traumatol ; 30(6): 951-954, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32591913
18.
J Infect ; 81(2): 282-288, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32479771

RESUMO

BACKGROUND: The COVID-19 pandemic continues to escalate. There is urgent need to stratify patients. Understanding risk of deterioration will assist in admission and discharge decisions, and help selection for clinical studies to indicate where risk of therapy-related complications is justified. METHODS: An observational cohort of patients acutely admitted to two London hospitals with COVID-19 and positive SARS-CoV-2 swab results was assessed. Demographic details, clinical data, comorbidities, blood parameters and chest radiograph severity scores were collected from electronic health records. Endpoints assessed were critical care admission and death. A risk score was developed to predict outcomes. FINDINGS: Analyses included 1,157 patients. Older age, male sex, comorbidities, respiratory rate, oxygenation, radiographic severity, higher neutrophils, higher CRP and lower albumin at presentation predicted critical care admission and mortality. Non-white ethnicity predicted critical care admission but not death. Social deprivation was not predictive of outcome. A risk score was developed incorporating twelve characteristics: age>40, male, non-white ethnicity, oxygen saturations<93%, radiological severity score>3, neutrophil count>8.0 x109/L, CRP>40 mg/L, albumin<34 g/L, creatinine>100 µmol/L, diabetes mellitus, hypertension and chronic lung disease. Risk scores of 4 or higher corresponded to a 28-day cumulative incidence of critical care admission or death of 40.7% (95% CI: 37.1 to 44.4), versus 12.4% (95% CI: 8.2 to 16.7) for scores less than 4. INTERPRETATION: Our study identified predictors of critical care admission and death in people admitted to hospital with COVID-19. These predictors were incorporated into a risk score that will inform clinical care and stratify patients for clinical trials.


Assuntos
Infecções por Coronavirus/mortalidade , Cuidados Críticos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Pneumonia Viral/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/diagnóstico por imagem , Registros Eletrônicos de Saúde , Feminino , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico por imagem , Radiografia , Fatores de Risco , Tórax/diagnóstico por imagem , Adulto Jovem
19.
Stud Health Technol Inform ; 270: 228-232, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32570380

RESUMO

INTRODUCTION: Computable phenotypes are gaining importance as structured and reproducible method of using electronic health data to identify people with certain clinical conditions. A formal standard is not available for defining and formally representing phenotyping algorithms. In this paper, we have tried to build a formal representation of such phenotyping algorithm. METHODS: We built EN 13606 EHR standard for building clinical archetypes to represent the computable phenotyping algorithm for 'diagnosis of cardiac failure'. As part of this work, we created a set of new clinical archetypes for defining 'cardiac failure diagnosis'. The EN13606 editor called Object Dictionary Client was used which was in-house developed by University College London. We evaluated the ability of EN 13606 to provide clinical archetypes to define EHR phenotyping algorithms using the predefined desiderata for the purpose [Mo et al]. RESULTS: EN 13606 archetypes could represent phenotype components grouped and nested based on their logical meaning. It was possible to build the EHR phenotyping algorithm with the clinical elements and their interrelationships along with hierarchical structure and temporal criteria. But the specific mathematical calculation and temporal relations involved in the algorithm was difficult to incorporate. These will need to be coded and integrated within the clinical information system. These archetypes can be mapped for comparison with the openEHR models. Binding to external clinical terminology is fully supported. However, it does not satisfy all the desiderata defined by Mo et al. A possible way could be an approach using phenotype ontologies and its architectural representation integrated with ISO interoperability. CONCLUSION: The EN13606 archetypes can be used to define the phenotype algorithm that basically identifies patients by a set of clinical characteristics in their records. Phenotype representations defined in EN 13606 do not satisfy all the desiderata proposed by Mo et al. and thus currently has a limited ability to define the computable phenotyping algorithms. Further work is required to make the EN13606 standard to fully support the objective.


Assuntos
Registros Eletrônicos de Saúde , Registro Médico Coordenado/métodos , Sistemas Computadorizados de Registros Médicos/organização & administração , Fenótipo , Medicina de Precisão , Algoritmos , Sistemas de Gerenciamento de Base de Dados , Estudos de Viabilidade , Humanos , Armazenamento e Recuperação da Informação , Londres , Sistemas Computadorizados de Registros Médicos/normas , Modelos Teóricos
20.
Sci Total Environ ; 737: 139722, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32526570

RESUMO

Platanusx hispanica (London plane) is a tree species widely used in urban areas due to the diversity of ecosystem services it provides. However, its functions also have some negative effects or associated disservices, such as the emission of Biogenic Volatile Organic Compounds (BVOCs) and allergens. This work aims to analyze the effect that urban environmental conditions and air pollutants have on pollen emissions of plane tree. The study has been carried out in Granada, in the southeast of the Iberian Peninsula, a city with a Mediterranean climate and one of the most polluted in Spain. Granada is also one of the Mediterranean cities in which the increase in the percentage of the population affected by allergy to Platanus pollen in recent decades has been most significant. The 1992-2019 Platanus pollen data series has been considered to establish the main aerobiological parameters, trends and correlations with meteorological variables and particulate and gaseous atmospheric pollutants, both before and during the flowering period. The average Seasonal Pollen Integral (SPIn) of about 2700 pollen grains has shown a significant increase throughout the series. This increase in allergen emissions could be related to the increase in crown volume associated with tree growth, but also to other environmental factors. Precipitation and minimum temperatures of the winter prior to flowering were the parameters that have shown the most influence with SPIn, while O3 and NOx are the pollutants that have the most effect on the peak value. Due to the good adaptation that London plane has to changing climatic conditions in urban environments, its hegemonic presence as an element of Urban Green infrastructure must be reviewed so that the net balance of ecosystem services is not diminished by the disservices.


Assuntos
Poluentes Atmosféricos/análise , Árvores , Alérgenos/análise , Cidades , Ecossistema , Londres , Polinização , Espanha
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