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1.
PLoS One ; 16(4): e0249456, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33852592

RESUMEN

The outbreak of SARS-CoV-2 is thought to have originated in Wuhan, China in late 2019 and has since spread quickly around the world. To date, the virus has infected tens of millions of people worldwide, compelling governments to implement strict policies to counteract community spread. Federal, provincial, and municipal governments have employed various public health policies, including social distancing, mandatory mask wearing, and the closure of schools and businesses. However, the implementation of these policies can be difficult and costly, making it imperative that both policy makers and the citizenry understand their potential benefits and the risks of non-compliance. In this work, a mathematical model is developed to study the impact of social behaviour on the course of the pandemic in the province of Ontario. The approach is based upon a standard SEIRD model with a variable transmission rate that depends on the behaviour of the population. The model parameters, which characterize the disease dynamics, are estimated from Ontario COVID-19 epidemiological data using machine learning techniques. A key result of the model, following from the variable transmission rate, is the prediction of the occurrence of a second wave using the most current infection data and disease-specific traits. The qualitative behaviour of different future transmission-reduction strategies is examined, and the time-varying reproduction number is analyzed using existing epidemiological data and future projections. Importantly, the effective reproduction number, and thus the course of the pandemic, is found to be sensitive to the adherence to public health policies, illustrating the need for vigilance as the economy continues to reopen.


Asunto(s)
/epidemiología , Modelos Estadísticos , Cuarentena/estadística & datos numéricos , Personal Administrativo , Gobierno , Adhesión a Directriz/estadística & datos numéricos , Humanos , Ontario/epidemiología , Pandemias , Política Pública , Cuarentena/psicología , Conducta Social
2.
PLoS One ; 16(4): e0249891, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33852626

RESUMEN

Mask wearing has been advocated by public health officials as a way to reduce the spread of COVID-19. In the United States, policies on mask wearing have varied from state to state over the course of the pandemic. Even as more and more states encourage or even mandate mask wearing, many citizens still resist the notion. Our research examines mask wearing policy and adherence in association with COVID-19 case rates. We used state-level data on mask wearing policy for the general public and on proportion of residents who stated they always wear masks in public. For all 50 states and the District of Columbia (DC), these data were abstracted by month for April ─ September 2020 to measure their impact on COVID-19 rates in the subsequent month (May ─ October 2020). Monthly COVID-19 case rates (number of cases per capita over two weeks) >200 per 100,000 residents were considered high. Fourteen of the 15 states with no mask wearing policy for the general public through September reported a high COVID-19 rate. Of the 8 states with at least 75% mask adherence, none reported a high COVID-19 rate. States with the lowest levels of mask adherence were most likely to have high COVID-19 rates in the subsequent month, independent of mask policy or demographic factors. Mean COVID-19 rates for states with at least 75% mask adherence in the preceding month was 109.26 per 100,000 compared to 249.99 per 100,000 for those with less adherence. Our analysis suggests high adherence to mask wearing could be a key factor in reducing the spread of COVID-19. This association between high mask adherence and reduced COVID-19 rates should influence policy makers and public health officials to focus on ways to improve mask adherence across the population in order to mitigate the spread of COVID-19.


Asunto(s)
/epidemiología , Adhesión a Directriz/estadística & datos numéricos , Máscaras/estadística & datos numéricos , /prevención & control , Transmisión de Enfermedad Infecciosa/prevención & control , Política de Salud/tendencias , Humanos , Pandemias , Cooperación del Paciente/psicología , Salud Pública , Estados Unidos/epidemiología
3.
JMIR Public Health Surveill ; 7(4): e25762, 2021 04 13.
Artículo en Inglés | MEDLINE | ID: mdl-33819910

RESUMEN

BACKGROUND: Public health campaigns aimed at curbing the spread of COVID-19 are important in reducing disease transmission, but traditional information-based campaigns have received unexpectedly extreme backlash. OBJECTIVE: This study aimed to investigate whether customizing of public service announcements (PSAs) providing health guidelines to match individuals' identities increases their compliance. METHODS: We conducted a within- and between-subjects, randomized controlled cross-sectional, web-based study in July 2020. Participants viewed two PSAs: one advocating wearing a mask in public settings and one advocating staying at home. The control PSA only provided information, and the treatment PSAs were designed to appeal to the identities held by individuals; that is, either a Christian identity or an economically motivated identity. Participants were asked about their identity and then provided a control PSA and treatment PSA matching their identity, in random order. The PSAs were of approximately 100 words. RESULTS: We recruited 300 social media users from Amazon Mechanical Turk in accordance with usual protocols to ensure data quality. In total, 8 failed the data quality checks, and the remaining 292 were included in the analysis. In the identity-based PSA, the source of the PSA was changed, and a phrase of approximately 12 words relevant to the individual's identity was inserted. A PSA tailored for Christians, when matched with a Christian identity, increased the likelihood of compliance by 12 percentage points. A PSA that focused on economic values, when shown to individuals who identified as economically motivated, increased the likelihood of compliance by 6 points. CONCLUSIONS: Using social media to deliver COVID-19 public health announcements customized to individuals' identities is a promising measure to increase compliance with public health guidelines. TRIAL REGISTRATION: ISRCTN Registry 22331899; https://www.isrctn.com/ISRCTN22331899.


Asunto(s)
/prevención & control , Adhesión a Directriz/estadística & datos numéricos , Comunicación Persuasiva , Avisos de Utilidad Pública como Asunto , Identificación Social , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Guías como Asunto , Humanos , Masculino , Máscaras , Persona de Mediana Edad , Cuarentena , Medios de Comunicación Sociales , Estados Unidos/epidemiología , Adulto Joven
4.
Int Breastfeed J ; 16(1): 30, 2021 03 31.
Artículo en Inglés | MEDLINE | ID: mdl-33789708

RESUMEN

BACKGROUND: The World Health Organization recognizes exclusive breastfeeding a safe source of nutrition available for children in most humanitarian emergencies, as in the current pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Despite the Brazilian national guideline protecting breastfeeding practices, there are many concerns about protecting infants from their infected mothers. This study aimed to analyze how the Brazilian hospitals and maternity services promote and support mothers suspected or diagnosed with coronavirus disease (COVID-19). METHODS: This is a descriptive cross-sectional and multicenter study which collected data from 24 Brazilian hospitals and maternity services between March and July 2020. Representatives of the institutions completed a questionnaire based on acts to promote and support breastfeeding, the Baby-Friendly Hospital Initiative, and Brazil's federal law recommendations. RESULTS: The results showed that in delivery rooms, 98.5% of the services prohibited immediate and uninterrupted skin-to-skin contact between mothers and their infants and did not support mothers to initiate breastfeeding in the first hour. On the postnatal ward, 98.5% of the services allowed breastfeeding while implementing respiratory hygiene practices to prevent transmission of COVID-19. Companions for mothers were forbidden in 83.3% of the hospitals. Hospital discharge was mostly between 24 and 28 h (79.1%); discharge guidelines were not individualized. Additionally, a lack of support was noticed from the home environment's health community network (83.3%). Hospital and home breast pumping were allowed (87.5%), but breast milk donation was not accepted (95.8%). There was a lack of guidance regarding the use of infant comforting strategies. Guidelines specific for vulnerable populations were not covered in the material evaluated. CONCLUSIONS: In Brazil, hospitals have not followed recommendations to protect, promote, and support breastfeeding during the COVID-19 outbreak. The disagreement between international guidelines has been a major issue. The absence of recommendations on breastfeeding support during the pandemic led to difficulties in developing standards among hospitals in different regions of Brazil and other countries worldwide. The scientific community needs to discuss how to improve maternal and infant care services to protect breastfeeding in the current pandemic.


Asunto(s)
Lactancia Materna , Adhesión a Directriz , Higiene , Brasil/epidemiología , Lactancia Materna/efectos adversos , /etiología , Estudios Transversales , Brotes de Enfermedades/prevención & control , Femenino , Adhesión a Directriz/estadística & datos numéricos , Hospitales , Humanos , Servicios de Salud Materna , Pandemias , Embarazo , Encuestas y Cuestionarios
5.
BMC Cancer ; 21(1): 236, 2021 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-33676431

RESUMEN

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) negatively affects physical function and chemotherapy dosing, yet, clinicians infrequently document CIPN assessment and/or adhere to evidence-based CIPN management in practice. The primary aims of this two-phase, pre-posttest study were to explore the impact of a CIPN clinician decision support algorithm on clinicians' frequency of CIPN assessment documentation and adherence to evidence-based management. METHODS: One hundred sixty-two patients receiving neurotoxic chemotherapy (e.g., taxanes, platinums, or bortezomib) answered patient-reported outcome measures on CIPN severity and interference prior to three clinic visits at breast, gastrointestinal, or multiple myeloma outpatient clinics (n = 81 usual care phase [UCP], n = 81 algorithm phase [AP]). During the AP, study staff delivered a copy of the CIPN assessment and management algorithm to clinicians (N = 53) prior to each clinic visit. Changes in clinicians' CIPN assessment documentation (i.e., index of numbness, tingling, and/or CIPN pain documentation) and adherence to evidence-based management at the third clinic visit were compared between the AP and UCP using Pearson's chi-squared test. RESULTS: Clinicians' frequency of adherence to evidence-based CIPN management was higher in the AP (29/52 [56%]) than the UCP (20/46 [43%]), but the change was not statistically significant (p = 0.31). There were no improvements in clinicians' CIPN assessment frequency during the AP (assessment index = 0.5440) in comparison to during the UCP (assessment index = 0.6468). CONCLUSIONS: Implementation of a clinician-decision support algorithm did not significantly improve clinicians' CIPN assessment documentation or adherence to evidence-based management. Further research is needed to develop theory-based implementation interventions to bolster the frequency of CIPN assessment and use of evidence-based management strategies in practice. TRIAL REGISTRATION: ClinicalTrials.Gov, NCT03514680 . Registered 21 April 2018.


Asunto(s)
Antineoplásicos/efectos adversos , Toma de Decisiones Clínicas/métodos , Técnicas de Apoyo para la Decisión , Neoplasias/tratamiento farmacológico , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Adulto , Anciano , Algoritmos , Medicina Basada en la Evidencia/normas , Estudios de Factibilidad , Femenino , Adhesión a Directriz/estadística & datos numéricos , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Enfermeras Practicantes/estadística & datos numéricos , Medición de Resultados Informados por el Paciente , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/terapia , Asistentes Médicos/estadística & datos numéricos , Médicos/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Calidad de Vida , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios/estadística & datos numéricos
6.
J Hosp Infect ; 111: 27-34, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33716086

RESUMEN

BACKGROUND: The coronavirus disease (COVID-19) pandemic has affected healthcare workers (HCWs) in their clinical practice. HCWs were challenged with new guidelines and practices to protect themselves from occupational risks. AIM: To determine whether hand hygiene behaviour by real-time measurement was related to the dynamic of the epidemic, and the type of patient being cared for in France. METHODS: This study used an automated hand hygiene recording system to measure HCW hand hygiene on entry to and exit from patient rooms throughout the COVID-19 pandemic. The correlation between hand hygiene compliance and COVID-19 epidemiological data was analysed. Analysis of variance was performed to compare compliance rate during the different periods of the epidemic. FINDINGS: HCW hand hygiene rate on room entry decreased over time; on room exit, it increased by 13.73% during the first wave of COVID-19, decreased by 9.87% during the post-lockdown period, then rebounded by 2.82% during the second wave of the epidemic. Hand hygiene during patient care and hand hygiene on room exit had a positive relationship with the local COVID-19 epidemic; conversely, hand hygiene on room entry did not depend on the trend of the epidemic, nor on nursing of COVID-19 patients, and it decreased over time. CONCLUSION: HCWs modified their behaviours to face the risk propensity of the pandemic. However, to improve the poor compliance at room entry, reducing confusion between the hand hygiene recommendation and glove recommendation may be necessary; disinfection of gloving hands might solve this issue.


Asunto(s)
/prevención & control , Infección Hospitalaria/prevención & control , Adhesión a Directriz/estadística & datos numéricos , Higiene de las Manos/estadística & datos numéricos , Higiene de las Manos/normas , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Adulto , Femenino , Francia , Humanos , Control de Infecciones/métodos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/prevención & control , Pandemias
7.
J Hosp Infect ; 111: 6-26, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33744382

RESUMEN

BACKGROUND: There is general consensus that hand hygiene is the most effective way to prevent healthcare-associated infections. However, low rates of compliance amongst healthcare workers have been reported globally. The coronavirus disease 2019 pandemic has further emphasized the need for global improvement in hand hygiene compliance by healthcare workers. AIM: This comprehensive systematic review provides an up-to-date compilation of clinical trials, reported between 2014 and 2020, assessing hand hygiene interventions in order to inform healthcare leaders and practitioners regarding approaches to reduce healthcare-associated infections using hand hygiene. METHODS: CINAHL, Cochrane, EMbase, Medline, PubMed and Web of Science databases were searched for clinical trials published between March 2014 and December 2020 on the topic of hand hygiene compliance among healthcare workers. In total, 332 papers were identified from these searches, of which 57 studies met the inclusion criteria. FINDINGS: Forty-five of the 57 studies (79%) included in this review were conducted in Asia, Europe and the USA. The large majority of these clinical trials were conducted in acute care facilities, including hospital wards and intensive care facilities. Nurses represented the largest group of healthcare workers studied (44 studies, 77%), followed by physicians (41 studies, 72%). Thirty-six studies (63%) adopted the World Health Organization's multi-modal framework or a variation of this framework, and many of them recorded hand hygiene opportunities at each of the 'Five Moments'. However, recording of hand hygiene technique was not common. CONCLUSION: Both single intervention and multi-modal hand hygiene strategies can achieve modest-to-moderate improvements in hand hygiene compliance among healthcare workers.


Asunto(s)
/prevención & control , Infección Hospitalaria/prevención & control , Adhesión a Directriz/tendencias , Higiene de las Manos/normas , Higiene de las Manos/tendencias , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Adulto , Femenino , Predicción , Adhesión a Directriz/estadística & datos numéricos , Higiene de las Manos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad
8.
Mayo Clin Proc ; 96(4): 975-986, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33722396

RESUMEN

OBJECTIVE: To examine the screening rates for kidney damage and function among patients with type 2 diabetes (T2D) and chronic kidney disease stage at diabetes diagnosis using a US administrative claims database. PATIENTS AND METHODS: This cohort study used a claims database enriched with laboratory results data. Patients with T2D (defined as 1 inpatient or 2 outpatient claims for diabetes), aged 18 years or older, and with at least 1 year of follow-up enrollment were identified. Patients with type 1 diabetes, kidney disease, or other related conditions at baseline were excluded. We estimated screening rates using laboratory orders for serum creatinine and estimated glomerular filtration rate (eGFR) measurement and urine albumin to creatinine ratio (UACR). Chronic kidney disease severity was reported using the Kidney Disease: Improving Global Outcomes classification based on laboratory results. RESULTS: A total of 1,881,447 patients with T2D were eligible for analysis. Mean ± SD age was 63.1±13.1 years; 947,150 patients (50.3%) were male. Serum creatinine tests were ordered within 14 days of the index date among 290,722 patients of 622,915 (46.7%) patients with newly-recognized T2D. Overall, 1,595,964 patients (84.8%) had at least one serum creatinine test ordered during the 1-year follow-up period. Fewer patients received a UACR test during follow-up (814,897 [43.3%]). Less than half of all patients with T2D received a laboratory test order for both serum creatinine and urine albumin measurements during the follow-up period. CONCLUSION: Physicians treating patients with diabetes are selectively adhering to chronic kidney disease screening guidelines, as indicated by high rates of eGFR testing, but less frequent UACR testing. Despite recommendations to monitor both eGFR and UACR, less than half of patients were screened for albuminuria during the 1-year follow-up.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Adhesión a Directriz/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Tamizaje Masivo/normas , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/etiología , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos
9.
Medicine (Baltimore) ; 100(11): e24836, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725954

RESUMEN

ABSTRACT: Anesthesiologists and surgeons have demonstrated a lack of familiarity with professional guidelines when providing care for surgical patients with a do-not-resuscitate (DNR) order. This substantially infringes on patient's self-autonomy; therefore, leading to substandard care particularly for palliative surgical procedures. The interventional nature of surgical procedures may create a different mentality of surgical "buy-in," that may unintentionally prioritize survivability over maintaining patient self-autonomy. While previous literature has demonstrated gains in communication skills with simulation training, no specific educational curriculum has been proposed to specifically address perioperative code status discussions. We designed a simulated standardized patient actor (SPA) encounter at the beginning of post-graduate year (PGY) 2, corresponding to the initiation of anesthesiology specific training, allowing residents to focus on the perioperative discussion in relation to the SPA's DNR order.Forty four anesthesiology residents volunteered to participate in the study. PGY-2 group (n = 17) completed an immediate post-intervention assessment, while PGY-3 group (n = 13) completed the assessment approximately 1 year after the educational initiative to ascertain retention. PGY-4 residents (n = 14) did not undergo any specific educational intervention on the topic, but were given the same assessment. The assessment consisted of an anonymized survey that examined familiarity with professional guidelines and hospital policies in relation to perioperative DNR orders. Subsequently, survey responses were compared between classes.Study participants that had not participated in the educational intervention reported a lack of prior formalized instruction on caring for intraoperative DNR patients. Second and third year residents outperformed senior residents in being aware of the professional guidelines that detail perioperative code status decision-making (47%, 62% vs 21%, P = .004). PGY-3 residents outperformed PGY-4 residents in correctly identifying a commonly held misconception that institutional policies allow for automatic perioperative DNR suspensions (85% vs 43%; P = .02). Residents from the PGY-3 class, who were 1 year removed the educational intervention while gaining 1 additional year of clinical anesthesiology training, consistently outperformed more senior residents who never received the intervention.Our training model for code-status training with anesthesiology residents showed significant gains. The best results were achieved when combining clinical experience with focused educational training.


Asunto(s)
Competencia Clínica/estadística & datos numéricos , Atención Perioperativa/psicología , Medicina Perioperatoria/educación , Órdenes de Resucitación/psicología , Estudiantes de Medicina/psicología , Adulto , Anestesiología/educación , Femenino , Adhesión a Directriz/estadística & datos numéricos , Humanos , Internado y Residencia/estadística & datos numéricos , Conocimiento , Masculino , Simulación de Paciente , Autonomía Personal , Aprendizaje Basado en Problemas , Encuestas y Cuestionarios
10.
J Infect Public Health ; 14(4): 454-460, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33743365

RESUMEN

BACKGROUND: During the ongoing coronavirus disease (COVID-19) pandemic, hospitals have strengthened their guidelines on infection prevention and control (IPC), and a rigorous adherence to these guidelines is crucial. An infection control surveillance-working group (ICS-WG) and infection control coordinators (ICCs) team were created to monitor the IPC practices of the healthcare workers (HCWs) in a regional hospital in Korea. This study analyzed the surveillance results and aimed to identify what IPC practices needed improvement. METHODS: During phase 1 (March to April 2020), the ICS-WG performed random audits, recorded incidences of improper IPC practices, and provided advice to the violators. During phase 2 (April to July), the ICCs inspected the hospital units and proposed practical ideas about IPC. The surveillance and proposals targeted the following practices: patient screening, usage of personal protective equipment (PPE), hand and respiratory hygiene, equipment reprocessing, environmental cleaning, management of medical waste, and social distancing. RESULTS: In phase 1, of the 127 violations observed, most (32.3%) corresponded to hand and respiratory hygiene. In phase 2, the highest proportion of violation per category was observed in the management of medical waste (37.8%); among these, a higher proportion of violation (71.4%) was observed in the collection of medical waste. Of the 106 proposals made by the ICCs, the most addressed practice was patient screening (28.3%). No case of nosocomial infection was reported during the study period. CONCLUSION: Adherence to proper hand and respiratory hygiene was inadequate at the early stage of the COVID-19 pandemic. The results indicate that more attention and further training are needed for the management of medical waste, particularly medical waste collection, and that continuous upgrading of the strategies for patient screening is essential. These results will be useful in helping other healthcare facilities to establish their IPC strategies.


Asunto(s)
/prevención & control , Adhesión a Directriz/estadística & datos numéricos , Personal de Salud , Control de Infecciones , Auditoría Clínica , Higiene de las Manos , Humanos , Pandemias , República de Corea
11.
N Z Med J ; 134(1531): 36-54, 2021 03 12.
Artículo en Inglés | MEDLINE | ID: mdl-33767486

RESUMEN

AIM: A number of evidence-based medications are recommended following an acute coronary syndrome (ACS), including statins, antithrombotics (antiplatelet and/or anticoagulants), a beta-blocker and an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACE-I/ARB). This study aimed to describe the dispensing of the cardioprotective medications in the first year following an ACS hospitalisation in New Zealand and how this varies according to age, sex and type of coronary intervention. METHOD: National hospitalisation data was used to identify all New Zealand residents aged 35-79 years who were discharged from hospital in the years 2013/14 with a primary discharge diagnosis of ACS. Using anonymous linkage to national pharmaceutical dispensing and mortality datasets, the dispensing of each group of medications was examined in survivors of quarters one, two and four of the first year post discharge. RESULTS: There were 14,496 patients; mean age was 63.4 years and 68.8% were male. Dispensing of medications in survivors steadily fell across quarters one, two and four: 90.8%, 82.1% and 78.8% of patients were dispensed statins; 90.6%, 79.8% and 78.1% were dispensed aspirin; 82.7%, 72.6% and 70.0% were dispensed beta-blockers; 69.6%, 62.7% and 61.3% were dispensed ACE-I/ARB; 67.7%, 53.6% and 40.4% were dispensed a P2Y12 inhibitor; and 68.6%, 53.0% and 40.7% were dispensed a combination of two or more antithrombotics. CONCLUSION: Cardioprotective medication dispensing was lower than would have been the case if the current ACS guidelines were followed. The greatest decrease in dispensing occurred between quarter one and quarter two, which highlights a potentially important period for targeted interventions to improve adherence.


Asunto(s)
Síndrome Coronario Agudo/tratamiento farmacológico , Cardiotónicos/uso terapéutico , Adhesión a Directriz/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Prevención Secundaria , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Angiografía Coronaria/estadística & datos numéricos , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Factores Sexuales , Adulto Joven
12.
Antimicrob Resist Infect Control ; 10(1): 61, 2021 03 29.
Artículo en Inglés | MEDLINE | ID: mdl-33781341

RESUMEN

OBJECTIVE: The appropriate use of facemasks, recommended or mandated by authorities, is critical to prevent the spread of COVID-19 in the community. We aim to evaluate frequency and quality of facemask use in general populations. METHODS: A multi-site observational study was carried out from June to July 2020 in the west of France. An observer was positioned at a predetermined place, facing a landmark, and all individual passing between the observer and the landmark were included. The observer collected information on facemask use (type, quality of positioning), location and demographic characteristics. RESULTS: A total of 3354 observations were recorded. A facemask was worn by 56.4% (n = 1892) of individuals, including surgical facemasks (56.8%, n = 1075) and cloth masks (43.2%, n = 817). The facemask was correctly positioned in 75.2% (n = 1422) of cases. The factors independently associated with wearing a facemask were being indoors (adjusted odds ratio [aOR], 2.7; 95% confidence interval [CI] 2.28-3.19), being in a mandatory area (aOR, 6.92; 95% CI 5-9.7), female gender (aOR, 1.75; 95% CI 1.54-2.04), age 41-65 years (aOR, 1.7; 95% CI 1.43-2.02) and age > 65 years (aOR, 2.28; 95% CI 1.83-2.85). The factors independently associated with correct mask position were rural location (aOR, 1.38; 95% CI 1.07-1.79), being in an indoor area (aOR, 1.85; 95% CI 1.49-2.3), use of clothmask (aOR, 1.53; 95% CI 1.23-1.91), and age > 40 years (aOR, 1.75 95%CI 1.37-2.23). CONCLUSIONS: During the initial phase of the COVID-19 pandemic, the frequency and quality of facemask wearing remained low in the community setting. Young people in general, and men in particular, represent the priority targets for information campaigns. Simplifying the rules to require universal mandatory facemasking seemed to be the best approach for health authorities.


Asunto(s)
/prevención & control , Control de Enfermedades Transmisibles/instrumentación , Adhesión a Directriz/estadística & datos numéricos , Conductas Relacionadas con la Salud , Máscaras , Adulto , Anciano , Control de Enfermedades Transmisibles/métodos , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Adulto Joven
13.
Ann R Coll Surg Engl ; 103(4): 302-307, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33682433

RESUMEN

INTRODUCTION: The epidemiology of acute paediatric orthopaedic trauma managed surgically across the NHS is poorly described. Compliance against national standards for the management of supracondylar humeral fractures is also unknown at a national level. METHODS: Collaborators in 129 NHS hospitals prospectively collected data on surgically managed acute paediatric orthopaedic trauma cases. Data were collected over a seven-day period and included demographics, injury characteristics, operative details and timing of surgery. A national audit was also undertaken to evaluate compliance with the British Orthopaedic Association Standards for Trauma Guideline 11: Supracondylar Fractures of the Humerus in Children. RESULTS: Data were captured on 770 surgically treated cases. The three most common injuries were forearm fractures of both bones (n = 235), distal radius fractures (n = 194) and supracondylar elbow fractures (n = 89). The mode day of injury was Friday (n = 136) and the mode day of surgery was Saturday (n = 138). 88% of supracondylar fractures received surgery on the day of presentation or the following day. Only 14% of supracondylar fractures were treated surgically after 8pm; 33/89 used 2.0mm Kirschner wires, 38/89 used 1.6mm wires and 2/89 used 1.2mm wires. CONCLUSION: Forearm fractures of both bones, distal radius fractures and supracondylar humeral fractures were the three most common injuries treated surgically. There is wide variation in compliance against national standards in the management of supracondylar humeral fractures with 88% undertaking surgery on the day of or the day following presentation but only 37% using the recommended 2.0mm Kirschner wires.


Asunto(s)
Fijación de Fractura/métodos , Adhesión a Directriz/estadística & datos numéricos , Fracturas del Húmero/epidemiología , Fracturas del Húmero/cirugía , Pautas de la Práctica en Medicina/estadística & datos numéricos , Fracturas del Radio/epidemiología , Fracturas del Radio/cirugía , Adolescente , Niño , Preescolar , Estudios Transversales , Femenino , Fijación de Fractura/estadística & datos numéricos , Humanos , Incidencia , Masculino , Auditoría Médica , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Medicina Estatal , Reino Unido/epidemiología
14.
Mayo Clin Proc ; 96(4): 912-920, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33714601

RESUMEN

OBJECTIVE: To assess the prevalence and characteristics of coronavirus disease 2019 (COVID-19) cases during the reopening period in older adults, given that little is known about the prevalence of COVID-19 after the stay-at-home order was lifted in the United States, nor the actual effects of adherence to recommended public health measures (RPHM) on the risk of COVID-19. PATIENTS AND METHODS: This was a cross-sectional study nested in a parent prospective cohort study, which followed a population-based sample of 2325 adults 50 years and older residing in southeast Minnesota to assess the incidence of viral infections. Participants were instructed to self-collect both nasal and oropharyngeal swabs, which were tested by reverse transcription polymerase chain reaction-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) assay between May 8, 2020, and June, 30, 2020. We assessed the prevalence of COVID-19 cases and characteristics of study subjects. RESULTS: A total of 1505 eligible subjects participated in the study whose mean age was 68 years, with 885 (59%) women, 32 (2%) racial/ethnic minorities, and 906 (60%) with high-risk conditions for influenza. The prevalence of other Coronaviridae (human coronavirus [HCoV]-229E, HCoV-NL63, and HCoV-OC43) during the 2019 to 2020 flu season was 109 (7%), and none tested positive for SARS-CoV-2. Almost all participants reported adhering to the RPHM (1,488 [99%] for social distancing, 1,438 [96%] for wearing mask in a public space, 1,476 [98%] for hand hygiene, and 1,441 (96%) for staying home mostly). Eighty-six percent of participants resided in a single-family home. CONCLUSION: We did not identify SARS-COV-2 infection in our study cohort. The combination of participants' behavior in following the RPHM and their living environment may considerably mitigate the risk of COVID-19.


Asunto(s)
Control de Enfermedades Transmisibles , Adhesión a Directriz/estadística & datos numéricos , Salud Pública , Anciano , /epidemiología , /psicología , /estadística & datos numéricos , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Control de Enfermedades Transmisibles/estadística & datos numéricos , Estudios Transversales , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Humanos , Masculino , Minnesota/epidemiología , Prevalencia , Salud Pública/métodos , Salud Pública/estadística & datos numéricos , Conducta de Reducción del Riesgo , Precauciones Universales/métodos , Precauciones Universales/estadística & datos numéricos , Virología/métodos
15.
PLoS One ; 16(3): e0249392, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33784361

RESUMEN

In the absence of vaccines or causal therapies, behavioral measures such as wearing face masks and maintaining social distance are central to fighting Covid-19. Yet, their benefits are often questioned by the population and the level of adherence to the measures is variable. We examined in representative samples across eight countries (N = 7,568) whether adherence reported around June 1, 2020 predicted the increase in Covid-19 mortality by August 31, 2020. Mortality increased 81.3% in low adherence countries (United States, Sweden, Poland, Russia), 8.4% in high adherence countries (Germany, France, Spain, United Kingdom). Across countries adherence and subsequent mortality increases correlated with r = -0.91. No African or South American countries were included in the present study, which limits the generalizability of the findings. While reported Covid-19 mortality is likely to be influenced by other factors, the almost tenfold difference in additional mortality is significant, and may inform decisions when choosing whether to prioritize individual liberty rights or health-protective measures.


Asunto(s)
/mortalidad , Adhesión a Directriz/estadística & datos numéricos , Conductas Relacionadas con la Salud , Adolescente , Adulto , Femenino , Humanos , Internacionalidad , Masculino , Persona de Mediana Edad , Adulto Joven
16.
BMC Surg ; 21(1): 132, 2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33726715

RESUMEN

BACKGROUND: To identify whether compliance with Enhanced Recovery After Surgery (ERAS) Society recommendations is associated with length of stay (LOS) in a New Zealand hospital for patients undergoing segmental colectomy in mixed acute and elective general surgery wards. METHODS: Consecutive elective colorectal surgeries (n = 770) between October 2012 and February 2019 were audited. Patients with non-segmental colectomies, multi-organ surgeries, LOS > 14 days, and those who died were excluded. Logistic regression was used to determine the relationship between patient demographics, compliance with ERAS guidelines, and suboptimal LOS (> 4 days). RESULTS: Analysis included 376 patients. Age, surgery prior to 2014, surgical approach, non-colorectal surgical team, operation type, and complications were significantly associated with suboptimal LOS. Non-compliance with ERAS recommendations for laparoscopy [OR 8.9, 95% CI (4.52, 19.67)], removal of indwelling catheters (IDC) [OR 3.14, 95% CI (1.85, 5.51)], use of abdominal drains [OR 4.27, 95% CI (0.99, 18.35)], and removal of PCA [OR 8.71, 95% CI (1.78, 157.27)], were associated with suboptimal LOS (univariable analysis). Multivariable analysis showed that age, surgical team, late removal of IDC, and open approach were independent predictors of suboptimal LOS. CONCLUSIONS: Non-compliance with ERAS guidelines for laparoscopic approach and early removal of IDC was higher among procedures performed by non-colorectal surgery teams, and was also associated with adverse postoperative events and suboptimal LOS. This study demonstrates the importance of the surgical team's expertise in affecting surgical outcomes, and did not find significant independent associations between most individual ERAS guidelines and suboptimal LOS once adjusting for other factors.


Asunto(s)
Colectomía , Relaciones Interprofesionales , Grupo de Atención al Paciente , Rol Profesional , Estudios de Cohortes , Procedimientos Quirúrgicos Electivos , Recuperación Mejorada Después de la Cirugía , Adhesión a Directriz/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Nueva Zelanda , Grupo de Atención al Paciente/organización & administración , Guías de Práctica Clínica como Asunto , Resultado del Tratamiento
17.
BMC Public Health ; 21(1): 466, 2021 03 08.
Artículo en Inglés | MEDLINE | ID: mdl-33685426

RESUMEN

BACKGROUND: The high prevalence and mortality of coronavirus disease 2019 (COVID-19) have made it the most important health and social challenge around the world. However, this disease can be largely prevented by adherence to hygienic principles and protective behaviors. It seems that identifying the processes involved in protective health behaviors can be effective in planning and implementing suitable interventions to encourage the community toward protective behaviors. Therefore, the present study aimed to predict the preventive behaviors of COVID-19 according to the Protection Motivation Theory (PMT). METHODS: This cross-sectional study was conducted over 2 months in Hormozgan Province, Iran. The study population consisted of all citizens above the age of 15 years. An online questionnaire was used to collect the data. The questionnaire link was available to the participants through social networks. The questionnaire consisted of two sections, including the demographic information and the PMT constructs. All statistical calculations and hypothesis testing were performed in SPSS Version 21 and AMOS Version 21. The significance level was considered to be 0.05 for hypothesis testing. RESULTS: A total of 2032 subjects, with the mean age of 34.84 ± 9.8 years (r = 15-98), participated in this study. Most of the participants were 31-40 years old, female (60.4%), married (72%), urban residents (87.3%), and employed (58.8%). The majority of them also had a bachelor's degree or higher (58.8%). Significant positive correlations were observed between the preventive behaviors of COVID-19 and the perceived vulnerability (r = 0.192, P < 0.001), perceived severity (r = 0.092, P < 0.001), response efficacy (r = 0.398, P < 0.001), self-efficacy (r = 0.497, P < 0.001), and protection motivation (r = 0.595, P < 0.001). On the other hand, significant negative correlations were found between the preventive behaviors of COVID-19 and maladaptive behavior rewards (r = - 0.243, P < 0.001) and perceived costs (r = - 0.121, P < 0.001). CONCLUSION: The present findings showed that maladaptive behavior reward and fear negatively predicted the protective behaviors. On the other hand, response efficacy and self-efficacy positively predicted the protective behaviors; the impact of self-efficacy was the strongest. Overall, the information provided in this study can contribute to health policymaking in Iran.


Asunto(s)
/prevención & control , Control de Enfermedades Transmisibles/estadística & datos numéricos , Miedo , Adhesión a Directriz/estadística & datos numéricos , Conductas Relacionadas con la Salud , Motivación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Actitud Frente a la Salud , Estudios Transversales , Femenino , Humanos , Irán/epidemiología , Masculino , Persona de Mediana Edad , Autoeficacia , Encuestas y Cuestionarios , Adulto Joven
18.
BMC Surg ; 21(1): 152, 2021 Mar 21.
Artículo en Inglés | MEDLINE | ID: mdl-33743667

RESUMEN

BACKGROUND: Inguinal hernia surgery is a frequent procedure among general surgeons in Costa Rica, but the management and technique are not uniform. The International Guideline for Groin Hernia management was published in 2018 to standardize the inguinal hernia surgery, but the diffusion of the guidelines and its adherence have been extremely varied. PURPOSE: Collect and analyze the current reality regarding groin hernia management in Costa Rica. Secondly evaluate the diffusion and development comparing it to the guideline's recommendations. METHOD: Questionnaire of 42 single and multiple answer questions according to the topics of the International Guideline directed to general surgeons. Diffusion of the inquiry through surgical and hernia association chats and email. Timeframe June-December 2019. RESULTS: 64 surveys were collected, which is a representative number of the general surgeons national college. The most frequent procedure between these was the abdominal wall surgery. Every surgeon did more than 52 groin hernia surgeries in one year, most of them outpatients. The epidural anesthesia was used the most and Lichtenstein's technique was the most frequently used (64%). 68% of the surgeons know how to perform a minimally invasive inguinal hernia surgery but with variable volumes. 38% of participants considered themselves experts in groin hernia management and 52% did not know the 2018 International Guideline. The recommendations of such guideline are followed only partially. CONCLUSIONS: The 2018 Hernia Surge International Guidelines have low diffusion among Costa Rican surgeons. The laparoscopic approach is widely accepted but there are no studies to assess the results and the quality. There should be protocols and studies adapted to Costa Rica's national situation.


Asunto(s)
Ingle/cirugía , Adhesión a Directriz/estadística & datos numéricos , Hernia Inguinal/cirugía , Herniorrafia/métodos , Laparoscopía/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cirujanos , Adulto , Anestesia Local/estadística & datos numéricos , Costa Rica/epidemiología , Femenino , Herniorrafia/normas , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Encuestas y Cuestionarios
19.
Proc Natl Acad Sci U S A ; 118(12)2021 03 23.
Artículo en Inglés | MEDLINE | ID: mdl-33658331

RESUMEN

We evaluate the impacts of implementing and lifting nonpharmaceutical interventions (NPIs) in US counties on the daily growth rate of COVID-19 cases and compliance, measured through the percentage of devices staying home, and evaluate whether introducing and lifting NPIs protecting selective populations is an effective strategy. We use difference-in-differences methods, leveraging on daily county-level data and exploit the staggered introduction and lifting of policies across counties over time. We also assess heterogenous impacts due to counties' population characteristics, namely ethnicity and household income. Results show that introducing NPIs led to a reduction in cases through the percentage of devices staying home. When counties lifted NPIs, they benefited from reduced mobility outside of the home during the lockdown, but only for a short period. In the long term, counties experienced diminished health and mobility gains accrued from previously implemented policies. Notably, we find heterogenous impacts due to population characteristics implying that measures can mitigate the disproportionate burden of COVID-19 on marginalized populations and find that selectively targeting populations may not be effective.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles/métodos , /economía , Control de Enfermedades Transmisibles/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricos , Política de Salud/economía , Política de Salud/tendencias , Humanos , Pandemias , Factores Socioeconómicos , Estados Unidos/epidemiología
20.
Medicine (Baltimore) ; 100(12): e25151, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761684

RESUMEN

ABSTRACT: In 2014, the American College of Cardiology/American Heart Association (ACC/AHA) released guidelines for ordering pre-operative echocardiograms in patients undergoing non-cardiac surgery. The purpose of this study is to determine if pre-operative echocardiograms ordered prior to fragility hip fracture repair are ordered according to these guidelines, change anesthetic management or affect patient outcomes. In addition, we attempted to evaluate the efficacy of the ACC/AHA guidelines.We conducted a 4-year retrospective chart review of acute fragility hip fractures at a single institution. Charts were reviewed to determine which patients met criteria for a pre-operative echocardiogram. Within this group we then compared patients who received a pre-operative echocardiogram to those who did not. Comparisons were made with regard to time to surgery, changes from standard anesthetic management, major adverse cardiac events, length of hospital stay, and 1-year mortality. We also examined which patients received postoperative echocardiograms and the incidence of adverse cardiac events in this group.Of 402 patients, 87 (22%) had ACC/AHA indications for pre-operative echocardiogram, and 42 (48%) of them received one. The indication to order a pre-operative echocardiogram in stable heart failure or valve disease patients if their last echo was greater than 1 year was only followed 23% of the time. In the pre-operative echocardiogram group, anesthetic management was adjusted more frequently (P = .025), and average time to surgery was greater (P < .001). The incidence of a major adverse cardiac event was 10% in the ACC/AHA echocardiogram indicated group and 3% in the non-indicated echocardiogram group. An equal number of echocardiograms were completed postoperatively as were completed under ACC/AHA pre-operative guidelines. Sixty-seven percent of the postoperative echocardiograms did not have ACC/AHA pre-operative indications.Our data demonstrates that pre-operative echocardiograms for "stable heart failure and valvular disease with greater than 1 year from last echocardiogram" is infrequently performed without significant adverse cardiac outcomes. Pre-operative echocardiography was associated with more anesthetic adjustments and longer time to surgery. Postoperative echocardiograms were done for cardiopulmonary complications. Studies need to examine and refine clinical parameters that would improve the selection of patients who would benefit from pre-operative echocardiograms.


Asunto(s)
Ecocardiografía/normas , Cardiopatías/prevención & control , Fracturas de Cadera/diagnóstico por imagen , Fracturas Osteoporóticas/diagnóstico por imagen , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios/normas , Anciano de 80 o más Años , Femenino , Fijación de Fractura/efectos adversos , Fijación de Fractura/normas , Adhesión a Directriz/estadística & datos numéricos , Cardiopatías/epidemiología , Cardiopatías/etiología , Fracturas de Cadera/cirugía , Humanos , Incidencia , Masculino , Fracturas Osteoporóticas/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Medición de Riesgo
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