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1.
Sci Rep ; 11(1): 3354, 2021 02 08.
Artículo en Inglés | MEDLINE | ID: mdl-33558571

RESUMEN

The application, timing, and duration of lockdown strategies during a pandemic remain poorly quantified with regards to expected public health outcomes. Previous projection models have reached conflicting conclusions about the effect of complete lockdowns on COVID-19 outcomes. We developed a stochastic continuous-time Markov chain (CTMC) model with eight states including the environment (SEAMHQRD-V), and derived a formula for the basic reproduction number, R0, for that model. Applying the [Formula: see text] formula as a function in previously-published social contact matrices from 152 countries, we produced the distribution and four categories of possible [Formula: see text] for the 152 countries and chose one country from each quarter as a representative for four social contact categories (Canada, China, Mexico, and Niger). The model was then used to predict the effects of lockdown timing in those four categories through the representative countries. The analysis for the effect of a lockdown was performed without the influence of the other control measures, like social distancing and mask wearing, to quantify its absolute effect. Hypothetical lockdown timing was shown to be the critical parameter in ameliorating pandemic peak incidence. More importantly, we found that well-timed lockdowns can split the peak of hospitalizations into two smaller distant peaks while extending the overall pandemic duration. The timing of lockdowns reveals that a "tunneling" effect on incidence can be achieved to bypass the peak and prevent pandemic caseloads from exceeding hospital capacity.


Asunto(s)
/epidemiología , Modelos Estadísticos , Pandemias , Cuarentena/métodos , Adolescente , Adulto , Anciano , Número Básico de Reproducción , /virología , Canadá/epidemiología , Niño , Preescolar , China/epidemiología , Hospitalización , Humanos , Incidencia , Lactante , Recién Nacido , Cadenas de Markov , México/epidemiología , Persona de Mediana Edad , Niger/epidemiología , Salud Pública , Factores de Tiempo , Adulto Joven
2.
PLoS One ; 16(2): e0246405, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33566813

RESUMEN

The aim of this study was to examine aspects of children's health literacy; the information sources they were accessing, their information preferences, their perceived understanding of and their reported information needs in relation to COVID-19. An online survey for children aged 7-12 years of age and parent/caregivers from the UK, Sweden, Brazil, Spain, Canada and Australia was conducted between 6th of April and the 1st of June 2020. The surveys included demographic questions and both closed and open questions focussing on access to and understanding of COVID-19 information. Descriptive statistics and qualitative content analysis procedures were conducted. The findings show that parents are the main source of information for children during the pandemic in most countries (89%, n = 347), except in Sweden where school was the main source of information. However, in many cases parents chose to shield, filter or adapt their child's access to information about COVID-19, especially in relation to the death rates within each country. Despite this, children in this study reported knowing that COVID-19 was deadly and spreads quickly. This paper argues for a community rather than individual approach to addressing children's health literacy needs during a pandemic.


Asunto(s)
/mortalidad , Alfabetización en Salud/estadística & datos numéricos , Australia/epidemiología , Brasil/epidemiología , /transmisión , Canadá/epidemiología , Niño , Salud del Niño , Estudios Transversales , Femenino , Humanos , Masculino , Sistemas en Línea , Pandemias/estadística & datos numéricos , España/epidemiología , Encuestas y Cuestionarios , Suecia/epidemiología , Reino Unido/epidemiología
3.
PLoS One ; 16(1): e0244537, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33406102

RESUMEN

OBJECTIVES: The unprecedented worldwide social distancing response to COVID-19 resulted in a quick reversal of escalating case numbers. Recently, local governments globally have begun to relax social distancing regulations. Using the situation in Manitoba, Canada as an example, we estimated the impact that social distancing relaxation may have on the pandemic. METHODS: We fit a mathematical model to empirically estimated numbers of people infected, recovered, and died from COVID-19 in Manitoba. We then explored the impact of social distancing relaxation on: (a) time until near elimination of COVID-19 (< one case per million), (b) time until peak prevalence, (c) proportion of the population infected within one year, (d) peak prevalence, and (e) deaths within one year. RESULTS: Assuming a closed population, near elimination of COVID-19 in Manitoba could have been achieved in 4-6 months (by July or August) if there were no relaxation of social distancing. Relaxing to 15% of pre-COVID effective contacts may extend the local epidemic for more than two years (median 2.1). Relaxation to 50% of pre-COVID effective contacts may result in a peak prevalence of 31-38% of the population, within 3-4 months of initial relaxation. CONCLUSION: Slight relaxation of social distancing may immensely impact the pandemic duration and expected peak prevalence. Only holding the course with respect to social distancing may have resulted in near elimination before Fall of 2020; relaxing social distancing to 15% of pre-COVID-19 contacts will flatten the epidemic curve but greatly extend the duration of the pandemic.


Asunto(s)
/psicología , Cuarentena/métodos , Canadá/epidemiología , Trazado de Contacto/métodos , Trazado de Contacto/tendencias , Humanos , Manitoba/epidemiología , Modelos Teóricos , Pandemias/prevención & control , Cuarentena/psicología , /patogenicidad
4.
BMC Public Health ; 21(1): 59, 2021 01 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407303

RESUMEN

BACKGROUND: First-year students entering postsecondary education must navigate a new and complex academic and social environment. Research indicates that this transition and developmental period can be challenging and stressful - academically, emotionally and socially - and that mental health and wellbeing can be compromised. Additionally, mental health disorders can also compromise students' ability to successfully navigate this transition. In the COVID-19 pandemic, the incoming 2020 cohort of first-year students face heightened and new challenges. Most will have spent the conclusion of high school learning virtually, in quarantine, in an uncertain and difficult time, and are then experiencing their first year of university while living, learning and socializing off-campus, virtually and remotely. In response to COVID-19 and with an appreciation of the considerable stresses students face generally and particularly in 2020-21, and the potential effects on mental health and wellbeing, McMaster University, a mid-sized research intensive university with approximately 30,000 students, has developed an innovative program to support students, called Archway. This initiative has been developed to help to prevent and to intervene early to address common transitional issues students experience that can influence mental health and wellbeing, with the ultimate goals of increasing student connectedness, supports, and retention. METHODS: The current study will use a mixed-method design to evaluate Archway and gain a better understanding of the transition into first-year postsecondary for students who engage and participate in Archway at various levels. The study will not only help to determine the effect of this program for students during COVID-19, but it will help us to better understand the challenges of this transition more broadly. DISCUSSION: Findings have the potential to inform future efforts to support students and protect their mental health and wellbeing through the use of virtual and remote platforms and mechanisms that meet their increasingly diverse needs and circumstances.


Asunto(s)
Ajuste Emocional , Promoción de la Salud/métodos , Salud Mental , Estudiantes/psicología , Logro , Canadá/epidemiología , Humanos , Estudios Longitudinales , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa , Estudiantes/estadística & datos numéricos , Universidades
5.
Epidemiol Psychiatr Sci ; 30: e4, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33413716

RESUMEN

AIMS: There is currently no universally accepted measure for population-based surveillance of mood and anxiety disorders. As such, the use of multiple linked measures could provide a more accurate estimate of population prevalence. Our primary objective was to apply Bayesian methods to two commonly employed population measures of mood and anxiety disorders to make inferences regarding the population prevalence and measurement properties of a combined measure. METHODS: We used data from the 2012 Canadian Community Health Survey - Mental Health linked to health administrative databases in Ontario, Canada. Structured interview diagnoses were obtained from the survey, and health administrative diagnoses were identified using a standardised algorithm. These two prevalence estimates, in addition to data on the concordance between these measures and prior estimates of their psychometric properties, were used to inform our combined estimate. The marginal posterior densities of all parameters were estimated using Hamiltonian Monte Carlo (HMC), a Markov Chain Monte Carlo technique. Summaries of posterior distributions, including the means and 95% equally tailed posterior credible intervals, were used for interpretation of the results. RESULTS: The combined prevalence mean was 8.6%, with a credible interval of 6.8-10.6%. This combined estimate sits between Bayesian-derived prevalence estimates from administrative data-derived diagnoses (mean = 7.4%) and the survey-derived diagnoses (mean = 13.9%). The results of our sensitivity analysis suggest that varying the specificity of the survey-derived measure has an appreciable impact on the combined posterior prevalence estimate. Our combined posterior prevalence estimate remained stable when varying other prior information. We detected no problematic HMC behaviour, and our posterior predictive checks suggest that our model can reliably recreate our data. CONCLUSIONS: Accurate population-based estimates of disease are the cornerstone of health service planning and resource allocation. As a greater number of linked population data sources become available, so too does the opportunity for researchers to fully capitalise on the data. The true population prevalence of mood and anxiety disorders may reside between estimates obtained from survey data and health administrative data. We have demonstrated how the use of Bayesian approaches may provide a more informed and accurate estimate of mood and anxiety disorders in the population. This work provides a blueprint for future population-based estimates of disease using linked health data.


Asunto(s)
Trastornos de Ansiedad/epidemiología , Trastornos del Humor/epidemiología , Vigilancia de la Población/métodos , Adolescente , Trastornos de Ansiedad/psicología , Teorema de Bayes , Canadá/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Trastornos del Humor/psicología , Prevalencia
8.
Ann Allergy Asthma Immunol ; 126(1): 83-88.e1, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32950685

RESUMEN

BACKGROUND: Food allergy has a known effect on quality of life (QoL), but this has not been extensively studied during the coronavirus disease 2019 pandemic. OBJECTIVE: To characterize the levels of anxiety of mothers of children aged 0 to 8 years with food allergy compared with families of children without a food allergy and the health-related QoL among children with food allergy during the coronavirus disease 2019 pandemic. METHODS: In a mixed-methods study, Canadian mothers of children aged 0 to 8 years with (cases) and without (controls) food allergy provided demographic data and completed age-appropriate anxiety questionnaires between April 14, 2020, and April 28, 2020. The cases also provided food allergy-related data and completed the Food Allergy Quality of Life Questionnaire. In-depth interviews were subsequently conducted with purposefully selected cases. RESULTS: In a total of 580 participants, 5.5% were cases and 94.5% were controls. For mothers of children aged 0 to 1.5 years, anxiety levels did not differ between cases and controls. For mothers of children aged 1.5 to 8 years, anxiety levels were higher in cases vs controls (P < .05). Among the cases, neither overall nor domain-specific Food Allergy Quality of Life Questionnaire scores differed between age groups (0-3 vs 4-7 years), even after adjustment for confounding variables, including childcare during the pandemic. Qualitatively, the following 3 themes were identified: unexpected challenges of food shopping; less food-related food anxiety during the pandemic; and differences and delays in food allergy testing and therapy. CONCLUSION: Mothers of children with food allergy reported high anxiety and poor health-related QoL. Yet, qualitatively, day-to-day food allergy management was better during the pandemic.


Asunto(s)
Ansiedad/psicología , Hipersensibilidad a los Alimentos/psicología , Pandemias , Calidad de Vida/psicología , Adulto , Ansiedad/diagnóstico , Ansiedad/etiología , Ansiedad/inmunología , /psicología , Canadá/epidemiología , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/inmunología , Humanos , Lactante , Recién Nacido , Masculino , Madres/psicología , Encuestas y Cuestionarios
9.
J Frailty Aging ; 10(1): 31-37, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33331619

RESUMEN

BACKGROUND: Given the important association between cardiovascular disease and cognitive decline, and their significant implications on frailty status, the contribution of neurocognitive frailty measure helping with the assessment of patient outcomes is dearly needed. OBJECTIVES: The present study examines the prognostic value of the Neurocognitive Frailty Index (NFI) in the elderly with cardiovascular disease. DESIGN: Secondary analysis of the Canadian Study of Health and Aging (CSHA) dataset was used for prediction of 5-year cognitive changes. SETTING: Community and institutional sample. PARTICIPANTS: Canadians aged 65 and over [Mean age: 80.4 years (SD=6.9; Range of 66-100)]. MEASUREMENT: Neurocognitive Frailty Index (NFI) and Modified Mini-Mental State (3MS) scores for cognitive functioning of all subjects at follow-up and mortality rate were measured. RESULTS: The NFI mean score was 9.63 (SD = 6.04) and ranged from 0 to 33. This study demonstrated that the NFI was significantly associated with cognitive changes for subjects with heart disease and this correlation was a stronger predictor than age. CONCLUSION: The clinical relevance of this study is that our result supports the prognostic utility of the NFI tool in treatment planning for those with modifiable cardiovascular disease risk factors in the development of dementia.


Asunto(s)
Envejecimiento/psicología , Enfermedades Cardiovasculares/mortalidad , Cognición/fisiología , Fragilidad/psicología , Evaluación Geriátrica/métodos , Anciano , Anciano de 80 o más Años , Canadá/epidemiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/psicología , Envejecimiento Cognitivo , Análisis de Datos , Anciano Frágil/psicología , Humanos , Tasa de Supervivencia
10.
J Urol ; 205(1): 78-85, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32614274

RESUMEN

PURPOSE: The time between radiographic identification of a renal tumor and surgery can be concerning for patients and clinicians due to fears of tumor progression while awaiting treatment. This study aimed to evaluate the association between surgical wait time and oncologic outcomes for patients with renal cell carcinoma. MATERIALS AND METHODS: The Canadian Kidney Cancer Information System is a multi-institutional prospective cohort initiated in January 2011. Patients with clinical stage T1b or greater renal cell carcinoma diagnosed between January 2011 and December 2019 were included in this analysis. Outcomes of interest were pathological up staging, cancer recurrence, cancer specific survival and overall survival. Time to recurrence and death were estimated using Kaplan-Meier estimates and associations were determined using Cox proportional hazards models. RESULTS: A total of 1,769 patients satisfied the study criteria. Median wait times were 54 days (IQR 29-86) for the overall cohort and 81 days (IQR 49-127) for cT1b tumors (1,166 patients), 45 days (IQR 27-71) for cT2 tumors (672 cases) and 35 days (IQR 18-61) for cT3/4 tumors (563). Adjusting for comorbidity, tumor size, grade, histological subtype, margin status and pathological stage, there was no association between prolonged wait time and cancer recurrence or death. CONCLUSIONS: In the context of current surgeon triaging practices surgical wait times up to 24 weeks were not associated with adverse oncologic outcomes after 2 years of followup.


Asunto(s)
Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Recurrencia Local de Neoplasia/epidemiología , Nefrectomía/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Anciano , Canadá/epidemiología , Carcinoma de Células Renales/diagnóstico , Carcinoma de Células Renales/mortalidad , Carcinoma de Células Renales/patología , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Riñón/diagnóstico por imagen , Riñón/patología , Riñón/cirugía , Neoplasias Renales/diagnóstico , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Estadificación de Neoplasias , Nefrectomía/normas , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Radiografía/estadística & datos numéricos , Factores de Tiempo , Tiempo de Tratamiento/normas , Triaje/normas , Triaje/estadística & datos numéricos
11.
BMJ Open ; 10(12): e043805, 2020 12 12.
Artículo en Inglés | MEDLINE | ID: mdl-33310814

RESUMEN

INTRODUCTION: The negative impacts of COVID-19 have rippled through every facet of society. Understanding the multidimensional impacts of this pandemic is crucial to identify the most critical needs and to inform targeted interventions. This population survey study aimed to investigate the acute phase of the COVID-19 outbreak in terms of perceived threats and concerns, occupational and financial impacts, social impacts and stress between 3 April and 15 May 2020. METHODS: 6040 participants are included in this report. A multivariate linear regression model was used to identify factors associated with stress changes (as measured by the Cohen's Perceived Stress Scale (PSS)) relative to pre-outbreak retrospective estimates. RESULTS: On average, PSS scores increased from low stress levels before the outbreak to moderate stress levels during the outbreak (p<0.001). The independent factors associated with stress worsening were: having a mental disorder, female sex, having underage children, heavier alcohol consumption, working with the general public, shorter sleep duration, younger age, less time elapsed since the start of the outbreak, lower stress before the outbreak, worse symptoms that could be linked to COVID-19, lower coping skills, worse obsessive-compulsive symptoms related to germs and contamination, personalities loading on extraversion, conscientiousness and neuroticism, left wing political views, worse family relationships and spending less time exercising and doing artistic activities. CONCLUSION: Cross-sectional analyses showed a significant increase from low to moderate stress during the COVID-19 outbreak. Identified modifiable factors associated with increased stress may be informative for intervention development. TRIAL REGISTRATION NUMBER: NCT04369690; Results.


Asunto(s)
/psicología , Empleo/estadística & datos numéricos , Renta/estadística & datos numéricos , Aislamiento Social , Estrés Psicológico/epidemiología , Adaptación Psicológica , Adulto , Anciano , Canadá/epidemiología , Estudios Transversales , Femenino , Humanos , Modelos Lineales , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Análisis Multivariante , Pandemias/economía , Estudios Prospectivos , Factores de Riesgo , Encuestas y Cuestionarios
14.
JMIR Public Health Surveill ; 6(4): e20343, 2020 12 23.
Artículo en Inglés | MEDLINE | ID: mdl-33315582

RESUMEN

A country's early response to a pandemic is critical for controlling the disease outbreak. During the COVID-19 pandemic, a number of southeast Asian countries adopted centralized, coordinated, rapid, and comprehensive approaches that involved smart technology (the "techno-driven" approach). In comparison, Canada's approach appeared to be decentralized, uncoordinated, and slow, and it focused on educating citizens and enhancing social and human capital (the "human-driven" approach). We propose that in future pandemics, early and coordinated "techno-driven" approaches should receive more careful consideration to curtail outbreaks; however, these approaches must be balanced with protecting individuals' freedoms.


Asunto(s)
/epidemiología , Pandemias/prevención & control , Práctica de Salud Pública , Canadá/epidemiología , Humanos
15.
J Med Internet Res ; 22(12): e24868, 2020 12 30.
Artículo en Inglés | MEDLINE | ID: mdl-33315583

RESUMEN

BACKGROUND: The COVID-19 pandemic has resulted in profound mental health impacts among the general population worldwide. As many in-person mental health support services have been suspended or transitioned online to facilitate physical distancing, there have been numerous calls for the rapid expansion of asynchronous virtual mental health (AVMH) resources. These AVMH resources have great potential to provide support for people coping with negative mental health impacts associated with the pandemic; however, literature examining use prior to COVID-19 illustrates that the uptake of these resources is consistently low. OBJECTIVE: The aim of this paper is to examine the use of AVMH resources in Canada during the COVID-19 pandemic among the general population and among a participant subgroup classified as experiencing an adverse mental health impact related to the pandemic. METHODS: Data from this study were drawn from the first wave of a large multiwave cross-sectional monitoring survey, distributed from May 14 to 29, 2020. Participants (N=3000) were adults living in Canada. Descriptive statistics were used to characterize the sample, and bivariate cross-tabulations were used to examine the relationships between the use of AVMH resources and self-reported indicators of mental health that included a range of emotional and coping-related responses to the pandemic. Univariate and fully adjusted multivariate logistic regression models were used to examine associations between sociodemographic and health-related characteristics and use of AVMH resources in the subgroup of participants who reported experiencing one or more adverse mental health impacts identified in the set of self-reported mental health indicators. RESULTS: Among the total sample, 2.0% (n=59) of participants reported accessing AVMH resources in the prior 2 weeks to cope with stress related to the COVID-19 pandemic, with the highest rates of use among individuals who reported self-harm (n=5, 10.4%) and those who reported coping "not well" with COVID-19-related stress (n=22, 5.5%). Within the subgroup of 1954 participants (65.1% of the total sample) who reported an adverse mental health impact related to COVID-19, 54 (2.8%) reported use of AVMH resources. Individuals were more likely to have used AVMH resources if they had reported receiving in-person mental health supports, were connecting virtually with a mental health worker or counselor, or belonged to a visible minority group. CONCLUSIONS: Despite substantial government investment into AVMH resources, uptake is low among both the general population and individuals who may benefit from the use of these resources as a means of coping with the adverse mental health impacts of the COVID-19 pandemic. Further research is needed to improve our understanding of the barriers to use.


Asunto(s)
/epidemiología , Recursos en Salud , Encuestas Epidemiológicas , Salud Mental/estadística & datos numéricos , Estrés Psicológico/psicología , Estrés Psicológico/terapia , Adaptación Psicológica , Adulto , Canadá/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Pandemias , Autoinforme
16.
BMC Med Inform Decis Mak ; 20(Suppl 10): 271, 2020 12 15.
Artículo en Inglés | MEDLINE | ID: mdl-33319710

RESUMEN

BACKGROUND: The Kentucky Cancer Registry (KCR) is a central cancer registry for the state of Kentucky that receives data about incident cancer cases from all healthcare facilities in the state within 6 months of diagnosis. Similar to all other U.S. and Canadian cancer registries, KCR uses a data dictionary provided by the North American Association of Central Cancer Registries (NAACCR) for standardized data entry. The NAACCR data dictionary is not an ontological system. Mapping between the NAACCR data dictionary and the National Cancer Institute (NCI) Thesaurus (NCIt) will facilitate the enrichment, dissemination and utilization of cancer registry data. We introduce a web-based system, called Interactive Mapping Interface (IMI), for creating mappings from data dictionaries to ontologies, in particular from NAACCR to NCIt. METHOD: IMI has been designed as a general approach with three components: (1) ontology library; (2) mapping interface; and (3) recommendation engine. The ontology library provides a list of ontologies as targets for building mappings. The mapping interface consists of six modules: project management, mapping dashboard, access control, logs and comments, hierarchical visualization, and result review and export. The built-in recommendation engine automatically identifies a list of candidate concepts to facilitate the mapping process. RESULTS: We report the architecture design and interface features of IMI. To validate our approach, we implemented an IMI prototype and pilot-tested features using the IMI interface to map a sample set of NAACCR data elements to NCIt concepts. 47 out of 301 NAACCR data elements have been mapped to NCIt concepts. Five branches of hierarchical tree have been identified from these mapped concepts for visual inspection. CONCLUSIONS: IMI provides an interactive, web-based interface for building mappings from data dictionaries to ontologies. Although our pilot-testing scope is limited, our results demonstrate feasibility using IMI for semantic enrichment of cancer registry data by mapping NAACCR data elements to NCIt concepts.


Asunto(s)
Ontologías Biológicas , Neoplasias , Canadá/epidemiología , Humanos , Internet , Neoplasias/diagnóstico , Neoplasias/epidemiología , Sistema de Registros , Vocabulario Controlado
18.
Curr Oncol ; 27(5): 270-274, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33173379

RESUMEN

The coronavirus disease 2019 (covid-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 has necessitated changes to the way patients with chronic diseases are managed. Given that patients with multiple myeloma are at increased risk of covid-19 infection and related complications, national bodies and experts around the globe have made recommendations for risk mitigation strategies for those vulnerable patients. Understandably, because of the novelty of the virus, many of the proposed risk mitigation strategies have thus far been reactionary and cannot be supported by strong evidence. In this editorial, we highlight some of the risk mitigation strategies implemented at our institutions across Canada during the first wave of covid-19, and we discuss the considerations that should be made when managing patients during the second wave and beyond.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/complicaciones , Mieloma Múltiple/terapia , Neumonía Viral/complicaciones , Guías de Práctica Clínica como Asunto/normas , Telemedicina/métodos , Canadá/epidemiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Manejo de la Enfermedad , Humanos , Mieloma Múltiple/virología , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/virología , Gestión de Riesgos
19.
BMC Infect Dis ; 20(1): 831, 2020 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-33176701

RESUMEN

BACKGROUND: The discovery of antibiotics in the mid-twentieth century marked a major transition in tuberculosis (TB) treatment and control. There are few studies describing the duration of TB disease and its treatment from the pre-chemotherapy era and little data on how these treatments changed in response to the development of effective antibiotics. The goal of this research is to understand how inpatient treatment for high incidence populations, the First Nations peoples of Saskatchewan, Canada, changed in response to increasing availability of antibiotics effective against TB. We expected that as treatment regimens transitioned from convalescence-only to triple antibiotic therapy, the length of inpatient treatment would shorten. METHODS: Analyses were performed on records of sanatoria admissions and discharges occurring between 1933 and 1959 in Saskatchewan, Canada. Year of antibiotic discovery was taken as a proxy for treatment regimen: no chemotherapy (pre-1944), mono-therapy (Streptomycin, 1944-1946), dual-therapy (Streptomycin and PAS, 1946-1952), and triple-therapy (Streptomycin, PAS, and INH 1952-). A pooled linear regression of log-transformed length of first admission as predicted by year of admission was modeled to assess the relationship between admission length and year of admission, corrected for clinical and demographic variables. RESULTS: First admission length increased 19% in the triple-therapy era as compared to the pre-chemotherapy era, from 316 days (10.4 months) to 377 days (12.4 months). After the discovery of INH (1952), we find statistically significant increases in the proportion of successfully completed therapies (0.55 versus 0.60, p = 0.035), but also in patients who left hospital against medical advice (0.19 versus 0.29, p < 0.0001), indicating that as hospitalizations lengthened, more patients chose to discharge without the sanction of their physician. The readmission rate increased from 10 to 50% of all admissions while the province-level TB-specific death rate fell from 63.1 per 10,000 in 1933 to 4.7 per 10,000 in 1958. CONCLUSION: Counterintuitively, we find that the length of first admissions increased with the discovery of TB-treating antibiotics. Increasing admission volume and readmission rate indicate an intensification of inpatient TB treatment during this era. These analyses provide a novel estimate of the effect of changing treatment policy on sanatorium admissions in this population.


Asunto(s)
Antibacterianos/uso terapéutico , Tiempo de Internación/tendencias , Readmisión del Paciente/tendencias , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Canadá/epidemiología , Niño , Preescolar , Femenino , Hospitales , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Alta del Paciente , Estudios Retrospectivos , Resultado del Tratamiento , Tuberculosis/microbiología , Adulto Joven
20.
J Anxiety Disord ; 76: 102327, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33137601

RESUMEN

BACKGROUND: Many psychological factors play a role in the COVID-19 pandemic, including various forms of worry, avoidance, and coping. Adding to the complexity, some people believe the threat of COVID-19 is exaggerated. We used network analysis to investigate how these diverse elements are interrelated. METHODS: A population-representative sample of 3075 American and Canadian adults completed an online survey, including measures of COVID-19-related worry, avoidance, self-protective behaviors, and other variables. RESULTS: The network contained three major hubs, replicated across gender and age groups. The most important hub centered around worries about the dangerousness of COVID-19, and formed the core of the previously identified COVID Stress Syndrome. The second most important hub, which was negatively correlated with the first hub, centered around the belief that the COVID-19 threat is exaggerated, and was associated with disregard for social distancing, poor hand hygiene, and anti-vaccination attitudes. The third most important hub, which was linked to the first hub, centered around COVID-19-related compulsive checking and reassurance-seeking, including self-protective behaviors such as panic buying and use of personal protective equipment. CONCLUSION: Network analysis showed how various forms of worry, avoidance, coping, and other variables are interrelated. Implications for managing disease and distress are discussed.


Asunto(s)
Adaptación Psicológica , Ansiedad/epidemiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Adolescente , Adulto , Anciano , Actitud , Canadá/epidemiología , Conducta Compulsiva , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Pánico , Equipo de Protección Personal , Estrés Psicológico/epidemiología , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Vacunas Virales , Adulto Joven
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