Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 41.858
Filtrar
1.
PLoS One ; 15(11): e0241327, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33137155

RESUMEN

OBJECTIVE: Poor housing conditions have been linked with worse health outcomes and infectious disease spread. Since the relationship of poor housing conditions with incidence and mortality of COVID-19 is unknown, we investigated the association between poor housing condition and COVID-19 incidence and mortality in US counties. METHODS: We conducted cross-sectional analysis of county-level data from the US Centers for Disease Control, US Census Bureau and John Hopkins Coronavirus Resource Center for 3135 US counties. The exposure of interest was percentage of households with poor housing conditions (one or greater of: overcrowding, high housing cost, incomplete kitchen facilities, or incomplete plumbing facilities). Outcomes were incidence rate ratios (IRR) and mortality rate ratios (MRR) of COVID-19 across US counties through 4/21/2020. Multilevel generalized linear modeling (with total population of each county as a denominator) was utilized to estimate relative risk of incidence and mortality related to poor housing conditions with adjustment for population density and county characteristics including demographics, income, education, prevalence of medical comorbidities, access to healthcare insurance and emergency rooms, and state-level COVID-19 test density. We report incidence rate ratios (IRRs) and mortality ratios (MRRs) for a 5% increase in prevalence in households with poor housing conditions. RESULTS: Across 3135 US counties, the mean percentage of households with poor housing conditions was 14.2% (range 2.7% to 60.2%). On April 21st, the mean (SD) number of cases and deaths of COVID-19 were 255.68 (2877.03) cases and 13.90 (272.22) deaths per county, respectively. In the adjusted models standardized by county population, with each 5% increase in percent households with poor housing conditions, there was a 50% higher risk of COVID-19 incidence (IRR 1.50, 95% CI: 1.38-1.62) and a 42% higher risk of COVID-19 mortality (MRR 1.42, 95% CI: 1.25-1.61). Results remained similar using earlier timepoints (3/31/2020 and 4/10/2020). CONCLUSIONS AND RELEVANCE: Counties with a higher percentage of households with poor housing had higher incidence of, and mortality associated with, COVID-19. These findings suggest targeted health policies to support individuals living in poor housing conditions should be considered in further efforts to mitigate adverse outcomes associated with COVID-19.


Asunto(s)
Infecciones por Coronavirus/patología , Neumonía Viral/patología , Clase Social , Adulto , Anciano , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Estudios Transversales , Composición Familiar , Femenino , Vivienda , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Neumonía Viral/virología , Riesgo , Estados Unidos/epidemiología , Adulto Joven
2.
JAMA Netw Open ; 3(10): e2026064, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33104209

RESUMEN

Importance: An immediate research priority is to investigate and monitor the psychological well-being among high-risk groups during the coronavirus disease 2019 (COVID-19) pandemic. Objective: To examine levels of severity of depressive symptoms over time among individuals with high risk in the UK during the COVID-19 pandemic. Design, Setting, and Participants: This cohort study is part of an ongoing large panel study of adults aged 18 years and older residing in the UK, the COVID-19 Social Study, established on March 21, 2020. Data analysis was conducted in May 2020. Exposures: Sociodemographic risk factors included belonging to the Black, Asian, and minority racial/ethnic communities, low socioeconomic position (SEP), and essential worker roles (eg, workers in health and social care, education, childcare, or key public services). Health-related and psychosocial risk factors included preexisting physical and mental health conditions, experience of psychological or physical abuse, and low social support. Main Outcomes and Measures: Depressive symptoms were measured on 7 occasions from March 21 to April 2, 2020, using the 9-item Patient Health Questionnaire (PHQ-9). Group-based depressive symptom trajectories were derived using latent growth mixture modeling. Results: The analytical sample comprised 51 417 adults aged 18 years and older (mean [SD] age, 48.8 [16.8] years; 26 276 [51.1%] women; 6145 members [12.0%] of Black, Asian, and minority racial/ethnic communities). Among these, 17 143 participants (33.3%) were in the lowest SEP quartile, and 11 342 participants (22.1%) were classified as essential workers. Three levels of severity of depressive symptoms were identified: low (30 850 participants [60.0%]), moderate (14 911 participants [29.0%]), and severe (5656 participants [11.0%]). After adjusting for covariates, experiences of physical or psychological abuse (odds ratio [OR], 13.16; 95% CI, 12.95-13.37; P < .001), preexisting mental health conditions (OR, 12.99; 95% CI, 12.87-13.11; P < .001), preexisting physical health conditions (OR, 3.41; 95% CI, 3.29-3.54; P < .001), low social support (OR, 12.72; 95% CI, 12.57-12.86; P < .001), and low SEP (OR, 5.22; 95% CI, 5.08-5.36; P < .001) were significantly associated with severe depressive symptoms. No significant association was found for race/ethnicity (OR, 1.07; 95% CI, 0.85-1.28; P = .56). Participants with essential worker roles were less likely to experience severe depressive symptoms (OR, 0.66; 95% CI, 0.53-0.80; P < .001). Similar patterns of associations were found for the group of participants with moderate depressive symptoms (abuse: OR, 5.34; 95% CI, 5.15-5.54; P < .001; mental health condition: OR, 4.24; 95% CI, 4.24-4.24; P < .001; physical health condition: OR, 1.89; 95% CI, 1.80-1.98; P < .001; low social support: OR, 4.71; 95% CI, 4.60-4.82; P < .001; low SEP: OR, 1.97; 95% CI, 1.87-2.08; P < .001). Conclusions and Relevance: In this cohort study of UK adults participating in the COVID-19 Social Study, people with psychosocial and health-related risk factors, as well as those with low SEP, were at the most risk of experiencing moderate or severe depressive symptoms during the COVID-19 pandemic.


Asunto(s)
Infecciones por Coronavirus/psicología , Depresión , Trastorno Depresivo , Estado de Salud , Pandemias , Neumonía Viral/psicología , Índice de Severidad de la Enfermedad , Clase Social , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , Estudios de Cohortes , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/etnología , Infecciones por Coronavirus/virología , Depresión/epidemiología , Depresión/etiología , Trastorno Depresivo/epidemiología , Trastorno Depresivo/etiología , Empleo , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Neumonía Viral/epidemiología , Neumonía Viral/etnología , Neumonía Viral/virología , Grupos de Población/psicología , Factores de Riesgo , Reino Unido , Adulto Joven
3.
Maturitas ; 141: 33-38, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33036700

RESUMEN

Earlier menopause onset has been linked to a greater risk of cardiovascular disease. Both menopause onset and cardiovascular disease risk vary by geographical region, race/ethnicity and socioeconomic status. As such, it is plausible to hypothesize that these factors may influence the association of menopause onset and cardiovascular disease risk. Taking a global approach, this narrative review focuses on how geographic, racial/ethnic and socioeconomic factors might influence menopause onset, mainly natural menopause, and possibly its association with cardiovascular disease risk. The contribution of genetic factors to menopause onset variation is also summarized. A clear gap in the literature has been identified. Several meta-analyses have assessed the question of whether menopause onset is related to cardiovascular disease risk by combining large populations of diverse racial/ethnic backgrounds and socioeconomic status across wide geographical regions. None of these analyses adequately assessed how these factors might modify the association of menopause onset and cardiovascular disease risk. Testing such a question requires the study of a large group of women of diverse racial/ethnic backgrounds across different geographical locations with good documentation of their socioeconomic status, clinical and environmental factors. The increasing evidence supporting age at menopause onset as a marker of overall health calls for worldwide efforts to implement a standardized approach to define age at menopause in both the clinical and the research fields.


Asunto(s)
Enfermedades Cardiovasculares/etnología , Menopausia/etnología , Grupos Étnicos , Femenino , Humanos , Clase Social , Factores Socioeconómicos
4.
PLoS One ; 15(10): e0239766, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33052947

RESUMEN

Millions of people worldwide use online learning for post-secondary education and professional development, but participation from historically underrepresented groups remains low. Their choices to enroll in online courses can be influenced by course features that signal anticipated success and belonging, which motivates research to identify features associated with sociodemographic variation in enrollments. This pre-registered field study of 1.4 million enrollments in 159 online courses across 20 institutions identifies features that predict enrollment patterns in terms of age, gender, educational attainment, and socioeconomic status. Among forty visual and verbal features, course discipline, stated requirements, and presence of gender cues emerge as significant predictors of enrollment, while instructor skin color, linguistic style of course descriptions, prestige markers, and references to diversity do not predict who enrolls. This suggests strategic changes to how courses are presented to improve diversity and inclusion in online education.


Asunto(s)
Instrucción por Computador/estadística & datos numéricos , Curriculum/estadística & datos numéricos , Educación a Distancia/estadística & datos numéricos , Adulto , Femenino , Humanos , Masculino , Clase Social
5.
Int J Equity Health ; 19(1): 184, 2020 10 19.
Artículo en Inglés | MEDLINE | ID: mdl-33076929

RESUMEN

In healthcare, we find an industry that typifies the unique blend of racism, classism, and other forms of structural discrimination that comprise the U.S. caste system-the artificially-constructed and legally-reinforced social hierarchy for assigning worth and determining opportunity for individuals based on race, class, and other factors. Despite myths of meritocracy, healthcare is actually a casteocracy; and conversations about racism in healthcare largely occupy an echo chamber among the privileged upper caste of hospital professionals. To address racism in healthcare, we must consider the history that brought us here and understand how we effectively perpetuate an employee caste system within our own walls.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud/organización & administración , Neumonía Viral/epidemiología , Racismo/prevención & control , Clase Social , Humanos , Pandemias , Estados Unidos/epidemiología
6.
Medicine (Baltimore) ; 99(43): e22967, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120860

RESUMEN

Oral health can affect or be a manifestation of general health. Although oral health assessment has been used as a proxy for general health, few studies have reported an association between oral health status and allergic diseases. This cross-sectional study aimed to investigate the relationship between subjective oral health status and asthma/allergic rhinitis in a nationwide representative sample of Korean adults.A total of 227,977 participants from the Korean Community Health Survey 2015 were enrolled. Participants were asked about their subjective oral health status (very good, good, normal, poor, very poor), periodontal status (mobility, swelling, calculus, bleeding), teeth brushing frequency, and scaling history within the past 12 months. Histories of physician-diagnosed asthma and allergic rhinitis throughout life were surveyed. The associations between subjective oral health status and allergic diseases were analyzed using multiple logistic regression analysis. Age, sex, economic level, educational level, region of residence, smoking, alcohol, obesity, subjective general health status, stress level, physical activity, periodontal status, teeth brushing frequency, and scaling history within the past 12 months were adjusted as covariates.A higher prevalence of asthma (3.6%) was reported in the poor oral health group than in the good (1.8%) and normal (2.1%) groups (P < .001). Poor oral health status was significantly related to asthma, with an adjusted odds ratio (aOR) of 1.19 (95% CI = 1.07-1.33, P = .002). Although the prevalence of allergic rhinitis was not higher in the poor oral health group (13.4%) than in the good (15.4%) and normal oral health groups (15.9%), the aOR for allergic rhinitis was 1.05 (95% CI = 1.00-1.11, P = .045) in the poor oral health group after adjusting for covariates.Subjective poor oral health status was significantly associated with asthma and allergic rhinitis in Korean adults.


Asunto(s)
Asma/epidemiología , Salud Bucal/estadística & datos numéricos , Rinitis Alérgica/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Estudios Transversales , Femenino , Encuestas Epidemiológicas/métodos , Humanos , Masculino , Persona de Mediana Edad , Salud Bucal/tendencias , Prevalencia , República de Corea/epidemiología , Clase Social
8.
Zootaxa ; 4789(1): zootaxa.4789.1.12, 2020 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-33056454

RESUMEN

Gastrotermes spinatus gen. n. sp. n is described from workers of a single foraging group collected in Cameroon. This soil-feeding termite aligns with the Labidotermes subgroup (Apicotermes group) because of its non-protruding and symmetrical enteric valve armature, its short P1, and its globular P3a. An asymmetrical field of robust sclerotized spines at the opening of the P3a is unique among the other Labidotermes subgroup genera.


Asunto(s)
Isópteros , Animales , Clase Social , Suelo
9.
Medicine (Baltimore) ; 99(40): e22538, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019462

RESUMEN

The current studies revealed inconsistent relationship between reproductive factors and osteoarthritis. Community-based research has not been conducted in China. The study was to examine the association of reproductive factors with the prevalence of knee osteoarthritis (OA).Through a multistage stratified random sampling method, 10 streets or villages from 5 cities in Hunan province were randomly selected, a total 2746 eligible women aged 50 to 83 were recruited in this cross-sectional study. A structured questionnaire including demographic factors, socio-economic status, reproductive factors, and knee OA was used. According to the criteria of American College of Rheumatology, clinical knee OA was assessed by doctors in community or village health clinics for knee pain, age, morning stiffness, crepitus on active motion or for knee pain, morning stiffness, crepitus on active motion, and tenderness of the bony navigation of the joint. Self-reported age of menarche, parity, abortion history, and menopausal status were collected.The prevalence of knee OA was 13.44%. Abortion is associated with knee OA (odds ratio [OR] = 1.271, 95% confidence interval [CI] = 1.007, 1.606), but age at menarche, parity, and menopausal status were not the factors. Furthermore, age (OR = 1.040, 95% CI = 1.020, 1.060), weight (OR = 1.019, 95% CI = 1.004, 1.035), higher education level (OR = 1.530, 95% CI = 1.121, 2.088), higher monthly household income (OR = .583, 95% CI = 0.441, 0.770 for 3000-4999 ¥ and OR = 0.599, 95% CI = 0.431, 0.833 for 5000 ¥ or more), and chronic gastritis (OR = 3.364, 95% CI = 2.548, 4.442) were associated with knee OA.Abortion may increase the risk of knee OA. Special attention should be paid to women with a history of abortion, and women who are planning to abort should be informed of the risk of knee OA later in life. The relationship between abortion and knee OA should be interpreted with caution and further confirmed.


Asunto(s)
Aborto Espontáneo/epidemiología , Osteoartritis de la Rodilla/epidemiología , Osteoartritis de la Rodilla/etiología , Anciano , Anciano de 80 o más Años , China/epidemiología , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/patología , Dolor/diagnóstico , Dolor/epidemiología , Prevalencia , Radiografía/métodos , Medición de Riesgo , Autoinforme , Clase Social , Encuestas y Cuestionarios
10.
Prev Chronic Dis ; 17: E124, 2020 10 08.
Artículo en Inglés | MEDLINE | ID: mdl-33034555

RESUMEN

Miami-Dade County zip code-level (N = 91 zip codes) coronavirus disease 2019 (COVID-19) cases (N = 89,556 as of July 21, 2020) reported from the Florida Department of Health were used to estimate rates of COVID-19 per 1,000 population at the census block group level (N = 1,594 study block groups). To identify associations between rates of COVID-19 infections and multidimensional indexes of social determinants of health (SDOH) across Miami-Dade County, Florida, I applied a global model (ordinary least squares) and a local regression model (geographically weighted regression). Findings indicated that a social disadvantage index positively affected COVID-19 infection rates, whereas a socioeconomic status and opportunity index and a convergence of vulnerability index had an inverse but significant connection to COVID-19 infection rates over the study area. Rates of COVID-19 infections were localized to specific geographic areas and ranged from 0 to 60.75 per 1,000 population per square mile.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Clase Social , Determinantes Sociales de la Salud , Florida/epidemiología , Humanos , Pandemias , Análisis de Regresión , Factores de Riesgo , Factores Socioeconómicos
11.
Indian J Dent Res ; 31(4): 515-519, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33107449

RESUMEN

Aim: To assess the association between Individual deprivation measure with dental anxiety and socioeconomic status among patients visiting dentists in Chennai city, Tamil Nadu. Methods: A cross-sectional study was conducted among 50 patients aged 18-70 years who visited a private dental institution. Data on socio-demographics and detailed history about dental visits were obtained. Dental anxiety was measured using Corah Dental Anxiety Scale along with Individual deprivation measure questionnaire. Data were analysed using SPSS package 20. Descriptive statistics and one-way ANOVA were used for statistical analysis. Results: A total of 50 patients were enrolled in the study, 38% belonged to 31-40 years of age, 56% were male, 16% postponed dental visit due to dental anxiety, 54% belonged to upper middle class and 64% of the subjects had moderate anxiety. In all, 71.9% of the subjects with moderate anxiety were not deprived and 88.9% of upper middle class subjects were not deprived. Significant association was found between socioeconomic status and dental anxiety with Individual deprivation measure with a P < 0.05. Increasing socioeconomic status was associated with more deprivation and dental anxiety was higher among less deprived patients. Conclusion: Individual deprivation measure was associated with dental anxiety. Less deprived and higher socioeconomic class population had a significant higher dental anxiety.


Asunto(s)
Ansiedad al Tratamiento Odontológico , Clase Social , Adolescente , Adulto , Anciano , Estudios Transversales , Ansiedad al Tratamiento Odontológico/epidemiología , Odontólogos , Femenino , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Adulto Joven
12.
BMC Infect Dis ; 20(1): 762, 2020 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-33066737

RESUMEN

BACKGROUND: Clostridioides difficile infection (CDI) is commonly associated with outcomes like recurrence and readmission. The effect of social determinants of health, such as 'neighborhood' socioeconomic disadvantage, on a CDI patient's health outcomes is unclear. Living in a disadvantaged neighborhood could interfere with a CDI patient's ability to follow post-discharge care recommendations and the success probability of these recommendations, thereby increasing risk of readmission. We hypothesized that neighborhood disadvantage was associated with 30-day readmission risk in Medicare patients with CDI. METHODS: In this retrospective cohort study, odds of 30-day readmission for CDI patients are evaluated controlling for patient sociodemographics, comorbidities, and hospital and stay-level variables. The cohort was created from a random 20% national sample of Medicare patients during the first 11 months of 2014. RESULTS: From the cohort of 19,490 patients (39% male; 80% white; 83% 65 years or older), 22% were readmitted within 30 days of an index stay. Unadjusted analyses showed that patients from the most disadvantaged neighborhoods were readmitted at a higher rate than those from less disadvantaged neighborhoods (26% vs. 21% rate: unadjusted OR = 1.32 [1.20, 1.45]). This relationship held in adjusted analyses, in which residence in the most disadvantaged neighborhoods was associated with 16% increased odds of readmission (adjusted OR = 1.16 [1.04, 1.28]). CONCLUSIONS: Residence in disadvantaged neighborhoods poses a significantly increased risk of readmission in CDI patients. Further research should focus on in-depth assessments of this population to better understand the mechanisms underlying these risks and if these findings apply to other infectious diseases.


Asunto(s)
Infecciones por Clostridium/epidemiología , Clostridium difficile , Readmisión del Paciente , Características de la Residencia , Clase Social , Adolescente , Adulto , Cuidados Posteriores , Anciano , Infecciones por Clostridium/microbiología , Femenino , Humanos , Tiempo de Internación , Masculino , Medicare , Persona de Mediana Edad , Alta del Paciente , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos , Adulto Joven
14.
Am J Respir Crit Care Med ; 202(7): e95-e112, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33000953

RESUMEN

Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.


Asunto(s)
Toma de Decisiones Conjunta , Detección Precoz del Cáncer/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Neoplasias Pulmonares/diagnóstico , Fumar/etnología , Determinación de la Elegibilidad , Grupos Étnicos/estadística & datos numéricos , Costos de la Atención en Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Ciencia de la Implementación , Cobertura del Seguro , Comercialización de los Servicios de Salud/métodos , Medicaid , Pacientes no Asegurados/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Derivación y Consulta/estadística & datos numéricos , Factores Sexuales , Fumar/epidemiología , Fumar/terapia , Cese del Hábito de Fumar/estadística & datos numéricos , Clase Social , Estados Unidos
15.
Ann Emerg Med ; 76(4): 413-426, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33012377

RESUMEN

STUDY OBJECTIVE: Emergency medical services (EMS) may serve as a key source of real-time data about the evolving health of coronavirus disease 2019 (COVID-19)-affected populations, especially in low- and middle-income countries with less rapid and reliable vital statistics registration systems. Although official COVID-19 statistics in Mexico report almost exclusively inhospital mortality events, excess out-of-hospital mortality has been identified in other countries, including 1 EMS study in Italy that showed a 58% increase. Additionally, EMS and hospital reports from several countries have suggested that silent hypoxemia-low Spo2 in the absence of dyspnea-is associated with COVID-19. It is unclear, however, how these phenomena can be generalized to low- and middle-income countries. We assess how EMS data can be used in a sentinel capacity in Tijuana, a city on the Mexico-United States border with earlier exposure to COVID-19 than many low- and middle-income country settings. METHODS: In this observational study, we calculated numbers of weekly out-of-hospital deaths and respiratory cases handled by EMS in Tijuana, and estimated the difference between peak epidemic rates and expected trends based on data from 2014 to 2019. Results were compared with official COVID-19 statistics, stratified by neighborhood socioeconomic status, and examined for changing demographic or clinical features, including mean Spo2. RESULTS: An estimated 194.7 excess out-of-hospital deaths (95% confidence interval 135.5 to 253.9 deaths) occurred during the peak window (April 14 to May 11), representing an increase of 145% (95% CI 70% to 338%) compared with expected levels. During the same window, only 5 COVID-19-related out-of-hospital deaths were reported in official statistics. This corresponded with an increase in respiratory cases of 236.5% (95% CI 100.7% to 940.0%) and a decrease in mean Spo2 to 77.7% from 90.2% at baseline. The highest out-of-hospital death rates were observed in low-socioeconomic-status areas, although respiratory cases were more concentrated in high-socioeconomic-status areas. CONCLUSION: EMS systems may play an important sentinel role in monitoring excess out-of-hospital mortality and other trends during the COVID-19 crisis in low- and middle-income countries. Using EMS data, we observed increases in out-of-hospital deaths in Tijuana that were nearly 3-fold greater than increases reported in EMS data in Italy. Increased testing in out-of-hospital settings may be required to determine whether excess mortality is being driven by COVID-19 infection, health system saturation, or patient avoidance of health care. We also found evidence of worsening rates of hypoxemia among respiratory patients treated by EMS, suggesting a possible increase in silent hypoxemia, which should be met with increased detection and clinical management efforts. Finally, we observed social disparities in out-of-hospital death that warrant monitoring and amelioration.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Servicios Médicos de Urgencia/estadística & datos numéricos , Hipoxia/virología , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , Niño , Preescolar , Registros Electrónicos de Salud , Femenino , Humanos , Lactante , Masculino , México/epidemiología , Persona de Mediana Edad , Pandemias , Vigilancia en Salud Pública , Clase Social , Adulto Joven
16.
Int J Biol Sci ; 16(15): 2895-2905, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33061804

RESUMEN

Background: There are more than 258 million international migrants worldwide and the majority reside in countries with ongoing novel coronavirus disease 2019 (COVID-19) epidemic outbreaks. International migrants may not receive adequate and timely disease information during epidemics, increasing vulnerability to disease transmission. This is one of very limited studies focusing on international migrants' COVID-19 prevention knowledge and attitudes during the epidemic. Methods: A national cross-sectional online survey was conducted across 100 cities and 26 regions in China from February 17 and March 1, 2020. The sample included 1,426 international migrants representing 77 countries and 6 continents. Knowledge was defined as the number of correct responses to questions about COVID-19. Attitudes included worries, expectations, and general preparedness. Multivariable ordinal logistic regressions evaluated correlates of knowledge and attitudes including information channels and preferences, and trust in Chinese institutions and groups. Results: Just half of the sample, 730/1426 (51.2%) had a good level of knowledge and 656/1426 (46.0%) had a positive attitude towards the COVID-19 epidemic. Knowledge was associated with receiving information through social media (aOR: 2.0, 95%CI: 1.2-3.2), the Internet (aOR: 1.4, 95%CI: 1.2-1.8), the community (aOR: 1.5, 95%CI: 1.2-1.8), and encountering language barriers when receiving medical services (aOR: 0.8, 95%CI: 0.7-1.0). Positive attitude was associated with the level of trust in various Chinese institutions and groups. Conclusions: Roughly half of the sample reported inadequate knowledge and poor attitudes toward prevention and control of COVID-19. Tailored public health campaigns are needed to ensure that international migrants possess adequate knowledge to protect their health during future epidemics and disasters.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Emigrantes e Inmigrantes , Conocimientos, Actitudes y Práctica en Salud , Neumonía Viral/epidemiología , Adolescente , Adulto , Actitud , Betacoronavirus , China/epidemiología , Estudios Transversales , Grupos Étnicos , Femenino , Humanos , Internacionalidad , Internet , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pandemias , Proyectos Piloto , Clase Social , Encuestas y Cuestionarios , Confianza , Adulto Joven
18.
PLoS One ; 15(9): e0238627, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32915831

RESUMEN

People often form perceptions about how prevalent a behavior is in a social group. However, these perceptions can be inaccurate and biased. While persistent undesirable practices in low-income countries have drawn global attention, evidence regarding people's perception of how prevalent these practices are is scarce. Among those harmful practices, open defecation in India remains a significant public health concern, where it perpetuates the vicious cycle of disease and poverty. In this study, we focus on measuring the perceived prevalence of open defecation among respondents in Bihar, India. We examined the bias in perceived prevalence, which is defined as a pattern of deviation from the actual prevalence of open defecation. Results showed that respondents who defecate in the open overestimate the prevalence of open defecation, whereas those who consistently use toilets underestimate it. This finding suggests a false consensus bias in the perceived prevalence of open defecation. Scholars, policymakers, and program implementers who seek to correct misperceptions about open defecation by broadcasting real prevalence should be aware of biases in the perceived prevalence and address them in behavior change interventions.


Asunto(s)
Defecación/ética , Salud Pública/normas , Saneamiento/normas , Conducta Social , Adolescente , Adulto , Anciano , Atención/fisiología , Defecación/fisiología , Femenino , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Salud Pública/tendencias , Clase Social , Encuestas y Cuestionarios , Adulto Joven
19.
PLoS One ; 15(9): e0239031, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32941493

RESUMEN

BACKGROUND: Identifying determinants of health and understanding their role in health production constitutes an important research theme. We aimed to document the state of recent multi-country research on this theme in the literature. METHODS: We followed the PRISMA-ScR guidelines to systematically identify, triage and review literature (January 2013-July 2019). We searched for studies that performed cross-national statistical analyses aiming to evaluate the impact of one or more aggregate level determinants on one or more general population health outcomes in high-income countries. To assess in which combinations and to what extent individual (or thematically linked) determinants had been studied together, we performed multidimensional scaling and cluster analysis. RESULTS: Sixty studies were selected, out of an original yield of 3686. Life-expectancy and overall mortality were the most widely used population health indicators, while determinants came from the areas of healthcare, culture, politics, socio-economics, environment, labor, fertility, demographics, life-style, and psychology. The family of regression models was the predominant statistical approach. Results from our multidimensional scaling showed that a relatively tight core of determinants have received much attention, as main covariates of interest or controls, whereas the majority of other determinants were studied in very limited contexts. We consider findings from these studies regarding the importance of any given health determinant inconclusive at present. Across a multitude of model specifications, different country samples, and varying time periods, effects fluctuated between statistically significant and not significant, and between beneficial and detrimental to health. CONCLUSIONS: We conclude that efforts to understand the underlying mechanisms of population health are far from settled, and the present state of research on the topic leaves much to be desired. It is essential that future research considers multiple factors simultaneously and takes advantage of more sophisticated methodology with regards to quantifying health as well as analyzing determinants' influence.


Asunto(s)
Indicadores de Salud , Salud/estadística & datos numéricos , Salud/tendencias , Tasa de Natalidad , Demografía , Países Desarrollados , Países en Desarrollo , Economía , Empleo , Humanos , Renta , Esperanza de Vida , Política , Dinámica Poblacional , Clase Social , Factores Socioeconómicos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA