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1.
J Med Internet Res ; 23(2): e25429, 2021 02 09.
Artículo en Inglés | MEDLINE | ID: mdl-33523826

RESUMEN

BACKGROUND: As the number of COVID-19 cases increased precipitously in the United States, policy makers and health officials marshalled their pandemic responses. As the economic impacts multiplied, anecdotal reports noted the increased use of web-based crowdfunding to defray these costs. OBJECTIVE: We examined the web-based crowdfunding response in the early stage of the COVID-19 pandemic in the United States to understand the incidence of initiation of COVID-19-related campaigns and compare them to non-COVID-19-related campaigns. METHODS: On May 16, 2020, we extracted all available data available on US campaigns that contained narratives and were created between January 1 and May 10, 2020, on GoFundMe. We identified the subset of COVID-19-related campaigns using keywords relevant to the COVID-19 pandemic. We explored the incidence of COVID-19-related campaigns by geography, by category, and over time, and we compared the characteristics of the campaigns to those of non-COVID-19-related campaigns after March 11, when the pandemic was declared. We then used a natural language processing algorithm to cluster campaigns by narrative content using overlapping keywords. RESULTS: We found that there was a substantial increase in overall GoFundMe web-based crowdfunding campaigns in March, largely attributable to COVID-19-related campaigns. However, as the COVID-19 pandemic persisted and progressed, the number of campaigns per COVID-19 case declined more than tenfold across all states. The states with the earliest disease burden had the fewest campaigns per case, indicating a lack of a case-dependent response. COVID-19-related campaigns raised more money, had a longer narrative description, and were more likely to be shared on Facebook than other campaigns in the study period. CONCLUSIONS: Web-based crowdfunding appears to be a stopgap for only a minority of campaigners. The novelty of an emergency likely impacts both campaign initiation and crowdfunding success, as it reflects the affective response of a community. Crowdfunding activity likely serves as an early signal for emerging needs and societal sentiment for communities in acute distress that could be used by governments and aid organizations to guide disaster relief and policy.


Asunto(s)
/epidemiología , Colaboración de las Masas/estadística & datos numéricos , Apoyo Financiero , /economía , Costo de Enfermedad , Estudios Transversales , Colaboración de las Masas/economía , Gobierno , Humanos , Narración , Procesamiento de Lenguaje Natural , Pandemias , Estados Unidos/epidemiología
2.
Orv Hetil ; 162(7): 269-279, 2021 02 14.
Artículo en Húngaro | MEDLINE | ID: mdl-33582650

RESUMEN

Összefoglaló. Bevezetés: A kutatócsoport 99 fo, cerebralis paresisben (CP) szenvedo gyermek (8-18 éves) önállóan közölt életminoségét értékelte, és az eredményeket összehasonlította egy 237 fos kontrollcsoport adataival, amelyek hasonló életkorú, egészséges általános populációhoz tartozó gyermekektol származtak. Célkituzés: A kutatás célja annak megismerése volt, hogy a CP-ben szenvedo gyermekek hogyan vélekednek egészségi állapotukról és társadalmi helyzetükrol. Módszer: Életminoség-kérdoív alkalmazása. Betegségspecifikus és társadalmi-demográfiai mutatók mérése, kiértékelése. Eredmények: Az CP-ben szenvedo gyermekek és szüleik az egészséggel kapcsolatos életminoséget rosszabbnak ítélték meg, mint társaik. Eredményeink azt mutatják, hogy a noi nem, a rosszabb motoros funkció és a komorbiditások (epilepszia, incontinentia és intellektuális károsodás) negatív hatású. A szüloi vélemény alkalmas volt proxyjelentésként a korreláció mért erossége miatt. Figyelemre méltó, hogy az agyi bénulás típusai közül az egyoldali spasticus CP-ben szenvedo gyermekek életminoség-értéke a legalacsonyabb. A válaszadók valószínuleg a test két oldala között lévo funkcionális különbséget érezték. A szellemi fogyatékosság a betegpopuláció több mint felénél fordult elo. Testvéreik között a mentális betegség 5,7-szer gyakoribb. A CP-s gyerekek családi környezete sokkal hátrányosabb volt, mint az egészséges gyermekeké. A kutatás eredményei alapján megállapítható, hogy a szülo alacsonyabb iskolai végzettsége és munkaeropiaci inaktivitása, valamint az egyszülos család a CP-s gyerekeknél szignifikánsan magasabb arányban fordult elo, és ezek a tényezok negatív hatást gyakoroltak az életminoségre. Következtetés: A fogyatékkal élo gyermekek életminoségét a betegség és a szociodemográfiai környezet egyaránt befolyásolja. Orv Hetil. 2021; 162(7): 269-279. INTRODUCTION: Self-reported health-related quality of life (HRQoL) of 99 children (8-18 years) with cerebral palsy (CP) was assessed and compared with 237, age-matched healthy control children from the general population. OBJECTIVE: The aim was to find out the opinions of children with CP about their health status and social condition. METHOD: Assessment of quality of life questionnaire was carried out. Measurements of disease-specific and sociodemographic variables were done. RESULTS: Children with CP and their parents rated HRQoL poorer than their counterparts. Our results show that female sex, worse gross motor function and comorbidities (epilepsy, incontinence and intellectual impairment) had negative impact. The parental opinion was suitable as proxy report because of the measured strength of the correlation. Among the types of CP, interestingly, children with unilateral spastic CP had the poorest HRQoL. They were likely to feel a functional difference between the two sides of the body. Intellectual disability occurred in more than half of our patient population. Among their siblings, mental illness is 5.7 times more common. The family environment was much more disadvantageous than in the case of healthy children. As our study shows, lower education, inactive status in the labour market and single-parent family occurred at a much higher rate and worsened the quality of life. CONCLUSION: Quality of life of children with disability was influenced by both the sociodemographic background and the disease. Orv Hetil. 2021; 162(7): 269-279.


Asunto(s)
Parálisis Cerebral/psicología , Costo de Enfermedad , Calidad de Vida/psicología , Factores Socioeconómicos , Niño , Femenino , Humanos , Masculino , Perfil de Impacto de Enfermedad , Encuestas y Cuestionarios
3.
BMC Health Serv Res ; 21(1): 132, 2021 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-33573650

RESUMEN

This study aimed to estimate both direct medical and indirect costs of treating the Coronavirus disease 2019 (COVID-19) from a societal perspective in the patients at a referral hospital in Fars province as well as the economic burden of COVID-19 in Iran in 2020. METHODS: This study is a partial economic evaluation and a cross-sectional cost-description study conducted based on the data of the COVID-19 patients referred to a referral university hospital in Fars province between March and July 2020. The data were collected by examining the patients' records and accounting information systems. The subjects included all the inpatients with COVID-19 (477 individuals) who admitted to the medical centre during the 4 months. Bottom-up costing (also called micro-costing approach), incidence-based and income-based human capital approaches were used as the main methodological features of this study. RESULTS: The direct medical costs were estimated to be 28,240,025,968 Rials ($ 1,791,172) in total with mean cost of 59,203,409 Rials ($ 3755) per person (SD = 4684 $/ 73,855,161 Rials) in which significant part (41%) was that of intensive and general care beds (11,596,217,487 Rials equal to $ 735,510 (M = 24,310,728 Rials or $ 1542, SD = 34,184,949 Rials or $ 2168(. The second to which were the costs of medicines and medical consumables (28%). The mean indirect costs, including income loss due to premature death, economic production loss due to hospitalization and job absenteeism during recovery course were estimated to be 129,870,974 Rials ($ 11,634) per person. Furthermore, the economic burden of the disease in the country for inpatient cases with the definitive diagnosis was 22,688,925,933,095 Rials equal to $ 1,439,083,784. CONCLUSION: The results of this study showed that the severe status of the disease would bring about the extremely high cost of illness in this case. It is estimated that the high prevalence rate of COVID-19 has been imposing a heavy economic burden on the country and health system directly that may result in rationing or painful cost-control approaches.


Asunto(s)
/economía , Costo de Enfermedad , Absentismo , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Hospitales Universitarios/economía , Humanos , Incidencia , Renta/estadística & datos numéricos , Irán/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Derivación y Consulta , Adulto Joven
4.
Bull World Health Organ ; 99(2): 112-124, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33551505

RESUMEN

Objective: To estimate the economic cost of coronavirus disease 19 (COVID-19) in 31 provincial-level administrative regions and in total, in China. Methods: We used data from government reports, clinical guidelines and other publications to estimate the main cost components of COVID-19 during 1 January-31 March 2020. These components were: identification and diagnosis of close contacts; suspected cases and confirmed cases of COVID-19; treatment of COVID-19 cases; compulsory quarantine of close contacts and suspected cases; and productivity losses for all affected residents. Primary outcomes were total health-care and societal costs. Findings: The total estimated health-care and societal costs associated with COVID-19 were 4.26 billion Chinese yuan (¥; 0.62 billion United States dollars, US$) and ¥ 2646.70 billion (US$ 383.02 billion), respectively. Inpatient care accounted for 44.2% (¥ 0.95 billion/¥ 2.15 billion) of routine health-care costs followed by medicines, accounting for 32.5% (¥ 0.70 billion/¥ 2.15 billion). Productivity losses accounted for 99.8% (¥ 2641.61 billion/¥ 2646.70 billion) of societal costs, which were mostly attributable to the effect of movement-restriction policies on people who did not have COVID-19. Societal costs were most sensitive to salary costs and number of working days lost due to movement-restriction policies. Hubei province had the highest health-care cost while Guangdong province had the highest societal cost. Conclusion: Our results highlight the high economic burden of the COVID-19 outbreak in China. The control measures to prevent the spread of disease resulted in substantial costs from productivity losses amounting to 2.7% (US$ 382.29 billion/US$ 14.14 trillion) of China's annual gross domestic product.


Asunto(s)
/economía , Costo de Enfermedad , Pandemias/economía , China , Eficiencia , Producto Interno Bruto , Costos de la Atención en Salud , Humanos , Modelos Económicos
5.
Medicina (Kaunas) ; 57(1)2021 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-33430175

RESUMEN

Background and objectives: To explore the impacts that Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) has on the patient and their family members using the WHOQOL-BREF (Abbreviated World Health Organisation Quality of Life questionnaire) and FROM-16 (Family Reported Outcome Measure-16) quality of life assessments. Materials and Methods: A quantitative research study using postal questionnaires was conducted. A total of 39 adult volunteers expressed an interest in participating in the study: 24 returned appropriately completed questionnaires. Patients with ME/CFS completed the WHOQOL-BREF and up to four of their family members completed the FROM-16 questionnaire. Results: ME/CFS negatively affects the quality of life of the patient (median scores WHOQOL-BREF: Physical health = 19, Psychological = 44, Social relationships = 37.5, Environment = 56, n = 24) and their family members' quality of life (FROM-16: Emotional = 9.5, Personal and social = 11.5, Overall = 20.5, n = 42). There was a significant correlation between the patient's reported quality of life scores and their family members' mean FROM-16 total scores. Conclusions: This study identifies the major impact that having an adult family member with ME/CFS has on the lives of partners and of other family members. Quality of life of ME/CFS patients was reduced most by physical health compared to the other domains. Quality of life of family members was particularly impacted by worry, family activities, frustration and sadness. This highlights the importance of measuring the impact on the lives of family members using tools such as the FROM-16 in the ME/CFS clinical encounter and ensuring appropriate support is widely available to family members.


Asunto(s)
Familia/psicología , Síndrome de Fatiga Crónica/fisiopatología , Calidad de Vida , Adolescente , Adulto , Niños Adultos/psicología , Anciano , Anciano de 80 o más Años , Costo de Enfermedad , Emociones , Síndrome de Fatiga Crónica/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Padres/psicología , Esposos/psicología , Adulto Joven
10.
PLoS Negl Trop Dis ; 15(1): e0008958, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33395425

RESUMEN

The SARS-CoV-2 virus has spread rapidly around the globe. Nevertheless, there is limited information describing the characteristics and outcomes of COVID-19 patients in Latin America. We conducted a cross-sectional analysis of 9,468 confirmed COVID-19 cases reported in Ecuador. We calculated overall incidence, mortality, case fatality rates, disability adjusted life years, attack and crude mortality rates, as well as relative risk and relative odds of death, adjusted for age, sex and presence of comorbidities. A total of 9,468 positive COVID-19 cases and 474 deaths were included in the analysis. Men accounted for 55.4% (n = 5, 247) of cases and women for 44.6% (n = 4, 221). We found the presence of comorbidities, being male and older than 65 years were important determinants of mortality. Coastal regions were most affected by COVID-19, with higher mortality rates than the highlands. Fatigue was reported in 53.2% of the patients, followed by headache (43%), dry cough (41.7%), ageusia (37.1%) and anosmia (36.1%). We present an analysis of the burden of COVID-19 in Ecuador. Our findings show that men are at higher risk of dying from COVID-19 than women, and risk increases with age and the presence of comorbidities. We also found that blue-collar workers and the unemployed are at greater risk of dying. These early observations offer clinical insights for the medical community to help improve patient care and for public health officials to strengthen Ecuador's response to the outbreak.


Asunto(s)
/mortalidad , Brotes de Enfermedades , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Costo de Enfermedad , Estudios Transversales , Ecuador/epidemiología , Femenino , Geografía , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Persona de Mediana Edad , Ocupaciones , Factores de Riesgo , Distribución por Sexo , Clase Social , Evaluación de Síntomas , Desempleo , Adulto Joven
11.
Ecotoxicol Environ Saf ; 209: 111856, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33412383

RESUMEN

BACKGROUND: Exposure to fine particulate matter (PM2.5) is one of the leading contributors to disease burden. However, little is known about the spatial and temporal trends of the disease burden attributable to PM2.5 in the three major economies in East Asia. We aimed to estimate the patterns and temporal variations of the disease burden attributable to PM2.5 in China, Japan, and South Korea from 1990 to 2017. METHODS: We obtained data on disease burden attributable to PM2.5 from the Global Burden of Disease Study (GBD) 2017. We retrieved the numbers and age-standardized mortality rate (ASMR) and disability-adjusted life years (DALYs) rate (ASDR) of disease attributable to PM2.5 by age, sex, socio-demographic index (SDI), and country. We used percentage change and estimated annual percentage change (EAPC) to assess the trends of ASMR and ASDR attributable to PM2.5 between 1990 and 2017. We further calculated the contribution of population growth, population aging, and changes in mortality or DALYs rate to the net changes in total deaths and DALYs associated with PM2.5. RESULTS: We found considerable differences in the disease burden attributable to PM2.5 in China, Japan, and South Korea. In 2017, the ASMR and ASDR of disease attributable to PM2.5 in China were 49.37 (95% UI: 41.18, 57.5) per 100,000 population and 1065.9 (95% UI: 891.28, 1237.38) per 100,000 population, respectively, which was about four times higher than that of Japan and twice higher than that of South Korea. Regardless of country, the ASMR and ASDR were more pronounced among elders and males. From 1990 to 2017, the declines in ASMR and ASDR were more pronounced in Japan and South Korea than in China. The changes in PM2.5 associated total deaths and DALYs between 1990 and 2017 were the combined effects of population aging, population growth, and changes in mortality or DALY rate, resulting in a net increase in total deaths and DALYs in China but little changes in Japan and South Korea. CONCLUSIONS: PM2.5 still contributed to significant disease burdens in 2017, although age-standardized disease burden has declined from 1990 to 2017. There has been an increasing trend in total deaths and DALYs in China, which was primarily driven by population aging.


Asunto(s)
Exposición a Riesgos Ambientales/estadística & datos numéricos , Estado de Salud , Material Particulado/análisis , Anciano , Preescolar , China , Costo de Enfermedad , Personas con Discapacidad , Femenino , Carga Global de Enfermedades/tendencias , Humanos , Japón , Masculino , Persona de Mediana Edad , Años de Vida Ajustados por Calidad de Vida , República de Corea , Factores de Riesgo
12.
PLoS One ; 16(1): e0244920, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33417613

RESUMEN

BACKGROUND: The COVID-19 virus impacts human health and the world economy, causing in Peru, more than 800 thousand infected and a strong recession expressed in a drop of -12% in its economic growth rate for 2020. In this context, the objective of the study is to analyze the dynamics of the short-term behavior of economic activity, as well as to explain the causal relationships in a Pandemic context based on the basic number of spread (Re) of COVID-19 per day. METHODS: An Autoregressive Distributed Lags (ARDL) model was used. RESULTS: A negative and statistically significant impact of the COVID-19 shock was found on the level of economic activity and a long-term Cointegration relationship with an error correction model (CEM), with the expected sign and statistically significant at 1%. CONCLUSION: The Pandemic has behaved as a systemic shock of supply and aggregate demand at the macroeconomic level, which together have an impact on the recession or level of economic activity. The authors propose changing public health policy from an indiscriminate suppression strategy to a targeted, effective and intelligent mitigation strategy that minimizes the risk of human life costs and socioeconomic costs, in a context of uncertainty about the end of the Pandemic and complemented by economic, fiscal and monetary policies that mitigate the economic recession, considering the underlying structural characteristics of the Peruvian economy.


Asunto(s)
/economía , Desarrollo Económico , Recesión Económica , Modelos Económicos , Costo de Enfermedad , Humanos , Pandemias , Perú
13.
N C Med J ; 82(1): 14-20, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33397749

RESUMEN

BACKGROUND Patients with cancer are at risk for both objective and subjective financial distress. Financial distress during treatment is adversely associated with physical and mental well-being. Little is known about whether patients' subjective financial distress changes during the course of their treatment.method This is a cross-sectional study of insured adults with solid tumors on anti-cancer therapy for ≥1 month, surveyed at a referral center and three rural oncology clinics. The goal was to investigate how financial distress varies depending on where patients are in the course of cancer therapy. Financial distress (FD) was assessed via a validated measure; out-of-pocket (OOP) costs were estimated and medical records were reviewed for disease/treatment data. Logistic regression was used to evaluate the potential association between treatment length and financial distress.RESULTS Among 300 participants (86% response rate), median age was 60 years (range 27-91), 52.3% were male, 78.3% had stage IV cancer or metastatic recurrence, 36.7% were retired, and 56% had private insurance. Median income was $60,000/year and median OOP costs including insurance premiums were $592/month. Median FD score (7.4/10, SD 2.5) corresponded to low FD with 16.3% reporting high/overwhelming distress. Treatment duration was not associated with the odds of experiencing high/overwhelming FD in single-predictor (OR = 1.01, CI [.93, 1.09], P = .86) or multiple predictor regression models (OR = .98, CI [.86, 1.12], P = .79). Treatment duration was not correlated with FD as a continuous variable (P = .92).LIMITATIONS This study is limited by its cross-sectional design and generalizability to patients with early-stage cancer and those being treated outside of a major referral center.CONCLUSION Severity of cancer treatment-related financial distress did not correlate with time on treatment, indicating that patients are at risk for FD throughout the treatment continuum. Screening for and addressing financial distress should occur throughout the course of cancer therapy.


Asunto(s)
Gastos en Salud , Neoplasias , Adulto , Anciano , Anciano de 80 o más Años , Costo de Enfermedad , Estudios Transversales , Femenino , Humanos , Renta , Masculino , Persona de Mediana Edad , Neoplasias/terapia
14.
Epilepsy Behav ; 115: 107491, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33323340

RESUMEN

OBJECTIVE: Epilepsy is a neurologic disease that carries a high disease burden and likely, a huge treatment gap especially in low-to-middle income countries (LMIC) such as the Philippines. This review aimed to examine the treatment gaps and challenges that burden Philippine epilepsy care. MATERIALS & METHODS: Pertinent data on epidemiology, research, health financing and health systems, pharmacologic and surgical treatment options, cost of care, and workforce were obtained through a literature search and review of relevant Philippine government websites. RESULTS: The estimated prevalence of epilepsy in the Philippines is 0.9%. Epilepsy research in the Philippines is low in quantity compared with the rest of Southeast Asia (SEA). Inequities in quality and quantity of healthcare services delivered to local government units (LGUs) have arisen because of devolution. Programs for epilepsy care by both government and nongovernment institutions have been implemented. Healthcare expenditure in the Philippines is still largely out-of-pocket, with only partial coverage from the public sector. There is limited access to antiseizure medications (ASMs), mainly due to cost. Epilepsy surgery is an underutilized treatment option. There are only 20 epileptologists in the Philippines, with one epileptologist for every 45,000 patients with epilepsy. In addition, epilepsy care service delivery has been further impeded by the coronavirus disease of 2019 (COVID-19) pandemic. CONCLUSION: There is a large treatment gap in epilepsy care in the Philippines in terms of high epilepsy disease burden, socioeconomic limitations and inadequate public support, sparse clinico-epidemiologic research on epilepsy, inaccessibility of health care services and essential pharmacotherapy, underutilization of surgical options, and lack of specialists capable of rendering epilepsy care. Acknowledgment of the existence of these treatment gaps and addressing such are expected to improve the overall survival and quality of life of patients with epilepsy in the Philippines.


Asunto(s)
/prevención & control , Costo de Enfermedad , Epilepsia/terapia , Accesibilidad a los Servicios de Salud/tendencias , Programas Nacionales de Salud/tendencias , Anticonvulsivantes/economía , Anticonvulsivantes/uso terapéutico , /epidemiología , Países en Desarrollo/economía , Epilepsia/economía , Epilepsia/epidemiología , Servicios de Salud/economía , Servicios de Salud/tendencias , Accesibilidad a los Servicios de Salud/economía , Humanos , Programas Nacionales de Salud/economía , Filipinas/epidemiología , Calidad de Vida
15.
Int J Nurs Stud ; 114: 103811, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33352440

RESUMEN

INTRODUCTION: There are no publicly available national data on healthcare worker infections in Australia. It has been documented in many countries that healthcare workers (HCW) are at increased occupational risk of COVID-19. We aimed to estimate the burden of COVID-19 on Australia HCW and the health system by obtaining and organizing data on HCW infections, analyzing national HCW cases in regards to occupational risk and analyzing healthcare outbreak. METHODS: We searched government reports and websites and media reports to create a comprehensive line listing of Australian HCW infections and nosocomial outbreaks between January 25th and July 8th, 2020. A line list of HCW related COVID-19 reported cases was created and enhanced by matching data extracted from media reports of healthcare related COVID-19 relevant outbreaks and reports, using matching criteria. Rates of infections and odds ratios (ORs) for HCW were calculated per state, by comparing overall cases to HCW cases. To investigate the sources of infection amongst HCW, transmission data were collated and graphed to show distribution of sources. RESULTS: We identified 36 hospital outbreaks or HCW infection reports between January 25th and July 8th, 2020. According to our estimates, at least 536 HCW in Australia had been infected with COVID-19, comprising 6.03% of all reported infections. The rate of HCW infection was 90/100000 and of community infection 34/100,000. HCW were 2.69 times more likely to contract COVID-19 (95% CI 2.48 to 2.93; P < 0.001). The timing of hospital outbreaks did not always correspond to community peaks. Where data were available, a total of 131 HCW across 21 outbreaks led to 1656 HCW being furloughed for quarantine. In one outbreak, one hospital was closed and 1200 HCW quarantined. CONCLUSION: The study shows that HCW were at nearly 3 times the risk of infection. Of concern, this nearly tripling of risk occurred during a period of low community prevalence suggesting failures at multiple hazard levels including PPE policies within the work environment. Even in a country with relatively good control of COVID-19, HCW are at greater risk of infection than the general community and nosocomial outbreaks can have substantial effects on workforce capacity by the quarantine of numerous HCW during an outbreak. The occurrence of hospital outbreaks even when community incidence was low highlights the high risk setting that hospitals present. Australia faced a resurgence of COVID-19 after the study period, with multiple hospital outbreaks. We recommend formal reporting of HCW infections, testing protocols for nosocomial outbreaks, cohorting of workforce to minimize the impact, and improved PPE guidelines to provide precautionary and optimal protection for HCW.


Asunto(s)
/epidemiología , Brotes de Enfermedades , Personal de Salud/estadística & datos numéricos , Enfermedades Profesionales/epidemiología , Australia , Costo de Enfermedad , Hospitales , Humanos , Programas Nacionales de Salud , Enfermedades Profesionales/virología , Exposición Profesional , Pandemias , Prevalencia , Factores de Riesgo
16.
J Public Health Manag Pract ; 27 Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward: S43-S56, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32956299

RESUMEN

OBJECTIVE: To overcome the absence of national, state, and local public health data on the unequal economic and social burden of COVID-19 in the United States. DESIGN: We analyze US county COVID-19 deaths and confirmed COVID-19 cases and positive COVID-19 tests in Illinois and New York City zip codes by area percent poverty, percent crowding, percent population of color, and the Index of Concentration at the Extremes. SETTING: US counties and zip codes in Illinois and New York City, as of May 5, 2020. MAIN OUTCOME MEASURES: Rates, rate differences, and rate ratios of COVID-19 mortality, confirmed cases, and positive tests by category of county and zip code-level area-based socioeconomic measures. RESULTS: As of May 5, 2020, the COVID-19 death rate per 100 000 person-years equaled the following: 143.2 (95% confidence interval [CI]: 140.9, 145.5) vs 83.3 (95% CI: 78.3, 88.4) in high versus low poverty counties (≥20% vs <5% of persons below poverty); 124.4 (95% CI: 122.7, 126.0) versus 48.2 (95% CI: 47.2, 49.2) in counties in the top versus bottom quintile for household crowding; and 127.7 (95% CI: 126.0, 129.4) versus 25.9 (95% CI: 25.1, 26.6) for counties in the top versus bottom quintile for the percentage of persons who are people of color. Socioeconomic gradients in Illinois confirmed cases and New York City positive tests by zip code-level area-based socioeconomic measures were also observed. CONCLUSIONS: Stark social inequities exist in the United States for COVID-19 outcomes. We recommend that public health departments use these straightforward cost-effective methods to report on social inequities in COVID-19 outcomes to provide an evidence base for policy and resource allocation.


Asunto(s)
/epidemiología , Costo de Enfermedad , Grupos Étnicos/estadística & datos numéricos , Renta/estadística & datos numéricos , Gobierno Local , Pandemias/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores Socioeconómicos , Estudios Transversales , Humanos , Illinois/epidemiología , Ciudad de Nueva York/epidemiología , Factores Raciales , Estados Unidos/epidemiología
17.
Psychiatry Res ; 296: 113648, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33348199

RESUMEN

This study sought to examine if mental health issues, namely depression and anxiety symptoms, and loneliness were experienced differently according to various demographic groups during the COVID-19 pandemic (i.e., a societal stressor). An online survey, comprising demographic questions and questionnaires on depression, anxiety and loneliness symptoms, was distributed in Canada during the height of social distancing restrictions during the COVID-19 pandemic. Respondents (N=661) from lower income households experienced greater anxiety, depression and loneliness. Specifically, loneliness was greater in those with an annual income <$50,000/yr versus higher income brackets. Younger females (18-29yr) displayed greater anxiety, depressive symptoms and loneliness than their male counterparts; this difference did not exist among the other age groups (30-64yr, >65yr). Moreover, loneliness scores increased with increasing depression and anxiety symptom severity category. The relationship between loneliness and depression symptoms was moderated by gender, such that females experienced higher depressive symptoms when encountering greater loneliness. These data identify younger females, individuals with lower income, and those living alone as experiencing greater loneliness and mental health challenges during the height of the pandemic in Canada. We highlight the strong relationship between loneliness, depression and anxiety, and emphasize increased vulnerability among certain cohorts.


Asunto(s)
Trastornos de Ansiedad/psicología , Trastorno Depresivo/psicología , Soledad/psicología , Determinantes Sociales de la Salud , Adulto , Factores de Edad , Anciano , Trastornos de Ansiedad/diagnóstico , Canadá , Costo de Enfermedad , Trastorno Depresivo/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos , Adulto Joven
18.
Eur Heart J ; 42(5): 520-528, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33321517

RESUMEN

AIMS: Our objective was to determine the ventricular arrhythmia burden in implantable cardioverter-defibrillator (ICD) patients during COVID-19. METHODS AND RESULTS: In this multicentre, observational, cohort study over a 100-day period during the COVID-19 pandemic in the USA, we assessed ventricular arrhythmias in ICD patients from 20 centres in 13 states, via remote monitoring. Comparison was via a 100-day control period (late 2019) and seasonal control period (early 2019). The primary outcome was the impact of COVID-19 on ventricular arrhythmia burden. The secondary outcome was correlation with COVID-19 incidence. During the COVID-19 period, 5963 ICD patients underwent remote monitoring, with 16 942 episodes of treated ventricular arrhythmias (2.8 events per 100 patient-days). Ventricular arrhythmia burden progressively declined during COVID-19 (P < 0.001). The proportion of patients with ventricular arrhythmias amongst the high COVID-19 incidence states was significantly reduced compared with those in low incidence states [odds ratio 0.61, 95% confidence interval (CI) 0.54-0.69, P < 0.001]. Comparing patients remotely monitored during both COVID-19 and control periods (n = 2458), significantly fewer ventricular arrhythmias occurred during COVID-19 [incident rate ratio (IRR) 0.68, 95% CI 0.58-0.79, P < 0.001]. This difference persisted when comparing the 1719 patients monitored during both the COVID-19 and seasonal control periods (IRR 0.69, 95% CI 0.56-0.85, P < 0.001). CONCLUSIONS: During COVID-19, there was a 32% reduction in ventricular arrhythmias needing device therapies, coinciding with measures of social isolation. There was a 39% reduction in the proportion of patients with ventricular arrhythmias in states with higher COVID-19 incidence. These findings highlight the potential role of real-life stressors in ventricular arrhythmia burden in individuals with ICDs. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry; URL: https://www.anzctr.org.au/; Unique Identifier: ACTRN12620000641998.


Asunto(s)
Arritmias Cardíacas/epidemiología , Desfibriladores Implantables , Fibrilación Ventricular/epidemiología , Adulto , Anciano , Arritmias Cardíacas/etiología , Arritmias Cardíacas/terapia , /prevención & control , Costo de Enfermedad , Femenino , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico , Pandemias , Factores Protectores , Sistema de Registros , Factores de Riesgo , Estrés Psicológico , Telemedicina , Estados Unidos/epidemiología , Fibrilación Ventricular/etiología , Fibrilación Ventricular/terapia
19.
Support Care Cancer ; 29(1): 349-358, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32361832

RESUMEN

PURPOSE: Fighting cancer is a costly battle, and understanding the relationship between patient-reported financial toxicity (FT) and health outcomes can help inform interventions for post-treatment cancer survivors. METHODS: Stages I-III solid tumor, insured US cancer survivors (N = 103) completed a survey addressing FT (as measured by the standardized COST measure) and clinically relevant health outcomes (including health-related quality of life [HRQOL] and adherence to recommended survivorship health behaviors). Univariate and multivariate analyses were used to assess demographic and disease-specific correlates of FT, and to assess the predictive value of FT on HRQOL and adherence to survivorship health behaviors. RESULTS: Approximately 18% of respondents noted FT levels associated with significant financial burden. In univariate analyses, after correcting for multiple comparisons, greater FT was associated with unpartnered status, non-retirement, and lower level of educational attainment. Greater FT was also significantly associated with HRQOL components of anxiety, fatigue, pain, physical functioning, and social functioning. FT was not significantly associated with any measured survivorship health behaviors. In multivariate analyses, FT was found to be a meaningful predictor of patient-reported anxiety, fatigue, physical functioning, and social functioning above and beyond theoretically and statistically relevant demographic characteristics. CONCLUSIONS: Although overall levels of FT were lower among cancer survivors in this sample, as compared with active treatment patients assessed in previous studies, financial burden continued to be a concern for a significant minority of cancer survivors and was associated with components of reduced HRQOL. Further research is needed to understand FT among underinsured survivors and those treated in community oncology settings. IMPLICATIONS FOR CANCER SURVIVORS: Incorporation of FT assessment into survivorship care planning could enhance clinical assessment of survivors' FT vulnerability, help address the dynamic and persistent challenges of survivorship, and help identify those most in need of intervention across the cancer care continuum.


Asunto(s)
Supervivientes de Cáncer/psicología , Costo de Enfermedad , Gastos en Salud , Neoplasias/economía , Calidad de Vida/psicología , Adulto , Ansiedad/psicología , Fatiga/psicología , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Persona de Mediana Edad , Grupos Minoritarios , Neoplasias/terapia , Medición de Resultados Informados por el Paciente , Encuestas y Cuestionarios , Supervivencia
20.
Med Clin North Am ; 105(1): 55-73, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33246523

RESUMEN

Primary care physicians frequently evaluate patients with constipation. The history is crucial in uncovering warning symptoms and signs that warrant colonoscopy. Particular elements in the history and rectal examination also can provide clues regarding the underlying etiology. Regardless of etiology, lifestyle modifications, fiber, and laxatives are first-line therapies. Patients who fail first-line therapies can be offered second-line treatments and/or referred for testing of defecatory function. In those with severely refractory symptoms, referrals to a gastroenterologist and a surgeon should be considered.


Asunto(s)
Estreñimiento/diagnóstico , Estreñimiento/tratamiento farmacológico , Adulto , Colonoscopía , Estreñimiento/etiología , Estreñimiento/fisiopatología , Costo de Enfermedad , Fibras de la Dieta/uso terapéutico , Tacto Rectal , Femenino , Humanos , Laxativos/uso terapéutico , Masculino , Manometría , Persona de Mediana Edad , Atención Primaria de Salud , Calidad de Vida , Factores de Riesgo
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