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2.
Colomb Med (Cali) ; 51(2): e4266, 2020 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-33012884

RESUMEN

Background: The best scientific evidence is required to design effective Non-pharmaceutical interventions to help policymakers to contain COVID-19. Aim: To describe which Non-pharmaceutical interventions used different countries and a when they use them. It also explores how Non-pharmaceutical interventions impact the number of cases, the mortality, and the capacity of health systems. Methods: We consulted eight web pages of transnational organizations, 17 of international media, 99 of government institutions in the 19 countries included, and besides, we included nine studies (out of 34 identified) that met inclusion criteria. Result: Some countries are focused on establishing travel restrictions, isolation of identified cases, and high-risk people. Others have a combination of mandatory quarantine and other drastic social distancing measures. The timing to implement the interventions varied from the first fifteen days after detecting the first case to more than 30 days. The effectiveness of isolated non-pharmaceutical interventions may be limited, but combined interventions have shown to be effective in reducing the transmissibility of the disease, the collapse of health care services, and mortality. When the number of new cases has been controlled, it is necessary to maintain social distancing measures, self-isolation, and contact tracing for several months. The policy decision-making in this time should be aimed to optimize the opportunities of saving lives, reducing the collapse of health services, and minimizing the economic and social impact over the general population, but principally over the most vulnerable. The timing of implementing and lifting interventions could have a substantial effect on those objectives.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Política de Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Formulación de Políticas , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Prestación de Atención de Salud/organización & administración , Humanos , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Cuarentena , Aislamiento Social , Factores de Tiempo
3.
Prev Chronic Dis ; 17: E109, 2020 09 17.
Artículo en Inglés | MEDLINE | ID: mdl-32945766

RESUMEN

INTRODUCTION: In response to the coronavirus disease 2019 (COVID-19) pandemic, New York City closed all nonessential businesses and restricted the out-of-home activities of residents as of March 22, 2020. This order affected different neighborhoods differently, as stores and workplaces are not randomly distributed across the city, and different populations may have responded differently to the out-of-home restrictions. This study examines how the business closures and activity restrictions affected COVID-19 testing results. An evaluation of whether such actions slowed the spread of the pandemic is a crucial step in designing effective public health policies. METHODS: Daily data on the fraction of COVID-19 tests yielding a positive result at the zip code level were analyzed in relation to the number of visits to local businesses (based on smartphone location) and the number of smartphones that stayed fixed at their home location. The regression model also included vectors of fixed effects for the day of the week, the calendar date, and the zip code of residence. RESULTS: A large number of visits to local businesses increased the positivity rate of COVID-19 tests, while a large number of smartphones that stayed at home decreased it. A doubling in the relative number of visits increases the positivity rate by about 12.4 percentage points (95% CI, 5.3 to 19.6). A doubling in the relative number of stay-at-home devices lowered it by 2.0 percentage points (95% CI, -2.9 to -1.2). The business closures and out-of-home activity restrictions decreased the positivity rate, accounting for approximately 25% of the decline observed in April and May 2020. CONCLUSION: Policy measures decreased the likelihood of positive results in COVID-19 tests. These specific policy tools may be successfully used when comparable health crises arise in the future.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico , Comercio/legislación & jurisprudencia , Control de Enfermedades Transmisibles , Infecciones por Coronavirus , Transmisión de Enfermedad Infecciosa , Pandemias , Neumonía Viral , Técnicas de Laboratorio Clínico/métodos , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Control de Enfermedades Transmisibles/instrumentación , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Transmisión de Enfermedad Infecciosa/prevención & control , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Humanos , Ciudad de Nueva York/epidemiología , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Formulación de Políticas , Gestión de la Salud Poblacional , Salud Pública/métodos , Salud Pública/estadística & datos numéricos , Medición de Riesgo/métodos , Teléfono Inteligente/estadística & datos numéricos , Distancia Social
4.
Artículo en Inglés | MEDLINE | ID: mdl-32962172

RESUMEN

With the development of the Internet, social networking sites have empowered the public to directly express their views about social issues and hence contribute to social change. As a new type of voice behavior, public voice on social media has aroused wide concern among scholars. However, why public voice is expressed and how it influences social development and betterment in times of public health emergencies remains unstudied. A key point is whether governments can take effective countermeasures when faced with public health emergencies. In such situation, public voice is of great significance in the formulation and implementation of coping policies. This qualitive study uses China's Health Code policy under COVID-19 to explore why the public performs voice behavior on social media and how this influences policy evolution and product innovation through cooperative governance. A stimulus-cognition-emotion-behavior model is established to explain public voice, indicating that it is influenced by cognitive processes and public emotions under policy stimulus. What is more, as a form of public participation in cooperative governance, public voice plays a significant role in promoting policy evolution and product innovation, and represents a useful form of cooperation with governments and enterprises to jointly maintain social stability under public health emergencies.


Asunto(s)
Infecciones por Coronavirus , Pandemias , Neumonía Viral , Formulación de Políticas , Salud Pública , Medios de Comunicación Sociales , Betacoronavirus , China , Conducta Cooperativa , Urgencias Médicas , Política de Salud , Humanos
6.
S Afr Med J ; 110(7): 613-616, 2020 05 21.
Artículo en Inglés | MEDLINE | ID: mdl-32880333

RESUMEN

Faced with a pandemic, doctors around the world are forced to make difficult ethical decisions about clinical, economic and politically charged issues in medicine and healthcare, with little time or resources for support. A decision-making framework is suggested to guide policy and clinical practice to support the needs of healthcare workers, help to allocate scarce resources equitably and promote communication among stakeholders, while drawing on South African doctors' knowledge, culture and experience.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Comunicación Interdisciplinaria , Evaluación de Resultado en la Atención de Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Pautas de la Práctica en Medicina/organización & administración , Actitud del Personal de Salud , Toma de Decisiones Clínicas , Infecciones por Coronavirus/epidemiología , Países en Desarrollo , Femenino , Política de Salud , Recursos en Salud , Humanos , Masculino , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Formulación de Políticas , Sudáfrica
7.
J Med Internet Res ; 22(9): e22469, 2020 09 17.
Artículo en Inglés | MEDLINE | ID: mdl-32886622

RESUMEN

BACKGROUND: Implementing and lifting social distancing (LSD) is an urgent global issue during the COVID-19 pandemic, particularly when the travel ban is lifted to revive international businesses and economies. However, when and whether LSD can be considered is subject to the spread of SARS-CoV-2, the recovery rate, and the case-fatality rate. It is imperative to provide real-time assessment of three factors to guide LSD. OBJECTIVE: A simple LSD index was developed for health decision makers to do real-time assessment of COVID-19 at the global, country, region, and community level. METHODS: Data on the retrospective cohort of 186 countries with three factors were retrieved from a publicly available repository from January to early July. A simple index for guiding LSD was measured by the cumulative number of COVID-19 cases and recoveries, and the case-fatality rate was envisaged. If the LSD index was less than 1, LSD can be considered. The dynamic changes of the COVID-19 pandemic were evaluated to assess whether and when health decision makers allowed for LSD and when to reimplement social distancing after resurgences of the epidemic. RESULTS: After large-scale outbreaks in a few countries before mid-March (prepandemic phase), the global weekly LSD index peaked at 4.27 in March and lasted until mid-June (pandemic phase), during which most countries were affected and needed to take various social distancing measures. Since, the value of LSD has gradually declined to 0.99 on July 5 (postpandemic phase), at which 64.7% (120/186) of countries and regions had an LSD<1 with the decile between 0 and 1 to refine risk stratification by countries. The LSD index decreased to 1 in about 115 days. In addition, we present the results of dynamic changes of the LSD index for the world and for each country and region with different time windows from January to July 5. The results of the LSD index on the resurgence of the COVID-19 epidemic in certain regions and validation by other emerging infectious diseases are presented. CONCLUSIONS: This simple LSD index provides a quantitative assessment of whether and when to ease or implement social distancing to provide advice for health decision makers and travelers.


Asunto(s)
Algoritmos , Infecciones por Coronavirus/prevención & control , Política de Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Formulación de Políticas , Aislamiento Social , Betacoronavirus , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/transmisión , Humanos , Neumonía Viral/mortalidad , Neumonía Viral/transmisión , Estudios Retrospectivos , Viaje
9.
J Stroke Cerebrovasc Dis ; 29(10): 105179, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32912564

RESUMEN

BACKGROUND: Approach to acute cerebrovascular disease management has evolved in the past few months to accommodate the rising needs of the 2019 novel coronavirus (COVID-19) pandemic. In this study, we investigated the changes in practices and policies related to stroke care through an online survey. METHODS: A 12 question, cross-sectional survey targeting practitioners involved in acute stroke care in the US was distributed electronically through national society surveys, social media and personal communication. RESULTS: Respondants from 39 states completed 206 surveys with the majority (82.5%) from comprehensive stroke centers. Approximately half stated some change in transport practices with 14 (7%) reporting significant reduction in transfers. Common strategies to limit healthcare provider exposure included using personal protective equipment (PPE) for all patients (127; 63.5%) as well as limiting the number of practitioners in the room (129; 64.5%). Most respondents (81%) noted an overall decrease in stroke volume. Many (34%) felt that the outcome or care of acute stroke patients had been impacted by COVID-19. This was associated with a change in hospital transport guidelines (OR 1.325, P = 0.047, 95% CI: 1.004-1.748), change in eligibility criteria for IV-tPA or mechanical thrombectomy (MT) (OR 3.146, P = 0.052, 95% CI: 0.988-10.017), and modified admission practices for post IV-tPA or MT patients (OR 2.141, P = 0.023, 95% CI: 1.110-4.132). CONCLUSION: Our study highlights a change in practices and polices related to acute stroke management in response to COVID-19 which are variable among institutions. There is also a reported reduction in stroke volume across hospitals. Amongst these changes, updates in hospital transport guidelines and practices related to IV-tPA and MT may affect the perceived care and outcome of acute stroke patients.


Asunto(s)
Actitud del Personal de Salud , Infecciones por Coronavirus/terapia , Prestación Integrada de Atención de Salud/tendencias , Conocimientos, Actitudes y Práctica en Salud , Control de Infecciones/tendencias , Neumonía Viral/terapia , Pautas de la Práctica en Medicina/tendencias , Accidente Cerebrovascular/terapia , Betacoronavirus/patogenicidad , Toma de Decisiones Clínicas , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Estudios Transversales , Determinación de la Elegibilidad/tendencias , Encuestas de Atención de la Salud , Interacciones Huésped-Patógeno , Humanos , Exposición Profesional/prevención & control , Pandemias , Admisión del Paciente/tendencias , Transferencia de Pacientes/tendencias , Equipo de Protección Personal/tendencias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/virología , Formulación de Políticas , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/virología , Telemedicina/tendencias , Factores de Tiempo , Estados Unidos/epidemiología
10.
Recurso de Internet en Inglés | LIS - Localizador de Información en Salud | ID: lis-47761

RESUMEN

In January 2020, we published the findings of a two year in-depth inquiry into the ethical issues relating to research in global health emergencies. The inquiry was run by an international working group which gathered evidence and experience from many contributors across the globe. Better evidence about what helps or doesn’t help during an emergency is needed in order to improve the response to global health emergencies. Research conducted during an emergency itself plays a crucial role in obtaining this evidence, and helps support the immediate response, as well as learning for the future. The aim of the report is to identify ways in which research can be undertaken ethically during emergencies, in order to promote the contribution that ethically-conducted research can make to improving current and future emergency preparedness and response. We have made 24 recommendations to ‘duty bearers’ such as research funders, research organisations, governments, and researchers. These are summarised in our call for action. We suggest changes that would align their policies and practices more closely to three core values of fairness, equal respect, and helping reduce suffering. The report presents these values in the form of an ‘ethical compass’ to guide the conduct of the very wide range of people involved in research in global health emergencies.


Asunto(s)
Servicios Médicos de Urgencia/ética , Práctica Clínica Basada en la Evidencia/ética , Sistemas de Salud/organización & administración , Formulación de Políticas , Bioética
11.
Health Aff (Millwood) ; 39(8): 1405-1411, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32744939

RESUMEN

Clinical care in the United States has been transformed during the coronavirus disease 2019 (COVID-19) pandemic. To support these changes, regulators and payers have temporarily modified long-standing policies, recognizing the need for a trade-off between the costs and benefits of oversight during times of crisis. Specifically, there has been a heightened receptivity to the importance of preserving physicians' and other health care professionals' time, cognitive bandwidth, and emotional reserve for the direct care of patients, instead of squandering these resources on low-value tasks and frustrating technology. Instead of reflexively reverting to past practices and policies, there is now an opportunity to take advantage of the lessons of COVID-19 for the further transformation of health care to achieve Quadruple Aim outcomes (better care for individuals, better health for the population, better experience for clinicians, and lower costs). We outline some of the policy and practice changes that we believe should endure after the crisis has passed, and we recommend using similar logic during noncrisis times to make additional changes to further reduce administrative burden, and thus improve patient care.


Asunto(s)
Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud/organización & administración , Política de Salud/legislación & jurisprudencia , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Infecciones por Coronavirus/terapia , Manejo de la Enfermedad , Femenino , Humanos , Masculino , Innovación Organizacional , Pandemias/prevención & control , Neumonía Viral/terapia , Formulación de Políticas , Administración de la Práctica Médica , Pautas de la Práctica en Medicina/organización & administración , Desarrollo de Programa , Estados Unidos
12.
Am J Disaster Med ; 15(2): 113-128, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32804391

RESUMEN

During the 2017-2018 listeriosis outbreak in South Africa (SA), the total number of cases reached 1,060. In this study, the disaster management response to the 2017-2018 South Africa listeriosis outbreak is analyzed. The hazard was in part the contamination of a brand of a ready-to-eat (RTE) "polony" with a strain of Listeria monocytogenes ST6. The initial phase of the 2017-2018 listeriosis outbreak was characterized by a rapid increase in the number of detected human cases. The listeriosis outbreak was officially proclaimed in December 2017, resulting in listeriosis being added to the list of notifiable diseases in SA. The delay between onset and proclamation was a result of the difficulty in identifica-tion of the actual number of cases of listeriosis in the country. The response to the disaster included the coordination of the National Department of Health, the National Institute of Communicable Diseases (NICD), businesses/producers of the contaminated brand of RTE products, and the public. Some of these activities led to the removal of the contami-nated products from the retail sector in March 2018, resulting in a decrease in the number of cases found in SA. In re-sponse to the outbreak, the National Department of Health formed a multisector incidence response team and imple-mented the Emergency Response Plan. Impacts of future listeriosis outbreaks could be mitigated by the adoption of international listeriosis guidelines such as the WHO/FAO and FDA. Practical steps in this context should include setting a limit of L. monocytogenes in RTE products. WHO/FAO and FDA listeriosis policies which are described "zero toler-ance" where a limit of < 100 L. monocytogenes cells/g at the moment of consumption is acceptable can be adopted. Additional resources must be provided for research into infectious doses and the various routes of human exposure.


Asunto(s)
Brotes de Enfermedades/prevención & control , Guías como Asunto , Legislación como Asunto , Listeria monocytogenes , Listeriosis/epidemiología , Formulación de Políticas , Desastres , Notificación de Enfermedades , Microbiología de Alimentos , Humanos , Listeriosis/diagnóstico , Sudáfrica
13.
PLoS One ; 15(8): e0237734, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32817681

RESUMEN

BACKGROUND: Over the last decades, health systems worldwide have faced a decline in public trust. For marginalized minority populations, who generally suffer from poverty and political exclusion, the roots of this trend go much deeper, establishing a state of bi-directional distrust between them and health institutions. Although studied to a lesser extent compared to trust, distrust does impede health initiatives, such as infectious diseases prevention programs, mostly of so-called Neglected Zoonotic Diseases (NZDs). Where distrust prevails, even trust building actions such as defining rights and obligations, prioritizing "the greater good" and increasing transparency, are prone to failure. In this study, we deepen the understanding of the concept of distrust through a unique case study of Brucellosis, a prevalent bacterial zoonotic disease endemic to disadvantaged Bedouin communities in southern Israel. METHODS: In the years 2015-2019, we qualitatively studied socio-political aspects in a governmental Brucellosis control campaign in southern Israel. We used in-depth interviews with 38 governmental and private health workers, agriculture and nature preservation workers, livestock owners and community leaders. Further, we conducted participant observation in 10 livestock pens and in policymaking meetings, and collected policy and media documents in order to triangulate the results. RESULTS: We conceptualize three different types of distrust between authorities and marginalized communities-"intention-based distrust", "values-based distrust" and "circular distrust"-to better explain how distrust originates and reinforces itself, reproducing the endemicity of NZDs. Based on that, we portray a practical framework to reduce distrust in health policies, by reframing local discourses, reshaping disease monitoring schemes from enforcement-based to participation-based, and promoting political inclusion of disadvantaged communities. CONCLUSIONS: The suggested analysis and framework redirect health policy objectives to not only acknowledge, contain and reduce the consequences of distrust, but also to strive for societal justice as a tool for health promotion.


Asunto(s)
Brucelosis/epidemiología , Programas de Gobierno , Política de Salud , Zoonosis/epidemiología , Animales , Árabes/psicología , Brucelosis/microbiología , Femenino , Humanos , Relaciones Interpersonales , Israel/epidemiología , Masculino , Enfermedades Desatendidas/epidemiología , Enfermedades Desatendidas/microbiología , Formulación de Políticas , Confianza/psicología , Zoonosis/microbiología
14.
PLoS One ; 15(8): e0236699, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32760079

RESUMEN

INTRODUCTION: Unhealthy food environments drive the increase of diet-related non-communicable diseases (NCDs). OBJECTIVE: We aimed to examine healthy food environment policies in Kenya and identify priorities for future action. METHODS: Using the Healthy Food Environment Policy Index (Food-EPI) we collected evidence on the extent of government action to create healthy food environments across 13 policy and infrastructure support domains and 43 related good practice indicators between 2017 and 2018. A panel of 15 national experts rated the extent of government action on each indicator compared to the policy development cycle and international best practice respectively. Based on gaps found, actions to improve food environments in Kenya were identified and prioritized. RESULTS: In the policy development cycle, 16/43 (37%) of good practice policy indicators were judged to be in 'implementation' phase, including: food composition targets, packaged foods' ingredient lists/nutrient declarations; systems regulating health claims; restrictions on marketing breast milk substitutes; and school nutrition policies. Infrastructure support actions in 'implementation' phase included: food-based dietary guidelines; strong political support to reduce NCDs; comprehensive NCD action plan; transparency in developing food policies; and surveys monitoring nutritional status. Half (22/43) of the indicators were judged to be 'in development'. Compared to international best practice, the Kenyan Government was judged to be performing relatively well ('medium' implementation) in one policy (restrictions on marketing breast milk substitutes) and three infrastructure support areas (political leadership; comprehensive implementation plan; and ensuring all food policies are sensitive to nutrition). Implementation for 36 (83.7%) indicators were rated as 'low' or 'very little'. Taking into account importance and feasibility, seven actions within the areas of leadership, food composition, labelling, promotion, prices and health-in-all-policies were prioritized. CONCLUSION: This baseline assessment is important in creating awareness to address gaps in food environment policy. Regular monitoring using Food-EPI may contribute to addressing the burden of diet-related NCDs in Kenya.


Asunto(s)
Benchmarking , Promoción de la Salud , Enfermedades no Transmisibles/prevención & control , Política Nutricional , Dieta Saludable , Gobierno , Humanos , Kenia , Formulación de Políticas , Salud Pública
16.
PLoS One ; 15(8): e0236559, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32817636

RESUMEN

Chronic obstructive pulmonary disease (COPD) poses a significant but heterogeneous burden to individuals and healthcare systems. Policymakers develop targeted policies to minimize this burden but need personalized tools to evaluate novel interventions and target them to subpopulations most likely to benefit. We developed a platform to identify subgroups that are at increased risk of emergency department visits, hospitalizations and mortality and to provide stratified patient input in economic evaluations of COPD interventions. We relied on administrative and survey data from Ontario, Canada and applied a combination of microsimulation and multi-state modeling methods. We illustrated the functionality of the platform by quantifying outcomes across smoking status (current, former, never smokers) and by estimating the effect of smoking cessation on resource use and survival, by comparing outcomes of hypothetical cohorts of smokers who quit at diagnosis and smokers that continued to smoke post diagnosis. The cumulative incidence of all-cause mortality was 37.9% (95% CI: 34.9, 41.4) for never smokers, 34.7% (95% CI: 32.1, 36.9) for current smokers, and 46.4% (95% CI: 43.6, 49.0) for former smokers, at 14 years. Over 14 years, smokers who did not quit at diagnosis had 16.3% (95% CI: 9.6, 38.4%) more COPD-related emergency department visits than smokers who quit at diagnosis. In summary, we combined methods from clinical and economic modeling to create a novel tool that policymakers and health economists can use to inform future COPD policy decisions and quantify the effect of modifying COPD risk factors on resource utilization and morality.


Asunto(s)
Aceptación de la Atención de Salud/estadística & datos numéricos , Formulación de Políticas , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Cese del Hábito de Fumar/estadística & datos numéricos , Fumar Tabaco/efectos adversos , Anciano , Análisis Costo-Beneficio , Femenino , Recursos en Salud/economía , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Modelos Teóricos , No Fumadores/estadística & datos numéricos , Ontario , Estudios Retrospectivos , Factores de Riesgo , Fumadores/estadística & datos numéricos
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