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Braz. j. biol ; 83: e248281, 2023. tab
Artículo en Inglés | LILACS, VETINDEX | ID: biblio-1350304


Abstract The COVID-19 is a contagious viral disease, was first emerged in Wuhan, China in December 2019 and became the whole world on alert. The mortality rate in top most countries in Asia with special reference to Pakistan has been focused. Since February 26 to September 2020 the total confirmed cases and mortality rate was measured through Wikipedia and the notable journals. Iran is the only country having highest number of deaths (5.73%) followed by Indonesia (3.77%) while Saudi Arabia shows the lowest number of deaths as 1.39%. In Pakistan the first case was confirmed in 26th February, 2020. The nCov-19 has closely related to severe acute respiratory syndrome (SARS) hence SARS COV-2 was named. This virus is responsible for more than 33.9 million deaths in over all the world as of 20th September, 2020. The number of new cases is increasing time to time. Sindh province of Pakistan has reported the highest number of cases till September, 20, 2020 as compared to other parts of the country and has the highest number of death followed by Khyber Pakhtunkhwa. Because of the person to person contact the disease is spreading rapidly. The individuals who has already infected with other diseases like cancer or diabetic etc. are vulnerable. The nCOV-19 is the most contagious due to its mode of transmission. There is still no vaccine is available for the treatment of disease caused by nCoV-2019. It is therefore the only option to control this pandemic is to adopt effective preventive measures.

Resumo A covid-19 é uma doença viral contagiosa, que surgiu pela primeira vez em Wuhan, China, em dezembro de 2019, e deixou o mundo todo em alerta. A taxa de mortalidade na maioria dos principais países da Ásia, com referência especial ao Paquistão, foi enfocada. De 26 de fevereiro a setembro de 2020, o total de casos confirmados e a taxa de mortalidade foram medidos por meio da Wikipedia e de periódicos notáveis. O Irã é o único país com maior número de mortes (5,73%), seguido pela Indonésia (3,77%), enquanto a Arábia Saudita mostra o menor número de mortes, 1,39%. No Paquistão, o primeiro caso foi confirmado em 26 de fevereiro de 2020. O nCov-19 está intimamente relacionado à síndrome respiratória aguda grave (SARS), daí o nome SARS COV-2. Esse vírus é responsável por mais de 33,9 milhões de mortes em todo o mundo em 20 de setembro de 2020. O número de novos casos está aumentando de tempos em tempos. A província de Sindh, no Paquistão, registrou o maior número de casos até 20 de setembro de 2020, em comparação com outras partes do país, e tem o maior número de mortes, seguida por Khyber Pakhtunkhwa. Por causa do contato pessoa a pessoa, a doença está se espalhando rapidamente. Indivíduos que já foram diagnosticados com outras doenças, como câncer ou diabetes, etc. são mais vulneráveis. O nCOV-19 é o mais contagioso devido ao seu modo de transmissão. Ainda não há vacina disponível para o tratamento da doença causada pelo nCoV-2019. Portanto, a única opção para controlar essa pandemia é a adoção de medidas preventivas eficazes.

Humanos , Pandemias , COVID-19 , Pakistán/epidemiología , China , SARS-CoV-2
Ann R Coll Surg Engl ; 104(4): 269-273, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-34941446


INTRODUCTION: The first wave of the COVID-19 pandemic led to an unprecedented time for the management of colorectal cancer, with uncertainty as to cancer-specific risks and the circumventing of gold standard oncological strategies. Our study aimed to acquire a snapshot of the practice of multidisciplinary team (MDT) management and variability in response to rapidly emerging guidelines. METHODS: The survey was disseminated to 150 colorectal cancer MDTs across England and Wales taken from the National Bowel Cancer Audit data set between 15 April and 30 June 2020 for completion by colorectal surgeons. RESULTS: Sixty-seven MDTs responded to the survey. Fifty-seven centres reported that they continued to perform colorectal cancer resections during the initial lockdown period. Fifty centres (74.6%) introduced routine preoperative COVID-19 testing and 50 (74.6%) employed full personal protective equipment for elective cases. Laparoscopic resections were continued by 25 centres (42.1%), whereas 28 (48.3%) changed to an open approach. Forty-nine (79.0%) centres reported experiencing patient-led surgical cancellations in 0-25% of their listings. If surgery was delayed significantly then 24 centres (38.7%) employed alternative neoadjuvant therapy, with short-course radiotherapy being their preferred adjunct of choice for rectal cancer. Just over 50% of the MDTs stated that they were uncomfortable or very uncomfortable with their management strategies. CONCLUSIONS: Our study demonstrates variability in the MDT management of colorectal cancer during the initial COVID-19 lockdown, incorporating adaptive patient behaviour and initially limited data on oncological safety profiles leading to challenging decision-making.

COVID-19 , Neoplasias del Recto , COVID-19/epidemiología , COVID-19/prevención & control , Prueba de COVID-19 , Control de Enfermedades Transmisibles , Humanos , Pandemias/prevención & control
Subst Use Misuse ; 57(5): 730-741, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35193461


Background: Rates of cannabis use appear to be highest among emerging adults (EA). Evidence suggests that cannabis smoking, as well as alternate methods of cannabis use (e.g., vaping, edibles) have become a prevalent mode of consumption among this population. Substance use or misuse peaks during emerging adulthood and may be influenced by extreme economic, social and community developments, such as policy changes, public health concerns, and significant global events such as pandemics. For instance, it is highly likely that cannabis consumption trends among at-risk populations were influenced by the legalization of recreational cannabis in Canada, the declaration of the "e-cigarette or vaping product use associated lung injury" or "EVALI" outbreak, and the "COVID-19" pandemic. ObjectivesWe aimed to examine self-reported changes in frequency of cannabis use among EA in Canada (N = 312): pre-legalization, post-legalization; pre-EVALI, post-EVALI; pre-COVID-19, since-COVID-19. ResultsThere was a gradual increase in average frequency of smoking and vaping cannabis across the six different time intervals from the pre-legalization period (2018) to the COVID-19 pandemic period (2020). Males reported higher frequencies of cannabis smoking and vaping compared to females. ConclusionsDespite health concerns and expectations that EVALI and COVID-19 events would lead to decreased consumption, our results suggest an average increase in smoking and vaping cannabis, although the most notable increase was after legalization. There are important sex differences in behavioral factors of cannabis use in EA, though it appears that the "gender-gap" in cannabis consumption is closing. These findings may facilitate the development of intervention programs for policy measures to address cannabis-attributable outcomes in the face of contextual factors that promote use, such as public emergencies or changes in policy landscapes.

COVID-19 , Cannabis , Sistemas Electrónicos de Liberación de Nicotina , Adulto , COVID-19/epidemiología , Femenino , Humanos , Masculino , Pandemias , Políticas , Salud Pública
Braz. j. oral sci ; 21: e226321, jan.-dez. 2022. ilus
Artículo en Inglés | LILACS, BBO - Odontología | ID: biblio-1354787


Aim: This cross-sectional observational study aimed to evaluate the influence of the Universities lockdown measures on academic perspectives and psychosocial aspects of Brazilian finalyear dental students. Methods: 268 undergraduate students regularly enrolled in a Dentistry course at public universities were asked about anxiety, depression, stress sensitivity, and their academic perspectives by using an online survey. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression, while the Perceived Stress Scale (PSS) evaluated stress levels. The academic perspective was evaluated by five affirmatives regarding possible difficulties that will be faced when school reopens and after graduation. The possible association between fear of having COVID-19 with psychosocial outcomes and COVID-19 association with academic perspectives were analyzed by ANOVA and chisquare tests, respectively, considering a significance level of 5%. Results: Considering possible associations between the fear of having COVID-19 and psychosocial aspects, significant values were found for anxiety (P = 0.018) and stress sensitivity (P = 0.002). Regarding students' academic perspectives, COVID-19 had significant impact on less opportunity to perform procedures (P = 0.023), additional expenses with personal protective equipment (P = 0.007), and concerns of consulting elderly people (P = 0.012). Conclusion: The COVID-19 pandemic led to increased psychological impairments and enlarged concerns with learning and biosecurity, which might impact academic perspectives. Thus, being aware of these apprehensions, university professors and staff can improve the clinical training of final-year dental students in an empathetic way

Humanos , Masculino , Femenino , Ansiedad , Estudiantes de Odontología , Depresión , Pandemias , COVID-19
Arch. argent. pediatr ; 120(4): 225-231, Agosto 2022. tab
Artículo en Inglés, Español | LILACS, BINACIS | ID: biblio-1371502


Introducción. Se ha postulado que el aislamiento social debido a la pandemia de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) aumentaría la incidencia de abuso sexual infantojuvenil (ASIJ). Objetivo. Comparar la incidencia y las características de las consultas realizadas en Ginecología en relación con ASIJ antes y durante la pandemia de COVID-19. Materiales y métodos. Se realizó un estudio descriptivo, observacional y comparativo entre las situaciones de sospecha de ASIJ ocurridas durante la pandemia de COVID-19 en relación con las del mismo período del año previo en un hospital pediátrico de alta complejidad. Resultados. Se consignaron 122 consultas por sospecha de ASIJ, 78 en el período previo a la pandemia y 44 en la pandemia. El motivo de consulta al hospital más frecuente, en ambos grupos, fue el relato de ASIJ y, al Servicio de Ginecología en particular, la evaluación de genitales externos. La mayor parte presentó un examen físico normal. Se observó una mayor prevalencia de infecciones de transmisión sexual (ITS) en el grupo de pandemia. Se realizaron más internaciones y denuncias para protección de víctimas en dicho grupo. Se registró que el agresor era conocido de la víctima en casi el 90 % de las víctimas de ambos grupos. Conclusiones. Durante la pandemia se evidenció una disminución en el número total de consultas a Ginecología, de modo que aquellas por sospecha de ASIJ representaron un mayor porcentaje. Sin embargo, las características en relación con la presencia de lesiones graves, infecciones de transmisión sexual o embarazo no se vieron modificadas

Introduction. It has been suggested that the social isolation due to the coronavirus disease 2019 (COVID-19) may increase the incidence of child and adolescent sexual abuse (CASA). Objective. To compare the incidence and characteristics of medical consultations made to the Department of Gynecology due to CASA before and during the COVID-19 pandemic. Materials and methods. Descriptive, observational, and comparative study about suspected CASA events occurred during the COVID-19 pandemic compared to those occurred in the previous year at a tertiary care children's hospital. Results. One hundred and twenty-two medical consultations due to suspected CASA were recorded; 78 before and 44 during the pandemic. In both groups, the most common reason for consultation at the hospital was an account of CASA and, at the Department of Gynecology in particular, the external genitalia examination. Most subjects had a normal physical examination. There was a higher prevalence of STI in the pandemic group. In addition, there were also more hospitalizations and police reports for victims protection in this group. The abuser was known to the victim in almost 90% of cases in both groups. Conclusions. During the pandemic, the total number of medical consultations to the Department of Gynecology decreased so the percentage of those due to suspected CASA was higher. However, the presence of severe lesions, STIs or pregnancy did not change

Humanos , Femenino , Embarazo , Niño , Adolescente , Abuso Sexual Infantil/diagnóstico , Enfermedades de Transmisión Sexual , COVID-19/epidemiología , Derivación y Consulta , Pandemias , Ginecología , Hospitales Pediátricos
Arch. argent. pediatr ; 120(4): 264-268, Agosto 2022. tab, ilus
Artículo en Inglés, Español | LILACS, BINACIS | ID: biblio-1372367


Introducción. Durante el 2020, la circulación de otros virus respiratorios fue inferior a lo acostumbrado. Es probable que, almodificarse las medidas de mitigación para la infección por el coronavirus 2019, dicha prevalencia haya aumentado en 2021. Objetivo. Estimar la prevalencia de virus respiratorioshabituales en pacientes de 0 a 5 años asistidos en Departamento de Urgencias de un hospital pediátrico de la Ciudad Autónoma de Buenos Aires. Métodos. Estudio transversal con 348 pacientes que consultaronpor sospecha de enfermedad por el coronavirus 2019(COVID-19), en quienes se descartó dicha enfermedad y se realizó la pesquisa sistemática de virus respiratorios habitualesResultados. En el 40 % de los pacientes se identificó el virus sincicial respiratorio (VSR), un virus respiratorio habitual. La edad menor de 2 años se mostró como predictor independiente de VSR (razón de momios [OR]: 4,15; intervalos de confianza del 95 % [IC95 %]: 2,46-6,99). Conclusión. En la población estudiada, 40 % de los pacientes con sospecha de COVID-19 en quienes se descartó infección por SARS-CoV-2 presentaban infección por VSR.

Introduction. During 2020, circulation of other respiratory viruses was lower than usual. Most likely, as mitigation measures for coronavirus disease 2019 (COVID-19) were modified, their prevalence in 2021 may have increased. Objective. To estimate the prevalence of common respiratory viruses among patients aged 0­5 years seen at the Emergency Department of a children's hospital in the City of Buenos Aires. Methods. Cross-sectional study of 348 patients consulting for suspected COVID-19 in whom SARS-CoV-2 infection was ruled out and routine screening for common respiratory viruses was performed. Results. Respiratory syncytial virus (RSV), a common respiratory virus, was identified in 40% of patients. Age younger than 2 years was an independent predictor of RSV (odds ratio [OR]: 4.15; 95% confidence interval [CI]: 2.46­6.99). Conclusion. In the study population, 40% of patients suspected of COVID-19 in whom SARS-CoV-2 infection was ruled out had RSV infection.

Humanos , Recién Nacido , Lactante , Preescolar , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/epidemiología , Virus , Virus Sincitial Respiratorio Humano , COVID-19/diagnóstico , COVID-19/epidemiología , Pacientes Ambulatorios , Estudios Transversales , Pandemias , SARS-CoV-2
Arch. argent. pediatr ; 120(4): 269-273, Agosto 2022. tab, ilus
Artículo en Inglés, Español | LILACS, BINACIS | ID: biblio-1372375


Introducción. Durante la pandemia de COVID-19, disminuyeron las notificaciones de infecciones respiratorias. El objetivo fue estimar la prevalencia de virus sincicial respiratorio (VSR) e influenza en niños escolarizados asistidos en un hospital pediátrico durante el retorno a la presencialidad. Métodos. Estudio transversal de casos sospechosos de COVID-19, de 3-18 años, con prueba negativa para SARSCoV-2, entre agosto y octubre de 2021. Se estratificó por nivel educativo. Se utilizó PCR para detectar VSR e influenza. Resultados. Se incluyeron 619 niños: 234 del nivel inicial, 224 del primario y 161 del secundario; 25,5 % (158) fueron positivos para VSR (36,3 % del nivel inicial versus 21 % del primario y 16 % del secundario); en adolescentes se asoció la infección al contacto escolar con caso sintomático (OR 2,5; IC95%: 1-6,80; p = 0,04). No se aisló virus influenza. Conclusión. VSR se aisló en un cuarto de la población estudiada, con mayor frecuencia en el nivel inicial; en adolescentes, se asoció con contacto escolar sintomático. No se detectaron casos de influenza

Introduction. Reporting of respiratory infections reduced during the COVID-19 pandemic. The objective was to estimate the prevalence of respiratory syncytial virus (RSV) and influenza in schoolchildren seen at a children's hospital during the return to school. Methods. Cross-sectional study of patients aged 3­18 years suspected of COVID-19 with a negative test for SARS-CoV-2 between August and October 2021. Participants were stratified by level of education. PCR was used to detect RSV and influenza. Results. A total of 619 children were included: 234 in preschool, 224 in primary and 161 in secondary school; 25.5% (158) tested positive for RS (36.3% in the pre-school level versus 21% in primary and 16% in secondary school). Infection among adolescents was associated with school contact with symptomatic cases (OR 2.5; 95%CI 1­6.80; p = 0.04). No case of influenza was detected. Conclusion. RSV was isolated in one fourth of the study population, with a higher frequency in pre-school; among adolescents, it was associated with school contact with symptomatic cases. No case of influenza was detected.

Humanos , Preescolar , Niño , Adolescente , Virus Sincitial Respiratorio Humano , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Infecciones por Virus Sincitial Respiratorio/epidemiología , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , COVID-19 , Estudios Transversales , Pandemias , SARS-CoV-2 , Hospitales Pediátricos
Arch. argent. pediatr ; 120(4): S62-S68, Agosto 2022. tab, ilus
Artículo en Español | LILACS, BINACIS | ID: biblio-1373150


La pandemia por coronavirus ha transformado el modo de comunicarnos. La telesalud ha ganado relevancia y ha pasado a ser un tema prioritario en la agenda de innovación de los sistemas sanitarios. La atención de la población adolescente presenta algunas características que la distinguen de las demás. El objetivo de este documento es generar una guía de buenas prácticas que sea de utilidad en la consulta virtual del paciente adolescente. Esta guía se presenta como una herramienta de soporte para los profesionales de la salud, entendiendo que deberá ser revisada y actualizada en sucesivas versiones.

The coronavirus pandemic has transformed the way we communicate. Telehealth has gained relevance and has become a priority issue on the innovation agenda of health systems. Clinical attention of the adolescent population has some unique characteristics that set it apart from others. The objective of this document is to generate a guide of good practices that is useful in the virtual consultation with the adolescent patient. This guide is presented as a support tool for health professionals, understanding that it must be reviewed and updated in successive versions

Humanos , Adolescente , Telemedicina , Infecciones por Coronavirus , Consulta Remota , Personal de Salud , Pandemias
Arch. argent. pediatr ; 120(4): e183-e186, Agosto 2022.
Artículo en Español | LILACS, BINACIS | ID: biblio-1379148


Las encefalitis son cuadros clínicos frecuentes en la edad pediátrica. Pueden dividirse en aquellas causadas por la infección del sistema nervioso central y en las de etiología inmunomediada (algunas de las cuales pueden ser para- o posinfecciosas). En marzo de 2020 la Organización Mundial de la Salud declaró la pandemia por el coronavirus de tipo 2 del síndrome respiratorio agudo grave (SARS-CoV-2, por su sigla en inglés). Los reportes pediátricos de enfermedad por dicho agente describen una amplia gama de manifestaciones clínicas: compromiso respiratorio, gastrointestinal, síntomas neurológicos, entre otros; y el síndrome inflamatorio multisistémico asociado a COVID-19 (SIM-C). Describimos el caso de un niño de 2 años con diagnóstico de encefalitis por anticuerpos antirreceptor N-metil-d-aspartato (anti-NMDAR), en quien se comprobó, mediante serología, una infección reciente por SARS-CoV-2. La presencia de marcadores serológicos positivos para SARS-CoV-2 en un paciente que presentó encefalitis por anticuerpos anti-NMDAR podría interpretarse como una asociación temporal, estableciéndose la posibilidad de que el virus haya actuado como gatillo de una enfermedad autoinmunitaria.

Encephalitis are frequent clinical pictures in pediatric age. They can be divided into those caused by infection of the central nervous system and those of immune-mediated etiology (some of which may be para- or post-infectious). In March 2020, the WHO declared a SARS-CoV-2 pandemic. Pediatric reports of disease caused by this agent describe a wide range of clinical manifestations: respiratory and gastrointestinal compromise, neurological symptoms, among others; and a multisystemic inflammatory syndrome in children associated with COVID-19 (MIS-C).We describe the case of a 2-year-old boy with a diagnosis of anti-NMDAR antibody encephalitis, in whom a recent SARSCoV-2 infection was serologically proven. The presence of positive serological markers for SARS-CoV-2 in a patient who presented encephalitis due to anti-NMDAR antibodies could be interpreted as a temporal association; establishing the possibility that the virus has acted as a trigger for an autoimmune disease

Humanos , Masculino , Preescolar , Encefalitis/diagnóstico , COVID-19/complicaciones , COVID-19/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica , Pandemias , SARS-CoV-2
J Prim Care Community Health ; 13: 21501319221114831, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35920022


BACKGROUND: In this report, we outline our approach to implementing a hybrid in-person and virtual clinic model at a student-run free clinic (SRFC) during the COVID-19 pandemic. Individuals of low socioeconomic status (SES) are at an increased risk for COVID-19 infection and severe clinical outcomes. It is unclear if telehealth is a viable continuity of care enabler for the underserved. METHODS: The Weill Cornell Community Clinic (WCCC) implemented a novel telehealth clinic model to serve uninsured patients in May 2020. A phone survey of was conducted to assess WCCC patients access to technology needed for telehealth visits (eg, personal computers, smartphones). Patient no-show rates were retrospectively assessed for both in-person (pre-pandemic) and hybrid continuity of care models. RESULTS: The phone survey found that 90% of WCCC patients had access to technology needed for telehealth visits. In the 8 months following implementation of the hybrid model, telehealth and in-person no-show rates were 11% (14/128) and 15% (10/67) respectively; the combined hybrid no-show rate was 12% (24/195). For comparison, the in-person 2019 no-show rate was 23% (84/367). This study aligns with previous reports that telehealth improves patient attendance. CONCLUSION: Literature on the transition of SRFCs from in-person to telehealth care delivery models is limited. At the WCCC, the reduction in no-show rates supports the feasibility and benefits of adopting telehealth for the delivery of care to underserved patient populations. We believe the hybrid telehealth model described here is a viable model for other student run free clinics to increase access to care in low SES communities.

COVID-19 , Clínica Administrada por Estudiantes , Estudiantes de Medicina , Telemedicina , Humanos , Pandemias , Atención Primaria de Salud , Estudios Retrospectivos
BMJ Open ; 12(8): e063279, 2022 Aug 03.
Artículo en Inglés | MEDLINE | ID: mdl-35922108


OBJECTIVES: The COVID-19 pandemic has changed the working environment, how we think of it and how it stands to develop into the future. Knowledge about how people have continued to work on-site and adjusted to working from home during the COVID-19 lockdown will be vital for planning work arrangements in the post-pandemic period. Our primary objective was to investigate experiences of working from home or having colleagues working from home during a late stage of the COVID-19 lockdown among researchers and healthcare providers in a hospital research setting. Second, we aimed to investigate researchers' productivity through changes in various proxy measures during lockdown as compared with pre-lockdown. DESIGN: Mixed-method participatory Group Concept Mapping (GCM). SETTING AND PARTICIPANTS: GCM, based on a mixed-method participatory approach, was applied involving researchers' and healthcare providers' online sorting and rating experiences working from home during the COVID-19 pandemic. At a face-to-face meeting, participants achieved consensus on the number and labelling of domains-the basis for developing a conceptual model. RESULTS: Through the GCM approach, 47 participants generated 125 unique statements of experiences related to working from home, which were organised into seven clusters. Using these clusters, we developed a conceptual model that illustrated the pros and cons of working from home. CONCLUSION: The future work setting, the role of the office and the overall work environment need to respond to workers' increased wish for flexible work arrangements and co-decision.

COVID-19 , Personal de Salud , Investigadores , Control de Enfermedades Transmisibles , Dinamarca , Hospitales , Humanos , Pandemias , SARS-CoV-2
BMJ Open ; 12(8): e059477, 2022 Aug 04.
Artículo en Inglés | MEDLINE | ID: mdl-35926985


OBJECTIVES: Since the onset of the COVID-19 pandemic in 2020, there have been plausible suggestions about the need to augment vitamin D intake by supplementation in order to prevent SARS-CoV2 infection and reduce mortality. Some groups have advocated supplementation for all adults, but governmental agencies have advocated targeted supplementation. We sought to explore the effect of the COVID-19 pandemic on both vitamin D status and on the dose of new-to-market vitamin D supplements. SETTING: University hospital, Dublin, Ireland. PARTICIPANTS: Laboratory-based samples of circulating 25-hydroxyvitamin D (25OHD) (n=100 505). PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes: comparing yearly average 25OHD prior to the pandemic (April 2019 to March 2020) with during the pandemic (April 2020 to March 2021) and comparing the dose of new-to-market vitamin D supplements between 2017 and 2021 (n=2689). SECONDARY OUTCOME: comparing prevalence of vitamin D deficiency and vitamin D excess during the two time periods. RESULTS: The average yearly serum 25OHD measurement increased by 2.8 nmol/L (61.4, 95% CI 61.5 to 61.7 vs 58.6, 95% CI 58.4 to 58.9, p<0.001), which was almost threefold higher than two similar trend analyses that we conducted between 1993 and 2016. There was a lower prevalence of low 25OHD and a higher prevalence of high 25OHD. The dose of new-to-market vitamin D supplements was higher in the years 2020-2021 compared with the years 2017-2019 (p<0.001). CONCLUSIONS: We showed significant increases in serum 25OHD and in the dose of new-to-market vitamin D supplements. The frequency of low vitamin D status reduced indicating benefit, but the frequency of vitamin D excess increased indicating risk of harm. Rather than a blanket recommendation about vitamin D supplementation for all adults, we recommend a targeted approach of supplementation within current governmental guidelines to at-risk groups and cautioning consumers about adverse effects of high dose supplements on the market.

COVID-19 , Deficiencia de Vitamina D , Adulto , COVID-19/epidemiología , COVID-19/prevención & control , Suplementos Dietéticos , Humanos , Pandemias/prevención & control , ARN Viral , SARS-CoV-2 , Vitamina D , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina D/prevención & control , Vitaminas
BMJ Open ; 12(8): e060767, 2022 Aug 04.
Artículo en Inglés | MEDLINE | ID: mdl-35926987


INTRODUCTION: COVID-19 is a highly infectious disease, characterised by respiratory, physical and psychological dysfunctions. Rehabilitation could effectively alleviate the symptoms and promote recovery of the physical and mental health of patients with COVID-19. Recently, rehabilitation medical institutions have issued clinical practice guidelines (CPGs) and expert consensus statements involving recommendations for rehabilitation assessments and rehabilitation therapies for COVID-19. This systematic review aims to assess the methodological quality and reporting quality of the guidance documents, evaluate the heterogeneity of the recommendations and summarise the recommendations with respect to rehabilitation assessments and rehabilitation therapies for COVID-19 to provide a quick reference for front-line clinicians, therapists and patients as well as reasonable suggestions for future guidelines. METHODS AND ANALYSIS: The electronic databases including PubMed, Embase, Chinese Biomedical Literature Database (CBM), Chinese Science and Technology Periodical Database (VIP), Wanfang Database and China National Knowledge Infrastructure (CNKI) and websites of governments or organisations (eg, National Guideline Clearinghouse, Guidelines International Network, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network and WHO) will be searched for eligible CPGs and expert consensus statements from inception to August 2022. CPGs and expert consensus statements published in Chinese or English and presenting recommendations for modern functional rehabilitation techniques and/or traditional Chinese medicine rehabilitation techniques for COVID-19 will be included. Reviews, interpretations, old versions of CPGs and expert consensus statements and those for the management of other diseases during the pandemic will be excluded. Two reviewers will independently review each article, extract data, appraise the methodological quality following the Appraisal of Guidelines for Research & Evaluation II tool and assess the reporting quality with the Reporting Items for Practice Guidelines in Healthcare statement. The Measurement Scale of Rate of Agreement will be used to evaluate the heterogeneity of the recommendations in different CPGs and expert consensus statements. Agreement between reviewers will be calculated using the intraclass correlation coefficient. We will also summarise the recommendations for rehabilitation in patients with COVID-19. The results will be narratively described and presented as tables or figures. ETHICS AND DISSEMINATION: Ethics approval is not needed for this systematic review because information from published documents will be used. The findings will be submitted for publication in a peer-reviewed journal and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PROSPERO REGISTRATION NUMBER: CRD42020190761.

COVID-19 , COVID-19/rehabilitación , China , Consenso , Humanos , Medicina Tradicional China , Pandemias , Guías de Práctica Clínica como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto
BMC Public Health ; 22(1): 1481, 2022 08 04.
Artículo en Inglés | MEDLINE | ID: mdl-35927650


BACKGROUND: This paper describes the protocol for a longitudinal cohort study, "Project SafeSchools" (PSS), which focuses on measuring the effects of COVID-19 and the return to in-person learning on Diné (Navajo) and White Mountain Apache (Apache) youth, parents, and educators. The early surges of the COVID-19 pandemic led to the closure of most reservation and border town schools serving Diné and Apache communities. This study aims to: (1) understand the barriers and facilitators to school re-opening and in-person school attendance from the perspective of multiple stakeholders in Diné and Apache communities; and (2) evaluate the educational, social, emotional, physical, and mental health impacts of returning to in-person learning for caregivers and youth ages 4-16 who reside or work on the Diné Nation and the White Mountain Apache Tribal lands. METHODS: We aim to recruit up to N = 200 primary caregivers of Diné and Apache youth ages 4-16 and up to N = 120 school personnel. In addition, up to n = 120 of these primary caregivers and their children, ages 11-16, will be selected to participate in qualitative interviews to learn more about the effects of the pandemic on their health and wellbeing. Data from caregiver and school personnel participants will be collected in three waves via self-report surveys that measure COVID-19 related behaviors and attitudes, mental health, educational attitudes, and cultural practices and beliefs for both themselves and their child (caregiver participants only). We hypothesize that an individual's engagement with a variety of cultural activities during school closures and as school re-opened will have a protective effect on adult and youth mental health as they return to in-person learning. DISCUSSION: The results of this study will inform the development or implementation of preventative interventions that may help Diné and Apache youth and their families recover from the negative impact of the COVID-19 pandemic, and positively impact their health and wellness.

COVID-19 , Adolescente , COVID-19/epidemiología , Niño , Preescolar , Humanos , Estudios Longitudinales , Pandemias , Estudios Prospectivos , Instituciones Académicas , Estudiantes/psicología
BMC Infect Dis ; 22(1): 668, 2022 Aug 04.
Artículo en Inglés | MEDLINE | ID: mdl-35927713


BACKGROUND: Uganda accounts for 5% of all malaria cases and deaths reported globally and, in endemic countries, pregnancy is a risk factor for both acquisition of P. falciparum infection and development of severe malaria. In recent years, malaria control has been threatened by COVID-19 pandemic and by the emergence, in Northern Uganda, of both resistance to artemisinin derivatives and to sulfadoxine-pyrimethamine. METHODS: In this facility-based, prospective, observational study, pregnant women will be recruited at antenatal-care visits and followed-up until delivery. Collected data will explore the incidence of asymptomatic parasitemia and malaria-related outcomes, as well as the attitudes towards malaria prevention, administration of intermittent preventive treatment, healthcare seeking behavior and use of insecticide-treated nets. A subpopulation of women diagnosed with malaria will be recruited and their blood samples will be analyzed for detection of genetic markers of resistance to artemisinin derivatives and sulfadoxine-pyrimethamine. Also, to investigate the impact of COVID-19 on malaria care among pregnant women, a retrospective, interrupted-time series will be conducted on at the study sites for the period January 2018 to December 2021. DISCUSSION: The present study will explore the impact of COVID-19 pandemic on incidence of malaria and malaria-related adverse outcomes, along with the prevalence of resistance to artemisinin derivatives and to sulfadoxine-pyrimethamine. To our knowledge, this is the first study aiming to explore the combined effect of these factors on a cohort of pregnant women. TRIAL REGISTRATION: This study has been registered on the public website on 26th April, 2022. CLINICALTRIALS: gov Identifier: NCT05348746.

Antimaláricos , Artemisininas , COVID-19 , Malaria Falciparum , Antimaláricos/uso terapéutico , Artemisininas/uso terapéutico , Combinación de Medicamentos , Resistencia a Medicamentos , Femenino , Humanos , Malaria Falciparum/tratamiento farmacológico , Malaria Falciparum/epidemiología , Malaria Falciparum/prevención & control , Estudios Observacionales como Asunto , Pandemias , Embarazo , Mujeres Embarazadas , Estudios Prospectivos , Pirimetamina/uso terapéutico , Estudios Retrospectivos , Sulfadoxina/uso terapéutico , Uganda/epidemiología
Front Public Health ; 10: 917732, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35928479


Objective: This study aimed to determine the efficacy, effectiveness, and cost-effectiveness of inactivated COVID-19 vaccines (CoronaVac and BBIBP-CorV) in China using existing international clinical trials and real-world evidence. Methods: Through a search of PubMed, Embase, Web of Science, and CNKI, studies investigating the effectiveness of inactivated COVID-19 vaccines were identified, and a meta-analysis was undertaken to synthesize the vaccine efficacy and effectiveness data. Moreover, a decision-analytic model was developed to estimate the cost-effectiveness of inactivated vaccines for combating the COVID-19 pandemic in the Chinese context from a societal perspective. Results of the meta-analysis, along with cost data from official websites and works of literature were used to populate the model. Sensitivity analysis was performed to test the robustness of the model results. Results: A total of 24 studies were included in the meta-analysis. In comparison to no immunization, the effectiveness of inactivated vaccine against COVID-19 infection, hospitalization, ICU admission and death were 65.18% (95% CI 62.62, 67.75), 79.10% (95% CI 71.69, 86.51), 90.46% (95% CI 89.42, 91.50), and 86.69% (95% CI 85.68, 87.70); and the efficacy against COVID-19 infection and hospitalization were 70.56% (95% CI 57.87, 83.24) and 100% (95% CI 61.72, 100). Inactivated vaccine vaccination prevented more infections, hospitalizations, ICU admissions, and deaths with lower total costs, thus was cost-saving from a societal perspective in China. Base-case analysis results were robust in the one-way sensitivity analysis, and the percentage of ICU admission or death and direct medical cost ranked the top influential factors in our models. In the probabilistic sensitivity analysis, vaccination had a 100% probability of being cost-effective. Conclusion: Inactivated vaccine is effective in preventing COVID-19 infection, hospitalization, ICU admission and avoiding COVID-19 related death, and COVID-19 vaccination program is cost-saving from societal perspective in China.

Vacunas contra la COVID-19 , COVID-19 , Análisis Costo-Beneficio , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19/uso terapéutico , China/epidemiología , Humanos , Pandemias/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Vacunas de Productos Inactivados/uso terapéutico
Front Public Health ; 10: 871567, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35928486


The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) spreads rapidly, causing outbreaks that grow exponentially within a short period before interventions are sought and effectively implemented. Testing is part of the first line of defense against Corona Virus Disease of 2019 (COVID-19), playing a critical role in the early identification and isolation of cases to slow transmission, provision of targeted care to those affected, and protection of health system operations. Laboratory tests for COVID-19 based on nucleic acid amplification techniques were rapidly developed in the early days of the pandemic, but such tests typically require sophisticated laboratory infrastructure and skilled staff. In March 2020, Zimbabwe confirmed its first case of COVID-19; this was followed by an increase in infection rates as the pandemic spread across the country, thus increasing the demand for testing. One national laboratory was set to test all the country's COVID-19 suspect cases, building pressure on human and financial resources. Staff burnout and longer turnaround times of more than 48 h were experienced, and results were released late for clinical relevance. Leveraging on existing PCR testing platforms, including GeneXpert machines, eased the pressure for a short period before facing the stockout of SARs-CoV-2 cartridges for a long time, leading to work overload at a few testing sites contributing to long turnaround times. On September 11, WHO released the interim guidance to use antigen rapid diagnostic test as a diagnostic tool. The Zimbabwe laboratory pillar quickly adopted it and made plans for its implementation. The National Microbiology Reference Laboratory verified the two emergency-listed kits, the Panbio Abbott and the Standard Q, Biosensor, and they met the WHO minimum performance of ≥97% specificity and ≥80% sensitivity. Decentralizing diagnostic testing leveraging existing human resources became a game-changer in improving COVID-19 containment measures. Task shifting through training on Antigen rapid diagnostic tests (Ag-RDT) commenced, and testing was decentralized to all the ten provinces, from 1 central testing laboratory to more than 1,000 testing centers. WhatsApp platforms made it easier for data to be reported from remote areas. Result turnaround times were improved to the same day, and accessibility to testing was enhanced.

Prueba de COVID-19 , COVID-19 , Pandemias , COVID-19/diagnóstico , COVID-19/epidemiología , Accesibilidad a los Servicios de Salud , Humanos , Pandemias/prevención & control , SARS-CoV-2 , Zimbabwe/epidemiología
Glob Health Action ; 15(1): 2077536, 2022 Dec 31.
Artículo en Inglés | MEDLINE | ID: mdl-35930464


BACKGROUND: Vaccine scares undermine longstanding global health achievements. Remarkably little data has documented the lived experiences of policymakers working amidst vaccine scares and navigating their fallout. As a result, chances and challenges of large-scale national recuperation efforts are poorly understood. OBJECTIVE: This study aims to explore the perspectives of policymakers involved in ongoing efforts to boost vaccine confidence in the Philippines following a 2017 Dengvaxia scare and the current COVID-19 pandemic. METHODS: Between August and November 2020, we conducted 19 semi-structured narrative interviews with purposively selected policymakers from governmental agencies and non-governmental organizations in the Philippines. Interviews were conducted online, transcribed, and analyzed following the tenets of reflexive thematic analysis. RESULTS: We present results as an emerging model that draws on a chronology conveyed by policymakers in their own words. The Dengvaxia scare proved 'a decisive wedge' that splintered Filipino society and pitted governmental agencies against one another. The scare stoked distorted vaccination narratives, which were 'accelerated rapidly' via social media, and ignited feelings of uncertainty among policymakers of how to convey clear, accurate health messaging and how to prevent drops in care-seeking more broadly. CONCLUSIONS: Efforts to regain trust placed exceptional burdens on an already-strained health system. Respondent-driven recommendations on how to reinforce vaccine confidence and improve vaccination rollout include: developing clear vaccine messages, fostering healthcare providers' and policymakers' communication skills, and rebuilding trust within, toward and across governmental agencies. Further research on how to build enabling environments and rebuild trust in and across institutions remains paramount.

COVID-19 , Vacunas , COVID-19/prevención & control , Comunicación , Humanos , Pandemias , Filipinas , Vacunación