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1.
PLoS One ; 16(8): e0256496, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34424913

RESUMEN

BACKGROUND: While vaccines ensure individual protection against COVID-19 infection, delay in receipt or refusal of vaccines will have both individual and community impacts. The behavioral factors of vaccine hesitancy or refusal are a crucial dimension that need to be understood in order to design appropriate interventions. The aim of this study was to explore the behavioral determinants of COVID-19 vaccine acceptance and to provide recommendations to increase the acceptance and uptake of COVID-19 vaccines in Bangladesh. METHODS: We employed a Barrier Analysis (BA) approach to examine twelve potential behavioral determinants (drawn from the Health Belief Model [HBM] and Theory of Reasoned Action [TRA]) of intended vaccine acceptance. We conducted 45 interviews with those who intended to take the vaccine (Acceptors) and another 45 interviews with those who did not have that intention (Non-acceptors). We performed data analysis to find statistically significant differences and to identify which beliefs were most highly associated with acceptance and non-acceptance with COVID-19 vaccines. RESULTS: The behavioral determinants associated with COVID-19 vaccine acceptance in Dhaka included perceived social norms, perceived safety of COVID-19 vaccines and trust in them, perceived risk/susceptibility, perceived self-efficacy, perceived positive and negative consequences, perceived action efficacy, perceived severity of COVID-19, access, and perceived divine will. In line with the HBM, beliefs about the disease itself were highly predictive of vaccine acceptance, and some of the strongest statistically-significant (p<0.001) predictors of vaccine acceptance in this population are beliefs around both injunctive and descriptive social norms. Specifically, Acceptors were 3.2 times more likely to say they would be very likely to get a COVID-19 vaccine if a doctor or nurse recommended it, twice as likely to say that most people they know will get a vaccine, and 1.3 times more likely to say that most close family and friends will get a vaccine. The perceived safety of vaccines was found to be important since Non-acceptors were 1.8 times more likely to say that COVID-19 vaccines are "not safe at all". Beliefs about one's risk of getting COVID-19 disease and the severity of it were predictive of being a vaccine acceptor: Acceptors were 1.4 times more likely to say that it was very likely that someone in their household would get COVID-19, 1.3 times more likely to say that they were very concerned about getting COVID-19, and 1.3 times more likely to say that it would be very serious if someone in their household contracted COVID-19. Other responses of Acceptors on what makes immunization easier may be helpful in programming to boost acceptance, such as providing vaccination through government health facilities, schools, and kiosks, and having vaccinators maintain proper COVID-19 health and safety protocols. CONCLUSION: An effective behavior change strategy for COVID-19 vaccines uptake will need to address multiple beliefs and behavioral determinants, reducing barriers and leveraging enablers identified in this study. National plans for promoting COVID-19 vaccination should address the barriers, enablers, and behavioral determinants found in this study in order to maximize the impact on COVID-19 vaccination acceptance.


Asunto(s)
COVID-19/psicología , Negativa a la Vacunación/estadística & datos numéricos , Vacunación/psicología , Adulto , Actitud , Bangladesh , COVID-19/prevención & control , Vacunas contra la COVID-19/uso terapéutico , Cultura , Femenino , Humanos , Masculino , Persona de Mediana Edad , Población Urbana/estadística & datos numéricos , Negativa a la Vacunación/psicología
2.
AANA J ; 89(4): 325-333, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34342570

RESUMEN

Certified Registered Nurse Anesthetists (CRNAs) work in practice models ranging from full scope (independent) to limited scope (dependent). Little is known about the influence of population density on CRNAs' scope of practice (SOP) and job satisfaction in Arizona, an independent practice state. The objectives were to examine relationships between (1) SOP and population density and (2) job satisfaction and SOP. In this descriptive study, an 11-question survey was sent to CRNAs practicing in Arizona. A total of 515 surveys were distributed; 261 responses (50%) were received, and 230 respondents (46%) met inclusion criteria. Spearman rank-order correlation was used to analyze the relationship between SOP and population density and between SOP and job satisfaction. Rank biserial correlation was used to examine association between CRNAs' SOP and geographic location. More than half the participants were male (54%), and 46% were female (age range, 27-75 years; years' experience, 1-50 years). Population density had no association with SOP (P=.074). However, SOP and job satisfaction showed a positive correlation (P<.001). These findings suggest that removal of regulatory barriers to CRNAs' SOP could decrease costs and increase access to care. Autonomy plays a clear role in job satisfaction, which may have implications for recruitment and retention.


Asunto(s)
Satisfacción en el Trabajo , Enfermeras Anestesistas/psicología , Enfermeras Anestesistas/estadística & datos numéricos , Densidad de Población , Rol Profesional/psicología , Población Rural/estadística & datos numéricos , Alcance de la Práctica , Población Urbana/estadística & datos numéricos , Adulto , Arizona , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
3.
Nutrients ; 13(7)2021 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-34371864

RESUMEN

This study determined the intakes of complementary foods (CFs) and milk-based formulas (MFs) by a total of 119 subjects aged 6-23.9 months from urban day care centers. Dietary intakes were assessed using two-day weighed food records. Intake adequacy of energy and nutrients was compared to the Recommended Nutrient Intakes (RNI) for Malaysia. The most commonly consumed CFs were cereals (rice, noodles, bread). The subjects derived approximately half of their energy requirements (kcals) from CFs (57 ± 35%) and MFs (56 ± 31%). Protein intake was in excess of their RNI requirements, from both CFs (145 ± 72%) and MFs (133 ± 88%). Main sources of protein included meat, dairy products, and western fast food. Intake of CFs provided less than the RNI requirements for vitamin A, thiamine, riboflavin, folate, vitamin C, calcium, iron, and zinc. Neither CF nor MF intake met the Adequate Intake (AI) requirements for essential fatty acids. These findings indicate imbalances in the dietary intake of the subjects that may have adverse health implications, including increased risk of rapid weight gain from excess protein intake, and linear growth faltering and intellectual impairment from multiple micronutrient deficiencies. Interventions are needed to improve child feeding knowledge and practices among parents and child care providers.


Asunto(s)
Proteínas en la Dieta/análisis , Ácidos Grasos Esenciales/análisis , Alimentos Infantiles/estadística & datos numéricos , Micronutrientes/análisis , Población Urbana/estadística & datos numéricos , Animales , Guarderías Infantiles , Registros de Dieta , Encuestas sobre Dietas , Ingestión de Alimentos , Ácidos Grasos Esenciales/deficiencia , Femenino , Humanos , Lactante , Alimentos Infantiles/análisis , Fórmulas Infantiles/análisis , Fórmulas Infantiles/estadística & datos numéricos , Trastornos de la Nutrición del Lactante/epidemiología , Trastornos de la Nutrición del Lactante/etiología , Fenómenos Fisiológicos Nutricionales del Lactante , Malasia/epidemiología , Masculino , Micronutrientes/deficiencia , Leche , Necesidades Nutricionales
4.
Nutrients ; 13(7)2021 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-34371796

RESUMEN

Overlapping micronutrient interventions might increase the risk of excessive micronutrient intake, with potentially adverse health effects. To evaluate how strategies currently implemented in Benin and Ghana contribute to micronutrient intake in women of reproductive age (WRA), and to assess the risk for excess intakes, scenarios of basic rural and urban diets were built, and different on-going interventions were added. We estimated micronutrient intakes for all different scenarios. Four types of intervention were included in the scenarios: fortification, biofortification, supplementation and use of locally available nutrient-rich foods. Basic diets contributed poorly to daily micronutrient intake in WRA. Fortification of oil and salt were essential to reach daily requirements for vitamin A and iodine, while fortified flour contributed less. Biofortified products could make an important contribution to the coverage of vitamin A needs, while they were not sufficient to cover the needs of WRA. Iron and folic acid supplementation was a major contributor in the intake of iron and folate, but only in pregnant and lactating women. Risk of excess were found for three micronutrients (vitamin A, folic acid and niacin) in specific contexts, with excess only coming from voluntary fortified food, supplementation and the simultaneous overlap of several interventions. Better regulation and control of fortification and targeting of supplementation could avoid excess intakes.


Asunto(s)
Micronutrientes/análisis , Terapia Nutricional/estadística & datos numéricos , Hipernutrición/etiología , Salud Reproductiva/estadística & datos numéricos , Salud de la Mujer/estadística & datos numéricos , Adolescente , Adulto , Benin/epidemiología , Biofortificación/estadística & datos numéricos , Simulación por Computador , Dieta/estadística & datos numéricos , Suplementos Dietéticos/estadística & datos numéricos , Ingestión de Alimentos , Femenino , Ácido Fólico/análisis , Alimentos Fortificados/estadística & datos numéricos , Ghana/epidemiología , Humanos , Persona de Mediana Edad , Niacina/análisis , Terapia Nutricional/efectos adversos , Terapia Nutricional/métodos , Estado Nutricional , Hipernutrición/epidemiología , Embarazo , Ingesta Diaria Recomendada , Factores de Riesgo , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Vitamina A/análisis , Adulto Joven
5.
PLoS One ; 16(7): e0254430, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34280210

RESUMEN

We have investigated the importance of the rate of vaccination to contain COVID-19 in urban areas. We used an extremely simple epidemiological model that is amenable to implementation in an Excel spreadsheet and includes the demographics of social distancing, efficacy of massive testing and quarantine, and coverage and rate of vaccination as the main parameters to model the progression of COVID-19 pandemics in densely populated urban areas. Our model predicts that effective containment of pandemic progression in densely populated cities would be more effectively achieved by vaccination campaigns that consider the fast distribution and application of vaccines (i.e., 50% coverage in 6 months) while social distancing measures are still in place. Our results suggest that the rate of vaccination is more important than the overall vaccination coverage for containing COVID-19. In addition, our modeling indicates that widespread testing and quarantining of infected subjects would greatly benefit the success of vaccination campaigns. We envision this simple model as a friendly, readily accessible, and cost-effective tool for assisting health officials and local governments in the rational design/planning of vaccination strategies.


Asunto(s)
Vacunas contra la COVID-19/administración & dosificación , COVID-19/prevención & control , Programas Informáticos , Vacunación/estadística & datos numéricos , COVID-19/epidemiología , Humanos , Modelos Estadísticos , Cuarentena/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Vacunación/métodos
6.
Nutrients ; 13(7)2021 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-34206813

RESUMEN

This study aimed to determine the relationships among hyperglycemia (HG), the presence of type 2 diabetes (T2D), and the outcomes of COVID-19. Demographic data, blood glucose levels (BG) measured on admission, and hospital outcomes of COVID-19 patients hospitalized at Boston University Medical Center from 1 March to 4 August 2020 were extracted from the hospital database. HG was defined as BG > 200 mg/dL. Patients with type 1 diabetes or BG < 70 mg/dL were excluded. A total of 458 patients with T2D and 976 patients without T2D were included in the study. The mean ± SD age was 56 ± 17 years and 642 (45%) were female. HG occurred in 193 (42%) and 42 (4%) of patients with and without T2D, respectively. Overall, the in-hospital mortality rate was 9%. Among patients without T2D, HG was statistically significantly associated with mortality, ICU admission, intubation, acute kidney injury, and severe sepsis/septic shock, after adjusting for potential confounders (p < 0.05). However, only ICU admission and acute kidney injury were associated with HG among patients with T2D (p < 0.05). Among the 235 patients with HG, the presence of T2D was associated with decreased odds of mortality, ICU admission, intubation, and severe sepsis/septic shock, after adjusting for potential confounders, including BG (p < 0.05). In conclusion, HG in the subset of patients without T2D could be a strong indicator of high inflammatory burden, leading to a higher risk of severe COVID-19.


Asunto(s)
COVID-19/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Hospitalización/estadística & datos numéricos , Hiperglucemia/epidemiología , Lesión Renal Aguda/epidemiología , Adulto , Anciano , Glucemia , Boston/epidemiología , COVID-19/mortalidad , Estudios de Cohortes , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Intubación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , SARS-CoV-2 , Sepsis/epidemiología , Índice de Severidad de la Enfermedad , Población Urbana/estadística & datos numéricos
7.
Nutrients ; 13(6)2021 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-34199924

RESUMEN

The nutrition status of children is gaining more attention with a rapid nutrition transition. This study aimed to investigate trends and urban-rural differences in dietary energy and macronutrient composition among Chinese children. A total of 7565 participants aged 6 to 17 years were obtained from three rounds (1991, 2004 and 2015) of the Chinese Health and Nutrition Survey (CHNS). The individual diet was evaluated via three consecutive 24-hour dietary recalls and compared with the Chinese Dietary Reference Intakes (DRIs). From 1991 to 2015, there was a significant increase in children's fat intake, the proportion of energy intake from fat, and the proportion of children with more than 30% of energy from fat and less than 50% of energy from carbohydrates (p < 0.001). Compared with the DRI, the proportion with higher fat and lower carbohydrate intakes were, respectively, 64.7% and 46.8% in 2015. The urban-rural disparities in fat and carbohydrate intake gradually narrowed, while the gap in protein intake increased notably over time (p < 0.001). Chinese children experienced a rapid transformation to a low-carbohydrate and high-fat diet. Urban-rural disparities persistently existed; further nutritional interventions and education were of great significance, so as to ensure a more balanced diet for Chinese children.


Asunto(s)
Ingestión de Alimentos , Ingestión de Energía , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adolescente , Niño , China/epidemiología , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Encuestas Nutricionales , Factores Socioeconómicos
8.
Lancet ; 398(10294): 53-63, 2021 07 03.
Artículo en Inglés | MEDLINE | ID: mdl-34217401

RESUMEN

BACKGROUND: In China, mean body-mass index (BMI) and obesity in adults have increased steadily since the early 1980s. However, to our knowledge, there has been no reliable assessment of recent trends, nationally, regionally, or in certain population subgroups. To address this evidence gap, we present detailed analyses of relevant data from six consecutive nationally representative health surveys done between 2004 and 2018. We aimed to examine the long-term and recent trends in mean BMI and prevalence of obesity among Chinese adults, with specific emphasis on changes before and after 2010 (when various national non-communicable disease prevention programmes were initiated), assess how these trends might vary by sex, age, urban-rural locality, and socioeconomic status, and estimate the number of people who were obese in 2018 compared with 2004. METHODS: We used data from the China Chronic Disease and Risk Factors Surveillance programme, which was established in 2004 with the aim to provide periodic nationwide data on the prevalence of major chronic diseases and the associated behavioural and metabolic risk factors in the general population. Between 2004 and 2018 six nationally representative surveys were done. 776 571 individuals were invited and 746 020 (96·1%) participated, including 33 051 in 2004, 51 050 in 2007, 98 174 in 2010, 189 115 in 2013, 189 754 in 2015, and 184 876 in 2018. After exclusions, 645 223 participants aged 18-69 years remained for the present analyses. The mean BMI and prevalence of obesity (BMI ≥30 kg/m2) were calculated and time trends compared by sex, age, urban-rural locality, geographical region, and socioeconomic status. FINDINGS: Standardised mean BMI levels rose from 22·7 kg/m2 (95% CI 22·5-22·9) in 2004 to 24·4 kg/m2 (24·3-24·6) in 2018 and obesity prevalence from 3·1% (2·5-3·7) to 8·1% (7·6-8·7). Between 2010 and 2018, mean BMI rose by 0·09 kg/m2 annually (0·06-0·11), which was half of that reported during 2004-10 (0·17 kg/m2, 95% CI 0·12-0·22). Similarly, the annual increase in obesity prevalence was somewhat smaller after 2010 than before 2010 (6·0% annual relative increase, 95% CI 4·4-7·6 vs 8·7% annual relative increase, 4·9-12·8; p=0·13). Since 2010, the rise in mean BMI and obesity prevalence has slowed down substantially in urban men and women, and moderately in rural men, but continued steadily in rural women. By 2018, mean BMI was higher in rural than urban women (24·3 kg/m2vs 23·9 kg/m2; p=0·0045), but remained lower in rural than urban men (24·5 kg/m2vs 25·1 kg/m2; p=0·0007). Across all six surveys, mean BMI was persistently lower in women with higher levels of education compared with women with lower levels of education, but the inverse was true among men. Overall, an estimated 85 million adults (95% CI 70 million-100 million; 48 million men [95% CI 39 million-57 million] and 37 million women [31 million-43 million]) aged 18-69 years in China were obese in 2018, which was three times as many as in 2004. INTERPRETATION: In China, the rise in mean BMI among the adult population appears to have slowed down over the past decade. However, we found divergent trends by sex, geographical area, and socioeconomic status, highlighting the need for a more targeted approach to prevent further increases in obesity in the Chinese general population. FUNDING: China National Key Research and Development Program, China National Key Project of Public Health Program, and Youth Scientific Research Foundation of the National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention.


Asunto(s)
Índice de Masa Corporal , Obesidad/epidemiología , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Anciano , China/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Adulto Joven
9.
Afr J Prim Health Care Fam Med ; 13(1): e1-e7, 2021 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-34212744

RESUMEN

BACKGROUND: Hypertension is a public health threat of global concern with increasing prevalence in many countries, including Nigeria. AIM: The aim of the study was to determine the prevalence and determinants of hypertension in a rural agrarian community in Edo North, Nigeria. SETTING: The study was carried out in Ayua, a community in Edo North, southern Nigeria. METHODS: This cross-sectional descriptive study involved the use of a structured interviewer-administered questionnaire to obtain relevant data. Body mass index (BMI), blood pressure and glucose were recorded. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0. RESULTS: Two hundred and nineteen participants aged 15 years completed the study with a mean age of 54.03 ± 16.61 years and females comprising 159 (72.6%) of the total. The prevalence of hypertension was 27.9% (in 61 participants). Twenty-one (9.8%) respondents gave a family history of hypertension. The mean BMI amongst respondents was 27.10 ± 6.61 kg/m2. Obesity and pre-obesity were found in 58 (26.5%) and 71(32.4%) respondents, respectively. The determinants of hypertension were age and BMI. Compared with those who were less than 40 years old, those aged 40-65 years and 65 years had 1.9 and 4.2 times increased odds of developing hypertension, respectively. Similarly, compared with the non-obese, obese participants had 2.3 times increased odd of having hypertension. CONCLUSION: Hypertension was highly prevalent in this rural community. Health sensitisation and intervention programmes are recommended in rural communities for early detection and management of hypertension, especially amongst older and obese adults.


Asunto(s)
Hipertensión/epidemiología , Obesidad/epidemiología , Determinantes Sociales de la Salud , Adulto , Anciano , Presión Sanguínea/fisiología , Índice de Masa Corporal , Estudios Transversales , Femenino , Humanos , Hipertensión/etnología , Hipertensión/psicología , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Obesidad/complicaciones , Obesidad/etnología , Obesidad/psicología , Prevalencia , Factores de Riesgo , Población Rural/estadística & datos numéricos , Factores Socioeconómicos , Población Urbana/estadística & datos numéricos
10.
Ann Agric Environ Med ; 28(2): 243-249, 2021 Jun 14.
Artículo en Inglés | MEDLINE | ID: mdl-34184505

RESUMEN

OBJECTIVE: The aim of the study was to explore the influence of exudative age-related macular degeneration on the quality of life of patients from urban and rural areas. MATERIAL AND METHODS: The retrospective study included 144 Polish Caucasians with exudative age-related macular degeneration, treated with anti-VEGF, recruited from Department of Medical Retina in Lublinbetween March and June 2017. Clinical assessment included age, gender, visual acuity, complete ophthalmic examination, fundus fluorescein angiography and optical coherence tomography, medical history and the NEI VFQ-25 questionnaire. RESULTS: The mean age of the study group was 76.73±12.3 years, average time of AMD was 4.24±4.1 years. 21.5% of patients reported comorbidities such as hypertension, cardiovascular disease, diabetes mellitus. 99 (68.75%) lived in a city, while 45(31.25%) in a village. There was a tendency of females to complain more than males about moderate and severe discomfort and pain (p = 0.09). Most of the patients did not drive a car before the onset of the disease (female vs.male: 81% vs 62.9%; p = 0.01). 62.8% males and 25.8% females gave up driving (p = 0.003), whereas significantly more males gave up driving' and 25% of villagers gave up driving (p = 0.07). The parameter because of the eyesight - female vs. male: 50% vs. 20.8%; p = 0.03. There was a tendency of village respondents to complain more often about extreme difficulty in reading newspapers, street signs or the names of stores than (p = 0.08). 44.2% city residents. Rural patients felt to achieve much less because of their eyesight, which was not observed in patients from the city (p = 0.06). CONCLUSIONS: The place of residence and gender influenced perception of the disease in exudative form of age-related macular degeneration.


Asunto(s)
Degeneración Macular/psicología , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Degeneración Macular/fisiopatología , Masculino , Persona de Mediana Edad , Calidad de Vida , Estudios Retrospectivos , Agudeza Visual
11.
JMIR Public Health Surveill ; 7(7): e29865, 2021 07 20.
Artículo en Inglés | MEDLINE | ID: mdl-34174781

RESUMEN

BACKGROUND: COVID-19 has disrupted lives and livelihoods and caused widespread panic worldwide. Emerging reports suggest that people living in rural areas in some countries are more susceptible to COVID-19. However, there is a lack of quantitative evidence that can shed light on whether residents of rural areas are more concerned about COVID-19 than residents of urban areas. OBJECTIVE: This infodemiology study investigated attitudes toward COVID-19 in different Japanese prefectures by aggregating and analyzing Yahoo! JAPAN search queries. METHODS: We measured COVID-19 concerns in each Japanese prefecture by aggregating search counts of COVID-19-related queries of Yahoo! JAPAN users and data related to COVID-19 cases. We then defined two indices-the localized concern index (LCI) and localized concern index by patient percentage (LCIPP)-to quantitatively represent the degree of concern. To investigate the impact of emergency declarations on people's concerns, we divided our study period into three phases according to the timing of the state of emergency in Japan: before, during, and after. In addition, we evaluated the relationship between the LCI and LCIPP in different prefectures by correlating them with prefecture-level indicators of urbanization. RESULTS: Our results demonstrated that the concerns about COVID-19 in the prefectures changed in accordance with the declaration of the state of emergency. The correlation analyses also indicated that the differentiated types of public concern measured by the LCI and LCIPP reflect the prefectures' level of urbanization to a certain extent (ie, the LCI appears to be more suitable for quantifying COVID-19 concern in urban areas, while the LCIPP seems to be more appropriate for rural areas). CONCLUSIONS: We quantitatively defined Japanese Yahoo users' concerns about COVID-19 by using the search counts of COVID-19-related search queries. Our results also showed that the LCI and LCIPP have external validity.


Asunto(s)
Ansiedad/epidemiología , Actitud Frente a la Salud , COVID-19/psicología , Internet/estadística & datos numéricos , Motor de Búsqueda/estadística & datos numéricos , Adulto , Anciano , COVID-19/epidemiología , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos
12.
PLoS One ; 16(6): e0252373, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34106993

RESUMEN

OBJECTIVE: To assess whether the basic reproduction number (R0) of COVID-19 is different across countries and what national-level demographic, social, and environmental factors other than interventions characterize initial vulnerability to the virus. METHODS: We fit logistic growth curves to reported daily case numbers, up to the first epidemic peak, for 58 countries for which 16 explanatory covariates are available. This fitting has been shown to robustly estimate R0 from the specified period. We then use a generalized additive model (GAM) to discern both linear and nonlinear effects, and include 5 random effect covariates to account for potential differences in testing and reporting that can bias the estimated R0. FINDINGS: We found that the mean R0 is 1.70 (S.D. 0.57), with a range between 1.10 (Ghana) and 3.52 (South Korea). We identified four factors-population between 20-34 years old (youth), population residing in urban agglomerates over 1 million (city), social media use to organize offline action (social media), and GINI income inequality-as having strong relationships with R0, across countries. An intermediate level of youth and GINI inequality are associated with high R0, (n-shape relationships), while high city population and high social media use are associated with high R0. Pollution, temperature, and humidity did not have strong relationships with R0 but were positive. CONCLUSION: Countries have different characteristics that predispose them to greater intrinsic vulnerability to COVID-19. Studies that aim to measure the effectiveness of interventions across locations should account for these baseline differences in social and demographic characteristics.


Asunto(s)
Número Básico de Reproducción/estadística & datos numéricos , COVID-19/epidemiología , Renta/estadística & datos numéricos , Medios de Comunicación Sociales/estadística & datos numéricos , Factores de Edad , COVID-19/economía , COVID-19/transmisión , COVID-19/virología , Bases de Datos Factuales , Salud Global , Humanos , Modelos Estadísticos , Pandemias , SARS-CoV-2/aislamiento & purificación , Factores Socioeconómicos , Población Urbana/estadística & datos numéricos
13.
PLoS One ; 16(6): e0253466, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34138950

RESUMEN

OBJECTIVE: Reports of disparities in COVID-19 mortality rates are emerging in the public health literature as the pandemic continues to unfold. Alcohol misuse varies across the US and is related to poorer health and comorbidities that likely affect the severity of COVID-19 infection. High levels of pre-pandemic alcohol misuse in some counties may have set the stage for worse COVID-19 outcomes. Furthermore, this relationship may depend on how rural a county is, as access to healthcare in rural communities has lagged behind more urban areas. The objective of this study was to test for associations between county-level COVID-19 mortality, pre-pandemic county-level excessive drinking, and county rurality. METHOD: We used national COVID-19 data from the New York Times to calculate county-level case fatality rates (n = 3,039 counties and county equivalents; October 1 -December 31, 2020) and other external county-level data sources for indicators of rurality and health. We used beta regression to model case fatality rates, adjusted for several county-level population characteristics. We included a multilevel component to our model and defined state as a random intercept. Our focal predictor was a single variable representing nine possible combinations of low/mid/high alcohol misuse and low/mid/high rurality. RESULTS: The median county-level COVID-19 case fatality rate was 1.57%. Compared to counties with low alcohol misuse and low rurality (referent), counties with high levels of alcohol and mid (ß = -0.17, p = 0.008) or high levels of rurality (ß = -0.24, p<0.001) demonstrated significantly lower case fatality rates. CONCLUSIONS: Our findings highlight the intersecting roles of county-level alcohol consumption, rurality, and COVID-19 mortality.


Asunto(s)
Alcoholismo/epidemiología , COVID-19/epidemiología , Población Rural/estadística & datos numéricos , SARS-CoV-2/aislamiento & purificación , Población Urbana/estadística & datos numéricos , Alcoholismo/fisiopatología , COVID-19/mortalidad , COVID-19/virología , Comorbilidad , Geografía , Disparidades en el Estado de Salud , Humanos , Modelos Teóricos , Análisis Multivariante , Pandemias/prevención & control , Factores de Riesgo , SARS-CoV-2/fisiología , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Tasa de Supervivencia , Estados Unidos/epidemiología
14.
Nutrients ; 13(6)2021 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-34072813

RESUMEN

Anemia is a worldwide concern. This cross-sectional population-based study examined the prevalence of iron-deficiency anemia (IDA) among residents of São Paulo (n = 898; 12-93 years), considering sociodemographic factors, dietary iron inadequacy, and food contributors to iron intake. Blood cell count and iron biomarkers were quantified. Dietary iron intake was measured using two 24-h dietary recalls. Iron intake inadequacy was estimated using a probabilistic approach. The prevalence of anemia was 6.7%, depleted iron stores 5.1%, and IDA 1.1%. Women of all age groups, older adults, and those who were underweight or obese had the highest prevalence of anemia, and female adolescents had the highest prevalence of depleted iron stores. Female adolescents and adults were more vulnerable to depleted iron stores. Male adults and older adults had a considerable prevalence of iron overload. Except for female adolescents and adults, all groups had mild probabilities of inadequate iron intake. The main food iron contributor was wheat flour. Hemoglobin concentrations were directly associated with being an adult, having a higher income, and inversely associated with being female. Serum ferritin concentrations were directly associated with age and inversely correlated with female sex. Residents of São Paulo had a low prevalence of anemia, iron deficiency, and IDA, and sociodemographic factors interfered with these parameters.


Asunto(s)
Anemia Ferropénica/epidemiología , Adolescente , Adulto , Factores de Edad , Brasil/epidemiología , Niño , Estudios Transversales , Dieta/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores Sexuales , Factores Socioeconómicos , Población Urbana/estadística & datos numéricos , Adulto Joven
15.
Environ Health Prev Med ; 26(1): 64, 2021 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-34098871

RESUMEN

INTRODUCTION: Cervical cancer and its etiopathogenesis, the age of women in whom it is diagnosed, average life expectancy, and prognosis are information widely covered in scientific reports. However, there is no coherent information regarding which regions-urban or rural-it may occur more often. This is important because the literature on the subject reports that people living in rural areas have a worse prognosis when it comes to detection, treatment, and life expectancy than city dwellers. MATERIAL AND METHODS: The subjects of the study were women and their knowledge about cervical cancer. The research was carried out using a survey directly distributed among respondents and via the Internet, portals, and discussion groups for women from Poland. Three hundred twenty-nine women took part in the study, including 164 from rural and 165 from urban areas. The collected data enabled the following: (1) an analysis of the studied groups, (2) assessment of the respondents' knowledge about cervical cancer, and (3) comparison of women's knowledge depending on where they live. RESULTS: The average assessment of all respondents' knowledge was 3.59, with women living in rural areas scoring 3.18 and respondents from the city-4.01. Statistical significance (p < 0.001) between the level of knowledge and place of residence was determined. The results indicate that an increase in the level of education in the subjects significantly increases the chance of getting the correct answer. In the case of age analysis, the coefficients indicate a decrease in the chance of obtaining the correct answer in older subjects despite the fact that a statistically significant level was reached in individual questions. CONCLUSIONS: Women living in rural areas have less knowledge of cervical cancer than female respondents from the city. There is a need for more awareness campaigns to provide comprehensive information about cervical cancer to women in rural areas. A holistic approach to the presented issue can solve existing difficulties and barriers to maintaining health regardless of the place of life and residence. IMPLICATION FOR CANCER SURVIVORS: They need intensive care for women's groups most burdened with risk factors.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Neoplasias del Cuello Uterino/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Encuestas y Cuestionarios , Salud de la Mujer , Adulto Joven
16.
JAMA Netw Open ; 4(6): e2116425, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-34170303

RESUMEN

Importance: The COVID-19 pandemic has severely disrupted US educational institutions. Given potential adverse financial and psychosocial effects of campus closures, many institutions developed strategies to reopen campuses in the fall 2020 semester despite the ongoing threat of COVID-19. However, many institutions opted to have limited campus reopening to minimize potential risk of spread of SARS-CoV-2. Objective: To analyze how Boston University (BU) fully reopened its campus in the fall of 2020 and controlled COVID-19 transmission despite worsening transmission in Boston, Massachusetts. Design, Setting, and Participants: This multifaceted intervention case series was conducted at a large urban university campus in Boston, Massachusetts, during the fall 2020 semester. The BU response included a high-throughput SARS-CoV-2 polymerase chain reaction testing facility with capacity to deliver results in less than 24 hours; routine asymptomatic screening for COVID-19; daily health attestations; adherence monitoring and feedback; robust contact tracing, quarantine, and isolation in on-campus facilities; face mask use; enhanced hand hygiene; social distancing recommendations; dedensification of classrooms and public places; and enhancement of all building air systems. Data were analyzed from December 20, 2020, to January 31, 2021. Main Outcomes and Measures: SARS-CoV-2 diagnosis confirmed by reverse transcription-polymerase chain reaction of anterior nares specimens and sources of transmission, as determined through contact tracing. Results: Between August and December 2020, BU conducted more than 500 000 COVID-19 tests and identified 719 individuals with COVID-19, including 496 students (69.0%), 11 faculty (1.5%), and 212 staff (29.5%). Overall, 718 individuals, or 1.8% of the BU community, had test results positive for SARS-CoV-2. Of 837 close contacts traced, 86 individuals (10.3%) had test results positive for COVID-19. BU contact tracers identified a source of transmission for 370 individuals (51.5%), with 206 individuals (55.7%) identifying a non-BU source. Among 5 faculty and 84 staff with SARS-CoV-2 with a known source of infection, most reported a transmission source outside of BU (all 5 faculty members [100%] and 67 staff members [79.8%]). A BU source was identified by 108 of 183 undergraduate students with SARS-CoV-2 (59.0%) and 39 of 98 graduate students with SARS-CoV-2 (39.8%); notably, no transmission was traced to a classroom setting. Conclusions and Relevance: In this case series of COVID-19 transmission, BU used a coordinated strategy of testing, contact tracing, isolation, and quarantine, with robust management and oversight, to control COVID-19 transmission in an urban university setting.


Asunto(s)
COVID-19/prevención & control , Control de Infecciones/normas , Universidades/tendencias , Población Urbana/estadística & datos numéricos , Boston/epidemiología , COVID-19/epidemiología , COVID-19/transmisión , Trazado de Contacto/instrumentación , Trazado de Contacto/métodos , Higiene de las Manos/métodos , Humanos , Control de Infecciones/métodos , Control de Infecciones/estadística & datos numéricos , Cuarentena/métodos , Universidades/organización & administración
17.
Pan Afr Med J ; 38: 249, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34104297

RESUMEN

Introduction: blood donation (BD) is affected by several factors, among which people's knowledge and attitude are the key determinants. However, the level of knowledge and attitude towards BD in Ethiopia is not yet well studied. Therefore, this study aimed to assess the level and factors associated with knowledge and attitude towards blood donation among health science college students in Southwest Ethiopia. Methods: a cross-sectional study was conducted among 394 health science students from June 1st to 15th 2019. The data were collected using a structured self-administered questionnaire. The data were entered using EPI-data version 4.2.0.0 and analyzed using SPSS version 20. The correlation analysis was done to determine the association between the knowledge sum score and the attitude sum score. A binary logistic regression analysis was done to determine the association between the dependent and independent variables. Results: the proportions of good knowledge and positive attitude towards BD were 69.3%, 95% CI (64.8%-73.4%) and 58.1%, 95% CI (52.3%-63.0%) respectively. The study also found that age ≥23 years (adjusted odds ratio (AOR)=1.67, 95% CI (1.04-2.67)), having a father with primary and secondary school and above (AOR=2.24, 95% CI (1.20-4.17) and AOR=2.26, 95% CI (1.26-4.06) respectively) and ever donated blood (AOR=3.64, 95%CI (2.26-5.85)) were factors associated with good knowledge of blood donation. Being a rural resident (AOR=1.59, 95% CI (1.01-2.40)) and graduating class student (AOR=0.56, 95% CI (0.34-0.96)) were factors associated with a positive attitude towards blood donation. The knowledge-related questions´ sum score value was positively correlated with the attitude-related questions' sum score value (r=0.30, P<0.001). Conclusion: the knowledge and attitude towards BD among the study population are a substantial deficiency. Therefore, more effort is needed to increase the level of knowledge and attitude towards BD by inculcating short training courses for these groups of population in the existing curriculum.


Asunto(s)
Donantes de Sangre/psicología , Conocimientos, Actitudes y Práctica en Salud , Estudiantes/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Etiopía , Femenino , Humanos , Masculino , Población Rural/estadística & datos numéricos , Encuestas y Cuestionarios , Universidades , Población Urbana/estadística & datos numéricos , Adulto Joven
18.
MMWR Morb Mortal Wkly Rep ; 70(22): 818-824, 2021 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-34081685

RESUMEN

Disparities in vaccination coverage by social vulnerability, defined as social and structural factors associated with adverse health outcomes, were noted during the first 2.5 months of the U.S. COVID-19 vaccination campaign, which began during mid-December 2020 (1). As vaccine eligibility and availability continue to expand, assuring equitable coverage for disproportionately affected communities remains a priority. CDC examined COVID-19 vaccine administration and 2018 CDC social vulnerability index (SVI) data to ascertain whether inequities in COVID-19 vaccination coverage with respect to county-level SVI have persisted, overall and by urbanicity. Vaccination coverage was defined as the number of persons aged ≥18 years (adults) who had received ≥1 dose of any Food and Drug Administration (FDA)-authorized COVID-19 vaccine divided by the total adult population in a specified SVI category.† SVI was examined overall and by its four themes (socioeconomic status, household composition and disability, racial/ethnic minority status and language, and housing type and transportation). Counties were categorized into SVI quartiles, in which quartile 1 (Q1) represented the lowest level of vulnerability and quartile 4 (Q4), the highest. Trends in vaccination coverage were assessed by SVI quartile and urbanicity, which was categorized as large central metropolitan, large fringe metropolitan (areas surrounding large cities, e.g., suburban), medium and small metropolitan, and nonmetropolitan counties.§ During December 14, 2020-May 1, 2021, disparities in vaccination coverage by SVI increased, especially in large fringe metropolitan (e.g., suburban) and nonmetropolitan counties. By May 1, 2021, vaccination coverage was lower among adults living in counties with the highest overall SVI; differences were most pronounced in large fringe metropolitan (Q4 coverage = 45.0% versus Q1 coverage = 61.7%) and nonmetropolitan (Q4 = 40.6% versus Q1 = 52.9%) counties. Vaccination coverage disparities were largest for two SVI themes: socioeconomic status (Q4 = 44.3% versus Q1 = 61.0%) and household composition and disability (Q4 = 42.0% versus Q1 = 60.1%). Outreach efforts, including expanding public health messaging tailored to local populations and increasing vaccination access, could help increase vaccination coverage in high-SVI counties.


Asunto(s)
Vacunas contra la COVID-19/administración & dosificación , Disparidades en Atención de Salud/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Cobertura de Vacunación/estadística & datos numéricos , Poblaciones Vulnerables/estadística & datos numéricos , Adulto , COVID-19/epidemiología , COVID-19/prevención & control , Ciudades/epidemiología , Humanos , Factores Socioeconómicos , Estados Unidos/epidemiología
20.
Pan Afr Med J ; 38: 203, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33995809

RESUMEN

Introduction: the emergence of HIV/TB co-infection has changed the global health landscape globally, particularly in sub-Saharan Africa and Asia with a high prevalence rate. It has further worsened and compound patient diagnosis, treatment/management approach and infection control. Rifampicin resistance TB (RR-TB) is a good indicator of treatment failure and infection control in the community. This study determines the prevalence of RR-TB among HIV/TB coinfected patients in Benue State, Nigeria. Methods: the case-control study was carried out at Federal Medical Centre, Makurdi and General Hospital, Otupko, between January 2017 and February 2018. One thousand and ten suspected tuberculosis and HIV patients were enrolled in the study, diagnosed according to WHO guidelines. Sputum samples were collected and then analyzed by acid-fast bacilli smear test and GeneXpert MTB/RIF assay. Results: overall prevalence of tuberculosis by acid-fast test was 74 (7.3%), 171 (16.93%) by GeneXpert assay and 2.18% by RR-TB test respectively. Significant difference was observed between the detection technique and demographic variables, high prevalence among urban patient compared to rural (8.85%vs 5.40%; X2= 4.38; P = 0.036) and ethnic background of the patients (X2= 23.21; P = 0.000) by acid fast test. With GeneXpert, high prevalence recorded among patient within age-group15-45years (X2= 8.01; P = 0.046) and ethnic group (X2= 6.30; P = 0.044). The occurrence of HIV/TB co-infection was less associated with Idoma ethnic group (COR; 0.440; 95% C.I; 0.246 - 0.786). Conclusion: the relatively high prevalence of HIV/TB co-infection and RR-TB is a tremendous public health threat, considering society's attendant implication. Further surveillance studies are needed to evaluate the situation in Benue State better.


Asunto(s)
Antituberculosos/farmacología , Infecciones por VIH/complicaciones , Rifampin/farmacología , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis/epidemiología , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Preescolar , Coinfección , Femenino , Infecciones por VIH/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Prevalencia , Población Rural/estadística & datos numéricos , Esputo/microbiología , Tuberculosis/tratamiento farmacológico , Tuberculosis/microbiología , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Población Urbana/estadística & datos numéricos , Adulto Joven
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