Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 27.377
Filtrar
1.
Brasília; IPEA; 20200500. 73 p. ilus.(Texto para Discussão / IPEA, 2559).
Monografía en Portugués | LILACS, ECOS | ID: biblio-1100677

RESUMEN

Este texto apresenta um panorama internacional das medidas econômicas adotadas para reduzir os graves efeitos econômicos da pandemia de Sars-COV-2 em três países: Estados Unidos, Reino Unido e Espanha. A análise toma como base primordialmente documentos governamentais que normatizaram as medidas de política econômica. São analisados os diversos canais por meio dos quais a crise sanitária afeta a economia. Por um lado, estão os fatores de oferta: oferta de trabalho, produtividade do trabalho e funcionamento das cadeias produtivas. Por outro lado, encontram-se os fatores de demanda: consumo das famílias, investimento privado e comércio exterior. O terceiro canal diz respeito aos fatores financeiros que incidem sobre as variáveis de demanda e, principalmente, sobre o grau de liquidez das empresas financeiras e não financeiras. As medidas adotadas nos três países apresentam como características comuns a mobilização de grande volume de recursos fiscais e financeiros, a adoção de uma grande diversidade de instrumentos de política econômica e o uso de arranjos institucionais sofisticados em termos de regras de focalização e de mecanismos de operacionalização das medidas adotadas.


This text presents an international overview of the economic measures adopted to reduce the serious economic effects of the Sars-COV-2 pandemic in three countries: the USA, the United Kingdom and Spain. The analysis is based primarily on government documents that regulated economic policy measures. The various channels through which the health crisis affects the economy are analyzed. On one hand, there are the supply factors: labor supply, labor productivity and the functioning of production chains. On the other hand, there are demand factors: household consumption, private investment and foreign trade. The third channel concerns the financial factors on demand variables and, mainly, on the degree of liquidity of financial and non-financial companies. The measures adopted in the three countries have as common characteristics the mobilization of large volumes of fiscal and financial resources, the adoption of a wide range of economic policy instruments and the use of sophisticated institutional arrangements in terms of targeting rules and mechanisms for operationalizing the measures adopted.


Asunto(s)
Política Pública , Coronavirus , Pandemias , España/epidemiología , Estados Unidos/epidemiología , Reino Unido/epidemiología
2.
Artículo en Inglés | MEDLINE | ID: mdl-33203076

RESUMEN

The COVID-19 pandemic led to unprecedented restrictions on people's movements and interactions, as well as the cancellation of major sports events and social activities, directly altering the gambling landscape. There is urgent need to provide regulators, policy makers and treatment providers with evidence on the patterns and context of gambling during COVID-19 and its aftermath. This protocol describes a study addressing the following three questions: (1) How has COVID-19 changed gambling practices and the risk factors for, and experience of, gambling harms? (2) What is the effect of COVID-19 on gambling marketing? (3) How has COVID-19 changed high risk groups' gambling experiences and practices? This mixed-method study focuses on two groups, namely young adults and sports bettors. In workpackage-1, we will extend an existing longitudinal survey of gambling in young adults (aged 16-24 years) (first wave conducted June-August 2019), adding COVID-19-related questions to the second wave (July-August 2020) and extending to a third wave in 2021; and undertake a survey of sports bettors in the UK (baseline n = 4000, ~July-August 2020), with follow-ups in ~October-November 2020 and ~February-March 2021. In workpackage-2, we will examine changes in expenditure on paid-for gambling advertising from January 2019 to July 2021 and undertake a mixed-method content analysis of a random sample of paid-for gambling advertising (n ~ 200) and social media marketing (n ~ 100) during the initial COVID-19 "lockdown". Workpackage-3 will involve qualitative interviews with a purposive sample of (a) young adults (aged 18-24 years) and (b) sports bettors.


Asunto(s)
Infecciones por Coronavirus , Juego de Azar , Mercadotecnía , Pandemias , Neumonía Viral , Juegos de Video , Adolescente , Adulto , Betacoronavirus , Juego de Azar/epidemiología , Humanos , Proyectos de Investigación , Reino Unido/epidemiología , Adulto Joven
3.
Bone Joint J ; 102-B(11): 1475-1483, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33135447

RESUMEN

AIMS: The aim of this study was to determine the current incidence and epidemiology of humeral diaphyseal fractures. The secondary aim was to explore variation in patient and injury characteristics by fracture location within the humeral diaphysis. METHODS: Over ten years (2008 to 2017), all adult patients (aged ≥ 16 years) sustaining an acute fracture of the humeral diaphysis managed at the study centre were retrospectively identified from a trauma database. Patient age, sex, medical/social background, injury mechanism, fracture classification, and associated injuries were recorded and analyzed. RESULTS: A total of 900 fractures (typical 88.9%, n = 800/900; pathological 8.3%, n = 75/900; periprosthetic 2.8%, n = 25/900) were identified in 898 patients (mean age 57 years (16 to 97), 55.5% (n = 498/898) female). Overall fracture incidence was 12.6/100,000/year. For patients with a typical fracture (n = 798, mean age 56 years (16 to 96), 55.1% (n = 440/798) female), there was a bimodal distribution in men and unimodal distribution in older women (Type G). A fall from standing was the most common injury mechanism (72.6%, n = 581/800). The majority of fractures involved the middle-third of the diaphysis (47.6%, n = 381/800) followed by the proximal- (30.5%, n = 244/800) and distal-thirds (n = 175/800, 21.9%). In all, 18 injuries (2.3%) were open and a radial nerve palsy occurred in 6.7% (n = 53/795). Fractures involving the proximal- and middle-thirds were more likely to occur in older (p < 0.001), female patients (p < 0.001) with comorbidities (p < 0.001) after a fall from standing (p < 0.001). Proximal-third fractures were also more likely to occur in patients with alcohol excess (p = 0.003) and to be classified as AO-Orthopaedic Trauma Association type B or C injuries (p < 0.001). CONCLUSION: This study updates the incidence and epidemiology of humeral diaphyseal fractures. Important differences in patient and injury characteristics were observed based upon fracture location. Injuries involving the proximal- and middle-thirds of the humeral diaphysis should be considered as fragility fractures. Cite this article: Bone Joint J 2020;102-B(11):1475-1483.


Asunto(s)
Diáfisis/lesiones , Fracturas del Húmero/epidemiología , Húmero/lesiones , Fracturas Osteoporóticas/epidemiología , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Reino Unido/epidemiología , Adulto Joven
4.
PLoS One ; 15(11): e0241544, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33141867

RESUMEN

INTRODUCTION: COVID-19 has spread globally to now be considered a pandemic by the World Health Organisation. Initially patients appeared to have a respiratory limited disease but there are now increasing reports of multiple organ involvement including renal disease in association with COVID-19. We studied the development and outcomes of acute kidney injury (AKI) in patients with COVID-19, in a large multicultural city hospital trust in the UK, to better understand the role renal disease has in the disease process. METHODS: This was a retrospective review using electronic records and laboratory data of adult patients admitted to the four Manchester University Foundation Trust Hospitals between March 10 and April 30 2020 with a diagnosis of COVID-19. Records were reviewed for baseline characteristics, medications, comorbidities, social deprivation index, observations, biochemistry and outcomes including mortality, admission to critical care, mechanical ventilation and the need for renal replacement therapy. RESULTS: There were 1032 patients included in the study of whom 210 (20.3%) had AKI in association with the diagnosis of COVID-19. The overall mortality with AKI was considerably higher at 52.4% compared to 26.3% without AKI (p-value <0.001). More patients with AKI required escalation to critical care (34.8% vs 11.2%, p-value <0.001). Following admission to critical care those with AKI were more likely to die (54.8% vs 25.0%, p-value <0.001) and more likely to require mechanical ventilation (86.3% vs 66.3%, p-value 0.006). DISCUSSION: We have shown that the development of AKI is associated with dramatically worse outcomes for patients, in both mortality and the requirement for critical care. Patients with COVID-19 presenting with, or at risk of AKI should be closely monitored and appropriately managed to prevent any decline in renal function, given the significant risk of deterioration and death.


Asunto(s)
Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/virología , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Femenino , Mortalidad Hospitalaria , Hospitalización , Hospitales Urbanos , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Neumonía Viral/mortalidad , Neumonía Viral/virología , Respiración Artificial/métodos , Estudios Retrospectivos , Reino Unido/epidemiología
5.
PLoS One ; 15(11): e0240399, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33147219

RESUMEN

OBJECTIVES: To investigate whether people who think they have had COVID-19 are less likely to report engaging with lockdown measures compared with those who think they have not had COVID-19. DESIGN: On-line cross-sectional survey. SETTING: Data were collected between 20th and 22nd April 2020. PARTICIPANTS: 6149 participants living in the UK aged 18 years or over. MAIN OUTCOME MEASURES: Perceived immunity to COVID-19, self-reported adherence to social distancing measures (going out for essential shopping, nonessential shopping, and meeting up with friends/family; total out-of-home activity), worry about COVID-19 and perceived risk of COVID-19 to oneself and people in the UK. Knowledge that cough and high temperature / fever are the main symptoms of COVID-19. We used logistic regression analyses and one-way ANOVAs to investigate associations between believing you had had COVID-19 and binary and continuous outcomes respectively. RESULTS: In this sample, 1493 people (24.3%) thought they had had COVID-19 but only 245 (4.0%) reported having received a positive test result. Reported test results were often incongruent with participants' belief that they had had COVID-19. People who believed that they had had COVID-19 were: more likely to agree that they had some immunity to COVID-19; less likely to report adhering to lockdown measures; less worried about COVID-19; and less likely to know that cough and high temperature / fever are two of the most common symptoms of COVID-19. CONCLUSIONS: At the time of data collection, the percentage of people in the UK who thought they had already had COVID-19 was about twice the estimated infection rate. Those who believed they had had COVID-19 were more likely to report leaving home. This may contribute to transmission of the virus. Clear communications to this growing group are needed to explain why protective measures continue to be important and to encourage sustained adherence.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Adolescente , Adulto , Ansiedad , Tos/psicología , Estudios Transversales , Cultura , Femenino , Fiebre/psicología , Humanos , Masculino , Persona de Mediana Edad , Autoinforme , Distancia Social , Aislamiento Social/psicología , Reino Unido/epidemiología , Adulto Joven
8.
Int Immunopharmacol ; 88: 106995, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33182059

RESUMEN

There is recent evidence that interleukin-6 (IL-6) levels are elevated in cases of complicated COVID-19, but it is also possible that this cytokine may have a far more important role in the pathogenesis of viral infection. IL-6 is known to be modulated by Vitamin D, and there is preliminary evidence that deficiency of this vitamin is linked to poorer outcomes. To identify whether IL-6 levels prior to infection might predict outcome, early data on COVID-19 mortality from Italy and the UK were compared with previously published results of mean IL-6 levels from these countries as well as from the USA. There was a highly significant correlation (r = 0.9883; p = 0.00025) between age-stratified mortality rates and IL-6 levels from previously published data on healthy individuals. To determine whether Vitamin D may be beneficial at lowering IL-6 levels in patients, a limited analysis of trials examining the relationship between these entities published since 2015 was undertaken. Eight out of 11 studies described a significant lowering effect of Vitamin D on IL-6. Given that IL-6 likely facilitates viral cell entry and replication, levels prior to infection may predict mortality. This provides a rationale for prophylactic and therapeutic measures directed at lowering IL-6, including Vitamin D prescription.


Asunto(s)
Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/mortalidad , Interleucina-6/sangre , Neumonía Viral/sangre , Neumonía Viral/mortalidad , Vitamina D/uso terapéutico , Vitaminas/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Reino Unido/epidemiología , Adulto Joven
11.
Proc Biol Sci ; 287(1938): 20200906, 2020 11 11.
Artículo en Inglés | MEDLINE | ID: mdl-33143581

RESUMEN

Foot-and-mouth disease (FMD) is an extremely infectious viral infection of cloven-hoofed animals which is highly challenging to control and can give rise to national animal health crises, especially if there is a lack of pre-existing immunity due to the emergence of new strains or following incursions into disease-free regions. The 2001 FMD epidemic in the UK was on a scale that initially overwhelmed the national veterinary services and was eventually controlled by livestock lockdown and slaughter on an unprecedented scale. In 2020, the rapid emergence of COVID-19 has led to a human pandemic unparalleled in living memory. The enormous logistics of multi-agency control efforts for COVID-19 are reminiscent of the 2001 FMD epidemic in the UK, as are the use of movement restrictions, not normally a feature of human disease control. The UK experience is internationally relevant as few countries have experienced national epidemic crises for both diseases. In this review, we reflect on the experiences and lessons learnt from UK and international responses to FMD and COVID-19 with respect to their management, including the challenge of preclinical viral transmission, threat awareness, early detection, different interpretations of scientific information, lockdown, biosecurity behaviour change, shortage of testing capacity and the choices for eradication versus living with infection. A major lesson is that the similarity of issues and critical resources needed to manage large-scale outbreaks demonstrates that there is benefit to a 'One Health' approach to preparedness, with potential for greater cooperation in planning and the consideration of shared critical resources.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Fiebre Aftosa/epidemiología , Neumonía Viral/epidemiología , Animales , Betacoronavirus , Fiebre Aftosa/prevención & control , Humanos , Pandemias , Reino Unido/epidemiología
12.
BMC Public Health ; 20(1): 1635, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33183297

RESUMEN

BACKGROUND: The internet is now the first line source of health information for many people worldwide. In the current Coronavirus Disease 2019 (COVID-19) global pandemic, health information is being produced, revised, updated and disseminated at an increasingly rapid rate. The general public are faced with a plethora of misinformation regarding COVID-19 and the readability of online information has an impact on their understanding of the disease. The accessibility of online healthcare information relating to COVID-19 is unknown. We sought to evaluate the readability of online information relating to COVID-19 in four English speaking regions: Ireland, the United Kingdom, Canada and the United States, and compare readability of website source provenance and regional origin. METHODS: The Google® search engine was used to collate the first 20 webpage URLs for three individual searches for 'COVID', 'COVID-19', and 'coronavirus' from Ireland, the United Kingdom, Canada and the United States. The Gunning Fog Index (GFI), Flesch-Kincaid Grade (FKG) Score, Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG) score were calculated to assess the readability. RESULTS: There were poor levels of readability webpages reviewed, with only 17.2% of webpages at a universally readable level. There was a significant difference in readability between the different webpages based on their information source (p < 0.01). Public Health organisations and Government organisations provided the most readable COVID-19 material, while digital media sources were significantly less readable. There were no significant differences in readability between regions. CONCLUSION: Much of the general public have relied on online information during the pandemic. Information on COVID-19 should be made more readable, and those writing webpages and information tools should ensure universal accessibility is considered in their production. Governments and healthcare practitioners should have an awareness of the online sources of information available, and ensure that readability of our own productions is at a universally readable level which will increase understanding and adherence to health guidelines.


Asunto(s)
Comprensión , Información de Salud al Consumidor/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Internet , Pandemias , Neumonía Viral/epidemiología , Canadá/epidemiología , Humanos , Irlanda/epidemiología , Reino Unido/epidemiología , Estados Unidos/epidemiología
13.
PLoS One ; 15(10): e0240775, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33085693

RESUMEN

Testing is viewed as a critical aspect of any strategy to tackle epidemics. Much of the dialogue around testing has concentrated on how countries can scale up capacity, but the uncertainty in testing has not received nearly as much attention beyond asking if a test is accurate enough to be used. Even for highly accurate tests, false positives and false negatives will accumulate as mass testing strategies are employed under pressure, and these misdiagnoses could have major implications on the ability of governments to suppress the virus. The present analysis uses a modified SIR model to understand the implication and magnitude of misdiagnosis in the context of ending lockdown measures. The results indicate that increased testing capacity alone will not provide a solution to lockdown measures. The progression of the epidemic and peak infections is shown to depend heavily on test characteristics, test targeting, and prevalence of the infection. Antibody based immunity passports are rejected as a solution to ending lockdown, as they can put the population at risk if poorly targeted. Similarly, mass screening for active viral infection may only be beneficial if it can be sufficiently well targeted, otherwise reliance on this approach for protection of the population can again put them at risk. A well targeted active viral test combined with a slow release rate is a viable strategy for continuous suppression of the virus.


Asunto(s)
Betacoronavirus/inmunología , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Tamizaje Masivo/métodos , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Incertidumbre , Anticuerpos Antivirales/sangre , Betacoronavirus/genética , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/virología , Exactitud de los Datos , Errores Diagnósticos , Humanos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Neumonía Viral/virología , Prevalencia , Cuarentena/métodos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Sensibilidad y Especificidad , Pruebas Serológicas , Reino Unido/epidemiología
14.
PLoS One ; 15(10): e0241027, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33085729

RESUMEN

As the number of cases of COVID-19 continues to grow, local health services are at risk of being overwhelmed with patients requiring intensive care. We develop and implement an algorithm to provide optimal re-routing strategies to either transfer patients requiring Intensive Care Units (ICU) or ventilators, constrained by feasibility of transfer. We validate our approach with realistic data from the United Kingdom and Spain. In the UK, we consider the National Health Service at the level of trusts and define a 4-regular geometric graph which indicates the four nearest neighbours of any given trust. In Spain we coarse-grain the healthcare system at the level of autonomous communities, and extract similar contact networks. Through random search optimisation we identify the best load sharing strategy, where the cost function to minimise is based on the total number of ICU units above capacity. Our framework is general and flexible allowing for additional criteria, alternative cost functions, and can be extended to other resources beyond ICU units or ventilators. Assuming a uniform ICU demand, we show that it is possible to enable access to ICU for up to 1000 additional cases in the UK in a single step of the algorithm. Under a more realistic and heterogeneous demand, our method is able to balance about 600 beds per step in the Spanish system only using local sharing, and over 1300 using countrywide sharing, potentially saving a large percentage of these lives that would otherwise not have access to ICU.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Recursos en Salud/provisión & distribución , Modelos Teóricos , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Algoritmos , Infecciones por Coronavirus/virología , Cuidados Críticos , Capacidad de Camas en Hospitales , Humanos , Unidades de Cuidados Intensivos/provisión & distribución , Pandemias , Transferencia de Pacientes , Neumonía Viral/virología , España/epidemiología , Reino Unido/epidemiología , Ventiladores Mecánicos/provisión & distribución
15.
PLoS Med ; 17(10): e1003406, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33125416

RESUMEN

BACKGROUND: Initial reports indicate a high incidence of acute kidney injury (AKI) in Coronavirus Disease 2019 (COVID-19), but more data are required to clarify if COVID-19 is an independent risk factor for AKI and how COVID-19-associated AKI may differ from AKI due to other causes. We therefore sought to study the relationship between COVID-19, AKI, and outcomes in a retrospective cohort of patients admitted to 2 acute hospitals in Derby, United Kingdom. METHODS AND FINDINGS: We extracted electronic data from 4,759 hospitalised patients who were tested for COVID-19 between 5 March 2020 and 12 May 2020. The data were linked to electronic patient records and laboratory information management systems. The primary outcome was AKI, and secondary outcomes included in-hospital mortality, need for ventilatory support, intensive care unit (ICU) admission, and length of stay. As compared to the COVID-19-negative group (n = 3,374), COVID-19 patients (n = 1,161) were older (72.1 ± 16.1 versus 65.3 ± 20.4 years, p < 0.001), had a greater proportion of men (56.6% versus 44.9%, p < 0.001), greater proportion of Asian ethnicity (8.3% versus 4.0%, p < 0.001), and lower proportion of white ethnicity (75.5% versus 82.5%, p < 0.001). AKI developed in 304 (26.2%) COVID-19-positive patients (COVID-19 AKI) and 420 (12.4%) COVID-19-negative patients (AKI controls). COVID-19 patients aged 65 to 84 years (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.11 to 2.50), needing mechanical ventilation (OR 8.74, 95% CI 5.27 to 14.77), having congestive cardiac failure (OR 1.72, 95% CI 1.18 to 2.50), chronic liver disease (OR 3.43, 95% CI 1.17 to 10.00), and chronic kidney disease (CKD) (OR 2.81, 95% CI 1.97 to 4.01) had higher odds for developing AKI. Mortality was higher in COVID-19 AKI versus COVID-19 patients without AKI (60.5% versus 27.4%, p < 0.001), and AKI was an independent predictor of mortality (OR 3.27, 95% CI 2.39 to 4.48). Compared with AKI controls, COVID-19 AKI was observed in a higher proportion of men (58.9% versus 51%, p = 0.04) and lower proportion with white ethnicity (74.7% versus 86.9%, p = 0.003); was more frequently associated with cerebrovascular disease (11.8% versus 6.0%, p = 0.006), chronic lung disease (28.0% versus 19.3%, p = 0.007), diabetes (24.7% versus 17.9%, p = 0.03), and CKD (34.2% versus 20.0%, p < 0.001); and was more likely to be hospital acquired (61.2% versus 46.4%, p < 0.001). Mortality was higher in the COVID-19 AKI as compared to the control AKI group (60.5% versus 27.6%, p < 0.001). In multivariable analysis, AKI patients aged 65 to 84 years, (OR 3.08, 95% CI 1.77 to 5.35) and ≥85 years of age (OR 3.54, 95% CI 1.87 to 6.70), peak AKI stage 2 (OR 1.74, 95% CI 1.05 to 2.90), AKI stage 3 (OR 2.01, 95% CI 1.13 to 3.57), and COVID-19 (OR 3.80, 95% CI 2.62 to 5.51) had higher odds of death. Limitations of the study include retrospective design, lack of urinalysis data, and low ethnic diversity of the region. CONCLUSIONS: We observed a high incidence of AKI in patients with COVID-19 that was associated with a 3-fold higher odds of death than COVID-19 without AKI and a 4-fold higher odds of death than AKI due to other causes. These data indicate that patients with COVID-19 should be monitored for the development of AKI and measures taken to prevent this. TRIAL REGISTRATION: ClinicalTrials.gov NCT04407156.


Asunto(s)
Lesión Renal Aguda/etiología , Infecciones por Coronavirus/complicaciones , Mortalidad Hospitalaria , Neumonía Viral/complicaciones , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , Comorbilidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Grupos Étnicos , Femenino , Hospitalización , Humanos , Incidencia , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Neumonía Viral/virología , Insuficiencia Renal Crónica/complicaciones , Respiración Artificial , Estudios Retrospectivos , Factores de Riesgo , Reino Unido/epidemiología , Adulto Joven
16.
Value Health ; 23(11): 1432-1437, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33127013

RESUMEN

OBJECTIVE: This study aims to cost and calculate the relative cost-effectiveness of the hypothetical suppression policies found in the Imperial College COVID-19 Response Team model. METHODS: Key population-level disease projections in deaths, intensive care unit bed days, and non-intensive care unit bed days were taken from the Imperial College COVID-19 Response Team report of March 2020, which influenced the decision to introduce suppression policies in the United Kingdom. National income loss estimates were from a study that estimated the impact of a hypothetical pandemic on the UK economy, with sensitivity analyses based on projections that are more recent. Individual quality-adjusted life-year (QALY) loss and costed resource use inputs were taken from published sources. RESULTS: Imperial model projected suppression polices compared to an unmitigated pandemic, even with the most pessimistic national income loss scenarios under suppression (10%), give incremental cost-effectiveness ratios below £50 000 per QALY. Assuming a maximum reduction in national income of 7.75%, incremental cost-effectiveness ratios for Imperial model projected suppression versus mitigation are below 60 000 per QALY. CONCLUSIONS: Results are uncertain and conditional on the accuracy of the Imperial model projections; they are also sensitive to estimates of national income loss. Nevertheless, it would be difficult to claim that the hypothetical Imperial model-projected suppression policies are obviously cost-ineffective relative to the alternatives available. Despite evolving differences between government policy and Imperial model-projected suppression policy, it is hoped this article will provide some early insight into the trade-offs that are involved.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Erradicación de la Enfermedad/economía , Política de Salud/economía , Neumonía Viral/epidemiología , Betacoronavirus , Análisis Costo-Beneficio , Humanos , Pandemias , Años de Vida Ajustados por Calidad de Vida , Reino Unido/epidemiología
17.
Int J Equity Health ; 19(1): 189, 2020 10 27.
Artículo en Inglés | MEDLINE | ID: mdl-33109197

RESUMEN

There has been mounting evidence of the disproportionate involvement of black, Asian and minority ethnic (BAME) communities by the Covid-19 pandemic. In the UK, this racial disparity was brought to the fore by the fact that the first 11 doctors to die in the UK from Covid-19 were of BAME background. The mortality rate from Covid-19 among people of black African descent in English hospitals has been shown to be 3.5 times higher when compared to rates among white British people. A Public Health England report revealed that Covid-19 was more likely to be diagnosed among black ethnic groups compared to white ethnic groups with the highest mortality occurring among BAME persons and persons living in the more deprived areas. People of BAME background account for 4.5% of the English population and make up 21% of the National Health Service (NHS) workforce. The UK poverty rate among BAME populations is twice as high as for white groups. Also, people of BAME backgrounds are more likely to be engaged in frontline roles. The disproportionate involvement of BAME communities by Covid-19 in the UK illuminates perennial inequalities within the society and reaffirms the strong association between ethnicity, race, socio-economic status and health outcomes. Potential reasons for the observed differences include the overrepresentation of BAME persons in frontline roles, unequal distribution of socio-economic resources, disproportionate risks to BAME staff within the NHS workspace and high ethnic predisposition to certain diseases which have been linked to poorer outcomes with Covid-19. The ethnoracialised differences in health outcomes from Covid-19 in the UK require urgent remedial measures. We provide intersectional approaches to tackle the complex racial disparities which though not entirely new in itself, have been often systematically ignored.


Asunto(s)
Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , Infecciones por Coronavirus/etnología , Infecciones por Coronavirus/terapia , Disparidades en el Estado de Salud , Grupos Minoritarios/estadística & datos numéricos , Neumonía Viral/etnología , Neumonía Viral/terapia , Medicina Estatal/organización & administración , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Humanos , Pandemias , Reino Unido/epidemiología
18.
BMJ Glob Health ; 5(10)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33097548

RESUMEN

OBJECTIVE: To investigate how health issues affect voting behaviour by considering the COVID-19 pandemic, which offers a unique opportunity to examine this interplay. DESIGN: We employ a survey experiment in which treatment groups are exposed to key facts about the pandemic, followed by questions intended to elicit attitudes toward the incumbent party and government responsibility for the pandemic. SETTING: The survey was conducted amid the lockdown period of 15-26 April 2020 in three large democratic countries with the common governing language of English: India, the United Kingdom and the United States. Due to limitations on travel and recruitment, subjects were recruited through the M-Turk internet platform and the survey was administered entirely online. Respondents numbered 3648. RESULTS: Our expectation was that respondents in the treatment groups would favour, or disfavour, the incumbent and assign blame to government for the pandemic compared with the control group. We observe no such results. Several reasons may be adduced for this null finding. One reason could be that public health is not viewed as a political issue. However, people do think health is an important policy area (>85% agree) and that government has some responsibility for health (>90% agree). Another reason could be that people view public health policies through partisan lenses, which means that health is largely endogenous, and yet we find little evidence of polarisation in our data. Alternatively, it could be that the global nature of the pandemic inoculated politicians from blame and yet a majority of people do think the government is to blame for the spread of the pandemic (~50% agree). CONCLUSIONS: While we cannot precisely determine the mechanisms at work, the null findings contained in this study suggest that politicians are unlikely to be punished or rewarded for their failures or successes in managing COVID-19 in the next election. TRIAL REGISTRATION: Initial research hypotheses centred on expected variation between two treatments, as set forth in a detailed pre-analysis plan, registered at E-Gap: http://egap.org/registration/6645. Finding no difference between the treatments, we decided to focus this paper on the treatment/control comparison. Importantly, results that follow the pre-analysis plan strictly are entirely consistent with results presented here: null findings obtained throughout.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Regulación Gubernamental , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Política , Betacoronavirus , Humanos , India/epidemiología , Pandemias , Opinión Pública , Encuestas y Cuestionarios , Reino Unido/epidemiología , Estados Unidos/epidemiología
19.
Epidemiol Infect ; 148: e257, 2020 10 23.
Artículo en Inglés | MEDLINE | ID: mdl-33092672

RESUMEN

The outbreak of the novel coronavirus severe acute respiratory syndrome-coronavirus-2 has raised major health policy questions and dilemmas. Whilst respiratory droplets are believed to be the dominant transmission mechanisms, indirect transmission may also occur through shared contact of contaminated common objects that is not directly curtailed by a lockdown. The conditions under which contaminated common objects may lead to significant spread of coronavirus disease 2019 during lockdown and its easing is examined using the susceptible-exposed-infectious-removed model with a fomite term added. Modelling the weekly death rate in the UK, a maximum-likelihood analysis finds a statistically significant fomite contribution, with 0.009 ± 0.001 (95% CI) infection-inducing fomites introduced into the environment per day per infectious person. Post-lockdown, comparison with the prediction of a corresponding counterfactual model with no fomite transmission suggests fomites, through enhancing the overall transmission rate, may have contributed to as much as 25% of the deaths following lockdown. It is suggested that adding a fomite term to more complex simulations may assist in the understanding of the spread of the illness and in making policy decisions to control it.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/transmisión , Fómites/virología , Neumonía Viral/mortalidad , Neumonía Viral/transmisión , Factores de Edad , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/prevención & control , Política de Salud/tendencias , Humanos , Incidencia , Funciones de Verosimilitud , Modelos Teóricos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Servicios Postales/estadística & datos numéricos , Reino Unido/epidemiología
20.
Br J Gen Pract ; 70(700): 528-529, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33122266
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA