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3.
Rev Soc Bras Med Trop ; 54: e01382021, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34231772

RESUMEN

INTRODUCTION: We investigated the association of self-reported comorbidities with fatality risk among individuals infected with Coronavirus disease 2019 (COVID-19) in Espírito Santo State, Brazil. METHODS: We included 212,620 individuals, ≥30 years old. The data were obtained from the COVID-19 panel. Kaplan-Meier curves and Cox regression model were used. RESULTS: COVID-19-positive individuals presenting with chronic conditions were at a higher risk of fatality than individuals without these comorbidities. Age had a significant effect on these relationships. CONCLUSIONS: Comorbidities were associated with an increased risk of fatality. Middle-aged people (30-59 years) with comorbidities should also be considered as a vulnerable group.


Asunto(s)
COVID-19 , Adulto , Brasil/epidemiología , Comorbilidad , Ambiente , Humanos , Persona de Mediana Edad , SARS-CoV-2
4.
Rev Soc Bras Med Trop ; 54: e01742021, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34231773

RESUMEN

INTRODUCTION: We aimed to evaluate the impact of the new coronavirus disease 2019 on coronary hospitalizations in the Brazilian private health system. METHODS: Data on coronary admissions in 2020 and a 2-year historical series were collected from the UNIMED-BH insurance system. RESULTS: Admission rates in 2020 reduced by 26% (95%CI, 22-30) in comparison with 2018/2019, markedly from March to May (37%) compared to the peak of the pandemic (June-September, 19%). Mortality was higher in 2020 (5.4%, 95%CI 4.5-6.4) than in 2018/2019 (3.6%, 95%CI 3.2-4.1). CONCLUSIONS: There was a significant decrease in coronary admissions, with higher mortality during the COVID-19 pandemic.


Asunto(s)
COVID-19 , Pandemias , Brasil/epidemiología , Hospitalización , Hospitales , Humanos , SARS-CoV-2
5.
Rev Soc Bras Med Trop ; 54: e01952020, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34231774

RESUMEN

INTRODUCTION: Psychosocial aspects need to be discussed in the context of the Covid-19 pandemic. Currently, no studies have investigated the factors associated with social isolation and loneliness among community-dwelling older adults. Therefore, this study analyzed the association of social isolation and loneliness with socioeconomic, clinical, and health characteristics, and Covid-19-related variables, among community-dwelling older adults during the pandemic. METHODS: A cross-sectional study was conducted via a telephone survey of community-dwelling older adults aged ≥60 years in Macapa, Amapa, Brazil. A structured form was used to collect data. Descriptive and inferential analyses were performed using Pearson's correlation test and a linear regression model. RESULTS: Participants comprised 86 community-dwelling older adults with a mean age of 71.78+6.98 years. Among them, 9.3% were diagnosed with Covid-19, of whom 3.5% were hospitalized. Most participants reported no difficulty obtaining food, medicines, or attending routine medical appointments during the pandemic. Furthermore, 23.3% (n=20) were socially isolated, and 20.9% (n=18) reported feelings of loneliness. The mean values for fear, anxiety, and obsession were 19.01±7.25, 1.01±1.90, and 2.84±3.28, respectively. A moderate positive correlation was identified between loneliness and the number of diseases, and a weak positive correlation between loneliness and the number of medications and depressive symptoms and risk for sarcopenia. The linear regression model indicated that higher loneliness scores were associated with a greater number of diseases (ß=0.288; p=0.007). CONCLUSIONS: The findings suggest a probable resilience of the older population to Covid-19, despite the association of loneliness with many diseases in times of a pandemic.


Asunto(s)
COVID-19 , Pandemias , Anciano , Brasil , Estudios Transversales , Humanos , Vida Independiente , Soledad , Persona de Mediana Edad , SARS-CoV-2 , Aislamiento Social
7.
Rev Soc Bras Med Trop ; 54: e02102021, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34231775

RESUMEN

INTRODUCTION: This epidemiological household survey aimed to estimate the prevalence of the current and past SARS-CoV-2 infections in Ribeirão Preto, a municipality of southeast Brazil. METHODS: The survey was conducted in two phases using a clustered sampling scheme. The first phase spanned May 1-3 and involved 709 participants. The second phase spanned June 11-14, 2020, and involved 646 participants. RESULTS: During the first phase, RT-PCR performed on nasopharyngeal swabs was positive at 0.14%. The serological tests were positive in 1.27% of the patients during the first phase and 2.79% during the second phase. People living in households with more than five members had a prevalence of 10.83% (95%CI: 1.58-74.27) higher than those living alone or with someone other. Considering the proportion of the positive serological test results with sex and age adjustments, approximately 2.37% (95%CI: 1.32-3.42) of the population had been cumulatively infected by mid-June 2020, which is equivalent to 16,670 people (95%CI: 9,267-24,074). Considering that 68 deaths from the disease in the residents of the city had been confirmed as at the date of the second phase of the survey, the infection fatality rate was estimated to be 0.41% (95%CI: 0.28-0.73). Our results suggest that approximately 88% of the cases of SARS-CoV-2 infection at the time of the survey were not reported to the local epidemiological surveillance service. CONCLUSIONS: The findings of this study provide in-depth knowledge of the COVID-19 pandemic in Brazil and are helpful for the preventive and decision-making policies of public managers.


Asunto(s)
COVID-19 , SARS-CoV-2 , Brasil/epidemiología , Humanos , Pandemias , Prevalencia
8.
Rev Soc Bras Med Trop ; 54: e10622021, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34231777

RESUMEN

INTRODUCTION: Considering the persistent positivity on RT-qPCR tests, the results of SARS-CoV-2 were monitored to evaluate the viral RNA shedding period. METHODS: Between March and June 2020, the sequential results of 29 healthcare workers' were monitored using RT-qPCR. RESULTS: More than 50% of the individuals remained RT-qPCR positive after 14 days. Furthermore, this is the first study to describe positive RT-qPCR for SARS-CoV-2 in a healthcare worker with mild symptoms 95 days after the first positive test. CONCLUSIONS: Sequential RT-qPCR results were heterogeneous, and the viral RNA shedding period is unique for each person.


Asunto(s)
COVID-19 , Ácidos Nucleicos , Humanos , ARN Viral/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , SARS-CoV-2 , Esparcimiento de Virus
9.
Rev Lat Am Enfermagem ; 29: e3422, 2021 Jul 02.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: mdl-34231787

RESUMEN

OBJECTIVE: to analyze the vulnerabilities of children in the access to primary health care during the COVID-19 pandemic in Brazil and Portugal. METHOD: documentary study based on Brazilian and Portuguese governmental guidelines issued between March and August 2020 regarding access of children to primary health care. Thematic analysis was based on the precepts of health vulnerability. RESULTS: 13 documents were issued in both countries addressing access to vaccination and childcare. Due to the SARS-CoV-2, restrictions were imposed on the circulation of people in social environments, health services, and social protection, decreasing the demand for health services. Both countries continued programs to promote the health of breastfeeding infants. In-person childcare consultations were suspended for low-risk children in both countries. Portugal maintained routine vaccination while Brazil interrupted vaccination in the first 15 days of the pandemic. The countries adopted remote care strategies - telemonitoring, teleconsultation, and mobile applications - to maintain the bond between children and health services. CONCLUSION: longitudinality was affected due to restricted access of children to health promotion actions, determining greater programmatic vulnerability. Individual vulnerabilities are related to exposure to preventable and primary health care-sensitive diseases.


Asunto(s)
COVID-19 , Pandemias , Brasil/epidemiología , Niño , Salud del Niño , Femenino , Humanos , Lactante , Portugal/epidemiología , SARS-CoV-2
10.
Medicine (Baltimore) ; 100(27): e25938, 2021 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-34232165

RESUMEN

ABSTRACT: 2019 Novel Coronavirus (COVID-19) is a new acute infectious disease of respiratory system, posed a great threat to human health because of its strong infectivity and rapid progress. This study aimed to assess the severity of COVID-19 Pneumonia by analyzing the change of CT manifestations and body temperature.This retrospective review included 22 patients with COVID-19 pneumonia. The imaging manifestations and clinical features were observed and evaluated.Most of the infected patients were men (13/22, 59%). Fever (>38°C) (17/22, 77%) and cough (6/22, 27%) were the main symptoms. Leukocytes count decreased in 23% of patients and lymphocyte decreased in 41%. Twenty-one patients with pneumonia had abnormal findings on chest CT. The special CT manifestations were observed at the first CT examination when the lesions progressed, including a single ground glass nodule with uneven density, multiple ground glass opacities distributed in subpleural, and the ground glass opacities confined in superior lobe. The special CT manifestations were observed at the first CT examination when the lesions resolved, including ground glass opacities with homogeneous density. The lesion involved in the bilateral lungs and the absorption of the lesions mainly occurred in bilateral inferior lobes. Three patients had normalized body temperature increased more than 1°C within 1 to 2 days after admission. Ten patients fluctuated more than 1°C within 1 to 7 days after admission and the second CT scans showed the disease was at the progressive stage.Dynamic analysis of CT manifestations and body temperature have the potential to predict the severity of COVID-19 pneumonia.


Asunto(s)
Temperatura Corporal/fisiología , COVID-19/diagnóstico , Pulmón/diagnóstico por imagen , Pandemias , SARS-CoV-2 , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , COVID-19/epidemiología , COVID-19/fisiopatología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo
11.
Medicine (Baltimore) ; 100(27): e26526, 2021 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-34232186

RESUMEN

ABSTRACT: Smartphone alerting systems (SAS) for first responders potentially shorten the resuscitation-free interval of patients with acute cardiac arrest. During the corona virus disease-19 (COVID-19) pandemic, many systems are suspended due to potential risks for the responders.Objective of the study was to establish a concept for SAS during the COVID-19 pandemic and to evaluate whether a SAS can safely be operated in pandemic conditions.A SAS had been implemented in Freiburg (Germany) in 2018 alerting nearby registered first responders in case of emergencies with suspected cardiac arrest. Due to the pandemic, SAS was stopped in March 2020. A concept for a safe restart was elaborated with provision of a set with ventilation bag/mask, airway filter, and personal protective equipment (PPE) for every volunteer. A standard operating procedure was elaborated following the COVID-19 guidelines of the European Resuscitation Council.Willingness of the participants to respond alarms during the pandemic was investigated using an online survey. The response rates of first responders were monitored before and after deactivation, and during the second wave of the pandemic.The system was restarted in May 2020. The willingness to respond to alarms was lower during the pandemic without PPE. It remained lower than before the pandemic when the volunteers had been equipped with PPE, but the alarm response rate remained at approximately 50% during the second wave of the pandemic.When volunteers are equipped with PPE, the operation of a SAS does not need to be paused, and the willingness to respond remains high among first responders.


Asunto(s)
COVID-19/epidemiología , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Pandemias , Equipo de Protección Personal , Teléfono Inteligente , Socorristas , Alemania/epidemiología , Humanos , Estudios Retrospectivos , SARS-CoV-2
12.
Medicine (Baltimore) ; 100(27): e26520, 2021 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-34232185

RESUMEN

ABSTRACT: The 2019 coronavirus disease (COVID-19) has spread to the whole world. Psychological and sleep problems among confirmed patients have drawn extensive attention which may be highly related to immune function and inflammatory responses of people. The aim of this study is to examine the correlation of mental health status, sleep quality, and inflammatory markers, virus negative conversion time (NCT) among confirmed patients during the COVID-19 outbreak.A cross-sectional survey was conducted in this study. Data from 66 patients assessed with demographic information, anxious symptom, depressive symptom, stress, and sleep quality were collected using a smartphone-based questionnaire platform and then clinical characteristics and laboratory indicators were collected using case review.Nearly 30% of the participants reported depression, anxiety, perceived pressure, and poor sleep quality. Compared with the group without depression, neutrophil count, and ratio of neutrophil count to lymphocyte count (NLR) in the depression disorder group were increased (P = .028, 0.043). There was also a significant difference in NLR and NCT between the anxiety group and the non-anxiety group (P = .021, .024). Similarly, compared with the good sleep quality group, NLR in the poor sleep quality group was increased (P = .011). Correlation analysis indicated that Self-Rating Depression Scale score was positively related to neutrophil count and NLR (r = 0.366, 0.330, P = .016, .031). The total score of Pittsburgh Sleep Quality Index (PSQI) was negatively related to lymphocyte count (r = -0.317, P = .049), and the sleep disturbance as 1 of the 7 dimensions of PSQI scale was positively correlated with NCT and NLR (r = 0.370, 0.340, P = .020, .034).In our study, confirmed patients were prone to have psychological and sleep problems. The level of inflammation in patients with psychological and sleep problems was higher than that in patients without corresponding problems. The inflammatory level increased with the increase of Self-Rating Depression Scale score, and the lymphocyte count decreased with the increase of the PSQI score. NCT was prolonged in the anxiety group and sleep disturbance was positively correlated with NCT.


Asunto(s)
COVID-19/epidemiología , Estado de Salud , Salud Mental , SARS-CoV-2 , Trastornos del Sueño-Vigilia/epidemiología , Sueño/fisiología , Adolescente , Adulto , Anciano , China/epidemiología , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Trastornos del Sueño-Vigilia/fisiopatología , Adulto Joven
13.
Medicine (Baltimore) ; 100(27): e26583, 2021 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-34232205

RESUMEN

ABSTRACT: During the early period of the COVID-19 pandemic there was a substantial decrease in pediatric emergency department (PED) visitation. The intent of this study is to report PED utilization during the COVID-19 pandemic in an urban pediatric referral center located close to the epicenter in the northeastern US.A retrospective analysis of medical records of patients visiting the PED at Robert Wood Johnson University Hospital (RWJUH) was performed. Data included: daily census, admission rate, Emergency Severity Index, and ICD-10 diagnosis codes for the period of February through July, 2018 to 2020.By the week of March 26th, visits had decreased by 70% compared to the average of the previous 2 years. This census nadir lasted for 6 weeks. At 5 weeks postnadir the average daily census recovered to levels 40% lower than prior year norms and remained at that level during subsequent months. The greatest decreases were seen in low-acuity visits. Visits for behavioral health and fractures decreased by approximately 50% and 70%, respectively, but recovered to prior year norms by June and July of 2020. Visits for asthma exacerbation decreased by as much as 87% and remained at record lows for the remainder of the study period.A substantial and persistent decrease in PED visitation was experienced during the COVID-19 pandemic. Whereas visits for behavioral health and fractures have recovered to prior year norms, visits for asthma exacerbation remain at record lows. Further research is needed to ascertain the causes of these changes, including patient perceptions of the PED.


Asunto(s)
COVID-19/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Pandemias , COVID-19/terapia , Niño , Femenino , Humanos , Masculino , Estudios Retrospectivos , SARS-CoV-2 , Estados Unidos/epidemiología
17.
BMJ Open ; 11(7): e045386, 2021 07 07.
Artículo en Inglés | MEDLINE | ID: mdl-34233970

RESUMEN

OBJECTIVE: To evaluate the level of worry and its influencing factors during the COVID-19 epidemic among teachers in Henan Province in China. STUDY DESIGN: A cross-sectional study was conducted. METHODS: We designed a cross-sectional survey that included 88 611 teachers from three cities in Henan Province, China between 4 February 2020 and 12 February 2020. Level of worry was measured using a five-item Likert scale, with 1 being 'not worried' and 5 being 'very worried'. The OR and 95% CI of potential influencing factors for level of worry among study participants were estimated using ordinal logistic regression models. RESULTS: About 59% of teachers reported being 'very worried' about the COVID-19 epidemic. The proportion of female teachers was higher than of male teachers (60.33% vs 52.89%). In all age groups considered in this study, a 'very worried' condition accounted for the highest proportion. The age group 40-49 years had the lowest proportion of participants who were very worried, 52.34% of whom were men and 58.62% were women. After controlling for potential confounding factors, age, education level, type of teacher, school location, attention level, fear level, anxiety level and behaviour status were all related to level of worry (all p<0.05). CONCLUSION: During the COVID-19 epidemic, there was a high proportion of teachers who were 'very worried' about the situation in Henan Province, China. Our study may remind policymakers to consider factors including age, educational status, type of teacher, school location, source of information on COVID-19, attention level, anxiety level, fear level and behaviour status to alleviate worry.


Asunto(s)
COVID-19 , Epidemias , Adulto , Ansiedad/epidemiología , China/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , SARS-CoV-2 , Encuestas y Cuestionarios
19.
BMJ Open ; 11(7): e045886, 2021 07 07.
Artículo en Inglés | MEDLINE | ID: mdl-34233974

RESUMEN

OBJECTIVES: This study quantified how the efficiency of testing and contact tracing impacts the spread of COVID-19. The average time interval between infection and quarantine, whether asymptomatic cases are tested or not, and initial delays to beginning a testing and tracing programme were investigated. SETTING: We developed a novel individual-level network model, called CoTECT (Testing Efficiency and Contact Tracing model for COVID-19), using key parameters from recent studies to quantify the impacts of testing and tracing efficiency. The model distinguishes infection from confirmation by integrating a 'T' compartment, which represents infections confirmed by testing and quarantine. The compartments of presymptomatic (E), asymptomatic (I), symptomatic (Is), and death with (F) or without (f) test confirmation were also included in the model. Three scenarios were evaluated in a closed population of 3000 individuals to mimic community-level dynamics. Real-world data from four Nordic countries were also analysed. PRIMARY AND SECONDARY OUTCOME MEASURES: Simulation result: total/peak daily infections and confirmed cases, total deaths (confirmed/unconfirmed by testing), fatalities and the case fatality rate. Real-world analysis: confirmed cases and deaths per million people. RESULTS: (1) Shortening the duration between Is and T from 12 to 4 days reduces infections by 85.2% and deaths by 88.8%. (2) Testing and tracing regardless of symptoms reduce infections by 35.7% and deaths by 46.2% compared with testing only symptomatic cases. (3) Reducing the delay to implementing a testing and tracing programme from 50 to 10 days reduces infections by 35.2% and deaths by 44.6%. These results were robust to sensitivity analysis. An analysis of real-world data showed that tests per case early in the pandemic are critical for reducing confirmed cases and the fatality rate. CONCLUSIONS: Reducing testing delays will help to contain outbreaks. These results provide policymakers with quantitative evidence of efficiency as a critical value in developing testing and contact tracing strategies.


Asunto(s)
COVID-19 , Pandemias , Trazado de Contacto , Humanos , Pandemias/prevención & control , SARS-CoV-2 , Países Escandinavos y Nórdicos
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