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1.
Commun Biol ; 4(1): 489, 2021 04 21.
Artículo en Inglés | MEDLINE | ID: mdl-33883675

RESUMEN

We investigated SARS-CoV-2 transmission dynamics in Italy, one of the countries hit hardest by the pandemic, using phylodynamic analysis of viral genetic and epidemiological data. We observed the co-circulation of multiple SARS-CoV-2 lineages over time, which were linked to multiple importations and characterized by large transmission clusters concomitant with a high number of infections. Subsequent implementation of a three-phase nationwide lockdown strategy greatly reduced infection numbers and hospitalizations. Yet we present evidence of sustained viral spread among sporadic clusters acting as "hidden reservoirs" during summer 2020. Mathematical modelling shows that increased mobility among residents eventually catalyzed the coalescence of such clusters, thus driving up the number of infections and initiating a new epidemic wave. Our results suggest that the efficacy of public health interventions is, ultimately, limited by the size and structure of epidemic reservoirs, which may warrant prioritization during vaccine deployment.


Asunto(s)
COVID-19/transmisión , Control de Enfermedades Transmisibles/métodos , Genoma Viral/genética , Mutación , Salud Pública/métodos , SARS-CoV-2/genética , COVID-19/epidemiología , COVID-19/virología , Geografía , Humanos , Italia/epidemiología , Pandemias , Filogenia , Salud Pública/tendencias , SARS-CoV-2/clasificación , SARS-CoV-2/fisiología
2.
Prev Chronic Dis ; 18: E33, 2021 04 08.
Artículo en Inglés | MEDLINE | ID: mdl-33830913

RESUMEN

The Centers for Disease Control and Prevention (CDC) define chronic diseases as conditions that last 1 year or more and that require ongoing medical attention or limit activities of daily living, or both (1). Chronic diseases may be influenced by a combination of genetics, lifestyle and social behaviors, health care system factors, community influences, and environmental determinants of health (2). These risk factors often coexist and interact with each other. Therefore, a better understanding of determinants of chronic diseases such as tobacco use, unhealthy eating, and physical inactivity stands to benefit from effective strategies for improving primary, secondary, and tertiary disease prevention and management in diverse global settings (3). Strategies to prevent and manage chronic disease outcomes such as diabetes and cardiovascular diseases (CVDs) have global commonalities (4-7). The impact of chronic diseases is disproportionately evident in Black and Brown communities (8,9). Chronic disease prevention and management typically focus on behavioral interventions such as healthy eating, increased physical activity, and cessation of unhealthy practices such as tobacco and alcohol use (10-15). In 2020, the COVID-19 pandemic added to the fact that chronic diseases disproportionately affect low-resource communities, where many Black and Brown populations live (16,17). COVID-19 demonstrated that chronic disease disparities actually present as preexisting conditions in Black and Brown communities, who are disproportionately affected by COVID-19 outcomes. Although most of the articles in this Preventing Chronic Disease (PCD) collection were published before the pandemic, the insights they present, combined with the racial and ethnic data on the burden of COVID-19 thus far, support this reality. Many researchers and public health practitioners often consider the need to sufficiently address the relationships between chronic diseases and social, behavioral, and community factors (18). Global lessons in the prevention and management of chronic diseases, therefore, can help researchers and practitioners benefit from the shared lessons and experience derived from research and interventions conducted in different parts of the world. There are more than 7 billion people worldwide, who speak diverse languages and who have different nationalities, identities, and health systems. Yet, if we share challenges and opportunities for chronic disease prevention and management, many of the global adversities to improving health and well-being can be ameliorated, which is the purpose of this collection. The authors in this collection share lessons that represent experiences in diverse contexts across countries and regions of the world.


Asunto(s)
COVID-19/epidemiología , Enfermedad Crónica , Salud Global , Salud Pública , Determinantes Sociales de la Salud , Causalidad , Enfermedad Crónica/epidemiología , Enfermedad Crónica/prevención & control , Enfermedad Crónica/terapia , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Humanos , Difusión de la Información , Estilo de Vida , Psicología , Salud Pública/normas , Salud Pública/tendencias , SARS-CoV-2 , Determinantes Sociales de la Salud/etnología , Determinantes Sociales de la Salud/estadística & datos numéricos
5.
OMICS ; 25(4): 249-254, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33794130

RESUMEN

Digital health is a rapidly emerging field that offers several promising potentials: health care delivery remotely, in urban and rural areas, in any time zone, and in times of pandemics and ecological crises. Digital health encompasses electronic health, computing science, big data, artificial intelligence, and the Internet of Things, to name but a few technical components. Digital health is part of a vision for systems medicine. The advances in digital health have been, however, uneven and highly variable across communities, countries, medical specialties, and societal contexts. This article critically examines the determinants of digital health (DDH). DDH describes and critically responds to inequities and differences in digital health theory and practice across people, places, spaces, and time. DDH is not limited to studying variability in design and access to digital technologies. DDH is situated within a larger context of the political determinants of health. Hence, this article presents an analysis of DDH, as seen through political science, and the feminist studies of technology and society. A feminist lens would strengthen systems-driven, historically and critically informed governance for DDH. This would be a timely antidote against unchecked destructive/extractive governance narratives (e.g., technocracy and patriarchy) that produce and reproduce the health inequities. Moreover, feminist framing of DDH can help cultivate epistemic competence to detect and reject false equivalences in how we understand the emerging digital world(s). False equivalence, very common in the current pandemic and post-truth era, is a type of flawed reasoning in decision-making where equal weight is given to arguments with concrete material evidence, and those that are conjecture, untrue, or unjust. A feminist conceptual lens on DDH would help remedy what I refer to in this article as "the normative deficits" in science and technology policy that became endemic with the rise of neoliberal governance since the 1980s in particular. In this context, it is helpful to recall the feminist writer Ursula K. Le Guin. Le Guin posed "what if?" questions, to break free from oppressive narratives such as patriarchy and re-imagine technology futures. It is time to envision an emancipated, equitable, and more democratic world by asking "what if we lived in a feminist world?" That would be truly awesome, for everyone, women and men, children, youth, and future generations, to steer digital technologies and the new field of DDH toward broadly relevant, ethical, experiential, democratic, and socially responsive health outcomes.


Asunto(s)
COVID-19/epidemiología , Tecnología Digital/organización & administración , Feminismo , Disparidades en Atención de Salud/ética , Pandemias/prevención & control , SARS-CoV-2/patogenicidad , Inteligencia Artificial/tendencias , Macrodatos , Atención a la Salud/ética , Femenino , Humanos , Política , Salud Pública/tendencias
7.
Am J Public Health ; 111(5): 937-948, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33734840

RESUMEN

Objectives. To examine how sociodemographic, political, religious, and civic characteristics; trust in science; and fixed versus fluid worldview were associated with evolving public support for social distancing, indoor mask wearing, and contact tracing to control the COVID-19 pandemic.Methods. Surveys were conducted with a nationally representative cohort of US adults in April, July, and November 2020.Results. Support for social distancing among US adults dropped from 89% in April to 79% in July, but then remained stable in November 2020 at 78%. In July and November, more than three quarters of respondents supported mask wearing and nearly as many supported contact tracing. In regression-adjusted models, support differences for social distancing, mask wearing, and contact tracing were most pronounced by age, partisanship, and trust in science. Having a more fluid worldview independently predicted higher support for contact tracing.Conclusions. Ongoing resistance to nonpharmaceutical public health responses among key subgroups challenge transmission control.Public Health Implications. Developing persuasive communication efforts targeting young adults, political conservatives, and those distrusting science should be a critical priority.


Asunto(s)
COVID-19/prevención & control , Trazado de Contacto , Máscaras/tendencias , Distanciamiento Físico , Salud Pública/tendencias , Adulto , Anciano , Trazado de Contacto/estadística & datos numéricos , Trazado de Contacto/tendencias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Política , Ciencia , Factores Socioeconómicos , Encuestas y Cuestionarios
12.
PLoS One ; 16(3): e0248234, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33690679

RESUMEN

In the ongoing COVID-19 pandemic, public health experts have produced guidelines to limit the spread of the coronavirus, but individuals do not always comply with experts' recommendations. Here, we tested whether a specific psychological belief-identification with all humanity-predicts cooperation with public health guidelines as well as helpful behavior during the COVID-19 pandemic. We hypothesized that peoples' endorsement of this belief-their relative perception of a connection and moral commitment to other humans-would predict their tendencies to adopt World Health Organization (WHO) guidelines and to help others. To assess this, we conducted a global online study (N = 2537 participants) of four WHO-recommended health behaviors and four pandemic-related moral dilemmas that we constructed to be relevant to helping others at a potential cost to oneself. We used generalized linear mixed models (GLMM) that included 10 predictor variables (demographic, contextual, and psychological) for each of five outcome measures (a WHO cooperative health behavior score, plus responses to each of our four moral, helping dilemmas). Identification with all humanity was the most consistent and consequential predictor of individuals' cooperative health behavior and helpful responding. Analyses showed that the identification with all humanity significantly predicted each of the five outcomes while controlling for the other variables (Prange < 10-22 to < 0.009). The mean effect size of the identification with all humanity predictor on these outcomes was more than twice as large as the effect sizes of other predictors. Identification with all humanity is a psychological construct that, through targeted interventions, may help scientists and policymakers to better understand and promote cooperative health behavior and help-oriented concern for others during the current pandemic as well as in future humanitarian crises.


Asunto(s)
COVID-19/psicología , Conducta Cooperativa , Salud Pública/tendencias , Adulto , Anciano , Anciano de 80 o más Años , Altruismo , Infecciones por Coronavirus/epidemiología , Femenino , Conductas Relacionadas con la Salud/ética , Humanos , Masculino , Persona de Mediana Edad , Pandemias , SARS-CoV-2/patogenicidad , Encuestas y Cuestionarios
14.
Nat Med ; 27(3): 396-400, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33723454

RESUMEN

Fourteen months into the SARS-CoV-2 pandemic, we identify key lessons in the global and national responses to the pandemic. The World Health Organization has played a pivotal technical, normative and coordinating role, but has been constrained by its lack of authority over sovereign member states. Many governments also mistakenly attempted to manage COVID-19 like influenza, resulting in repeated lockdowns, high excess morbidity and mortality, and poor economic recovery. Despite the incredible speed of the development and approval of effective and safe vaccines, the emergence of new SARS-CoV-2 variants means that all countries will have to rely on a globally coordinated public health effort for several years to defeat this pandemic.


Asunto(s)
COVID-19/epidemiología , Control de Enfermedades Transmisibles , Salud Global , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Control de Enfermedades Transmisibles/tendencias , Salud Global/historia , Salud Global/tendencias , Gobierno , Historia del Siglo XXI , Humanos , Pandemias/historia , Salud Pública/historia , Salud Pública/métodos , Salud Pública/tendencias , Administración en Salud Pública/métodos , Administración en Salud Pública/normas , Administración en Salud Pública/tendencias , SARS-CoV-2/fisiología
15.
PLoS One ; 16(3): e0248892, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33760836

RESUMEN

BACKGROUND: High levels of vaccination coverage in populations will be required even with vaccines that have high levels of effectiveness to prevent and stop outbreaks of coronavirus. The World Health Organisation has suggested that governments take a proactive response to vaccine hesitancy 'hotspots' based on social and behavioural insights. METHODS: Representative longitudinal online survey of over 3000 adults from Australia that examines the demographic, attitudinal, political and social attitudes and COVID-19 health behavior correlates of vaccine hesitance and resistance to a COVID-19 vaccine. RESULTS: Overall, 59% would definitely get the vaccine, 29% had low levels of hesitancy, 7% had high levels of hesitancy and 6% were resistant. Females, those living in disadvantaged areas, those who reported that risks of COVID-19 was overstated, those who had more populist views and higher levels of religiosity were more likely to be hesitant or resistant while those who had higher levels of household income, those who had higher levels of social distancing, who downloaded the COVID-Safe App, who had more confidence in their state or territory government or confidence in their hospitals, or were more supportive of migration were more likely to intend to get vaccinated. CONCLUSIONS: Our findings suggest that vaccine hesitancy, which accounts for a significant proportion of the population can be addressed by public health messaging but for a significant minority of the population with strongly held beliefs, alternative policy measures may well be needed to achieve sufficient vaccination coverage to end the pandemic.


Asunto(s)
Vacunas contra la COVID-19/administración & dosificación , COVID-19/prevención & control , Aceptación de la Atención de Salud/psicología , SARS-CoV-2/inmunología , Negativa a la Vacunación/psicología , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , COVID-19/epidemiología , COVID-19/psicología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Aceptación de la Atención de Salud/estadística & datos numéricos , Salud Pública/tendencias , Encuestas y Cuestionarios/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Negativa a la Vacunación/estadística & datos numéricos
17.
Lancet Planet Health ; 5(2): e102-e107, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33581061

RESUMEN

The scale of the COVID-19 pandemic is a consequence of international trade and globalisation, with the virus spreading along established trade and travel routes. However, the pandemic also affects international trade through reductions in both supply and demand. In this Viewpoint we describe the many implications for health and propose ways to mitigate them. Problems include reduced access to medical supplies (in particular, personal protective equipment and tests), budgetary shortfalls as a result of reduced tariffs and taxes, and a general decline in economic activity-leading, in many cases, to recessions, threats to social safety nets, and to increased precariousness of income, employment, and food security. However, in exceptional cases, the pandemic has also brought some transient benefits, including to the environment. Looking ahead, there will be great pressure to further liberalise rules on trade to encourage economic recovery, but it is essential that trade policy be informed by its many consequences for health to ensure that the benefits are maximised and threats are minimised through active identification and mitigation.


Asunto(s)
COVID-19/epidemiología , COVID-19/terapia , Comercio , Pandemias/economía , Salud Pública , SARS-CoV-2 , Comercio/economía , Comercio/tendencias , Humanos , Internacionalidad , Salud Pública/economía , Salud Pública/tendencias
19.
Epilepsy Behav ; 116: 107791, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33578223

RESUMEN

Climate change is with us. As professionals who place value on evidence-based practice, climate change is something we cannot ignore. The current pandemic of the novel coronavirus, SARS-CoV-2, has demonstrated how global crises can arise suddenly and have a significant impact on public health. Global warming, a chronic process punctuated by acute episodes of extreme weather events, is an insidious global health crisis needing at least as much attention. Many neurological diseases are complex chronic conditions influenced at many levels by changes in the environment. This review aimed to collate and evaluate reports from clinical and basic science about the relationship between climate change and epilepsy. The keywords climate change, seasonal variation, temperature, humidity, thermoregulation, biorhythm, gene, circadian rhythm, heat, and weather were used to search the published evidence. A number of climatic variables are associated with increased seizure frequency in people with epilepsy. Climate change-induced increase in seizure precipitants such as fevers, stress, and sleep deprivation (e.g. as a result of more frequent extreme weather events) or vector-borne infections may trigger or exacerbate seizures, lead to deterioration of seizure control, and affect neurological, cerebrovascular, or cardiovascular comorbidities and risk of sudden unexpected death in epilepsy. Risks are likely to be modified by many factors, ranging from individual genetic variation and temperature-dependent channel function, to housing quality and global supply chains. According to the results of the limited number of experimental studies with animal models of seizures or epilepsy, different seizure types appear to have distinct susceptibility to seasonal influences. Increased body temperature, whether in the context of fever or not, has a critical role in seizure threshold and seizure-related brain damage. Links between climate change and epilepsy are likely to be multifactorial, complex, and often indirect, which makes predictions difficult. We need more data on possible climate-driven altered risks for seizures, epilepsy, and epileptogenesis, to identify underlying mechanisms at systems, cellular, and molecular levels for better understanding of the impact of climate change on epilepsy. Further focussed data would help us to develop evidence for mitigation methods to do more to protect people with epilepsy from the effects of climate change.


Asunto(s)
COVID-19/epidemiología , Cambio Climático , Epilepsia/epidemiología , Salud Global/tendencias , Salud Pública/tendencias , Animales , COVID-19/prevención & control , Muerte Súbita , Epilepsia/terapia , Calor/efectos adversos , Humanos , Humedad/efectos adversos , Privación de Sueño/epidemiología , Privación de Sueño/terapia , Tiempo (Meteorología)
20.
Nat Commun ; 12(1): 1039, 2021 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-33589602

RESUMEN

Recent studies have reported a variety of health consequences of climate change. However, the vulnerability of individuals and cities to climate change remains to be evaluated. We project the excess cause-, age-, region-, and education-specific mortality attributable to future high temperatures in 161 Chinese districts/counties using 28 global climate models (GCMs) under two representative concentration pathways (RCPs). To assess the influence of population ageing on the projection of future heat-related mortality, we further project the age-specific effect estimates under five shared socioeconomic pathways (SSPs). Heat-related excess mortality is projected to increase from 1.9% (95% eCI: 0.2-3.3%) in the 2010s to 2.4% (0.4-4.1%) in the 2030 s and 5.5% (0.5-9.9%) in the 2090 s under RCP8.5, with corresponding relative changes of 0.5% (0.0-1.2%) and 3.6% (-0.5-7.5%). The projected slopes are steeper in southern, eastern, central and northern China. People with cardiorespiratory diseases, females, the elderly and those with low educational attainment could be more affected. Population ageing amplifies future heat-related excess deaths 2.3- to 5.8-fold under different SSPs, particularly for the northeast region. Our findings can help guide public health responses to ameliorate the risk of climate change.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Cambio Climático/mortalidad , Enfermedades Pulmonares/mortalidad , Modelos Estadísticos , Salud Pública/tendencias , Adolescente , Adulto , Anciano , Enfermedades Cardiovasculares/epidemiología , Niño , Preescolar , China/epidemiología , Simulación por Computador , Escolaridad , Femenino , Calor , Humanos , Lactante , Recién Nacido , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Análisis de Supervivencia
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