Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 582
Filtrar
2.
Am J Epidemiol ; 190(1): 161-175, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-32870978

RESUMO

Health-care workers (HCWs) are at the frontline of response to coronavirus disease 2019 (COVID-19), being at a higher risk of acquiring the disease and, subsequently, exposing patients and others. Searches of 8 bibliographic databases were performed to systematically review the evidence on the prevalence, risk factors, clinical characteristics, and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among HCWs. A total of 97 studies (all published in 2020) met the inclusion criteria. The estimated prevalence of SARS-CoV-2 infection from HCWs' samples, using reverse transcription-polymerase chain reaction and the presence of antibodies, was 11% (95% confidence interval (CI): 7, 15) and 7% (95% CI: 4, 11), respectively. The most frequently affected personnel were nurses (48%, 95% CI: 41, 56), whereas most of the COVID-19-positive medical personnel were working in hospital nonemergency wards during screening (43%, 95% CI: 28, 59). Anosmia, fever, and myalgia were the only symptoms associated with HCW SARS-CoV-2 positivity. Among HCWs positive for COVID-19 by reverse transcription-polymerase chain reaction, 40% (95% CI: 17, 65) were asymptomatic at time of diagnosis. Finally, severe clinical complications developed in 5% (95% CI: 3, 8) of the COVID-19-positive HCWs, and 0.5% (95% CI: 0.02, 1.3) died. Health-care workers suffer a significant burden from COVID-19, with those working in hospital nonemergency wards and nurses being the most commonly infected personnel.

3.
Obes Rev ; 2020 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-33230898

RESUMO

In May 2020, Latin America became the epicenter of the COVID-19 pandemic, a region already afflicted by social disparities, poor healthcare access, inadequate nutrition and a large prevalence of noncommunicable chronic diseases. Obesity and its comorbidities are increasingly prevalent in Latin America, with a more rapid growth in individuals with lower income, and currently a disease associated with COVID-19 severity, complications and death. In this document, the Latin American Association of Obesity Societies and collaborators present a review of the burden of two pandemics in Latin America, discuss possible mechanisms that explain their relationship with each other and provide public health and individual recommendations, as well as questions for future studies.

4.
Thyroid ; 2020 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-33198599

RESUMO

Background: Thyroid hormones are important metabolic regulators exerting effects in multiple systemic functions including muscular and cardiorespiratory function. Thyroid hormones may influence physical activity levels. However, there are currently no studies evaluating the association between thyroid function and physical activity levels in the general population. Methods: In a population-based cohort study between 2006 and 2013, we assessed the cross-sectional and longitudinal (with a mean follow-up time of 5 years) association of serum thyrotropin (TSH) and free thyroxine (fT4) with physical activity (metabolic equivalent task [MET] hours per week). Information on physical activity was collected using a validated questionnaire (Longitudinal Aging Study Amsterdam, median 22.50 MET hours per week). The association of TSH and fT4 with physical activity was examined using linear regression models in the cross-sectional and longitudinal analyses, adjusted for age, sex, lifestyle factors, and cardiovascular disease. In sensitivity analyses, we examined the association between thyroid function and physical activity including only participants within the reference range of thyroid function. We additionally examined moderate and vigorous physical activity separately as outcomes. Results: We included 2470 participants for the cross-sectional analysis (mean age 57.3 years, 58% women) and 1907 participants for the longitudinal analysis (mean age 56.9 years). There was no association between TSH (mIU/L) or fT4 (ng/dL) and physical activity (ß = 0.65, 95% confidence interval [CI, -1.67 to 2.98] and ß = 2.76, [CI -7.15 to 12.66], respectively) on cross-sectional analysis. Similarly, in the longitudinal analyses, we observed no association of TSH (ß = 1.16, [CI -1.31 to 3.63]) or fT4 (ß = -6.63, [CI -17.06 to 3.80]) with physical activity. Conclusions: We did not observe an association between the endogenous thyroid hormone level and total physical activity. Further studies need to be performed to evaluate whether thyroid hormone replacement therapy is associated with physical activity.

6.
PLoS One ; 15(11): e0230035, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33186364

RESUMO

BACKGROUND: Genome-wide association studies have identified multiple genomic loci associated with coronary artery disease, but most are common variants in non-coding regions that provide limited information on causal genes and etiology of the disease. To overcome the limited scope that common variants provide, we focused our investigation on low-frequency and rare sequence variations primarily residing in coding regions of the genome. METHODS AND RESULTS: Using samples of individuals of European ancestry from ten cohorts within the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium, both cross-sectional and prospective analyses were conducted to examine associations between genetic variants and myocardial infarction (MI), coronary heart disease (CHD), and all-cause mortality following these events. For prevalent events, a total of 27,349 participants of European ancestry, including 1831 prevalent MI cases and 2518 prevalent CHD cases were used. For incident cases, a total of 55,736 participants of European ancestry were included (3,031 incident MI cases and 5,425 incident CHD cases). There were 1,860 all-cause deaths among the 3,751 MI and CHD cases from six cohorts that contributed to the analysis of all-cause mortality. Single variant and gene-based analyses were performed separately in each cohort and then meta-analyzed for each outcome. A low-frequency intronic variant (rs988583) in PLCL1 was significantly associated with prevalent MI (OR = 1.80, 95% confidence interval: 1.43, 2.27; P = 7.12 × 10-7). We conducted gene-based burden tests for genes with a cumulative minor allele count (cMAC) ≥ 5 and variants with minor allele frequency (MAF) < 5%. TMPRSS5 and LDLRAD1 were significantly associated with prevalent MI and CHD, respectively, and RC3H2 and ANGPTL4 were significantly associated with incident MI and CHD, respectively. No loci were significantly associated with all-cause mortality following a MI or CHD event. CONCLUSION: This study identified one known locus (ANGPTL4) and four new loci (PLCL1, RC3H2, TMPRSS5, and LDLRAD1) associated with cardiovascular disease risk that warrant further investigation.


Assuntos
Envelhecimento/genética , Doença da Artéria Coronariana/genética , Grupo com Ancestrais do Continente Europeu/genética , Loci Gênicos , Estudo de Associação Genômica Ampla , Infarto do Miocárdio/genética , Polimorfismo de Nucleotídeo Único , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/mortalidade , Estudos Transversais , Europa (Continente)/epidemiologia , Humanos , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/mortalidade , Estudos Prospectivos
7.
Biomédica (Bogotá) ; 40(supl.2): 16-26, oct. 2020. graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1142444

RESUMO

Resumen Actualmente, el mundo se enfrenta a la pandemia generada por el SARS-CoV-2, infección para la cual no hay medidas farmacológicas de prevención ni tratamiento. Hasta el momento, ha dejado más de 4'880.000 casos confirmados y 322.000 muertes. Se han propuesto diferentes estrategias para el control de la enfermedad que implican la participación de diferentes sectores de la sociedad con acciones guiadas por lineamientos jurídicos y basados en medidas de salud pública, entre ellas, la contención, la mitigación, el aislamiento físico y la cuarentena. Dado que se trata de una situación de dimensión poblacional, la información tiene un papel fundamental; sin embargo, la proliferación de términos nuevos, muchas veces usados erróneamente, causa confusión y desinformación y, en consecuencia, limitan la participación ciudanía. En ese contexto, en el presente documento se hizo una revisión de los términos utilizados en epidemias y pandemias de enfermedades infecciosas, con énfasis en la COVID-19, para facilitar al público general la comprensión de los términos relevantes sobre el comportamiento de los agentes patógenos y de su ciclo epidémico y pandémico, así como los criterios para la adopción de las decisiones pertinentes en salud pública. Se aspira a que el glosario resultante ayude al uso correcto de los términos y a homogenizar la información.


Abstract Currently, the world is facing the pandemic generated by SARS-CoV-2. There are no no pharmacological measures for the prevention or treatment of this infection and, so far, it has caused more than 4'880.000 confirmed cases and 322.000 deaths. The different strategies for the control of the disease that have been proposed involve the participation of different actors. Such participation, guided by legal guidelines based on public health measures, include containment, mitigation, physical isolation, and quarantine. As this is a population-based problem, information plays a primary role; however, the many new terms hat have arisen and their misuse confuse and, therefore, misinform thus limiting citizen participation. For this reason, we conducted a review of the terms used in epidemics and pandemics of infectious diseases, particularly COVID-19. We considered and differentiated the relevant terms to facilitate the understanding of pathogen's behavior and epidemic and pandemic cycles, as well as the criteria for public health decision-making for the general public. This glossary should facilitate the use of the terms and standardize the information.

8.
9.
Glob Heart ; 15(1): 58, 2020 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-32923351

RESUMO

Whilst current public health measures focused on good hygiene practices and limiting person-to-person transmission contribute effectively in managing the COVID-19 pandemic, they will not prevent all individuals from becoming infected. Thus, it is of importance to explore what individuals could do to mitigate adverse outcomes. The value of beneficial health behaviours and a healthy lifestyle to improve immune functioning and lower adverse consequences of COVID-19 are increasingly being emphasized. Here we discuss seven key health behaviours and corresponding recommendations that may assist in reducing unfavourable COVID-19 outcomes.


Assuntos
Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/prevenção & controle , Infecções por Coronavirus/complicações , Comportamentos Relacionados com a Saúde , Estilo de Vida Saudável , Síndrome Metabólica/complicações , Síndrome Metabólica/prevenção & controle , Pneumonia Viral/complicações , Humanos , Pandemias , Guias de Prática Clínica como Assunto
10.
Eur J Nutr ; 2020 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-32865658

RESUMO

PURPOSE: Cardiovascular disease (CVD) is a leading cause of mortality globally and is strongly influenced by dietary risk factors. The aim was to assess the association between egg consumption and risk of CVD risk/mortality, including coronary heart disease (CHD), stroke, and heart failure. METHODS: MEDLINE, Embase, and Web of Science databases were searched through April 2020 for prospective studies. Two independent reviewers screened and extracted the data through standardized methods. Size effects were calculated as summary relative risks (SRRs) in a dose-response fashion through random-effects meta-analyses. RESULTS: Thirty-nine studies including nearly 2 million individuals and 85,053 CHD, 25,103 stroke, 7536 heart failure, and 147,124 CVD cases were included. The summary analysis including 17 datasets from 14 studies conducted on CVD (incidence and/or mortality) showed that intake of up to six eggs per week is inversely associated with CVD events, when compared to no consumption [for four eggs per week, SRR = 0.95 (95% CI: 0.90; 1.00)]; a decreased risk of CVD incidence was observed for consumption of up to one egg per day [SRR = 0.94 (95% CI: 0.89; 0.99)]. The summary analysis for CHD incidence/mortality including 24 datasets from 16 studies showed a decreased risk up to two eggs per week [(SRR = 0.96 (95% CI: 0.91; 1.00)]. No associations were retrieved with risk of stroke. The summary analysis for heart failure risk including six datasets from four studies showed that intake of one egg per day was associated with increased risk raising for higher intakes compared to no consumption [for 1 egg per day, SRR = 1.15 (95% CI:1.02; 1.30)]. After considering GRADE criteria for strength of the evidence, it was rated low for all outcomes but stroke, for which it was moderate (yet referring to no risk). CONCLUSION: There is no conclusive evidence on the role of egg in CVD risk, despite the fact that higher quality studies are warranted to obtain stronger evidence for a possible protection of CVD associated with moderate weekly egg consumption compared to no intake; equally, future studies may strengthen the evidence for increased heart failure risk associated with high regular egg consumption.

11.
Eur J Epidemiol ; 35(8): 763-773, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32816244

RESUMO

Iron metabolism and anemia may play an important role in multiple organ dysfunction syndrome in Coronavirus disease 2019 (COVID-19). We conducted a systematic review and meta-analysis to evaluate biomarkers of anemia and iron metabolism (hemoglobin, ferritin, transferrin, soluble transferrin receptor, hepcidin, haptoglobin, unsaturated iron-binding capacity, erythropoietin, free erythrocyte protoporphyrine, and erythrocyte indices) in patients diagnosed with COVID-19, and explored their prognostic value. Six bibliographic databases were searched up to August 3rd 2020. We included 189 unique studies, with data from 57,563 COVID-19 patients. Pooled mean hemoglobin and ferritin levels in COVID-19 patients across all ages were 129.7 g/L (95% Confidence Interval (CI), 128.51; 130.88) and 777.33 ng/mL (95% CI, 701.33; 852.77), respectively. Hemoglobin levels were lower with older age, higher percentage of subjects with diabetes, hypertension and overall comorbidities, and admitted to intensive care. Ferritin level increased with older age, increasing proportion of hypertensive study participants, and increasing proportion of mortality. Compared to moderate cases, severe COVID-19 cases had lower hemoglobin [weighted mean difference (WMD), - 4.08 g/L (95% CI - 5.12; - 3.05)] and red blood cell count [WMD, - 0.16 × 1012 /L (95% CI - 0.31; - 0.014)], and higher ferritin [WMD, - 473.25 ng/mL (95% CI 382.52; 563.98)] and red cell distribution width [WMD, 1.82% (95% CI 0.10; 3.55)]. A significant difference in mean ferritin levels of 606.37 ng/mL (95% CI 461.86; 750.88) was found between survivors and non-survivors, but not in hemoglobin levels. Future studies should explore the impact of iron metabolism and anemia in the pathophysiology, prognosis, and treatment of COVID-19.


Assuntos
Anemia/diagnóstico , Infecções por Coronavirus , Coronavirus/metabolismo , Ferro/metabolismo , Pandemias , Pneumonia Viral , Betacoronavirus , Biomarcadores/análise , Biomarcadores/sangue , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Eritropoetina , Ferritinas/sangue , Hemoglobinas/análise , Hemoglobinas/metabolismo , Hepcidinas/sangue , Hepcidinas/metabolismo , Humanos , Ferro/sangue , Pneumonia Viral/epidemiologia , Receptores da Transferrina/sangue , Transferrina/análise , Transferrina/metabolismo
12.
Menopause ; 27(9): 1081-1092, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32852463

RESUMO

IMPORTANCE: Phytoestrogens are becoming popular constituents of human diets and are increasingly used by postmenopausal women. OBJECTIVE: Our study aims to determine the effects of phytoestrogen supplementation on intermediate cardiovascular disease (CVD) risk factors in postmenopausal women. EVIDENCE REVIEW: Five electronic databases (Medline, EMBASE, Web of Science, Cochrane CENTRAL, Google Scholar) were systematically searched to identify eligible studies, that is, randomized controlled trials (RCTs) that assessed the association of phytoestrogen supplementation with CVD risk factors (serum lipids, homocysteine, fibrinogen, markers of inflammation, oxidative stress and endothelial function, carotid intima-media thickness [CIMT]) in postmenopausal women. Data were extracted by two independent reviewers using a predefined data collection form. FINDINGS: In total, 56 RCTs were identified, including 4,039 individual postmenopausal women. There was substantial heterogeneity in quality across studies. Twenty-six (46%) RCTs showed poor quality and there was an indication of publication bias presence for some of the biomarkers. Results are reported in pooled mean difference (95% CI) of changes. Use of phytoestrogens was associated with a decrease in serum total cholesterol (-0.27 mmol/L [-0.41 to -0.13]), low-density lipoprotein (-0.25 mmol/L [-0.37 to -0.13]), triglycerides (-0.20 mmol/L [-0.28 to -0.11]), and apolipoprotein B (-0.13 g/L [-0.23 to -0.03]) and with an increase in serum apolipoprotein A-1 (0.04 g/L [0.02-0.07]. Also, phytoestrogen supplementation was associated with a decrease in serum intercellular adhesion molecule 1 (-18.86 ng/mL [-30.06 to -7.65]) and E-selectin (-2.32 ng/mL [-4.05 to -0.59]). There was no association observed between phytoestrogen supplementation and inflammatory markers, fibrinogen, homocysteine, or other endothelial function markers. In contrast, use of phytoestrogens was associated with an increase in CIMT (9.34 µm [95% CI, 0.39-18.29]). Effect estimates of phytoestrogen supplementation on oxidative stress could not be pooled. CONCLUSIONS AND RELEVANCE: Phytoestrogen supplementation seems to modestly improve the CVD risk profile of postmenopausal women by influencing blood lipids and parameters of endothelial function. In women with an increased risk of atherosclerosis, although modest, a harmful effect on CIMT progression may be present. Because of limited quality and the heterogeneous nature of the current evidence, additional rigorous studies are needed to explore the role of phytoestrogens in menopausal cardiovascular health. : Video Summary: http://links.lww.com/MENO/A593.

13.
Eur J Epidemiol ; 35(8): 743-748, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32656618

RESUMO

In low and middle-income countries (LMICs), strict social distancing measures (e.g., nationwide lockdown) in response to the COVID-19 pandemic are unsustainable in the long-term due to knock-on socioeconomic and psychological effects. However, an optimal epidemiology-focused strategy for 'safe-reopening' (i.e., balancing between the economic and health consequences) remain unclear, particularly given the suboptimal disease surveillance and diagnostic infrastructure in these settings. As the lockdown is now being relaxed in many LMICs, in this paper, we have (1) conducted an epidemiology-based "options appraisal" of various available non-pharmacological intervention options that can be employed to safely lift the lockdowns (namely, sustained mitigation, zonal lockdown and rolling lockdown strategies), and (2) propose suitable application, pre-requisites, and inherent limitations for each measure. Among these, a sustained mitigation-only approach (adopted in many high-income countries) may not be feasible in most LMIC settings given the absence of nationwide population surveillance, generalised testing, contact tracing and critical care infrastructure needed to tackle the likely resurgence of infections. By contrast, zonal or local lockdowns may be suitable for some countries where systematic identification of new outbreak clusters in real-time would be feasible. This requires a generalised testing and surveillance structure, and a well-thought out (and executed) zone management plan. Finally, an intermittent, rolling lockdown strategy has recently been suggested by the World Health Organization as a potential strategy to get the epidemic under control in some LMI settings, where generalised mitigation and zonal containment is unfeasible. This strategy, however, needs to be carefully considered for economic costs and necessary supply chain reforms. In conclusion, while we propose three community-based, non-pharmacological options for LMICs, a suitable measure should be context-specific and based on: (1) epidemiological considerations, (2) social and economic costs, (3) existing health systems capabilities and (4) future-proof plans to implement and sustain the strategy.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Máscaras , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena , Isolamento Social , Betacoronavirus , Coronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Máscaras/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Saúde Pública , Quarentena/estatística & dados numéricos
14.
Am J Prev Med ; 59(3): 412-419, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32713616

RESUMO

INTRODUCTION: Associations between time spent on physical activity, sedentary behavior, and sleep and quality of life are usually studied without considering that their combined time is fixed. This study investigates the reallocation of time spent on physical activity, sedentary behavior, and sleep during the 24-hour day and their associations with quality of life. METHODS: Data from the 2011-2016 Rotterdam Study were used to perform this cross-sectional analysis among 1,934 participants aged 51-94 years. Time spent in activity levels (sedentary, light-intensity physical activity, moderate-to-vigorous physical activity, and sleep) were objectively measured with a wrist-worn accelerometer combined with a sleep diary. Quality of life was measured using the EuroQoL 5D-3L questionnaire. The compositional isotemporal substitution method was used in 2018 to examine the association between the distribution of time spent in different activity behaviors and quality of life. RESULTS: Reallocation of 30 minutes from sedentary behavior, light-intensity physical activity, or sleep to moderate-to-vigorous physical activity was associated with a higher quality of life, whereas reallocation from moderate-to-vigorous physical activity to sedentary behavior, light-intensity physical activity, or sleep was associated with lower quality of life. To illustrate this, a reallocation of 30 minutes from sedentary behavior to moderate-to-vigorous physical activity was associated with a 3% (95% CI=2, 4) higher quality of life score. By contrast, a reallocation of 30 minutes from moderate-to-vigorous physical activity to sedentary behavior was associated with a 4% (95% CI=2, 6) lower quality of life score. CONCLUSIONS: Moderate-to-vigorous physical activity is important with regard to the quality of life of middle-aged and elderly individuals. The benefits of preventing less time spent in moderate-to-vigorous physical activity were greater than the benefits of more time spent in moderate-to-vigorous physical activity. These results could shift the attention to interventions focused on preventing reductions in moderate-to-vigorous physical activity levels. Further longitudinal studies are needed to confirm these findings and explore causality.

16.
17.
Palliat Med ; 34(8): 1019-1029, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32588755

RESUMO

BACKGROUND: Use of implantable cardioverter defibrillators is increasingly common. As patients approach the end of life, it is appropriate to deactivate the shock function. AIM: To assess the prevalence of implantable cardioverter defibrillator reprogramming to deactivate the shock function at the end of life and the prevalence of advance directives among this population. DESIGN: Following a previously established protocol available in PROSPERO, we performed a narrative synthesis of our findings and used the logit transformation method to perform our quantitative synthesis. DATA SOURCES: We searched seven bibliographic databases (Embase, Cochrane Central register of controlled Trials, Medline-Ovid, Web-of-Science, Scopus, PsychInfo, and CINAHL) and additional sources until April 2019. RESULTS: Of the references we identified, 14 were included. We found a pooled prevalence of implantable cardioverter defibrillator reprogramming at the end of life of 28% (95% confidence interval, 22%-36%) with higher reprogramming rates after the recommendations for managing the device at the end of life were published. Among patients with advance directives, the pooled prevalence of advance directives that explicitly mentioned the device was 1% (95% confidence interval, 1%-3%). CONCLUSIONS: The prevalence of implantable cardioverter defibrillator reprogramming and advance directives that explicitly mentioned the device was very low. Study data suggested reprogramming decisions were made very late, after the patient experienced multiple shocks. Patient suffering could be ameliorated if physicians and other healthcare professionals adhere to clinical guidelines for the good management of the device at the end of life and include deactivating the shock function in the discussion that leads to the advance directive.

18.
Eur J Epidemiol ; 35(5): 389-399, 2020 May.
Artigo em Inglês | MEDLINE | ID: covidwho-306254

RESUMO

To date, non-pharmacological interventions (NPI) have been the mainstay for controlling the coronavirus disease-2019 (COVID-19) pandemic. While NPIs are effective in preventing health systems overload, these long-term measures are likely to have significant adverse economic consequences. Therefore, many countries are currently considering to lift the NPIs-increasing the likelihood of disease resurgence. In this regard, dynamic NPIs, with intervals of relaxed social distancing, may provide a more suitable alternative. However, the ideal frequency and duration of intermittent NPIs, and the ideal "break" when interventions can be temporarily relaxed, remain uncertain, especially in resource-poor settings. We employed a multivariate prediction model, based on up-to-date transmission and clinical parameters, to simulate outbreak trajectories in 16 countries, from diverse regions and economic categories. In each country, we then modelled the impacts on intensive care unit (ICU) admissions and deaths over an 18-month period for following scenarios: (1) no intervention, (2) consecutive cycles of mitigation measures followed by a relaxation period, and (3) consecutive cycles of suppression measures followed by a relaxation period. We defined these dynamic interventions based on reduction of the mean reproduction number during each cycle, assuming a basic reproduction number (R0) of 2.2 for no intervention, and subsequent effective reproduction numbers (R) of 0.8 and 0.5 for illustrative dynamic mitigation and suppression interventions, respectively. We found that dynamic cycles of 50-day mitigation followed by a 30-day relaxation reduced transmission, however, were unsuccessful in lowering ICU hospitalizations below manageable limits. By contrast, dynamic cycles of 50-day suppression followed by a 30-day relaxation kept the ICU demands below the national capacities. Additionally, we estimated that a significant number of new infections and deaths, especially in resource-poor countries, would be averted if these dynamic suppression measures were kept in place over an 18-month period. This multi-country analysis demonstrates that intermittent reductions of R below 1 through a potential combination of suppression interventions and relaxation can be an effective strategy for COVID-19 pandemic control. Such a "schedule" of social distancing might be particularly relevant to low-income countries, where a single, prolonged suppression intervention is unsustainable. Efficient implementation of dynamic suppression interventions, therefore, confers a pragmatic option to: (1) prevent critical care overload and deaths, (2) gain time to develop preventive and clinical measures, and (3) reduce economic hardship globally.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Coronavirus , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Modelos Teóricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
19.
Maturitas ; 136: 38-41, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-52546

RESUMO

The zoonotic virus now named SARS-CoV-2 first infected humans in China, and COVID-19 has rapidly become pandemic. To mitigate its impact on societies, health systems and economies, countries have adopted non-pharmacological preventive practices such as 'spatial' or 'social' distancing, the use of protective masks, and handwashing; these have been widely implemented. However, measures aimed at protecting physical health and healthcare systems have side-effects that might have a big impact on individuals' wellbeing. As the pandemic reaches low- and middle-income countries, weaker health systems, limited resources and the lower socioeconomic status of their populations make halting the pandemic more challenging. In this article, we explore the impact of COVID-19 and its prevention measures on the wellbeing of vulnerable populations. Special attention must be given to homeless, indigenous, migrant and imprisoned populations, as well as people living with disabilities and the elderly. More than just resolute governmental action will be required to overcome the pandemic. Links between science and political actions have to be strengthened. Fighting COVID-19 is a collective endeavour and community action, on a global scale, is of paramount importance.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Prioridades em Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Idoso , Países em Desenvolvimento , Humanos , Saúde Mental , Isolamento Social/psicologia , Populações Vulneráveis
20.
Mol Psychiatry ; 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393786

RESUMO

We conducted genome-wide association studies (GWAS) of relative intake from the macronutrients fat, protein, carbohydrates, and sugar in over 235,000 individuals of European ancestries. We identified 21 unique, approximately independent lead SNPs. Fourteen lead SNPs are uniquely associated with one macronutrient at genome-wide significance (P < 5 × 10-8), while five of the 21 lead SNPs reach suggestive significance (P < 1 × 10-5) for at least one other macronutrient. While the phenotypes are genetically correlated, each phenotype carries a partially unique genetic architecture. Relative protein intake exhibits the strongest relationships with poor health, including positive genetic associations with obesity, type 2 diabetes, and heart disease (rg ≈ 0.15-0.5). In contrast, relative carbohydrate and sugar intake have negative genetic correlations with waist circumference, waist-hip ratio, and neighborhood deprivation (|rg| ≈ 0.1-0.3) and positive genetic correlations with physical activity (rg ≈ 0.1 and 0.2). Relative fat intake has no consistent pattern of genetic correlations with poor health but has a negative genetic correlation with educational attainment (rg ≈-0.1). Although our analyses do not allow us to draw causal conclusions, we find no evidence of negative health consequences associated with relative carbohydrate, sugar, or fat intake. However, our results are consistent with the hypothesis that relative protein intake plays a role in the etiology of metabolic dysfunction.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA