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1.
MMWR Morb Mortal Wkly Rep ; 69(44): 1654-1659, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33151922

RESUMO

On June 3, 2020, a woman aged 73 years (patient A) with symptoms consistent with coronavirus disease 2019 (COVID-19) (1) was evaluated at the emergency department of the Hopi Health Care Center (HHCC, an Indian Health Services facility) and received a positive test result for SARS-CoV-2, the virus that causes COVID-19. The patient's symptoms commenced on May 27, and a sibling (patient B) of the patient experienced symptom onset the following day. On May 23, both patients had driven together and spent time in a retail store in Flagstaff, Arizona. Because of their similar exposures, symptom onset dates, and overlapping close contacts, these patients are referred to as co-index patients. The co-index patients had a total of 58 primary (i.e., direct) and secondary contacts (i.e., contacts of a primary contact); among these, 27 (47%) received positive SARS-CoV-2 test results. Four (15%) of the 27 contacts who became ill were household members of co-index patient B, 14 (52%) had attended family gatherings, one was a child who might have transmitted SARS-CoV-2 to six contacts, and eight (30%) were community members. Findings from the outbreak investigation prompted the HHCC and Hopi Tribe leadership to strengthen community education through community health representatives, public health nurses, and radio campaigns. In communities with similar extended family interaction, emphasizing safe ways to stay in touch, along with wearing a mask, frequent hand washing, and physical distancing might help limit the spread of disease.


Assuntos
Infecções por Coronavirus/etnologia , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças , Índios Norte-Americanos/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/etnologia , Pneumonia Viral/prevenção & controle , Adolescente , Adulto , Idoso , Arizona/epidemiologia , Betacoronavirus/isolamento & purificação , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Busca de Comunicante , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Feminino , Humanos , Lactente , Laboratórios , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/transmissão , Adulto Jovem
2.
AMA J Ethics ; 22(10): E856-861, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33103647

RESUMO

Native Americans have twice the poverty rate of the general US population, suffer significant health inequity, and are chronically underrepresented, at only 0.08%, in the US physician workforce. The COVID-19 pandemic has illuminated key ethical, clinical, and economic complexities in health decision making among Native patients. This article discusses 3 levels of autonomy relevant to health decisions, including taking care of our own by increasing numbers of Native medical students.


Assuntos
Infecções por Coronavirus , Educação Médica , Equidade em Saúde , Serviços de Saúde do Indígena , Mão de Obra em Saúde , Índios Norte-Americanos , Pandemias , Médicos , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Tomada de Decisões , Humanos , Autonomia Pessoal , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia
3.
AMA J Ethics ; 22(10): E898-903, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33103654

RESUMO

The disproportionate negative impact of the COVID-19 pandemic on Native communities is a result of transgenerational traumas-mental and physical-which have been ongoing and developing for centuries. This article considers 19th-century American visual and narrative representations of Native experiences of and responses to transgenerational trauma. This article also suggests ethical implications for Native American health of interpreting those representations and suggests an obligation to look on 19th-century White American artists' romanticizations of Native experiences with humility.


Assuntos
Arte , Infecções por Coronavirus/complicações , Trauma Histórico/complicações , Historiografia , Índios Norte-Americanos/psicologia , Pneumonia Viral/complicações , Saúde da População , Violência , Arte/história , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Características da Família , Trauma Histórico/etnologia , História do Século XIX , Humanos , Narração , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estados Unidos , Violência/ética , Violência/história , Violência/psicologia
4.
PLoS Med ; 17(10): e1003402, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33079941

RESUMO

BACKGROUND: In the United States, non-Hispanic Black (NHB), Hispanic, and non-Hispanic American Indian/Alaska Native (NHAIAN) populations experience excess COVID-19 mortality, compared to the non-Hispanic White (NHW) population, but racial/ethnic differences in age at death are not known. The release of national COVID-19 death data by racial/ethnic group now permits analysis of age-specific mortality rates for these groups and the non-Hispanic Asian or Pacific Islander (NHAPI) population. Our objectives were to examine variation in age-specific COVID-19 mortality rates by racial/ethnicity and to calculate the impact of this mortality using years of potential life lost (YPLL). METHODS AND FINDINGS: This cross-sectional study used the recently publicly available data on US COVID-19 deaths with reported race/ethnicity, for the time period February 1, 2020, to July 22, 2020. Population data were drawn from the US Census. As of July 22, 2020, the number of COVID-19 deaths equaled 68,377 for NHW, 29,476 for NHB, 23,256 for Hispanic, 1,143 for NHAIAN, and 6,468 for NHAPI populations; the corresponding population sizes were 186.4 million, 40.6 million, 2.6 million, 19.5 million, and 57.7 million. Age-standardized rate ratios relative to NHW were 3.6 (95% CI 3.5, 3.8; p < 0.001) for NHB, 2.8 (95% CI 2.7, 3.0; p < 0.001) for Hispanic, 2.2 (95% CI 1.8, 2.6; p < 0.001) for NHAIAN, and 1.6 (95% CI 1.4, 1.7; p < 0.001) for NHAP populations. By contrast, NHB rate ratios relative to NHW were 7.1 (95% CI 5.8, 8.7; p < 0.001) for persons aged 25-34 years, 9.0 (95% CI 7.9, 10.2; p < 0.001) for persons aged 35-44 years, and 7.4 (95% CI 6.9, 7.9; p < 0.001) for persons aged 45-54 years. Even at older ages, NHB rate ratios were between 2.0 and 5.7. Similarly, rate ratios for the Hispanic versus NHW population were 7.0 (95% CI 5.8, 8.7; p < 0.001), 8.8 (95% CI 7.8, 9.9; p < 0.001), and 7.0 (95% CI 6.6, 7.5; p < 0.001) for the corresponding age strata above, with remaining rate ratios ranging from 1.4 to 5.0. Rate ratios for NHAIAN were similarly high through age 74 years. Among NHAPI persons, rate ratios ranged from 2.0 to 2.8 for persons aged 25-74 years and were 1.6 and 1.2 for persons aged 75-84 and 85+ years, respectively. As a consequence, more YPLL before age 65 were experienced by the NHB and Hispanic populations than the NHW population-despite the fact that the NHW population is larger-with a ratio of 4.6:1 and 3.2:1, respectively, for NHB and Hispanic persons. Study limitations include likely lag time in receipt of completed death certificates received by the Centers for Disease Control and Prevention for transmission to NCHS, with consequent lag in capturing the total number of deaths compared to data reported on state dashboards. CONCLUSIONS: In this study, we observed racial variation in age-specific mortality rates not fully captured with examination of age-standardized rates alone. These findings suggest the importance of examining age-specific mortality rates and underscores how age standardization can obscure extreme variations within age strata. To avoid overlooking such variation, data that permit age-specific analyses should be routinely publicly available.


Assuntos
Afro-Americanos , Grupo com Ancestrais do Continente Asiático , Infecções por Coronavirus/etnologia , Disparidades nos Níveis de Saúde , Hispano-Americanos , Índios Norte-Americanos , Grupo com Ancestrais Oceânicos , Pneumonia Viral/etnologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Grupos de Populações Continentais , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Estudos Transversais , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu , Humanos , Pessoa de Meia-Idade , Mortalidade Prematura , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Estados Unidos/epidemiologia
5.
MMWR Morb Mortal Wkly Rep ; 69(37): 1283-1287, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32941412

RESUMO

Human papillomavirus (HPV) causes most cervical cancers and some cancers of the penis, vulva, vagina, oropharynx, and anus. Cervical precancers can be detected through screening. HPV vaccination with the 9-valent HPV vaccine (9vHPV) can prevent approximately 92% of HPV-attributable cancers (1).* Previous studies have shown lower incidence of HPV-associated cancers in non-Hispanic American Indian and Alaska Native (AI/AN) populations compared with other racial subgroups (2); however, these rates might have been underestimated as a result of racial misclassification. Previous studies have shown that cancer registry data corrected for racial misclassification resulted in more accurate cancer incidence estimates for AI/AN populations (3,4). In addition, regional variations in cancer incidence among AI/AN populations suggest that nationally aggregated data might not adequately describe cancer outcomes within these populations (5). These variations might, in part, result from geographic disparities in the use of health services, such as cancer screening or vaccination (6). CDC analyzed data for 2013-2017 from central cancer registries linked with the Indian Health Service (IHS) patient registration database to assess the incidence of HPV-associated cancers and to estimate the number of cancers caused by HPV among AI/AN populations overall and by region. During 2013-2017, an estimated 1,030 HPV-associated cancers were reported in AI/AN populations. Of these cancers, 740 (72%) were determined to be attributable to HPV types targeted by 9vHPV; the majority were cervical cancers in females and oropharyngeal cancers in males. These data can help identify regions where AI/AN populations have disproportionately high rates of HPV-associated cancers and inform targeted regional vaccination and screening programs in AI/AN communities.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Índios Norte-Americanos/estatística & dados numéricos , Neoplasias/etnologia , Neoplasias/virologia , Papillomaviridae/patogenicidade , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/etnologia , Feminino , Humanos , Incidência , Masculino , Sistema de Registros , Estados Unidos/epidemiologia
6.
J Ambul Care Manage ; 43(4): 301-305, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32858729

RESUMO

Over 100 Community Health Representatives (CHRs) as part of the oldest and largest Community Health Worker (CHW) program in the United States serve the Dine People on the Navajo Nation. The CHRs work under a tribally determined scope of practice that embraces the importance of self-determination of tribal nations, a philosophy central to the CHW field nationally. Navajo CHRs are the epitome of frontline workers, as they extend their traditional role to encompass long-term emergency response during coronavirus disease-2019 (COVID-19). This article describes the Navajo CHR role in the pandemic through the lens of an interview with the program's director, Mae-Gilene Begay.


Assuntos
Agentes Comunitários de Saúde , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/epidemiologia , Índios Norte-Americanos , Pneumonia Viral/etnologia , Pneumonia Viral/epidemiologia , Papel Profissional , United States Indian Health Service/organização & administração , Betacoronavirus , Humanos , Pandemias , Estados Unidos/epidemiologia
7.
MMWR Morb Mortal Wkly Rep ; 69(34): 1166-1169, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32853193

RESUMO

Although non-Hispanic American Indian and Alaska Native (AI/AN) persons account for 0.7% of the U.S. population,* a recent analysis reported that 1.3% of coronavirus disease 2019 (COVID-19) cases reported to CDC with known race and ethnicity were among AI/AN persons (1). To assess the impact of COVID-19 among the AI/AN population, reports of laboratory-confirmed COVID-19 cases during January 22†-July 3, 2020 were analyzed. The analysis was limited to 23 states§ with >70% complete race/ethnicity information and five or more laboratory-confirmed COVID-19 cases among both AI/AN persons (alone or in combination with other races and ethnicities) and non-Hispanic white (white) persons. Among 424,899 COVID-19 cases reported by these states, 340,059 (80%) had complete race/ethnicity information; among these 340,059 cases, 9,072 (2.7%) occurred among AI/AN persons, and 138,960 (40.9%) among white persons. Among 340,059 cases with complete patient race/ethnicity data, the cumulative incidence among AI/AN persons in these 23 states was 594 per 100,000 AI/AN population (95% confidence interval [CI] = 203-1,740), compared with 169 per 100,000 white population (95% CI = 137-209) (rate ratio [RR] = 3.5; 95% CI = 1.2-10.1). AI/AN persons with COVID-19 were younger (median age = 40 years; interquartile range [IQR] = 26-56 years) than were white persons (median age = 51 years; IQR = 32-67 years). More complete case report data and timely, culturally responsive, and evidence-based public health efforts that leverage the strengths of AI/AN communities are needed to decrease COVID-19 transmission and improve patient outcomes.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Infecções por Coronavirus/etnologia , Disparidades nos Níveis de Saúde , Índios Norte-Americanos/estatística & dados numéricos , Pneumonia Viral/etnologia , Adolescente , Adulto , Idoso , Betacoronavirus/isolamento & purificação , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Índice de Gravidade de Doença , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
8.
Public Health ; 186: 78-82, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32791340

RESUMO

OBJECTIVES: The objective of this study was to compare immunization rates of American Indian (AI) and White children in North Dakota and identify disparities in immunization rates by race. STUDY DESIGN: The study design was to assess immunization coverage rates by race using immunization information system (IIS) data. METHODS: Data from the North Dakota Immunization Information System (NDIIS) for children aged 19-35 months during quarter four of 2014, 2015, 2016, 2017 and 2018 were used to assess and compare immunization coverage rates for AI and White children. NDIIS data were also analyzed for timeliness of vaccine administration, Vaccines for Children (VFC) status, and the number of doses still needed to be considered up to date (UTD) with routinely recommended immunizations. RESULTS: In quarter four of 2018 (Q4 2018), only 60% of AI children were UTD with the complete 4:3:1:3:3:1:4 vaccine series compared with 74.5% of White children of the same age. Fewer VFC-eligible AI children (59.1%) are UTD than VFC-eligible White children (68.7%). AI children were also more likely to be delayed at each immunization milestone, leading to fewer AI children to be UTD by 19 to 35 months of age. CONCLUSIONS: This study shows that there is a racial disparity in immunization coverage rates between AI and White children in North Dakota. Public health and private healthcare providers should work to identify and address barriers to vaccination and should implement strategies to increase immunization rates for AI children.


Assuntos
Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Índios Norte-Americanos/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Pré-Escolar , Humanos , Imunização , Programas de Imunização , Lactente , North Dakota/epidemiologia , Vacinação/estatística & dados numéricos
9.
Front Health Serv Manage ; 37(1): 45-48, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842089

RESUMO

For populations experiencing the preexisting conditions of poverty and all its related social inequalities, the COVID-19 pandemic further complicates the delivery of healthcare. Two members of the American College of Healthcare Executives-Tim Egan, president and CEO of Roseland Community Hospital on the South Side of Chicago, Illinois, and Lynette Bonar, RN, FACHE, CEO of Tuba City Regional Health Care Corporation on the Navajo and Hopi reservations in Arizona-deal with those complications daily. Presented here together, their perspectives show resilience, cultural sensitivity, and commitment to protect the well-being of their diverse communities.


Assuntos
Adaptação Psicológica , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Pessoal de Saúde/psicologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Adulto , Arizona , Atitude do Pessoal de Saúde , Betacoronavirus , Chicago , Cidades/estatística & dados numéricos , Feminino , Humanos , Índios Norte-Americanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , População Rural , População Urbana
10.
Am J Hum Genet ; 107(2): 251-264, 2020 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-32640185

RESUMO

Applying exome sequencing to populations with unique genetic architecture has the potential to reveal novel genes and variants associated with traits and diseases. We sequenced and analyzed the exomes of 6,716 individuals from a Southwestern American Indian (SWAI) population with well-characterized metabolic traits. We found that the SWAI population has distinct allelic architecture compared to populations of European and East Asian ancestry, and there were many predicted loss-of-function (pLOF) and nonsynonymous variants that were highly enriched or private in the SWAI population. We used pLOF and nonsynonymous variants in the SWAI population to evaluate gene-burden associations of candidate genes from European genome-wide association studies (GWASs) for type 2 diabetes, body mass index, and four major plasma lipids. We found 19 significant gene-burden associations for 11 genes, providing additional evidence for prioritizing candidate effector genes of GWAS signals. Interestingly, these associations were mainly driven by pLOF and nonsynonymous variants that are unique or highly enriched in the SWAI population. Particularly, we found four pLOF or nonsynonymous variants in APOB, APOE, PCSK9, and TM6SF2 that are private or enriched in the SWAI population and associated with low-density lipoprotein (LDL) cholesterol levels. Their large estimated effects on LDL cholesterol levels suggest strong impacts on protein function and potential clinical implications of these variants in cardiovascular health. In summary, our study illustrates the utility and potential of exome sequencing in genetically unique populations, such as the SWAI population, to prioritize candidate effector genes within GWAS loci and to find additional variants in known disease genes with potential clinical impact.


Assuntos
Exoma/genética , Predisposição Genética para Doença/genética , Índios Norte-Americanos/genética , Polimorfismo de Nucleotídeo Único/genética , Alelos , Índice de Massa Corporal , Feminino , Genética Populacional/métodos , Estudo de Associação Genômica Ampla/métodos , Humanos , Masculino , Fenótipo , Sudoeste dos Estados Unidos
13.
Artigo em Inglês | MEDLINE | ID: mdl-32708798

RESUMO

In 2020, global injustice has taken center stage during the uprising of the Black Lives Matter movement and other social movements. Activists are calling attention to longstanding disparities in health outcomes and an urgent need for justice. Given the global socio-political moment, how can health researchers draw on current critical theory and social movements to create structures for equitable outcomes in health research and practice? Here, we demonstrate principles for effective health research and social justice work that builds on community-engaged approaches by weaving critical Indigenous approaches into structural project designs. Our project, "Health Resilience among American Indians in Arizona", brought new and seasoned researchers together to collect and analyze data on the knowledge of healthcare providers concerning American Indian health and well-being. Four years after the conclusion of the project, the team developed and created a post-project self-assessment to investigate lasting impacts of project participation. In this communication, we discuss the principles of defining and measuring the capacity to build together. This work responds to the call from Indigenous scholars and community leaders to build an internal narrative of change. While we will not present the full instrument, we will discuss building a strong foundation using the principles of engagement for planning and implementing justice and change.


Assuntos
Justiça Social , Arizona , Processos Grupais , Humanos , Índios Norte-Americanos , Narração
15.
J Med Microbiol ; 69(8): 1049-1061, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32602832

RESUMO

Introduction. Metal exposure is an important factor for inducing antibiotic resistance in bacteria. Dandelion extracts have been used for centuries in traditional Chinese and Native American medicine.Aim. We assessed the effects of dandelion water extracts and taraxasterol on heavy metal-induced antibiotic resistance in Escherichia coli as well as the underlying mechanisms.Methodology. Dandelion extracts were obtained through 4 h of boiling in distilled water. Bacterial growth was monitored with a spectrophotometer. Biochemical assays were performed to assess the activities and gene transcriptions of ß-lactamase and acetyltransferase. Oxidative stress was determined using an oxidation-sensitive probe, H2DCFDA.Results. The present study demonstrated that higher concentrations of nickel (>5 µg ml-1), cadmium (>0.1 µg ml-1), arsenic (>0.1 µg ml-1) and copper (>5 µg ml-1) significantly inhibited the growth of E. coli. Lower concentrations of nickel (0.5 µg ml-1), cadmium (0.05 µg ml-1) and arsenic (0.05 µg ml-1) had no effect on bacterial growth, but helped the bacteria become resistant to two antibiotics, kanamycin and ampicillin. The addition of dandelion root extracts and taraxasterol significantly reversed the antibiotic resistance induced by these heavy metals. The supplements of antibiotics and cadmium generated synergistic effects on the activities of ß-lactamase and acetyltransferase (two antibiotic resistance-related proteins), which were significantly blocked by either dandelion root extract or taraxasterol. In contrast, oxidative stress was not involved in the preventative roles of dandelion root extracts and taraxasterol in heavy metal-induced antibiotic resistance.Conclusion. This study suggests that heavy metals induce bacterial antibiotic resistance and dandelion root extracts and taraxasterol could be used to help reverse bacterial resistance to antibiotics.


Assuntos
Resistência Microbiana a Medicamentos/efeitos dos fármacos , Metais Pesados/efeitos adversos , Extratos Vegetais/farmacologia , Esteróis/farmacologia , Taraxacum/química , Triterpenos/farmacologia , Resistência a Ampicilina/efeitos dos fármacos , Arsênico/efeitos adversos , Cádmio/efeitos adversos , Cobre/efeitos adversos , Escherichia coli/efeitos dos fármacos , Humanos , Índios Norte-Americanos , Resistência a Canamicina/efeitos dos fármacos , Medicina Tradicional Chinesa , Medicina Tradicional , Níquel/efeitos adversos , Raízes de Plantas/química
17.
Public Health Rep ; 135(4): 461-471, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32633599

RESUMO

OBJECTIVES: Hepatitis C virus (HCV) and HIV transmission in the United States may increase as a result of increasing rates of opioid use disorder (OUD) and associated injection drug use (IDU). Epidemiologic trends among American Indian/Alaska Native (AI/AN) persons are not well known. METHODS: We analyzed 2010-2014 Indian Health Service data on health care encounters to assess regional and temporal trends in IDU indicators among adults aged ≥18 years. IDU indicators included acute or chronic HCV infection (only among adults aged 18-35 years), arm cellulitis and abscess, OUD, and opioid-related overdose. We calculated rates per 10 000 AI/AN adults for each IDU indicator overall and stratified by sex, age group, and region and evaluated rate ratios and trends by using Poisson regression analysis. RESULTS: Rates of HCV infection among adults aged 18-35 increased 9.4% per year, and rates of OUD among all adults increased 13.3% per year from 2010 to 2014. The rate of HCV infection among young women was approximately 1.3 times that among young men. Rates of opioid-related overdose among adults aged <50 years were approximately 1.4 times the rates among adults aged ≥50 years. Among young adults with HCV infection, 25.6% had concurrent OUD. Among all adults with arm cellulitis and abscess, 5.6% had concurrent OUD. CONCLUSIONS: Rates of HCV infection and OUD increased significantly in the AI/AN population. Strengthened public health efforts could ensure that AI/AN communities can address increasing needs for culturally appropriate interventions, including comprehensive syringe services programs, medication-assisted treatment, and opioid-related overdose prevention and can meet the growing need for treatment of HCV infection.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Hepatite C/epidemiologia , Índios Norte-Americanos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , United States Indian Health Service/estatística & dados numéricos , United States Indian Health Service/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
18.
Nat Rev Genet ; 21(9): 509, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32690946
19.
Nature ; 583(7817): 524-525, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32641787
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