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1.
J. Health NPEPS ; 6(1)jun. 2021.
Artigo em Português | LILACS | ID: biblio-1147344

RESUMO

Objetivo: analisar a letalidade da COVID-19 por sexo e idade entre os profissionais de saúde do Estado Pará, Brasil. Método: estudo epidemiológico e observacional, com utilização de dados secundários públicos sobre casos e óbitos acumulados por COVID-19 e dados demográficos, entre março e outubro de 2020. O número de casos e óbitos por COVID-19 ocorridos entre profissionais de saúde foram comparados em relação à idade e ao sexo pelo teste qui-quadrado, seguido por regressão logística pelo método Backward Stepwise de Wald. Resultados: entre os 15.332 casos confirmados de COVID-19, 70,3% eram do sexo feminino e 61,3% com idade entre 30 a 49 anos (39,2±11,6 anos). Registraram-se 97 óbitos, com uma taxa de letalidade de 0,6%. A probabilidade de óbito foi 52,8 vezes (20,7-134,5) e 4,0 vezes (2,5-6,2) maior entre jovens e homens quando comparados às demais notificações. Conclusão: a taxa de letalidade entre os profissionais de saúde é alta, especialmente entre homens jovens. Este é um alerta sobre os impactos da doença entre os trabalhadores da saúde e suscita ao poder público, especificamente ao setor saúde melhores condições de trabalho e políticas de saúde do trabalhador.(AU)


Objective: to analyze the lethality of COVID-19 by sex and age among health professionals in the state of Pará, Brazil. Method: epidemiological and observational study, using public secondary data on cases and deaths accumulated by COVID-19 and demographic data, between March and October 2020. The number of cases and deaths by COVID-19 that occurred among health professionals were compared in relation to age and sex using the chi-square test, followed by logistic regression using Wald's Backward Stepwise method. Results: among the 15,332 confirmed cases of COVID-19, 70.3% were female and 61.3% aged between 30 and 49 years (39.2 ± 11.6 years). 97 deaths were recorded, with a fatality rate of 0.6%. The probability of death was 52.8 times (20.7-134.5) and 4.0 times (2.5-6.2) higher among young men and men when compared to other reports. Conclusion: the lethality rate among health professionals is high, especially among young men. This is an alert about the impacts of the disease among health workers and raises the public authorities, specifically the health sector, better working conditions and worker health policies.(AU)


Objetivo: analizar la letalidad de COVID-19 por sexo y edad en profesionales de la salud en el estado de Pará, Brasil. Método: estudio epidemiológico y observacional, utilizando datos secundarios públicos sobre casos y defunciones acumulados por COVID-19 y datos demográficos, entre marzo y octubre de 2020. Se comparó el número de casos y defunciones por COVID-19 ocurridos entre profesionales de la salud en relación con edad y sexo usando la prueba de chi-cuadrado, seguida de regresión logística usando el método de Wald Backward Stepwise. Resultados: entre los 15.332 casos confirmados de COVID-19, el 70,3% eran mujeres y el 61,3% tenían entre 30 y 49 años (39,2 ± 11,6 años). Se registraron 97 muertes, con una tasa de letalidad del 0,6%. La probabilidad de muerte fue 52,8 veces (20,7-134,5) y 4,0 veces (2,5-6,2) más grande entre hombres y jóvenes en comparación con otros informes. Conclusión: la tasa de letalidad entre los profesionales de la salud es alta, especialmente entre los hombres jóvenes. Se trata de una alerta sobre los impactos de la enfermedad entre los trabajadores de la salud y plantea a las autoridades públicas, específicamente al sector salud, mejores condiciones laborales y políticas de salud laboral.(AU)


Assuntos
Humanos , Saúde do Trabalhador , Pessoal de Saúde/estatística & dados numéricos , Infecções por Coronavirus/mortalidade , Política de Saúde , Brasil , Estudos Epidemiológicos
2.
MMWR Morb Mortal Wkly Rep ; 70(13): 473-477, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33793457

RESUMO

Incarcerated and detained persons are at increased risk for acquiring COVID-19. However, little is known about their willingness to receive a COVID-19 vaccination. During September-December 2020, residents in three prisons and 13 jails in four states were surveyed regarding their willingness to receive a COVID-19 vaccination and their reasons for COVID-19 vaccination hesitancy or refusal. Among 5,110 participants, 2,294 (44.9%) said they would receive a COVID-19 vaccination, 498 (9.8%) said they would hesitate to receive it, and 2,318 (45.4%) said they would refuse to receive it. Willingness to receive a COVID-19 vaccination was lowest among Black/African American (Black) (36.7%; 510 of 1,390) persons, participants aged 18-29 years (38.5%; 583 of 1,516), and those who lived in jails versus prisons (43.7%; 1,850 of 4,232). Common reasons reported for COVID-19 vaccine hesitancy were waiting for more information (54.8%) and efficacy or safety concerns (31.0%). The most common reason for COVID-19 vaccination refusal was distrust of health care, correctional, or government personnel or institutions (20.1%). Public health interventions to improve vaccine confidence and trust are needed to increase vaccination acceptance by incarcerated or detained persons.


Assuntos
/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Prisioneiros/psicologia , Vacinação/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , /prevenção & controle , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prisioneiros/estatística & dados numéricos , Prisões , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
3.
MMWR Morb Mortal Wkly Rep ; 70(13): 490-494, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33793459

RESUMO

The spread of disease and increase in deaths during large outbreaks of transmissible diseases is often associated with fear and grief (1). Social restrictions, limits on operating nonessential businesses, and other measures to reduce pandemic-related mortality and morbidity can lead to isolation and unemployment or underemployment, further increasing the risk for mental health problems (2). To rapidly monitor changes in mental health status and access to care during the COVID-19 pandemic, CDC partnered with the U.S. Census Bureau to conduct the Household Pulse Survey (HPS). This report describes trends in the percentage of adults with symptoms of an anxiety disorder or a depressive disorder and those who sought mental health services. During August 19, 2020-February 1, 2021, the percentage of adults with symptoms of an anxiety or a depressive disorder during the past 7 days increased significantly (from 36.4% to 41.5%), as did the percentage reporting that they needed but did not receive mental health counseling or therapy during the past 4 weeks (from 9.2% to 11.7%). Increases were largest among adults aged 18-29 years and among those with less than a high school education. HPS data can be used in near real time to evaluate the impact of strategies that address mental health status and care of adults during the COVID-19 pandemic and to guide interventions for groups that are disproportionately affected.


Assuntos
Ansiedade/epidemiologia , Ansiedade/terapia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
4.
MMWR Morb Mortal Wkly Rep ; 70(13): 461-466, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33793461

RESUMO

Clinical preventive services play an important role in preventing deaths, and Healthy People 2020 has set national goals for using clinical preventive services to improve population health (1). The Patient Protection and Affordable Care Act (ACA) requires many health plans to cover certain recommended clinical preventive services without cost-sharing when provided in-network (covered clinical preventive services).* To ascertain prevalence of the use of selected recommended clinical preventive services among persons aged ≥18 years, CDC analyzed data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), a state-based annual nationwide survey conducted via landline and mobile phones in the United States, for 10 clinical preventive services covered in-network with no cost-sharing pursuant to the ACA. The weighted prevalence of colon, cervical, and breast cancer screening, pneumococcal and tetanus vaccination, and diabetes screening ranged from 66.0% to 79.2%; the prevalence of the other four clinical preventive services were <50%: 16.5% for human papillomavirus (HPV) vaccination, 26.6% for zoster (shingles) vaccination, 33.2% for influenza vaccination, and 45.8% for HIV testing. Prevalence of HIV testing had the widest variation (3.1-fold differences) across states among the 10 services included in this report. The prevalence of use of clinical preventive services varied by insurance status, income level, and rurality, findings that are consistent with previous studies (2-6). The use of nine of the 10 services examined was lower among the uninsured, those with lower income, and those living in rural communities. Among those factors examined, insurance status was the dominant factor strongly associated with use of clinical preventive services, followed by income-level and rurality. Understanding factors influencing use of recommended clinical preventive services can potentially help decision makers better identify policies to increase their use including strategies to increase insurance coverage.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Reforma dos Serviços de Saúde , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
5.
MMWR Morb Mortal Wkly Rep ; 70(13): 495-500, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33793460

RESUMO

Messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines have been shown to be effective in preventing symptomatic COVID-19 in randomized placebo-controlled Phase III trials (1,2); however, the benefits of these vaccines for preventing asymptomatic and symptomatic SARS-CoV-2 (the virus that causes COVID-19) infection, particularly when administered in real-world conditions, is less well understood. Using prospective cohorts of health care personnel, first responders, and other essential and frontline workers* in eight U.S. locations during December 14, 2020-March 13, 2021, CDC routinely tested for SARS-CoV-2 infections every week regardless of symptom status and at the onset of symptoms consistent with COVID-19-associated illness. Among 3,950 participants with no previous laboratory documentation of SARS-CoV-2 infection, 2,479 (62.8%) received both recommended mRNA doses and 477 (12.1%) received only one dose of mRNA vaccine.† Among unvaccinated participants, 1.38 SARS-CoV-2 infections were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) per 1,000 person-days.§ In contrast, among fully immunized (≥14 days after second dose) persons, 0.04 infections per 1,000 person-days were reported, and among partially immunized (≥14 days after first dose and before second dose) persons, 0.19 infections per 1,000 person-days were reported. Estimated mRNA vaccine effectiveness for prevention of infection, adjusted for study site, was 90% for full immunization and 80% for partial immunization. These findings indicate that authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection, regardless of symptom status, among working-age adults in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.


Assuntos
/imunologia , Socorristas , Pessoal de Saúde , Doenças Profissionais/prevenção & controle , Ocupações/classificação , Adolescente , Adulto , /administração & dosagem , Socorristas/estatística & dados numéricos , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estados Unidos/epidemiologia , Vacinas Sintéticas/imunologia , Adulto Jovem
6.
MMWR Morb Mortal Wkly Rep ; 70(13): 478-482, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33793462

RESUMO

SARS-CoV-2, the virus that causes COVID-19, can spread rapidly in prisons and can be introduced by staff members and newly transferred incarcerated persons (1,2). On September 28, 2020, the Wisconsin Department of Health Services (DHS) contacted CDC to report a COVID-19 outbreak in a state prison (prison A). During October 6-20, a CDC team investigated the outbreak, which began with 12 cases detected from specimens collected during August 17-24 from incarcerated persons housed within the same unit, 10 of whom were transferred together on August 13 and under quarantine following prison intake procedures (intake quarantine). Potentially exposed persons within the unit began a 14-day group quarantine on August 25. However, quarantine was not restarted after quarantined persons were potentially exposed to incarcerated persons with COVID-19 who were moved to the unit. During the subsequent 8 weeks (August 14-October 22), 869 (79.4%) of 1,095 incarcerated persons and 69 (22.6%) of 305 staff members at prison A received positive test results for SARS-CoV-2. Whole genome sequencing (WGS) of specimens from 172 cases among incarcerated persons showed that all clustered in the same lineage; this finding, along with others, demonstrated that facility spread originated with the transferred cohort. To effectively implement a cohorted quarantine, which is a harm reduction strategy for correctional settings with limited space, CDC's interim guidance recommendation is to serial test cohorts, restarting the 14-day quarantine period when a new case is identified (3). Implementing more effective intake quarantine procedures and available mitigation measures, including vaccination, among incarcerated persons is important to controlling transmission in prisons. Understanding and addressing the challenges faced by correctional facilities to implement medical isolation and quarantine can help reduce and prevent outbreaks.


Assuntos
/epidemiologia , Surtos de Doenças , Prisioneiros/estatística & dados numéricos , Prisões , /prevenção & controle , Humanos , Quarentena , Wisconsin/epidemiologia
7.
MMWR Morb Mortal Wkly Rep ; 70(13): 483-489, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33793463

RESUMO

Long-standing systemic social, economic, and environmental inequities in the United States have put many communities of color (racial and ethnic minority groups) at increased risk for exposure to and infection with SARS-CoV-2, the virus that causes COVID-19, as well as more severe COVID-19-related outcomes (1-3). Because race and ethnicity are missing for a proportion of reported COVID-19 cases, counties with substantial missing information often are excluded from analyses of disparities (4). Thus, as a complement to these case-based analyses, population-based studies can help direct public health interventions. Using data from the 50 states and the District of Columbia (DC), CDC identified counties where five racial and ethnic minority groups (Hispanic or Latino [Hispanic], non-Hispanic Black or African American [Black], non-Hispanic Asian [Asian], non-Hispanic American Indian or Alaska Native [AI/AN], and non-Hispanic Native Hawaiian or other Pacific Islander [NH/PI]) might have experienced high COVID-19 impact during April 1-December 22, 2020. These counties had high 2-week COVID-19 incidences (>100 new cases per 100,000 persons in the total population) and percentages of persons in five racial and ethnic groups that were larger than the national percentages (denoted as "large"). During April 1-14, a total of 359 (11.4%) of 3,142 U.S. counties reported high COVID-19 incidence, including 28.7% of counties with large percentages of Asian persons and 27.9% of counties with large percentages of Black persons. During August 5-18, high COVID-19 incidence was reported by 2,034 (64.7%) counties, including 92.4% of counties with large percentages of Black persons and 74.5% of counties with large percentages of Hispanic persons. During December 9-22, high COVID-19 incidence was reported by 3,114 (99.1%) counties, including >95% of those with large percentages of persons in each of the five racial and ethnic minority groups. The findings of this population-based analysis complement those of case-based analyses. In jurisdictions with substantial missing race and ethnicity information, this method could be applied to smaller geographic areas, to identify communities of color that might be experiencing high potential COVID-19 impact. As areas with high rates of new infection change over time, public health efforts can be tailored to the needs of communities of color as the pandemic evolves and integrated with longer-term plans to improve health equity.


Assuntos
/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , /etnologia , Monitoramento Epidemiológico , Disparidades nos Níveis de Saúde , Humanos , Incidência , Medição de Risco , Estados Unidos/epidemiologia
8.
BMJ ; 372: n608, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789843

RESUMO

OBJECTIVE: To investigate rates of adherence to the UK's test, trace, and isolate system over the initial 11 months of the covid-19 pandemic. DESIGN: Series of cross sectional online surveys. SETTING: 37 nationally representative surveys in the UK, 2 March 2020 to 27 January 2021. PARTICIPANTS: 74 697 responses from 53 880 people living in the UK, aged 16 years or older (37 survey waves, about 2000 participants in each wave). MAIN OUTCOME MEASURES: Identification of the main symptoms of covid-19 (cough, high temperature or fever, and loss of sense of smell or taste), self-reported adherence to self-isolation if symptoms were present and intention to self-isolate if symptoms were to develop, requesting a test for covid-19 if symptoms were present and intention to request a test if symptoms were to develop, and intention to share details of close contacts. RESULTS: Only 51.5% of participants (95% confidence interval 51.0% to 51.9%, n=26 030/50 570) identified the main symptoms of covid-19; the corresponding values in the most recent wave of data collection (25-27 January 2021) were 50.8% (48.6% to 53.0%, n=1019/2007). Across all waves, duration adjusted adherence to full self-isolation was 42.5% (95% confidence interval 39.7% to 45.2%, n=515/1213); in the most recent wave of data collection (25-27 January 2021), it was 51.8% (40.8% to 62.8%, n=43/83). Across all waves, requesting a test for covid-19 was 18.0% (95% confidence interval 16.6% to 19.3%, n=552/3068), increasing to 22.2% (14.6% to 29.9%, n=26/117) from 25 to 27 January. Across all waves, intention to share details of close contacts was 79.1% (95% confidence interval 78.8% to 79.5%, n=36 145/45 680), increasing to 81.9% (80.1% to 83.6%, n=1547/1890) from 25 to 27 January. Non-adherence was associated with being male, younger age, having a dependent child in the household, lower socioeconomic grade, greater financial hardship during the pandemic, and working in a key sector. CONCLUSIONS: Levels of adherence to test, trace, and isolate are low, although some improvement has occurred over time. Practical support and financial reimbursement are likely to improve adherence. Targeting messaging and policies to men, younger age groups, and key workers might also be necessary.


Assuntos
/estatística & dados numéricos , Busca de Comunicante/estatística & dados numéricos , Isolamento Social , Adulto , Idoso , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Inquéritos e Questionários , Reino Unido/epidemiologia
9.
BMJ Open ; 11(3): e044853, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789854

RESUMO

OBJECTIVES: One major goal of the emergency department (ED) is to decide, whether patients need to be hospitalised or can be sent home safely. We aim at providing criteria for these decisions without knowing the SARS-CoV-2 test result in suspected cases. SETTING: Tertiary emergency medicine. PARTICIPANTS: All patients were treated at the ED of the Charité during the pandemic peak and underwent SARS-CoV-2 testing. Patients with positive test results were characterised in detail and underwent a 14-day-follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES: Logistic regression and classification and regression tree (CART) analyses were performed to identify predictors (primary endpoint), which confirm safe discharge. The clinical endpoint was all-cause mortality or need for mechanical ventilation during index stay or after readmission. RESULTS: The primary test population of suspected COVID-19 consisted of n=1255 cases, 45.2% were women (n=567). Of these, n=110 tested positive for SARS-CoV-2 (8.8%). The median age of SARS-CoV-2-positive cases was 45 years (IQR: 33-66 years), whereas the median age of the group tested negative for SARS-CoV-2 was 42 years (IQR: 30-60 years) (p=0.096). 43.6% were directly admitted to hospital care.CART analysis identified the variables oxygen saturation (<95%), dyspnoea and history of cardiovascular (CV) disease to distinguish between high and low-risk groups. If all three variables were negative, most patients were discharged from ED, and the incidence of the clinical endpoint was 0%. The validation cohort confirmed the safety of discharge using these variables and revealed an incidence of the clinical endpoint from 14.3% in patients with CV disease, 9.4% in patients with dyspnoea and 18.2% in patients with O2 satuaration below 95%. CONCLUSIONS: Based on easily available variables like dyspnoea, oxygen saturation, history of CV disease, approximately 25% of patients subsequently confirmed with COVID-19 can be identified for safe discharge. TRIAL REGISTRATION NUMBER: DRKS00023117.


Assuntos
/epidemiologia , Tomada de Decisões , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adulto , Idoso , /terapia , /estatística & dados numéricos , Estudos de Coortes , Tosse/etiologia , Dispneia/etiologia , Serviço Hospitalar de Emergência/organização & administração , Feminino , Febre/etiologia , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Respiração Artificial/estatística & dados numéricos
10.
BMJ Open ; 11(3): e045427, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789856

RESUMO

OBJECTIVES: This study aimed to determine the lifetime prevalence of male-perpetrated intimate partner violence (IPV), and to assess the association with food insecurity, sociodemographic factors and health risk behaviours in Uganda in the year preceding COVID-19-associated lockdowns. DESIGN: Population-based, cross-sectional household survey. SETTING: Urban, semiurban and rural communities of the Wakiso and Hoima districts in Uganda. PARTICIPANTS: A total of N=2014 males aged 13-80 years participated in the survey. The current study included males who reported having ever been in a sexual union and responded to the IPV questions (N=1314). MEASURES: Data were collected face-to-face from May 2018 to July 2019 using an interviewer-mediated questionnaire. Lifetime IPV perpetration was measured as 'no physical and/or sexual IPV', 'physical' versus 'sexual violence only', and 'physical and sexual violence'. Past-year food insecurity was measured through the Food Insecurity Experience Scale and categorised into 'none', 'low' and 'high'. Multinomial logistic regression was used to determine the crude and adjusted relative risk ratios (aRRRs) of IPV perpetration in relation to self-reported food insecurity, adjusting for sociodemographic and health risk behaviours. RESULTS: The prevalence of self-reported lifetime IPV perpetration was 14.6% for physical and 6.5% for sexual violence, while 5.3% reported to have perpetrated both physical and sexual IPV. Most (75.7%) males reported no food insecurity, followed by low (20.7%) and high (3.6%) food insecurity. In adjusted models, food insecurity was associated with increased risk of having perpetrated both physical and sexual violence (aRRR=2.57, 95% CI 1.52 to 4.32). IPV perpetration was also independently associated with having had more than one lifetime sexual partner and drinking alcohol, but not with education level or religion. CONCLUSION: This study suggests that food insecurity is associated with male IPV perpetration, and more efforts are needed to prevent and mitigate the expected worsening of this situation as a result of the COVID-19 pandemic.


Assuntos
Violência por Parceiro Íntimo/estatística & dados numéricos , Parceiros Sexuais/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Humanos , Violência por Parceiro Íntimo/psicologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População Rural , Autorrelato , População Suburbana , Inquéritos e Questionários , Uganda/epidemiologia , População Urbana , Adulto Jovem
11.
BMJ ; 372: n693, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789877

RESUMO

OBJECTIVE: To quantify rates of organ specific dysfunction in individuals with covid-19 after discharge from hospital compared with a matched control group from the general population. DESIGN: Retrospective cohort study. SETTING: NHS hospitals in England. PARTICIPANTS: 47 780 individuals (mean age 65, 55% men) in hospital with covid-19 and discharged alive by 31 August 2020, exactly matched to controls from a pool of about 50 million people in England for personal and clinical characteristics from 10 years of electronic health records. MAIN OUTCOME MEASURES: Rates of hospital readmission (or any admission for controls), all cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 30 September 2020. Variations in rate ratios by age, sex, and ethnicity. RESULTS: Over a mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14 060 of 47 780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group. Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 years v 4.6 (4.3 to 4.8) for age ≥70, and 11.4 (9.8 to 13.3) for non-white v 5.2 (5.0 to 5.5) for white individuals). CONCLUSIONS: Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population. The increase in risk was not confined to the elderly and was not uniform across ethnicities. The diagnosis, treatment, and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches, and urgent research is needed to establish the risk factors.


Assuntos
/complicações , Hospitalização/estatística & dados numéricos , Insuficiência de Múltiplos Órgãos/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Adulto , Idoso , /mortalidade , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Diabetes Mellitus/epidemiologia , Inglaterra/epidemiologia , Grupos Étnicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Doenças Respiratórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , /isolamento & purificação
15.
Anticancer Res ; 41(4): 1903-1908, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813395

RESUMO

BACKGROUND/AIM: We employed a survey to the American Society of Plastic Surgeons (ASPS) to investigate the management of breast reconstruction across the US during the COVID-19 pandemic. PATIENTS AND METHODS: An electronic survey on breast reconstruction practice demographics, COVID-19-related restrictions on breast reconstruction, and pertinent dates of restrictions was employed. RESULTS: A total of 228 responses were obtained. Demographics were balanced for geography with most respondents located in either urban or suburban settings (91.2%). The majority proceeded with mastectomy/reconstruction as originally planned (39.0%), followed by hormonal/chemotherapy only (22.6%). The most common reconstructive option was tissue expander/implant-based reconstruction (47.7%). Most institutions implemented restrictions between March 11-20th (59%). Almost all respondents (91.8%) reported mandatory pre-operative SARS-Cov-2 testing once cases resumed. CONCLUSION: COVID-19 has forced the breast surgical team to adapt to new conditions to the detriment of women with breast cancer requiring reconstruction. Varying restrictions have limited access to breast reconstruction, carrying consequences yet to be determined.


Assuntos
/epidemiologia , Mamoplastia/estatística & dados numéricos , Mastectomia/estatística & dados numéricos , Pandemias , Padrões de Prática Médica/estatística & dados numéricos , Implantes de Mama/estatística & dados numéricos , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Estudos Transversais , Feminino , Humanos , Controle de Infecções/normas , Quarentena , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários , Dispositivos para Expansão de Tecidos/estatística & dados numéricos , Estados Unidos/epidemiologia
16.
Anticancer Res ; 41(4): 2193-2195, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813433

RESUMO

BACKGROUND/AIM: Since January 2020, coronavirus disease (COVID-19) cases have been confirmed in Japan, and the number of patients with COVID-19 has been increasing. Two emergency declarations have been made previously and one is currently in effect. Based on our experience of a situation that could affect cancer treatment, this study retrospectively examined the correlation between perioperative anticancer therapy and COVID-19 incidence in patients with breast cancer. PATIENTS AND METHODS: Patients who underwent perioperative anticancer therapy for breast cancer at our hospital from February 2020 to February 2021 were included in this study. The presence or absence of COVID-19, timing of anticancer drug initiation, and clinical data were collected. RESULTS: No cases of COVID-19 were diagnosed in patients receiving perioperative anticancer therapy at our hospital. CONCLUSION: Regimen modification, active use of supportive care, and patient lifestyle were factors reducing the incidence of COVID-19.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias da Mama , Assistência Perioperatória/métodos , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante/estatística & dados numéricos , Terapia Combinada , Feminino , Humanos , Hospedeiro Imunocomprometido , Incidência , Japão/epidemiologia , Pessoa de Meia-Idade , Terapia Neoadjuvante/estatística & dados numéricos , Assistência Perioperatória/efeitos adversos , Assistência Perioperatória/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , /fisiologia
17.
Natl Vital Stat Rep ; 70(2): 1-51, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33814033

RESUMO

Objectives-This report presents 2019 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods-Descriptive tabulations of data reported on the birth certificates of the 3.75 million births that occurred in 2019 are presented. Data are presented for maternal age, livebirth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age are also shown. Trend data for 2010 through 2019 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2019. Results-A total of 3,747,540 births were registered in the United States in 2019, down 1% from 2018. The general fertility rate declined from 2018 to 58.3 births per 1,000 women aged 15-44 in 2019. The birth rate for females aged 15-19 fell 4% between 2018 and 2019. Birth rates declined for women aged 20-34 and increased for women aged 35-44 for 2018-2019. The total fertility rate declined to 1,706.0 births per 1,000 women in 2019. Birth rates declined for both married and unmarried women from 2018 to 2019. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.6% in 2019; the percentage of all women who smoked during pregnancy declined to 6.0%. The cesarean delivery rate decreased to 31.7% in 2019 (Figure 1). Medicaid was the source of payment for 42.1% of all births in 2019. The preterm birth rate rose for the fifth straight year to 10.23% in 2019; the rate of low birthweight was essentially unchanged from 2018 at 8.31%. Twin and triplet and higher-order multiple birth rates both declined in 2019 compared with 2018.


Assuntos
Coeficiente de Natalidade/tendências , Adolescente , Adulto , Declaração de Nascimento , Ordem de Nascimento , Coeficiente de Natalidade/etnologia , Peso ao Nascer , Grupos de Populações Continentais/estatística & dados numéricos , Parto Obstétrico/economia , Parto Obstétrico/métodos , Feminino , Idade Gestacional , Hispano-Americanos/estatística & dados numéricos , Humanos , Recém-Nascido , Masculino , Estado Civil/etnologia , Estado Civil/estatística & dados numéricos , Idade Materna , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Uso de Tabaco/epidemiologia , Uso de Tabaco/etnologia , Estados Unidos/epidemiologia , Adulto Jovem
18.
Natl Vital Stat Rep ; 70(1): 1-18, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33814036

RESUMO

Objectives-This report presents complete period life tables for each of the 50 states and the District of Columbia by sex based on age-specific death rates in 2018. Methods-Data used to prepare the 2018 state-specific life tables include 2018 final mortality statistics; July 1, 2018 population estimates based on the 2010 decennial census; and 2018 Medicare data for persons aged 66-99. The methodology used to estimate the state-specific life tables is the same as that used to estimate the 2018 national life tables, with some modifications. Results-Among the 50 states and the District of Columbia, Hawaii had the highest life expectancy at birth, 81.0 years in 2018, and West Virginia had the lowest, 74.4 years. Life expectancy at age 65 ranged from 17.5 years in Kentucky to 21.1 years in Hawaii. Life expectancy at birth was higher for females in all states and the District of Columbia. The difference in life expectancy between females and males ranged from 3.8 years in Utah to 6.2 years in New Mexico.


Assuntos
Expectativa de Vida/tendências , Tábuas de Vida , Mortalidade/tendências , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Grupos Étnicos/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Expectativa de Vida/etnologia , Masculino , Pessoa de Meia-Idade , Mortalidade/etnologia , Distribuição por Sexo , Estados Unidos/epidemiologia , Adulto Jovem
19.
Epidemiol Psychiatr Sci ; 30: e28, 2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33820580

RESUMO

AIMS: Antipsychotics are primarily labelled for the treatment of severe mental illness and have documented clinical utility in certain neurological disorders or palliative care. However, off-label use of antipsychotics is common and increasing, and prior studies on antipsychotic utilisation have not specifically assessed users in neurology, palliative care or general practice. We aimed to explore diagnoses associated with antipsychotic use, treatment patterns and characteristics of users without diagnoses relevant to antipsychotic treatment. METHODS: Population-based study identifiying all users of antipsychotics in Denmark (pop 5.7 mio.) 1997-2018 in the Danish National Prescription Register (DNPR). Possible indications for antipsychotic therapy were evaluated using in- and outpatient contacts from the DNPR. Users were divided hierarchically into six groups: severe mental disorders (schizophrenia, bipolar-spectrum disorders), chronic mental disorders (dementias, mental retardation, autism), other mental disorders (depression-spectrum, anxiety and personality disorders, etc.), selected neurological diseases, cancer and antipsychotic users without any of these diagnoses. This last group was characterised regarding demographics, antipsychotic use, health care utilisation and likely antipsychotic treatment initiator in 2018. RESULTS: Altogether, 630 307 antipsychotic users were identified, of whom 127 649 had filled prescriptions during 2018. Users without diagnoses relevant to antipsychotic treatment comprised of the largest group (37%), followed by schizophrenia and bipolar-spectrum disorders (34%), other mental disorders (15%), dementia, autism and mental retardation (11%), cancer (2.2%) and neurological diagnoses (2.0%). Of 37 478 incident users in 2018, 39% had no diagnosis relevant to antipsychotic treatment, 7.9% had major depression, 7.7% neurotic/stress-related disorders and 7.5% dementia. Quetiapine was most commonly used, both overall (51%) and among users without diagnoses relevant to antipsychotic treatment (58%). Of 14 474 incident users in 2018 without diagnoses relevant to antipsychotic treatment, treatment was most likely initiated by a general practitioner (65%), with only 17% seeing a psychiatrist during the following year. As many as 18% of patients with adjustment disorders and 14% of those without relevant diagnoses for antipsychotic use, remained on antipsychotic treatment 5 years after their first prescription. CONCLUSIONS: Over one-third of antipsychotic users in Denmark did not have psychiatric, neurological or cancer diagnoses as possible indications for antipsychotic therapy. Many antipsychotics are initiated or prescribed in general practice, and a concerningly large subgroup without documented diagnoses relevant for antipsychotics continued to receive them. Rational prescribing, adequate side effect monitoring and further research into reasons for the observed antipsychotic use patterns and their risk-benefit ratio are needed.


Assuntos
Antipsicóticos , Uso de Medicamentos , Transtornos Mentais , Uso Off-Label , Antipsicóticos/uso terapêutico , Dinamarca/epidemiologia , Uso de Medicamentos/estatística & dados numéricos , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Uso Off-Label/estatística & dados numéricos
20.
s.l; Organización Panamericana de la Salud; abr. 6, 2021. 31 p.
Não convencional em Espanhol | LILACS | ID: biblio-1152192

RESUMO

A la fecha, se reportan 4.329 pacientes (1,2%) en aislamiento domiciliario, 493 pacientes (0,1%) se encuentran hospitalizados (430 en sala general y 63 en Unidades de Cuidado Intensivo -UCI). Se informan 345.120 (96,9%) casos como recuperados


Assuntos
Humanos , Masculino , Feminino , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Panamá/epidemiologia
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