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1.
Nutrients ; 13(8)2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34444903

RESUMO

Relatively little progress has been made in reducing anemia prevalence among women of reproductive age (WRA anemia). Interventions, policies and programs aimed at reducing WRA anemia have the potential to improve overall not only women's, but also children's health and nutrition outcomes. To our knowledge, this is the first review that aimed to compile evidence on the determinants and drivers of WRA anemia reduction in low- and middle-income countries (LMICs). We synthesized the available evidence on the determinants and drivers, including government policies and programs, of WRA anemia and their mitigation strategies across a wide range of countries and geographies, thus contributing to the complex and multifactorial etiology of anemia. We carried out a systematic review of published peer-reviewed and grey literature assessing national or subnational decline in WRA anemia prevalence and the associated drivers in LMICs. Among the 21 studies meeting our inclusion criteria, proximal determinants of healthcare utilization, especially during pregnancy and with the use of contraceptives, were strong drivers of WRA anemia reduction. Changes in other maternal characteristics, such as an increase in age at first pregnancy, BMI, birth spacing, and reduction in parity, were associated with modest improvements in anemia prevalence. Access to fortified foods, especially iron-fortified flour, was also a predictor of a decrease in WRA anemia. Of the intermediate determinants, an increase in household wealth, educational attainment and access to improved sanitation contributed significantly to WRA anemia reduction. Although several common determinants emerged at the proximal and intermediate levels, the set of anemia determinants and the strength of the association between each driver and WRA anemia reduction were unique in each setting included in this review. Further research is needed to provide targeted recommendations for each country and region where WRA anemia prevalence remains high.


Assuntos
Anemia/epidemiologia , Anemia/prevenção & controle , Promoção da Saúde/tendências , Saúde Reprodutiva/tendências , Saúde da Mulher/tendências , Adolescente , Adulto , Países em Desenvolvimento , Feminino , Abastecimento de Alimentos , Carga Global da Doença , Acesso aos Serviços de Saúde/tendências , Humanos , Pessoa de Meia-Idade , Prevalência , Serviços de Saúde Reprodutiva/tendências , Determinantes Sociais da Saúde , Adulto Jovem
2.
J Forensic Nurs ; 17(2): 93-97, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34432402

RESUMO

INTRODUCTION: Despite a global focus on intimate partner violence during the COVID-19 pandemic, there has been little exploration into how the pandemic and its associated restrictions have impacted sexual assault survivors and their ability to access specialized care and resources. The purpose of this research brief is to use longitudinal data to compare the number of medical forensic examinations done seasonally prepandemic and during the COVID-19 pandemic shelter-in-place order. METHODS: This analysis uses retrospective data on medical forensic examinations from January 2010 through November 2020 from one large academic Midwestern hospital. RESULTS: Results show that monthly medical forensic examinations have increased over time, from a mean of 4.5 cases per month (range: 1-9) in 2010 to a mean of 9 cases per month (range: 7-11) in 2019. In April 2020, when COVID-19-related shutdowns were at their first peak, cases dropped to a historic low of 0 examinations (the lowest number of cases in the past 10 years). CONCLUSIONS: The data show an initial drop in the number of survivors seeking postassault care after the COVID shutdown; however, cases rebounded through the second full month of shutdown orders. Programs that provide medical forensic examinations need to be prepared for subsequent waves of survivors, who may be COVID-19 positive. We must be better prepared for many of the adverse consequences impacting individuals around the country related to COVID-19 responses.


Assuntos
COVID-19/epidemiologia , Vítimas de Crime , Acesso aos Serviços de Saúde/tendências , Exame Físico/tendências , Delitos Sexuais , Sobreviventes , Humanos , Michigan/epidemiologia , Estudos Retrospectivos , SARS-CoV-2
3.
JAMA ; 326(7): 637-648, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34402830

RESUMO

Importance: The elimination of racial and ethnic differences in health status and health care access is a US goal, but it is unclear whether the country has made progress over the last 2 decades. Objective: To determine 20-year trends in the racial and ethnic differences in self-reported measures of health status and health care access and affordability among adults in the US. Design, Setting, and Participants: Serial cross-sectional study of National Health Interview Survey data, 1999-2018, that included 596 355 adults. Exposures: Self-reported race, ethnicity, and income level. Main Outcomes and Measures: Rates and racial and ethnic differences in self-reported health status and health care access and affordability. Results: The study included 596 355 adults (mean [SE] age, 46.2 [0.07] years, 51.8% [SE, 0.10] women), of whom 4.7% were Asian, 11.8% were Black, 13.8% were Latino/Hispanic, and 69.7% were White. The estimated percentages of people with low income were 28.2%, 46.1%, 51.5%, and 23.9% among Asian, Black, Latino/Hispanic, and White individuals, respectively. Black individuals with low income had the highest estimated prevalence of poor or fair health status (29.1% [95% CI, 26.5%-31.7%] in 1999 and 24.9% [95% CI, 21.8%-28.3%] in 2018), while White individuals with middle and high income had the lowest (6.4% [95% CI, 5.9%-6.8%] in 1999 and 6.3% [95% CI, 5.8%-6.7%] in 2018). Black individuals had a significantly higher estimated prevalence of poor or fair health status than White individuals in 1999, regardless of income strata (P < .001 for the overall and low-income groups; P = .03 for middle and high-income group). From 1999 to 2018, racial and ethnic gaps in poor or fair health status did not change significantly, with or without income stratification, except for a significant decrease in the difference between White and Black individuals with low income (-6.7 percentage points [95% CI, -11.3 to -2.0]; P = .005); the difference in 2018 was no longer statistically significant (P = .13). Black and White individuals had the highest levels of self-reported functional limitations, which increased significantly among all groups over time. There were significant reductions in the racial and ethnic differences in some self-reported measures of health care access, but not affordability, with and without income stratification. Conclusions and Relevance: In a serial cross-sectional survey study of US adults from 1999 to 2018, racial and ethnic differences in self-reported health status, access, and affordability improved in some subgroups, but largely persisted.


Assuntos
Atenção à Saúde/etnologia , Acesso aos Serviços de Saúde/tendências , Nível de Saúde , Disparidades em Assistência à Saúde/tendências , Adolescente , Adulto , Idoso , Custos e Análise de Custo , Estudos Transversais , Atenção à Saúde/tendências , Feminino , Disparidades nos Níveis de Saúde , Inquéritos Epidemiológicos , Disparidades em Assistência à Saúde/etnologia , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
5.
Viruses ; 13(7)2021 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-34372569

RESUMO

There is a high incidence and prevalence of hepatitis C viral infection in persons with or without substance use disorders (SUDs) in the Middle East and North Africa (MENA) region, but only a small number receive comprehensive care. Highly effective direct-acting antiviral (DAA) medications are available at substantially lower costs; however, complete elimination of the hepatitis C virus (HCV) can only be achieved if integrated care strategies target those at highest risk for HCV infection and transmission and improve access to care. Due to the high prevalence of SUD in the MENA region, strategies to eliminate HCV must focus on integrated healthcare across multiple subspecialties, including addiction medicine, psychiatry, infectious diseases, hepatology, and social work. In this invited manuscript, we review the epidemiology of HCV in the MENA region and highlight intervention strategies to attain the WHO's goal of HCV eradication by 2030.


Assuntos
Intervenção Médica Precoce/métodos , Hepatite C/psicologia , Abuso de Substâncias por Via Intravenosa/virologia , África do Norte/epidemiologia , Usuários de Drogas/psicologia , Acesso aos Serviços de Saúde/tendências , Hepacivirus/patogenicidade , Hepatite C/tratamento farmacológico , Hepatite C/virologia , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/psicologia , Hepatite C Crônica/virologia , Humanos , Incidência , Oriente Médio/epidemiologia , Prevalência , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/complicações
7.
Arch. argent. pediatr ; 119(4): 266-270, agosto 2021. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1280929

RESUMO

Objetivo. Describir el impacto de la pandemia por COVID-19 en el programa de cirugía cardiovascular pediátrica y estimar el tiempo para reducir la lista de espera quirúrgica. Métodos. Estudio descriptivo y retrospectivo. Se compararon resultados quirúrgicos del período preCOVID versus el período COVID. Se utilizó un modelo matemático para estimar el tiempo para reducir la lista de espera. Resultados. Entre el 23 de marzo y el 31 de agosto de 2020 se operaron 83 pacientes, que representan una reducción del 60 %, respecto al período preCOVID. La mediana de edad fue de 6 meses (rango intercuartílico [RIC]: 25-75, 1,8 meses a 2,9 años; p = 0,0023. El tiempo para eliminar la lista de espera varía entre 10 y 19 meses. Conclusiones. El programa tuvo una reducción del 60 %. El tiempo de resolución de la lista de espera puede ser al menos 10 a 19 meses


Objective. To describe the impact of the COVID-19 pandemic on a pediatric cardiovascular surgery program and estimate the necessary time to reduce the surgery waiting list. Methods. Retrospective, descriptive study. Surgical outcomes from the pre-COVID-19 period and COVID-19 period were compared. A mathematical model was used to estimate the time necessary to reduce the waiting list. Results. Between March 23rd and August 31st, 2020, 83 patients underwent surgery, accounting for a 60 % reduction compared to the pre-COVID-19 period. Their median age was 6 months (interquartile range [IQR]: 25-75, 1.8 months to 2.9 years; p = 0.0023). The time necessary to eliminate the waiting list ranges from 10 to 19 months. Conclusions. There was a 60 % reduction in the program. The time required to clear the backlog of cases may range from, at least, 10 to 19 month


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Procedimentos Cirúrgicos Cardiovasculares/tendências , Listas de Espera , Tempo para o Tratamento/tendências , Acesso aos Serviços de Saúde/tendências , Hospitais Públicos/tendências , Argentina/epidemiologia , Estudos Retrospectivos , Pandemias , COVID-19/prevenção & controle , COVID-19/epidemiologia , Modelos Teóricos
8.
Arch. argent. pediatr ; 119(4): 224-229, agosto 2021. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1280889

RESUMO

Introducción. La apendicitis constituye la principal causa de abdomen agudo quirúrgico en pediatría. Durante la pandemia por COVID-19, se replantearon las estrategias de manejo ydisminuyeron las consultas en las guardias, lo que podría asociarse a diagnósticos tardíos y complicaciones. El objetivo de este estudio fue analizar el impacto de la pandemia en los niños con apendicitis aguda. Métodos. Estudio analítico retrospectivocomparativo de pacientes pediátricos conapendicitis aguda durante los cinco meses del confinamiento por COVID-19 versus los meses equivalentes del año previo. Se analizaron la incidencia, la clínica, el estadio, el abordajequirúrgico y las complicaciones. Resultados. Los casos totales de apendicitisse redujeron un 25 % (n = 67 versus n = 50 en 2020). El tiempo medio hasta la consulta fue de 24 horas en ambos períodos (p = 0,989). La incidencia de peritonitis fue del 44 % (n = 22) versus el 37 % (n = 22) (p = 0,22) en 2019. No se evidenció diferencia en los estadios deenfermedad de acuerdo con lo informado en los partes quirúrgicos. En 2019, todas las cirugías se realizaron por vía laparoscópica; en 2020, solo un42 % (n = 21). La incidencia de complicaciones fue del 6 %, contra 7,5 % en el período previo (p = 0,75). Un paciente fue COVID-19 positivo. Conclusión. A pesar de la reducción en el númerode casos de apendicitis, no se evidenció una demora en la consulta en nuestra población. El mayor impacto se asoció a la readecuación del manejo, evitando el abordaje laparoscópico para reducir la diseminación del virus.


Introduction. Appendicitis is the leading cause of surgical acute abdomen in pediatrics. During the COVID-19 pandemic, management strategies were reassessed and the number of visits to the emergency department dropped down, which may be associated with delayed diagnoses and complications. The objective of this study was to analyze the impact of the pandemic on children with acute appendicitis. Methods. Analytical, retrospective, comparative study of pediatric patients with acute appendicitis in the 5 months of COVID-19 lockdown versus the same period in the previous year. Incidence, clinical data, stage, surgical approach, and complications were analyzed. Results. The total number of appendicitis cases went down by 25 % (n = 67 versus n = 50 in 2020). The mean time to consultation was 24 hours in both periods (p = 0.989). The incidence of peritonitis was 44 % (n = 22) versus 37 % (n = 22) (p = 0.22) in 2019. No differences were  observed in terms of appendicitis stage based on surgery reports. In 2019, all surgeries were laparoscopic; while in 2020, only 42 % (n = 21). The incidence of complications was 6 % versus 7.5 % in the previous period (p = 0.75). One patient was COVID-19 positive. Conclusion. Although in our population the number of appendicitis cases dropped down, consultation was not delayed. The greater impact was associated with the reformulation of management strategies, in which the laparoscopic approach is avoided to reduce virus transmission.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Apendicectomia/tendências , Apendicite/cirurgia , Apendicite/diagnóstico , Apendicite/epidemiologia , Padrões de Prática Médica/tendências , Diagnóstico Tardio/tendências , COVID-19/prevenção & controle , Acesso aos Serviços de Saúde/tendências , Apendicectomia/métodos , Argentina/epidemiologia , Doença Aguda , Incidência , Estudos Retrospectivos , Laparoscopia/tendências , Pandemias/prevenção & controle , Centros de Atenção Terciária , COVID-19/diagnóstico , COVID-19/epidemiologia , Hospitais Gerais
9.
Arch Argent Pediatr ; 119(4): 224-229, 2021 08.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34309297

RESUMO

INTRODUCTION: Appendicitis is the leading cause of surgical acute abdomen in pediatrics. During the COVID-19 pandemic, management strategies were reassessed and the number of visits to the emergency department dropped down, which may be associated with delayed diagnoses and complications. The objective of this study was to analyze the impact of the pandemic on children with acute appendicitis. METHODS: Analytical, retrospective, comparative study of pediatric patients with acute appendicitis in the 5 months of COVID-19 lockdown versus the same period in the previous year. Incidence, clinical data, stage, surgical approach, and complications were analyzed. RESULTS: The total number of appendicitis cases went down by 25% (n = 67 versus n = 50 in 2020). The mean time to consultation was 24 hours in both periods (p = 0.989). The incidence of peritonitis was 44% (n = 22) versus 37% (n = 22) (p = 0.22) in 2019. No differences were observed in terms of appendicitis stage based on surgery reports. In 2019, all surgeries were laparoscopic; while in 2020, only 42% (n = 21). The incidence of complications was 6% versus 7.5% in the previous period (p = 0.75). One patient was COVID-19 positive. CONCLUSION: Although in our population the number of appendicitis cases dropped down, consultation was not delayed. The greater impact was associated with the reformulation of management strategies, in which the laparoscopic approach is avoided to reduce virus transmission.


Assuntos
Apendicectomia/tendências , Apendicite , COVID-19/prevenção & controle , Diagnóstico Tardio/tendências , Acesso aos Serviços de Saúde/tendências , Padrões de Prática Médica/tendências , Doença Aguda , Adolescente , Apendicectomia/métodos , Apendicite/diagnóstico , Apendicite/epidemiologia , Apendicite/cirurgia , Argentina/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , Criança , Pré-Escolar , Feminino , Hospitais Gerais , Humanos , Incidência , Lactente , Recém-Nascido , Laparoscopia/tendências , Masculino , Pandemias/prevenção & controle , Estudos Retrospectivos , Centros de Atenção Terciária
10.
Arch Argent Pediatr ; 119(4): 266-269, 2021 08.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34309303

RESUMO

OBJECTIVE: To describe the impact of the COVID-19 pandemic on a pediatric cardiovascular surgery program and estimate the necessary time to reduce the surgery waiting list. METHODS: Retrospective, descriptive study. Surgical outcomes from the pre-COVID-19 period and COVID-19 period were compared. A mathematical model was used to estimate the time necessary to reduce the waiting list. RESULTS: Between March 23rd and August 31st, 2020, 83 patients underwent surgery, accounting for a 60 % reduction compared to the pre-COVID-19 period. Their median age was 6 months (interquartile range [IQR]: 25-75, 1.8 months to 2.9 years; p = 0.0023). The time necessary to eliminate the waiting list ranges from 10 to 19 months. CONCLUSIONS: There was a 60 % reduction in the program. The time required to clear the backlog of cases may range from, at least, 10 to 19 months.


Assuntos
COVID-19 , Procedimentos Cirúrgicos Cardiovasculares/tendências , Acesso aos Serviços de Saúde/tendências , Hospitais Públicos/tendências , Tempo para o Tratamento/tendências , Listas de Espera , Argentina/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Pré-Escolar , Humanos , Lactente , Modelos Teóricos , Pandemias , Estudos Retrospectivos
11.
Immunity ; 54(7): 1353-1362, 2021 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-34260880

RESUMO

Development COVID-19 vaccines in a record time has been an unprecedented global scientific achievement. However, the world has failed to ensure equitable access to what should have been a global public good. What options remain available to African countries to ensure immunization of their populations and ultimately overcome the pandemic?


Assuntos
Vacinas contra COVID-19/provisão & distribuição , Acesso aos Serviços de Saúde/estatística & dados numéricos , SARS-CoV-2/imunologia , África/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/classificação , Saúde Global , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/tendências , Humanos , Vacinação/estatística & dados numéricos , Vacinação/tendências
12.
BMC Fam Pract ; 22(1): 140, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210271

RESUMO

BACKGROUND: Health services internationally have been compelled to change their methods of service delivery in response to the global COVID-19 pandemic, to mitigate the spread of infection amongst health professionals and patients. In Aotearoa/New Zealand, widespread electronic delivery of prescriptions (e-prescribing) was enabled. The aim of the research was to explore patients' experiences of how lockdown, changes to prescribing and the interface between general practices and community pharmacy affected access to prescription medications. METHOD: The research employed a mixed-method approach. This included an online survey (n = 1,010) and in-depth interviews with a subset of survey respondents (n = 38) during the first COVID-19 lockdown (March-May 2020). Respondents were recruited through a snowballing approach, starting with social media and email list contacts of the research team. In keeping with the approach, descriptive statistics of survey data and thematic analysis of qualitative interview and open-ended questions in survey data were combined. RESULTS: For most respondents who received a prescription during lockdown, this was sent directly to the pharmacy. Most people picked up their medication from the pharmacy; home delivery of medication was rare (4%). Survey and interview respondents wanted e-prescribing to continue post-lockdown and described where things worked well and where they encountered delays in the process of acquiring prescription medication. CONCLUSIONS: E-prescribing has the potential to improve access to prescription medication and is convenient for patients. The increase in e-prescribing during lockdown highlighted how the system could be improved, through better feedback about errors, more consistency across practices and pharmacies, more proactive communication with patients, and equitable prescribing costs.


Assuntos
COVID-19 , Atenção à Saúde , Prescrição Eletrônica , Medicina Geral , Acesso aos Serviços de Saúde , Preferência do Paciente/estatística & dados numéricos , Atitude do Pessoal de Saúde , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Serviços Comunitários de Farmácia/normas , Serviços Comunitários de Farmácia/estatística & dados numéricos , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Prescrição Eletrônica/economia , Prescrição Eletrônica/normas , Prescrição Eletrônica/estatística & dados numéricos , Feminino , Medicina Geral/métodos , Medicina Geral/tendências , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Melhoria de Qualidade , SARS-CoV-2 , Inquéritos e Questionários
13.
Am J Public Health ; 111(8): 1504-1512, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34185578

RESUMO

Objectives. To examine changes in abortions in Louisiana before and after the COVID-19 pandemic onset and assess whether variations in abortion service availability during this time might explain observed changes. Methods. We collected monthly service data from abortion clinics in Louisiana and neighboring states among Louisiana residents (January 2018‒May 2020) and assessed changes in abortions following pandemic onset. We conducted mystery client calls to 30 abortion clinics in Louisiana and neighboring states (April‒July 2020) and examined the percentage of open and scheduling clinics and median waits. Results. The number of abortions per month among Louisiana residents in Louisiana clinics decreased 31% (incidence rate ratio = 0.69; 95% confidence interval [CI] = 0.59, 0.79) from before to after pandemic onset, while the odds of having a second-trimester abortion increased (adjusted odds ratio [AOR] = 1.91; 95% CI = 1.10, 3.33). The decrease was not offset by an increase in out-of-state abortions. In Louisiana, only 1 or 2 (of 3) clinics were open (with a median wait > 2 weeks) through early May. Conclusions. The COVID-19 pandemic onset was associated with a significant decrease in the number of abortions and increase in the proportion of abortions provided in the second trimester among Louisiana residents. These changes followed service disruptions.


Assuntos
Aborto Legal/tendências , Instituições de Assistência Ambulatorial/tendências , COVID-19/epidemiologia , Acesso aos Serviços de Saúde/tendências , Adolescente , Adulto , Feminino , Humanos , Louisiana , Gravidez , Segundo Trimestre da Gravidez , Estados Unidos
14.
J Surg Oncol ; 124(3): 261-267, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34137039

RESUMO

OBJECTIVE: At the end of 1 year of the coronavirus disease (COVID-19) pandemic, we aimed to reveal the changes in breast cancer cases in the context of cause and effect based on the data of surgically treated patients in our institution. PATIENTS AND METHODS: Patients with breast cancer were divided into two groups. Group 1 consisted of patients who were operated in the year before the COVID-19 pandemic, and Group 2 consisted of patients who were operated within the first year of the pandemic. Tumor size, axillary lymph node positivity, distant organ metastasis status, neoadjuvant chemotherapy, and type of surgery performed were compared between the two groups. RESULTS: The tumor size, axillary lymph node positivity, and neoadjuvant chemotherapy were higher in Group 2 than in Group 1 (p = .005, p = .012, p = .042, respectively). In addition, the number of breast-conserving surgery + sentinel lymph node biopsy were lower, while the number of mastectomy and modified radical mastectomy were higher in Group 2 than in Group 1 (p = .034). CONCLUSION: Patients presented with larger breast tumors and increased axillary involvement during the pandemic. Moreover, distant organ metastases may increase in the future.


Assuntos
Neoplasias da Mama/diagnóstico , COVID-19 , Diagnóstico Tardio/tendências , Acesso aos Serviços de Saúde/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante , Feminino , Humanos , Excisão de Linfonodo/tendências , Metástase Linfática , Mastectomia/métodos , Mastectomia/tendências , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estudos Retrospectivos , Carga Tumoral , Turquia
15.
Prim Care Diabetes ; 15(4): 653-681, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34083122

RESUMO

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic crisis in health care systems worldwide. These may have significant implications for the management of cardiometabolic diseases. We conducted a systematic review of published evidence to assess the indirect impact of the COVID-19 pandemic on hospitalisations for cardiovascular diseases and their management. METHODS: Studies that evaluated volume of hospitalisations for cardiometabolic conditions and their management with comparisons between the COVID-19 and pre-COVID periods were identified from MEDLINE, Embase and the reference list of relevant studies from January 2020 to 25 February 2021. RESULTS: We identified 103 observational studies, with most studies assessing hospitalisations for acute cardiovascular conditions such as acute coronary syndrome, ischemic strokes and heart failure. About 89% of studies reported a decline in hospitalisations during the pandemic compared to pre-pandemic times, with reductions ranging from 20.2 to 73%. Severe presentation, less utilization of cardiovascular procedures, and longer patient- and healthcare-related delays were common during the pandemic. Most studies reported shorter length of hospital stay during the pandemic than before the pandemic (1-8 vs 2-12 days) or no difference in length of stay. Most studies reported no change in in-hospital mortality among hospitalised patients. CONCLUSION: Clinical care of patients for acute cardiovascular conditions, their management and outcomes have been adversely impacted by the COVID-19 pandemic. Patients should be educated via population-wide approaches on the need for timely medical contact and health systems should put strategies in place to provide timely care to patients at high risk. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2021: CRD42021236102.


Assuntos
COVID-19 , Doenças Cardiovasculares/terapia , Acesso aos Serviços de Saúde/tendências , Hospitalização/tendências , Doenças Metabólicas/terapia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Mortalidade Hospitalar/tendências , Humanos , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/mortalidade , Estudos Observacionais como Assunto , Prognóstico , Índice de Gravidade de Doença , Fatores de Tempo
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