Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.611
Filtrar
1.
J Int Med Res ; 48(8): 300060520938943, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32865095

RESUMO

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) began in December 2019 and continues to spread worldwide. Rapid and accurate identification of suspected cases is critical in slowing spread of the virus that causes the disease. We aimed to highlight discrepancies in the various criteria used by international agencies and highly impacted individual countries around the world. METHODS: We reviewed the criteria for identifying a suspected case of COVID-19 used by two international public health agencies and 10 countries across Asia, Europe, and North America. The criteria included information on the clinical causes of illness and epidemiological risk factors. Non-English language guidelines were translated into English by a co-author who is fluent in that particular language. RESULTS: Although most criteria are modifications of World Health Organization recommendations, the specific clinical features and epidemiological risks for triggering evaluation of patients with suspected COVID-19 differed widely among countries. The rationale for these differences may be related to each country's resources, politics, experience with previous outbreaks or pandemics, health insurance system, COVID-19 outbreak severity, and other undetermined factors. CONCLUSION: We found no consensus regarding the best diagnostic criteria for identifying a suspected case of COVID-19.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Regulamento Sanitário Internacional , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Saúde Pública/legislação & jurisprudência , Ásia/epidemiologia , Betacoronavirus , Centers for Disease Control and Prevention, U.S. , Europa (Continente)/epidemiologia , Humanos , Cooperação Internacional , América do Norte/epidemiologia , Pandemias , Estados Unidos , Organização Mundial da Saúde
2.
J Transl Med ; 18(1): 338, 2020 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-32878627

RESUMO

BACKGROUND: Severe acute respiratory syndrome CoV-2 (SARS-CoV-2) caused the first coronavirus disease 2019 (COVID-19) outbreak in China and has become a public health emergency of international concern. SARS-CoV-2 outbreak has been declared a pandemic by WHO on March 11th, 2020 and the same month several Countries put in place different lockdown restrictions and testing strategies in order to contain the spread of the virus. METHODS: The calculation of the Case Fatality Rate of SARS-CoV-2 in the Countries selected was made by using the data available at https://github.com/owid/covi-19-data/tree/master/public/data . Case fatality rate was calculated as the ratio between the death cases due to COVID-19, over the total number of SARS-CoV-2 reported cases 14 days before. Standard Case Fatality Rate values were normalized by the Country-specific ρ factor, i.e. the number of PCR tests/1 million inhabitants over the number of reported cases/1 million inhabitants. Case-fatality rates between Countries were compared using proportion test. Post-hoc analysis in the case of more than two groups was performed using pairwise comparison of proportions and p value was adjusted using Holm method. We also analyzed 487 genomic sequences from the GISAID database derived from patients infected by SARS-CoV-2 from January 2020 to April 2020 in Italy, Spain, Germany, France, Sweden, UK and USA. SARS-CoV-2 reference genome was obtained from the GenBank database (NC_045512.2). Genomes alignment was performed using Muscle and Jalview software. We, then, calculated the Case Fatality Rate of SARS-CoV-2 in the Countries selected. RESULTS: In this study we analyse how different lockdown strategies and PCR testing capability adopted by Italy, France, Germany, Spain, Sweden, UK and USA have influenced the Case Fatality Rate and the viral mutations spread. We calculated case fatality rates by dividing the death number of a specific day by the number of patients with confirmed COVID-19 infection observed 14 days before and normalized by a ρ factor which takes into account the diagnostic PCR testing capability of each Country and the number of positive cases detected. We notice the stabilization of a clear pattern of mutations at sites nt241, nt3037, nt14408 and nt23403. A novel nonsynonymous SARS-CoV-2 mutation in the spike protein (nt24368) has been found in genomes sequenced in Sweden, which enacted a soft lockdown strategy. CONCLUSIONS: Strict lockdown strategies together with a wide diagnostic PCR testing of the population were correlated with a relevant decline of the case fatality rate in different Countries. The emergence of specific patterns of mutations concomitant with the decline in case fatality rate needs further confirmation and their biological significance remains unclear.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Mutação/genética , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Europa (Continente)/epidemiologia , Genoma Viral , Geografia , Humanos , América do Norte/epidemiologia , Pandemias , Análise de Sequência de DNA
3.
J Popul Ther Clin Pharmacol ; 27(S Pt 1): e53-e57, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32757541

RESUMO

During the COVID-19 pandemic, most citizens in North America receive daily updates, which highlight the number of new cases per day in a specified region. However, as this data metric is often presented alone on media and news platforms, the spread of the novel coronavirus may often be misinterpreted. Among these daily updates which are critical to informing the public, the authors emphasize the importance of controlling for variation attributed to changes in surveillance. The number of test results that have been analyzed each day along with the total number of tests being conducted in a region have a significant impact on capturing virus spread and should always be included in widespread data. Presenting these variables may help to differentiate increases or decreases of new cases attributed to the expansion of surveillance and testing, or rather other environmental and behavioral factors. Overall, to best inform politicians, healthcare workers, and all citizens of the progress against COVID-19, there is a need to constantly improve analyses and reporting of data.


Assuntos
Técnicas de Laboratório Clínico , Infecções por Coronavirus/epidemiologia , Disseminação de Informação/métodos , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/diagnóstico , Humanos , América do Norte/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Vigilância da População/métodos
4.
PLoS Med ; 17(8): e1003182, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32810184

RESUMO

BACKGROUND: Fetal smoke exposure is a common and key avoidable risk factor for birth complications and seems to influence later risk of overweight. It is unclear whether this increased risk is also present if mothers smoke during the first trimester only or reduce the number of cigarettes during pregnancy, or when only fathers smoke. We aimed to assess the associations of parental smoking during pregnancy, specifically of quitting or reducing smoking and maternal and paternal smoking combined, with preterm birth, small size for gestational age, and childhood overweight. METHODS AND FINDINGS: We performed an individual participant data meta-analysis among 229,158 families from 28 pregnancy/birth cohorts from Europe and North America. All 28 cohorts had information on maternal smoking, and 16 also had information on paternal smoking. In total, 22 cohorts were population-based, with birth years ranging from 1991 to 2015. The mothers' median age was 30.0 years, and most mothers were medium or highly educated. We used multilevel binary logistic regression models adjusted for maternal and paternal sociodemographic and lifestyle-related characteristics. Compared with nonsmoking mothers, maternal first trimester smoking only was not associated with adverse birth outcomes but was associated with a higher risk of childhood overweight (odds ratio [OR] 1.17 [95% CI 1.02-1.35], P value = 0.030). Children from mothers who continued smoking during pregnancy had higher risks of preterm birth (OR 1.08 [95% CI 1.02-1.15], P value = 0.012), small size for gestational age (OR 2.15 [95% CI 2.07-2.23], P value < 0.001), and childhood overweight (OR 1.42 [95% CI 1.35-1.48], P value < 0.001). Mothers who reduced the number of cigarettes between the first and third trimester, without quitting, still had a higher risk of small size for gestational age. However, the corresponding risk estimates were smaller than for women who continued the same amount of cigarettes throughout pregnancy (OR 1.89 [95% CI 1.52-2.34] instead of OR 2.20 [95% CI 2.02-2.42] when reducing from 5-9 to ≤4 cigarettes/day; OR 2.79 [95% CI 2.39-3.25] and OR 1.93 [95% CI 1.46-2.57] instead of OR 2.95 [95% CI 2.75-3.15] when reducing from ≥10 to 5-9 and ≤4 cigarettes/day, respectively [P values < 0.001]). Reducing the number of cigarettes during pregnancy did not affect the risks of preterm birth and childhood overweight. Among nonsmoking mothers, paternal smoking was associated with childhood overweight (OR 1.21 [95% CI 1.16-1.27], P value < 0.001) but not with adverse birth outcomes. Limitations of this study include the self-report of parental smoking information and the possibility of residual confounding. As this study only included participants from Europe and North America, results need to be carefully interpreted regarding other populations. CONCLUSIONS: We observed that as compared to nonsmoking during pregnancy, quitting smoking in the first trimester is associated with the same risk of preterm birth and small size for gestational age, but with a higher risk of childhood overweight. Reducing the number of cigarettes, without quitting, has limited beneficial effects. Paternal smoking seems to be associated, independently of maternal smoking, with the risk of childhood overweight. Population strategies should focus on parental smoking prevention before or at the start, rather than during, pregnancy.


Assuntos
Pais , Obesidade Pediátrica/epidemiologia , Nascimento Prematuro/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Fumar/efeitos adversos , Fumar/epidemiologia , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , América do Norte/epidemiologia , Obesidade Pediátrica/diagnóstico , Gravidez , Nascimento Prematuro/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Fatores de Risco , Fumar/tendências
5.
PLoS One ; 15(8): e0237191, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32776959

RESUMO

The American dog tick, Dermacentor variabilis, is a veterinary- and medically- significant tick species that is known to transmit several diseases to animal and human hosts. The spatial distribution of this species in North America is not well understood, however; and knowledge of likely changes to its future geographic distribution owing to ongoing climate change is needed for proper public health planning and messaging. Two recent studies have evaluated these topics for D. variabilis; however, less-rigorous modeling approaches in those studies may have led to erroneous predictions. We evaluated the present and future distribution of this species using a correlative maximum entropy approach, using publicly available occurrence information. Future potential distributions were predicted under two representative concentration pathway (RCP) scenarios; RCP 4.5 for low-emissions and RCP 8.5 for high-emissions. Our results indicated a broader current distribution of this species in all directions relative to its currently known extent, and dramatic potential for westward and northward expansion of suitable areas under both climate change scenarios. Implications for disease ecology and public health are discussed.


Assuntos
Distribuição Animal/fisiologia , Dermacentor/fisiologia , Doenças do Cão/epidemiologia , Infestações por Carrapato/epidemiologia , Infestações por Carrapato/veterinária , Algoritmos , Animais , Mudança Climática , Cães , Ecossistema , Previsões , Humanos , Modelos Estatísticos , América do Norte/epidemiologia , Chuva , Temperatura
6.
J Bone Joint Surg Am ; 102(13): e70, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32618918

RESUMO

BACKGROUND: The detection of coronavirus disease 2019 (COVID-19) cases remains a huge challenge. As of April 22, 2020, the COVID-19 pandemic continues to take its toll, with >2.6 million confirmed infections and >183,000 deaths. Dire projections are surfacing almost every day, and policymakers worldwide are using projections for critical decisions. Given this background, we modeled unobserved infections to examine the extent to which we might be grossly underestimating COVID-19 infections in North America. METHODS: We developed a machine-learning model to uncover hidden patterns based on reported cases and to predict potential infections. First, our model relied on dimensionality reduction to identify parameters that were key to uncovering hidden patterns. Next, our predictive analysis used an unbiased hierarchical Bayesian estimator approach to infer past infections from current fatalities. RESULTS: Our analysis indicates that, when we assumed a 13-day lag time from infection to death, the United States, as of April 22, 2020, likely had at least 1.3 million undetected infections. With a longer lag time-for example, 23 days-there could have been at least 1.7 million undetected infections. Given these assumptions, the number of undetected infections in Canada could have ranged from 60,000 to 80,000. Duarte's elegant unbiased estimator approach suggested that, as of April 22, 2020, the United States had up to >1.6 million undetected infections and Canada had at least 60,000 to 86,000 undetected infections. However, the Johns Hopkins University Center for Systems Science and Engineering data feed on April 22, 2020, reported only 840,476 and 41,650 confirmed cases for the United States and Canada, respectively. CONCLUSIONS: We have identified 2 key findings: (1) as of April 22, 2020, the United States may have had 1.5 to 2.029 times the number of reported infections and Canada may have had 1.44 to 2.06 times the number of reported infections and (2) even if we assume that the fatality and growth rates in the unobservable population (undetected infections) are similar to those in the observable population (confirmed infections), the number of undetected infections may be within ranges similar to those described above. In summary, 2 different approaches indicated similar ranges of undetected infections in North America. LEVEL OF EVIDENCE: Prognostic Level V. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Infecções por Coronavirus/diagnóstico , Aprendizado de Máquina , Pandemias/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Teorema de Bayes , Betacoronavirus , Canadá/epidemiologia , Simulação por Computador , Infecções por Coronavirus/epidemiologia , Previsões , Humanos , América do Norte/epidemiologia , Pneumonia Viral/epidemiologia , Estados Unidos/epidemiologia
7.
Lancet Psychiatry ; 7(8): 692-702, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32711710

RESUMO

BACKGROUND: Many clinical trials have assessed treatments for depressive disorders and bipolar depression. However, whether, and which, assessed outcome domains really matter to patients, informal caregivers, and health-care professionals remains unclear. METHODS: We did an international online survey in French, German, and English. Participants were adult patients with a history of depression, informal caregivers, and health-care professionals, recruited by purposeful sampling. To identify outcome domains, participants answered four open-ended questions about their expectations for depression treatment. We disseminated the survey without restriction via social media, patient and professional associations, and a media campaign. Four researchers independently did qualitative content analyses. We assessed data saturation using mathematical models to ensure the comprehensive identification of outcome domains. FINDINGS: Between April 5, 2018, and Dec 10, 2018, 1912 patients, 464 informal caregivers, and 627 health-care professionals from 52 countries provided 8183 open-ended answers. We identified 80 outcome domains related to symptoms (64 domains), such as mental pain (or psychological or psychic pain, 523 [17%] of 3003 participants) and motivation (384 [13%]), and functioning (16 domains), such as social isolation (541 [18%]). We identified 57 other outcome domains regarding safety of treatment, health care organisation, and social representation, such as stigmatisation (408 [14%]). INTERPRETATION: This study provides a list of outcome domains important to patients, informal caregivers, and health-care professionals. Unfortunately, many of these domains are rarely measured in clinical trials. Results from this study should set the foundation for a core outcome set for depression. FUNDING: Fondation pour la Recherche Medicale and NIHR Oxford Health Biomedical Research Centre.


Assuntos
Cuidadores/psicologia , Depressão/psicologia , Pessoal de Saúde/psicologia , Motivação/fisiologia , Dor/psicologia , Isolamento Social/psicologia , Adulto , Áustria/epidemiologia , Depressão/diagnóstico , Depressão/terapia , Estudos de Avaliação como Assunto , Feminino , França/epidemiologia , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Desempenho Físico Funcional , Estereotipagem , Inquéritos e Questionários , Reino Unido/epidemiologia
8.
Lancet ; 396(10246): 239-254, 2020 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-32711800

RESUMO

BACKGROUND: Tenofovir alafenamide shows high antiviral efficacy and improved renal and bone safety compared with tenofovir disoproxil fumarate when used for HIV treatment. Here, we report primary results from a blinded phase 3 study evaluating the efficacy and safety of pre-exposure prophylaxis (PrEP) with emtricitabine and tenofovir alafenamide versus emtricitabine and tenofovir disoproxil fumarate for HIV prevention. METHODS: This study is an ongoing, randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial done at 94 community, public health, and hospital-associated clinics located in regions of Europe and North America, where there is a high incidence of HIV or prevalence of people living with HIV, or both. We enrolled adult cisgender men who have sex with men and transgender women who have sex with men, both with a high risk of acquiring HIV on the basis of their self-reported sexual behaviour in the past 12 weeks or their recent history (within 24 weeks of enrolment) of bacterial sexually transmitted infections. Participants with current or previous use of PrEP with emtricitabine and tenofovir disoproxil fumarate were not excluded. We used a computer-generated random allocation sequence to randomly assign (1:1) participants to receive either emtricitabine (200 mg) and tenofovir alafenamide (25 mg) tablets daily, with matched placebo tablets (emtricitabine and tenofovir alafenamide group), or emtricitabine (200 mg) and tenofovir disoproxil fumarate (300 mg) tablets daily, with matched placebo tablets (emtricitabine and tenofovir disoproxil fumarate group). As such, all participants were given two tablets. The trial sponsor, investigators, participants, and the study staff who provided the study drugs, assessed the outcomes, and collected the data were masked to group assignment. The primary efficacy outcome was incident HIV infection, which was assessed when all participants had completed 48 weeks of follow-up and half of all participants had completed 96 weeks of follow-up. This full analysis set included all randomly assigned participants who had received at least one dose of the assigned study drug and had at least one post-baseline HIV test. Non-inferiority of emtricitabine and tenofovir alafenamide to emtricitabine and tenofovir disoproxil fumarate was established if the upper bound of the 95·003% CI of the HIV incidence rate ratio (IRR) was less than the prespecified non-inferiority margin of 1·62. We prespecified six secondary bone mineral density and renal biomarker safety endpoints to evaluate using the safety analysis set. This analysis set included all randomly assigned participants who had received at least one dose of the assigned study drug. This trial is registered with ClinicalTrials.gov, NCT02842086, and is no longer recruiting. FINDINGS: Between Sept 13, 2016, and June 30, 2017, 5387 (92%) of 5857 participants were randomly assigned and received emtricitabine and tenofovir alafenamide (n=2694) or emtricitabine and tenofovir disoproxil fumarate (n=2693). At the time of the primary efficacy analysis (ie, when all participants had completed 48 weeks and 50% had completed 96 weeks) emtricitabine and tenofovir alafenamide was non-inferior to emtricitabine and tenofovir disoproxil fumarate for HIV prevention, as the upper limit of the 95% CI of the IRR, was less than the prespecified non-inferiority margin of 1·62 (IRR 0·47 [95% CI 0·19-1·15]). After 8756 person-years of follow-up, 22 participants were diagnosed with HIV, seven participants in the emtricitabine and tenofovir alafenamide group (0·16 infections per 100 person-years [95% CI 0·06-0·33]), and 15 participants in the emtricitabine and tenofovir disoproxil fumarate group (0·34 infections per 100 person-years [0·19-0·56]). Both regimens were well tolerated, with a low number of participants reporting adverse events that led to discontinuation of the study drug (36 [1%] of 2694 participants in the emtricitabine and tenofovir alafenamide group vs 49 [2%] of 2693 participants in the emtricitabine and tenofovir disoproxil fumarate group). Emtricitabine and tenofovir alafenamide was superior to emtricitabine and tenofovir disoproxil fumarate in all six prespecified bone mineral density and renal biomarker safety endpoints. INTERPRETATION: Daily emtricitabine and tenofovir alafenamide shows non-inferior efficacy to daily emtricitabine and tenofovir disoproxil fumarate for HIV prevention, and the number of adverse events for both regimens was low. Emtricitabine and tenofovir alafenamide had more favourable effects on bone mineral density and biomarkers of renal safety than emtricitabine and tenofovir disoproxil fumarate. FUNDING: Gilead Sciences.


Assuntos
Adenina/análogos & derivados , Fármacos Anti-HIV/uso terapêutico , Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila/uso terapêutico , Emtricitabina/uso terapêutico , Infecções por HIV/tratamento farmacológico , Tenofovir/uso terapêutico , Adenina/efeitos adversos , Adenina/uso terapêutico , Adulto , Fármacos Anti-HIV/efeitos adversos , Método Duplo-Cego , Emtricitabina/efeitos adversos , Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila/efeitos adversos , Europa (Continente)/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , HIV-1/efeitos dos fármacos , Homossexualidade Masculina/etnologia , Humanos , Masculino , América do Norte/epidemiologia , Placebos/administração & dosagem , Profilaxia Pré-Exposição/métodos , Prevalência , Segurança , Minorias Sexuais e de Gênero , Tenofovir/efeitos adversos , Resultado do Tratamento
11.
J Am Soc Echocardiogr ; 33(8): 1040-1047, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32600742

RESUMO

BACKGROUND: The COVID-19 pandemic has placed an extraordinary strain on healthcare systems across North America. Defining the optimal approach for managing a critically ill COVID-19 patient is rapidly changing. Goal-directed transesophageal echocardiography (TEE) is frequently used by physicians caring for intubated critically ill patients as a reliable imaging modality that is well suited to answer questions at bedside. METHODS: A multidisciplinary (intensive care, critical care cardiology, and emergency medicine) group of experts in point-of-care echocardiography and TEE from the United States and Canada convened to review the available evidence, share experiences, and produce a consensus statement aiming to provide clinicians with a framework to maximize the safety of patients and healthcare providers when considering focused point-of-care TEE in critically ill patients during the COVID-19 pandemic. RESULTS: Although transthoracic echocardiography can provide the information needed in most patients, there are specific scenarios in which TEE represents the modality of choice. TEE provides acute care clinicians with a goal-directed framework to guide clinical care and represents an ideal modality to evaluate hemodynamic instability during prone ventilation, perform serial evaluations of the lungs, support cardiac arrest resuscitation, and guide veno-venous ECMO cannulation. To aid other clinicians in performing TEE during the COVID-19 pandemic, we describe a set of principles and practical aspects for performing examinations with a focus on the logistics, personnel, and equipment required before, during, and after an examination. CONCLUSIONS: In the right clinical scenario, TEE is a tool that can provide the information needed to deliver the best and safest possible care for the critically ill patients.


Assuntos
Infecções por Coronavirus/epidemiologia , Cuidados Críticos/organização & administração , Infecção Hospitalar/prevenção & controle , Ecocardiografia Transesofagiana/métodos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Canadá/epidemiologia , Consenso , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Controle de Infecções/métodos , Masculino , América do Norte/epidemiologia , Pandemias/prevenção & controle , Posicionamento do Paciente , Pneumonia Viral/prevenção & controle , Sistemas Automatizados de Assistência Junto ao Leito , Medição de Risco , Gestão da Segurança
12.
Eur J Clin Invest ; 50(10): e13364, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32725884

RESUMO

BACKGROUND: COVID-19 is currently the most urgent threat to public health in the world. The aim of this study is to provide an overview of the first cases of COVID-19 to make further improvements in health policies and prevention measurements in response to the outbreak of COVID-19. METHODS: We performed a search in PubMed, the CNKI (China National Knowledge Infrastructure), Web of Science and the WHO database of publications on COVID-19 for peer-reviewed papers from 1 December 2019 to 9 July 2020. We analysed the demographics, epidemiological characteristics, clinical features, signs and symptoms of the disease at the onset. RESULTS: We identified the first cases of COVID-19 in 16 different countries/regions from Asia, Europe, North America and South America. Of these 16 cases, 8 (50.0%) were male, with a mean of age 43.38 ± 15.19 years. All the cases had a history of travel or exposure. Twelve cases (75.0%) occurred in January, eight patients were Chinese, two patients were international students in Wuhan, one patient had a history of travelling in Wuhan, and one patient was in contact with Chinese patient. The longest hospital stay was 24 days (1 patient), and the shortest was 5 days (1 patient). The usual hospital stay was 9 days (4 patients). CONCLUSION: Understanding the epidemiological characteristics, clinical characteristics, and diagnosis and treatment of the first patients in various countries are of great significance for the identification, prevention and control of COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Tempo de Internação/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Viagem , Adulto , Distribuição por Idade , Idoso , Ásia/epidemiologia , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/fisiopatologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Pandemias , Pneumonia Viral/fisiopatologia , Distribuição por Sexo , América do Sul/epidemiologia , Doença Relacionada a Viagens , Adulto Jovem
13.
PLoS Med ; 17(7): e1003198, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32722671

RESUMO

BACKGROUND: Obesity represents an urgent problem that needs to be properly addressed, especially among children. Public and global health policy- and decision-makers need timely, reliable quantitative information to develop effective interventions aimed at counteracting the burden generated by high body mass index (BMI). Few studies have assessed the high-BMI-related burden on a global scale. METHODS AND FINDINGS: Following the methodology framework and analytical strategies used in the Global Burden of Disease Study (GBD) 2017, the global deaths and disability-adjusted life years (DALYs) attributable to high BMI were analyzed by age, sex, year, and geographical location and by Socio-demographic Index (SDI). All causes of death and DALYs estimated in GBD 2017 were organized into 4 hierarchical levels: level 1 contained 3 broad cause groupings, level 2 included more specific categories within the level 1 groupings, level 3 comprised more detailed causes within the level 2 categories, and level 4 included sub-causes of some level 3 causes. From 1990 to 2017, the global deaths and DALYs attributable to high BMI have more than doubled for both females and males. However, during the study period, the age-standardized rate of high-BMI-related deaths remained stable for females and only increased by 14.5% for males, and the age-standardized rate of high-BMI-related DALYs only increased by 12.7% for females and 26.8% for males. In 2017, the 6 leading GBD level 3 causes of high-BMI-related DALYs were ischemic heart disease, stroke, diabetes mellitus, chronic kidney disease, hypertensive heart disease, and low back pain. For most GBD level 3 causes of high-BMI-related DALYs, high-income North America had the highest attributable proportions of age-standardized DALYs due to high BMI among the 21 GBD regions in both sexes, whereas the lowest attributable proportions were observed in high-income Asia Pacific for females and in eastern sub-Saharan Africa for males. The association between SDI and high-BMI-related DALYs suggested that the lowest age-standardized DALY rates were found in countries in the low-SDI quintile and high-SDI quintile in 2017, and from 1990 to 2017, the age-standardized DALY rates tended to increase in regions with the lowest SDI, but declined in regions with the highest SDI, with the exception of high-income North America. The study's main limitations included the use of information collected from some self-reported data, the employment of cutoff values that may not be adequate for all populations and groups at risk, and the use of a metric that cannot distinguish between lean and fat mass. CONCLUSIONS: In this study, we observed that the number of global deaths and DALYs attributable to high BMI has substantially increased between 1990 and 2017. Successful population-wide initiatives targeting high BMI may mitigate the burden of a wide range of diseases. Given the large variations in high-BMI-related burden of disease by SDI, future strategies to prevent and reduce the burden should be developed and implemented based on country-specific development status.


Assuntos
Índice de Massa Corporal , Carga Global da Doença , África ao Sul do Saara/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Feminino , Saúde Global , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , América do Norte/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/mortalidade , Anos de Vida Ajustados por Qualidade de Vida , Fatores Socioeconômicos
14.
Parasitol Res ; 119(10): 3243-3254, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32710171

RESUMO

The composition and diversity of parasite communities are useful tools to characterise ecosystem health and integrity. Environmental disturbances may affect parasite infection in fish directly, by their effects on the free-living stages, or indirectly, on the intermediate hosts. Slimy sculpins, Cottus cognatus, a small fish inhabiting cold waters of North America, have been considered as sentinels due to their limited mobility, often occupying relatively small areas throughout their lives and thus reflecting the local environment. Ninety-six specimens of C. cognatus were sampled from four tributaries of the Athabasca River to assess patterns of helminth parasite community structure in this fish and to study the composition and diversity of its parasite communities in relation to water quality. The localities included single samples from High Hills, Horse and Dunkirk rivers, and two from the Steepbank River. Twelve metazoan parasite species were found, most of them being larval forms. Significant differences occurred in the structure and composition of parasite assemblages of sculpins from the tributaries, although similarities were observed in connected and nearby sites. Parasite communities were influenced mainly by a combination of local environmental conditions, distance and connectivity, and were separated based on the distribution and abundance of autogenic and allogenic parasites. Water quality appeared to influence the distribution of trematode species that use gastropods as intermediate hosts, while proximity and connectivity of sites led to sharing allogenic parasite species in slimy sculpin.


Assuntos
Perciformes/parasitologia , Trematódeos/isolamento & purificação , Infecções por Trematódeos/epidemiologia , Infecções por Trematódeos/veterinária , Animais , Drenagem , Ecossistema , Peixes , Cavalos , América do Norte/epidemiologia , Rios/parasitologia , Qualidade da Água
15.
Lancet HIV ; 7(6): e434-e442, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32504576

RESUMO

During 2011-16, HIV outbreaks occurred among people who inject drugs (PWID) in Canada (southeastern Saskatchewan), Greece (Athens), Ireland (Dublin), Israel (Tel Aviv), Luxembourg, Romania (Bucharest), Scotland (Glasgow), and USA (Scott County, Indiana). Factors common to many of these outbreaks included community economic problems, homelessness, and changes in drug injection patterns. The outbreaks differed in size (from under 100 to over 1000 newly reported HIV cases among PWID) and in the extent to which combined prevention had been implemented before, during, and after the outbreaks. Countries need to ensure high coverage of HIV prevention services and coverage higher than the current UNAIDS recommendation might be needed in areas in which short acting drugs are injected. In addition, monitoring of PWID with special attention for changing drug use patterns, risk behaviours, and susceptible subgroups (eg, PWID experiencing homelessness) needs to be in place to prevent or rapidly detect and contain new HIV outbreaks.


Assuntos
Surtos de Doenças , Infecções por HIV/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Israel/epidemiologia , Masculino , América do Norte/epidemiologia , Fatores Socioeconômicos
16.
Infect Genet Evol ; 84: 104384, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32473976

RESUMO

In less than five months, COVID-19 has spread from a small focus in Wuhan, China, to more than 5 million people in almost every country in the world, dominating the concern of most governments and public health systems. The social and political distresses caused by this epidemic will certainly impact our world for a long time to come. Here, we synthesize lessons from a range of scientific perspectives rooted in epidemiology, virology, genetics, ecology and evolutionary biology so as to provide perspective on how this pandemic started, how it is developing, and how best we can stop it.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Surtos de Doenças , Interações Hospedeiro-Patógeno/genética , Peptidil Dipeptidase A/genética , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Glicoproteína da Espícula de Coronavírus/genética , Animais , Ásia/epidemiologia , Betacoronavirus/classificação , Betacoronavirus/genética , Coevolução Biológica , Quirópteros/virologia , Infecções por Coronavirus/diagnóstico , Europa (Continente)/epidemiologia , Eutérios/virologia , Expressão Gênica , Interações Hospedeiro-Patógeno/efeitos dos fármacos , Interações Hospedeiro-Patógeno/imunologia , Humanos , Imunidade Inata , América do Norte/epidemiologia , Pandemias , Peptidil Dipeptidase A/imunologia , Filogenia , Pneumonia Viral/diagnóstico , Índice de Gravidade de Doença , Glicoproteína da Espícula de Coronavírus/antagonistas & inibidores , Glicoproteína da Espícula de Coronavírus/imunologia
17.
Int J Cardiovasc Imaging ; 36(8): 1387-1393, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32474676

RESUMO

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an evolving global pandemic that is predicted to strain healthcare resources at multiple locations throughout North America and the World. As of April 6, 2020, the apex of infection rates is predicted to occur within 1 to 5 weeks at various locations. Widespread reports of personal protective equipment (PPE) shortages, and healthcare worker exposure to disease have become commonplace. To mitigate this crisis, we are suggesting imaging strategies that aim to use the least PPE, require the smallest number of potential staff exposures, and streamlines utilization of imaging. They are broadly organized by (1) substituting a noninvasive diagnostic test in place of a semi-invasive or invasive diagnostic tests, and (2) consolidating diagnostic imaging.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Recursos em Saúde/provisão & distribução , Controle de Infecções/organização & administração , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Betacoronavirus , Tomada de Decisões , Humanos , América do Norte/epidemiologia , Equipamento de Proteção Individual/provisão & distribução , Sociedades Médicas
18.
J Pediatr Surg ; 55(8): 1431-1435, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32561172

RESUMO

INTRODUCTION: The impact of COVID-19 pandemic on pediatric surgical care systems is unknown. We present an initial evaluation of self-reported pediatric surgical policy changes from hospitals across North America. METHODS: On March 30, 2020, an online open access, data gathering spreadsheet was made available to pediatric surgeons through the American Pediatric Surgical Association (APSA) website, which captured information surrounding COVID-19 related policy changes. Responses from the first month of the pandemic were collected. Open-ended responses were evaluated and categorized into themes and descriptive statistics were performed to identify areas of consensus. RESULTS: Responses from 38 hospitals were evaluated. Policy changes relating to three domains of program structure and care processes were identified: internal structure, clinical workflow, and COVID-19 safety/prevention. Interhospital consensus was high for reducing in-hospital staffing, limiting clinical fellow exposure, implementing telehealth for conducting outpatient clinical visits, and using universal precautions for trauma. Heterogeneity in practices existed for scheduling procedures, implementing testing protocols, and regulating use of personal protective equipment. CONCLUSIONS: The COVID-19 pandemic has induced significant upheaval in the usual processes of pediatric surgical care. While policies evolve, additional research is needed to determine the effect of these changes on patient and healthcare delivery outcomes. LEVEL OF EVIDENCE: III.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Hospitais Pediátricos , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Operatórios/normas , Telemedicina/métodos , Criança , Transmissão de Doença Infecciosa/estatística & dados numéricos , Humanos , América do Norte/epidemiologia , Pandemias
19.
Chaos ; 30(4): 041102, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: covidwho-159518

RESUMO

In this work, we analyze the growth of the cumulative number of confirmed infected cases by a novel coronavirus (COVID-19) until March 27, 2020, from countries of Asia, Europe, North America, and South America. Our results show that (i) power-law growth is observed in all countries; (ii) by using the distance correlation, the power-law curves between countries are statistically highly correlated, suggesting the universality of such curves around the world; and (iii) soft quarantine strategies are inefficient to flatten the growth curves. Furthermore, we present a model and strategies that allow the government to reach the flattening of the power-law curves. We found that besides the social distancing of individuals, of well known relevance, the strategy of identifying and isolating infected individuals in a large daily rate can help to flatten the power-laws. These are the essential strategies followed in the Republic of Korea. The high correlation between the power-law curves of different countries strongly indicates that the government containment measures can be applied with success around the whole world. These measures are scathing and to be applied as soon as possible.


Assuntos
Betacoronavirus , Infecções por Coronavirus/transmissão , Modelos Estatísticos , Pneumonia Viral/transmissão , Quarentena/métodos , Ásia/epidemiologia , Betacoronavirus/crescimento & desenvolvimento , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Europa (Continente)/epidemiologia , Geografia Médica , Atividades Humanas , Humanos , América do Norte/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Prevalência , América do Sul/epidemiologia
20.
Chaos ; 30(4): 041102, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32357675

RESUMO

In this work, we analyze the growth of the cumulative number of confirmed infected cases by a novel coronavirus (COVID-19) until March 27, 2020, from countries of Asia, Europe, North America, and South America. Our results show that (i) power-law growth is observed in all countries; (ii) by using the distance correlation, the power-law curves between countries are statistically highly correlated, suggesting the universality of such curves around the world; and (iii) soft quarantine strategies are inefficient to flatten the growth curves. Furthermore, we present a model and strategies that allow the government to reach the flattening of the power-law curves. We found that besides the social distancing of individuals, of well known relevance, the strategy of identifying and isolating infected individuals in a large daily rate can help to flatten the power-laws. These are the essential strategies followed in the Republic of Korea. The high correlation between the power-law curves of different countries strongly indicates that the government containment measures can be applied with success around the whole world. These measures are scathing and to be applied as soon as possible.


Assuntos
Betacoronavirus , Infecções por Coronavirus/transmissão , Modelos Estatísticos , Pneumonia Viral/transmissão , Quarentena/métodos , Ásia/epidemiologia , Betacoronavirus/crescimento & desenvolvimento , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Europa (Continente)/epidemiologia , Geografia Médica , Atividades Humanas , Humanos , América do Norte/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Prevalência , América do Sul/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA