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2.
Artigo em Inglês | MEDLINE | ID: mdl-33525441

RESUMO

During the COVID-19 pandemic, social interactions were restricted, including community services for disabled older adults. This study aimed to describe the change of use in community services related to long-term care insurance (LTCI) during the pandemic in Japan. A retrospective descriptive study was conducted using data collected via a cloud-based management support platform for older adult care provider "Kaipoke", by a private-sector company "SMS Co., Ltd.", in which care-managers of LTCI manage their office work. Data collection occurred from July 2019 to June 2020. Study subjects were LTCI service users aged 65 years and above. Subjects were living at home. We examined changes in the number of users of LTCI services before and after the COVID-19 pandemic began, using an interrupted time-series analysis. Results indicated that the use of outpatient services was reduced; however, home-visit services were maintained. The decrease in use was significant in the seven prefectures where the infection initially spread. There are concerns that older adults or surrounding caregivers can be affected by such changes in LTC service use. It is therefore necessary to implement sustainable measures from a long-term perspective and investigate their influence as part of future studies.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Serviços de Assistência Domiciliar/estatística & dados numéricos , Seguro de Assistência de Longo Prazo , Pandemias , Idoso , Humanos , Análise de Séries Temporais Interrompida , Japão/epidemiologia , Estudos Retrospectivos , Seguridade Social
4.
Emerg Infect Dis ; 27(2): 666-669, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33496645

RESUMO

We conducted 3 population-based cross-sectional surveys, at 1-month intervals, to estimate the prevalence and time-trend of severe acute respiratory syndrome coronavirus 2 infection in Puducherry, India. Seropositivity rate increased from 4.9% to 34.5% over 2 months and was 20-fold higher than the number of diagnosed cases of infection.


Assuntos
Anticorpos Antivirais/sangue , /diagnóstico , /imunologia , Adulto , Análise por Conglomerados , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Análise de Séries Temporais Interrompida , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Soroepidemiológicos , Fatores de Tempo
5.
BMC Infect Dis ; 21(1): 50, 2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33430792

RESUMO

BACKGROUND: Hand hygiene (HH) is the cornerstone of infection control, and the promotion of HH is the focus of the world. The study aims to compare the role of two different types of electronic hand hygiene monitoring systems (EHHMSs) in promoting HH of healthcare workers (HCWs) in the intensive care unit (ICU). METHODS: In a 16-bed ICU of a general tertiary hospital in Shenzhen, the research was divided into three stages with interrupted time series (ITS) design. In the first stage, the direct observation method was used to monitor and feed back the HH compliance rate of HCWs monthly. In the second stage, the type1 EHHMS was applied to monitor and feed back the individual number of HH events monthly. In the third stage, the type2 EHHMS with a function of instant reminder and feedback was employed, and the personal HH compliance rates were fed back monthly. Meanwhile, direct observation continued in the last two stages. RESULTS: In the second stage, The HH compliance rate increased. However, there was no significant difference in the trajectory of the rate compared with the first stage. In the first month of the third stage, the HH compliance rate increased by 12.324% immediately and then ascended by 1.242% over time. The number of HH events per bed day and HH products' consumption per bed day were consistent with the change of HH compliance rate observed. CONCLUSION: Monitoring and feedback can improve the HH of HCWs. The EHHMS, with the function of real-time reminders and feedback, has a more noticeable effect on promoting HH.


Assuntos
Equipamentos e Provisões Elétricas , Higiene das Mãos/métodos , Pessoal de Saúde , Promoção da Saúde/métodos , Controle de Infecções/métodos , Unidades de Terapia Intensiva , Adulto , China , Infecção Hospitalar/prevenção & controle , Retroalimentação , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Análise de Séries Temporais Interrompida , Masculino , Sistemas de Alerta , Centros de Atenção Terciária
6.
Cochrane Database Syst Rev ; 1: CD011865, 2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33469932

RESUMO

BACKGROUND: Changes to the method of payment for healthcare providers, including pay-for-performance schemes, are increasingly being used by governments, health insurers, and employers to help align financial incentives with health system goals. In this review we focused on changes to the method and level of payment for all types of healthcare providers in outpatient healthcare settings. Outpatient healthcare settings, broadly defined as 'out of hospital' care including primary care, are important for health systems in reducing the use of more expensive hospital services. OBJECTIVES: To assess the impact of different payment methods for healthcare providers working in outpatient healthcare settings on the quantity and quality of health service provision, patient outcomes, healthcare provider outcomes, cost of service provision, and adverse effects. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase (searched 5 March 2019), and several other databases. In addition, we searched clinical trials platforms, grey literature, screened reference lists of included studies, did a cited reference search for included studies, and contacted study authors to identify additional studies. We screened records from an updated search in August 2020, with any potentially relevant studies categorised as awaiting classification. SELECTION CRITERIA: Randomised trials, non-randomised trials, controlled before-after studies, interrupted time series, and repeated measures studies that compared different payment methods for healthcare providers working in outpatient care settings. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We conducted a structured synthesis. We first categorised the payment methods comparisons and outcomes, and then described the effects of different types of payment methods on different outcome categories. Where feasible, we used meta-analysis to synthesise the effects of payment interventions under the same category. Where it was not possible to perform meta-analysis, we have reported means/medians and full ranges of the available point estimates. We have reported the risk ratio (RR) for dichotomous outcomes and the relative difference (as per cent change or mean difference (MD)) for continuous outcomes. MAIN RESULTS: We included 27 studies in the review: 12 randomised trials, 13 controlled before-and-after studies, one interrupted time series, and one repeated measure study. Most healthcare providers were primary care physicians. Most of the payment methods were implemented by health insurance schemes in high-income countries, with only one study from a low- or middle-income country. The included studies were categorised into four groups based on comparisons of different payment methods. (1) Pay for performance (P4P) plus existing payment methods compared with existing payment methods for healthcare providers working in outpatient healthcare settings P4P incentives probably improve child immunisation status (RR 1.27, 95% confidence interval (CI) 1.19 to 1.36; 3760 patients; moderate-certainty evidence) and may slightly increase the number of patients who are asked more detailed questions on their disease by their pharmacist (MD 1.24, 95% CI 0.93 to 1.54; 454 patients; low-certainty evidence). P4P may slightly improve primary care physicians' prescribing of guideline-recommended antihypertensive medicines compared with an existing payment method (RR 1.07, 95% CI 1.02 to 1.12; 362 patients; low-certainty evidence). We are uncertain about the effects of extra P4P incentives on mean blood pressure reduction for patients and costs for providing services compared with an existing payment method (very low-certainty evidence). Outcomes related to workload or other health professional outcomes were not reported in the included studies. One randomised trial found that compared to the control group, the performance of incentivised professionals was not sustained after the P4P intervention had ended. (2) Fee for service (FFS) compared with existing payment methods for healthcare providers working in outpatient healthcare settings We are uncertain about the effect of FFS on the quantity of health services delivered (outpatient visits and hospitalisations), patient health outcomes, and total drugs cost compared to an existing payment method due to very low-certainty evidence. The quality of service provision and health professional outcomes were not reported in the included studies. One randomised trial reported that physicians paid via FFS may see more well patients than salaried physicians (low-certainty evidence), possibly implying that more unnecessary services were delivered through FFS. (3) FFS mixed with existing payment methods compared with existing payment methods for healthcare providers working in outpatient healthcare settings FFS mixed payment method may increase the quantity of health services provided compared with an existing payment method (RR 1.37, 95% CI 1.07 to 1.76; low-certainty evidence). We are uncertain about the effect of FFS mixed payment on quality of services provided, patient health outcomes, and health professional outcomes compared with an existing payment method due to very low-certainty evidence. Cost outcomes and adverse effects were not reported in the included studies. (4) Enhanced FFS compared with FFS for healthcare providers working in outpatient healthcare settings Enhanced FFS (higher FFS payment) probably increases child immunisation rates (RR 1.25, 95% CI 1.06 to 1.48; moderate-certainty evidence). We are uncertain whether higher FFS payment results in more primary care visits and about the effect of enhanced FFS on the net expenditure per year on covered children with regular FFS (very low-certainty evidence). Quality of service provision, patient outcomes, health professional outcomes, and adverse effects were not reported in the included studies. AUTHORS' CONCLUSIONS: For healthcare providers working in outpatient healthcare settings, P4P or an increase in FFS payment level probably increases the quantity of health service provision (moderate-certainty evidence), and P4P may slightly improve the quality of service provision for targeted conditions (low-certainty evidence). The effects of changes in payment methods on health outcomes is uncertain due to very low-certainty evidence. Information to explore the influence of specific payment method design features, such as the size of incentives and type of performance measures, was insufficient. Furthermore, due to limited and very low-certainty evidence, it is uncertain if changing payment models without including additional funding for professionals would have similar effects. There is a need for further well-conducted research on payment methods for healthcare providers working in outpatient healthcare settings in low- and middle-income countries; more studies comparing the impacts of different designs of the same payment method; and studies that consider the unintended consequences of payment interventions.


Assuntos
Instituições de Assistência Ambulatorial/economia , Pessoal de Saúde/economia , Mecanismo de Reembolso/economia , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Capitação , Estudos Controlados Antes e Depois/estatística & dados numéricos , Custos e Análise de Custo , Assistência à Saúde/economia , Assistência à Saúde/normas , Assistência à Saúde/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/economia , Planos de Pagamento por Serviço Prestado/normas , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Humanos , Análise de Séries Temporais Interrompida , Médicos de Atenção Primária/economia , Médicos de Atenção Primária/estatística & dados numéricos , Qualidade da Assistência à Saúde/economia , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Mecanismo de Reembolso/classificação , Mecanismo de Reembolso/estatística & dados numéricos , Reembolso de Incentivo/economia , Reembolso de Incentivo/normas , Reembolso de Incentivo/estatística & dados numéricos , Salários e Benefícios/economia , Resultado do Tratamento
7.
Res Social Adm Pharm ; 17(1): 2005-2008, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33317769

RESUMO

BACKGROUND: Healthcare access has changed drastically during the COVID-19 pandemic. Elective medical procedures, including routine office visits, were restricted raising concerns regarding opioid and benzodiazepine provider and prescription availability. OBJECTIVE: To examine how the cancelation of elective medical procedures due to COVID-19 impacted the dispensing of opioid and benzodiazepine prescriptions in Texas. METHODS: Interrupted time series analyses were preformed to examine changes in prescription trends for opioids and benzodiazepines before and after the restriction on elective medical procedures. Samples of patients who filled an opioid or benzodiazepine prescription from January 5, 2020 to May 12, 2020 were identified from the Texas Prescription Monitoring Program. Elective medical procedures were restricted starting March 23, 2020 indicating the beginning of the intervention period. RESULTS: Restricting elective procedures was associated with a significant decrease in the number of patients (ß = -6029, 95%CI = -8810.40, -3246.72) and prescribers (ß = -2784, 95%CI = -3671.09, -1896.19) filling and writing opioid prescriptions, respectively. Also, the number of patients filling benzodiazepine prescriptions decreased significantly (ß = -1982, 95%CI = -3712.43, -252.14) as did the number of prescribers (ß = -708.62, 95%CI = -1190.54, -226.71). CONCLUSION: Restricting elective procedures resulted in a large care gap for patients taking opioid or benzodiazepine prescriptions.


Assuntos
Analgésicos Opioides/administração & dosagem , Benzodiazepinas/administração & dosagem , Padrões de Prática Médica/estatística & dados numéricos , Prescrições de Medicamentos , Política de Saúde , Acesso aos Serviços de Saúde , Humanos , Análise de Séries Temporais Interrompida , Programas de Monitoramento de Prescrição de Medicamentos , Texas
8.
Rev Saude Publica ; 54: 139, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33331531

RESUMO

OBJECTIVE: To verify the effect of the Pact for Health on premature mortality (30-69 years) attributed to cervical cancer in Brazil and its macroregions, using interrupted time series analysis. METHODS: Segmented regression was used to assess "change in level" and "change in trend" in premature mortality rates attributed to cervical cancer considering the post-Pact period (2010-2018), controlling by the pre-Pact period (1998-2006). Understanding the triennium 2007-2009 as essential for the adoption and implementation of the policy, it was excluded from the main modeling, but assessed in the sensitivity analysis. RESULTS: From 1998 to 2018, there were more than 119,000 deaths due to cervical cancer in women aged 30 to 69 years in Brazil. The Northern region experienced the highest rates (> 20 per 100,000). Comparing with baseline (1998-2006), segmented regression showed a progressive increase in changing trend from cervical cancer deaths in Brazil as a whole (coefficient = 0.513; 95%CI 0.430 to 0.596) and in the Southeast region (coefficient = 0.515; 95%CI 0.358 to 0.674), South region (coefficient = 0.925; 95%CI 0.642 to 1.208), and Midwest region (coefficient = 0.590; 95%CI 0.103 to 1.077). The Northeast region presented the most promising effects with immediate reduction in change level (-0.635; 95%CI -1.177 to -0.092) and progressive reduction in the changing trend of premature deaths (coefficient= -0.151; 95%CI -0.231 to -0.007). CONCLUSIONS: Premature mortality rates due to cervical cancer are high in Brazil and its macroregions. This interrupted time series was not able to reveal the effectiveness of initiatives related to the Pact for Health on premature deaths from cervical cancer nationally and in all macroregions equally. The best results are restricted to the Northeast region.


Assuntos
Mortalidade Prematura , Neoplasias do Colo do Útero/mortalidade , Adulto , Idoso , Brasil/epidemiologia , Feminino , Humanos , Análise de Séries Temporais Interrompida , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/patologia
9.
Cochrane Database Syst Rev ; 12: CD012921, 2020 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-33368213

RESUMO

BACKGROUND: Drug- and alcohol-related impairment in the workplace has been linked to an increased risk of injury for workers. Randomly testing populations of workers for these substances has become a practice in many jurisdictions, with the intention of reducing the risk of workplace incidents and accidents. Despite the proliferation of random drug and alcohol testing (RDAT), there is currently a lack of consensus about whether it is effective at preventing workplace injury, or improving other non-injury accident outcomes in the work place. OBJECTIVES: To assess the effectiveness of workplace RDAT to prevent injuries and improve non-injury accident outcomes (unplanned events that result in damage or loss of property) in workers compared with no workplace RDAT. SEARCH METHODS: We conducted a systematic literature search to identify eligible published and unpublished studies. The date of the last search was 1 November 2020. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, two other databases, Google Scholar, and three trials registers. We also screened the reference lists of relevant publications known to us. SELECTION CRITERIA: Study designs that were eligible for inclusion in our review included randomised controlled trials (RCTs), cluster-randomised trials (CRTs), interrupted time-series (ITS) studies, and controlled before-after (CBA) studies. Studies needed to evaluate the effectiveness of RDAT in preventing workplace injury or improving other non-injury workplace outcomes. We also considered unpublished data from clinical trial registries. We included employees working in all safety-sensitive occupations, except for commercial drivers, who are the subject of another Cochrane Review. DATA COLLECTION AND ANALYSIS: Independently, two review authors used a data collection form to extract relevant characteristics from the included study. They then analysed a line graph included in the study of the prevalence rate of alcohol violations per year. Independently, the review authors completed a GRADE assessment, as a means of rating the quality of the evidence. MAIN RESULTS: Although our searching originally identified 4198 unique hits, only one study was eligible for inclusion in this review. This was an ITS study that measured the effect of random alcohol testing (RAT) on the test positivity rate of employees of major airlines in the USA from 1995 to 2002. The study included data from 511,745 random alcohol tests, and reported no information about testing for other substances. The rate of positive results was the only outcome of interest reported by the study. The average rate of positive results found by RAT increased from 0.07% to 0.11% when the minimum percentage of workers who underwent RAT annually was reduced from 25% to 10%. Our analyses found this change to be a statistically significant increase (estimated change in level, where the level reflects the average percentage points of positive tests = 0.040, 95% confidence interval 0.005 to 0.075; P = 0.031). Our GRADE assessment, for the observed effect of lower minimum testing percentages associating with a higher rate of positive test results, found the quality of the evidence to be 'very low' across the five GRADE domains. The one included study did not address the following outcomes of interest: fatal injuries; non-fatal injuries; non-injury accidents; absenteeism; and adverse effects associated with RDAT. AUTHORS' CONCLUSIONS: In the aviation industry in the USA, the only setting for which the eligible study reported data, there was a statistically significant increase in the rate of positive RAT results following a reduction in the percentage of workers tested, which we deem to be clinically relevant. This result suggests an inverse relationship between the proportion of positive test results and the rate of testing, which is consistent with a deterrent effect for testing. No data were reported on adverse effects related to RDAT. We could not draw definitive conclusions regarding the effectiveness of RDAT for employees in safety-sensitive occupations (not including commercial driving), or with safety-sensitive job functions. We identified only one eligible study that reflected one industry in one country, was of non-randomised design, and tested only for alcohol, not for drugs or other substances. Our GRADE assessment resulted in a 'very low' rating for the quality of the evidence on the only outcome reported. The paucity of eligible research was a major limitation in our review, and additional studies evaluating the effect of RDAT on safety outcomes are needed.


Assuntos
Alcoolismo/diagnóstico , Traumatismos Ocupacionais/prevenção & controle , Detecção do Abuso de Substâncias/métodos , Aviação , Humanos , Análise de Séries Temporais Interrompida , Detecção do Abuso de Substâncias/estatística & dados numéricos
10.
BMJ ; 371: m4465, 2020 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-33328152

RESUMO

OBJECTIVE: To investigate the association between popular football games played in Europe and the incidence of traffic accidents in Asia. DESIGN: Study based on 41 538 traffic accidents involving taxis in Singapore and 1 814 320 traffic accidents in Taiwan, combined with 12 788 European club football games over a seven year period. SETTING: Singapore and Taiwan. PARTICIPANTS: The largest taxi company in Singapore, with fine grained traffic accident records in a three year span; all traffic accident records in Taiwan in a six year span. EXPOSURE: Days when high profile football games were played or not played. MAIN OUTCOME MEASURE: Number of traffic accidents. RESULTS: Regression based and time series models suggest that days with high profile European football matches were more positively associated with traffic accidents than days with less popular European football matches. For an approximate €134.74m (£120.25m; $159.76m) increase in average market value for matches played on a given day, approximately one extra accident would occur among Singapore taxi drivers, and for an approximate €7.99m increase in average market value of matches, approximately one extra accident would occur among all drivers in Taiwan. This association remained after control for weather conditions, time of the year, weekend versus weekday effects, driver demographics, and underlying temporal trends. It was also stronger for daytime traffic accidents than for night time traffic accidents, suggesting that the association between high profile football matches and traffic accidents cannot be attributed to night time celebration or attention deficits while watching and driving. Annually, this increased rate of traffic accidents may translate to approximately 371 accidents among taxi drivers in Singapore and approximately 41 079 accidents among the Taiwanese public, as well as economic losses of approximately €821 448 among Singapore taxi drivers and approximately €13 994 409 among Taiwanese drivers and insurers. The total health and economic impact of this finding is likely to be much higher because GMT+8 is the most populous time zone, encompassing 24% of the world's population. CONCLUSIONS: Days featuring high profile football matches in Europe were associated with more traffic accidents in Taiwan and Singapore than were days with lower profile football matches. A potential causal mechanism may be Asian drivers losing sleep by watching high profile European matches, which are often played in the middle of the night in Asia.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Futebol/estatística & dados numéricos , Condução de Veículo/estatística & dados numéricos , Europa (Continente) , Feminino , Humanos , Análise de Séries Temporais Interrompida , Masculino , Singapura , Privação do Sono/complicações , Futebol/economia , Taiwan
11.
JAMA Netw Open ; 3(12): e2031083, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33369659

RESUMO

Importance: Health taxes are policy tools used to reduce harmful consumption of products and raise tax revenue, and they may also be associated with signaling (ie, informational and educational) factors that enhance their impact. Objectives: To examine changes in prices and volume sold of sweetened beverages following the implementation and repeal of the Cook County, Illinois, Sweetened Beverage Tax (SBT) compared with the comparison site of St Louis County and city, Missouri, which did not impose a tax. Design, Setting, and Participants: This study used interrupted time series analyses to assess changes in price and volume sold of taxed (based on beverage type and sweetener status) and untaxed beverages in Cook County compared with St Louis following the implementation of the SBT on August 2, 2017, and its repeal effective December 1, 2017. Statistical analysis was performed from January to June 2020. Exposures: Implementation and repeal of the Cook County SBT. Main Outcomes and Measures: Changes in taxed and untaxed beverage prices and volume sold. Nielsen food store scanner data were obtained for weekly volume and dollar amount sold of nonalcoholic beverage universal product codes (UPCs) for each site in supermarkets and mass merchandise, grocery, drug, convenience, and dollar stores. Results: The analytic samples included 16 510 UPCs for volume and 2141 UPCs (balanced sample) for prices for 122 pretax weeks, 16 tax weeks, and 35 postrepeal weeks. Compared with St Louis, posttax implementation in Cook County resulted in a level increase in taxed beverage prices of 1.13 cents per fluid ounce (95% CI, 1.01 to 1.25 cents per fluid ounce), representing a slight overshifting, followed by a posttax repeal level decrease of -1.19 cents per fluid ounce (95% CI, -1.33 to -1.04 cents per fluid ounce), with no resulting change pretax to posttax repeal. Volume sold of taxed beverages in Cook County compared with St Louis exhibited a posttax implementation level decrease of 25.7% (ß = -0.297; 95% CI, -0.415 to -0.179) and a posttax repeal level increase of 30.5% (ß = 0.266, 95% CI, 0.124 to 0.408), with no net change in volume sold from pretax to 8 months after repeal. Conclusions and Relevance: This study using interrupted time series analysis found no net change in volume sold of taxed beverages following the implementation and repeal of the Cook County SBT, suggesting the tax had no signaling association. Repeals of such taxes may fully reverse their associations with reduced demand and harms associated with sweetened beverage intake.


Assuntos
Comércio/estatística & dados numéricos , Comportamento do Consumidor/economia , Bebidas Adoçadas com Açúcar/economia , Impostos/economia , Implementação de Plano de Saúde , Humanos , Illinois , Análise de Séries Temporais Interrompida
12.
J Addict Med ; 14(6): e372-e374, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33031213

RESUMO

OBJECTIVES: To measure the change in the daily number of patients receiving buprenorphine and buprenorphine prescribers during the early phase of the COVID-19 (SARS-CoV-2) pandemic in Texas. METHODS: Counts of the number of patients filling and number of providers prescribing buprenorphine were calculated for each weekday between November 4, 2019 and May 12, 2020. The change in daily patients and prescribers between March 2, 2020 and May 12, 2020, was modeled as a change in slope compared to the baseline period using autoregressive, interrupted time series regression. RESULTS: The rate of change of daily buprenorphine prescriptions (ß = -1.75, 95% CI = -5.8-2.34) and prescribers (ß = -0.32, 95% CI = -1.47-0.82) declined insignificantly during the COVID-19 period compared to the baseline. CONCLUSIONS: Despite a 57% decline in ambulatory care utilization in the south-central US during March and April of 2020, health services utilization related to buprenorphine in Texas remained robust. Protecting access to buprenorphine as the COVID-19 pandemic continues to unfold will require intensive efforts from clinicians and policy makers alike. While the presented results are promising, researchers must continue monitoring and exploring the clinical and humanistic impact of COVID-19 on the treatment of substance use disorders.


Assuntos
Buprenorfina/uso terapêutico , Infecções por Coronavirus/epidemiologia , Política de Saúde , Antagonistas de Entorpecentes/uso terapêutico , Pneumonia Viral/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Humanos , Análise de Séries Temporais Interrompida , Tratamento de Substituição de Opiáceos/métodos , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Pandemias , Padrões de Prática Médica/estatística & dados numéricos , Texas
13.
PLoS One ; 15(10): e0240021, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031389

RESUMO

BACKGROUND: Rotavirus infection is a common cause of gastroenteritis in children worldwide, with a high mortality burden in developing countries, particularly during the first two years of life. Rotavirus vaccination was introduced into the United Kingdom childhood vaccination schedule in July 2013, with high coverage (>90%) achieved by June 2016. We used an emergency department (ED) syndromic surveillance system to assess the impact of the rotavirus vaccination programme, specifically through the demonstration of any immediate and continuing impact on ED gastroenteritis visits in England. METHODS: This retrospective, observational study used syndromic surveillance data collected from 3 EDs in the two years before (July 2011-June 2013) and 3 years post (July 2013-June 2016) introduction of rotavirus vaccination. The weekly levels of ED visits for gastroenteritis (by age group and in total) during the period before rotavirus vaccination was first described alongside the findings of laboratory surveillance of rotavirus during the same period. An interrupted time-series analysis was then performed to demonstrate the impact of rotavirus vaccination introduction on gastroenteritis ED visit levels. RESULTS: During the two years before vaccine introduction ED visits for gastroenteritis in total and for the 0-4 years age group were seen to rise and fall in line with the seasonal rotavirus increases reported by laboratory surveillance. ED gastroenteritis visits by young children were lower in the three years following introduction of rotavirus vaccination (reduced from 8% of visits to 6% of visits). These attendance levels in young children (0-4years) remained higher than in older age groups, however the previously large seasonal increases in children were greatly reduced, from peaks of 16% to 3-10% of ED visits per week. CONCLUSIONS: ED syndromic surveillance demonstrated a reduction in gastroenteritis visits following rotavirus vaccine introduction. This work establishes ED syndromic surveillance as a platform for rapid impact assessment of future vaccine programmes.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Programas de Imunização , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Gastroenterite/diagnóstico , Gastroenterite/epidemiologia , Gastroenterite/virologia , Humanos , Lactente , Análise de Séries Temporais Interrompida , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções por Rotavirus/patologia , Infecções por Rotavirus/prevenção & controle , Infecções por Rotavirus/virologia , Vacinas contra Rotavirus/imunologia , Estações do Ano , Vigilância de Evento Sentinela , Reino Unido/epidemiologia , Adulto Jovem
16.
Pediatrics ; 146(5)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33020248

RESUMO

BACKGROUND AND OBJECTIVES: Noncigarette tobacco use is increasing. In this study, we reexamined (1) parental knowledge or suspicion of their children's tobacco use and (2) associations of household tobacco-free rules with youth initiation. METHODS: Participants were youth (aged 12-17) in waves 1 to 4 (2013-2018) of the Population Assessment of Tobacco and Health Study. A pseudo cross-sectional time-series analysis (N = 23 170) was used to examine parent or guardian knowledge or suspicion of their child's tobacco use according to youth-reported use categories: cigarette only, electronic cigarette only, smokeless tobacco only, noncigarette combustible only, and poly use. A longitudinal analysis among wave 1 never users (n = 8994) was used to examine rules barring tobacco inside the home and whether parents talked with youth about not using tobacco as predictors of youth tobacco initiation after 1 to 3 years. Survey-weighted multivariable models were adjusted for tobacco use risk factors. RESULTS: In all waves, parents or guardians much less often knew or suspected that their children used tobacco if youth only reported use of electronic cigarettes, noncigarette combustible products, or smokeless tobacco compared with cigarettes. Youth tobacco initiation was lower when youth and parents agreed that rules prohibited all tobacco use throughout the home (1-year adjusted odds ratio: 0.74; 95% confidence interval: 0.59-0.94) but not when parents talked with youth about tobacco (adjusted odds ratio: 1.08; 95% confidence interval: 0.94-1.23). CONCLUSIONS: Many parents are unaware of their children's noncigarette tobacco use. Setting expectations for tobacco-free environments appears more effective at preventing youth tobacco initiation than parents advising children not to use tobacco.


Assuntos
Características da Família , Conhecimentos, Atitudes e Prática em Saúde , Pais , Política Antifumo , Uso de Tabaco , Adolescente , Criança , Intervalos de Confiança , Estudos Transversais , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Feminino , Humanos , Análise de Séries Temporais Interrompida/estatística & dados numéricos , Masculino , Razão de Chances , Fumar/epidemiologia , Prevenção do Hábito de Fumar , Uso de Tabaco/epidemiologia , Uso de Tabaco/prevenção & controle , Tabaco sem Fumaça/estatística & dados numéricos
19.
Cad Saude Publica ; 36(10): e00213920, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33084836

RESUMO

In response to the COVID-19 pandemic, governments worldwide have implemented social distancing policies with different levels of both enforcement and compliance. We conducted an interrupted time series analysis to estimate the impact of lockdowns on reducing the number of cases and deaths due to COVID-19 in Brazil. Official daily data was collected for four city capitals before and after their respective policies interventions based on a 14 days observation window. We estimated a segmented linear regression to evaluate the effectiveness of lockdown measures on COVID-19 incidence and mortality. The initial number of new cases and new deaths had a positive trend prior to policy change. After lockdown, a statistically significant decrease in new confirmed cases was found in all state capitals. We also found evidence that lockdown measures were likely to reverse the trend of new daily deaths due to COVID-19. In São Luís, we observed a reduction of 37.85% while in Fortaleza the decrease was 33.4% on the average difference in daily deaths if the lockdown had not been implemented. Similarly, the intervention diminished mortality in Recife by 21.76% and Belém by 16.77%. Social distancing policies can be useful tools in flattening the epidemic curve.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/mortalidade , Pneumonia Viral/prevenção & controle , Betacoronavirus , Brasil/epidemiologia , Humanos , Análise de Séries Temporais Interrompida , Quarentena , Isolamento Social
20.
PLoS One ; 15(9): e0238323, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32898853

RESUMO

India, a persistently significant contributor to the global malaria burden, rolled out several anti-malaria interventions at the national and state level to control and recently, to eliminate the disease. Odisha, the eastern Indian state with the highest malaria burden experienced substantial gains shown by various anti-malaria initiatives implemented under the National Vector-borne Disease Control Programme (NVBDCP). However, recalcitrant high-transmission "pockets" of malaria persist in hard-to-reach stretches of the state, characterised by limited access to routine malaria surveillance and the forested hilly topography favouring unbridled vector breeding. The prevalence of asymptomatic malaria in such pockets serves as perpetual malaria reservoir, thus hindering its elimination. Therefore, a project with the acronym DAMaN was initiated since 2017 by state NVBDCP, targeting locally identified high endemic 'pockets' in 23 districts. DAMaN comprised biennial mass screening and treatment, provisioning of long-lasting insecticidal net (LLIN) and behavioural change communication. Subsequently, to inform policy, assessment of DAMaN was conceived that aims to estimate the coverage of the various components of the project; the prevalence of malaria, even at sub-patent level especially among pregnant/lactating women and children; and its impact on malaria incidence. A survey of DAMaN beneficiaries will measure coverage; and knowledge and practices related to LLIN; along with collection of blood specimens from a probability sample. A multi-stage stratified clustered sample of 2228 households (~33% having pregnant/lactating women) will be selected from 6 DAMaN districts. Routine DAMaN project data (2017-2018) and NVBDCP data (2013-2018) will be extracted. Rapid Diagnostic Test, Polymerase Chain Reaction and blood smear microscopy will be conducted to detect malarial parasitemia. In addition to measuring DAMaN's coverage and malarial prevalence in DAMaN pockets, its impact will be estimated using pre-post differences and Interrupted Time Series analysis using 2017 as the "inflection" point. The assessment may help to validate the unique strategies employed by DAMaN.


Assuntos
Antimaláricos/uso terapêutico , Mosquiteiros Tratados com Inseticida/estatística & dados numéricos , Malária/epidemiologia , Malária/prevenção & controle , Controle de Mosquitos/organização & administração , Controle de Mosquitos/normas , Plasmodium malariae/efeitos dos fármacos , Adolescente , Criança , Pré-Escolar , Feminino , Governo , Humanos , Incidência , Índia/epidemiologia , Lactente , Análise de Séries Temporais Interrompida , Malária/parasitologia , Malária/transmissão , Gravidez , Inquéritos e Questionários
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