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1.
Global Health ; 16(1): 95, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: covidwho-840960

RESUMO

BACKGROUND: The COVID-19 pandemic disrupted the personal, professional and social life of Australians with some people more impacted than others. OBJECTIVES: This study aimed to identify factors associated with psychological distress, fear and coping strategies during the COVID-19 pandemic in Australia. METHODS: A cross-sectional online survey was conducted among residents in Australia, including patients, frontline health and other essential service workers, and community members during June 2020. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10); level of fear was assessed using the Fear of COVID-19 Scale (FCV-19S); and coping strategies were assessed using the Brief Resilient Coping Scale (BRCS). Logistic regression was used to identify factors associated with the extent of psychological distress, level of fear and coping strategies while adjusting for potential confounders. RESULTS: Among 587 participants, the majority (391, 73.2%) were 30-59 years old and female (363, 61.8%). More than half (349, 59.5%) were born outside Australia and two-third (418, 71.5%) completed at least a Bachelor's degree. The majority (401, 71.5%) had a source of income, 243 (42.3%) self-identified as a frontline worker, and 335 (58.9%) reported financial impact due to COVID-19. Comorbidities such as pre-existing mental health conditions (AOR 3.13, 95% CIs 1.12-8.75), increased smoking (8.66, 1.08-69.1) and alcohol drinking (2.39, 1.05-5.47) over the last four weeks, high levels of fear (2.93, 1.83-4.67) and being female (1.74, 1.15-2.65) were associated with higher levels of psychological distress. Perceived distress due to change of employment status (4.14, 1.39-12.4), alcohol drinking (3.64, 1.54-8.58), providing care to known or suspected cases (3.64, 1.54-8.58), being female (1.56, 1.00-2.45), being 30-59 years old (2.29, 1.21-4.35) and having medium to high levels of psychological distress (2.90, 1.82-5.62) were associated with a higher level of fear; while healthcare service use in the last four weeks was associated with medium to high resilience. CONCLUSIONS: This study identified individuals who were at higher risk of distress and fear during the COVID-19 pandemic specifically in the State of Victoria, Australia. Specific interventions to support the mental wellbeing of these individuals should be considered in addition to the existing resources within primary healthcare settings.


Assuntos
Adaptação Psicológica , Infecções por Coronavirus/psicologia , Medo , Pandemias , Pneumonia Viral/psicologia , Angústia Psicológica , Adulto , Austrália/epidemiologia , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Fatores de Risco
2.
PLoS One ; 15(10): e0240153, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-811273

RESUMO

The novel coronavirus COVID-19 arrived on Australian shores around 25 January 2020. This paper presents a novel method of dynamically modeling and forecasting the COVID-19 pandemic in Australia with a high degree of accuracy and in a timely manner using limited data; a valuable resource that can be used to guide government decision-making on societal restrictions on a daily and/or weekly basis. The "partially-observable stochastic process" used in this study predicts not only the future actual values with extremely low error, but also the percentage of unobserved COVID-19 cases in the population. The model can further assist policy makers to assess the effectiveness of several possible alternative scenarios in their decision-making processes.


Assuntos
Infecções por Coronavirus/epidemiologia , Modelos Estatísticos , Pneumonia Viral/epidemiologia , Austrália/epidemiologia , Betacoronavirus , Humanos , Pandemias
3.
J Med Imaging Radiat Oncol ; 64(5): 668-670, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33001577

RESUMO

This case report describes our early radiological experiences of middle-aged patients with COVID-19 at Westmead Hospital, Sydney. We found limited relationship between initial CT imaging appearances and progression to severe disease. The most effective use of imaging in COVID-19 is yet to be determined.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Pneumopatias/virologia , Pneumonia Viral/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios X , Adulto , Austrália/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia
4.
Global Health ; 16(1): 95, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032629

RESUMO

BACKGROUND: The COVID-19 pandemic disrupted the personal, professional and social life of Australians with some people more impacted than others. OBJECTIVES: This study aimed to identify factors associated with psychological distress, fear and coping strategies during the COVID-19 pandemic in Australia. METHODS: A cross-sectional online survey was conducted among residents in Australia, including patients, frontline health and other essential service workers, and community members during June 2020. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10); level of fear was assessed using the Fear of COVID-19 Scale (FCV-19S); and coping strategies were assessed using the Brief Resilient Coping Scale (BRCS). Logistic regression was used to identify factors associated with the extent of psychological distress, level of fear and coping strategies while adjusting for potential confounders. RESULTS: Among 587 participants, the majority (391, 73.2%) were 30-59 years old and female (363, 61.8%). More than half (349, 59.5%) were born outside Australia and two-third (418, 71.5%) completed at least a Bachelor's degree. The majority (401, 71.5%) had a source of income, 243 (42.3%) self-identified as a frontline worker, and 335 (58.9%) reported financial impact due to COVID-19. Comorbidities such as pre-existing mental health conditions (AOR 3.13, 95% CIs 1.12-8.75), increased smoking (8.66, 1.08-69.1) and alcohol drinking (2.39, 1.05-5.47) over the last four weeks, high levels of fear (2.93, 1.83-4.67) and being female (1.74, 1.15-2.65) were associated with higher levels of psychological distress. Perceived distress due to change of employment status (4.14, 1.39-12.4), alcohol drinking (3.64, 1.54-8.58), providing care to known or suspected cases (3.64, 1.54-8.58), being female (1.56, 1.00-2.45), being 30-59 years old (2.29, 1.21-4.35) and having medium to high levels of psychological distress (2.90, 1.82-5.62) were associated with a higher level of fear; while healthcare service use in the last four weeks was associated with medium to high resilience. CONCLUSIONS: This study identified individuals who were at higher risk of distress and fear during the COVID-19 pandemic specifically in the State of Victoria, Australia. Specific interventions to support the mental wellbeing of these individuals should be considered in addition to the existing resources within primary healthcare settings.


Assuntos
Adaptação Psicológica , Infecções por Coronavirus/psicologia , Medo , Pandemias , Pneumonia Viral/psicologia , Angústia Psicológica , Adulto , Austrália/epidemiologia , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Fatores de Risco
5.
PLoS One ; 15(10): e0240153, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33007054

RESUMO

The novel coronavirus COVID-19 arrived on Australian shores around 25 January 2020. This paper presents a novel method of dynamically modeling and forecasting the COVID-19 pandemic in Australia with a high degree of accuracy and in a timely manner using limited data; a valuable resource that can be used to guide government decision-making on societal restrictions on a daily and/or weekly basis. The "partially-observable stochastic process" used in this study predicts not only the future actual values with extremely low error, but also the percentage of unobserved COVID-19 cases in the population. The model can further assist policy makers to assess the effectiveness of several possible alternative scenarios in their decision-making processes.


Assuntos
Infecções por Coronavirus/epidemiologia , Modelos Estatísticos , Pneumonia Viral/epidemiologia , Austrália/epidemiologia , Betacoronavirus , Humanos , Pandemias
6.
J Med Imaging Radiat Oncol ; 64(5): 668-670, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: covidwho-807728

RESUMO

This case report describes our early radiological experiences of middle-aged patients with COVID-19 at Westmead Hospital, Sydney. We found limited relationship between initial CT imaging appearances and progression to severe disease. The most effective use of imaging in COVID-19 is yet to be determined.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Pneumopatias/virologia , Pneumonia Viral/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios X , Adulto , Austrália/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia
7.
Artigo em Inglês | MEDLINE | ID: mdl-33019735

RESUMO

A growing body of literature recognises the profound impact of adversity on mental health outcomes for people living in rural and remote areas. With the cumulative effects of persistent drought, record-breaking bushfires, limited access to quality health services, the COVID-19 pandemic and ongoing economic and social challenges, there is much to understand about the impact of adversity on mental health and wellbeing in rural populations. In this conceptual paper, we aim to review and adapt our existing understanding of rural adversity. We undertook a wide-ranging review of the literature, sought insights from multiple disciplines and critically developed our findings with an expert disciplinary group from across Australia. We propose that rural adversity be understood using a rural ecosystem lens to develop greater clarity around the dimensions and experiences of adversity, and to help identify the opportunities for interventions. We put forward a dynamic conceptual model of the impact of rural adversity on mental health and wellbeing, and close with a discussion of the implications for policy and practice. Whilst this paper has been written from an Australian perspective, it has implications for rural communities internationally.


Assuntos
Acesso aos Serviços de Saúde , Saúde Mental , População Rural , Austrália/epidemiologia , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia
8.
JMIR Public Health Surveill ; 6(4): e22305, 2020 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-33006559

RESUMO

BACKGROUND: Hand hygiene is one of the most effective ways to remove germs, prevent the spread of infectious pathogens, and avoid getting sick. Since the COVID-19 pandemic began, health authorities have been advocating good hand hygiene practices. OBJECTIVE: The primary aim of this study is to field test a prototype smart handwashing station deployed in a school setting during the COVID-19 pandemic. METHODS: We deployed a smart handwashing station and examined key technological considerations including connectivity, security, and data management systems, as well as the health and safety of users. RESULTS: The smart handwashing station was deployed for 10 days in a school setting in Australia during the COVID-19 pandemic. The smart handwashing station's electrical components remained operational during field testing and underwent robust cleaning protocols each day. The handwashing station was used 1138 times during the field test and there was no COVID-19 transmission at the school during the testing. CONCLUSIONS: This study demonstrates that a personalized feedback approach using technology can successfully be implemented at a school and can provide a platform to improve hand hygiene among school-aged children.


Assuntos
Infecções por Coronavirus/prevenção & controle , Desinfecção das Mãos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Instituições Acadêmicas , Austrália/epidemiologia , Criança , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
9.
Nat Commun ; 11(1): 4376, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32873808

RESUMO

Genomic sequencing has significant potential to inform public health management for SARS-CoV-2. Here we report high-throughput genomics for SARS-CoV-2, sequencing 80% of cases in Victoria, Australia (population 6.24 million) between 6 January and 14 April 2020 (total 1,333 COVID-19 cases). We integrate epidemiological, genomic and phylodynamic data to identify clusters and impact of interventions. The global diversity of SARS-CoV-2 is represented, consistent with multiple importations. Seventy-six distinct genomic clusters were identified, including large clusters associated with social venues, healthcare and cruise ships. Sequencing sequential samples from 98 patients reveals minimal intra-patient SARS-CoV-2 genomic diversity. Phylodynamic modelling indicates a significant reduction in the effective viral reproductive number (Re) from 1.63 to 0.48 after implementing travel restrictions and physical distancing. Our data provide a concrete framework for the use of SARS-CoV-2 genomics in public health responses, including its use to rapidly identify SARS-CoV-2 transmission chains, increasingly important as social restrictions ease globally.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Adulto , Austrália/epidemiologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/transmissão , Feminino , Genoma Viral , Genômica/métodos , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Pandemias , Filogenia , Pneumonia Viral/transmissão , Saúde Pública , Estudos Retrospectivos , Viagem
10.
Lancet Oncol ; 21(9): 1213-1223, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32888453

RESUMO

BACKGROUND: There is a strong unmet need to improve systemic therapy in mesothelioma. Chemotherapy with cisplatin and pemetrexed improves survival in malignant pleural mesothelioma, and immune checkpoint inhibitors are an emerging treatment in this disease. We aimed to evaluate the activity of durvalumab, an anti-PD-L1 antibody, given during and after first-line chemotherapy with cisplatin and pemetrexed in patients with advanced malignant pleural mesothelioma. METHODS: DREAM was a multicentre, single-arm, open-label, phase 2 trial done in nine hospitals in Australia. Eligible patients were aged 18 years or older and had histologically confirmed malignant pleural mesothelioma considered unsuitable for cancer-directed surgery, an Eastern Cooperative Oncology Group performance status of 0 or 1, and measurable disease as per the modified Response Evaluation Criteria in Solid Tumors version 1.0 (mRECIST) for mesothelioma that was previously untreated with systemic therapy. All histological subtypes were eligible. The first six participants were treated for two cycles in a safety run-in. All participants received cisplatin 75 mg/m2, pemetrexed 500 mg/m2, and durvalumab 1125 mg intravenously on day 1 of a 3-weekly schedule for a maximum of six cycles. Change from cisplatin to carboplatin with an area under the curve of 5 was permitted. Durvalumab was continued for a maximum of 12 months. The primary endpoint was progression-free survival at 6 months, measured according to mRECIST for malignant pleural mesothelioma and analysed in the intention-to-treat population. Safety analyses included all participants who receive at least one dose of any study drug. This study is registered with the Australia New Zealand Clinical Trials Registry, ACTRN12616001170415. FINDINGS: Between Dec 28, 2016, and Sept 27, 2017, 55 participants were enrolled. 54 patients were eligible and were followed up for a median of 28·2 months (IQR 26·5-30·2). 31 (57%; 95% CI 44-70) of 54 patients were alive and progression-free at 6 months. The most common grade 3-4 adverse events were neutropenia (seven [13%] patients), nausea (six [11%]), and anaemia (four [7%]). A total of 60 serious adverse events occurred in 29 participants, five of which were considered possibly related to durvalumab. Five patients died during the study treatment; none of these five deaths were attributed to study treatment. INTERPRETATION: The combination of durvalumab, cisplatin, and pemetrexed has promising activity and an acceptable safety profile that warrants further investigation in a randomised phase 3 trial. FUNDING: AstraZeneca.


Assuntos
Anticorpos Monoclonais/administração & dosagem , Cisplatino/administração & dosagem , Neoplasias Pulmonares/tratamento farmacológico , Mesotelioma/tratamento farmacológico , Pemetrexede/administração & dosagem , Neoplasias Pleurais/tratamento farmacológico , Adolescente , Adulto , Idoso , Anticorpos Anti-Idiotípicos/administração & dosagem , Anticorpos Anti-Idiotípicos/efeitos adversos , Anticorpos Monoclonais/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Austrália/epidemiologia , Antígeno B7-H1/antagonistas & inibidores , Antígeno B7-H1/genética , Cisplatino/efeitos adversos , Feminino , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/patologia , Masculino , Mesotelioma/genética , Mesotelioma/imunologia , Mesotelioma/patologia , Pessoa de Meia-Idade , Pemetrexede/efeitos adversos , Neoplasias Pleurais/genética , Neoplasias Pleurais/imunologia , Neoplasias Pleurais/patologia , Intervalo Livre de Progressão
12.
Artigo em Inglês | MEDLINE | ID: mdl-32938338

RESUMO

Background: Large gatherings are associated with the spread of coronavirus 2019 disease (COVID-19); however, transmission dynamics are not well understood. We investigated a cluster of COVID-19 cases in returning Australian residents who attended wedding events in Bali, Indonesia, during 15- 21 March 2020. Attendees participated in various social events and were in close proximity, providing multiple opportunities for transmission. Methods: We conducted a retrospective cohort study of the 41 attendees, of whom 17 participated in a structured interview that included history of illness, risk exposures and event attendance. We obtained data for the remaining 24 participants through corroborative histories and public health unit case investigations. Results: COVID-19 was identified in 56% of attendees (23/41), with illness onset between 21 March and 2 April 2020. One secondary case was identified in a household contact of an attendee. The median age of cases was 31 years (range 3-64). One case was hospitalised and did not require critical care. There were no deaths. No cases occurred among six attendees who left prior to the actual wedding day. Guests attended multiple events and participated in high-risk transmission behaviours such as shaking hands, kissing, dancing, sharing drinks and sharing shisha (water pipes). Attack rates ranged from 64% to 87% for different exposures. We could not identify a single risk exposure that accounted for all cases; it is therefore likely there were multiple episodes of transmission. Conclusion: Our investigation identified a high attack rate of COVID-19 among a cohort of wedding event attendees. Attendees engaged in close physical contact, shared drinks and shisha, and were in close proximity during the wedding events, which may have contributed to the high attack rate. This outbreak highlights the significant role social events can play in transmission of COVID-19 and underscores why it is important to limit gatherings and close physical contact to control the spread of the virus.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Austrália/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Busca de Comunicante , Infecções por Coronavirus/transmissão , Feminino , Humanos , Indonésia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/transmissão , Estudos Retrospectivos , Adulto Jovem
13.
Crit Care Resusc ; 22(3): 237-244, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32900330

RESUMO

OBJECTIVES: To describe the characteristics and outcomes of adults with a subarachnoid haemorrhage (SAH) admitted to Australian and New Zealand intensive care units (ICUs) with a cardiac arrest in the preceding 24 hours. DESIGN: Retrospective cohort study. SETTING: Study data from 144 Australian and New Zealand ICUs were obtained from the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database. PARTICIPANTS: A total of 439 of 11 047 (3.9%) patients admitted to an ICU with a SAH had a documented cardiac arrest in the 24 hours preceding their ICU admission. The mean age of patients with SAH and a preceding cardiac arrest was 55.3 years (SD, 13.7) and 251 of 439 (57.2%) were female. MAIN OUTCOME MEASURES: The primary outcome of interest was in-hospital mortality. Key secondary outcomes were ICU mortality, ICU and hospital lengths of stay, the proportion of patients discharged home. RESULTS: SAH patients with a history of cardiac arrest preceding ICU admission had a higher mortality rate (81.5% v 23.3%; P < 0.0001) and a lower rate of discharge home (4.6% v 37.0%; P < 0.0001) compared with patients with SAH who did not have a cardiac arrest. Among patients with SAH who had a cardiac arrest and survived, 20 of 81 (24.7%) were discharged home. In SAH patients with cardiac arrest, having a GCS of 3, the Australian and New Zealand Risk of Death score, and being admitted to ICU for palliative care or organ donation were significant predictors of in-hospital death. CONCLUSIONS: Almost one in five SAH patients who had a documented cardiac arrest in the 24 hours preceding ICU admission to an Australian and New Zealand ICU survived to hospital discharge, with around a quarter of these survivors discharged home. The neurological outcomes of these patients are uncertain, and understanding the burden of disability in survivors is an important area for further research.


Assuntos
Parada Cardíaca/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Hemorragia Subaracnóidea/mortalidade , Adulto , Austrália/epidemiologia , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Estudos Retrospectivos , Hemorragia Subaracnóidea/terapia
14.
Artigo em Inglês | MEDLINE | ID: mdl-32907528

RESUMO

Cumulatively to 30 August there have been 25,686 case notifications and 577 deaths. The number of new cases reported nationally this fortnight was 1,751, a 61% decrease from the previous fortnight (4,501). On average this represented 125 cases diagnosed each day over the reporting period, a decrease from 322 cases per day over the previous reporting period. 94% (1,640) of all cases were reported in Victoria, with a smaller number of cases reported from New South Wales (86), Queensland (19), Western Australia (5) and South Australia (1). In Victoria, the majority of cases (1,528; 93%) were locally acquired, with a further 112 (7%) under investigation at the time of analysis, but likely also to be locally acquired. Of the remaining 111 cases reported, 22 (20%) were overseas acquired; 82 (74%) were locally acquired, predominantly in NSW, and 7 (6%) were reported as under investigation. The continued decrease in new cases observed this fortnight in Victoria is likely associated with the enhanced public health measures that are currently in place in Victoria. Locally acquired cases which were predominantly associated with several interconnected clusters continued to be reported in NSW. In Qld a cluster of cases associated with a youth detention centre was identified. A total of 26 deaths were reported from cases diagnosed in this reporting period, all from Victoria and aged 75 years or older. Testing rates remain high across all jurisdictions, with an overall positivity rate for the reporting period of 0.27%. Victoria reported a positivity rate of 0.90% for this reporting period; in all other jurisdictions the positivity rate was 0.03% or lower.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Betacoronavirus/genética , Criança , Pré-Escolar , Análise por Conglomerados , Infecções por Coronavirus/mortalidade , Saúde Global , Humanos , Lactente , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos , Pandemias , Pneumonia Viral/mortalidade , Administração em Saúde Pública , Adulto Jovem
15.
Intern Med J ; 50(8): 924-930, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32881266

RESUMO

BACKGROUND: Infectious diseases (ID) physicians perform a pivotal role in directing the response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). AIM: To assess the impact of SARS-CoV-2 on workload and the perceptions of ID physicians regarding the national response in Australia and New Zealand in the pre-pandemic. METHODS: A survey of ID physicians in Australia and New Zealand was undertaken from 3 to 10 March 2020. Respondents were asked to estimate time spent on SARS-CoV-2-related activities in February and report their agreement with statements on a 5-point Likert scale ranging from 'strongly agree' to 'strongly disagree'. We also asked about the intended use of investigational agents. RESULTS: There were 214 respondents (36% of 600 eligible participants). The median workload due to SARS-CoV-2-related activities was 34% of one full-time equivalent (interquartile range 18-68%). Less than a quarter (50, 23%) of respondents had experience managing cases, while 33% (70) had experience preparing during similar pandemics. Nevertheless, 88% (188/213) believed they were well informed when giving testing and management advice, and 45% (95/212) believed their national response was well coordinated. Additionally, 41% (88/214) were worried about becoming infected through occupational exposure. Over half (116, 54%) the respondents intended to use lopinavir/ritonavir in confirmed cases of COVID-19 with severe disease. CONCLUSIONS: ID physicians spent a large proportion of time on SARS-CoV-2-related activities. Increased staffing is required to avoid burnout. Importantly, ID physicians feel well informed when giving advice. A national body should be established to co-ordinate response. Treatment efficacy trials are needed to clarify the utility of unproven treatments.


Assuntos
Infecções por Coronavirus , Pandemias , Médicos , Pneumonia Viral , Austrália/epidemiologia , Betacoronavirus , Esgotamento Profissional/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Infecções/epidemiologia , Nova Zelândia/epidemiologia , Pandemias/prevenção & controle , Papel do Médico , Médicos/psicologia , Médicos/provisão & distribução , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Psicologia , Inquéritos e Questionários , Carga de Trabalho
16.
Intern Med J ; 50(8): 918-923, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32881275

RESUMO

The novel Coronavirus disease 2019 (COVID-19) outbreak has led to rapid and profound changes in healthcare system delivery and society more broadly. Older adults, and those living with chronic or life-limiting conditions, are at increased risk of experiencing severe or critical symptoms associated with COVID-19 infection and are more likely to die. They may also experience non-COVID-19 related deterioration in their health status during this period. Advance care planning (ACP) is critical for this cohort, yet there is no coordinated strategy for increasing the low rates of ACP uptake in these groups, or more broadly. This paper outlines a number of key reasons why ACP is an urgent priority, and should form a part of the health system's COVID-19 response strategy. These include reducing the need for rationing, planning for surges in healthcare demand, respecting human rights, enabling proactive care coordination and leveraging societal change. We conclude with key recommendations for policy and practice in the system-wide implementation of ACP, to enable a more ethical, coordinated and person-centred response in the COVID-19 context.


Assuntos
Planejamento Antecipado de Cuidados , Infecções por Coronavirus , Assistência à Saúde , Pandemias , Pneumonia Viral , Planejamento Antecipado de Cuidados/ética , Planejamento Antecipado de Cuidados/organização & administração , Fatores Etários , Austrália/epidemiologia , Betacoronavirus , Deterioração Clínica , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Estado Terminal/terapia , Assistência à Saúde/organização & administração , Assistência à Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Direitos Humanos , Humanos , Inovação Organizacional , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia
19.
PLoS One ; 15(9): e0237469, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32870911

RESUMO

BACKGROUND: It is estimated that approximately half of new HIV diagnoses among heterosexual migrants in Victoria, Australia, were acquired post-migration. We investigated the characteristics of phylogenetic clusters in notified cases of HIV among heterosexual migrants. METHODS: Partial HIV pol sequences obtained from routine clinical genotype tests were linked to Victorian HIV notifications with the following exposures listed on the notification form: heterosexual sexual contact, injecting drug use, bisexual sexual contact, male-to male sexual contact or heterosexual sexual contact in combination with injecting drug use, unknown exposure. Those with heterosexual sexual contact as the only exposure were the focus of this study, with the other exposures included to better understand transmission networks. Additional reference sequences were extracted from the Los Alamos database. Maximum likelihood methods were used to infer the phylogeny and the robustness of the resulting tree was assessed using bootstrap analysis. Phylogenetic clusters were defined on the basis of bootstrap and genetic distance. RESULTS: HIV pol sequences were available for 332 of 445 HIV notifications attributed to only heterosexual sexual contact in Victoria from 2005-2014. Forty-three phylogenetic clusters containing at least one heterosexual migrant were detected, 30 (70%) of which were pairs. The characteristics of these phylogenetic clusters varied considerably by cluster size. Pairs were more likely to be composed of people living with HIV from a single country of birth (p = 0.032). Larger clusters (n≥3) were more likely to contain people born in Australian/New Zealand (p = 0.002), migrants from more than one country of birth (p = 0.013) and viral subtype-B, the most common subtype in Australia (p = 0.006). Pairs were significantly more likely to contain females (p = 0.037) and less likely to include HIV diagnoses with male-to-male sexual contact reported as a possible exposure (p<0.001) compared to larger clusters (n≥3). CONCLUSION: Migrants appear to be at elevated risk of HIV acquisition, in part due to intimate relationships between migrants from the same country of origin, and in part due to risks associated with the broader Australian HIV epidemic. However, there was no evidence of large transmission clusters driven by heterosexual transmission between migrants. A multipronged approach to prevention of HIV among migrants is warranted.


Assuntos
Infecções por HIV/epidemiologia , HIV/genética , Filogenia , Adulto , Austrália/epidemiologia , Análise por Conglomerados , Feminino , HIV/isolamento & purificação , Infecções por HIV/diagnóstico , HIV-1/genética , HIV-1/isolamento & purificação , Heterossexualidade , Humanos , Masculino , Pessoa de Meia-Idade , Migrantes , Produtos do Gene pol do Vírus da Imunodeficiência Humana/genética
20.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32943535

RESUMO

Potential long-lasting adverse effects of child maltreatment have been widely reported, although little is known about the distinctive long-term impact of differing types of maltreatment. Our objective for this special article is to integrate findings from the Mater-University of Queensland Study of Pregnancy, a longitudinal prenatal cohort study spanning 2 decades. We compare and contrast the associations of specific types of maltreatment with long-term cognitive, psychological, addiction, sexual health, and physical health outcomes assessed in up to 5200 offspring at 14 and/or 21 years of age. Overall, psychological maltreatment (emotional abuse and/or neglect) was associated with the greatest number of adverse outcomes in almost all areas of assessment. Sexual abuse was associated with early sexual debut and youth pregnancy, attention problems, posttraumatic stress disorder symptoms, and depression, although associations were not specific for sexual abuse. Physical abuse was associated with externalizing behavior problems, delinquency, and drug abuse. Neglect, but not emotional abuse, was associated with having multiple sexual partners, cannabis abuse and/or dependence, and experiencing visual hallucinations. Emotional abuse, but not neglect, revealed increased odds for psychosis, injecting-drug use, experiencing harassment later in life, pregnancy miscarriage, and reporting asthma symptoms. Significant cognitive delays and educational failure were seen for both abuse and neglect during adolescence and adulthood. In conclusion, child maltreatment, particularly emotional abuse and neglect, is associated with a wide range of long-term adverse health and developmental outcomes. A renewed focus on prevention and early intervention strategies, especially related to psychological maltreatment, will be required to address these challenges in the future.


Assuntos
Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/estatística & dados numéricos , Adolescente , Comportamento do Adolescente , Asma/epidemiologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/epidemiologia , Austrália/epidemiologia , Estatura , Criança , Cognição , Estudos de Coortes , Gorduras na Dieta/administração & dosagem , Escolaridade , Feminino , Humanos , Inteligência , Estudos Longitudinais , Transtornos Mentais/epidemiologia , Gravidez , Gravidez na Adolescência/estatística & dados numéricos , Qualidade de Vida , Comportamento Sexual , Transtornos do Sono-Vigília/epidemiologia , Evasão Escolar/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Adulto Jovem
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