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1.
Comunidad (Barc., Internet) ; 22(2): 0-0, jul.-oct. 2020. ilus, tab, mapas
Artigo em Espanhol | IBECS | ID: ibc-193594

RESUMO

INTRODUCCIÓN: el modelo de los activos comunitarios se caracteriza por fomentar condiciones de salud que potencian las capacidades y habilidades individuales y colectivas. El objetivo de este proyecto ha sido identificar el mapa de activos en salud del barrio Arturo Eyries de Valladolid, para promover la prescripción social por parte del personal sanitario y hacer más visibles los recursos de los que dispone la comunidad. METODOLOGÍA: se han utilizado diferentes técnicas de mapeo: búsqueda de datos en internet, redes sociales, periódicos, paseos por el barrio, entrevistas, mapas mudos y fotovoz. Se incluyeron pacientes y profesionales sanitarios del Centro de Salud Arturo Eyries. RESULTADOS: se ha recogido información de un total de 40 participantes: 10 profesionales sanitarios y 30 pacientes del centro de salud. El resultado de esta investigación fueron 37 activos clasificados en seis categorías: sanidad, ocio y cultura, apoyo social, educación, ejercicio físico y transporte. Con todo esto se ha creado un fichero de activos, un mapa del barrio, una página web, un tríptico y una sesión clínica para los profesionales del centro. CONCLUSIONES: este proyecto de mapeo constituye el punto de partida para mejorar el conocimiento que los profesionales sanitarios y los pacientes tienen sobre los recursos de salud de su entorno. Este trabajo representa el inicio de una red para la promoción de la salud, dirigida a implicar a instituciones y responsables políticos en la creación de una cartografía común, a nivel ciudad o incluso comunidad autónoma, de activos para la salud


INTRODUCTION: The community assets model is characterized by fostering health conditions that enhance individual and collective capacities and abilities. The aim of this project has been to identify the map of health assets in the Arturo Eyries neighbourhood of Valladolid to promote social prescription by health personnel, and to make the resources available to the community more visible. METHODOLOGY: Different mapping techniques have been used: internet data search, social networks, newspapers, walks around the neighbourhood, interviews, silent maps and photovoice. Patients and health professionals from the Arturo Eyries health centre were included in this study. RESULTS: Information was collected from a total of 40 participants: 10 health professionals and 30 health centre patients. The result of this research was 37 assets classified into six categories: health, leisure and culture, social support, education, physical exercise and transport. With all this, an asset file, a map of the neighbourhood, a web page, a leaflet and a clinical session for the centre's professionals were created. CONCLUSIONS: This mapping project is the starting point for improving the knowledge that health professionals and patients have about the health resources of their environment. This work represents the beginning of a network for health promotion, and we would like to involve institutions and the politicians in the creation of common mapping, at local or regional level, of health assets


Assuntos
Humanos , Promoção da Saúde/métodos , Medicina Comunitária , Pessoal de Saúde , Prática Clínica Baseada em Evidências , Características de Residência , Nível de Saúde , Espanha
2.
BMC Public Health ; 20(1): 1486, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32998719

RESUMO

BACKGROUND: The state of Ceará (Northeast Brazil) has shown a high incidence of coronavirus disease (COVID-19), and most of the cases that were diagnosed during the epidemic originated from the capital Fortaleza. Monitoring the dynamics of the COVID-19 epidemic is of strategic importance and requires the use of sensitive tools for epidemiological surveillance, including consistent analyses that allow the recognition of areas with a greater propensity for increased severity throughout the cycle of the epidemic. This study aims to classify neighborhoods in the city of Fortaleza according to their propensity for a severe epidemic of COVID-19 in 2020. METHODS: We conducted an ecological study within the geographical area of the 119 neighborhoods located in the city of Fortaleza. To define the main transmission networks (infection chains), we assumed that the spatial diffusion of the COVID-19 epidemic was influenced by population mobility. To measure the propensity for a severe epidemic, we calculated the infectivity burden (ItyB), infection burden (IonB), and population epidemic vulnerability index (PEVI). The propensity score for a severe epidemic in the neighborhoods of the city of Fortaleza was estimated by combining the IonB and PEVI. RESULTS: The neighborhoods with the highest propensity for a severe COVID-19 epidemic were Aldeota, Cais do Porto, Centro, Edson Queiroz, Vicente Pinzon, Jose de Alencar, Presidente Kennedy, Papicu, Vila Velha, Antonio Bezerra, and Cambeba. Importantly, we found that the propensity for a COVID-19 epidemic was high in areas with differing socioeconomic profiles. These areas include a very poor neighborhood situated on the western border of the city (Vila Velha), neighborhoods characterized by a large number of subnormal agglomerates in the Cais do Porto region (Vicente Pinzon), and those located in the oldest central area of the city, where despite the wealth, low-income groups have remained (Aldeota and the adjacent Edson Queiroz). CONCLUSION: Although measures against COVID-19 should be applied to the entire municipality of Fortaleza, the classification of neighborhoods generated through this study can help improve the specificity and efficiency of these measures.


Assuntos
Infecções por Coronavirus/epidemiologia , Epidemias , Pneumonia Viral/epidemiologia , Características de Residência/estatística & dados numéricos , Brasil/epidemiologia , Cidades/epidemiologia , Humanos , Incidência , Pandemias
3.
Rev Bras Epidemiol ; 23: e200102, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33027437

RESUMO

INTRODUCTION: The complexity of urbanization processes across Latin American societies encourages investigating its implications in health conditions, especially during childhood. One of the possible links between them is recreation, a component of the daily life of children and, therefore, essential to produce health and life itself. The objective of this study was to examine the associations between neighborhood context and active public park use among school-aged children in Cordoba, Argentina. METHODS: A cross-sectional study was conducted with 1466 children, aged 9 to 11, attending 19 schools and living in 110 neighborhoods. Multilevel models with Poisson distribution were used for the analyses, stratified by gender. Socio-demographic, behavioral, and physical covariates were included at the individual level, and socioeconomic neighborhood conditions at second level. RESULTS: Girls residing in neighborhoods with a worse socioeconomic context were less likely to report frequent public park use for physical activity, while those from neighborhoods with better socioeconomic conditions were more likely to, regardless of individual characteristics. CONCLUSION: This study suggests that socioeconomic conditions of neighborhoods are associated with public park use for physical activity in school-aged girls, demonstrating gender inequality in the use and appropriation of public spaces.


Assuntos
Exercício Físico , Parques Recreativos/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Argentina , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Análise Multinível , Fatores Socioeconômicos
4.
Artigo em Inglês | MEDLINE | ID: mdl-33031651

RESUMO

Objective: Amid the ongoing coronavirus disease 2019 (COVID-19) pandemic, health care workers of multiple disciplines have been designated as frontline doctors. This unforeseen situation has led to psychological problems among these health care workers. The objective of this study was to evaluate the mental health status of pan-Indian frontline doctors combating the COVID-19 pandemic. Methods: A cross-sectional, observational study was conducted among frontline doctors of tertiary care hospitals in India (East: Kolkata, West Bengal; North: New Delhi; West: Nagpur, Maharashtra; and South: Thiruvananthapuram, Kerala) from May 23, 2020, to June 6, 2020. Doctors involved in clinical services in outpatient departments, designated COVID-19 wards, screening blocks, fever clinics, and intensive care units completed an online questionnaire. The 9-item Patient Health Questionnaire and the Perceived Stress Scale were used to assess depression and perceived stress. Results: The results of 422 responses revealed a 63.5% and 45% prevalence of symptoms of depression and stress, respectively, among frontline COVID-19 doctors. Postgraduate trainees constituted the majority (45.5%) of the respondents. Moderately severe and severe depression was noted in 14.2% and 3.8% of the doctors, respectively. Moderate and severe stress was noted in 37.4% and 7.6% of participants, respectively. Multivariate regression analysis showed working ≥ 6 hours/day (adjusted odds ratio: 3.5; 95% CI, 1.9-6.3; P < .0001) to be a significant risk factor for moderate or severe perceived stress, while single relationship status (adjusted odds ratio: 2.9; 95% CI, 1.5-5.9; P = .002) and working ≥ 6 hours/day (adjusted odds ratio: 10.3; 95% CI, 4.3-24.6; P < .0001) significantly contributed to the development of moderate, moderately severe, or severe depression. Conclusions: The pandemic has taken a serious toll on the physical and mental health of doctors, as evident from our study. Regular screening of medical personnel involved in the diagnosis and treatment of patients with COVID-19 should be conducted to evaluate for stress, anxiety, and depression.


Assuntos
Infecções por Coronavirus , Depressão/epidemiologia , Transtorno Depressivo/epidemiologia , Pandemias , Médicos/psicologia , Pneumonia Viral , Estresse Psicológico/epidemiologia , Adulto , Betacoronavirus , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Internato e Residência , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Admissão e Escalonamento de Pessoal , Médicos/estatística & dados numéricos , Prevalência , Características de Residência , Fatores de Risco , Carga de Trabalho , Adulto Jovem
5.
MMWR Morb Mortal Wkly Rep ; 69(39): 1416-1418, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33001871

RESUMO

Preventing transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), in institutes of higher education presents a unique set of challenges because of the presence of congregate living settings and difficulty limiting socialization and group gatherings. Before August 2020, minimal data were available regarding COVID-19 outbreaks in these settings. On August 3, 2020, university A in North Carolina broadly opened campus for the first time since transitioning to primarily remote learning in March. Consistent with CDC guidance at that time (1,2), steps were taken to prevent the spread of SARS-CoV-2 on campus. During August 3-25, 670 laboratory-confirmed cases of COVID-19 were identified; 96% were among patients aged <22 years. Eighteen clusters of five or more epidemiologically linked cases within 14 days of one another were reported; 30% of cases were linked to a cluster. Student gatherings and congregate living settings, both on and off campus, likely contributed to the rapid spread of COVID-19 within the university community. On August 19, all university A classes transitioned to online, and additional mitigation efforts were implemented. At this point, 334 university A-associated COVID-19 cases had been reported to the local health department. The rapid increase in cases within 2 weeks of opening campus suggests that robust measures are needed to reduce transmission at institutes of higher education, including efforts to increase consistent use of masks, reduce the density of on-campus housing, increase testing for SARS-CoV-2, and discourage student gatherings.


Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Pneumonia Viral/epidemiologia , Universidades , Adolescente , Adulto , Infecções por Coronavirus/transmissão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Pandemias , Pneumonia Viral/transmissão , Características de Residência , Comportamento Social , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Adulto Jovem
6.
PLoS One ; 15(10): e0240007, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33017438

RESUMO

About 50% of individuals infected with the novel Coronavirus (SARS-CoV-2) suffer from intestinal infection as well as respiratory infection. They shed virus in their stool. Municipal sewage systems carry the virus and its genetic remnants. These viral traces can be detected in the sewage entering a wastewater treatment plant (WTP). Such virus signals indicate community infections but not locations of the infection within the community. In this paper, we frame and formulate the problem in a way that leads to algorithmic procedures homing in on locations and/or neighborhoods within the community that are most likely to have infections. Our data source is wastewater sampled and real-time tested from selected manholes. Our algorithms dynamically and adaptively develop a sequence of manholes to sample and test. The algorithms are often finished after 5 to 10 manhole samples, meaning that-in the field-the procedure can be carried out within one day. The goal is to provide timely information that will support faster more productive human testing for viral infection and thus reduce community disease spread. Leveraging the tree graph structure of the sewage system, we develop two algorithms, the first designed for a community that is certified at a given time to have zero infections and the second for a community known to have many infections. For the first, we assume that wastewater at the WTP has just revealed traces of SARS-CoV-2, indicating existence of a "Patient Zero" in the community. This first algorithm identifies the city block in which the infected person resides. For the second, we home in on a most infected neighborhood of the community, where a neighborhood is usually several city blocks. We present extensive computational results, some applied to a small New England city.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Fezes/virologia , Pandemias , Pneumonia Viral , Características de Residência , Esgotos/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Massachusetts , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia
7.
Acta amaz ; 50(3): 246-251, jul. - set. 2020.
Artigo em Inglês | LILACS | ID: biblio-1118846

RESUMO

The common opossum, Didelphis marsupialis thrives near human settlements. Understanding its ecology could help planning management decisions about this species, especially in anthropogenic landscapes. Yet, there are no density estimations for this species throughout its distribution range in Bolivia. We estimated the density of D. marsupialis in a rural agricultural community, where agroforestry plantations and fallows cover most of the land. We counted individuals in line transects and used DISTANCE software to calculate density. We covered a total of 70.21 km in 143 night counts, obtaining 38 records of D. marsupialis. We estimated a density of 0.30 individuals ha-1 (SE = 0.062; range: 0.20 - 0.45 individuals ha-1), with a mean encounter rate of 0.54 individuals km-1. Encounter rate varied between habitats, with mean values of 0.20 in secondary forests and 0.64 in agroforestry plantations. Our density estimate is near the lower range of previously reported values for the common opossum in other countries. We argue that our results may reflect the response to the availability of food resources and predation pressure in agroforestry plantations. (AU)


Assuntos
Assentamentos Humanos , Características de Residência , Densidade Demográfica , Recursos Alimentares , Didelphis
8.
Rev Esp Salud Publica ; 942020 09 16.
Artigo em Espanhol | MEDLINE | ID: mdl-32935664

RESUMO

OBJECTIVE: Social determinants and health inequalities have a huge impact on health of populations. It is important to study their role in the management of the Covid-19 epidemic, especially in cities, as certain variables like the number of tests and the access to health system cannot be assumed as equal. The aim of this work was to determine the relation of social determinants in the incidence of Covid-19 in the city of Barcelona. METHODS: An observational retrospective ecological study was performed, with the neighbourhood as the population unit, based on data of cumulative incidence published at May 14th, 2020 by the Public Health Agency of Barcelona. Covid-19 incidence disparities depending on the income of the neighbourhoods, the Pearson linear correlation of the variables selected (age, sex, net density, immigrants, comorbidities, smokers, Body Mass Index [BMI] and Available Income per Family Index [AIFI]) with the incidence and the correlation with a multivariant Generalized Linear Model (GLM) were estimated. RESULTS: It was found that neighbourhoods belonging to the lowest quintile of income had a 42% more incidence than those belonging to the highest quintile: 942 cases per 100,000 inhabitants versus 545 per 100,000 inhabitants of the highest quintile. The Pearson correlation was statistically significative between the incidence of Covid-19 and the percentage of population over 75 (r=0.487), the percentage of immigration of the neighbourhood and the origin of the immigrants (r=-0.257), the AIFI (r=-0.462), the percentage of smokers (r=0.243) and the percentage of people with BMI over 25 (r=0.483). The GLM showed that the most correlated variables with the incidence are the percentage of people over 75 (Z-score=0.258), the percentage of people from Maghreb (Z-score=-0.206) and Latin America (Z-score=0.19) and the percentage of people with BMI over 25 (Z-score=0.334). The results of the GLM were significative. CONCLUSIONS: Social determinants are correlated with the modification of the incidence of Covid-19 in the neighbourhoods of Barcelona, with special relevance of the prevalence of BMI over 25 and the percentage of immigrants and its origin.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Determinantes Sociais da Saúde , Adulto , Betacoronavirus , Índice de Massa Corporal , Emigrantes e Imigrantes , Emigração e Imigração , Feminino , Acesso aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Características de Residência , Estudos Retrospectivos , Fumar , Fatores Socioeconômicos , Espanha/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-32962038

RESUMO

Background: Infections are a leading cause of refugee morbidity. Recent data on the rate of airway infections and factors influencing their spread in refugee reception centers is scarce. Methods: A retrospective, cross-sectional study of de-identified medical records with a focus on respiratory infections in underage refugees was conducted at two large German refugee reception centers. Results: In total, medical data from n = 10,431 refugees over an observational period of n = 819 days was analyzed. Among pediatric patients (n = 4289), 55.3% presented at least once to the on-site medical ward with an acute respiratory infection or signs thereof. In 38.4% of pediatric consultations, acute airway infections or signs thereof were present. Airway infections spiked during colder months and were significantly more prevalent amongst preschool and resettled children. Their frequency displayed a positive correlation with the number of refugees housed at the reception centers. Conclusions: We show that respiratory infections are a leading cause for morbidity in young refugees and that their rate is influenced age, season, status, and residential density. This illustrates the need to protect refugee children from contracting airway infections which may also reduce the spread of coronavirus disease 2019 (COVID-19) during the current pandemic.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Refugiados/estatística & dados numéricos , Infecções Respiratórias/epidemiologia , Migrantes/estatística & dados numéricos , Betacoronavirus , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Humanos , Pneumonia Viral/epidemiologia , Habitação Popular , Características de Residência , Estudos Retrospectivos
10.
BMC Med ; 18(1): 271, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32883276

RESUMO

BACKGROUND: New York City was the first major urban center of the COVID-19 pandemic in the USA. Cases are clustered in the city, with certain neighborhoods experiencing more cases than others. We investigate whether potential socioeconomic factors can explain between-neighborhood variation in the COVID-19 test positivity rate. METHODS: Data were collected from 177 Zip Code Tabulation Areas (ZCTA) in New York City (99.9% of the population). We fit multiple Bayesian Besag-York-Mollié (BYM) mixed models using positive COVID-19 tests as the outcome, a set of 11 representative demographic, economic, and health-care associated ZCTA-level parameters as potential predictors, and the total number of COVID-19 tests as the exposure. The BYM model includes both spatial and nonspatial random effects to account for clustering and overdispersion. RESULTS: Multiple regression approaches indicated a consistent, statistically significant association between detected COVID-19 cases and dependent children (under 18 years old), population density, median household income, and race. In the final model, we found that an increase of only 5% in young population is associated with a 2.3% increase in COVID-19 positivity rate (95% confidence interval (CI) 0.4 to 4.2%, p=0.021). An increase of 10,000 people per km2 is associated with a 2.4% (95% CI 0.6 to 4.2%, p=0.011) increase in positivity rate. A decrease of $10,000 median household income is associated with a 1.6% (95% CI 0.7 to 2.4%, p<0.001) increase in COVID-19 positivity rate. With respect to race, a decrease of 10% in White population is associated with a 1.8% (95% CI 0.8 to 2.8%, p<0.001) increase in positivity rate, while an increase of 10% in Black population is associated with a 1.1% (95% CI 0.3 to 1.8%, p<0.001) increase in positivity rate. The percentage of Hispanic (p=0.718), Asian (p=0.966), or Other (p=0.588) populations were not statistically significant factors. CONCLUSIONS: Our findings indicate associations between neighborhoods with a large dependent youth population, densely populated, low-income, and predominantly black neighborhoods and COVID-19 test positivity rate. The study highlights the importance of public health management during and after the current COVID-19 pandemic. Further work is warranted to fully understand the mechanisms by which these factors may have affected the positivity rate, either in terms of the true number of cases or access to testing.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Características de Residência , Fatores Socioeconômicos , Adolescente , Teorema de Bayes , Betacoronavirus , Criança , Feminino , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Pandemias , Pobreza
11.
Nat Commun ; 11(1): 4674, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938924

RESUMO

SARS-CoV-2-related mortality and hospitalizations differ substantially between New York City neighborhoods. Mitigation efforts require knowing the extent to which these disparities reflect differences in prevalence and understanding the associated drivers. Here, we report the prevalence of SARS-CoV-2 in New York City boroughs inferred using tests administered to 1,746 pregnant women hospitalized for delivery between March 22nd and May 3rd, 2020. We also assess the relationship between prevalence and commuting-style movements into and out of each borough. Prevalence ranged from 11.3% (95% credible interval [8.9%, 13.9%]) in Manhattan to 26.0% (15.3%, 38.9%) in South Queens, with an estimated city-wide prevalence of 15.6% (13.9%, 17.4%). Prevalence was lowest in boroughs with the greatest reductions in morning movements out of and evening movements into the borough (Pearson R = -0.88 [-0.52, -0.99]). Widespread testing is needed to further specify disparities in prevalence and assess the risk of future outbreaks.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Características de Residência/estatística & dados numéricos , Transportes/estatística & dados numéricos , Adolescente , Adulto , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Feminino , Disparidades nos Níveis de Saúde , Humanos , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Gestantes , Prevalência , Adulto Jovem
12.
Int J Equity Health ; 19(1): 153, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907584

RESUMO

BACKGROUND: The first wave of the Covid-19 pandemic hit Israel in late February 2020. The present study examines patterns of the first wave of Covid-19 morbidity in Israel at the macro level, during the period of late February to early June 2020, when the first wave has faded out. The analysis focuses on the significance of four sociodemographic variables: socioeconomic status, population density, rate of elderly population and minority status (Jewish / Arab identity) of the population in cities with 5000 residents or more. Additionally, we take a closer look into the association between morbidity rates and one SES component - home Internet access. METHODS: The article is a cross sectional study of morbidity rates, investigated on a residential community basis. Following the descriptive statistics, we move on to present multivariate analysis to explore associations between these variables and Covid-19 morbidity in Israel. RESULTS: Both the descriptive statistics and regressions show morbidity rates to be positively associated with population density. Socioeconomic status as well as the size of elderly population were both significantly related to morbidity, but only in Jewish communities. Interestingly, the association was inverse in both cases. i.e., the higher the SES the lower the morbidity and the larger the elderly population, the lower the community's morbidity. Another interesting result is that overall, morbidity rates in Jewish cities were consistently higher than in Arab communities. CONCLUSIONS: We attribute the low morbidity rates in communities with relatively small elderly populations to the exceptionally high fertility rates in ultra-orthodox communities that sustained increased rates of morbidity; the lower morbidity in Arab communities is attributed to several factors, including the spatial Jewish-Arab segregation.


Assuntos
Árabes/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Judeus/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Características de Residência/estatística & dados numéricos , Idoso , Estudos Transversais , Humanos , Israel/epidemiologia , Morbidade/tendências , Densidade Demográfica , Classe Social
13.
Ann Epidemiol ; 49: 42-49, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32951804

RESUMO

PURPOSE: The ongoing coronavirus disease 2019 (COVID-19) severely impacted both health and the economy. Absent an effective vaccine, preventive measures used, some of which are being relaxed, have included school closures, restriction of movement, and banning of large gatherings. Our goal was to estimate the association of voter turnout with county-level COVID-19 risks. METHODS: We used publicly available data on voter turnout in the March 10 primary in three states, COVID-19 confirmed cases by day and county, and county-level census data. We used zero-inflated negative binomial regression to estimate the association of voter turnout with COVID-19 incidence, adjusted for county-level population density and proportions: over age 65 years, female, Black, with college education, with high school education, poor, obese, and smokers. RESULTS: COVID-19 risk was associated with voter turnout, most strongly in Michigan during the week starting 3 days postelection (risk ratio, 1.24; 95% confidence interval, 1.16-1.33). For longer periods, the association was progressively weaker (risk ratio 0.98-1.03). CONCLUSIONS: Despite increased absentee-ballot voting in the primary, our results suggest an association of voter turnout in at least one state with a detectable increase in risks associated with and perhaps due to greater exposures related to the primary.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Política , Distância Social , Infecções por Coronavirus/epidemiologia , Humanos , Incidência , Governo Local , Pneumonia Viral/epidemiologia , Características de Residência , Fatores de Risco , Fatores Socioeconômicos
14.
J UOEH ; 42(3): 251-259, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32879189

RESUMO

Preventing cardiovascular disease (CVD) is an urgent public health challenge. Although brachial-ankle pulse wave velocity (baPWV) can indicate the risk of arterial stiffness and CVD, findings regarding whether baPWV is associated with smoking are inconsistent. This study considered the influence of smoking on arteriosclerosis, specifically focusing on secondhand smoke (SHS), and aimed to construct a strategy for preventing the worsening of arteriosclerosis. We recruited 295 male employees from five companies who had smoking habits such as being smokers, living with smokers, and exposure to SHS outside the home. We measured body composition and hemodynamics, including blood pressure and baPWV, and found that baPWV had significant positive correlations with age, smoking index, alcohol consumption, body-fat percentage, blood pressure, and heart rate, and significant negative correlations with height, fat-free mass, and lower-limb muscle mass. Moreover, baPWV showed a significant adverse effect on participants who had metabolic syndrome (MetS) risk factors such as hypertension, dyslipidemia, and diabetes. Multiple regression analysis showed that baPWV had significant positive relationships with age, height, MetS risk factors, cohabitation with smokers, blood pressure, and heart rate, and a significant negative relationship with lower-limb muscle mass. The same results were obtained when adjusting for current smoking status, smoking index, cohabitation with smokers at birth, and frequency of exposure to SHS outside the home. Exposure to tobacco smoke due to cohabitation with smokers increased baPWV regardless of the person's smoking habits. Thus, to prevent an increase in baPWV in housemates and smokers, it is necessary for smokers to quit smoking.


Assuntos
Arteriosclerose/etiologia , Arteriosclerose/prevenção & controle , Saúde do Trabalhador , Características de Residência , Fumantes , Poluição por Fumaça de Tabaco/efeitos adversos , Rigidez Vascular , Local de Trabalho , Arteriosclerose/fisiopatologia , Progressão da Doença , Humanos , Masculino , Análise de Onda de Pulso , Fatores de Risco , Abandono do Hábito de Fumar
15.
Nihon Koshu Eisei Zasshi ; 67(8): 509-517, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32879237

RESUMO

Objective To explore health-related and socioeconomic factors that can predict future deterioration in Psychological Distress Scale (K6) scores.Method We conducted a baseline (2010, 2011) self-administered questionnaire survey of the Kobe Orthopedic and Biomedical Epidemiological study (KOBE study) involving 1,117 participants who had no previous history of cancer or cardiovascular diseases and were not under treatment for hypertension, diabetes, or dyslipidemia. We used the Japanese K6 as an indicator of stress and defined K6≧5 points as a high-stress group and K6<5 points as a low-stress group. A four-year follow-up survey (2014, 2015) was conducted on 1,004 people (follow-up rate of 90%). We excluded 39 participants with missing values, and 185 people whose K6 score was higher than 5 points at baseline. A final total of 780 participants' scores were examined for: gender, age, living situation, physical activity level, average sleep time, as well as the K6 score, the Japanese Hearing Handicap Inventory for Elderly (HHIE-S), and the Japanese Oswestry Disability Index (ODI). We conducted a logistic regression analysis using K6≧5 points at the four-year follow-up survey as the dependent variable and each factor at the baseline survey as the independent variable.Results Of the 780 subjects analyzed, 132 (16.9%) were highly stressed (K6≧5 points) at the four-year follow-up point. A logistic regression analysis found age (40s/70s) (odds ratio 3.38, 95% confidence interval 1.45-7.86), living situation (single/living together) (odds ratio 1.98, 95% confidence interval 1.07-3.68), and ODI scores (every 1%) (odds ratio 1.05, 95% confidence interval 1.01-1.09), to all be significantly associated with high stress.Conclusion This study suggests that age, living situation, and ODI scores are related to future stress.


Assuntos
Estresse Psicológico/diagnóstico , População Urbana , Adulto , Fatores Etários , Feminino , Seguimentos , Previsões , Humanos , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Características de Residência , Fatores Socioeconômicos , Estresse Psicológico/psicologia , Inquéritos e Questionários
16.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32973120

RESUMO

BACKGROUND: Low socioeconomic status (SES) has emerged as an important risk factor for higher short-term mortality and neurodevelopmental outcomes in children with hypoplastic left heart syndrome and related anomalies; yet little is known about how SES affects these outcomes over the long-term. METHODS: We linked data from the Single Ventricle Reconstruction trial to US Census Bureau data to analyze the relationship of neighborhood SES tertiles with mortality and transplantation, neurodevelopment, quality of life, and functional status at 5 and 6 years post-Norwood procedure (N = 525). Cox proportional hazards regression and linear regression were used to assess the association of SES with mortality and neurodevelopmental outcomes, respectively. RESULTS: Patients in the lowest SES tertile were more likely to be racial minorities, older at stage 2 and Fontan procedures, and to have more complications and fewer cardiac catheterizations over follow-up (all P < .05) compared with patients in higher SES tertiles. Unadjusted mortality was highest for patients in the lowest SES tertile and lowest in the highest tertile (41% vs 29%, respectively; log-rank P = .027). Adjustment for patient birth and Norwood factors attenuated these differences slightly (P = .055). Patients in the lowest SES tertile reported lower functional status and lower fine motor, problem-solving, adaptive behavior, and communication skills at 6 years (all P < .05). These differences persisted after adjustment for baseline and post-Norwood factors. Quality of life did not differ by SES. CONCLUSIONS: Among patients with hypoplastic left heart syndrome, those with low SES have worse neurodevelopmental and functional status outcomes at 6 years. These differences were not explained by other patient or clinical characteristics.


Assuntos
Técnica de Fontan/métodos , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Classe Social , Cateterismo Cardíaco/estatística & dados numéricos , Criança , Desenvolvimento Infantil , Pré-Escolar , Deficiências do Desenvolvimento/epidemiologia , Escolaridade , Feminino , Técnica de Fontan/mortalidade , Técnica de Fontan/estatística & dados numéricos , Transplante de Coração/estatística & dados numéricos , Humanos , Síndrome do Coração Esquerdo Hipoplásico/complicações , Síndrome do Coração Esquerdo Hipoplásico/etnologia , Síndrome do Coração Esquerdo Hipoplásico/mortalidade , Renda , Recém-Nascido , Masculino , Ocupações , Complicações Pós-Operatórias/epidemiologia , Modelos de Riscos Proporcionais , Qualidade de Vida , Características de Residência , Resultado do Tratamento , Coração Univentricular/mortalidade , Coração Univentricular/cirurgia
17.
BMC Public Health ; 20(1): 1385, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32912177

RESUMO

BACKGROUND: In El Salvador, Aedes aegypti mosquitoes transmitting Zika and other arboviruses use water storage containers as important oviposition sites. Promotion of water storage container cleaning is a key element of prevention programs. We explored community perceptions surrounding cleaning practices among pregnant women, male partners of pregnant women, and women likely to become pregnant. METHODS: Researchers conducted 11 focus groups and 12 in-depth interviews which included individual elicitations of Zika prevention measures practiced in the community. Focus group participants rated 18 images depicting Zika-related behaviors according to effectiveness and feasibility in the community context, discussed influencing determinants, voted on community intentions to perform prevention behaviors, and performed washbasin cleaning simulations. In-depth interviews with male partners of pregnant women used projective techniques with images to explore their perceptions on a subset of Zika prevention behaviors. RESULTS: General cleaning of the home, to ensure a healthy environment, was a strong community norm. In this context, participants gave water storage container cleaning a high rating, for both its effectiveness and feasibility. Participants were convinced that they cleaned their water storage containers effectively against Zika, but their actual skills were inadequate to destroy Aedes aegypti eggs. A further constraint was the schedule of water availability. Even during pregnancy, male partners rarely cleaned water storage containers because water became available in homes when they were at work. Furthermore, prevailing gender norms did not foster male participation in domestic cleaning activities. Despite these factors, many men were willing to provide substantial support with cleaning when their partners were pregnant, in order to protect their family. CONCLUSIONS: Behavior change programs for the prevention of Zika and other arboviruses need to improve community members' mosquito egg destruction skills rather than perpetuate the promotion of non-specific cleaning in and around the home as effective. Egg elimination must be clearly identified as the objective of water storage container maintenance and programs should highlight the effective techniques to achieve this goal. In addition, programs must build the skills of family members who support pregnant women to maintain the frequency of effective egg destruction in all water storage containers of the home.


Assuntos
Aedes/virologia , Conhecimentos, Atitudes e Prática em Saúde , Controle de Mosquitos/métodos , Abastecimento de Água , Água , Infecção por Zika virus/prevenção & controle , Zika virus , Adolescente , Adulto , Animais , El Salvador , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Características de Residência , Adulto Jovem , Zika virus/crescimento & desenvolvimento , Infecção por Zika virus/transmissão , Infecção por Zika virus/virologia
18.
JAMA Netw Open ; 3(9): e2015470, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32876682

RESUMO

Importance: Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it. Objective: To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities. Design, Setting, and Participants: This cross-sectional study used Medicare data regarding the postacute home health care setting from October 1, 2015, through September 30, 2016. The participants were Medicare fee-for-service and Medicare Advantage beneficiaries who were discharged alive from a hospital with a referral to home health care (2 379 506 discharges). Statistical analysis was performed from July 2019 to June 2020. Exposures: Hospital referral to home health care. Main Outcomes and Measures: Primary outcomes included whether discharges received their first home health care visit within 14 days of hospital discharge and the number of days between hospital discharge and the first home health visit. Differences in the likelihood of receiving home health care across patient, zip code, and hospital characteristics were also examined. Results: Among 2 379 506 discharges from the hospital with a home health care referral, 1 358 697 patients (57.1%) were female, 468 762 (19.7%) were non-White, and 466 383 (19.6%) were dually enrolled in Medicare and Medicaid; patients had a mean (SD) age of 73.9 (11.9) years and 4.1 (2.1) Elixhauser comorbidities. Only 1 284 300 patients (54.0%) discharged from the hospital with a home health referral received home health care services within 14 days of discharge. Of the remaining 1 095 206 patients (46.0%) discharged, 37.7% (896 660 discharges) never received any home health care, while 8.3% (198 546 discharges) were institutionalized or died within 14 days without a preceding home health care visit. Patients who were Black or Hispanic received home health at lower rates than did patients who were White (48.0% [95% CI, 47.8%-48.1%] of Black and 46.1% [95% CI, 45.7%-46.5%] of Hispanic discharges received home health within 14 days compared with 55.3% [95% CI, 55.2%-55.4%] of White discharges). In addition, disadvantaged patients waited longer for their first home health care visit. For example, patients living in high-unemployment zip codes waited a mean of 2.0 days (95% CI, 2.0-2.0 days), whereas those living in low-unemployment zip codes waited 1.8 days (95% CI, 1.8-1.8 days). Conclusions and Relevance: Disparities in the use of home health care remain an issue in the US. As home health care is increasingly presented as a safer alternative to institutional postacute care during coronavirus disease 2019, and payment reforms continue to pressure hospitals to discharge patients home, ensuring the availability of safe and equitable care will be crucial to maintaining high-quality care.


Assuntos
Assistência ao Convalescente/estatística & dados numéricos , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/etnologia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Encaminhamento e Consulta , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Medicaid/estatística & dados numéricos , Medicare , Medicare Part C , Alta do Paciente , Pobreza/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Estados Unidos
19.
Artigo em Inglês | MEDLINE | ID: mdl-32882867

RESUMO

The spread of COVID-19 is not evenly distributed. Neighborhood environments may structure risks and resources that produce COVID-19 disparities. Neighborhood built environments that allow greater flow of people into an area or impede social distancing practices may increase residents' risk for contracting the virus. We leveraged Google Street View (GSV) images and computer vision to detect built environment features (presence of a crosswalk, non-single family home, single-lane roads, dilapidated building and visible wires). We utilized Poisson regression models to determine associations of built environment characteristics with COVID-19 cases. Indicators of mixed land use (non-single family home), walkability (sidewalks), and physical disorder (dilapidated buildings and visible wires) were connected with higher COVID-19 cases. Indicators of lower urban development (single lane roads and green streets) were connected with fewer COVID-19 cases. Percent black and percent with less than a high school education were associated with more COVID-19 cases. Our findings suggest that built environment characteristics can help characterize community-level COVID-19 risk. Sociodemographic disparities also highlight differential COVID-19 risk across groups of people. Computer vision and big data image sources make national studies of built environment effects on COVID-19 risk possible, to inform local area decision-making.


Assuntos
Ambiente Construído , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Imagens de Satélites , Betacoronavirus , Planejamento Ambiental , Humanos , Características de Residência
20.
Medicine (Baltimore) ; 99(36): e22141, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899101

RESUMO

The aim of this case-control study was to evaluate the association between chronic rhinosinusitis (CRS) and neurodegenerative dementia in a large representative Korean population. The ≥ 50-year-old population was selected from the Korean Health Insurance Review and Assessment Service - National Sample Cohort from 2002 to 2015. A total of 17,634 neurodegenerative dementia patients were matched in a 1:4 ratio with 70,536 control participants for age, sex, income, and region of residence. Neurodegenerative dementia was defined using the ICD-10 codes G30 and F00. CRS was identified based on the ICD-10 code J32. Among the cohort, we selected participants who were treated ≥ 2 times and those who underwent head and neck computed tomography. The odds ratio (OR) for CRS in patients with dementia was analyzed using a conditional logistic regression model. Subgroup analyses were conducted according to age and sex. There was no difference in the prevalence of CRS with/without nasal polyps between the dementia (1.1%) and control (1.2%) groups (P = .825). CRS with/without nasal polyps was not significantly associated with dementia (adjusted OR = 0.96, 95% CI = 0.82-1.13, P = .653). In the subgroup analyses according to age and sex, the adjusted ORs for CRS with/without nasal polyps were not higher in the dementia group than in the control group. Previous CRS was not associated with neurodegenerative dementia in the Korean population.


Assuntos
Doença de Alzheimer/epidemiologia , Pólipos Nasais/epidemiologia , Sinusite/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Doença Crônica , Demência/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Características de Residência , Fatores de Risco , Fatores Sexuais
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