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1.
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
2.
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
3.
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
4.
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
5.
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
6.
Public Health Rep ; 135(5): 565-570, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735159

RESUMO

Community resilience is a community's ability to maintain functioning (ie, delivery of services) during and after a disaster event. The Composite of Post-Event Well-Being (COPEWELL) is a system dynamics model of community resilience that predicts a community's disaster-specific functioning over time. We explored COPEWELL's usefulness as a practice-based tool for understanding community resilience and to engage partners in identifying resilience-strengthening strategies. In 2014, along with academic partners, the New York City Department of Health and Mental Hygiene organized an interdisciplinary work group that used COPEWELL to advance cross-sector engagement, design approaches to understand and strengthen community resilience, and identify local data to explore COPEWELL implementation at neighborhood levels. The authors conducted participant interviews and collected shared experiences to capture information on lessons learned. The COPEWELL model led to an improved understanding of community resilience among agency members and community partners. Integration and enhanced alignment of efforts among preparedness, disaster resilience, and community development emerged. The work group identified strategies to strengthen resilience. Searches of neighborhood-level data sets and mapping helped prioritize communities that are vulnerable to disasters (eg, medically vulnerable, socially isolated, low income). These actions increased understanding of available data, identified data gaps, and generated ideas for future data collection. The COPEWELL model can be used to drive an understanding of resilience, identify key geographic areas at risk during and after a disaster, spur efforts to build on local metrics, and result in innovative interventions that integrate and align efforts among emergency preparedness, community development, and broader public health initiatives.


Assuntos
Desastres/estatística & dados numéricos , Modelos Teóricos , Características de Residência/estatística & dados numéricos , Resiliência Psicológica , Capital Social , Estresse Psicológico , Humanos , Cidade de Nova Iorque
7.
J Registry Manag ; 47(1): 4-12, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833378

RESUMO

OBJECTIVES: Researchers often approximate individual-level socioeconomic status (SES) from census tract and county data. However, area-level variables do not serve as accurate proxies for individual-level SES, particularly among some demographic subgroups. The present study aimed to analyze the potential bias introduced by this practice. METHODS: Data included (1) individual-level SES from the Mortality Disparities in American Communities study (n ≈ 3,471,000 collected in 2008), and (2) census tract- and county-level SES from the 2006-2010 American Community Survey. Analyses included correlations among SES indicators (eg, median household income, having a high school degree, unemployment) across individual versus census tract and county levels, stratified by sex, age, race/ethnicity, and urbanicity. Finally, generalized estimating equations evaluated demographic differences in whether area-level SES matched or underestimated individual-level SES. RESULTS: Low correlations were observed between individual- and area-level SES (census tract: Spearman's r range = 0.048 for unemployment to 0.232 for median household income; county: r range = 0.028 for unemployment to 0.157 for median household income; all P < .0001). SES indicators were more likely to match for males, older participants, and urban groups. Area-level SES indicators were more likely to underestimate individual-level SES for older participants and rural groups, indicating that individuals who are part of these groups may live in systematically lower-SES communities than their own SES might connote. CONCLUSIONS: In this population-based study of 3.5 million participants, area-level indicators were poor proxies for individual-level SES, particularly for participants living in rural areas.


Assuntos
Censos , Sistema de Registros/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Feminino , Humanos , Masculino , População Rural/estatística & dados numéricos , Classe Social , Fatores Socioeconômicos , População Urbana/estatística & dados numéricos
8.
Public Health Rep ; 135(5): 676-684, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32795209

RESUMO

OBJECTIVE: Infants born to women with hepatitis B virus (HBV) infection are at high risk for chronic HBV infection and premature death. We examined epidemiologic trends among women with HBV infection who gave birth in New York City (NYC) to inform public health prevention activities. METHODS: We obtained data on HBV-infected women residing and giving birth in NYC during 1998-2015 from the NYC Perinatal HBV Prevention Program. We obtained citywide birth data from the NYC Office of Vital Statistics. We calculated the incidence of births to HBV-infected women per 100 000 live births and stratified by maternal race, birthplace, and age. We calculated annual percentage change (APC) in incidence of births to HBV-infected women by using joinpoint regression. RESULTS: Of 29 896 HBV-infected women included in the study, 28 195 (94.3%) were non-US-born, of whom 16 600 (58.9%) were born in China. Overall incidence of births to HBV-infected women per 100 000 live births increased from 1156 in 1998 to 1573 in 2006 (APC = 3.1%; P < .001) but declined to 1329 in 2015 (APC = -1.4%; P = .02). Incidence among US-born women declined from 1998 to 2015 (330 to 84; APC = -7.3%; P < .001) and among non-US-born women increased from 1998 to 2007 (1877 to 2864; APC = 3.6%; P < .001) but not thereafter. Incidence among women born in China increased from 1998 to 2006 (13 275 to 16 480; APC = 1.8%; P = .02) but decreased to 12 631 through 2015 (APC = -3.3%; P < .001). CONCLUSIONS: The incidence of births to HBV-infected women in NYC declined significantly among US-born women but not among non-US-born women, highlighting the need for successful vaccination programs worldwide.


Assuntos
Transmissão de Doença Infecciosa/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Hepatite B Crônica/epidemiologia , Hepatite B Crônica/transmissão , Vigilância da População/métodos , Complicações Infecciosas na Gravidez/epidemiologia , Gestantes , Adolescente , Adulto , Feminino , Hepatite B Crônica/prevenção & controle , Humanos , Incidência , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Características de Residência/estatística & dados numéricos , Adulto Jovem
9.
Public Health Rep ; 135(5): 611-620, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32805191

RESUMO

OBJECTIVE: Although some studies have reported a higher incidence of HIV infection among non-US-born people than among US-born people, national data on this topic are scarce. We compared the epidemiology of HIV infection between US-born and non-US-born residents of the United States and examined the characteristics of non-US-born people with diagnosed HIV infection by region of birth (ROB). METHODS: We used a cross-sectional study design to produce national, population-based data describing HIV infection among US-born and non-US-born people. We analyzed National HIV Surveillance System data for people with HIV infection diagnosed during 2010-2017 and reported to the Centers for Disease Control and Prevention (CDC). We compared data on demographic characteristics, transmission risk category, and stage 3 infection (AIDS) classification within 3 months of HIV diagnosis, by nativity and ROB. RESULTS: During 2010-2017, 328 317 children and adult US residents were diagnosed with HIV infection and were reported to CDC: 214 973 (65.5%) were US-born, 50 301 (15.3%) were non-US-born, and 63 043 (19.2%) were missing data on country of birth. After adjusting for missing country of birth, 266 147 (81.1%) people were US-born and 62 170 (18.9%) were non-US-born. This group accounted for 15 928 of 65 645 (24.2%) HIV diagnoses among girls and women and 46 242 of 262 672 (17.6%) HIV diagnoses among boys and men. A larger percentage of non-US-born people than US-born people had stage 3 infection (AIDS) at HIV diagnosis (31.2% vs 23.9%). Among non-US-born people with HIV diagnoses, 19 876 (39.5%) resided in the South. CONCLUSIONS: Characterizing non-US-born people with HIV infection is essential for developing effective HIV interventions, particularly in areas with large immigrant populations.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Infecções por HIV/etnologia , Infecções por HIV/epidemiologia , Vigilância da População , Características de Residência/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Estudos Epidemiológicos , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
10.
Public Health Rep ; 135(5): 658-667, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32805192

RESUMO

OBJECTIVES: The health profile of Arab American mothers and infants may differ from that of non-Arab American mothers and infants in the United States as a result of social stigma experienced in the historical and current sociopolitical climate. The objective of our study was to compare maternal health behaviors, maternal health outcomes, and infant health outcomes of Arab American mothers and non-Hispanic white mothers in Massachusetts and to assess the role of nativity as an effect modifier. METHODS: Using data from Massachusetts birth certificates (2012-2016), we conducted adjusted logistic and linear regression models for maternal health behaviors, maternal health outcomes, and infant health outcomes. We used Arab ethnicity as the exposure of interest and nativity as an effect modifier. RESULTS: Arab American mothers had higher odds than non-Hispanic white mothers of initiating breastfeeding (adjusted odds ratio [aOR] = 2.61; 95% CI, 2.39-2.86), giving birth to small-for-gestational-age infants (aOR = 1.28; 95% CI, 1.18-1.39), and having gestational diabetes (aOR = 1.31; 95% CI, 1.20-1.44). Among Arab American mothers, non-US-born mothers had higher odds than US-born mothers of having gestational diabetes (aOR = 1.80; 95% CI, 1.33-2.44) and lower odds of initiating prenatal care in the first trimester (aOR = 0.41; 95% CI, 0.33-0.50). In linear regression models, infants born to non-US-born Arab American mothers weighed 42.1 g (95% CI, -75.8 to -8.4 g) less than infants born to US-born Arab American mothers. CONCLUSION: Although Arab American mothers engage in positive health behaviors, non-US-born mothers had poorer maternal health outcomes and access to prenatal care than US-born mothers, suggesting the need for targeted interventions for non-US-born Arab American mothers.


Assuntos
Árabes/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Saúde do Lactente/estatística & dados numéricos , Comportamento Materno/psicologia , Saúde Materna/estatística & dados numéricos , Mães/psicologia , Características de Residência/estatística & dados numéricos , Adulto , Árabes/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Massachusetts , Mães/estatística & dados numéricos
11.
Med Care ; 58(9): 793-799, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826744

RESUMO

OBJECTIVES: The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law enacted in 1986 prohibiting patient dumping (refusing or transferring patients with emergency medical conditions without appropriate stabilization), and discrimination based upon ability to pay. We evaluate hospital-level features associated with citation for EMTALA violation. MATERIALS AND METHODS: A retrospective analysis of observational data on EMTALA enforcement (2005-2013). Regression analysis evaluates the association between facility-level features and odds of EMTALA citation by hospital-year. RESULTS: Among 4916 EMTALA-obligated hospitals there were 1925 EMTALA citation events at 1413 facilities between 2005 and 2013, with 4.3% of hospitals cited per year. In adjusted analyses, increased odds of EMTALA citations were found at hospitals that were: for-profit [odds ratio (OR): 1.61; 95% confidence interval (CI): 1.32-1.96], in metropolitan areas (OR: 1.32; 95% CI: 1.11-1.57); that admitted a higher proportion of Medicaid patients (OR: 1.01; 95% CI: 1.0-1.01); and were in the top quartiles of hospital size (OR: 1.48; 95% CI: 1.10-1.99) and emergency department (ED) volume (OR: 1.56; 95% CI: 1.14-2.12). Predicted probability of repeat EMTALA citation in the year following initial citation was 17% among for-profit and 11% among other hospital types. Among citation events for patients presenting to the same hospital's ED, there were 1.30 EMTALA citation events per million ED visits, with 1.04 at private not-for-profit, 1.47 at government-owned, and 2.46 at for-profit hospitals. CONCLUSIONS: For-profit ownership is associated with increased odds of EMTALA citations after adjusting for other characteristics. Efforts to improve EMTALA might be considered to protect access to emergency care for vulnerable populations, particularly at large, urban, for-profit hospitals admitting high proportions of Medicaid patients.


Assuntos
Serviço Hospitalar de Emergência/legislação & jurisprudência , Serviço Hospitalar de Emergência/estatística & dados numéricos , Transferência de Pacientes/legislação & jurisprudência , Transferência de Pacientes/estatística & dados numéricos , Número de Leitos em Hospital/estatística & dados numéricos , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Medicaid/estatística & dados numéricos , Propriedade/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
12.
Artigo em Inglês | MEDLINE | ID: mdl-32645895

RESUMO

Increasing evidence suggests adults living in greener areas tend to have more favourable sleep-related outcomes, but children and adolescents are under-researched. We hypothesised that children and adolescents living in greener areas would have better quality and more sufficient levels of sleep on average, especially within the context of high traffic noise exposure. These hypotheses were tested using multilevel logistic regressions fitted on samples from the nationally representative Longitudinal Study of Australian Children (10-11 years old, n = 3469, and 14-15 years old, n = 2814) and the GINIplus and LISA cohorts (10 years old, n = 1461, and 15 years old, n = 4172) from the Munich, Wesel, and Leipzig areas of Germany. Questionnaire-based binary indicators of sleep sufficiency and sleep quality in each cohort were assessed with respect to objectively measured green space exposures adjusting for age, sex, and maternal education. Models were augmented with proxy measures of traffic noise and two-way interaction terms to test for effect modification. Cross-tabulations illustrated little convincing evidence of association between green space and insufficient sleep or poor sleep quality in either sample, except for insufficient sleep among 10 year old participants in Germany. These null findings were replicated in adjusted models. The proxy for traffic noise was associated with poor quality sleep in 15 year old participants in Germany, but no convincing evidence of modified association with green space was observed.


Assuntos
Sono/fisiologia , Adolescente , Austrália , Ambiente Construído , Criança , Estudos de Coortes , Meio Ambiente , Feminino , Alemanha , Humanos , Estudos Longitudinais , Masculino , Parques Recreativos , Qualidade de Vida , Características de Residência/estatística & dados numéricos
13.
MMWR Morb Mortal Wkly Rep ; 69(28): 933-937, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32673303

RESUMO

On April 3, 2020, the White House Coronavirus Task Force and CDC announced a new behavioral recommendation to help slow the spread of coronavirus disease 2019 (COVID-19) by encouraging the use of a cloth face covering when out in public (1). Widespread use of cloth face coverings has not been studied among the U.S. population, and therefore, little is known about encouraging the public to adopt this behavior. Immediately following the recommendation, an Internet survey sampled 503 adults during April 7-9 to assess their use of cloth face coverings and the behavioral and sociodemographic factors that might influence adherence to this recommendation. The same survey was administered 1 month later, during May 11-13, to another sample of 502 adults to assess changes in the prevalence estimates of use of cloth face coverings from April to May. Within days of the release of the first national recommendation for use of cloth face coverings, a majority of persons who reported leaving their home in the previous week reported using a cloth face covering (61.9%). Prevalence of use increased to 76.4% 1 month later, primarily associated with increases in use among non-Hispanic white persons (54.3% to 75.1%), persons aged ≥65 years (36.6% to 79.2%), and persons residing in the Midwest (43.7% to 73.8%). High rates were observed in April and by May, increased further among non-Hispanic black persons (74.4% to 82.3%), Hispanic or Latino persons (77.3% to 76.2%), non-Hispanic persons of other race (70.8% to 77.3%), persons aged 18-29 years (70.1% to 74.9%) and 30-39 years (73.9% to 84.4%), and persons residing in the Northeast (76.9% to 87.0%). The use of a cloth face covering was associated with theory-derived constructs that indicate a favorable attitude toward them, intention to use them, ability to use them, social support for using them, and beliefs that they offered protection for self, others, and the community. Research is needed to understand possible barriers to using cloth face coverings and ways to promote their consistent and correct use among those who have yet to adopt this behavior.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Máscaras/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Adolescente , Adulto , Idoso , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
14.
MMWR Morb Mortal Wkly Rep ; 69(29): 945-950, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32701937

RESUMO

Risk for severe coronavirus disease 2019 (COVID-19)-associated illness (illness requiring hospitalization, intensive care unit [ICU] admission, mechanical ventilation, or resulting in death) increases with increasing age as well as presence of underlying medical conditions that have shown strong and consistent evidence, including chronic obstructive pulmonary disease, cardiovascular disease, diabetes, chronic kidney disease, and obesity (1-4). Identifying and describing the prevalence of these conditions at the local level can help guide decision-making and efforts to prevent or control severe COVID-19-associated illness. Below state-level estimates, there is a lack of standardized publicly available data on underlying medical conditions that increase the risk for severe COVID-19-associated illness. A small area estimation approach was used to estimate county-level prevalence of selected conditions associated with severe COVID-19 disease among U.S. adults aged ≥18 years (5,6) using self-reported data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) and U.S. Census population data. The median prevalence of any underlying medical condition in residents among 3,142 counties in all 50 states and the District of Columbia (DC) was 47.2% (range = 22.0%-66.2%); counties with the highest prevalence were concentrated in the Southeast and Appalachian region. Whereas the estimated number of persons with any underlying medical condition was higher in population-dense metropolitan areas, overall prevalence was higher in rural nonmetropolitan areas. These data can provide important local-level information about the estimated number and proportion of persons with certain underlying medical conditions to help guide decisions regarding additional resource investment, and mitigation and prevention measures to slow the spread of COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/epidemiologia , Cardiopatias/epidemiologia , Obesidade/epidemiologia , Pneumonia Viral/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Características de Residência/estatística & dados numéricos , Adulto , Humanos , Pandemias , Prevalência , Medição de Risco , População Rural/estatística & dados numéricos , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos
15.
MMWR Morb Mortal Wkly Rep ; 69(29): 965-970, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32701941

RESUMO

Transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is ongoing in many communities throughout the United States. Although case-based and syndromic surveillance are critical for monitoring the pandemic, these systems rely on persons obtaining testing or reporting a COVID-19-like illness. Using serologic tests to detect the presence of SARS-CoV-2 antibodies is an adjunctive strategy that estimates the prevalence of past infection in a population. During April 28-May 3, 2020, coinciding with the end of a statewide shelter-in-place order, CDC and the Georgia Department of Public Health conducted a serologic survey in DeKalb and Fulton counties in metropolitan Atlanta to estimate SARS-CoV-2 seroprevalence in the population. A two-stage cluster sampling design was used to randomly select 30 census blocks in each county, with a target of seven participating households per census block. Weighted estimates were calculated to account for the probability of selection and adjusted for age group, sex, and race/ethnicity. A total of 394 households and 696 persons participated and had a serology result; 19 (2.7%) of 696 persons had SARS-CoV-2 antibodies detected. The estimated weighted seroprevalence across these two metropolitan Atlanta counties was 2.5% (95% confidence interval [CI] = 1.4-4.5). Non-Hispanic black participants more commonly had SARS-CoV-2 antibodies than did participants of other racial/ethnic groups (p<0.01). Among persons with SARS-CoV-2 antibodies, 13 (weighted % = 49.9; 95% CI = 24.4-75.5) reported a COVID-19-compatible illness,* six (weighted % = 28.2; 95% CI = 11.9-53.3) sought medical care for a COVID-19-compatible illness, and five (weighted % = 15.7; 95% CI = 5.1-39.4) had been tested for SARS-CoV-2 infection, demonstrating that many of these infections would not have been identified through case-based or syndromic surveillance. The relatively low seroprevalence estimate in this report indicates that most persons in the catchment area had not been infected with SARS-CoV-2 at the time of the survey. Continued preventive measures, including social distancing, consistent and correct use of face coverings, and hand hygiene, remain critical in controlling community spread of SARS-CoV-2.


Assuntos
Anticorpos Antivirais/sangue , Betacoronavirus/imunologia , Técnicas de Laboratório Clínico , Vigilância em Saúde Pública/métodos , Características de Residência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Infecções por Coronavirus/diagnóstico , Feminino , Georgia/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
Rev Bras Epidemiol ; 23: e200089, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32725091

RESUMO

OBJECTIVE: To investigate the association between the alcohol outlet density in residential areas and the current and lifetime alcohol consumption, adjusted for individual and family factors. METHOD: Information from a three-stage household stratified probabilistic cluster sampling survey (census tract, household, adult and adolescent), conducted in Belo Horizonte, Brazil ("Health in BH", 2008-2009) and data of the establishments were obtained from official sources and subsequently georeferenced. The outcome was the adolescents' report of current and lifetime alcohol consumption. The exposure variable was the alcohol outlet density, defined as the number of establishments within a 200-meter range from the adolescents' residence. The association was estimated by Poisson regression adjusted by individual and family variables. RESULTS: In total, 601 adolescents aged 14 to 17 years were included in this study. Of these, 53.3% were males and 71.0% lived in a family with income up to five minimum wages. The prevalence of lifetime alcohol consumption was 57.0% (95%CI 51.5 - 62.6) and the current was 11.9% (95%CI 8.7 - 15.0). The multivariate analysis showed a significant association between current alcohol consumption and density of snack bars (PR = 1.13; 95%CI 1.03 - 1.24), bars (PR = 1.21; 95CI% 1.05 - 1.38), and restaurants (PR = 1.11; 95%CI 1.02 - 1.21). Significant interactions between density of establishments with sex and age were found. CONCLUSION: Current alcohol consumption may be enhanced by the availability of some types of establishments located within a range of 200 meters from the adolescents' residence.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Comércio/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Adolescente , Brasil/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Restaurantes/estatística & dados numéricos
17.
Lancet Glob Health ; 8(8): e1018-e1026, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32622400

RESUMO

BACKGROUND: Brazil ranks second worldwide in total number of COVID-19 cases and deaths. Understanding the possible socioeconomic and ethnic health inequities is particularly important given the diverse population and fragile political and economic situation. We aimed to characterise the COVID-19 pandemic in Brazil and assess variations in mortality according to region, ethnicity, comorbidities, and symptoms. METHODS: We conducted a cross-sectional observational study of COVID-19 hospital mortality using data from the SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe) dataset to characterise the COVID-19 pandemic in Brazil. In the study, we included hospitalised patients who had a positive RT-PCR test for severe acute respiratory syndrome coronavirus 2 and who had ethnicity information in the dataset. Ethnicity of participants was classified according to the five categories used by the Brazilian Institute of Geography and Statistics: Branco (White), Preto (Black), Amarelo (East Asian), Indígeno (Indigenous), or Pardo (mixed ethnicity). We assessed regional variations in patients with COVID-19 admitted to hospital by state and by two socioeconomically grouped regions (north and central-south). We used mixed-effects Cox regression survival analysis to estimate the effects of ethnicity and comorbidity at an individual level in the context of regional variation. FINDINGS: Of 99 557 patients in the SIVEP-Gripe dataset, we included 11 321 patients in our study. 9278 (82·0%) of these patients were from the central-south region, and 2043 (18·0%) were from the north region. Compared with White Brazilians, Pardo and Black Brazilians with COVID-19 who were admitted to hospital had significantly higher risk of mortality (hazard ratio [HR] 1·45, 95% CI 1·33-1·58 for Pardo Brazilians; 1·32, 1·15-1·52 for Black Brazilians). Pardo ethnicity was the second most important risk factor (after age) for death. Comorbidities were more common in Brazilians admitted to hospital in the north region than in the central-south, with similar proportions between the various ethnic groups. States in the north had higher HRs compared with those of the central-south, except for Rio de Janeiro, which had a much higher HR than that of the other central-south states. INTERPRETATION: We found evidence of two distinct but associated effects: increased mortality in the north region (regional effect) and in the Pardo and Black populations (ethnicity effect). We speculate that the regional effect is driven by increasing comorbidity burden in regions with lower levels of socioeconomic development. The ethnicity effect might be related to differences in susceptibility to COVID-19 and access to health care (including intensive care) across ethnicities. Our analysis supports an urgent effort on the part of Brazilian authorities to consider how the national response to COVID-19 can better protect Pardo and Black Brazilians, as well as the population of poorer states, from their higher risk of dying of COVID-19. FUNDING: None.


Assuntos
Infecções por Coronavirus/etnologia , Infecções por Coronavirus/mortalidade , Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Mortalidade Hospitalar/etnologia , Mortalidade Hospitalar/tendências , Pneumonia Viral/etnologia , Pneumonia Viral/mortalidade , Características de Residência/estatística & dados numéricos , Adulto , Idoso , Brasil/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Fatores Socioeconômicos
18.
J Prim Care Community Health ; 11: 2150132720942695, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32674696

RESUMO

Introduction: The primary care clinic plays a major role in triage for coronavirus disease 2019 (COVID-19), where seroprevalence in the setting of primary care clinic remains less clear. As a point-of-care immunodiagnostic test for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the serosurvey represents an alternative to the polymerase chain reaction (PCR) test to measure the magnitude of COVID-19 outbreak in the communities lacking sufficient diagnostic capability for PCR testing. Methods: We assessed seropositivity for the SARS-CoV-2 IgG between April 21 and May 20, 2020, at 2 primary care clinics in Tokyo, Japan. Results: The overall positive percentage of SARS-CoV-2 IgG was 3.83% (95% confidence interval [CI]: 2.76-5.16) for the entire cohort (n = 1071). The 23 special wards of central Tokyo exhibited a significantly higher prevalence compared with the other areas of Tokyo after classification by residence (P = .02, 4.68% [3.08-6.79] vs 1.83 [0.68-3.95] in central and suburban Tokyo, respectively). In central Tokyo, the southern area showed the highest seroprevalence compared with the other areas (7.92% [3.48-15.01]), corresponding to the cumulative number of confirmed COVID-19 patients by PCR test reported by the Tokyo Metropolitan Government. Conclusion: The seroprevalence surveyed in this study was too low for herd immunity, suggesting the need for robust disease control and prevention. A regional-level approach, rather than state- or prefectural-level, could be of importance in ascertaining detailed profiles of the COVID-19 outbreak.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde , Características de Residência/estatística & dados numéricos , Adolescente , Adulto , Anticorpos Antivirais/sangue , Betacoronavirus/imunologia , Técnicas de Laboratório Clínico , Feminino , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Pandemias , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Soroepidemiológicos , Tóquio/epidemiologia , Adulto Jovem
19.
Rev Lat Am Enfermagem ; 28: e3344, 2020.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-32609281

RESUMO

OBJECTIVE: to analyze the relationship between per capita income and the cumulative incidence of COVID-19 in the neighborhoods of the city of Rio de Janeiro, RJ, Brazil. METHOD: an ecological study using neighborhoods as units of analysis. The cumulative incidence rate per 100,000 inhabitants and the median of potential confounding variables (sex, race, and age) were calculated. Multiple analysis included quantile regression, estimating the regression coefficients of the variable income for every five percentiles from the 10th to 90th percentiles to verify the relationship between income and incidence. RESULTS: the city's rate was 36.58 new cases per 100,000 inhabitants. In general, the highest rates were observed in the wealthiest regions. Multiple analysis was consistent with this observation since the per capita income affected all percentiles analyzed, with a median regression coefficient of 0.02 (p-value <0.001; R2 32.93). That is, there is an increase of R$ 0.02 in the neighborhood's per capita income for every unit of incidence. CONCLUSION: cumulative incident rates of COVID-19 are influenced by one's neighborhood of residency, suggesting that access to testing is uneven.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Renda , Pandemias , Pneumonia Viral/epidemiologia , Características de Residência/estatística & dados numéricos , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Distribuição por Idade , Brasil/epidemiologia , Cidades/epidemiologia , Infecções por Coronavirus/economia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias/economia , Pandemias/estatística & dados numéricos , Pneumonia Viral/economia , Distribuição por Sexo , Fatores Socioeconômicos
20.
Natl Vital Stat Rep ; 69(7): 1-18, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32730740

RESUMO

Objectives-This report presents 2018 infant mortality statistics by age at death, maternal race and Hispanic origin, maternal age, gestational age, leading causes of death, and maternal state of residence. Trends in infant mortality are also examined. Methods-Descriptive tabulations of data are presented and interpreted for infant deaths and infant mortality rates using the 2018 period linked birth/infant death file; the linked birth/infant death file is based on birth and death certificates registered in all states and the District of Columbia. Results-A total of 21,498 infant deaths were reported in the United States in 2018. The U.S. infant mortality rate was 5.67 infant deaths per 1,000 live births, lower than the rate of 5.79 in 2017 and an historic low in the country. The neonatal and post neonatal mortality rates for 2018 (3.78 and 1.89, respectively) demonstrated a nonsignificant decline compared with 2017 (3.85 and 1.94, respectively). The 2018 mortality rate declined for infants of Hispanic women compared with the 2017 rate; changes in rates for other race and Hispanic-origin groups were not statistically significant. The 2018 infant mortality rate for infants of non-Hispanic black women (10.75) was more than twice as high as that for infants of non-Hispanic white (4.63), non-Hispanic Asian (3.63), and Hispanic women (4.86). Infants born very preterm (less than 28 weeks of gestation) had the highest mortality rate (382.20), 186 times as high as that for infants born at term (37-41 weeks of gestation) (2.05). The five leading causes of infant death in 2018 were the same as in 2017; cause-of-death rankings and mortality rates varied by maternal race and Hispanic origin. Infant mortality rates by state for 2018 ranged from a low of 3.50 in New Hampshire to a high of 8.41 in Mississippi.


Assuntos
Mortalidade Infantil/tendências , Adolescente , Adulto , Distribuição por Idade , Causas de Morte/tendências , Grupos Étnicos/estatística & dados numéricos , Feminino , Idade Gestacional , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil/etnologia , Recém-Nascido , Masculino , Idade Materna , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Gravidez , Características de Residência/estatística & dados numéricos , Estados Unidos/epidemiologia , Estatísticas Vitais , Adulto Jovem
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