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1.
MMWR Morb Mortal Wkly Rep ; 70(17): 632-638, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33914721

RESUMO

Early studies suggest that COVID-19 vaccines protect against severe illness (1); however, postvaccination SARS-CoV-2 infections (i.e., breakthrough infections) can occur because COVID-19 vaccines do not offer 100% protection (2,3). Data evaluating the occurrence of breakthrough infections and impact of vaccination in decreasing transmission in congregate settings are limited. Skilled nursing facility (SNF) residents and staff members have been disproportionately affected by SARS-CoV-2, the virus that causes COVID-19 (4,5), and were prioritized for COVID-19 vaccination (6,7). Starting December 28, 2020, all 78 Chicago-based SNFs began COVID-19 vaccination clinics over several weeks through the federal Pharmacy Partnership for Long-Term Care Program (PPP).† In February 2021, through routine screening, the Chicago Department of Public Health (CDPH) identified a SARS-CoV-2 infection in a SNF resident >14 days after receipt of the second dose of a two-dose COVID-19 vaccination series. SARS-CoV-2 cases, vaccination status, and possible vaccine breakthrough infections were identified by matching facility reports with state case and vaccination registries. Among 627 persons with SARS-CoV-2 infection across 75 SNFs since vaccination clinics began, 22 SARS-CoV-2 infections were identified among 12 residents and 10 staff members across 15 facilities ≥14 days after receiving their second vaccine dose (i.e., breakthrough infections in fully vaccinated persons). Nearly two thirds (14 of 22; 64%) of persons with breakthrough infections were asymptomatic; two residents were hospitalized because of COVID-19, and one died. No facility-associated secondary transmission occurred. Although few SARS-CoV-2 infections in fully vaccinated persons were observed, these cases demonstrate the need for SNFs to follow recommended routine infection prevention and control practices and promote high vaccination coverage among SNF residents and staff members.


Assuntos
/administração & dosagem , Doenças Profissionais/epidemiologia , Instituições de Cuidados Especializados de Enfermagem , Adulto , Idoso , Doenças Assintomáticas/epidemiologia , Chicago/epidemiologia , Feminino , Humanos , Esquemas de Imunização , Controle de Infecções/organização & administração , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/prevenção & controle
2.
JAMA Netw Open ; 4(3): e214117, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33739433

RESUMO

Importance: Deficient (ie, <20 ng/mL) or insufficient (ie, 20 to <30 ng/mL) 25-hydroxyvitamin D (also known as calcifediol) levels are more common in Black individuals than White individuals and are associated with increased coronavirus disease 2019 (COVID-19) risk. Whether COVID-19 risk is associated with differences in vitamin D levels of 30 ng/mL or greater is not known. Objective: To examine whether COVID-19 test results are associated with differences in vitamin D levels of 30 ng/mL or greater, including for White individuals and for Black individuals. Design, Setting, and Participants: This retrospective cohort study was conducted at an academic medical center in Chicago, Illinois. Participants included individuals with data on vitamin D level within 365 days before COVID-19 testing, which was conducted from March 3 to December 30, 2020. Data were analyzed from September 11, 2020, to February 5, 2021. Exposures: The last vitamin D level before COVID-19 testing was categorized as less than 20 ng/mL (ie, deficient), 20 to less than 30 ng/mL (ie, insufficient), 30 to less than 40 ng/mL, or 40 ng/mL or greater. Treatment was defined by vitamin D type and dose 14 days before COVID-19 testing and treatment changes after last vitamin D level. Main Outcomes and Measures: The main outcome was a positive result for COVID-19 in polymerase chain reaction testing. Multivariable analyses tested whether previously measured vitamin D level was associated with having test results positive for COVID-19 in White individuals and in Black individuals, controlling for months and treatment changes since the vitamin D level was measured, as well as demographic characteristics and comorbidity indicators. Results: A total of 4638 individuals (mean [SD] age 52.8 [19.5] years; 3205 [69%] women) had data for a vitamin D level within 1 year before COVID-19 testing, including 2288 (49%) Black individuals, 1999 (43%) White individuals, and 351 individuals (8%) who were another race/ethnicity (eg, Asian, Mideast Indian, >1 race). Stratified by vitamin D level, 1251 individuals (27%) had less than 20 ng/mL, 1267 individuals (27%) had 20 to less than 30 ng/mL, 1023 individuals (22%) had 30 to less than 40 ng/mL, and 1097 individuals (24%) had 40 ng/mL or greater. Lower vitamin D levels were more common in Black individuals (<20 ng/mL: 829 of 2288 Black individuals [36%]) than White individuals (<20 ng/mL: 315 of 1999 White individuals [16%]). A total of 333 individuals (7%) had test results positive for COVID-19, including 102 White individuals (5%) and 211 Black individuals (9%). Multivariate analysis controlling for time since last vitamin D level measurement was used to estimate the outcomes associated with levels 14 days before COVID-19 testing. A positive test result for COVID-19 was not significantly associated with vitamin D levels in White individuals but was associated with vitamin D levels in Black individuals (compared with ≥40 ng/mL: <20 ng/mL incidence rate ratio [IRR], 2.55 [95% CI, 1.26-5.15]; P = .009; 20 to <30 ng/mL IRR, 1.69 [95% CI, 0.75-3.84]; P = .21; 30 to <40 ng/mL IRR, 2.64 [95% CI, 1.24-5.66]; P = .01). Stratified by vitamin D level, estimated COVID-19 positivity rates in Black individuals were 9.72% (95% CI, 6.74%-13.41%) for individuals with a vitamin D level less than 20 ng/mL, 6.47% (95% CI, 3.33%-10.28%) for individuals with a vitamin D level of 20 to less than 30 ng/mL, 10.10% (95% CI, 6.00%-15.47%) for individuals with a vitamin D level of 30 to less than 40 ng/mL, and 3.82% (95% CI, 1.78%-6.68%) for individuals with a vitamin D level of 40 ng/mL or higher. Multivariate analysis in individuals with a vitamin D level of 30 ng/mL or greater found that the IRR of a positive COVID-19 test result was 0.97 (95% CI, 0.94-0.99; P = .008) per 1-ng/mL increase in vitamin D overall and 0.95 (95% CI, 0.91-0.98; P = .003) per 1-ng/mL increase in vitamin D in Black individuals. Conclusions and Relevance: In this single-center retrospective cohort study, COVID-19 risk increased among Black individuals with vitamin D level less than 40 ng/mL compared with those with 40 ng/mL or greater and decreased with increasing levels among individuals with levels greater than 30 ng/mL. No significant associations were noted for White individuals. Randomized clinical trials should examine whether increasing vitamin D level to greater than 40 ng/mL affects COVID-19 risk.


Assuntos
/estatística & dados numéricos , Deficiência de Vitamina D , Vitamina D/análogos & derivados , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , /diagnóstico , /prevenção & controle , Chicago/epidemiologia , Estudos de Coortes , Comorbidade , Correlação de Dados , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco/etnologia , Vitamina D/análise , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/etnologia
4.
Health Place ; 68: 102540, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33647635

RESUMO

Epidemiological studies have highlighted the disparate impact of coronavirus disease 2019 (COVID-19) on racial and ethnic minority and socioeconomically disadvantaged populations, but data at the neighborhood-level is sparse. The objective of this study was to investigate the disparate impact of COVID-19 on disadvantaged neighborhoods and racial/ethnic minorities in Chicago, Illinois. Using data from the Cook County Medical Examiner, we conducted a neighborhood-level analysis of COVID-19 decedents in Chicago and quantified age-standardized years of potential life lost (YPLL) due to COVID-19 among demographic subgroups and neighborhoods with geospatial clustering of high and low rates of COVID-19 mortality. We show that age-standardized YPLL was markedly higher among the non-Hispanic (NH) Black (559 years per 100,000 population) and the Hispanic (811) compared with NH white decedents (312). We demonstrate that geomapping using residential address data at the individual-level identifies hot-spots of COVID-19 mortality in neighborhoods on the Northeast, West, and South areas of Chicago that reflect a legacy of residential segregation and persistence of inequality in education, income, and access to healthcare. Our results may contribute to ongoing public health and community-engaged efforts to prevent the spread of infection and mitigate the disproportionate loss of life among these communities due to COVID-19 as well as highlight the urgent need to broadly target neighborhood disadvantage as a cause of pervasive racial inequalities in life and health.


Assuntos
Grupos de Populações Continentais , Grupos Étnicos/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Anos de Vida Ajustados por Qualidade de Vida , Características de Residência/estatística & dados numéricos , Idoso , /mortalidade , Chicago/epidemiologia , Feminino , Humanos , Masculino
5.
Soc Work Health Care ; 60(1): 78-92, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33563143

RESUMO

The COVID-19 pandemic necessitated an immediate response and rapid transition from traditional face-to-face behavioral health services to behavioral telehealth at an organization serving sexual and gender diverse (SGD) individuals in Chicago. In this practice innovations article, we explore the unfolding public health crisis and the impact on service delivery for SGD individuals. Using a large multi-service organization as a case study, this paper describes how key members of the staff and leadership team shifted services online as a means of responding to isolation, loneliness, and disparities in access to healthcare for Chicago SGD communities. Lessons learned and practice recommendations are presented.


Assuntos
/epidemiologia , Disparidades em Assistência à Saúde/organização & administração , Serviços de Saúde Mental/organização & administração , Minorias Sexuais e de Gênero , Telemedicina/organização & administração , Chicago/epidemiologia , Humanos , Pandemias
6.
J Public Health Manag Pract ; 27(3): 229-232, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33394643

RESUMO

Reopening in-person education in public schools during the coronavirus 2019 (COVID-19) pandemic requires careful risk-benefit analysis, with no current established metrics. Equity concerns in urban public schools such as decreased enrollment among largely Black and Latinx prekindergarten and special needs public school students already disproportionately impacted by the pandemic itself have added urgency to Chicago Department of Public Health's analysis of COVID-19 transmission. Close tracking within a large school system revealed a lower attack rate for students and staff participating in in-person learning than for the community overall. By combining local data from a large urban private school system with national and international data on maintaining in-person learning during COVID-19 surges, Chicago believes in-person public education poses a low risk of transmission when the operational burden imposed by the second wave has subsided.


Assuntos
/transmissão , Transmissão de Doença Infecciosa/estatística & dados numéricos , Educação/normas , Guias como Assunto , Instituições Acadêmicas/estatística & dados numéricos , Instituições Acadêmicas/normas , Estudantes/estatística & dados numéricos , Adolescente , Chicago/epidemiologia , Criança , Pré-Escolar , Cidades/epidemiologia , Cidades/estatística & dados numéricos , Feminino , Humanos , Masculino , Pandemias , Medição de Risco/métodos , Medição de Risco/normas
7.
PLoS One ; 16(1): e0240202, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33507941

RESUMO

BACKGROUND: During the early phases of the COVID-19 pandemic in the U.S., African-American or Hispanic communities were disproportionately impacted. To better understand the epidemiology and relative effects of COVID-19 among hospitalized Hispanic patients, we compared individual and census-tract level characteristics of patients diagnosed with COVID-19 to those diagnosed with influenza, another viral infection with respiratory transmission. We evaluated temporal changes in epidemiology related to a shelter-in-place mandate. METHODS: We evaluated patients hospitalized at Cook County Health, the safety-net health system for the Chicago metropolitan area. Among self-identified hospitalized Hispanic patients, we compared those with influenza (2019-2020 season) to COVID-19 infection during March 16, 2020-May 11, 2020. We used multivariable analysis to identify differences in individual and census-tract level characteristics between the two groups. RESULTS: Relative to non-Hispanic blacks and whites, COVID-19 rapidly increased among Hispanics during promotion of social-distancing policies. Whereas non-Hispanic blacks were more likely to be hospitalized for influenza, Hispanic patients predominated among COVID-19 infections (40% relative increase compared to influenza). In the comparative analysis of influenza and COVID-19, Hispanic patients with COVID-19 were more likely to reside in census tracts with higher proportions of residents with the following characteristics: Hispanic; no high school diploma; non-US citizen; limited English speaking ability; employed in manufacturing or construction; and overcrowding. By multivariable analysis, Hispanic patients hospitalized with COVID-19 compared to those with influenza were more likely to be male (adjusted OR = 1.8; 95% CI 1.1 to 2.9), obese (aOR = 2.5; 95% CI 1.5 to 4.2), or reside in a census tract with ≥40% of residents without a high-school diploma (aOR = 2.5; 95% CI 1.3 to 4.8). CONCLUSIONS: The rapid and disproportionate increase in COVID-19 hospitalizations among Hispanics after the shelter-in-place mandate indicates that public health strategies were inadequate in protecting this population-in particular, for those residing in neighborhoods with lower levels of educational attainment.


Assuntos
/epidemiologia , Influenza Humana/epidemiologia , Adulto , Idoso , Chicago/epidemiologia , Feminino , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Hospitalização/tendências , Humanos , Illinois/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , /isolamento & purificação
9.
J Prim Care Community Health ; 11: 2150132720969557, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33174495

RESUMO

OBJECTIVE: In this brief report, we characterize pediatric primary care service utilization in metropolitan Chicago over the first 24 weeks of the COVID-19 pandemic response in relation to the comparable time period in 2019. METHODS: We examined retrospective visit and billing data, regardless of payer, from 16 independent pediatric practices that utilize a common electronic medical record platform within an Accountable Care Organization of 252 pediatricians in 71 offices throughout metropolitan Chicago. We categorized visits as Well-Child and Immunization-Only (WC-IO) or Other types and identified visits with a telemedicine billing modifier. Diagnoses for Other visits were tallied and categorized using the Agency for Healthcare Research and Quality Clinical Classification System. We summarized counts of visits and the proportion of visits with a telemedicine billing modifier in one-week epochs for 2020 compared with 2019. RESULTS: There were 102 942 total visits (72 030 WC-IO; 30 912 Other) in 2020 and 144 672 visits (80 578 WC-IO; 64 094 Other) in 2019. WC-IO visits in 2020 were half of 2019 visits at the start of the Illinois Stay-at-Home Order and returned greater than 90% of 2019 visits in 8 weeks. Other visit types have remained below 70% of 2019 visits. A telemedicine billing modifier peaked in mid-April (21% of all visits) and declined to <10% of all visits in June (Phase 2 reopening). The top 10 most common diagnoses differed between years. CONCLUSIONS: Recovery of well child and immunization visits suggests that practice-level efforts and policy change can ensure children receive recommended care as the pandemic evolves.


Assuntos
Assistência Ambulatorial , Saúde da Criança , Infecções por Coronavirus , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Pneumonia Viral , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Betacoronavirus , Chicago/epidemiologia , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Registros Eletrônicos de Saúde , Humanos , Imunização , Lactente , Visita a Consultório Médico/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Estudos Retrospectivos , Isolamento Social , Telemedicina
10.
J Stroke Cerebrovasc Dis ; 29(11): 105314, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32951959

RESUMO

BACKGROUND AND PURPOSE: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is associated with stroke. The role of sex on stroke outcome has not been investigated. To objective of this paper is to describe the characteristics of a diverse cohort of acute stroke patients with COVID-19 disease and determine the role of sex on outcome. METHODS: This is a retrospective study of patients with acute stroke and SARS-CoV-2 infection admitted between March 15 to May 15, 2020 to one of the six participating comprehensive stroke centers. Baseline characteristics, stroke subtype, workup, treatment and outcome are presented as total number and percentage or median and interquartile range. Outcome at discharge was determined by the modified Rankin Scale Score (mRS). Variables and outcomes were compared for males and females using univariate and multivariate analysis. RESULTS: The study included 83 patients, 47% of which were Black, 28% Hispanics/Latinos, and 16% whites. Median age was 64 years. Approximately 89% had at least one preexisting vascular risk factor (VRF). The most common complications were respiratory failure (59%) and septic shock (34%). Compared with females, a higher proportion of males experienced severe SARS-CoV-2 symptoms requiring ICU hospitalization (73% vs. 49%; p = 0.04). When divided by stroke subtype, there were 77% ischemic, 19% intracerebral hemorrhage and 3% subarachnoid hemorrhage. The most common ischemic stroke etiologies were cryptogenic (39%) and cardioembolic (27%). Compared with females, males had higher mortality (38% vs. 13%; p = 0.02) and were less likely to be discharged home (12% vs. 33%; p = 0.04). After adjustment for age, race/ethnicity, and number of VRFs, mRS was higher in males than in females (OR = 1.47, 95% CI = 1.03-2.09). CONCLUSION: In this cohort of SARS-CoV-2 stroke patients, most had clinical evidence of coronavirus infection on admission and preexisting VRFs. Severe in-hospital complications and worse outcomes after ischemic strokes were higher in males, than females.


Assuntos
Isquemia Encefálica/epidemiologia , Infecções por Coronavirus/epidemiologia , Disparidades nos Níveis de Saúde , Hemorragias Intracranianas/epidemiologia , Pneumonia Viral/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Chicago/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/terapia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Fatores de Tempo
11.
BMC Public Health ; 20(1): 1363, 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32891137

RESUMO

BACKGROUND: Chlamydia screening in high schools offers a way to reach adolescents outside of a traditional clinic setting. Using transmission dynamic modeling, we examined the potential impact of high-school-based chlamydia screening programs on the burden of infection within intervention schools and surrounding communities, under varying epidemiological and programmatic conditions. METHODS: A chlamydia transmission model was calibrated to epidemiological data from three different settings. Philadelphia and Chicago are two high-burden cities with existing school-based screening programs. Rural Iowa does not have an existing program but represents a low-burden setting. We modeled the effects of the two existing programs to analyze the potential influence of program coverage and student participation. All three settings were used to examine a broader set of hypothetical programs with varying coverage levels and time trends in participation. RESULTS: In the modeled Philadelphia program, prevalence among the intervention schools' sexually active 15-18 years old population was 4.34% (95% credible interval 3.75-4.71%)after 12 program years compared to 5.03% (4.39-5.43%) in absence of the program. In the modeled Chicago program, prevalence was estimated as 5.97% (2.60-7.88%) after 4 program years compared to 7.00% (3.08-9.29%) without the program. In the broader hypothetical scenarios including both high-burden and low-burden settings, impact of school-based screening programs was greater in absolute terms in the higher-prevalence settings, and benefits in the community were approximately proportional to population coverage of intervention schools. Most benefits were garnered if the student participation did not decline over time. CONCLUSIONS: Sustained high student participation in school-based screening programs and broad coverage of schools within a target community are likely needed to maximize program benefits in terms of reduced burden of chlamydia in the adolescent population.


Assuntos
Infecções por Chlamydia/prevenção & controle , Chlamydia trachomatis , Programas de Rastreamento , Serviços de Saúde Escolar , Instituições Acadêmicas , Estudantes , Adolescente , Chicago/epidemiologia , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Feminino , Humanos , Iowa/epidemiologia , Masculino , Modelos Teóricos , Aceitação pelo Paciente de Cuidados de Saúde , Philadelphia/epidemiologia , Prevalência
13.
Acad Emerg Med ; 27(10): 963-973, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32762106

RESUMO

BACKGROUND: SARS-CoV-2 is a global pandemic associated with significant morbidity and mortality. However, information from United States cohorts is limited. Understanding predictors of admission and critical illness in these patients is essential to guide prevention and risk stratification strategies. METHODS: This was a retrospective, registry-based cohort study including all patients presenting to Rush University Medical Center in Chicago, Illinois, with COVID-19 from March 4, 2020 to June 21, 2020. Demographic, clinical, laboratory, and treatment data were obtained from the registry and compared between hospitalized and nonhospitalized patients as well as those with critical illness. We used logistic regression modeling to explore risk factors associated with hospitalization and critical illness. RESULTS: A total of 8,673 COVID-19 patients were included in the study, of whom 1,483 (17.1%) were admitted to the hospital and 528 (6.1%) were admitted to the intensive care unit. Risk factors for hospital admission included advanced age, male sex (odds ratio [OR] = 1.69, 95% confidence interval [CI] = 1.44 to 1.98), Hispanic/Latino ethnicity (OR = 1.52, 95% CI = 1.18 to 1.92), hypertension (OR = 1.77, 95% CI = 1.46 to 2.16), diabetes mellitus (OR = 1.84, 95% CI = 1.53 to 2.22), prior CVA (OR = 3.20, 95% CI = 1.99 to 5.14), coronary artery disease (OR = 1.45, 95% CI = 1.03 to 2.06), heart failure (OR = 1.79, 95% CI = 1.23 to 2.61), chronic kidney disease (OR = 2.60, 95% CI = 1.77 to 3.83), end-stage renal disease (OR = 2.22, 95% CI = 1.12 to 4.41), cirrhosis (OR = 2.03, 95% CI = 1.42 to 2.91), fever (OR = 1.43, 95% CI = 1.19 to 1.71), and dyspnea (OR = 4.53, 95% CI = 3.75 to 5.47). Factors associated with critical illness included male sex (OR = 1.45, 95% CI = 1.12 to 1.88), congestive heart failure (OR = 1.45, 95% CI = 1.00 to 2.12), obstructive sleep apnea (OR = 1.58, 95% CI = 1.07 to 2.33), blood-borne cancer (OR = 3.53, 95% CI = 1.26 to 9.86), leukocytosis (OR = 1.53, 95% CI = 1.15 to 2.17), elevated neutrophil-to-lymphocyte ratio (OR = 1.61, 95% CI = 1.20 to 2.17), hypoalbuminemia (OR = 1.80, 95% CI = 1.39 to 2.32), elevated AST (OR = 1.66, 95% CI = 1.20 to 2.29), elevated lactate (OR = 1.95, 95% CI = 1.40 to 2.73), elevated D-Dimer (OR = 1.44, 95% CI = 1.05 to 1.97), and elevated troponin (OR = 3.65, 95% CI = 2.03 to 6.57). CONCLUSION: There are a number of factors associated with hospitalization and critical illness. Clinicians should consider these factors when evaluating patients with COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Estado Terminal/epidemiologia , Hospitalização/tendências , Unidades de Terapia Intensiva , Pandemias , Pneumonia Viral/epidemiologia , Medição de Risco/métodos , Chicago/epidemiologia , Estudos de Coortes , Comorbidade , Estado Terminal/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
14.
MMWR Morb Mortal Wkly Rep ; 69(28): 909-912, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32673295

RESUMO

During January 1-March 2, 2018, the number of mumps cases among adults reported to the Chicago Department of Public Health (CDPH) doubled compared with the same period in 2017. In response, CDPH created a supplementary questionnaire to collect additional information on populations affected and potential transmission routes. An epidemiologic analysis of routine and supplementary data, including spatiotemporal analysis, was performed to describe mumps cases reported to CDPH during 2018. A fourfold increase in mumps cases was reported during 2018 compared with 2017, with men who have sex with men (MSM) and persons living with human immunodeficiency virus (HIV) infection disproportionately represented among cases. A spatiotemporal, residential cluster was identified in a 9-square-mile area within six adjacent communities. The majority of persons affected were MSM, and this area was visited by many other persons with mumps diagnoses. Spatiotemporal analyses could be used in real time to identify case clusters to target public health response efforts, including to guide recommendations for additional measles, mumps, and rubella (MMR) vaccine and to identify specific transmission venues.


Assuntos
Surtos de Doenças , Infecções por HIV/epidemiologia , Disparidades nos Níveis de Saúde , Homossexualidade Masculina/estatística & dados numéricos , Caxumba/epidemiologia , Adulto , Chicago/epidemiologia , Análise por Conglomerados , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Masculino , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Caxumba/prevenção & controle , Fatores de Risco , Análise Espaço-Temporal
15.
J Am Acad Dermatol ; 83(5): 1538-1539, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32682892
17.
J Urban Health ; 97(4): 461-470, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32691212

RESUMO

There have been numerous reports that the impact of the ongoing COVID-19 epidemic has disproportionately impacted traditionally vulnerable communities associated with neighborhood attributes, such as the proportion of racial and ethnic minorities, migrants, and the lower income households. The goal of this ecological cross-sectional study is to examine the demographic and economic nature of spatial hot and cold spots of SARS-CoV-2 rates in New York City and Chicago as of April 13, 2020 using data from the New York City Department of Health and Mental Hygiene, Illinois Department of Public Health, and the American Community Survey. In both cities, cold spots (clusters of low SARS-CoV-2 rate ZIP code tabulation areas as identified by the Getis-Ord (GI*) statistic) demonstrated social determinants of health characteristics typically associated with better health outcomes and the ability to maintain physical distance ("social distancing"). These neighborhoods tended to be wealthier, have higher educational attainment, higher proportions of non-Hispanic white residents, and more workers in managerial occupations (all p values < 0.01 using Wilcoxon two-sample test). Hot spots (clusters of high SARS-CoV-2 rate ZIP code tabulation areas) had similarities as well, such as lower rates of college graduates and higher proportions of people of color. It also appears that household size (more people per household), rather than overall population density (people per square mile), is more strongly associated with hot spots. New York City had an average of 3.0 people per household in hot spots and 2.1 in cold spots (p < 0.01), and Chicago had 2.8 people per household in hot spots and 2.0 in cold spots (p = 0.03). However, hotspots were located in neighborhoods that were significantly less dense (New York City: 22,900 people per square mile in hot spots and 68,900 in cold spots (p < 0.01); Chicago: 10,000 people per square mile in hot spots and 23,400 in cold spots (p = 0.03)). Findings suggest important differences between the cities' hot spots as well. NYC hot spots can be described as working-class and middle-income communities, perhaps indicative of greater concentrations of service workers and other occupations (including those classified as "essential services" during the pandemic) that may not require a college degree but pay wages above poverty levels. Chicago's hot spot neighborhoods, on the other hand, are among the city's most vulnerable, low-income neighborhoods with extremely high rates of poverty, unemployment, and non-Hispanic Black residents.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Idoso , Chicago/epidemiologia , Estudos Transversais , Grupos Étnicos/estatística & dados numéricos , Humanos , Cidade de Nova Iorque/epidemiologia , Pandemias , Densidade Demográfica , Pobreza/estatística & dados numéricos , Características de Residência/estatística & dados numéricos
18.
Acad Med ; 95(7): 1050-1056, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32576763

RESUMO

PURPOSE: It is challenging to add rigorous, competency-based communication skills training to existing clerkship structures. The authors embedded a simulation-based mastery learning (SBML) curriculum into a medicine subinternship to demonstrate feasibility and determine the impact on the foundational skill of breaking bad news (BBN). METHOD: All fourth-year students enrolled in a medicine subinternship at Northwestern University Feinberg School of Medicine from September 2017 through August 2018 were expected to complete a BBN SBML curriculum. First, students completed a pretest with a standardized patient using a previously developed BBN assessment tool. Learners then participated in a 4-hour BBN skills workshop with didactic instruction, focused feedback, and deliberate practice with simulated patients. Students were required to meet or exceed a predetermined minimum passing standard (MPS) at posttest. The authors compared pretest and posttest scores to evaluate the effect of the intervention. Participant demographic characteristics and course evaluations were also collected. RESULTS: Eighty-five students were eligible for the study, and 79 (93%) completed all components. Although 55/79 (70%) reported having personally delivered serious news to actual patients, baseline performance was poor. Students' overall checklist performance significantly improved from a mean of 65.0% (SD = 16.2%) items correct to 94.2% (SD = 5.9%; P < .001) correct. There was also statistically significant improvement in scaled items assessing quality of communication, and all students achieved the MPS at mastery posttest. All students stated they would recommend the workshop to colleagues. CONCLUSIONS: It is feasible to embed SBML into a required clerkship. In the context of this study, rigorous SBML resulted in uniformly high levels of skill acquisition, documented competency, and was positively received by learners.


Assuntos
Variação Contingente Negativa/fisiologia , Avaliação Educacional/métodos , Internato e Residência/métodos , Aprendizagem/fisiologia , Treinamento por Simulação/métodos , Adulto , Lista de Checagem , Chicago/epidemiologia , Competência Clínica/estatística & dados numéricos , Comunicação , Currículo , Avaliação Educacional/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Medicina/métodos , Estudantes de Medicina , Universidades/estatística & dados numéricos
19.
J Neurol Sci ; 415: 116969, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32570113

RESUMO

OBJECTIVE: To report neurological manifestations seen in patients hospitalized with Coronavirus disease 2019 (COVID-19) from a large academic medical center in Chicago, Illinois. METHODS: We retrospectively reviewed data records of 50 patients with COVID-19 who were evaluated by the neurology services from March 1, 2020 - April 30, 2020. Patients were categorized into 2 groups based on timing of developing neurological manifestations: the "Neuro first" group had neurological manifestations upon initial assessment, and the "COVID first" group developed neurological symptoms greater than 24 h after hospitalization. The demographics, comorbidities, disease severity and neurological symptoms and diagnoses of both groups were analyzed. Statistical analysis was performed to compare the two groups. RESULTS: A total of 50 patients (48% African American and 24% Latino) were included in the analysis. Most common neurological manifestations observed were encephalopathy (n = 30), cerebrovascular disease (n = 20), cognitive impairment (n = 13), seizures (n = 13), hypoxic brain injury (n = 7), dysgeusia (n = 5), and extraocular movement abnormalities (n = 5). The "COVID-19 first" group had more evidence of physiologic disturbances on arrival with a more severe/critical disease course (83.3% vs 53.8%, p 0.025). CONCLUSION: Neurologic manifestations of COVID-19 are highly variable and can occur prior to the diagnosis of or as a complication of the viral infection. Despite similar baseline comorbidities and demographics, the COVID-19 patients who developed neurologic symptoms later in hospitalization had more severe disease courses. Differently from previous studies, we noted a high percentage of African American and Latino individuals in both groups.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Doenças do Sistema Nervoso/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Centros de Atenção Terciária , Betacoronavirus , Chicago/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/fisiopatologia , Pandemias , Estudos Retrospectivos , Fatores de Tempo
20.
J Surg Res ; 255: 188-194, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32563759

RESUMO

BACKGROUND: Peripheral nerve injuries can be devastating complications of surgery, potentially resulting in severe functional disability and decreased quality of life. Long surgeries with considerable tissue manipulation, for example, liver transplantation, may present increased risk; however, neuropraxia in transplantation has not been well investigated. MATERIALS AND METHODS: This is a retrospective study of all adult patients undergoing liver transplantation at a large academic center between January 2013 and December 2015. Descriptive analyses, logistic regressions, and forward selection procedures were used to determine the odds of developing neuropraxia and associated factors. RESULTS: Of the 283 liver recipients, the mean age was 55.8 y, 35.1% were female, 65.6% were Caucasian, 8.9% were African American, 16.7% were Hispanic, and mean model for end-stage liver disease sodium score at transplant was 24.2 ± 10.9. The underlying etiology was alcohol (26.2%), hepatitis C (34.8%), nonalcoholic steatohepatitis (13.1%), and other (14.2%). The incidence of neuropraxia after liver transplantation was 8.3% (n = 25), with 60% (n = 16) upper extremities, 82% left sided, and 84% male. There was no difference in age, race, body mass index, hypertension, diabetes, hyperlipidemia, or smoking in those with neuropraxia versus those without. In multivariate analysis, neuropraxia was significantly associated with male gender, lower model for end-stage liver disease score, and longer duration of surgery (P < 0.05). Symptoms lasted median 5 d, with a wide range up to 187 d. Neuropraxia-specific treatment (physical therapy or medications) was required in 32% (n = 9). CONCLUSIONS: Peripheral nerve injuries are an unexplored complication of liver transplantation. Although transient, a high number (8.2%) of patients developed neuropraxia, negatively affecting their ability for recovery. Exploration of mechanisms for minimizing risk and intraoperative detection and prevention should be considered to mitigate this complication.


Assuntos
Transplante de Fígado/efeitos adversos , Traumatismos dos Nervos Periféricos/etiologia , Complicações Pós-Operatórias/etiologia , Chicago/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
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