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1.
Epidemiol Prev ; 45(3): 155-163, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34212696

RESUMO

BACKGROUND: the exposure to a coal-fired power plant has been shown to increase mortality both for cardiovascular and respiratory causes among an exposed cohort in comparison with a cohort of unexposed. Hazard ratios between 1.30 and 1.90 were found for cardiovascular and respiratory mortality. OBJECTIVES: to estimate the individual life shortening among the exposed due to power plant emissions. DESIGN: survival for cardiovascular and respiratory disease in the exposed vs unexposed groups was estimated by the Kaplan-Meier method. For each gender and exposure, a fictitious cohort with a cumulative 30-year follow up was built combining three subcohorts of age at entry of 55-64, 65-74, and 75-84 years, with 10 years of follow up each. Survivals at 10 years in the 55-64-year subcohort were used as initial risks for 65-74-year subcohort; then, survivals at 10 years of the 65-74-year subcohort were used as initial risk in the 75-84-year subcohort. Eventually, 30-years cumulative follow up cohorts were obtained by gender and exposure. Individual life-shortening in people exposed was estimated as time from death of an exposed subject to the subsequent time when the unexposed cohort reached the same risk of the exposed subject at that time of the death. Here, it is proposed a method to take into account causes other than those considered. SETTING AND PARTICIPANTS: 144,018 subjects aged 55-74 years at entry of both genders belonging to the open cohort of residents of 12 municipalities (including Savona) from 2001 to 2013 in the area where the coal-fired power plant of Vado-Quiliano (Liguria Region, Northern Italy) is located. MAIN OUTCOME MEASURES: individual life shortening. RESULTS: after 5 years of follow up, the individual life shortening due to cardiorespiratory causes varied between 972 and 1,822 days for males and from 612 and 1,578 days among females. Taking into account other causes of death, reduces slightly (3% for males of 75 years at death) the estimate of life shortening found in this study. The comparison between the cohorts requires that the exposed and unexposed groups are comparable, except for the exposure, and that causes other than those considered are taken into account. Socioeconomic status had been found to have little effect on cause-specific death risk indicating that, at least in terms of socioeconomic status, the exposed and unexposed groups were similar. Taking into account causes other than those considered slightly reduced the found estimates (3% at age 75 in males). According to the proposal, the life-shortening for the considered causes is easy to calculate and provides an individual indicator of damage. Inferring from group statistics individual estimates could be the most controversial point of this approach. The proposed estimates are the most credible estimate of individual damage for each occurred death among the exposed people. CONCLUSIONS: an increased hazard ratio for a wide series of causes is equivalent to a life shortening among the exposed. A method to produce reasonable estimates of life-shortening is proposed as the effect of exposure at individual level. This approach is simple and do not require sophisticated statistical tools. It appears a promising approach for other settings.


Assuntos
Carbono , Doenças Cardiovasculares , Exposição Ambiental , Centrais Elétricas , Doenças Respiratórias , Idoso , Idoso de 80 Anos ou mais , Carbono/envenenamento , Doenças Cardiovasculares/mortalidade , Causas de Morte , Cidades/epidemiologia , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Respiratórias/mortalidade
2.
Rev Esp Salud Publica ; 952021 Jul 02.
Artigo em Espanhol | MEDLINE | ID: mdl-34212940

RESUMO

OBJECTIVE: The preventive measures to be taken in the face of a new epidemic require knowledge of the number of infected and which groups are most vulnerable. To know the cumulative incidence of COVID-19 in the city of Madrid and its 21 districts in the first 4 months of the epidemic and its relationship with some socioeconomic and demographic variables. METHODS: Cross-sectional ecological study (39,270 cases). The 39,270 cases diagnosed from the beginning of the pandemic until June 26, 2020, published by the Comunidad de Madrid in were studied. In the districts, the distribution of gross and fair incidence is related to the ones of the independent variables (Municipal Statistics and Estudio de Salud 2018, Madrid Salud). The Incidence and the r and r2 coefficients, obtained with the factors and the Multiple Linear Regression (MLR) model, are studied. RESULTS: The city of Madrid presents a cumulative incidence of COVID-19, which is double the national one (100), with a Standardized Cumulative Incidence Ratio (RIAE) of 204.59 per 100. The districts with the most RIAE were those in the southeast, all>240 per 100. In the districts, the per capita household rate, the per capita income, and the mortality rate from infectious diseases in men reached high and inverse correlations with RIAE (all r>-0.3). The RLM model with these 3 indicators predicts 30% of the RIAES. CONCLUSIONS: The relationship between material wealth and the risk of COVID-19 infection is inverse. The knowledge in the districts of per capita income, household rate and mortality rate due to infectious diseases in men reduces the uncertainty about the accumulated incidence by 30%.


Assuntos
COVID-19/epidemiologia , Disparidades nos Níveis de Saúde , Pandemias , Idoso , Idoso de 80 Anos ou mais , Cidades/epidemiologia , Estudos Transversais , Demografia , Feminino , Humanos , Incidência , Masculino , Fatores Socioeconômicos , Espanha/epidemiologia
3.
Rev Esp Salud Publica ; 952021 Jul 05.
Artigo em Espanhol | MEDLINE | ID: mdl-34219127

RESUMO

OBJECTIVE: Deescalation began in May 2020 increases social interaction, which has an influence on COVID-19 epidemiological surveillance. The aim of this study was the characterization of COVID-19 cases detected during this period. METHODS: We analyzed certain variables of interest coming from the epidemiological surveys carried out in an area of Madrid during May 2020, and stratified the results depending on its temporal relation with the deescalation. Prevalence for each category of response and average duration in minutes of the telephonic call were calculated. Confidence intervals were estimated at 95%. RESULTS: We included 167 cases, being 30.5% of them incident and 49.1% prevalent. The main source of infection was home (38.0%; CI 95% 31.4-46.2). Regarding healthcare and social care workers, the main source of infection was workplace (93.0%; 85.4-100). Average number of close contacts per case was 2.0 (1.8-2.2), being 1.5 (1.0-2.0) among pre-deescalation incident cases and 2.4 (1.8-3.0) among those post-deescalation. Average duration of each survey was 35.9 minutes (32.2-38.9), being 32.1 (24.4-39.8) among pre-deescalation incident cases and 37.0 (29.6-44.4) among those post-deescalation. Most of the contacts were household, both before and after beginning of deescalation. CONCLUSIONS: Home is the most prevalent place for the acquisition of the infection among general population, while workplace is the most prevalent among healthcare and social care workers. The initial phase of deescalation do not represents a change regarding sources of infection, but it may increase the number of close contacts.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Busca de Comunicante , Adolescente , Adulto , Idoso , COVID-19/transmissão , Criança , Pré-Escolar , Cidades/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia , Adulto Jovem
4.
Parasite ; 28: 56, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34236311

RESUMO

Toxoplasma gondii is a highly prevalent zoonotic parasite in Brazil capable of infecting mammals and birds. The increase in the urban populations of pets and the narrowing of the human-animal relationship can facilitate the transmission of important public health zoonoses, such as toxoplasmosis. This study aimed to evaluate the frequency and spatial distribution of T. gondii infection and its risk factors in domiciled dogs and cats attended at the Jorge Vaitsman Institute, Rio de Janeiro. Serum samples from 400 dogs and 272 cats were evaluated by an indirect fluorescent antibody test (IFAT) for IgG anti-T. gondii antibodies. Epidemiological questionnaires were used to interview the animals' owners to identify risk factors for infection. Of the total, 34% (136/400) of dogs and 8.1% (22/272) of cats had anti-T. gondii antibodies. Breed (OR: 2.10-95%, CI 1.27-3.46) was a risk factor for dogs, while sex (OR: 3.40-95%, CI 1.10-10.52) and homemade food consumption (OR: 8.49-95%, CI 2.48-29.05) were risk factors for cats. Offal consumption was considered a risk factor for both species evaluated (OR: 2.74-95%, CI 1.38-5.43 for dogs; OR: 7.66-95%, CI 1.24-47.29 for cats). The spatial analysis showed that T. gondii seropositive animals were widely distributed in the metropolitan region of Rio de Janeiro state, with a concentration observed mainly in the west and north zones of Rio de Janeiro city. The results emphasize the importance of adopting prophylactic measures to control T. gondii transmission in domiciled dogs and cats in Rio de Janeiro, contributing positively to public health.


Assuntos
Doenças do Gato , Doenças do Cão , Toxoplasma , Toxoplasmose Animal , Animais , Anticorpos Antiprotozoários , Brasil/epidemiologia , Doenças do Gato/epidemiologia , Gatos , Cidades/epidemiologia , Doenças do Cão/epidemiologia , Cães , Humanos , Fatores de Risco , Estudos Soroepidemiológicos , Toxoplasmose Animal/epidemiologia
5.
Cad Saude Publica ; 37(6): e00039221, 2021.
Artigo em Português | MEDLINE | ID: mdl-34259712

RESUMO

The sharp growth in COVID-19 cases and deaths has created a heavy overburden on Brazil's health system, especially in the cities of Manaus (Amazonas State), Rio de Janeiro, and São Paulo. The description of the pandemic's impact has been based on absolute numbers and crude mortality rates, failing to consider the age distribution patterns in different regions of the country. This study aims to compare the crude mortality rates from COVID-19 with age-standardized rates in the state capitals and Federal District. Information on deaths was accessed in the Information System on Influenza Surveillance (SIVEP-Gripe), and the population denominators were based on the estimate provided by the Brazilian Ministry of Health. Calculation of the age-standardized rates used the estimated age structure of the Brazilian population in 2020. The results show that the highest crude rates were in Manaus (253.6/100,000) and Rio de Janeiro (253.2/100,000). Age standardization led to a major increase in the North of Brazil. The highest age-adjusted rate was in Manaus (412.5/100,000), where 33% of COVID-19 deaths occurred in individuals under 60 years of age. Mortality in Manaus over 70 years of age was double that of Rio de Janeiro and triple that of São Paulo. The use of age-adjusted mortality rates eliminates interpretative biases, clearly exposing the even greater weight of COVID-19 in the North of Brazil.


Assuntos
COVID-19 , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Cidades/epidemiologia , Humanos , Pessoa de Meia-Idade , Mortalidade , SARS-CoV-2
6.
PLoS One ; 16(7): e0253171, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34242229

RESUMO

BACKGROUND: SARS-CoV-2 causes the new coronavirus disease (COVID-19) and it is weakening all health systems. Therefore, the most vulnerable populations are exposed to harmful consequences, such as illness and death. Thus, this study aims to estimate the temporal effect of COVID-19 dissemination on social indicators of the Northeastern region of Brazil. METHODS: An ecological time-series study was developed with the following: diagnosed cases of COVID-19 in the largest inland cities of Northeast Brazil, Human Development Index (HDI), poverty incidence, and Gini coefficient. Cities with high HDI, poverty rate, and Gini presented a larger number of patients. RESULTS: It was observed by evaluating case trends that COVID-19 spreads unevenly in inland cities of the Northeastern region of Brazil. CONCLUSIONS: In this sense, we emphasize that regional health managers should support small cities with vulnerable population and social assistance.


Assuntos
COVID-19/epidemiologia , COVID-19/transmissão , SARS-CoV-2 , Brasil/epidemiologia , Cidades/epidemiologia , Humanos , Incidência
7.
BMC Infect Dis ; 21(1): 687, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271868

RESUMO

BACKGROUND: COVID-19 can occur asymptomatically, as influenza-like illness, or as more severe forms, which characterize severe acute respiratory syndrome (SARS). Its mortality rate is higher in individuals over 80 years of age and in people with comorbidities, so these constitute the risk group for severe forms of the disease. We analyzed the factors associated with death in confirmed cases of COVID-19 in the state of Rio de Janeiro. This cross-sectional study evaluated the association between individual demographic, clinical, and epidemiological variables and the outcome (death) using data from the Unified Health System information systems. METHODS: We used the extreme boosting gradient (XGBoost) model to analyze the data, which uses decision trees weighted by the estimation difficulty. To evaluate the relevance of each independent variable, we used the SHapley Additive exPlanations (SHAP) metric. From the probabilities generated by the XGBoost model, we transformed the data to the logarithm of odds to estimate the odds ratio for each independent variable. RESULTS: This study showed that older individuals of black race/skin color with heart disease or diabetes who had dyspnea or fever were more likely to die. CONCLUSIONS: The early identification of patients who may progress to a more severe form of the disease can help improve the clinical management of patients with COVID-19 and is thus essential to reduce the lethality of the disease.


Assuntos
COVID-19/epidemiologia , COVID-19/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , COVID-19/diagnóstico , COVID-19/patologia , Criança , Pré-Escolar , Cidades/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mortalidade , Prognóstico , Medição de Risco , Fatores de Risco , SARS-CoV-2/fisiologia , Índice de Gravidade de Doença , Fatores Socioeconômicos , Análise de Sobrevida , Adulto Jovem
8.
Sci Rep ; 11(1): 12957, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-34155237

RESUMO

Shortly after the enactment of restrictions aimed at limiting the spread of COVID-19, various local government and public health authorities around the world reported an increased sighting of rats. Such reports have yet to be empirically validated. Here we combined data from multi-catch rodent stations (providing data on rodent captures), rodent bait stations (providing data on rodent activity) and residents' complaints to explore the effects of a six week lockdown period on rodent populations within the City of Sydney, Australia. The sampling interval encompassed October 2019 to July 2020 with lockdown defined as the interval from April 1st to May 15th, 2020. Rodent captures and activity (visits to bait stations) were stable prior to lockdown. Captures showed a rapid increase and then decline during the lockdown, while rodent visits to bait stations declined throughout this period. There were no changes in the frequency of complaints during lockdown relative to before and after lockdown. There was a non-directional change in the geographical distribution of indices of rodent abundance suggesting that rodents redistributed in response to resource scarcity. We hypothesize that lockdown measures initially resulted in increased rodent captures due to sudden shortage of human-derived food resources. Rodent visits to bait stations might not show this pattern due to the nature of the binary data collected, namely the presence or absence of a visit. Relocation of bait stations driven by pest management goals may also have affected the detection of any directional spatial effect. We conclude that the onset of COVID-19 may have disrupted commensal rodent populations, with possible implications for the future management of these ubiquitous urban indicator species.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Pandemias/prevenção & controle , Controle de Pragas/métodos , Quarentena/métodos , SARS-CoV-2 , Animais , Austrália/epidemiologia , COVID-19/virologia , Cidades/epidemiologia , Alimentos , Humanos , Ratos , População Urbana
9.
Sci Rep ; 11(1): 13001, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-34155241

RESUMO

Although international airports served as main entry points for SARS-CoV-2, the factors driving the uneven geographic spread of COVID-19 cases and deaths in Brazil remain mostly unknown. Here we show that three major factors influenced the early macro-geographical dynamics of COVID-19 in Brazil. Mathematical modeling revealed that the "super-spreading city" of São Paulo initially accounted for more than 85% of the case spread in the entire country. By adding only 16 other spreading cities, we accounted for 98-99% of the cases reported during the first 3 months of the pandemic in Brazil. Moreover, 26 federal highways accounted for about 30% of SARS-CoV-2's case spread. As cases increased in the Brazilian interior, the distribution of COVID-19 deaths began to correlate with the allocation of the country's intensive care units (ICUs), which is heavily weighted towards state capitals. Thus, severely ill patients living in the countryside had to be transported to state capitals to access ICU beds, creating a "boomerang effect" that contributed to skew the distribution of COVID-19 deaths. Therefore, if (i) a lockdown had been imposed earlier on in spreader-capitals, (ii) mandatory road traffic restrictions had been enforced, and (iii) a more equitable geographic distribution of ICU beds existed, the impact of COVID-19 in Brazil would be significantly lower.


Assuntos
COVID-19/prevenção & controle , COVID-19/transmissão , Portador Sadio/transmissão , Cuidados Críticos/métodos , Pandemias/prevenção & controle , Quarentena/métodos , SARS-CoV-2 , Doença Relacionada a Viagens , Automóveis , Brasil/epidemiologia , COVID-19/epidemiologia , COVID-19/virologia , Cidades/epidemiologia , Humanos , Unidades de Terapia Intensiva , Modelos Teóricos
10.
BMC Public Health ; 21(1): 1182, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-34154551

RESUMO

BACKGROUND: Some prevalent but rarely studied causes of hospital admissions, such as sepsis is still unknown whether affected by air pollution. METHODS: We used time-series regression within generalized additive models to estimate the effect of air pollutant level on the sepsis-related hospital admissions, for the years 2017-18, using data from six cities in Sichuan, China. Potential effect modifications by age and sex were also explored. The effects of air pollutant on hospital stays for sepsis were also quantified. RESULTS: Positive associations between short-term exposure to NO2 and O3 and risk of sepsis-related hospital admissions and stays were found. Each 10 µg/m3 increase in short-term NO2 at lag 03 and O3 at lag 4 was associated with an increase of 2.76% (95% CI: 0.67, 4.84%) and 0.64% (95% CI: 0.14, 1.14%) hospital admissions, respectively. An increase of 0.72% (95% CI: 0.05, 1.40%) hospital stay was associated with 10 µg/m3 increase in O3 concentration at lag 4. Besides, the adverse effect of exposure to NO2 was more significant in males and population aged less than 14 years; while more significant in females and population aged 14 ~ 65 and over 65 years for exposure to O3. These associations remained stable after the adjustment of other air pollutants.8. CONCLUSION: Exposure to ambient NO2 and O3 may cause substantial sepsis hospitalizations, and hospital stays in Sichuan, China. These associations were different in subgroup by age and sex.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Sepse , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , China/epidemiologia , Cidades/epidemiologia , Feminino , Hospitalização , Hospitais , Humanos , Masculino , Material Particulado/análise , Sepse/epidemiologia
11.
BMC Public Health ; 21(1): 1069, 2021 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090376

RESUMO

BACKGROUND: Ground-level ozone (O3) pollution is currently the one of the severe environmental problems in China. Although existing studies have quantified the O3-related health impact and economic loss, few have focused on the acute health effects of short-term exposure to O3 and have been limited to a single temporal and spatial dimension. METHODS: Based on the O3 concentration obtained from ground monitoring networks in 334 Chinese cities in 2015-2018, this study used a two-stage exposure parameter weighted Log-linear exposure-response function to estimate the cause-specific mortality for short-term exposure to O3. RESULTS: The value of statistical life (VSL) method that were used to calculate the economic loss at the city-level. Our results show that in China, the national all-cause mortality attributed to O3 was 0.27(95% CI: 0.14-0.55) to 0.39 (95% CI: 0.20-0.67) million across 2015-2018. The estimated economic loss caused by O3 was 387.76 (95% CI: 195.99-904.50) to 594.08 (95% CI: 303.34-1140.65) billion CNY, accounting for 0.52 to 0.69% of total reported GDP. Overall, the O3 attributed health and economic burden has begun to decline in China since 2017. However, highly polluted areas still face severe burden, and undeveloped areas suffer from high GDP losses. CONCLUSIONS: There are substantial health impacts and economic losses related to short-term O3 exposure in China. The government should pay attention to the emerging ozone pollution, and continue to strengthen the intervention in traditional priority areas while solving the pollution problem in non-priority areas.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Ozônio , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , China/epidemiologia , Cidades/epidemiologia , Exposição Ambiental/efeitos adversos , Humanos , Ozônio/análise , Ozônio/toxicidade , Material Particulado/análise
12.
Sci Rep ; 11(1): 12213, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108496

RESUMO

As we enter a chronic phase of the SARS-CoV-2 pandemic, with uncontrolled infection rates in many places, relative regional susceptibilities are a critical unknown for policy planning. Tests for SARS-CoV-2 infection or antibodies are indicative but unreliable measures of exposure. Here instead, for four highly-affected countries, we determine population susceptibilities by directly comparing country-wide observed epidemic dynamics data with that of their main metropolitan regions. We find significant susceptibility reductions in the metropolitan regions as a result of earlier seeding, with a relatively longer phase of exponential growth before the introduction of public health interventions. During the post-growth phase, the lower susceptibility of these regions contributed to the decline in cases, independent of intervention effects. Forward projections indicate that non-metropolitan regions will be more affected during recurrent epidemic waves compared with the initially heavier-hit metropolitan regions. Our findings have consequences for disease forecasts and resource utilisation.


Assuntos
COVID-19/epidemiologia , Pandemias/estatística & dados numéricos , COVID-19/mortalidade , COVID-19/prevenção & controle , Cidades/epidemiologia , Suscetibilidade a Doenças , Humanos , Modelos Estatísticos , Pandemias/prevenção & controle
13.
MMWR Morb Mortal Wkly Rep ; 70(22): 818-824, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34081685

RESUMO

Disparities in vaccination coverage by social vulnerability, defined as social and structural factors associated with adverse health outcomes, were noted during the first 2.5 months of the U.S. COVID-19 vaccination campaign, which began during mid-December 2020 (1). As vaccine eligibility and availability continue to expand, assuring equitable coverage for disproportionately affected communities remains a priority. CDC examined COVID-19 vaccine administration and 2018 CDC social vulnerability index (SVI) data to ascertain whether inequities in COVID-19 vaccination coverage with respect to county-level SVI have persisted, overall and by urbanicity. Vaccination coverage was defined as the number of persons aged ≥18 years (adults) who had received ≥1 dose of any Food and Drug Administration (FDA)-authorized COVID-19 vaccine divided by the total adult population in a specified SVI category.† SVI was examined overall and by its four themes (socioeconomic status, household composition and disability, racial/ethnic minority status and language, and housing type and transportation). Counties were categorized into SVI quartiles, in which quartile 1 (Q1) represented the lowest level of vulnerability and quartile 4 (Q4), the highest. Trends in vaccination coverage were assessed by SVI quartile and urbanicity, which was categorized as large central metropolitan, large fringe metropolitan (areas surrounding large cities, e.g., suburban), medium and small metropolitan, and nonmetropolitan counties.§ During December 14, 2020-May 1, 2021, disparities in vaccination coverage by SVI increased, especially in large fringe metropolitan (e.g., suburban) and nonmetropolitan counties. By May 1, 2021, vaccination coverage was lower among adults living in counties with the highest overall SVI; differences were most pronounced in large fringe metropolitan (Q4 coverage = 45.0% versus Q1 coverage = 61.7%) and nonmetropolitan (Q4 = 40.6% versus Q1 = 52.9%) counties. Vaccination coverage disparities were largest for two SVI themes: socioeconomic status (Q4 = 44.3% versus Q1 = 61.0%) and household composition and disability (Q4 = 42.0% versus Q1 = 60.1%). Outreach efforts, including expanding public health messaging tailored to local populations and increasing vaccination access, could help increase vaccination coverage in high-SVI counties.


Assuntos
Vacinas contra COVID-19/administração & dosagem , Disparidades em Assistência à Saúde/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Cidades/epidemiologia , Humanos , Fatores Socioeconômicos , Estados Unidos/epidemiologia
14.
Infez Med ; 29(2): 209-215, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34061785

RESUMO

Information regarding predictors of a worse COVID-19 prognosis in the South American population is scarce. We aimed to determine whether the blockade of the renin-angiotensin system is associated with a worse clinical course of COVID-19, and to evaluate what clinical variables are associated with COVID severity in our population. We included adult subjects with rtPCR-confirmed COVID-19. The use of renin system inhibitors was defined according to its registration in the electronic medical record or the hospital pharmacy registry during the previous three months. Our endpoint was a composite of death or mechanical ventilation requirement. Patients were followed up until discharge or death. A multiple logistic regression model was used to determine the predictors of the composite endpoint. In all, we included 4930 COVID+ patients, the median age was 52 years, and 48.1% were male. The endpoint occurred in 488 patients (9.9%). In adjusted analysis, neither angiotensin converting enzyme inhibitors nor angiotensin receptor blockers were associated with the outcome. Independent predictors of mortality and/or mechanical ventilation requirement were age, male sex, a history of diabetes and/or chronic kidney disease, smoking and dementia. To conclude, renin system inhibitors seem to be unrelated to COVID-19 severity, whereas prognosis is independently associated with age, male sex and comorbidities.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , COVID-19/tratamento farmacológico , Respiração Artificial/estatística & dados numéricos , Índice de Gravidade de Doença , Adulto , Fatores Etários , Idoso , Argentina/epidemiologia , COVID-19/epidemiologia , COVID-19/mortalidade , Cidades/epidemiologia , Comorbidade , Demência/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pandemias , Prognóstico , Insuficiência Renal Crônica/epidemiologia , Fatores Sexuais , Fumar/epidemiologia , Centros de Atenção Terciária
15.
Sci Adv ; 7(19)2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33962957

RESUMO

Nonpharmaceutical interventions to control SARS-CoV-2 spread have been implemented with different intensity, timing, and impact on transmission. As a result, post-lockdown COVID-19 dynamics are heterogeneous and difficult to interpret. We describe a set of contact surveys performed in four Chinese cities (Wuhan, Shanghai, Shenzhen, and Changsha) during the pre-pandemic, lockdown and post-lockdown periods to quantify changes in contact patterns. In the post-lockdown period, the mean number of contacts increased by 5 to 17% as compared to the lockdown period. However, it remains three to seven times lower than its pre-pandemic level sufficient to control SARS-CoV-2 transmission. We find that the impact of school interventions depends nonlinearly on the intensity of other activities. When most community activities are halted, school closure leads to a 77% decrease in the reproduction number; in contrast, when social mixing outside of schools is at pre-pandemic level, school closure leads to a 5% reduction in transmission.


Assuntos
COVID-19/epidemiologia , COVID-19/transmissão , Busca de Comunicante/estatística & dados numéricos , Pandemias/prevenção & controle , Quarentena , SARS-CoV-2 , Adolescente , Adulto , Idoso , COVID-19/virologia , Criança , Pré-Escolar , China/epidemiologia , Cidades/epidemiologia , Busca de Comunicante/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
17.
PLoS One ; 16(5): e0250493, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33983953

RESUMO

BACKGROUND: Brazil is witnessing a massive increase of corona virus disease (COVID-19). Its peculiar primary health care (PHC) system faces a burden due to the contagion occurring in the community environment. Then, the aim is to estimate the effect of the coverage of primary health care and social isolation on the evolution of confirmed cases and deaths by COVID-19, controlling sociodemographic, economic and health system aspects. METHODS: A time series design was designed with data on diagnosed cases of COVID-19 and their deaths as outcomes in the capital cities of the Northeast region of Brazil. Independent variables such as PHC coverage, hospital beds, social isolation, demographic density, Gini index and other indicators were analyzed. A Autoregressive Generalized Linear Model method was applied for model the relationship. RESULTS: We identified an exponential growth of cases (y = 0.00250.71x; p-value<0,001). However, there is a high variability in the occurrence of outcomes. PHC coverage≥75% (χ2 = 9.27; p-value = 0.01) and social isolation rate (χ2 = 365.99; p-value<0.001) proved to be mitigating factors for the spread of COVID-19 and its deaths. Capitals with hospital beds ≥ 3.2 per thousand inhabitants had fewer deaths (χ2 = 9.02; p-value = 0.003), but this was influenced by PHC coverage (χ2 = 30,87; p-value<0.001). CONCLUSIONS: PHC mitigates the occurrence of Covid-19 and its deaths in a region of social vulnerability in Brazil together with social isolation. However, it is not known until when the system will withstand the overload in view of the low adhesion to social isolation, the lack of support and appropriate direction from the government to its population.


Assuntos
COVID-19/epidemiologia , Brasil/epidemiologia , COVID-19/diagnóstico , COVID-19/prevenção & controle , Cidades/epidemiologia , Hospitalização , Humanos , Atenção Primária à Saúde , SARS-CoV-2/isolamento & purificação , Isolamento Social , Fatores de Tempo
18.
PLoS One ; 16(5): e0251349, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33984035

RESUMO

This paper contains a theoretical study of epidemic control. It is inspired by current events but not intended to be an accurate depiction of the SARS-CoV-2 pandemic. We consider the emergence of a highly transmissible pathogen, focusing on metropolitan areas. To ensure some degree of realism, we present a conceptual model of the outbreak and early attempts to stave off the onslaught, including the use of lockdowns. Model outputs show strong qualitative-in some respects even quantitative-resemblance to the events of Spring 2020 in many cities worldwide. We then use this model to project forward in time to examine different paths in epidemic control after the initial surge is tamed and before the arrival of vaccines. Three very different control strategies are analyzed, leading to vastly different outcomes in terms of economic recovery and total infected population (or progress toward herd immunity). Our model, which is a version of the SEIQR model, is a time-dependent dynamical system with feedback-control. One of the main conclusions of this analysis is that the course of the epidemic is not entirely dictated by the virus: how the population responds to it can play an equally important role in determining the eventual outcome.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Algoritmos , COVID-19/imunologia , Cidades/epidemiologia , Controle de Doenças Transmissíveis , Surtos de Doenças , Monitoramento Epidemiológico , Humanos , Imunidade Coletiva , Modelos Estatísticos , SARS-CoV-2/isolamento & purificação
19.
Medicine (Baltimore) ; 100(21): e25645, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032692

RESUMO

ABSTRACT: Since December 2019, pneumonia caused by a novel coronavirus (SARS-CoV-2), namely 2019 novel coronavirus disease (COVID-19), has rapidly spread from Wuhan city to other cities across China. The present study was designed to describe the epidemiology, clinical characteristics, treatment, and prognosis of 74 hospitalized patients with COVID-19.Clinical data of 74 COVID-19 patients were collected to analyze the epidemiological, demographic, laboratory, radiological, and treatment data. Thirty-two patients were followed up and tested for the presence of the viral nucleic acid and by pulmonary computed tomography (CT) scan at 7 and 14 days after they were discharged.Among all COVID-19 patients, the median incubation period for patients and the median period from symptom onset to admission was all 6 days; the median length of hospitalization was 13 days. Fever symptoms were presented in 83.78% of the patients, and the second most common symptom was cough (74.32%), followed by fatigue and expectoration (27.03%). Inflammatory indicators, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) of the intensive care unit (ICU) patients were significantly higher than that of the non-ICU patients (P < .05). However, 50.00% of the ICU patients had their the ratio of T helper cells to cytotoxic T cells (CD4/CD8) ratio lower than 1.1, whose proportion is much higher than that in non-ICU patients (P < .01).Compared with patients in Wuhan, COVID-19 patients in Anhui Province seemed to have milder symptoms of infection, suggesting that there may be some regional differences in the transmission of SARS-CoV-2 between different cities.


Assuntos
Antivirais/uso terapêutico , COVID-19/diagnóstico , Tosse/epidemiologia , Febre/epidemiologia , Oxigenação Hiperbárica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Antibioticoprofilaxia/estatística & dados numéricos , Sedimentação Sanguínea , Proteína C-Reativa/análise , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/terapia , Teste de Ácido Nucleico para COVID-19 , Criança , Pré-Escolar , China/epidemiologia , Cidades/epidemiologia , Tosse/sangue , Tosse/terapia , Tosse/virologia , Feminino , Febre/sangue , Febre/terapia , Febre/virologia , Seguimentos , Geografia , Humanos , Tempo de Internação/estatística & dados numéricos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , RNA Viral/isolamento & purificação , Estudos Retrospectivos , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Adulto Jovem
20.
Proc Natl Acad Sci U S A ; 118(24)2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34049993

RESUMO

The COVID-19 pandemic is a global threat presenting health, economic, and social challenges that continue to escalate. Metapopulation epidemic modeling studies in the susceptible-exposed-infectious-removed (SEIR) style have played important roles in informing public health policy making to mitigate the spread of COVID-19. These models typically rely on a key assumption on the homogeneity of the population. This assumption certainly cannot be expected to hold true in real situations; various geographic, socioeconomic, and cultural environments affect the behaviors that drive the spread of COVID-19 in different communities. What's more, variation of intracounty environments creates spatial heterogeneity of transmission in different regions. To address this issue, we develop a human mobility flow-augmented stochastic SEIR-style epidemic modeling framework with the ability to distinguish different regions and their corresponding behaviors. This modeling framework is then combined with data assimilation and machine learning techniques to reconstruct the historical growth trajectories of COVID-19 confirmed cases in two counties in Wisconsin. The associations between the spread of COVID-19 and business foot traffic, race and ethnicity, and age structure are then investigated. The results reveal that, in a college town (Dane County), the most important heterogeneity is age structure, while, in a large city area (Milwaukee County), racial and ethnic heterogeneity becomes more apparent. Scenario studies further indicate a strong response of the spread rate to various reopening policies, which suggests that policy makers may need to take these heterogeneities into account very carefully when designing policies for mitigating the ongoing spread of COVID-19 and reopening.


Assuntos
COVID-19/epidemiologia , COVID-19/transmissão , Migração Humana , Modelos Biológicos , Pandemias , SARS-CoV-2 , Cidades/epidemiologia , Humanos , Wisconsin/epidemiologia
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