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1.
J Urol ; 205(1): 241-247, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32716742

RESUMO

PURPOSE: Resumption of elective urology cases postponed due to the COVID-19 pandemic requires a systematic approach to case prioritization, which may be based on detailed cross-specialty questionnaires, specialty specific published expert opinion or by individual (operating) surgeon review. We evaluated whether each of these systems effectively stratifies cases and for agreement between approaches in order to inform departmental policy. MATERIALS AND METHODS: We evaluated triage of elective cases postponed within our department due to the COVID-19 pandemic (March 9, 2020 to May 22, 2020) using questionnaire based surgical prioritization (American College of Surgeons Medically Necessary, Time Sensitive Procedures [MeNTS] instrument), consensus/expert opinion based surgical prioritization (based on published urological recommendations) and individual surgeon based surgical prioritization scoring (developed and managed within our department). Lower scores represented greater urgency. MeNTS scores were compared across consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores. RESULTS: A total of 204 cases were evaluated. Median MeNTS score was 50 (IQR 44, 55), and mean consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores were 2.6±0.6 and 2.2±0.8, respectively. Median MeNTS scores were 52 (46.5, 57.5), 50 (44.5, 54.5) and 48 (43.5, 54) for individual surgeon based surgical prioritization priority 1, 2 and 3 cases (p=0.129), and 55 (51.5, 57), 47.5 (42, 56) and 49 (44, 54) for consensus/expert opinion based surgical prioritization priority scores 1, 2, and 3 (p=0.002). There was none to slight agreement between consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores (Kappa 0.131, p=0.002). CONCLUSIONS: Questionnaire based, expert opinion based and individual surgeon based approaches to case prioritization result in significantly different case prioritization. Questionnaire based surgical prioritization did not meaningfully stratify urological cases, and consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization frequently disagreed. The strengths and weaknesses of each of these systems should be considered in future disaster planning scenarios.


Assuntos
/prevenção & controle , Procedimentos Cirúrgicos Eletivos/normas , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/normas , Urologia/normas , Adulto , Idoso , /transmissão , Tomada de Decisão Clínica , Controle de Doenças Transmissíveis/normas , Consenso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Seleção de Pacientes , Medição de Risco/métodos , Medição de Risco/normas , Fatores de Tempo , Triagem/normas , Estados Unidos/epidemiologia , Adulto Jovem
2.
Health Commun ; 36(1): 6-14, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33225745

RESUMO

Wide-spread misinformation about the COVID-19 pandemic has presented challenges for communicating public health recommendations. Should campaigns to promote protective behaviors focus on debunking misinformation or targeting behavior-specific beliefs? To address this question, we examine whether belief in COVID-19 misinformation is directly associated with two behaviors (face mask wearing and social distancing), and whether behavior-specific beliefs can account for this association and better predict behavior, consistent with behavior-change theory. We conducted a nationally representative two-wave survey of U.S. adults from 5/26/20-6/12/20 (n = 1074) and 7/15/20-7/21//20 (n = 889; follow-up response 83%). Scales were developed and validated for COVID-19 related misinformation beliefs, social distancing and face mask wearing, and beliefs about the consequences of both behaviors. Cross-lagged panel linear regression models assessed relationships among the variables. While belief in misinformation was negatively associated with both face mask wearing (B = -.27, SE =.06) and social-distancing behaviors (B = -.46, SE =.08) measured at the same time, misinformation did not predict concurrent or lagged behavior when the behavior-specific beliefs were incorporated in the models. Beliefs about behavioral outcomes accounted for face mask wearing and social distancing, both cross-sectionally (B =.43, SE =.05; B =.63, SE =.09) and lagged over time (B =.20, SE = 04; B =.30, SE =.08). In conclusion, belief in COVID-19-related misinformation is less relevant to protective behaviors, but beliefs about the consequences of these behaviors are important predictors. With regard to misinformation, we recommend health campaigns aimed at promoting protective behaviors emphasize the benefits of these behaviors, rather than debunking unrelated false claims.


Assuntos
/prevenção & controle , Comunicação em Saúde/normas , Conhecimentos, Atitudes e Prática em Saúde , Máscaras/normas , Adulto , /psicologia , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/normas , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Saúde Pública , Comportamento de Redução do Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia
3.
BMJ Glob Health ; 5(12)2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33355265

RESUMO

OBJECTIVE: To generate rankings of 35 countries from all continents (except Africa) on performance against COVID-19. DESIGN: International time series, cross-sectional analysis. SELECTED COUNTRIES: Countries having 5500 or more cases (collectively including 85% of the world's cases) as of 16 April 2020 and that had reached 135 days into their pandemic by 30 July. MAIN OUTCOME MEASURES: The initial severity and late-pandemic performance of countries can reasonably be ranked by COVID-19 cases or deaths per million population. For guiding policy and informing public accountability during the pandemic, we propose mid-pandemic performance rankings based on doubling time in days of the total number of cases and deaths in a country. Rank orderings then follow. RESULTS: At day 25 into a country's pandemic, cross-country performance variation was modest: in most countries, cumulative deaths doubled in fewer than 5 days. By day 65, and even more so by day 135, great cross-country variation emerged. By day 135, 9 of the 10 top-performing countries on deaths were European, although they were initially hard hit by the pandemic. Thus, rankings change rapidly enough to point to the value of a dynamic indicator. Five countries-Brazil, Mexico, India, Indonesia and Israel-were among the seven poorest performers at day 135 on both cases and deaths. Doubling times for cases and for deaths are positively correlated, but differ sufficiently to point to the value of both indicators. CONCLUSIONS: Readily available data support transparently generated rankings of countries' performance against COVID-19 based on doubling times of cases and deaths. It is premature to judge the value of these rankings in practice, but the potential and early experience suggest they might help facilitate identification of good policies and inform judgements on national leadership.


Assuntos
Controle de Doenças Transmissíveis/normas , Países Desenvolvidos/classificação , Pandemias/prevenção & controle , Controle de Doenças Transmissíveis/estatística & dados numéricos , Estudos Transversais , Humanos
5.
BMC Public Health ; 20(1): 1919, 2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334334

RESUMO

BACKGROUND: Emergency risk communication is a critical component in emergency planning and response. It has been recognised as significant for planning for and responding to public health emergencies. While there is a growing body of guidelines and frameworks on emergency risk communication, it remains a relatively new field. There has also been limited attention on how emergency risk communication is being performed in public health organisations, such as acute hospitals, and what the associated challenges are. This article seeks to examine the perception of crisis and emergency risk communication in an acute hospital in response to COVID-19 pandemic in Singapore and to identify its associated enablers and barriers. METHODS: A 13-item Crisis and Emergency Risk Communication (CERC) Survey, based on the US Centers for Disease and Control (CDC) CERC framework, was developed and administered to hospital staff during February 24-28, 2020. The survey also included an open-ended question to solicit feedback on areas of CERC in need of improvement. Chi-square test was used for analysis of survey data. Thematic analysis was performed on qualitative feedback. RESULTS: Of the 1154 participants who responded to the survey, most (94.1%) reported that regular hospital updates on COVID-19 were understandable and actionable. Many (92.5%) stated that accurate, concise and timely information helped to keep them safe. A majority (92.3%) of them were clear about the hospital's response to the COVID-19 situation, and 79.4% of the respondents reported that the hospital had been able to understand their challenges and address their concerns. Sociodemographic characteristics, such as occupation, age, marital status, work experience, gender, and staff's primary work location influenced the responses to hospital CERC. Local leaders within the hospital would need support to better communicate and translate hospital updates in response to COVID-19 to actionable plans for their staff. Better communication in executing resource utilization plans, expressing more empathy and care for their staff, and enhancing communication channels, such as through the use of secure text messaging rather than emails would be important. CONCLUSION: CERC is relevant and important in the hospital setting to managing COVID-19 and should be considered concurrently with hospital emergency response domains.


Assuntos
/terapia , Controle de Doenças Transmissíveis/normas , Sistemas de Comunicação entre Serviços de Emergência/normas , Serviço Hospitalar de Emergência/organização & administração , Tratamento de Emergência/normas , Centers for Disease Control and Prevention, U.S. , Humanos , Disseminação de Informação/métodos , Pandemias/prevenção & controle , Singapura , Estados Unidos
6.
BMJ Open ; 10(12): e044197, 2020 12 29.
Artigo em Inglês | MEDLINE | ID: mdl-33376182

RESUMO

AIM: To explore indigenous communities' responses to the COVID-19 pandemic and its consequences for maternal and neonatal health (MNH) care in the Peruvian Amazon. METHODS: Mamás del Río is a community-based, MNH programme with comprehensive supervision covering monthly meetings with community health workers (CHW), community leaders and health facilities. With the onset of the lockdown, supervisors made telephone calls to discuss measures against COVID-19, governmental support, CHW activities in communities and provision of MNH care and COVID-19 preparedness at facilities. As part of the programme's ongoing mixed methods evaluation, we analysed written summaries of supervisor calls collected during the first 2 months of Peru's lockdown. RESULTS: Between March and May 2020, supervisors held two rounds of calls with CHWs and leaders of 68 communities and staff from 17 facilities. Most communities banned entry of foreigners, but about half tolerated residents travelling to regional towns for trade and social support. While social events were forbidden, strict home isolation was only practised in a third of communities as conflicting with daily routine. By the end of April, first clusters of suspected cases were reported in communities. COVID-19 test kits, training and medical face masks were not available in most rural facilities. Six out of seven facilities suspended routine antenatal and postnatal consultations while two-thirds of CHWs resumed home visits to pregnant women and newborns. CONCLUSIONS: Home isolation was hardly feasible in the rural Amazon context and community isolation was undermined by lack of external supplies and social support. With sustained community transmission, promotion of basic hygiene and mask use becomes essential. To avoid devastating effects on MNH, routine services at facilities need to be urgently re-established alongside COVID-19 preparedness plans. Community-based MNH programmes could offset detrimental indirect effects of the pandemic and provide an opportunity for local COVID-19 prevention and containment.


Assuntos
Controle de Doenças Transmissíveis , Serviços de Saúde Comunitária , Saúde do Lactente , Saúde Materna , Adulto , /prevenção & controle , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/normas , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/normas , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde do Indígena/tendências , Humanos , Saúde do Lactente/estatística & dados numéricos , Saúde do Lactente/tendências , Recém-Nascido , Masculino , Saúde Materna/estatística & dados numéricos , Saúde Materna/tendências , Peru/epidemiologia , Gravidez , Serviços Preventivos de Saúde/métodos
7.
Eur Rev Med Pharmacol Sci ; 24(21): 11402-11408, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33215462

RESUMO

OBJECTIVE: The study aimed to explore the best follow-up management strategy for patients undergoing peritoneal dialysis (PD) during the novel coronavirus pneumonia (NCP) epidemic. PATIENTS AND METHODS: Patients undergoing PD who were followed up during the NCP epidemic by our hospital were enrolled in this study. Because of the need to control the epidemic, a follow-up system was established during the epidemic period, with WeChat, QQ, and the telephone as the main methods of communication. Outpatient and emergency follow-ups were carried out to ensure the safety of dialysis and the prevention and control of the epidemic. The follow-up strategy included response measures related to the epidemic situation, prevention of peritonitis related to PD, water and salt control, exercise guidance, and psychological care. According to the patient's condition, the appointment system was implemented, with one consulting room and one process for each patient. The emergency patients were isolated in accordance with the epidemic situation. RESULTS: Since January 2020, among the 580 patients undergoing PD who were followed up in our department and their families, none had NCP infection. During the epidemic period, the standard hemoglobin level and the inpatient rate decreased. Complications related to PD, such as peritonitis, cardiovascular complications caused by volume overload, and pulmonary infection, did not significantly increase, and the withdrawal rate and mortality rate decreased compared with those in the same period last year. CONCLUSIONS: The patient follow-up strategy during the epidemic period had a significant positive effect on preventing and controlling the epidemic. Furthermore, during the epidemic period, encouraging patients and caregivers to pay attention to protection at home, avoid going out, strengthen self-management, and other measures were beneficial to the control of kidney disease itself, which is worth promoting. The close relationship between doctors and patients during the epidemic had a positive effect on the occurrence of complications related to patients undergoing PD.


Assuntos
Assistência ao Convalescente/métodos , Infecções por Coronavirus/prevenção & controle , Hemodiálise no Domicílio/normas , Falência Renal Crônica/terapia , Pandemias/prevenção & controle , Diálise Peritoneal/normas , Pneumonia Viral/prevenção & controle , Assistência ao Convalescente/normas , Betacoronavirus/patogenicidade , Cuidadores/psicologia , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Seguimentos , Hemodiálise no Domicílio/efeitos adversos , Hemodiálise no Domicílio/psicologia , Humanos , Educação de Pacientes como Assunto , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/psicologia , Peritonite/epidemiologia , Peritonite/etiologia , Relações Médico-Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/normas , Autogestão/psicologia , Telemedicina/normas , Resultado do Tratamento
8.
Eur Rev Med Pharmacol Sci ; 24(21): 11432-11439, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33215466

RESUMO

OBJECTIVE: Soap has been used by humankind since ancient times and was probably already known to the Sumerians. It is a fatty acid salt obtained from the reaction of a strong base with a fatty substance of animal (tallow) or plant origin (oil). This reaction is called saponification. Syndets, on the other hand, are much more recent and have been in use for about a century. In the case of liquid syndets, they are mainly alkyl sulphates and their derivatives alkyl ether sulphates while isethionates and sarcosinates are more commonly found in solid syndets. Synthetic soaps and detergents are surfactants and, as such, they have detergent properties. The way soap works accounts for its antimicrobial properties. Thanks to its amphiphilic structure, it is able to interact with the lipid membranes of microorganisms (viruses, bacteria, etc.) and inactivate them. In this coronavirus pandemic period, health authorities worldwide recommend hand washing with soap and water. We therefore wanted to provide a summary of the chemical characteristics and applications of soaps, on the one hand, and synthetic detergents, on the other. Soap is not the only product used for hand hygiene and, given the current situation, alternatives are complex and varied.


Assuntos
Anti-Infecciosos/farmacologia , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/prevenção & controle , Detergentes/farmacologia , Desinfecção das Mãos/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Sabões/farmacologia , Anti-Infecciosos/química , Anti-Infecciosos/normas , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Detergentes/química , Detergentes/normas , Desinfecção das Mãos/normas , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Sabões/química , Sabões/normas
9.
Eur Rev Med Pharmacol Sci ; 24(21): 11445-11454, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33215472

RESUMO

In Italy, SARS-CoV-2 outbreak registered a high transmission and disease rates. During the acute phase, oncologists provided to re-organize services and prioritize treatments, in order to limit viral spread and to protect cancer patients. The progressive reduction of the number of infections has prompted Italian government to gradually loosen the national confinement measures and to start the "Second phase" of measures to contain the pandemic. The issue on how to organize cancer care during this post-acute SARS-CoV-2 phase appears crucial and a reassessment of healthcare services is needed requiring new models of care for oncological patients. In order to address major challenges in cancer setting during post-acute SARS-CoV-2 phase, this work offers multidimensional solutions aimed to provide a new way to take care of cancer patients.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Oncologia/organização & administração , Modelos Organizacionais , Neoplasias/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus/patogenicidade , Técnicas de Laboratório Clínico/normas , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Serviços Hospitalares de Assistência Domiciliar/normas , Humanos , Itália/epidemiologia , Oncologia/normas , Neoplasias/diagnóstico , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Triagem/organização & administração , Triagem/normas
10.
Emerg Med J ; 37(12): 778-780, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33051275

RESUMO

BACKGROUND: It has been reported that patients attending the emergency department with other pathologies may not have received optimal medical care due to the lockdown measures in the early phase of the COVID-19 pandemic. METHODS: This was a retrospective study of patients presenting with cardiovascular emergencies to four tertiary regional emergency departments in western India during the government implementation of complete lockdown. RESULTS: 25.0% of patients during the lockdown period and 17.4% of patients during the pre-lockdown period presented outside the window period (presentation after 12 hours of symptom onset) compared with only 6% during the pre-COVID period. In the pre-COVID period, 46.9% of patients with ST elevation myocardial infarction underwent emergent catheterisation, while in the pre-lockdown and lockdown periods, these values were 26.1% and 18.8%, respectively. The proportion of patients treated with intravenous thrombolytic therapy increased from 18.4% in the pre-COVID period to 32.3% in the post-lockdown period. Inhospital mortality for acute coronary syndrome (ACS) increased from 2.69% in the pre-COVID period to 7.27% in the post-lockdown period. There was also a significant decline in emergency admissions for non-ACS conditions, such as acute decompensated heart failure and high degree or complete atrioventricular block. CONCLUSION: The COVID-19 pandemic has led to delays in patients seeking care for cardiac problems and also affected the use of optimum therapy in our institutions.


Assuntos
Doenças Cardiovasculares/terapia , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Pandemias/prevenção & controle , Admissão do Paciente/normas , Pneumonia Viral/prevenção & controle , Idoso , Angioplastia/normas , Angioplastia/estatística & dados numéricos , Betacoronavirus/patogenicidade , Doenças Cardiovasculares/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Emergências , Serviço Hospitalar de Emergência/normas , Tratamento de Emergência/normas , Tratamento de Emergência/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Trombectomia/normas , Trombectomia/estatística & dados numéricos
11.
BMJ Glob Health ; 5(10)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33051286

RESUMO

Internationally supported activities to build public health capacity and improve compliance with International Health Regulations (2005) so that countries are better able to 'prevent, protect against, control and provide a public health response to the international spread of disease' have had a positive impact in recent years. However, despite the proliferation of technical guidance, tools and roadmaps, as the recent COVID-19 emergency demonstrates, a significant challenge still remains. The unique and complex environment within countries is increasingly being recognised as a factor which needs greater consideration if system strengthening activities are to be successful.This paper reflects on the learning from and charts out the journey of the authors' in their efforts to support the Pakistan government to improve compliance with International Health Regulations, specifically through strengthening its Integrated Disease Surveillance and Response (IDSR) system.To effect change, public health technical specialists bring their grounded technical and scientific expertise along with their softer public health skills of, among other things, relationship building and multisector working. In the authors' experience, the importance of taking time throughout to build and maintain strong trusted relationships and peer-to-peer support has been the key to the successes experienced. The nature of this relationship and ongoing reflexive dialogue enabled the co-construction of the reality of the background environment, which, in turn, led to more realistic visioning of the desired system for IDSR, and therefore more appropriate bespoke technical support to be given, leading to the design and initial implementation of a country owned system developed with sustainability in mind.


Assuntos
Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/prevenção & controle , Cooperação Internacional , Regulamento Sanitário Internacional , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Vigilância da População/métodos , Administração em Saúde Pública , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Paquistão/epidemiologia , Pneumonia Viral/epidemiologia
12.
PLoS One ; 15(10): e0240013, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33052958

RESUMO

On March 15, 2020 Puerto Rico implemented non-pharmaceutical interventions (NPIs), including a mandatory curfew, as part of a state of emergency declaration to prevent the community transmission of the SARS-CoV-2 virus. The strict enforcement of this curfew was extended through May 25, with a gradual relaxation beginning on May 1. This report summarizes an assessment of these early mitigation measures on the progression of the COVID-19 pandemic in the island. From March 15 to May 15, 2020, 70,656 results of molecular (RT-PCR) tests were reported to the Puerto Rico Department of Health. Of these, 1,704 were positive, corresponding to 1,311 individuals with COVID-19 included in the study. We derived the epidemic growth rates (r) and the corresponding reproductive numbers (R) from the epidemic curve of these 1,311 individuals with laboratory-confirmed diagnosis of COVID-19 using their date of test collection as a proxy for symptoms onset. Through May 31, 2020, there were 143 COVID-19 associated deaths in Puerto Rico, for a case fatality risk of 10.9%. We compared the observed cases and deaths with Gompertz model projections had the mitigation measures not been implemented. The number of daily RT-PCR-confirmed cases peaked on March 30 (85 cases), showing a weekly cyclical trend, with lower counts on weekends and a decreasing secular trend since March 30. The initial exponential growth rate (r) was 15.87% (95% CI: 7.59%, 24.15%), corresponding to R of 1.82 (95% CI:1.37, 2.30). After March 30, the r value reverted to an exponential decay rate (negative) of -2.95% (95% CI: -4.99%, -0.92%), corresponding to R of 0.93 (95% CI: 0.86, 0.98). We estimate that, had the initial growth rate been maintained, a total of 6,155 additional COVID-19 cases would have occurred by May 15, with 211 additional COVID-19 deaths by May 31. These findings are consistent with very effective implementation of early NPIs as mitigation measures in Puerto Rico. These results also provide a baseline to assess the impact of the transition from mitigation to subsequent containment stages in Puerto Rico.


Assuntos
Técnicas de Laboratório Clínico/estatística & dados numéricos , Controle de Doenças Transmissíveis/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Porto Rico , Gestão de Riscos
13.
Int J Dermatol ; 59(12): 1437-1449, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33107038

RESUMO

Numerous unexplained pneumonia cases were reported to the World Health Organization (WHO) by Wuhan, China, in December 2020. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a zoonotic pathogen, came into sight, spreading coronavirus disease 2019 (COVID-19) all over the globe. Association of cutaneous signs and symptoms with COVID-19 is being studied worldwide, principally, to determine if these dermatoses can help in early recognition of SARS-CoV-2 infection. These dermatological manifestations can range from erythematous rash, urticaria to livedo reticularis, and acrocyanosis in patients of all age groups. Correspondingly, dermatologists treating COVID-19 patients, suffering from inflammatory dermatoses, with biologics or immunomodulators should exert caution and use specific protocols to adjust the doses of these medications. Prevention of person-to-person transmission of COVID-19 is being promoted universally, with the use of personal protective equipment (PPE), hand washes, and hand sanitizers around the clock. However, an array of cutaneous adverse effects such as contact dermatitis, irritant contact dermatitis, friction blisters, contact urticaria, acne, and infections are associated with the use of PPE. Extra-pulmonary manifestations of COVID-19 are still emerging in the community, and physicians and researchers are working together globally to strengthen the clinical management of these patients. Cases of COVID-19 continue to rise across the world, and an unprecedented approach has been taken to develop effective vaccines and therapeutic strategies against existing and forthcoming mutagenic strains of SARS-CoV-2.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Dermatite de Contato/epidemiologia , Dermatologia/tendências , Pneumonia Viral/epidemiologia , Dermatopatias Infecciosas/epidemiologia , Betacoronavirus/isolamento & purificação , Controle de Doenças Transmissíveis/instrumentação , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Dermatite de Contato/diagnóstico , Dermatite de Contato/etiologia , Dermatologia/normas , Higiene das Mãos/normas , Humanos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/efeitos adversos , Equipamento de Proteção Individual/normas , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/virologia
16.
Int J Dermatol ; 59(12): 1468-1474, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33040344

RESUMO

BACKGROUND: An association between wearing protective gear and eosinophilic folliculitis has not been reported. We aimed to investigate such during the COVID-19 pandemic. METHODS: In three outpatient clinics, we hand-reviewed records of all patients having consulted us during a Study Period (90 days) in the early phase of the pandemic. Our inclusion criteria for Study Subjects were: (i) clear clinical diagnosis, (ii) dermoscopic confirmation, (iii) differential diagnoses excluded, (iv) eosinophilia, (v) protective gear worn during sanitation services, (vi) temporal correlation, (vii) distributional correlation, (viii) physician-assessed association, and (ix) patient-assessed association. Control Periods in the same season were elected. RESULTS: Twenty-five study subjects fulfilled all inclusion criteria. The incidence was significantly higher than in the control periods (IR: 3.57, 95% CI: 1.79-7.43). Male predominance was significant (P < 0.001). Such for patients in the control periods were insignificant. Study subjects were 21.2 (95% CI: 11.0-31.4) years younger than patients in the control periods. For the study subjects, the distribution of erythematous or skin-colored folliculocentric dome-shaped papules and pustules were all compatible with body parts covered by the gear. Lesional biopsy performed on two patients revealed eosinophilic dermal infiltrates within and around the pilosebaceous units. Polarized dermoscopy revealed folliculitis with peri-/interfollicular vascular proliferation. Lesion onsets were 6.4 (SD: 2.1) days after wearing gear. Remissions were 16.7 (SD: 7.5) days after ceasing to wear gear and treatments. CONCLUSIONS: Wearing protective gear in volunteered sanitizing works could be associated with eosinophilic folliculitis. Owing to the significant temporal and distributional correlations, the association might be causal.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Eosinofilia/epidemiologia , Foliculite/epidemiologia , Pandemias/prevenção & controle , Equipamento de Proteção Individual/efeitos adversos , Pneumonia Viral/prevenção & controle , Dermatopatias Vesiculobolhosas/epidemiologia , Voluntários/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/patogenicidade , Biópsia , Controle de Doenças Transmissíveis/instrumentação , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Dermoscopia , Diagnóstico Diferencial , Eosinofilia/diagnóstico , Eosinofilia/etiologia , Eosinofilia/patologia , Feminino , Foliculite/diagnóstico , Foliculite/etiologia , Foliculite/patologia , Folículo Piloso/diagnóstico por imagem , Folículo Piloso/patologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Retrospectivos , Fatores de Risco , Saneamento , Fatores Sexuais , Dermatopatias Vesiculobolhosas/diagnóstico , Dermatopatias Vesiculobolhosas/etiologia , Dermatopatias Vesiculobolhosas/patologia , Fatores de Tempo , Adulto Jovem
20.
BMJ Glob Health ; 5(10)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33028700

RESUMO

INTRODUCTION: An international city, Hong Kong, in proximity to the first epicentre of COVID- 19, experienced two epidemic waves with different importation pressure. We compared the epidemiological features of patients with COVID-19 in the context of containment policies between the first and second waves. METHODS: We retrieved information on the first 1038 cases detected in Hong Kong (23 January to 25 April 2020) to analyse the epidemiological characteristics including age/gender-specific incidence, clustering, reproduction number (Rt ) and containment delay; in relation to the containment measures implemented. Factors associated with containment delay were evaluated by multiple linear regression analysis with age, gender, epidemic wave and infection source as covariates. A time series of 5-day moving average was plotted to examine the changes across the two epidemic waves. RESULTS: The incidence and mortality (135.5 and 0.5 per 1 000 000 population) was among the lowest in the world. Aggressive escalation of border control correlated with reductions in Rt from 1.35 to 0.57 and 0.92 to 0.18, and aversions of 450 and 1650 local infections during the first and second waves, respectively. Implementing COVID-19 tests for overseas returners correlated with an upsurge of asymptomatic case detection, and shortened containment delay in the second wave. Medium-sized cluster events in the first wave were family gatherings, whereas those in the second wave were leisure activities among youngsters. Containment delay was associated with older age (adjusted OR (AOR)=1.01, 95% CI 1.00 to 1.02, p=0.040), male gender (AOR=1.41, 95% CI 1.02 to 1.96, p=0.039) and local cases (AOR=11.18, 95% CI 7.43 to 16.83, p<0.001), and with significant improvement in the second wave compared with the first wave (average: 6.8 vs 3.7 days). A higher incidence rate was observed for males, raising possibility of gender predilection in susceptibility of developing symptoms. CONCLUSION: Prompt and stringent all-round containment strategies represent successful measures in pandemic control. These findings could inform formulation and implementation of pandemic mitigation strategies.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Criança , Pré-Escolar , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Feminino , Hong Kong , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Pneumonia Viral/prevenção & controle , Adulto Jovem
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