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1.
Bull Math Biol ; 83(8): 89, 2021 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-34216281

RESUMO

This work presents a model-agnostic evaluation of four different models that estimate a disease's basic reproduction number. The evaluation presented is twofold: first, the theory behind each of the models is reviewed and compared; then, each model is tested with eight impartial simulations. All scenarios were constructed in an experimental framework that allows each model to fulfill its assumptions and hence, obtain unbiased results for each case. Among these models is the one proposed by Thompson et al. (Epidemics 29:100356, 2019), i.e., a Bayesian estimation method well established in epidemiological practice. The other three models include a novel state-space method and two simulation-based approaches based on a Poisson infection process. The advantages and flaws of each model are discussed from both theoretical and practical standpoints. Finally, we present the evolution of Covid-19 outbreak in Colombia as a case study for computing the basic reproduction number with each one of the reviewed methods.


Assuntos
Número Básico de Reprodução/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/transmissão , Pandemias/estatística & dados numéricos , SARS-CoV-2 , Teorema de Bayes , Colômbia/epidemiologia , Simulação por Computador , Intervalos de Confiança , Epidemias/estatística & dados numéricos , Humanos , Conceitos Matemáticos , Modelos Biológicos , Modelos Estatísticos , Distribuição de Poisson
2.
Biomed Environ Sci ; 34(5): 395-399, 2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34059177

RESUMO

Climate change has been referred to as one of the greatest threats to human health, with reports citing likely increases in extreme meteorological events. In this study, we estimated the relationships between temperature and outpatients at a major hospital in Qingdao, China, during 2015-2017, and assessed the morbidity burden. The results showed that both low and high temperatures were associated with an increased risk of outpatient visits. High temperatures were responsible for more morbidity than low temperatures, with an attributed fraction (AF) of 16.86%. Most temperature-related burdens were attributed to moderate cold and hot temperatures, with AFs of 5.99% and 14.44%, respectively, with the young (0-17) and male showing greater susceptibility. The results suggest that governments should implement intervention measures to reduce the adverse effects of non-optimal temperatures on public health-especially in vulnerable groups.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Doenças Cardiovasculares/etiologia , Temperatura Baixa/efeitos adversos , Doenças do Sistema Digestório/etiologia , Utilização de Instalações e Serviços/estatística & dados numéricos , Temperatura Alta/efeitos adversos , Doenças Respiratórias/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Criança , Pré-Escolar , China/epidemiologia , Efeitos Psicossociais da Doença , Doenças do Sistema Digestório/epidemiologia , Doenças do Sistema Digestório/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/terapia , Fatores de Risco , Adulto Jovem
4.
Methods Enzymol ; 652: 321-340, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34059289

RESUMO

During reconstitution, membrane proteins are randomly inserted into liposomes according to Poisson distribution statistics. When the protein to lipid ratios in the reconstitution mixture are varied systematically, the characteristics of this statistical capture permit inferences about the proteins themselves, such as the number of subunits that assemble into a single functional unit. This chapter describes the Poisson distribution as applied to the reconstitution of membrane proteins into proteoliposomes and focuses on an application whereby this statistical behavior is used to determine the number of ion channel subunits that assemble into a functional pore. Practical considerations for performing these experiments are emphasized. Harnessing Poisson dilution statistics provides a function-based method to determine ion channel oligomerization, complementing other biophysical, biochemical, or structural approaches.


Assuntos
Canais Iônicos , Lipossomos , Biofísica , Proteínas de Membrana , Distribuição de Poisson
5.
Neurology ; 97(1): e52-e60, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-33931532

RESUMO

OBJECTIVE: To study whether the incidence of subarachnoid hemorrhage (SAH) varies between geographic regions of Finland. METHODS: By utilizing the nationwide Causes of Death and Hospital Discharge Registers, we identified all first-ever, hospitalized, and sudden-death (dying before hospitalization) SAH events in Finland between 1998 and 2017. Based on the patients' home residence, we divided SAHs into 5 geographic regions: southern, central, western, eastern, and northern Finland. We calculated crude and European age-standardized (European Standard Population [ESP] 2013) SAH incidence rates for each region and used a Poisson regression model to calculate age-, sex-, and calendar year-adjusted incidence rate ratios (IRRs) and 95% confidence intervals for regional and time-dependent differences. RESULTS: During the total 106,510,337 cumulative person-years, we identified 9,443 first-ever SAH cases, of which 24% resulted in death before hospitalization. As compared to western Finland, where the SAH incidence was the lowest (7.4 per 100,000 persons), the ESP-standardized SAH incidence was 1.4 times higher in eastern (10.2 per 100,000 persons; adjusted IRR, 1.37 [1.27-1.47]) and northern Finland (10.4 per 100,000 persons; adjusted IRR, 1.40 [1.30-1.51]). These differences were similar when men and women were analyzed independently. Although SAH incidence rates decreased in all 5 regions over 2 decades, the rate of decrease varied significantly by region. CONCLUSION: SAH incidence appears to vary substantially by region in Finland. Our results suggest that regional SAH studies can identify high-risk subpopulations, but can also considerably over- or underestimate incidence on a nationwide level.


Assuntos
Hemorragia Subaracnóidea/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Morte Súbita , Feminino , Finlândia/epidemiologia , Geografia , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Distribuição de Poisson , Sistema de Registros , Fatores Sexuais , Fumar/epidemiologia , Fatores Socioeconômicos
6.
J Theor Biol ; 525: 110758, 2021 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-33984354

RESUMO

Traditional predictive microbiology is not suited for cell growth predictions for low-level contamination, where individual cell heterogeneity becomes apparent. Accordingly, we simulated a stochastic birth process of bacteria population using kinetic parameters. We predicted the variation in behavior of Salmonella enterica serovar Typhimurium cells at low inoculum density. The modeled cells were grown in tryptic soy broth at 25 °C. Kinetic growth parameters were first determined empirically for an initial cell number of 104 cells. Monte Carlo simulation based on the growth kinetics and Poisson distribution for different initial cell numbers predicted the results of 50 replicate growth experiments with the initial cell number of 1, 10, and 64 cells. Indeed, measured behavior of 85% cells fell within the 95% prediction area of the simulation. The calculations link the kinetic and stochastic birth process with Poisson distribution. The developed model can be used to calculate the probability distribution of population size for exposure assessment and for the evaluation of a probability that a pathogen would exceed critical contamination level during food storage.


Assuntos
Salmonella enterica , Contagem de Colônia Microbiana , Contaminação de Alimentos , Microbiologia de Alimentos , Cinética , Método de Monte Carlo , Distribuição de Poisson , Processos Estocásticos
7.
J Environ Public Health ; 2021: 5543977, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34012470

RESUMO

Discrete count time series data with an excessive number of zeros have warranted the development of zero-inflated time series models to incorporate the inflation of zeros and the overdispersion that comes with it. In this paper, we investigated the characteristics of the trend of daily count of COVID-19 deaths in Ghana using zero-inflated models. We envisaged that the trend of COVID-19 deaths per day in Ghana portrays a general increase from the onset of the pandemic in the country to about day 160 after which there is a general decrease onward. We fitted a zero-inflated Poisson autoregressive model and zero-inflated negative binomial autoregressive model to the data in the partial-likelihood framework. The zero-inflated negative binomial autoregressive model outperformed the zero-inflated Poisson autoregressive model. On the other hand, the dynamic zero-inflated Poisson autoregressive model performed better than the dynamic negative binomial autoregressive model. The predicted new death based on the zero-inflated negative binomial autoregressive model indicated that Ghana's COVID-19 death per day will rise sharply few days after 30th November 2020 and drastically fall just as in the observed data.


Assuntos
COVID-19/mortalidade , Análise de Séries Temporais Interrompida/métodos , Modelos Estatísticos , Distribuição Binomial , Gana/epidemiologia , Humanos , Mortalidade/tendências , Distribuição de Poisson , Reprodutibilidade dos Testes , SARS-CoV-2
8.
BMJ ; 373: n1137, 2021 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011491

RESUMO

OBJECTIVE: To estimate the direct and indirect effects of the covid-19 pandemic on mortality in 2020 in 29 high income countries with reliable and complete age and sex disaggregated mortality data. DESIGN: Time series study of high income countries. SETTING: Austria, Belgium, Czech Republic, Denmark, England and Wales, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, Latvia, Lithuania, the Netherlands, New Zealand, Northern Ireland, Norway, Poland, Portugal, Scotland, Slovakia, Slovenia, South Korea, Spain, Sweden, Switzerland, and United States. PARTICIPANTS: Mortality data from the Short-term Mortality Fluctuations data series of the Human Mortality Database for 2016-20, harmonised and disaggregated by age and sex. INTERVENTIONS: Covid-19 pandemic and associated policy measures. MAIN OUTCOME MEASURES: Weekly excess deaths (observed deaths versus expected deaths predicted by model) in 2020, by sex and age (0-14, 15-64, 65-74, 75-84, and ≥85 years), estimated using an over-dispersed Poisson regression model that accounts for temporal trends and seasonal variability in mortality. RESULTS: An estimated 979 000 (95% confidence interval 954 000 to 1 001 000) excess deaths occurred in 2020 in the 29 high income countries analysed. All countries had excess deaths in 2020, except New Zealand, Norway, and Denmark. The five countries with the highest absolute number of excess deaths were the US (458 000, 454 000 to 461 000), Italy (89 100, 87 500 to 90 700), England and Wales (85 400, 83 900 to 86 800), Spain (84 100, 82 800 to 85 300), and Poland (60 100, 58 800 to 61 300). New Zealand had lower overall mortality than expected (-2500, -2900 to -2100). In many countries, the estimated number of excess deaths substantially exceeded the number of reported deaths from covid-19. The highest excess death rates (per 100 000) in men were in Lithuania (285, 259 to 311), Poland (191, 184 to 197), Spain (179, 174 to 184), Hungary (174, 161 to 188), and Italy (168, 163 to 173); the highest rates in women were in Lithuania (210, 185 to 234), Spain (180, 175 to 185), Hungary (169, 156 to 182), Slovenia (158, 132 to 184), and Belgium (151, 141 to 162). Little evidence was found of subsequent compensatory reductions following excess mortality. CONCLUSION: Approximately one million excess deaths occurred in 2020 in these 29 high income countries. Age standardised excess death rates were higher in men than women in almost all countries. Excess deaths substantially exceeded reported deaths from covid-19 in many countries, indicating that determining the full impact of the pandemic on mortality requires assessment of excess deaths. Many countries had lower deaths than expected in children <15 years. Sex inequality in mortality widened further in most countries in 2020.


Assuntos
COVID-19/mortalidade , Países Desenvolvidos/estatística & dados numéricos , Mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Europa (Continente)/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Distribuição de Poisson , República da Coreia/epidemiologia , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto Jovem
9.
BMC Pregnancy Childbirth ; 21(1): 357, 2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952188

RESUMO

BACKGROUND: There are no accurate estimates of the prevalence of non-severe maternal morbidities. Given the lack of instruments to fully assess these morbidities, the World Health Organization (WHO) developed an instrument called WOICE. We aimed to evaluate the prevalence of non-severe maternal morbidities in puerperal women and factors associated to impaired clinical, social and mental health conditions. METHOD: A cross-sectional study with postpartum women at a high-risk outpatient clinic in southeast Brazil, from November 2017 to December 2018. The WOICE questionnaire included three sections: the first with maternal and obstetric history, sociodemographic data, risk and environment factors, violence and sexual health; the second considers functionality and disability, general symptoms and mental health; and the third includes data on physical and laboratory tests. Data collection was supported by Tablets with REDCAP software. Initially, a descriptive analysis was performed, with general prevalence of all variables contained in the WOICE, including scales on anxiety and depression (GAD-7 and PHQ-9- impaired if ≥10), functionality (WHODAS- high disability scores when ≥37.4) and data on violence and substance use. Subsequently, an evaluation of cases with positive findings was performed, with a Poisson regression to investigate factors associated to impaired non-clinical and clinical conditions. RESULTS: Five hundred seventeen women were included, majority (54.3%) multiparous, between 20 and 34 years (65.4%) and with a partner (75,6%). Over a quarter had (26.2%) preterm birth. Around a third (30.2%) reported health problems informed by the physician, although more than 80% considered having good or very good health. About 10% reported any substance use and 5.9% reported exposure to violence. Anxiety was identified in 19.8% of cases, depression in 36.9% and impaired functioning in 4.4% of women. Poisson regression identified that poor overall health rating was associated to increased anxiety/depression and impaired functioning. Having a partner reduced perception of women on the presence of clinical morbidities. CONCLUSION: During postpartum care of a high-risk population, over one third of the considered women presented anxiety and depression; 10% reported substance use and around 6% exposure to violence. These aspects of women's health need further evaluation and specific interventions to improve quality of care.


Assuntos
Depressão Pós-Parto/epidemiologia , Gravidez de Alto Risco , Transtornos Puerperais/epidemiologia , Adulto , Ansiedade/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Exposição à Violência/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Distribuição de Poisson , Período Pós-Parto , Gravidez , Nascimento Prematuro/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Organização Mundial da Saúde , Adulto Jovem
10.
J Am Heart Assoc ; 10(11): e019708, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34044586

RESUMO

Background COVID-19 was temporally associated with an increase in out-of-hospital cardiac arrests, but the underlying mechanisms are unclear. We sought to determine if patients with implantable defibrillators residing in areas with high COVID-19 activity experienced an increase in defibrillator shocks during the COVID-19 outbreak. Methods and Results Using the Medtronic (Mounds View, MN) Carelink database from 2019 and 2020, we retrospectively determined the incidence of implantable defibrillator shock episodes among patients residing in New York City, New Orleans, LA, and Boston, MA. A total of 14 665 patients with a Medtronic implantable defibrillator (age, 66±13 years; and 72% men) were included in the analysis. Comparing analysis time periods coinciding with the COVID-19 outbreak in 2020 with the same periods in 2019, we observed a larger mean rate of defibrillator shock episodes per 1000 patients in New York City (17.8 versus 11.7, respectively), New Orleans (26.4 versus 13.5, respectively), and Boston (30.9 versus 20.6, respectively) during the COVID-19 surge. Age- and sex-adjusted hurdle model showed that the Poisson distribution rate of defibrillator shocks for patients with ≥1 shock was 3.11 times larger (95% CI, 1.08-8.99; P=0.036) in New York City, 3.74 times larger (95% CI, 0.88-15.89; P=0.074) in New Orleans, and 1.97 times larger (95% CI, 0.69-5.61; P=0.202) in Boston in 2020 versus 2019. However, the binomial odds of any given patient having a shock episode was not different in 2020 versus 2019. Conclusions Defibrillator shock episodes increased during the higher COVID-19 activity in New York City, New Orleans, and Boston. These observations may provide insights into COVID-19-related increase in cardiac arrests.


Assuntos
COVID-19 , Morte Súbita Cardíaca , Desfibriladores Implantáveis , Cardioversão Elétrica , Parada Cardíaca Extra-Hospitalar , Idoso , Boston/epidemiologia , COVID-19/complicações , COVID-19/epidemiologia , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Nova Orleans/epidemiologia , Cidade de Nova Iorque/epidemiologia , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/etiologia , Distribuição de Poisson , SARS-CoV-2
11.
Nat Genet ; 53(6): 770-777, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34031584

RESUMO

The high proportion of zeros in typical single-cell RNA sequencing datasets has led to widespread but inconsistent use of terminology such as dropout and missing data. Here, we argue that much of this terminology is unhelpful and confusing, and outline simple ideas to help to reduce confusion. These include: (1) observed single-cell RNA sequencing counts reflect both true gene expression levels and measurement error, and carefully distinguishing between these contributions helps to clarify thinking; and (2) method development should start with a Poisson measurement model, rather than more complex models, because it is simple and generally consistent with existing data. We outline how several existing methods can be viewed within this framework and highlight how these methods differ in their assumptions about expression variation. We also illustrate how our perspective helps to address questions of biological interest, such as whether messenger RNA expression levels are multimodal among cells.


Assuntos
Regulação da Expressão Gênica , Análise de Sequência de RNA , Análise de Célula Única , Humanos , Modelos Genéticos , Distribuição de Poisson , Terminologia como Assunto
12.
Enferm. glob ; 20(62): 216-253, abr. 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-202232

RESUMO

INTRODUCCIÓN: La violencia en el trabajo se define como una acción, incidente o comportamiento con una actitud voluntaria del agresor, como resultado de lo cual un profesional es agredido, amenazado o sufre algún daño durante el desempeño de su trabajo. El equipo de enfermería está expuesto diariamente a situaciones de violencia en el trabajo. OBJETIVO: Comprender y analizar los mecanismos de afrontamiento de la violencia utilizados por los profesionales de enfermería en el contexto hospitalario y en la Atención Primaria de Salud. MATERIALES Y MÉTODO: Estudio explicativo secuencial mixto, con 198 trabajadores de enfermería de un hospital y 169 de atención primaria de salud, en un municipio del sur de Brasil. Los datos fueron recolectados mediante una encuesta en la etapa cuantitativa y entrevistas en la cualitativa, analizados a través del paquete estadístico de software para las Ciencias Sociales y por el análisis temático. RESULTADOS: Se identificó que el 51% de los participantes fueron víctimas de violencia, y los mecanismos de afrontamiento utilizados por los trabajadores son individuales y colectivos, con predominio del primero, lo que demuestra que el problema a menudo se dirige a la víctima. El trabajo colectivo fue un factor contribuyente en la lucha contra la violencia, con énfasis en el diálogo y el apoyo entre el equipo. Sin embargo, no hubo apoyo institucional en la búsqueda de conducta frente a episodios de violencia y consecuencias para los perpetradores. CONCLUSIÓN: La prevalencia de violencia fue alta en ambos escenarios, con diferentes características en cuanto al perfil de víctimas y perpetradores. Se refuerza la importancia del enfrentamiento colectivo, como la forma más efectiva de combatir la violencia en el lugar de trabajo


INTRODUCTION: Violence at work is defined as an action, incident, or behavior with a voluntary attitude of the aggressor, as a result of which a professional is assaulted, threatened, or suffers some damage during the performance of their work. The nursing team is exposed daily to situations of violence at work. OBJECTIVE: To understand and analyze the mechanisms of coping with violence used by nursing professionals in the hospital context and Primary Health Care.MATERIALS AND METHOD: A mixed sequential explanatory study, with 198 nursing workers from a hospital and 169 from Primary Health Care, in a municipality in southern Brazil. The data were collected using a survey in the quantitative stage and interviews in the qualitative one analyzed through the software Statistical Package for the Social Sciences and by the thematic analysis.RESULTS: It was identified that 51% of the participants were victims of violence, and the coping mechanisms used by the workers are individual and collective, with a predominance of the first, showing that the problem is often directed at the victim. Collective work was a contributing factor in tackling violence, with emphasis on dialogue and support among the team. However, there was no institutional support in the search for conduct in the face of episodes of violence and consequences for perpetrators. CONCLUSION: The prevalence of violence was high in both scenarios, with different characteristics regarding the profile of victims and perpetrators. The importance of collective coping is reinforced, as the most effective way to combat violence in the workplace


INTRODUÇÃO: A violência no trabalho é definida como ação, incidente ou comportamento com atitude voluntária do agressor, em decorrência da qual um profissional é agredido, ameaçado, ou sofre algum dano durante a realização do seu trabalho. A equipe de enfermagem, está exposta cotidianamente a situações de violência no trabalho. OBJETIVO: Analisar os mecanismos de enfrentamento da violência utilizados pelos profissionais de enfermagem no contexto hospitalar e na Atenção Primária à Saúde. Materiais e MÉTODO: Estudo misto explanatório sequencial, com 198 trabalhadores de enfermagem de um hospital e 169 da Atenção Primária à Saúde, em um município do Sul do Brasil. Os dados foram coletados utilizando-se uma survey na etapa quantitativa e entrevistas na qualitativa, analisados com auxílio do software Statistical Package for the Social Sciences e pela análise temática. RESULTADOS: Identificou-se que 51% dos participantes foram vítimas de violência, sendo os mecanismos de enfrentamento utilizados pelos trabalhadores são de cunho individual e coletivo, com predomínio do primeiro, evidenciando-se que o problema frequentemente, é direcionado à vítima. O trabalho coletivo foi um fator contribuinte para o enfrentamento da violência, com destaque ao diálogo e apoio entre a equipe. No entanto, não se observou suportes institucionais na busca por condutas frente aos episódios de violência e consequência aos perpretadores. CONCLUSÃO: A prevalência da violência mostrou-se elevada nos dois cenários, com características diferentes quanto ao perfil das vítimas e perpretadores. Reforça-se a importância do enfrentamento coletivo, como a forma mais eficaz para o combate da violência no local de trabalho


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Violência no Trabalho/psicologia , Adaptação Psicológica , Atenção Primária à Saúde , Recursos Humanos de Enfermagem/estatística & dados numéricos , Serviços Hospitalares , Violência no Trabalho/estatística & dados numéricos , Recursos Humanos de Enfermagem/psicologia , Estatística como Assunto , Assistentes de Enfermagem/estatística & dados numéricos , Assistentes de Enfermagem , Inquéritos e Questionários , Distribuição de Poisson
13.
Am J Obstet Gynecol ; 224(6): 605.e1-605.e13, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33798475

RESUMO

BACKGROUND: Black-serving hospitals are associated with increased maternal risk. However, prior administrative data research on maternal disparities has generally included limited hospital factors. More detailed evaluation of hospital factors related to obstetric outcomes may be important in understanding disparities. OBJECTIVE: To examine detailed characteristics of Black-serving hospitals and how these characteristics are associated with risk for severe maternal morbidity (SMM). METHODS: This serial cross-sectional study linked the 2010-2011 Nationwide Inpatient Sample and the 2013 American Hospital Association Annual Survey Databases. Delivery hospitalizations occurring to women 15-54 years of age were identified. The proportions of non-Hispanic Black patients within a hospital was categorized into quartiles, and hospital factors such as specialized medical, surgical and safety-net services as well as payer mix were compared across these quartiles. A series of models was performed evaluating risk for SMM with Black-serving hospital quartile as the primary exposure. Log linear regression models with a Poisson distribution (and robust variance) were performed with unadjusted and adjusted risk ratios (aRR) with 95% confidence intervals (CIs) as measures of effect. RESULTS: Overall 965,202 deliveries from 430 hospitals met inclusion criteria and were included in the analysis. By quartile, non-Hispanic Black patients accounted for 1.3%, 5.4%, 13.4%, and 33.8% of patients. Many services were significantly less common in the lowest compared to the highest Black-serving hospital quartile including cardiac intensive care (48.9% versus 74.5%), neonatal intensive care (28.9% versus 64.9%), pediatric intensive care (20.0% versus 45.7%), pediatric cardiology (29.6% versus 44.7%), and HIV/AIDS services (36.3% versus 71.3%) (p≤0.01 for all). Indigent care clinics, crisis prevention, and enabling services (p≤0.01 for all) were more common at Black-serving hospitals as was Medicaid payer. Following adjustments for detailed hospital factors, the lowest Black serving hospital quartile carried the lowest risk for SMM. However, SMM risks were similar across the 2nd (aRR 1.31, 95% CI 1.08, 1.59), 3rd (aRR 1.27, 95% 1.05, 1.55), and 4th (aRR 1.29, 95% CI 1.07, 1.55) quartiles. CONCLUSION: Black-serving hospitals were more likely to provide a range of specialized medical, surgical, and safety-net services and to have a higher Medicaid burden. Payer mix and unmeasured confounding may account for some of the maternal risk associated with Black-serving hospitals.


Assuntos
Afro-Americanos , Serviços de Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Hospitais/estatística & dados numéricos , Complicações na Gravidez/etnologia , Adolescente , Adulto , Estudos Transversais , Bases de Dados Factuais , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Modelos Lineares , Medicaid , Pessoa de Meia-Idade , Distribuição de Poisson , Gravidez , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Provedores de Redes de Segurança/estatística & dados numéricos , Índice de Gravidade de Doença , Especialização/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
14.
Health Care Manag Sci ; 24(2): 439-453, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33843005

RESUMO

Demand for Personal Protective Equipment (PPE) such as surgical masks, gloves, and gowns has increased significantly since the onset of the COVID-19 pandemic. In hospital settings, both medical staff and patients are required to wear PPE. As these facilities resume regular operations, staff will be required to wear PPE at all times while additional PPE will be mandated during medical procedures. This will put increased pressure on hospitals which have had problems predicting PPE usage and sourcing its supply. To meet this challenge, we propose an approach to predict demand for PPE. Specifically, we model the admission of patients to a medical department using multiple independent [Formula: see text] queues. Each queue represents a class of patients with similar treatment plans and hospital length-of-stay. By estimating the total workload of each class, we derive closed-form estimates for the expected amount of PPE required over a specified time horizon using current PPE guidelines. We apply our approach to a data set of 22,039 patients admitted to the general internal medicine department at St. Michael's hospital in Toronto, Canada from April 2010 to November 2019. We find that gloves and surgical masks represent approximately 90% of predicted PPE usage. We also find that while demand for gloves is driven entirely by patient-practitioner interactions, 86% of the predicted demand for surgical masks can be attributed to the requirement that medical practitioners will need to wear them when not interacting with patients.


Assuntos
COVID-19 , Corpo Clínico Hospitalar , Equipamento de Proteção Individual/provisão & distribuição , Algoritmos , Análise por Conglomerados , Previsões , Humanos , Distribuição de Poisson , SARS-CoV-2
16.
J Biol Dyn ; 15(1): 195-212, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33827379

RESUMO

Incidence vs. Cumulative Cases (ICC) curves are introduced and shown to provide a simple framework for parameter identification in the case of the most elementary epidemiological model, consisting of susceptible, infected, and removed compartments. This novel methodology is used to estimate the basic reproduction ratio of recent outbreaks, including those associated with the ongoing COVID-19 pandemic.


Assuntos
COVID-19/epidemiologia , Pandemias/estatística & dados numéricos , SARS-CoV-2 , Número Básico de Reprodução/estatística & dados numéricos , COVID-19/transmissão , China/epidemiologia , Simulação por Computador , Suscetibilidade a Doenças , Gastroenterite/epidemiologia , Humanos , Incidência , Conceitos Matemáticos , Modelos Biológicos , Modelos Estatísticos , Dinâmica não Linear , Distribuição de Poisson , Razão Sinal-Ruído , Espanha/epidemiologia
17.
Ciênc. Saúde Colet ; 26(3): 987-1000, mar. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1153843

RESUMO

Abstract The objective was to identify the impact of social distance in the management of noncommunicable diseases (NCD) in the adult population from the state of Rio Grande do Sul, southern Brazil. This is an ambispective, population-based cohort study. Descriptive analysis and Poisson regression models were used and the results were reported as prevalence ratio and 95% confidence intervals. From a total of 1,288 participants, 43.1% needed medical care and 28.5% reported impaired management of NCDs during social distance. Female sex, age between 18 and 30 years old, living in the Serra region (central region of the state), people with depression and multimorbidity were more likely to have impaired management of NCDs. Being physically active reduced the probability of having impaired management of NCD by 15%. Reduced monthly income was associated with the difficulty in accessing prescription medicine and avoidance of seeking in-person medical assistance. Depression was associated with difficulties in accessing medications, while avoidance of seeking in-person medical assistance was more likely for people with multimorbidity, arthritis/arthrosis/fibromyalgia, heart disease, and high cholesterol.


Resumo O objetivo foi identificar o impacto do distanciamento social no manejo das doenças crônicas não transmissíveis (DCNT) na população adulta do estado do Rio Grande do Sul, sul do Brasil. Este é um estudo de coorte ambispectivo de base populacional. Foi utilizada análise descritiva e modelos de regressão de Poisson, os resultados são apresentados em razão de prevalência e intervalos de confiança de 95%. De um total de 1.288 participantes, 43,1% necessitaram de cuidados médicos e 28,5% relataram manejo prejudicado de DCNT durante o distanciamento social. Sexo feminino, idade entre 18 e 30 anos, residente na região da Serra (região central do estado), pessoas com depressão e multimorbidade apresentaram maior chance de manejo prejudicado das DCNT. Ser fisicamente ativo reduziu a probabilidade de ter gerenciamento prejudicado de DCNT em 15%. A redução da renda mensal esteve associada à dificuldade de acesso a medicamentos prescritos e a deixar de buscar atendimento médico presencial. A depressão foi associada a dificuldades de acesso a medicamentos, enquanto deixar de buscar assistência médica pessoalmente foi mais provável para pessoas com multimorbidade, artrite/artrose/fibromialgia, doenças cardíacas e colesterol alto.


Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Infecções por Coronavirus/epidemiologia , Pandemias , Doenças não Transmissíveis/terapia , Fatores Socioeconômicos , Brasil/epidemiologia , Exercício Físico , Aceitação pelo Paciente de Cuidados de Saúde , Distribuição de Poisson , Fatores Sexuais , Análise de Regressão , Estudos de Coortes , Fatores Etários , Depressão/psicologia , Multimorbidade , Acesso aos Serviços de Saúde/estatística & dados numéricos , Renda , Pessoa de Meia-Idade
18.
Drug Alcohol Depend ; 221: 108613, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33662671

RESUMO

BACKGROUND: Suicide is a worldwide phenomenon, as well as a challenge for public health, and alcoholic beverage abuse is one of the most important risk factors. However, the association between possible factors related to alcoholic beverage consumption in suicide victims has rarely been investigated. OBJECTIVE: To evaluate the factors associated with abusive alcoholic beverage consumption among people who died from suicide in the Brazilian Federal District (BFD). METHOD: A population-based and cross-sectional study with suicide victims in the BFD between 2016 and 2017. Information was collected about sociodemographic characteristics, autopsy appraisal, and drug use. A trained team evaluated all cases to define factors associated with abusive alcoholic beverage consumption. This outcome was measured using the Blood Alcohol Concentration. Poisson regression analysis was applied to calculate the Prevalence Ratios and respective populational confidence intervals. RESULTS: The findings of the present study were collected from a database containing information related to 278 suicide victims. Being male and having cocaine identified in the toxicological test were the factors that showed a strong association with abusive alcohol beverage consumption in suicide victims. Other factors showed a slight association (PR < 1.5): having an education level with greater than 8 years of study, being black, having a professional occupation or being retired or pensioner, and having the presence of cannabis in the toxicological test. CONCLUSION: Socioeconomic-demographic and behavioral factors proved to be positively associated with abusive alcoholic beverage consumption among suicide victims, suggesting the need for effective public health policy measures to combat this health problem.


Assuntos
Alcoolismo/epidemiologia , Suicídio/estatística & dados numéricos , Adulto , Alcoolismo/psicologia , Autopsia , Concentração Alcoólica no Sangue , Brasil/epidemiologia , Estudos Transversais , Bases de Dados Factuais , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Prevalência , Fatores de Risco , Fatores Sexuais , Suicídio/psicologia
19.
Cien Saude Colet ; 26(3): 987-1000, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33729353

RESUMO

The objective was to identify the impact of social distance in the management of noncommunicable diseases (NCD) in the adult population from the state of Rio Grande do Sul, southern Brazil. This is an ambispective, population-based cohort study. Descriptive analysis and Poisson regression models were used and the results were reported as prevalence ratio and 95% confidence intervals. From a total of 1,288 participants, 43.1% needed medical care and 28.5% reported impaired management of NCDs during social distance. Female sex, age between 18 and 30 years old, living in the Serra region (central region of the state), people with depression and multimorbidity were more likely to have impaired management of NCDs. Being physically active reduced the probability of having impaired management of NCD by 15%. Reduced monthly income was associated with the difficulty in accessing prescription medicine and avoidance of seeking in-person medical assistance. Depression was associated with difficulties in accessing medications, while avoidance of seeking in-person medical assistance was more likely for people with multimorbidity, arthritis/arthrosis/fibromyalgia, heart disease, and high cholesterol.


Assuntos
COVID-19/epidemiologia , Doenças não Transmissíveis/terapia , Pandemias , Distanciamento Físico , Adulto , Fatores Etários , Brasil/epidemiologia , Estudos de Coortes , Depressão/psicologia , Exercício Físico , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Multimorbidade , Aceitação pelo Paciente de Cuidados de Saúde , Distribuição de Poisson , Análise de Regressão , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
20.
Methods Mol Biol ; 2252: 269-294, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33765281

RESUMO

During translation, the rate of ribosome movement along mRNA varies. This leads to a non-uniform ribosome distribution along the transcript, depending on local mRNA sequence, structure, tRNA availability, and translation factor abundance, as well as the relationship between the overall rates of initiation, elongation, and termination. Stress, antibiotics, and genetic perturbations affecting composition and properties of translation machinery can alter the ribosome positional distribution dramatically. Here, we offer a computational protocol for analyzing positional distribution profiles using ribosome profiling (Ribo-Seq) data. The protocol uses papolarity, a new Python toolkit for the analysis of transcript-level short read coverage profiles. For a single sample, for each transcript papolarity allows for computing the classic polarity metric which, in the case of Ribo-Seq, reflects ribosome positional preferences. For comparison versus a control sample, papolarity estimates an improved metric, the relative linear regression slope of coverage along transcript length. This involves de-noising by profile segmentation with a Poisson model and aggregation of Ribo-Seq coverage within segments, thus achieving reliable estimates of the regression slope. The papolarity software and the associated protocol can be conveniently used for Ribo-Seq data analysis in the command-line Linux environment. Papolarity package is available through Python pip package manager. The source code is available at https://github.com/autosome-ru/papolarity .


Assuntos
Biologia Computacional/métodos , RNA Mensageiro/genética , Ribossomos/metabolismo , Animais , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Modelos Lineares , Distribuição de Poisson , Biossíntese de Proteínas , RNA Mensageiro/metabolismo , Análise de Sequência de RNA , Software
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