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2.
JAMA Netw Open ; 4(3): e214149, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33739434

RESUMO

Importance: Significant concern has been raised that crisis standards of care policies aimed at guiding resource allocation may be biased against people based on race/ethnicity. Objective: To evaluate whether unanticipated disparities by race or ethnicity arise from a single institution's resource allocation policy. Design, Setting, and Participants: This cohort study included adults (aged ≥18 years) who were cared for on a coronavirus disease 2019 (COVID-19) ward or in a monitored unit requiring invasive or noninvasive ventilation or high-flow nasal cannula between May 26 and July 14, 2020, at 2 academic hospitals in Miami, Florida. Exposures: Race (ie, White, Black, Asian, multiracial) and ethnicity (ie, non-Hispanic, Hispanic). Main Outcomes and Measures: The primary outcome was based on a resource allocation priority score (range, 1-8, with 1 indicating highest and 8 indicating lowest priority) that was assigned daily based on both estimated short-term (using Sequential Organ Failure Assessment score) and longer-term (using comorbidities) mortality. There were 2 coprimary outcomes: maximum and minimum score for each patient over all eligible patient-days. Standard summary statistics were used to describe the cohort, and multivariable Poisson regression was used to identify associations of race and ethnicity with each outcome. Results: The cohort consisted of 5613 patient-days of data from 1127 patients (median [interquartile range {IQR}] age, 62.7 [51.7-73.7]; 607 [53.9%] men). Of these, 711 (63.1%) were White patients, 323 (28.7%) were Black patients, 8 (0.7%) were Asian patients, and 31 (2.8%) were multiracial patients; 480 (42.6%) were non-Hispanic patients, and 611 (54.2%) were Hispanic patients. The median (IQR) maximum priority score for the cohort was 3 (1-4); the median (IQR) minimum score was 2 (1-3). After adjustment, there was no association of race with maximum priority score using White patients as the reference group (Black patients: incidence rate ratio [IRR], 1.00; 95% CI, 0.89-1.12; Asian patients: IRR, 0.95; 95% CI. 0.62-1.45; multiracial patients: IRR, 0.93; 95% CI, 0.72-1.19) or of ethnicity using non-Hispanic patients as the reference group (Hispanic patients: IRR, 0.98; 95% CI, 0.88-1.10); similarly, no association was found with minimum score for race, again with White patients as the reference group (Black patients: IRR, 1.01; 95% CI, 0.90-1.14; Asian patients: IRR, 0.96; 95% CI, 0.62-1.49; multiracial patients: IRR, 0.81; 95% CI, 0.61-1.07) or ethnicity, again with non-Hispanic patients as the reference group (Hispanic patients: IRR, 1.00; 95% CI, 0.89-1.13). Conclusions and Relevance: In this cohort study of adult patients admitted to a COVID-19 unit at 2 US hospitals, there was no association of race or ethnicity with the priority score underpinning the resource allocation policy. Despite this finding, any policy to guide altered standards of care during a crisis should be monitored to ensure equitable distribution of resources.


Assuntos
Alocação de Recursos para a Atenção à Saúde , Disparidades em Assistência à Saúde/etnologia , Hospitalização/estatística & dados numéricos , Alocação de Recursos , Padrão de Cuidado/estatística & dados numéricos , /etnologia , Estudos de Coortes , Grupos Étnicos , Feminino , Florida/epidemiologia , Alocação de Recursos para a Atenção à Saúde/métodos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/etnologia , Alocação de Recursos/métodos , Alocação de Recursos/organização & administração
5.
MMWR Morb Mortal Wkly Rep ; 70(12): 437-441, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33764962

RESUMO

After detection of cases of COVID-19 in Florida in March 2020, the governor declared a state of emergency on March 9,* and all school districts in the state suspended in-person instruction by March 20. Most kindergarten through grade 12 (K-12) public and private schools in Florida reopened for in-person learning during August 2020, with varying options for remote learning offered by school districts. During August 10-December 21, 2020, a total of 63,654 COVID-19 cases were reported in school-aged children; an estimated 60% of these cases were not school-related. Fewer than 1% of registered students were identified as having school-related COVID-19 and <11% of K-12 schools reported outbreaks. District incidences among students correlated with the background disease incidence in the county; resumption of in-person education was not associated with a proportionate increase in COVID-19 among school-aged children. Higher rates among students were observed in smaller districts, districts without mandatory mask-use policies, and districts with a lower proportion of students participating in remote learning. These findings highlight the importance of implementing both community-level and school-based strategies to reduce the spread of COVID-19 and suggest that school reopening can be achieved without resulting in widespread illness among students in K-12 school settings.


Assuntos
/epidemiologia , Instituições Acadêmicas/organização & administração , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Florida/epidemiologia , Humanos , Incidência , Fatores de Tempo
6.
J Parasitol ; 107(1): 59-73, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33535234

RESUMO

Cardicola Short, 1953 is the most speciose aporocotylid genus (35 species) and includes marine and estuarine species of fish blood flukes that infect "higher ray-finned fishes" (Euteleostei). Several clades within Cardicola are recovered in phylogenetic analyses of the large subunit ribosomal DNA (28S), but morphological synapomorphies for those nucleotide-based clades remain elusive. The type species, Cardicola cardiocola (Manter, 1947) Short, 1953, has not been recollected in 73 yr and the original description was incomplete; making a genus revision challenging because of the ambiguous systematic position of its type species. Herein, we redescribe C. cardiocola by using the holotype (USNM 1337732) and new specimens collected from the type host, jolthead porgy, Calamus bajonado (Sparidae), from nearby the type locality. It differs from its congeners by the combination of having a body that is 5 times longer than wide, an anterior sucker with concentric rows of spines, 2-6 tegumental body spines per row, an esophageal gland that is 22-43% of the esophageal length, a testis that is 3-5 times longer than wide and that fills the intercecal space, a vitelline duct connecting to the anterior aspect of the oötype, an ascending uterus that lacks any coil, a descending uterus yielding a single coil, an obvious cirrus sac separated by constriction from the seminal vesicle, a tegumental protrusion surrounding the terminal end of cirrus sac, and a male genital pore that is posterior to the remainder of the genitalia. We also describe a new congener infecting the heart of yellowedge grouper, Hyporthodus flavolimbatus (Serranidae), from the Gulf of Mexico. It differs from its congeners by the combination of having an anterior sucker that does not extend beyond the anterior body margin, 2-5 tegumental body spines per row, posterior ceca that are 9 times length of the anterior ceca and that lack any coil, a testis that is 3 times longer than wide and that does not fill the intercecal space, an ovary that is >60% of the body width, a vitelline duct that connects to the anterior aspect of the oötype, a uterus that is >10% of the body width and that extends posterior to all genitalia, and a rounded posterior body margin. It is the first species of Cardicola to be described from a grouper (Serranidae). The 28S and internal transcribed spacer 2 phylogenetic analyses recovered the new species as a distinct lineage within the clade of Cardicola spp.


Assuntos
Bass/parasitologia , Doenças dos Peixes/parasitologia , Trematódeos/classificação , Infecções por Trematódeos/veterinária , Animais , Teorema de Bayes , Doenças dos Peixes/epidemiologia , Florida/epidemiologia , Golfo do México/epidemiologia , Coração/parasitologia , Filogenia , Prevalência , Trematódeos/anatomia & histologia , Trematódeos/genética , Infecções por Trematódeos/epidemiologia , Infecções por Trematódeos/parasitologia
7.
Prev Chronic Dis ; 18: E17, 2021 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-33630730

RESUMO

INTRODUCTION: Coronavirus disease 2019 (COVID-19) surveillance can be enhanced by collecting population-level data on individual prevention measures. We described the use of a state-based, population-level surveillance system on COVID-19 prevention and information-seeking behaviors in Florida during the first month of survey administration. METHODS: Beginning in April 2020, respondents of the Florida Behavioral Risk Factor Surveillance System were asked a series of 8 questions about sources of COVID-19 information and prevention behaviors. We analyzed the prevalence of information-seeking and prevention behaviors among respondents who answered at least 1 of the 8 questions (N = 1,004) overall, by demographic characteristics, and by the presence of chronic conditions. RESULTS: Most respondents reported engaging in prevention behaviors, including handwashing (98.2%), reducing or avoiding travel (96.6%), avoiding crowds and public events (96.5%), and keeping household members at home (87.5%); however, the prevalence of prevention behaviors varied significantly by age, sex, and education. The most frequently reported source of COVID-19 information was the Centers for Disease Control and Prevention's website (40.8%) followed by the Florida Department of Health's website (32.9%). We found significant differences in information sources across all demographic and chronic condition subgroups. A larger proportion of respondents with chronic conditions (vs without chronic conditions) reported consulting their personal doctor for COVID-19 information. CONCLUSION: Understanding the uptake and characteristics associated with individual prevention and information-seeking behaviors at the population level facilitates COVID-19 response efforts. The rapid implementation of COVID-19-related questions in the Florida BRFSS provides a useful model for other population-based surveillance systems.


Assuntos
/psicologia , Comportamentos Relacionados com a Saúde , Comportamento de Busca de Informação/fisiologia , Pandemias , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Florida/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
8.
J Am Board Fam Med ; 34(Suppl): S179-S182, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33622834

RESUMO

INTRODUCTION: To date, there are no effective treatments for decreasing hospitalizations in Coronavirus disease 2019 (COVID-19) infections. It has been suggested that the influenza vaccine might attenuate the severity of COVID-19. METHODS: This is a retrospective single-centered cohort review of a de-identified database of 2005 patients over the age of 18 within the University of Florida health care system who tested positive for COVID-19. Comorbidities and influenza vaccination status were examined. The primary outcome was severity of disease as reflected by hospitalization and intensive care unit (ICU) admission. Logistic regression was performed to examine the relationship between influenza status and hospitalization. RESULTS: COVID-19-positive patients who had not received the influenza vaccination within the last year had a 2.44 (95% CI, 1.68, 3.61) greater odds of hospitalization and a 3.29 (95% CI, 1.18, 13.77) greater odds of ICU admission when compared with those who were vaccinated. These results were controlled to account for age, race, gender, hypertension, diabetes, chronic obstructive pulmonary disease, obesity, coronary artery disease, and congestive heart failure. DISCUSSION: Our analysis suggests that the influenza vaccination is potentially protective of moderate and severe cases of COVID-19 infection. This protective effect holds regardless of comorbidity. The literature points to a potential mechanism via natural killer cell activation. Though our data potentially is limited by its generalizability and our vaccination rate is low, it holds significant relevance given the upcoming influenza season. Not only could simply encouraging influenza vaccination decrease morbidity and mortality from the flu, but it might help flatten the curve of the COVID-19 pandemic as well. We encourage further studies into this finding.


Assuntos
/epidemiologia , Hospitalização/estatística & dados numéricos , Vacinas contra Influenza/administração & dosagem , Unidades de Terapia Intensiva/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adulto , Estudos de Casos e Controles , Comorbidade , Bases de Dados Factuais , Feminino , Florida/epidemiologia , Humanos , Vacinas contra Influenza/imunologia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Índice de Gravidade de Doença
9.
Nutrition ; 84: 111106, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33418230

RESUMO

OBJECTIVE: The 2019 coronavirus disease (COVID-19) pandemic has disproportionally affected a variety of patients with underlying risk factors such as respiratory and cardiovascular diseases, diabetes, obesity, and black race. Vitamin D deficiency, which can result in a compromised immune response, has been also linked to increased risk and increased morbidities associated with COVID-19. In the absence of large-scale longitudinal studies to determine the strength of association between vitamin deficiency and COVID-19, cross-sectional studies of large patient cohorts can be used. METHODS: We used the i2b2 patient's registry platform at the University of Florida Health Center to generate a count of patients using the international classification of diseases (ICD)-10 diagnosis codes for the period of October 1, 2015, through June 30, 2020. Logistic regression of the aggregates was used for the analysis. RESULTS: Patients with vitamin D deficiency were 4.6 times more likely to be positive for COVID-19 (indicated by the ICD-10 diagnostic code COVID19) than patients with no deficiency (P < 0.001). The association decreased slightly after adjusting for sex (odds ratio [OR] = 4.58; P < 0.001) and malabsorption (OR = 4.46; P < 0.001), respectively. The association decreased significantly but remained robust (P < 0.001) after adjusting for race (OR = 3.76; P < 0.001), periodontal disease status (OR = 3.64; P < 0.001), diabetes (OR = 3.28; P < 0.001), and obesity (OR = 2.27; P < 0.001), respectively. In addition, patients with vitamin D deficiency were 5 times more likely to be infected with COVID-19 than patients with no deficiency after adjusting for age groups (OR = 5.155; P < 0.001). CONCLUSIONS: Vitamin D deficiency is significantly associated with increased risk for COVID-19.


Assuntos
/epidemiologia , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/virologia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Florida/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Sistema de Registros , Fatores de Risco , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Adulto Jovem
10.
J Stroke Cerebrovasc Dis ; 30(3): 105586, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33412397

RESUMO

OBJECTIVES: How race/ethnic disparities in acute stroke care contribute to disparities in outcomes is not well-understood. We examined the relationship between acute stroke care measures with mortality within the first year and 30-day hospital readmission by race/ethnicity. MATERIALS AND METHODS: The study included fee-for-service Medicare beneficiaries age ≥65 with ischemic stroke in 2010-2013 treated at 66 hospitals in the Florida Stroke Registry. Stroke care metrics included intravenous Alteplase treatment, in-hospital antithrombotic therapy, DVT prophylaxis, discharge antithrombotic therapy, anticoagulation therapy, statin use, and smoking cessation counseling. We used mixed logistic models to assess the associations between stroke care and mortality (in-hospital, 30-day, 6-month, 1-year post-stroke) and hospital readmission by race/ethnicity, adjusting for demographics, stroke severity, and vascular risk factors. RESULTS: Among 14,100 ischemic stroke patients in the full study population (73% white, 11% Black, 15% Hispanic), mortality was 3% in-hospital, 12% at 30d, 21% at 6m, 26% at 1y, and 15% had a hospital readmission within 30 days. Patients who received antithrombotics early and at discharge had lower mortality at all time points, and the protective association for early antithrombotic use was strongest among whites. Eligible patients who received statin therapy at discharge had decreased 6m and 1y mortality, but specifically among minority groups. Statin therapy was associated with lower 30-day hospital readmission. CONCLUSIONS: Acute stroke care measures, particularly antithrombotic use and statin therapy, were associated with reduced odds of long-term mortality. The benefits of these acute care measures were less likely among Hispanic patients. Results underscore the importance of optimizing acute stroke care for all patients.


Assuntos
Fidelidade a Diretrizes , Disparidades em Assistência à Saúde/etnologia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Indicadores de Qualidade em Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Feminino , Fibrinolíticos/uso terapêutico , Florida/epidemiologia , Mortalidade Hospitalar , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , /etnologia , Masculino , Medicare , Readmissão do Paciente , Melhoria de Qualidade , Sistema de Registros , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Abandono do Hábito de Fumar , Terapia Trombolítica , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
11.
Mayo Clin Proc ; 96(1): 152-155, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33413812

RESUMO

Health care workers are at high risk for contracting coronavirus disease 2019. However, little is known about the risk of transmission between coworkers. The objective of this study was to determine the risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between coworkers in a surgical environment. This was an observational study of 394 health care workers in a surgical environment who were exposed to 2 known SARS-CoV-2-positive coworkers. Standard infection precautions were in place at the time of the exposure. All 394 exposed workers initially underwent nasopharyngeal swab testing for SARS-CoV-2 using the polymerase chain reaction technique. Of the original group, 387 were tested again with the same technique 1 week later. Of 394 SARS-CoV-2-exposed health care workers initially tested, 1 was positive. No new positive cases were found on repeated testing of 387 participants 1 week later. The risk of transmission of SARS-CoV-2 in a health care unit with universal masking and appropriate hand hygiene is low. This finding should provide some reassurance to surgical practices as they reopen.


Assuntos
/transmissão , Pessoal de Saúde , Controle de Infecções/métodos , Salas Cirúrgicas , Adulto , Idoso , Feminino , Florida/epidemiologia , Higiene das Mãos , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Equipamento de Proteção Individual , Fatores de Risco
12.
MMWR Morb Mortal Wkly Rep ; 70(2): 56-57, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33444298

RESUMO

In July 2020, the Florida Department of Health was alerted to three Candida auris bloodstream infections and one urinary tract infection in four patients with coronavirus disease 2019 (COVID-19) who received care in the same dedicated COVID-19 unit of an acute care hospital (hospital A). C. auris is a multidrug-resistant yeast that can cause invasive infection. Its ability to colonize patients asymptomatically and persist on surfaces has contributed to previous C. auris outbreaks in health care settings (1-7). Since the first C. auris case was identified in Florida in 2017, aggressive measures have been implemented to limit spread, including contact tracing and screening upon detection of a new case. Before the COVID-19 pandemic, hospital A conducted admission screening for C. auris and admitted colonized patients to a separate dedicated ward.


Assuntos
/terapia , Candida/isolamento & purificação , Candidíase/epidemiologia , Surtos de Doenças , Unidades Hospitalares , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Florida/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade
13.
J Zoo Wildl Med ; 51(4): 745-751, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33480554

RESUMO

Epizootic hemorrhagic disease virus (EHDV) and bluetongue virus (BTV) are vector-borne viruses of ruminants nearly worldwide. They can affect white-tailed deer (WTD; Odocoileus virginianus), the ranching industry, and nonindigenous hoof stock species managed for conservation. One potential risk factor for ranched WTD is commingling with nonindigenous species on high-fenced properties. Nonindigenous species provide novel viewing and hunting opportunities; however, their presence may create disease hazards. Furthermore, animals within conservation properties may be at a risk from commingling exotics and adjacent wild WTD. Currently, knowledge about EHDV and BTV seroprevalence and transmission is limited in nonindigenous populations in the southeastern United States. The authors conducted a serological survey of 10 Bovidae and 5 Cervidae species residing within two properties in northern Florida. The first site was a conservation property breeding threatened nonindigenous species for conservation. The second property was a private high-fenced game preserve managing WTD and nonindigenous species for breeding, sale, and harvest. Blood samples were tested for titers to three EHDV serotypes (1, 2, and 6) and active circulating viral EHDV and BTV. The private ranch had evidence of EHDV or BTV in one of three (33.3%) Bovidae species and four of five (80%) Cervidae species sampled. At the conservation property, evidence of EHDV infection was found in four of seven (57.1%) Bovidae and one of one (100%) Cervidae species sampled. The presence of antibodies in many nonindigenous species sampled might indicate these species are potential viral hosts and may be a risk to ranched WTD and other species within the same property. Nonindigenous species within the private ranch and conservation properties are at risk of contracting EHDV and BTV, and herd managers should reduce vector-host interactions and consider increased biosecurity measures when translocating animals.


Assuntos
Vírus Bluetongue , Bluetongue/epidemiologia , Vírus da Doença Hemorrágica Epizoótica , RNA Viral/sangue , Infecções por Reoviridae/veterinária , Ruminantes/virologia , Animais , Anticorpos Antivirais/sangue , Vírus Bluetongue/genética , Florida/epidemiologia , Vírus da Doença Hemorrágica Epizoótica/genética , Infecções por Reoviridae/epidemiologia , Infecções por Reoviridae/virologia , Estações do Ano , Especificidade da Espécie
14.
MMWR Morb Mortal Wkly Rep ; 70(4): 141-143, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33507895

RESUMO

On December 7, 2020, local public health officials in Florida county A were notified of a person with an antigen-positive SARS-CoV-2 test* result who had attended two high school wrestling tournaments held in the county on December 4 and 5. The tournaments included 10 participating high schools from three counties. The host school (school A in county A) participated in the tournaments on both days; five high school teams from two counties participated the first day only; four additional high school teams from the three counties participated the second day. A total of 130 wrestlers, coaches, and referees attended the tournaments (Table). During December 8-9, 13 wrestlers from school A received positive SARS-CoV-2 test results (Figure), including nine who were symptomatic, two who were asymptomatic, and two for whom symptom status at time of specimen collection was unknown. Local public health officials in the three counties initiated an investigation† and tested specimens from an additional 40 attendees from nine of the 10 participating schools. A total of 54 (41.5%) of the 130 tournament attendees received testing, and 38 cases of SARS-CoV-2 infection were identified; the minimum attack rate was 30.2% (38 of 126§), and 70.4% (38 of 54) of tests had a positive result. Among contacts of the 38 COVID-19 patients, 446 were determined by investigators to meet the CDC definition of a close contact,¶ including 62 who were household contacts and 384 who were in-school contacts (classmates, teachers, noncompeting wrestling team members, and other school athletic team members). Among these 446 contacts, five had received a diagnosis of COVID-19 during June-November and were excluded from attack rate calculations. Among 95 (21.3%) contacts who received SARS-CoV-2 testing, 41 (43.2%) received a positive test result (minimum attack rate = 9.3% [41 of 441]); 21 (51.2%) persons with positive test results were symptomatic, eight (19.5%) were asymptomatic, and symptom status for 12 (29.3%) was unknown at the time of specimen collection. Among contacts, attack rates were highest among household members (30.0%) and wrestling team members who did not attend the tournament (20.3%), as were the percentages of positive test results (60.0% among household members and 54.2% among team members). Among all contacts, the odds of receiving a positive test result were highest among household contacts (odds ratio = 2.7; 95% confidence interval = 1.2-6.0). Local health authorities reported the death of one adult contact aged >50 years.


Assuntos
/epidemiologia , Instituições Acadêmicas , Luta Romana , /prevenção & controle , Busca de Comunicante , Florida/epidemiologia , Humanos , /isolamento & purificação
15.
Sci Total Environ ; 758: 144151, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33316596

RESUMO

COVID-19 pandemic had expanded to the US since early 2020 and has caused nationwide economic loss and public health crisis. Until now, although the US has the most confirmed cases in the world and are still experiencing an increasing pandemic, several states insisted to re-open business activities and colleges while announced strict control measures. To provide a quantitative reference for official strategies, predicting the near future trend based on finer spatial resolution data and presumed scenarios are urgently needed. In this study, the first attempted COVID-19 case predicting model based on county-level demographic, environmental, and mobility data was constructed with multiple machine learning techniques and a hybrid framework. Different scenarios were also applied to selected metropolitan counties including New York City, Cook County in Illinois, Los Angeles County in California, and Miami-Dade County in Florida to assess the impact from lockdown, Phase I, and Phase III re-opening. Our results showed that, for selected counties, the mobility decreased substantially after the lockdown but kept increasing with an apparent weekly pattern, and the weekly pattern of mobility and infections implied high infections during the weekend. Meanwhile, our model was successfully built up, and the scenario assessment results indicated that, compared with Phase I re-opening, a 1-week and a 2-week lockdown could reduce 4%-29% and 15%-55% infections, respectively, in the future week, while 2-week Phase III re-opening could increase 16%-80% infections. We concluded that the mandatory orders in metropolitan counties such lockdown should last longer than one week, the effect could be observed. The impact of lockdown or re-opening was also county-dependent and varied with the local pandemic. In future works, we expect to involve a longer period of data, consider more county-dependent factors, and employ more sophisticated techniques to decrease the modeling uncertainty and apply it to counties nationally and other countries.


Assuntos
Pandemias , Controle de Doenças Transmissíveis , Florida/epidemiologia , Humanos , Illinois , Aprendizado de Máquina , Cidade de Nova Iorque
16.
Toxicon ; 191: 9-17, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33338449

RESUMO

Brevetoxins were confirmed in urine specimens from patients diagnosed with neurotoxic shellfish poisoning (NSP) after consumption of gastropods that were recreationally harvested from an area previously affected by a Karenia brevis bloom. Several species of gastropods (Triplofusus giganteus, Sinistrofulgur sinistrum, Cinctura hunteria, Strombus alatus, Fulguropsis spirata) and one clam (Macrocallista nimbosa) from the NSP implicated gastropod collection area (Jewfish Key, Sarasota Bay, Florida) were examined for brevetoxins using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and enzyme-linked immunosorbent assay (ELISA). All gastropods and the clam were contaminated with brevetoxins. Composite B-type toxin concentrations in gastropods ranged from 1.1 to 198 µg BTX-3 equiv./g by ELISA, levels likely capable of causing NSP in consumers. Several brevetoxin metabolites previously characterized in molluscan shellfish were identified in these gastropods. Brevetoxin analog profiles by ELISA were similar in the gastropod species examined. This work documents the occurrence of NSP through consumption of a type of seafood not typically monitored in Florida to protect human health, demonstrating the need to better assess and communicate the risk of NSP to gastropod harvesters in Karenia brevis endemic areas.


Assuntos
Toxinas Marinhas/urina , Oxocinas/urina , Intoxicação por Frutos do Mar/epidemiologia , Animais , Bioensaio , Bivalves , Cromatografia Líquida , Dinoflagelados , Ensaio de Imunoadsorção Enzimática , Florida/epidemiologia , Gastrópodes , Humanos , Frutos do Mar , Espectrometria de Massas em Tandem
17.
Prev Chronic Dis ; 17: E124, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-33034555

RESUMO

Miami-Dade County zip code-level (N = 91 zip codes) coronavirus disease 2019 (COVID-19) cases (N = 89,556 as of July 21, 2020) reported from the Florida Department of Health were used to estimate rates of COVID-19 per 1,000 population at the census block group level (N = 1,594 study block groups). To identify associations between rates of COVID-19 infections and multidimensional indexes of social determinants of health (SDOH) across Miami-Dade County, Florida, I applied a global model (ordinary least squares) and a local regression model (geographically weighted regression). Findings indicated that a social disadvantage index positively affected COVID-19 infection rates, whereas a socioeconomic status and opportunity index and a convergence of vulnerability index had an inverse but significant connection to COVID-19 infection rates over the study area. Rates of COVID-19 infections were localized to specific geographic areas and ranged from 0 to 60.75 per 1,000 population per square mile.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Classe Social , Determinantes Sociais da Saúde , Florida/epidemiologia , Humanos , Pandemias , Análise de Regressão , Fatores de Risco , Fatores Socioeconômicos
18.
MMWR Morb Mortal Wkly Rep ; 69(41): 1492-1493, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33056952

RESUMO

On June 16, 2020, a recreational ice hockey game was played at an ice rink in the Tampa Bay, Florida, metropolitan area. Teams A and B, each consisting of 11 players (typically six on the ice and five on the bench at any given time), included men aged 19-53 years. During the 5 days after the game, 15 persons (14 of the 22 players and a rink staff member) experienced signs and symptoms compatible with coronavirus disease 2019 (COVID-19)*; 13 of the 15 ill persons had positive laboratory test results indicating infection with SARS-CoV-2, the virus that causes COVID-19. Widespread transmission of SARS-CoV-2 has been documented at a choir practice (1) and at meat processing plants (2,3); however, apart from an outbreak involving 57 infected dancers that has been linked to high-intensity fitness dance classes in South Korea (4) and a cluster of five infected persons at a squash facility in Slovenia (5), few published reports are available regarding transmission associated with specific sports games or practices. In addition, outbreaks of COVID-19 infections among amateur hockey players in the United States have recently been reported in the news.†.


Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Hóquei , Pneumonia Viral/epidemiologia , Recreação , Adulto , Florida/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Adulto Jovem
19.
J Stroke Cerebrovasc Dis ; 29(10): 105077, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912524

RESUMO

BACKGROUND: As Covid-19 evolved into a world-wide pandemic, hospitals reported marked declines in strokes, only to be followed by reports of increased numbers of young people presenting with large-vessel occlusions. We reviewed our patient data-base to determine if similar or other novel trends were present. RESULTS: Our Thrombectomy Stroke Center experienced marked declines in ED visits from 2,349 in early March to 1,178 in late April, stroke alerts dropped from 34 to 14 during the same period. Average monthly stroke admissions dropped from 34 in 2019 to 23 in 2020. Nonetheless, in March, we had 12 patients eligible for tPA, which is twice the typical caseload and was unexpected given the low overall stroke presentations. Although the neurointervention caseload was low, the patients were significantly younger. Of the acute intervention patients in March, 5 of the 12 patients were ≤ 60 years old, and two were in their 30's. These trends are similar to those reported elsewhere but were highly unusual for our center as our catchment area is predominantly Caucasian with 34 % of the population > 65 years of age. CONCLUSIONS: Even in low risk centers Covid-19 will likely impart unique stroke presentations. It will be imperative to determine the mechanisms responsible for these changes so we can institute effective strategies for optimal stroke prevention as well as maintain timely acute interventions.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Feminino , Florida/epidemiologia , Interações entre Hospedeiro e Microrganismos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/virologia , Trombectomia , Terapia Trombolítica , Fatores de Tempo
20.
BMC Public Health ; 20(1): 1226, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787830

RESUMO

BACKGROUND: Diabetes is a leading cause of death and disability in the United States, and its precursor, pre-diabetes, is estimated to occur in one-third of American adults. Understanding the geographic disparities in the distribution of these conditions and identifying high-prevalence areas is critical to guiding control and prevention programs. Therefore, the objective of this study was to investigate clusters of pre-diabetes and diabetes risk in Florida and identify significant predictors of the conditions. METHODS: Data from the 2013 Behavioral Risk Factor Surveillance System were obtained from the Florida Department of Health. Spatial scan statistics were used to identify and locate significant high-prevalence local clusters. The county prevalence proportions of pre-diabetes and diabetes and the identified significant clusters were displayed in maps. Logistic regression was used to identify significant predictors of the two conditions for individuals living within and outside high-prevalence clusters. RESULTS: The study included a total of 34,186 respondents. The overall prevalence of pre-diabetes and diabetes were 8.2 and 11.5%, respectively. Three significant (p < 0.05) local, high-prevalence spatial clusters were detected for pre-diabetes, while five were detected for diabetes. The counties within the high-prevalence clusters had prevalence ratios ranging from 1.29 to 1.85. There were differences in the predictors of the conditions based on whether respondents lived within or outside high-prevalence clusters. Predictors of both pre-diabetes and diabetes regardless of region or place of residence were obesity/overweight, hypertension, and hypercholesterolemia. Income and physical activity level were significant predictors of diabetes but not pre-diabetes. Arthritis, sex, and marital status were significant predictors of diabetes only among residents of high-prevalence clusters, while educational attainment and smoking were significant predictors of diabetes only among residents of non-cluster counties. CONCLUSIONS: Geographic disparities of pre-diabetes and diabetes exist in Florida. Information from this study is useful for guiding resource allocation and targeting of intervention programs focusing on identified modifiable predictors of pre-diabetes and diabetes so as to reduce health disparities and improve the health of all Floridians.


Assuntos
Diabetes Mellitus/epidemiologia , Disparidades nos Níveis de Saúde , Estado Pré-Diabético/epidemiologia , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Florida/epidemiologia , Geografia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
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