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1.
MMWR Morb Mortal Wkly Rep ; 69(39): 1398-1403, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33001876

RESUMO

Coronavirus disease 2019 (COVID-19) is a viral respiratory illness caused by SARS-CoV-2. During January 21-July 25, 2020, in response to official requests for assistance with COVID-19 emergency public health response activities, CDC deployed 208 teams to assist 55 state, tribal, local, and territorial health departments. CDC deployment data were analyzed to summarize activities by deployed CDC teams in assisting state, tribal, local, and territorial health departments to identify and implement measures to contain SARS-CoV-2 transmission (1). Deployed teams assisted with the investigation of transmission in high-risk congregate settings, such as long-term care facilities (53 deployments; 26% of total), food processing facilities (24; 12%), correctional facilities (12; 6%), and settings that provide services to persons experiencing homelessness (10; 5%). Among the 208 deployed teams, 178 (85%) provided assistance to state health departments, 12 (6%) to tribal health departments, 10 (5%) to local health departments, and eight (4%) to territorial health departments. CDC collaborations with health departments have strengthened local capacity and provided outbreak response support. Collaborations focused attention on health equity issues among disproportionately affected populations (e.g., racial and ethnic minority populations, essential frontline workers, and persons experiencing homelessness) and through a place-based focus (e.g., persons living in rural or frontier areas). These collaborations also facilitated enhanced characterization of COVID-19 epidemiology, directly contributing to CDC data-informed guidance, including guidance for serial testing as a containment strategy in high-risk congregate settings, targeted interventions and prevention efforts among workers at food processing facilities, and social distancing.


Assuntos
Centers for Disease Control and Prevention, U.S./organização & administração , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Administração em Saúde Pública , Prática de Saúde Pública , Infecções por Coronavirus/epidemiologia , Humanos , Governo Local , Pneumonia Viral/epidemiologia , Governo Estadual , Estados Unidos/epidemiologia
5.
Epidemiol Infect ; 148: e220, 2020 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-32951623

RESUMO

Due to the outbreak of the deadly coronavirus disease in 2019 (COVID-19), Wuhan was on lockdown for more than 60 days by the state government. This study investigated the perceptions and attitudes of the public on quarantine as a practical approach to halting the spread of COVID-19. An online survey was conducted via WeChat between 10 January 2020 and 10 March 2020 on the general population in Hubei province at the height of the COVID-19 outbreak. In total, 549 respondents participated in the survey. Results revealed that the public displayed significantly strong support towards quarantine throughout the outbreak period, apart from locking people up and using imprisonment legal sanctions against those who failed to comply with the stringent regulations. The support exerted by the public stemmed from the execution of authorised officers to protect the public interest and provision of psychosocial support for those affected. In situations where quarantine could not be imposed, public health policy-makers and government officials should implement an extensive system of psychosocial support to safeguard, instruct and inform frontline public health workers. The public should also be enlisted in an open conversation concerning the ethical utility of restrictive values during the COVID-19 outbreak.


Assuntos
Atitude Frente a Saúde , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Opinião Pública , Quarentena , Adolescente , Adulto , Betacoronavirus , China/epidemiologia , Surtos de Doenças , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Governo Estadual , Adulto Jovem
7.
N Engl J Med ; 383(6): 558-566, 2020 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-32757524

RESUMO

BACKGROUND: Specialty drugs are used to treat complex or life-threatening conditions, often at high financial costs to both patients and health plans. Three states - Delaware, Louisiana, and Maryland - passed legislation to cap out-of-pocket payments for specialty drugs at $150 per prescription. A concern is that these caps could shift costs to health plans, increasing insurance premiums. Estimates of the effect of the caps on patient and health-plan spending could inform future policies. METHODS: We analyzed a sample that included 27,161 persons under 65 years of age who had rheumatoid arthritis, multiple sclerosis, hepatitis C, psoriasis, psoriatic arthritis, Crohn's disease, or ulcerative colitis and who were in commercial health plans from 2011 through 2016 that were administered by three large nationwide insurers. The primary outcome was the change in out-of-pocket spending among specialty-drug users who were in the 95th percentile for spending on specialty drugs. Other outcomes were changes in mean out-of-pocket and health-plan spending for specialty drugs, nonspecialty drugs, and nondrug health care and utilization of specialty drugs. We compared outcomes in the three states that enacted caps with neighboring control states that did not, 3 years before and up to 3 years after enactment of the spending cap. RESULTS: Caps were associated with an adjusted change in out-of-pocket costs of -$351 (95% confidence interval, -554 to -148) per specialty-drug user per month, representing a 32% reduction in spending, among users in the 95th percentile of spending on specialty drugs. This finding was supported by multiple sensitivity analyses. Caps were not associated with changes in other outcomes. CONCLUSIONS: Caps for spending on specialty drugs were associated with substantial reductions in spending on specialty drugs among patients with the highest out-of-pocket costs, without detectable increases in health-plan spending, a proxy for future insurance premiums. (Funded by the Robert Wood Johnson Foundation Health Data for Action Program.).


Assuntos
Doença Crônica/tratamento farmacológico , Custo Compartilhado de Seguro/legislação & jurisprudência , Custos de Medicamentos/legislação & jurisprudência , Gastos em Saúde/estatística & dados numéricos , Seguro de Serviços Farmacêuticos/economia , Governo Estadual , Adulto , Doença Crônica/economia , Custo Compartilhado de Seguro/economia , Delaware , Humanos , Seguro de Serviços Farmacêuticos/legislação & jurisprudência , Louisiana , Maryland , Pessoa de Meia-Idade , Honorários por Prescrição de Medicamentos/legislação & jurisprudência , Estados Unidos
8.
Asian J Psychiatr ; 51: 102165, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32732175

RESUMO

The coronavirus SARS-CoV-2 (COVID-19) pandemic offers many medical, economic, societal, and cultural challenges. The response by individual states in the United States of America varies, but with the common initial impetus for all being to "flatten the curve," which was intended to delay infections and spread the burden and impact on hospitals and medical systems. Starting with that intention, the responses by states has included many major steps not taken in prior pandemics. Those steps have significantly adversely affected hospitals rather than support them, and the overall impact has been to "flatten the economy" rather than just to "flatten the curve." Many state governors have stated that their decisions are "science-led" and "data driven" but the reality is that there is not relevant experimental data. The progression of decisions during the early pandemic decisions is traced, and the basis of decisions based in science or herd mentality is discussed. Experiences are not experiments, and experiences are not founded in the scientific process. Medical and government leaders must be vigilant to recognize the limitations of available data in responding to unique circumstances.


Assuntos
Infecções por Coronavirus , Recessão Econômica , Economia Médica , Política de Saúde , Controle de Infecções , Pandemias , Pneumonia Viral , Governo Estadual , Humanos , Estados Unidos
9.
Int J Law Psychiatry ; 71: 101579, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32768113

RESUMO

In response to the COVID-19 pandemic, as with other countries across the world, the Central and State Governments of India initiated several measures to slow down the spread of the virus and to 'flatten the curve'. One such measure was a 'total lockdown' for several weeks across the country. A complex and unexpected outcome of the lockdown which has medical, ethical, economic, and social dimensions is related to alcohol consumption. The lockdown and consequent acute non-availability of alcohol resulted in people with alcohol dependence going into withdrawals, black marketing of alcohol, and in extreme cases suicide resulting from the alleged frustration of not having access to alcohol. The health dilemmas around this situation are biological (e.g. pushing people into risky situations-potentially fatal alcohol withdrawal, consumption of illicit or other non-consumable alcohol) and psychosocial (e.g. isolation increasing the risk of relapses, loss of control over the decision to abstain which can be detrimental to recovery, restriction of access to services for alcohol problems). The legal and rights-related dilemmas are centred around whether States have the right to impinge on individual autonomy on the grounds of public health, the capacity of the health systems to provide appropriate services to cope with those who will struggle with the unavailability of alcohol, the constitutionality of the Central government's impinging on jurisdiction of states under the guise of a health emergency caused by the pandemic, and the ability of the State to make unbiased decisions about this issue when it is highly dependent on the revenue from the sale of alcohol and associated industries. The way forward could be a pragmatic and utilitarian approach involving continued access to alcohol, while observing all physical distancing norms necessary during the pandemic, for those who want to continue drinking; and implementing innovative measures such as tele-counselling for those who wish not to return back to drinking.


Assuntos
Abstinência de Álcool/ética , Abstinência de Álcool/psicologia , Infecções por Coronavirus/epidemiologia , Direitos Humanos , Pneumonia Viral/epidemiologia , Saúde Pública , Betacoronavirus , Governo Federal , Redução do Dano , Humanos , Índia/epidemiologia , Pandemias , Quarentena , Governo Estadual , Síndrome de Abstinência a Substâncias/epidemiologia
13.
J Eval Clin Pract ; 26(5): 1347-1351, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32794332

RESUMO

RATIONALE, AIMS AND OBJECTIVES: In the United States, the reluctance of the federal government to impose a national stay-at-home policy in wake of COVID-19 pandemic has left the decision of how to achieve social distancing to individual state governors. We hypothesized that in the absence of formal guidelines, the decision to close a state reflects the classic Weber-Fechner law of psychophysics - the amount by which a stimulus (such as number of cases or deaths) must increase in order to be noticed as a fraction of the intensity of that stimulus. METHODS: On 12 April 2020, we downloaded data from the New York Times database from all 50 states and the District of Columbia; by that time all but 7 states had issued the stay-at-home orders. We fitted the Weber-Fechner logarithmic function by regressing the log2 of cases and deaths, respectively, against the daily counts. We also conducted Cox regression analysis to determine if the probability of issuing the stay-at-home order increases proportionally as the number of cases or deaths increases. RESULTS: We found that the decision to issue the state-at-home order reflects the Weber-Fechner law. Both the number of infections (P = <.0001; R2 = .79) and deaths (P < .0001; R2 = .63) were significantly associated with the decision to issue the stay-at-home orders. The results indicate that for each doubling of infections or deaths, an additional four to six states will issue stay-at-home orders. Cox regression showed that when the number of deaths reached 256 and the number of infected people were over 16 000 the probability of issuing "stay-at-home" order was close to 100%. We found no difference in decision-making according to the political affiliation; the results remain unchanged on 16 July 2 020. CONCLUSIONS: when there are not clearly articulated rules to follow, decision-makers resort to simple heuristics, in this case one consistent with the Weber-Fechner law.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Governo Estadual , Betacoronavirus , Infecções por Coronavirus/mortalidade , Tomada de Decisões , Humanos , Modelos Estatísticos , Pandemias , Pneumonia Viral/mortalidade , Quinazolinas , Estados Unidos/epidemiologia
14.
Public Health Rep ; 135(1_suppl): 128S-137S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735195

RESUMO

OBJECTIVE: Law is an important factor in the diffusion of syringe services programs (SSPs). This study measures the current status of, and 5-year change in, state laws governing SSP operations and possession of syringes by participants. METHODS: Legal researchers developed a cross-sectional data set measuring key features of state laws and regulations governing the possession and distribution of syringes across the 50 US states and the District of Columbia in effect on August 1, 2019. We compared these data with previously collected data on laws as of August 1, 2014. RESULTS: Thirty-nine states (including the District of Columbia) had laws in effect on August 1, 2019, that removed legal impediments to, explicitly authorized, and/or regulated SSPs. Thirty-three states had 1 or more laws consistent with legal possession of syringes by SSP participants under at least some circumstances. Changes from 2014 to 2019 included an increase of 14 states explicitly authorizing SSPs by law and an increase of 12 states with at least 1 provision reducing legal barriers to SSPs. Since 2014, the number of states explicitly authorizing SSPs nearly doubled, and the new states included many rural, southern, or midwestern states that had been identified as having poor access to SSPs, as well as states at high risk for HIV and hepatitis C virus outbreaks. Substantial legal barriers to SSP operation and participant syringe possession remained in >20% of US states. CONCLUSION: Legal barriers to effective operation of SSPs have declined but continue to hinder the prevention and reduction of drug-related harm.


Assuntos
Programas de Troca de Agulhas/legislação & jurisprudência , Governo Estadual , Abuso de Substâncias por Via Intravenosa/epidemiologia , Estudos Transversais , Acesso aos Serviços de Saúde/organização & administração , Hepatite/diagnóstico , Humanos , Programas de Rastreamento/organização & administração , Características de Residência , Doenças Sexualmente Transmissíveis/diagnóstico , Serviço Social/organização & administração , Tuberculose/diagnóstico , Estados Unidos
15.
JAMA ; 324(9): 859-870, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32745200

RESUMO

Importance: In the US, states enacted nonpharmaceutical interventions, including school closure, to reduce the spread of coronavirus disease 2019 (COVID-19). All 50 states closed schools in March 2020 despite uncertainty if school closure would be effective. Objective: To determine if school closure and its timing were associated with decreased COVID-19 incidence and mortality. Design, Setting, and Participants: US population-based observational study conducted between March 9, 2020, and May 7, 2020, using interrupted time series analyses incorporating a lag period to allow for potential policy-associated changes to occur. To isolate the association of school closure with outcomes, state-level nonpharmaceutical interventions and attributes were included in negative binomial regression models. States were examined in quartiles based on state-level COVID-19 cumulative incidence per 100 000 residents at the time of school closure. Models were used to derive the estimated absolute differences between schools that closed and schools that remained open as well as the number of cases and deaths if states had closed schools when the cumulative incidence of COVID-19 was in the lowest quartile compared with the highest quartile. Exposures: Closure of primary and secondary schools. Main Outcomes and Measures: COVID-19 daily incidence and mortality per 100 000 residents. Results: COVID-19 cumulative incidence in states at the time of school closure ranged from 0 to 14.75 cases per 100 000 population. School closure was associated with a significant decline in the incidence of COVID-19 (adjusted relative change per week, -62% [95% CI, -71% to -49%]) and mortality (adjusted relative change per week, -58% [95% CI, -68% to -46%]). Both of these associations were largest in states with low cumulative incidence of COVID-19 at the time of school closure. For example, states with the lowest incidence of COVID-19 had a -72% (95% CI, -79% to -62%) relative change in incidence compared with -49% (95% CI, -62% to -33%) for those states with the highest cumulative incidence. In a model derived from this analysis, it was estimated that closing schools when the cumulative incidence of COVID-19 was in the lowest quartile compared with the highest quartile was associated with 128.7 fewer cases per 100 000 population over 26 days and with 1.5 fewer deaths per 100 000 population over 16 days. Conclusions and Relevance: Between March 9, 2020, and May 7, 2020, school closure in the US was temporally associated with decreased COVID-19 incidence and mortality; states that closed schools earlier, when cumulative incidence of COVID-19 was low, had the largest relative reduction in incidence and mortality. However, it remains possible that some of the reduction may have been related to other concurrent nonpharmaceutical interventions.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Instituições Acadêmicas , Humanos , Incidência , Análise de Séries Temporais Interrompida , Pandemias , Política Pública , Instituições Acadêmicas/organização & administração , Governo Estadual , Estados Unidos/epidemiologia
18.
Chiropr Man Therap ; 28(1): 44, 2020 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631385

RESUMO

INTRODUCTION: The COVID-19 pandemic led to unprecedented changes, as many state and local governments enacted stay-at-home orders and non-essential businesses were closed. State chiropractic licensing boards play an important role in protecting the public via regulation of licensure and provision of guidance regarding standards of practice, especially during times of change or uncertainty. OBJECTIVE: The purpose of this study was to summarize the guidance provided in each of the 50 United States, related to chiropractic practice during the COVID-19 pandemic. METHODS: A review of the public facing websites of governors and state chiropractic licensing boards was conducted in the United States. Data were collected regarding the official guidance provided by each state's chiropractic licensing board as well as the issuance of stay-at-home orders and designations of essential personnel by state governors. Descriptive statistics were used to report the findings from this project. RESULTS: Each of the 50 state governor's websites and individual state chiropractic licensing board's websites were surveyed. Stay-at-home or shelter-in-place orders were issued in 86% of all states. Chiropractors were classified as essential providers in 54% of states, non-essential in one state (2%), and no guidance was provided in the remaining 44% of all states. Fourteen states (28%) recommended restricting visits to only urgent cases and the remaining states (72%) provided no guidance. Twenty-seven states (54%) provided information regarding protecting against infectious disease and the remaining states (46%) provided no guidance. Twenty-two states (44%) provided recommendations regarding chiropractic telehealth and the remaining states (56%) provided no guidance. Seventeen states (34%) altered license renewal requirements and eight states (16%) issued warnings against advertising misleading or false information regarding spinal manipulation and protection from COVID-19. CONCLUSION: State guidance during the COVID-19 pandemic was heterogenous, widely variability in accessibility, and often no guidance was provided by state chiropractic licensing boards. Some state chiropractic licensing boards chose to assemble guidance for licensees into a single location, which we identified as a best practice for future situations where changes in chiropractic practice must be quickly communicated.


Assuntos
Betacoronavirus , Quiroprática/legislação & jurisprudência , Comércio/legislação & jurisprudência , Pandemias/legislação & jurisprudência , Governo Estadual , Quiroprática/normas , Infecções por Coronavirus , Humanos , Pneumonia Viral , Guias de Prática Clínica como Assunto , Estados Unidos
19.
J Appl Psychol ; 105(8): 771-783, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32614203

RESUMO

The coronavirus disease that emerged in 2019 (COVID-19) spotlights the need for effective leadership in a crisis. Leadership research in applied psychology suggests that women tend to be preferred over men as leaders during uncertain times. We contribute to this literature by examining, in the context of COVID-19, whether states with women governors had fewer deaths than states with men governors, and why. We tested this research question with publicly available data on COVID-19 deaths in the United States as of May 5, 2020 and found that states with women governors had fewer COVID-19 deaths compared to states with men governors. Governor sex also interacted with early stay-at-home orders; states with women governors who issued these orders early had fewer deaths compared to states with men governors who did the same. To provide insight into psychological mechanisms of this relationship, we conducted a qualitative analysis of governor briefings that took place between April 1, 2020 and May 5, 2020 (251 briefings, 38 governors, 1.2 million words). Compared to men, women governors expressed more empathy and confidence in their briefings. Practical implications are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Infecções por Coronavirus/mortalidade , Liderança , Pandemias/prevenção & controle , Pneumonia Viral/mortalidade , Governo Estadual , Mulheres , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Controle de Infecções/legislação & jurisprudência , Controle de Infecções/organização & administração , Controle de Infecções/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Fatores Sexuais , Estados Unidos/epidemiologia
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