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2.
Int J Health Serv ; 51(1): 31-36, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33100167

RESUMO

Currently, the fast spread of COVID-19 is the cause of a sanitary emergency in Brazil. This situation is largely due to President Bolsonaro's denial and the uncoordinated actions between the federal and local governments. In addition, the Brazilian government has reported that it would change its method of sharing information about the pandemic. On June 6, 2020, the presentation of accumulated cases and deaths was stopped, and the Supreme Court of Brazil determined that the federal government should continue to consolidate and disseminate the accumulated figures of cases and deaths. However, doubt about the transparency of the data remained. We used data reported by the government from Situation Reports 38-209 of the World Health Organization to assess the Benford's law fulfillment as an indicator of data quality. This rapid evaluation of data quality during the ongoing COVID-19 pandemic in Brazil suggests that the Brazilian public health surveillance system had an acceptable performance at the beginning of the epidemic. Since the end of June, the quality of cumulative death data began to decrease and remains in that condition as of August 2020. A similar situation has existed since August, with the data of accumulated new cases.


Assuntos
/epidemiologia , Disseminação de Informação , Política , Brasil/epidemiologia , Confiabilidade dos Dados , Governo Federal , Política de Saúde , Humanos , Pandemias , Vigilância da População/métodos , Saúde Pública
3.
Eur J Pharmacol ; 890: 173717, 2021 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-33152333

RESUMO

As mortality and morbidity from novel coronavirus disease (COVID-19) continue to mount worldwide, the scientific community as well as public health systems are under immense pressure to contain the pandemic as well as to develop effective medical countermeasures. Meanwhile, desperation has driven prescribers, researchers as well as administrators to recommend and try therapies supported by little or no reliable evidence. Recently, hydroxychloroquine-sulfate (HCQS) has got significant media and political attention for the treatment as well as prophylaxis of COVID-19 despite the lack of convincing and unequivocal data supporting its efficacy and safety in these patients. This has unfortunately, yet foreseeably led to several controversies and confusion among the medical fraternity, the patient community as well as the general public. Based on the available studies, many with high risk of bias, relatively small sample sizes, and abbreviated follow-ups, HCQS is unlikely to be of dramatic benefit in COVID-19 patients and yet has the potential to cause harm, particularly when used in combination with azithromycin or other medications in high risk individuals with comorbidities. Although definitive data from larger well-controlled randomized trials will be forthcoming in the future, and we may be able to identify specific patient subpopulations likely to benefit from hydroxychloroquine, till that time it will be prudent to prescribe it within investigational trial settings with close safety monitoring. Here we review the current evidence and developments related to the use of HCQS in COVID-19 patients and highlight the importance of risk-benefit assessment and rational use of HCQS during this devastating pandemic.


Assuntos
/tratamento farmacológico , Hidroxicloroquina/uso terapêutico , Governo Federal , Órgãos Governamentais , Humanos , Hidroxicloroquina/efeitos adversos
5.
Eur J Epidemiol ; 35(11): 995-1006, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33136249

RESUMO

The United States (US) has been among those nations most severely affected by the first-and subsequent-phases of the pandemic of COVID-19, the disease caused by SARS-CoV-2. With only 4% of the worldwide population, the US has seen about 22% of COVID-19 deaths. Despite formidable advantages in resources and expertise, presently the per capita mortality rate is over 585/million, respectively 2.4 and 5 times higher compared to Canada and Germany. As we enter Fall 2020, the US is enduring ongoing outbreaks across large regions of the country. Moreover, within the US, an early and persistent feature of the pandemic has been the disproportionate impact on populations already made vulnerable by racism and dangerous jobs, inadequate wages, and unaffordable housing, and this is true for both the headline public health threat and the additional disastrous economic impacts. In this article we assess the impact of missteps by the Federal Government in three specific areas: the introduction of the virus to the US and the establishment of community transmission; the lack of national COVID-19 workplace standards and enforcement, and lack of personal protective equipment (PPE) for workplaces as represented by complaints to the Occupational Safety and Health Administration (OSHA) which we find are correlated with deaths 16 days later (ρ = 0.83); and the total excess deaths in 2020 to date already total more than 230,000, while COVID-19 mortality rates exhibit severe-and rising-inequities in race/ethnicity, including among working age adults.


Assuntos
/epidemiologia , Governo Federal , Responsabilidade Social , /mortalidade , Disparidades nos Níveis de Saúde , Humanos , Equipamento de Proteção Individual/provisão & distribução , Saúde Pública , Estados Unidos
6.
PLoS One ; 15(11): e0242869, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33237947

RESUMO

This study characterized the evolution of Brazilian public telemedicine policy in the Brazilian Unified Health System for 30 years from 1988 to 2019 by analyzing its legal framework. We identified 79 telemedicine-related legislations from the federal government (laws, decrees, and ordinances) and 31 regulations of federal councils of health professionals. Three historical phases were established according to the public policy cycle, and material was classified according to the purpose of the normative documents. The content analysis was based on the advocacy coalition framework model. Of the federal legislations, 8.9% were for the Formulation/Decision-Making phase, 43% for the Organization/Implementation phase, and 48.1% for the Expansion/Maturation phase of telemedicine policy in Brazil. The Federal Council of Medicine was the most active in standardizing telemedicine and was responsible for 21 (67.7%) regulations. The first legislations were passed in 2000; however, the coalitions discussed topics related to telemedicine and created their belief systems from the 1990's. The time cycle which included formulation and decision making for Brazilian telemedicine policy, extended until 2007 with the creation of several technical working groups. The expansion and maturation of telemedicine services began in 2011 with the decentralization of telemedicine policy actions across the country. Telemedicine centers which performed telediagnosis influenced the computerization of primary health care units. We conclude that Brazilian telemedicine field has greatly grown and changed in recent years. However, despite the proliferation of legislations and regulations in the period studied, there is still no fully consolidated process for setting up a wholly defined regulatory framework for telemedicine in Brazil.


Assuntos
Assistência à Saúde/tendências , Atenção Primária à Saúde/tendências , Telemedicina/normas , Brasil/epidemiologia , Governo Federal , Pessoal de Saúde , Política de Saúde/tendências , Humanos , Política , Política Pública , Telemedicina/tendências
7.
Nat Hum Behav ; 4(11): 1186-1197, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33139897

RESUMO

Numerous polls suggest that COVID-19 is a profoundly partisan issue in the United States. Using the geotracking data of 15 million smartphones per day, we found that US counties that voted for Donald Trump (Republican) over Hillary Clinton (Democrat) in the 2016 presidential election exhibited 14% less physical distancing between March and May 2020. Partisanship was more strongly associated with physical distancing than numerous other factors, including counties' COVID-19 cases, population density, median income, and racial and age demographics. Contrary to our predictions, the observed partisan gap strengthened over time and remained when stay-at-home orders were active. Additionally, county-level consumption of conservative media (Fox News) was related to reduced physical distancing. Finally, the observed partisan differences in distancing were associated with subsequently higher COVID-19 infection and fatality growth rates in pro-Trump counties. Taken together, these data suggest that US citizens' responses to COVID-19 are subject to a deep-and consequential-partisan divide.


Assuntos
Atitude Frente a Saúde , Política , Governo Federal , Humanos , Percepção Social , Estados Unidos
8.
Science ; 370(6517): 639, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33154112
9.
J Med Internet Res ; 22(11): e20044, 2020 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-33151895

RESUMO

BACKGROUND: Individuals with large followings can influence public opinions and behaviors, especially during a pandemic. In the early days of the pandemic, US president Donald J Trump has endorsed the use of unproven therapies. Subsequently, a death attributed to the wrongful ingestion of a chloroquine-containing compound occurred. OBJECTIVE: We investigated Donald J Trump's speeches and Twitter posts, as well as Google searches and Amazon purchases, and television airtime for mentions of hydroxychloroquine, chloroquine, azithromycin, and remdesivir. METHODS: Twitter sourcing was catalogued with Factba.se, and analytics data, both past and present, were analyzed with Tweet Binder to assess average analytics data on key metrics. Donald J Trump's time spent discussing unverified treatments on the United States' 5 largest TV stations was catalogued with the Global Database of Events, Language, and Tone, and his speech transcripts were obtained from White House briefings. Google searches and shopping trends were analyzed with Google Trends. Amazon purchases were assessed using Helium 10 software. RESULTS: From March 1 to April 30, 2020, Donald J Trump made 11 tweets about unproven therapies and mentioned these therapies 65 times in White House briefings, especially touting hydroxychloroquine and chloroquine. These tweets had an impression reach of 300% above Donald J Trump's average. Following these tweets, at least 2% of airtime on conservative networks for treatment modalities like azithromycin and continuous mentions of such treatments were observed on stations like Fox News. Google searches and purchases increased following his first press conference on March 19, 2020, and increased again following his tweets on March 21, 2020. The same is true for medications on Amazon, with purchases for medicine substitutes, such as hydroxychloroquine, increasing by 200%. CONCLUSIONS: Individuals in positions of power can sway public purchasing, resulting in undesired effects when the individuals' claims are unverified. Public health officials must work to dissuade the use of unproven treatments for COVID-19.


Assuntos
Comunicação , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Governo Federal , Internet/estatística & dados numéricos , Meios de Comunicação de Massa/estatística & dados numéricos , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/uso terapêutico , Azitromicina/uso terapêutico , Cloroquina/uso terapêutico , Fraude/estatística & dados numéricos , Humanos , Hidroxicloroquina/uso terapêutico , Idioma , Pandemias , Saúde Pública/estatística & dados numéricos , Saúde Pública/tendências , Estados Unidos/epidemiologia
13.
Salud Colect ; 16: e2995, 2020 10 29.
Artigo em Espanhol | MEDLINE | ID: mdl-33147394

RESUMO

This essay intends to carry out an ethical and philosophical reflection on the effects of the emergency contingencies of the COVID-19 pandemic. With a focus on Brazil, it seeks to understand, critique, and attribute meaning to references to the pandemic, in particularly dramatic moments brought about by the synergy produced between the serious disease affecting the country and the world and a government that stands out for its remarkable unwillingness and inability to deal with this calamity. This text was written during the Brazilian "quarantine," which lasted from mid-March to late April, 2020. During this period, we were bombarded by facts that never ceased to haunt us, and lived each day under the terrible dominion of the pandemic. Therefore, this text was written in the midst of a social context marked by control efforts, with great attention directed at the health of those affected, despite the complex political framework and serious economic difficulties facing the country.


Assuntos
Infecções por Coronavirus , Política de Saúde , Pandemias , Pneumonia Viral , Quarentena , Atitude Frente a Saúde , Brasil/epidemiologia , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Governo Federal , Humanos , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Quarentena/economia , Quarentena/métodos , Quarentena/psicologia , Risco
19.
Science ; 370(6515): 394-399, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33093092
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