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1.
S Afr Med J ; 110(7): 678-685, 2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32880347

RESUMO

BACKGROUND: The outcome and response of idiopathic nephrotic syndrome (NS) to steroids have been linked to race. OBJECTIVES: To determine the age of presentation, sex, race, histopathology, kidney function and disease status at the last hospital visit and correlate these with steroid response in Indian and black African children with idiopathic NS. METHODS: This is a retrospective review of 231 children aged 1 - 14 years, who were seen at Inkosi Albert Luthuli Central Hospital, Durban, South Africa (SA) from 2003 to 2018. RESULTS: The mean (standard deviation (SD)) age of presentation was 6.2 (3.4) years, with the majority of children (n=107; 46.3%) presenting at an early age (1 - 3 years) with a mean (SD) follow-up of 3.0 (2.4) years. One-hundred and twenty-one (52.4%) were males and 110 (47.6%) were females, with a male/female ratio of 1.1:1. There were 166 (71.9%) black African and 65 (28.1%) Indian children. The latter presented at a younger age than black African children (p<0.001). Seventy-six (32.9%) children were steroid sensitive (SS) and 155 (67.1%) were steroid resistant (SR). Black African children were more likely to be SR (odds ratio (OR) 2.0; p=0.02; 95% confidence interval (CI) 1.1 - 3.7). A kidney biopsy was performed in 209 (90.5%) children. Minimal change disease (MCD) was observed in 32 (13.9%) children and 162 (70.1%) had focal segmental glomerulosclerosis (FSGS). Black African children were slightly more likely to have FSGS; this, however, did not reach statistical significance (122/166 (73.5%) v. 40/65 (61.5%); OR 1.73; p=0.08; 95% CI 0.94 - 3.18). On comparing disease status at last hospital visit by race, 49/65 (75.4%) Indian and 94/166 (56.6%) black African children were in remission. At last hospital visit, black African children were less likely to be in remission than Indian children (OR 0.47; p=0.02; 95% CI 0.2 - 0.9), while 15/65 (23.1%) Indian and 47/166 (28.3%) black African children had relapsed, with no significant difference between the two groups. One (1.5%) Indian child and 25 (15.1%) black African children had end-stage kidney disease (ESKD) (OR 9.27; p=0.03; 95% CI 1.2 - 70.4) ‒ the majority had FSGS. Sixteen (61.5%) received renal replacement therapy. CONCLUSIONS: Our study shows a rising incidence of FSGS, with the majority of patients having SRNS, particularly black African children. This highlights the need for alternative efficacious therapy in the management of this disease. Also, a higher percentage of black African children with both MCD and FSGS were SS on histopathological examination, which was in keeping with reports from other regions in SA. There are still major challenges for the inclusion of all children into a chronic dialysis and transplant programme.


Assuntos
Síndrome Nefrótica/epidemiologia , Adolescente , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Criança , Pré-Escolar , Resistência a Medicamentos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Glomerulosclerose Segmentar e Focal/epidemiologia , Glucocorticoides/farmacologia , Humanos , Lactente , Falência Renal Crônica/epidemiologia , Masculino , Nefrose Lipoide/epidemiologia , Terapia de Substituição Renal/estatística & dados numéricos , Estudos Retrospectivos , Distribuição por Sexo , África do Sul/epidemiologia
2.
PLoS Med ; 17(9): e1003379, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32960880

RESUMO

BACKGROUND: There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). We investigated racial and ethnic disparities in patterns of COVID-19 testing (i.e., who received testing and who tested positive) and subsequent mortality in the largest integrated healthcare system in the United States. METHODS AND FINDINGS: This retrospective cohort study included 5,834,543 individuals receiving care in the US Department of Veterans Affairs; most (91%) were men, 74% were non-Hispanic White (White), 19% were non-Hispanic Black (Black), and 7% were Hispanic. We evaluated associations between race/ethnicity and receipt of COVID-19 testing, a positive test result, and 30-day mortality, with multivariable adjustment for a wide range of demographic and clinical characteristics including comorbid conditions, health behaviors, medication history, site of care, and urban versus rural residence. Between February 8 and July 22, 2020, 254,595 individuals were tested for COVID-19, of whom 16,317 tested positive and 1,057 died. Black individuals were more likely to be tested (rate per 1,000 individuals: 60.0, 95% CI 59.6-60.5) than Hispanic (52.7, 95% CI 52.1-53.4) and White individuals (38.6, 95% CI 38.4-38.7). While individuals from minority backgrounds were more likely to test positive (Black versus White: odds ratio [OR] 1.93, 95% CI 1.85-2.01, p < 0.001; Hispanic versus White: OR 1.84, 95% CI 1.74-1.94, p < 0.001), 30-day mortality did not differ by race/ethnicity (Black versus White: OR 0.97, 95% CI 0.80-1.17, p = 0.74; Hispanic versus White: OR 0.99, 95% CI 0.73-1.34, p = 0.94). The disparity between Black and White individuals in testing positive for COVID-19 was stronger in the Midwest (OR 2.66, 95% CI 2.41-2.95, p < 0.001) than the West (OR 1.24, 95% CI 1.11-1.39, p < 0.001). The disparity in testing positive for COVID-19 between Hispanic and White individuals was consistent across region, calendar time, and outbreak pattern. Study limitations include underrepresentation of women and a lack of detailed information on social determinants of health. CONCLUSIONS: In this nationwide study, we found that Black and Hispanic individuals are experiencing an excess burden of SARS-CoV-2 infection not entirely explained by underlying medical conditions or where they live or receive care. There is an urgent need to proactively tailor strategies to contain and prevent further outbreaks in racial and ethnic minority communities.


Assuntos
Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Grupos Étnicos/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Veteranos/estatística & dados numéricos , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Estudos de Coortes , Infecções por Coronavirus/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/etnologia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
3.
JAMA Netw Open ; 3(9): e2015470, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32876682

RESUMO

Importance: Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it. Objective: To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities. Design, Setting, and Participants: This cross-sectional study used Medicare data regarding the postacute home health care setting from October 1, 2015, through September 30, 2016. The participants were Medicare fee-for-service and Medicare Advantage beneficiaries who were discharged alive from a hospital with a referral to home health care (2 379 506 discharges). Statistical analysis was performed from July 2019 to June 2020. Exposures: Hospital referral to home health care. Main Outcomes and Measures: Primary outcomes included whether discharges received their first home health care visit within 14 days of hospital discharge and the number of days between hospital discharge and the first home health visit. Differences in the likelihood of receiving home health care across patient, zip code, and hospital characteristics were also examined. Results: Among 2 379 506 discharges from the hospital with a home health care referral, 1 358 697 patients (57.1%) were female, 468 762 (19.7%) were non-White, and 466 383 (19.6%) were dually enrolled in Medicare and Medicaid; patients had a mean (SD) age of 73.9 (11.9) years and 4.1 (2.1) Elixhauser comorbidities. Only 1 284 300 patients (54.0%) discharged from the hospital with a home health referral received home health care services within 14 days of discharge. Of the remaining 1 095 206 patients (46.0%) discharged, 37.7% (896 660 discharges) never received any home health care, while 8.3% (198 546 discharges) were institutionalized or died within 14 days without a preceding home health care visit. Patients who were Black or Hispanic received home health at lower rates than did patients who were White (48.0% [95% CI, 47.8%-48.1%] of Black and 46.1% [95% CI, 45.7%-46.5%] of Hispanic discharges received home health within 14 days compared with 55.3% [95% CI, 55.2%-55.4%] of White discharges). In addition, disadvantaged patients waited longer for their first home health care visit. For example, patients living in high-unemployment zip codes waited a mean of 2.0 days (95% CI, 2.0-2.0 days), whereas those living in low-unemployment zip codes waited 1.8 days (95% CI, 1.8-1.8 days). Conclusions and Relevance: Disparities in the use of home health care remain an issue in the US. As home health care is increasingly presented as a safer alternative to institutional postacute care during coronavirus disease 2019, and payment reforms continue to pressure hospitals to discharge patients home, ensuring the availability of safe and equitable care will be crucial to maintaining high-quality care.


Assuntos
Assistência ao Convalescente/estatística & dados numéricos , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/etnologia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Encaminhamento e Consulta , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Medicaid/estatística & dados numéricos , Medicare , Medicare Part C , Alta do Paciente , Pobreza/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Estados Unidos
4.
Soins Pediatr Pueric ; 41(315): 20-22, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32951691

RESUMO

What place should be given to puberty? In France, it is an intimate act that belongs only to the young girl. In Sri Lanka, it is a family and collective act that is ritualized and celebrated. Young girls born into Tamil families living in France have to make these very different logics cohabit. Analyse of a young girl's great suffering at puberty and its methods of reconstruction, which take into account the ways of doing and thinking about puberty here and there.


Assuntos
Comportamento Ritualístico , Grupo com Ancestrais do Continente Europeu/psicologia , Puberdade/etnologia , Estresse Psicológico/etnologia , Adolescente , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , França , Humanos , Psicopatologia , Puberdade/psicologia
5.
Soins Pediatr Pueric ; 41(315): 23-27, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32951692

RESUMO

In a cross-cultural consultation, a young girl of Tamil origin born in France seeks the love of her parents by oscillating between two cultures. Through group development and translation, the daughter and the mother are brought to understand each other's suffering and discover that they share the same deep love, even though it is expressed differently.


Assuntos
Grupo com Ancestrais do Continente Europeu/psicologia , Relações Pais-Filho , Pais/psicologia , Adolescente , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , França , Humanos , Amor
6.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32883808

RESUMO

BACKGROUND: Children with isolated neutropenia (absolute neutrophil count [ANC] <1500/µL) are frequently referred to pediatric hematology and oncology clinics for further diagnostic evaluation. Scant literature exists on interventions and outcomes for isolated neutropenia. We hypothesized that children will have resolution of their neutropenia without the need for intervention(s) by a pediatric hematologist and oncologist. METHODS: We performed a 5.5-year institutional review board-approved retrospective chart review of children referred to our pediatric hematology and oncology clinics for isolated neutropenia. Neutropenia was categorized as mild (ANC of 1001-1500/µL), moderate (ANC of 500-1000 µL), severe (ANC of 201-500/µL), or very severe (ANC of ≤200/µL). RESULTS: Among 155 children referred with isolated neutropenia, 45 (29%) had mild neutropenia, 65 (42%) had moderate neutropenia, 30 (19%) had severe neutropenia, and 15 (10%) had very severe neutropenia. Only 29 (19%) children changed to an ANC category lower than their initial referral category. At a median follow-up of 12 months, 101 children had resolution of neutropenia, 40 children had mild neutropenia, 10 children had moderate neutropenia, 3 children had severe neutropenia, and 1 patient had very severe neutropenia. A specific diagnosis was not identified in most (54%) children. The most common etiologies were viral suppression (16%), autoimmune neutropenia (14%), and drug-induced neutropenia (8%). Black children had a 3.5 higher odds of having persistent mild neutropenia. Six (4%) children received granulocyte colony-stimulating factor therapy. CONCLUSIONS: Most children referred for isolated neutropenia do not progress in severity and do not require subspecialty interventions or hospitalizations.


Assuntos
Neutropenia/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Afro-Americanos/estatística & dados numéricos , Anticorpos Antinucleares/análise , Americanos Asiáticos/estatística & dados numéricos , Doenças Autoimunes/complicações , Neutropenia Febril Induzida por Quimioterapia/epidemiologia , Criança , Pré-Escolar , Progressão da Doença , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Seguimentos , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Hematologia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Oncologia , Neutropenia/diagnóstico , Neutropenia/tratamento farmacológico , Neutropenia/etiologia , Remissão Espontânea , Estudos Retrospectivos , Viroses/complicações
7.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32913134

RESUMO

BACKGROUND AND OBJECTIVES: Opioid misuse and overdose remains a leading US public health concern, and many youth are first exposed to opioids via medical use. In this study, we examine school-level prevalence and correlates of medical use and misuse of prescription opioids among US 12th-grade students. METHODS: A sample of 228 507 US 12th-graders in 1079 public and private schools from 2002 to 2017 from the Monitoring the Future study was used to identify school-level prevalence and correlates associated with medical use and misuse of prescription opioids. RESULTS: The past-year prevalence of prescription opioid misuse was 7.6% and ranged from 0% to 73% across US high schools. Lifetime medical use of prescription opioids was 16.9% and ranged from 0% to 85% across US high schools. The odds of prescription opioid misuse were higher at schools with higher proportions of male students, more white students, higher rates of marijuana use, and more medical use of prescription opioids. Students attending schools with the highest rates of medical use of prescription opioids had 57% increased odds of past-year prescription opioid misuse compared with schools with no medical use (adjusted odds ratio = 1.57, 95% confidence interval = 1.35-1.83); this association was found to weaken in recent years. CONCLUSIONS: Differences exist in the prevalence of prescription opioid misuse among US high schools. The association between greater school-level medical use of prescription opioids and higher prevalence of prescription opioid misuse, although declining, indicates a key risk factor to target for prevention efforts.


Assuntos
Analgésicos Opioides/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Adolescente , Intervalos de Confiança , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Abuso de Maconha/epidemiologia , Razão de Chances , Prevalência , Instituições Acadêmicas/estatística & dados numéricos , Fatores Sexuais , Estudantes/estatística & dados numéricos , Estados Unidos/epidemiologia
8.
ACS Chem Neurosci ; 11(19): 2944-2961, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-32870641

RESUMO

A significant proportion of people who test positive for COVID-19 have chemosensory deficits. However, the reported prevalence of these deficits in smell and taste varies widely, and the reason for the differences between studies is unclear. We determined the pooled prevalence of such chemosensory deficits in a systematic review and meta-analysis. We searched the COVID-19 portfolio of the National Institutes of Health for studies that reported the prevalence of smell or taste deficits or both in patients diagnosed with COVID-19. One-hundred-four studies reporting on 38 198 patients qualified and were subjected to a systematic review and meta-analysis. Estimated random prevalence of olfactory dysfunction was 43.0%, that of taste dysfunction was 44.6%, and that of overall chemosensory dysfunction was 47.4%. We examined the effects of age, gender, disease severity, and ethnicity on chemosensory dysfunction. Prevalence of smell or taste dysfunction or both decreased with older age, male gender, and disease severity. Ethnicity was highly significant: Caucasians had a three times higher prevalence of chemosensory dysfunctions (54.8%) than Asians (17.7%). The finding of geographic differences points to two causes that are not mutually exclusive. A virus mutation (D614G) may cause differing infectivity, while at the host level genetic, ethnicity-specific variants of the virus-binding entry proteins may facilitate virus entry in the olfactory epithelium and taste buds. Both explanations have major implications for infectivity, diagnosis, and management of the COVID-19 pandemic.


Assuntos
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Infecções por Coronavirus/fisiopatologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Transtornos do Olfato/etnologia , Pneumonia Viral/fisiopatologia , Fatores Etários , Betacoronavirus/genética , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Grupos Étnicos , Variação Genética , Humanos , Transtornos do Olfato/epidemiologia , Transtornos do Olfato/fisiopatologia , Pandemias , Peptidil Dipeptidase A/genética , Pneumonia Viral/epidemiologia , Prevalência , Serina Endopeptidases/genética , Índice de Gravidade de Doença , Fatores Sexuais
9.
N Z Med J ; 133(1522): 30-41, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32994614

RESUMO

AIM: Chronic respiratory diseases, such as chronic obstructive pulmonary disease, are a worldwide public health problem. Pulmonary rehabilitation is a gold-standard intervention for these diseases, yet attendance and completion rates are poor. Counties Manukau Health, in Auckland, New Zealand, has a high prevalence of chronic respiratory disease and a culturally diverse population, comprising large numbers of Maori and Pacific Island people, who are known to be disproportionately affected by chronic respiratory disease. The aim of this study was to investigate patient characteristics affecting engagement with the Counties Manukau Health pulmonary rehabilitation programme and identify factors predicting completion of the programme. METHODS: Investigators performed a retrospective analysis using routinely collected data of 2,756 patients invited to attend the pulmonary rehabilitation programme at Counties Manukau Health. Data were analysed to compare demographic and clinical outcomes of patients who completed, did not complete or did not attend the programme, and identified factors predicting completion. RESULTS: Significant differences were found between groups in demographic and clinical characteristics. Increasing age, higher six-minute walk test distance at programme commencement and European ethnicity were significant predictors of completion of the PR programme. CONCLUSIONS: Compared to European people, Maori were 52% less likely and Pacific Island people were 40% less likely to complete the programme. These findings are significant for the Counties Manukau Health population. Further work needs to focus on determining how to make programmes more engaging to different cultures and how we can aim to reduce health inequities in these populations.


Assuntos
Cooperação do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Terapia Respiratória/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
10.
N Z Med J ; 133(1521): 40-54, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32994636

RESUMO

AIMS: Ischaemic heart disease (IHD) mortality rates after myocardial infarction (MI) are higher in Maori and Pacific compared to European people. The reasons for these differences are complex and incompletely understood. Our aim was to use a contemporary real-world national cohort of patients presenting with their first MI to better understand the extent to which differences in the clinical presentation, cardiovascular (CVD) risk factors, comorbidity and in-hospital treatment explain the mortality outcomes for Maori and Pacific peoples. METHODS: New Zealand residents (≥20 years old) hospitalised with their first MI (2014-2017), and who underwent coronary angiography, were identified from the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. All-cause mortality up to one year after the index admission date was obtained by linkage to the national mortality database. RESULTS: There were 17,404 patients with a first ever MI. European/other comprised 76% of the population, Maori 11.5%, Pacific 5.1%, Indian 4.3% and Other Asian 2.9%. Over half (55%) of Maori, Pacific and Indian patients were admitted with their first MI before age 60 years, compared with 29% of European/other patients. Maori and Pacific patients had a higher burden of traditional and non-traditional cardiovascular risk factors, and despite being younger, were more likely to present with heart failure and, together with Indian peoples, advanced coronary disease at presentation with first MI. After adjustment for age and sex, Maori and Pacific, but not Indian or Other Asian patients had significantly higher all-cause mortality at one year compared with the European/other reference group (HR 2.55 (95% CI 2.12-3.07), HR 2.98 (95% CI 2.34-3.81) for Maori and Pacific respectively). When further adjusted for differences in clinical presentation, clinical history and cardiovascular risk factors, the excess mortality risk for Maori and Pacific patients was reduced substantially, but a differential persisted (HR 1.77 (95% CI 1.44-2.19), HR 1.42 (95% CI 1.07-1.83)) which was not further reduced by adjustment for differences in in-hospital management and discharge medications. CONCLUSION: In New Zealand patients after their first MI there is a three-fold variation in one-year mortality based on ethnicity. At least half of the inequity in outcomes for Maori, and three-quarters for Pacific people, is associated with differences in preventable or modifiable clinical factors present at, or prior to, presentation.


Assuntos
Disparidades nos Níveis de Saúde , Infarto do Miocárdio/mortalidade , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/prevenção & controle , Nova Zelândia/epidemiologia , Fatores de Risco
11.
N Z Med J ; 133(1521): 69-76, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32994638

RESUMO

Maori experience poorer health statistics in terms of cancer incidence and mortality compared to non-Maori. For prostate cancer, Maori men are less likely than non-Maori men to be diagnosed with prostate cancer, but those that are diagnosed are much more likely to die of the disease than non-Maori men resulting in an excess mortality rate in Maori men compared with non-Maori. A review of the literature included a review of the epidemiology of prostate cancer; of screening; of access to healthcare and of treatment modalities. Our conclusion was that there are a number of reasons for the disparity in outcomes for Maori including differences in staging and characteristics at diagnosis; differences in screening and treatment offered to Maori men; and general barriers to healthcare that exist for Maori men in New Zealand. We conclude that there is a need for more culturally appropriate care to be available to Maori men.


Assuntos
Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades em Assistência à Saúde , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Neoplasias da Próstata , Adulto , Idoso , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/terapia , Fatores de Risco , Fatores Socioeconômicos
12.
Artigo em Inglês | MEDLINE | ID: mdl-32829699

RESUMO

Confirmed cases in Australia: 12,636 notifications and 147 deaths as at 19 July 2020; during the latest reporting fortnight (6 to 19 July 2020) there have been 3,791 notifications and 37 deaths. The number of new cases reported nationally increased from 897 in the previous fortnight (22 June to 5 July) to 3,791 (6 to 19 July). The large increase in cases is due to multiple epidemiologically-linked outbreaks across a range of settings and locations in Victoria (94%; 3,575 cases), with very few cases reported by other jurisdictions (216) in this reporting period. Of the 3,575 cases reported in Victoria, all except one were reported as locally acquired. The majority of these cases were linked to several outbreaks. Of the 216 cases reported from other jurisdictions, approximately 55% (119 cases) were locally acquired. A total of 37 deaths were reported, all from Victoria. On average, 271 cases were reported each day over the reporting period, an increase from 54 cases per day over the previous reporting period. Testing rates have increased across all jurisdictions, predominantly in Victoria, with the nationwide cumulative positivity rate remaining very low at less than 0.5%. As at 19 July, a small proportion of cases have experienced severe disease, requiring hospitalisation or intensive care, with some fatalities. The cumulative crude case fatality rate amongst Australian cases is 1.2%. People who are older and have one or more comorbidity are more likely to experience severe disease.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Betacoronavirus , Criança , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mortalidade , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Índice de Gravidade de Doença , Distribuição por Sexo , Vitória/epidemiologia , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-32829705

RESUMO

Confirmed cases in Australia this reporting period (20 July to 2 August): 6,121 notifications, 71 deaths. Cumulative: 18,367 notifications, 240 deaths. Over the past fortnightly reporting period (20 July to 2 August), the number of new cases reported nationally increased from 3,462 in the previous fortnight to 6,121. The large increase in numbers is due to multiple epidemiologically-linked outbreaks across a range of settings and locations in Victoria (97%; 5,914 cases) with very few (207) cases reported by other jurisdictions in this reporting period. Of the 5,914 cases reported in Victoria, all were locally acquired. Of the remaining 207 cases nationally reported, only 23% were reported as locally acquired. ACT is the only jurisdiction reporting 0 cases, with its last case reported on 9 July. A total of 71 deaths were reported, all from Victoria. On average, 437 cases were reported each day over the reporting period, an increase from 247 cases per day over the previous fortnight. Testing rates remain high across all jurisdictions, with an overall positivity rate for the reporting period of 0.7%. Victoria reported a positivity rate of 1.7% for this reporting period; in all other jurisdictions the positivity rate was 0.07% or lower. Overall, syndromic surveillance of respiratory illness trends continues to show very low levels compared to previous years. 12% of cases have required hospitalisation or intensive care.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Betacoronavirus , Criança , Pré-Escolar , Comorbidade , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Índice de Gravidade de Doença , Distribuição por Sexo , Adulto Jovem
14.
BMJ Open ; 10(8): e039849, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32784264

RESUMO

INTRODUCTION: Data on race and ethnic disparities for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited. We analysed sociodemographic factors associated with higher likelihood of SARS-CoV-2 infection and explore mediating pathways for race and ethnic disparities in the SARS-CoV-2 pandemic. METHODS: This is a cross-sectional analysis of the COVID-19 Surveillance and Outcomes Registry, which captures data for a large healthcare system, comprising one central tertiary care hospital, seven large community hospitals and an expansive ambulatory/emergency care network in the Greater Houston area. Nasopharyngeal samples for individuals inclusive of all ages, races, ethnicities and sex were tested for SARS-CoV-2. We analysed sociodemographic (age, sex, race, ethnicity, household income, residence population density) and comorbidity (Charlson Comorbidity Index, hypertension, diabetes, obesity) factors. Multivariable logistic regression models were fitted to provide adjusted OR (aOR) and 95% CI for likelihood of a positive SARS-CoV-2 test. Structural equation modelling (SEM) framework was used to explore three mediation pathways (low income, high population density, high comorbidity burden) for the association between non-Hispanic black (NHB) race, Hispanic ethnicity and SARS-CoV-2 infection. RESULTS: Among 20 228 tested individuals, 1551 (7.7%) tested positive. The overall mean (SD) age was 51.1 (19.0) years, 62% were females, 22% were black and 18% were Hispanic. NHB and Hispanic ethnicity were associated with lower socioeconomic status and higher population density residence. In the fully adjusted model, NHB (vs non-Hispanic white; aOR, 2.23, CI 1.90 to 2.60) and Hispanic ethnicity (vs non-Hispanic; aOR, 1.95, CI 1.72 to 2.20) had a higher likelihood of infection. Older individuals and males were also at higher risk of infection. The SEM framework demonstrated a significant indirect effect of NHB and Hispanic ethnicity on SARS-CoV-2 infection mediated via a pathway including residence in densely populated zip code. CONCLUSIONS: There is strong evidence of race and ethnic disparities in the SARS-CoV-2 pandemic that are potentially mediated through unique social determinants of health.


Assuntos
Infecções por Coronavirus/etnologia , Disparidades nos Níveis de Saúde , Pandemias , Pneumonia Viral/etnologia , Fatores Raciais , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Betacoronavirus , Comorbidade , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Densidade Demográfica , Vigilância da População , Sistema de Registros , Fatores Socioeconômicos , Texas/epidemiologia
15.
Stroke ; 51(9): 2656-2663, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755349

RESUMO

BACKGROUND AND PURPOSE: The 2019 novel coronavirus outbreak and its associated disease (coronavirus disease 2019 [COVID-19]) have created a worldwide pandemic. Early data suggest higher rate of ischemic stroke in severe COVID-19 infection. We evaluated whether a relationship exists between emergent large vessel occlusion (ELVO) and the ongoing COVID-19 outbreak. METHODS: This is a retrospective, observational case series. Data were collected from all patients who presented with ELVO to the Mount Sinai Health System Hospitals across New York City during the peak 3 weeks of hospitalization and death from COVID-19. Patients' demographic, comorbid conditions, cardiovascular risk factors, COVID-19 disease status, and clinical presentation were extracted from the electronic medical record. Comparison was made between COVID-19 positive and negative cohorts. The incidence of ELVO stroke was compared with the pre-COVID period. RESULTS: Forty-five consecutive ELVO patients presented during the observation period. Fifty-three percent of patients tested positive for COVID-19. Total patients' mean (±SD) age was 66 (±17). Patients with COVID-19 were significantly younger than patients without COVID-19, 59±13 versus 74±17 (odds ratio [95% CI], 0.94 [0.81-0.98]; P=0.004). Seventy-five percent of patients with COVID-19 were male compared with 43% of patients without COVID-19 (odds ratio [95% CI], 3.99 [1.12-14.17]; P=0.032). Patients with COVID-19 were less likely to be White (8% versus 38% [odds ratio (95% CI), 0.15 (0.04-0.81); P=0.027]). In comparison to a similar time duration before the COVID-19 outbreak, a 2-fold increase in the total number of ELVO was observed (estimate: 0.78 [95% CI, 0.47-1.08], P≤0.0001). CONCLUSIONS: More than half of the ELVO stroke patients during the peak time of the New York City's COVID-19 outbreak were COVID-19 positive, and those patients with COVID-19 were younger, more likely to be male, and less likely to be White. Our findings also suggest an increase in the incidence of ELVO stroke during the peak of the COVID-19 outbreak.


Assuntos
Arteriopatias Oclusivas/epidemiologia , Isquemia Encefálica/epidemiologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Isquemia Encefálica/complicações , Infecções por Coronavirus/complicações , Registros Eletrônicos de Saúde , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Pandemias , Pneumonia Viral/complicações , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/complicações
16.
PLoS One ; 15(8): e0237026, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760109

RESUMO

The Occupational Information Network (O*NET) database has been used as a valuable source of occupational exposure information. Although good agreement between O*NET and self-reported measures has been reported, little attention has been paid to O*NET's utility in racially/ethnically diverse samples. Because O*NET offers job-level information, if different racial groups have different experiences under the same job title, O*NET measure would introduce systematic measurement error. Using the General Social Survey data (n = 7,041; 437 occupations), we compared self-report and O*NET-derived measures of job control in their associations with self-rated health (SRH) for non-Hispanic whites and racial/ethnic minorities. The correlation between self-report and O*NET job control measures were moderate for all gender-race groups (Pearson's r = .26 - .40). However, the logistic regression analysis showed that the association between O*NET job control and SRH was markedly weaker for racial/ethnic minorities than for non-Hispanic whites. The self-reported job control was associated with SRH in similar magnitudes for both groups, which precluded the possibility that job control was relevant only for non-Hispanic whites. O*NET may not capture job experience for racial/ethnic minorities, and thus its utility depends on the racial/ethnic composition of the sample.


Assuntos
Nível de Saúde , Ocupações , Racismo/estatística & dados numéricos , Adulto , Bases de Dados Factuais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Exposição Ocupacional , Saúde do Trabalhador , Ocupações/estatística & dados numéricos , Autorrelato , Fatores Socioeconômicos , Estados Unidos
17.
Public Health Rep ; 135(5): 685-690, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32762633

RESUMO

OBJECTIVES: Racial/ethnic disparities in HIV diagnosis rates remain despite the availability of effective treatment and prevention tools in the United States. In 2019, President Trump announced the "Ending the HIV Epidemic: A Plan for America" (EHE) initiative to reduce new HIV infections in the United States at least 75% by 2025 and at least 90% by 2030. The objective of this study was to show the potential effect of the EHE initiative on racial/ethnic disparities in HIV diagnosis rates at the national level. METHODS: We used 2017 HIV diagnoses data from the Centers for Disease Control and Prevention National HIV Surveillance System. We developed a counterfactual scenario to determine changes in racial/ethnic disparities if the 2017 HIV diagnosis rates were reduced by 75% in the geographic regions targeted by the EHE initiative. We used 4 measures to calculate results: rate ratio, population-attributable proportion (PAP), Gini coefficient, and Index of Disparity. RESULTS: The relative measures of racial/ethnic disparity decreased by 9%-21% in the EHE scenario compared with the 2017 HIV diagnoses data. The largest decrease was in the Hispanic/Latino:white rate ratio (-20.6%) and in the black:white rate ratio (-18.2%). The PAP measure decreased by 11.5%. The absolute versions of the Index of Disparity (unweighted and weighted) were approximately 50% lower in the EHE scenario than in the 2017 HIV diagnoses data. CONCLUSIONS: EHE efforts could reduce but will not eliminate racial/ethnic disparities in HIV diagnosis rates. Efforts to address racial/ethnic disparities should continue, and innovative approaches, specifically those that focus on social and structural factors, should be developed and implemented for populations that are disproportionately affected by HIV in the United States.


Assuntos
Epidemias/prevenção & controle , Epidemias/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Disparidades nos Níveis de Saúde , Saúde Pública/legislação & jurisprudência , Saúde Pública/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Grupos de Populações Continentais/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
18.
Public Health Rep ; 135(5): 658-667, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32805192

RESUMO

OBJECTIVES: The health profile of Arab American mothers and infants may differ from that of non-Arab American mothers and infants in the United States as a result of social stigma experienced in the historical and current sociopolitical climate. The objective of our study was to compare maternal health behaviors, maternal health outcomes, and infant health outcomes of Arab American mothers and non-Hispanic white mothers in Massachusetts and to assess the role of nativity as an effect modifier. METHODS: Using data from Massachusetts birth certificates (2012-2016), we conducted adjusted logistic and linear regression models for maternal health behaviors, maternal health outcomes, and infant health outcomes. We used Arab ethnicity as the exposure of interest and nativity as an effect modifier. RESULTS: Arab American mothers had higher odds than non-Hispanic white mothers of initiating breastfeeding (adjusted odds ratio [aOR] = 2.61; 95% CI, 2.39-2.86), giving birth to small-for-gestational-age infants (aOR = 1.28; 95% CI, 1.18-1.39), and having gestational diabetes (aOR = 1.31; 95% CI, 1.20-1.44). Among Arab American mothers, non-US-born mothers had higher odds than US-born mothers of having gestational diabetes (aOR = 1.80; 95% CI, 1.33-2.44) and lower odds of initiating prenatal care in the first trimester (aOR = 0.41; 95% CI, 0.33-0.50). In linear regression models, infants born to non-US-born Arab American mothers weighed 42.1 g (95% CI, -75.8 to -8.4 g) less than infants born to US-born Arab American mothers. CONCLUSION: Although Arab American mothers engage in positive health behaviors, non-US-born mothers had poorer maternal health outcomes and access to prenatal care than US-born mothers, suggesting the need for targeted interventions for non-US-born Arab American mothers.


Assuntos
Árabes/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Saúde do Lactente/estatística & dados numéricos , Comportamento Materno/psicologia , Saúde Materna/estatística & dados numéricos , Mães/psicologia , Características de Residência/estatística & dados numéricos , Adulto , Árabes/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Massachusetts , Mães/estatística & dados numéricos
19.
Proc Natl Acad Sci U S A ; 117(36): 21854-21856, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32839337

RESUMO

The COVID-19 pandemic is causing a catastrophic increase in US mortality. How does the scale of this pandemic compare to another US catastrophe: racial inequality? Using demographic models, I estimate how many excess White deaths would raise US White mortality to the best-ever (lowest) US Black level under alternative, plausible assumptions about the age patterning of excess mortality in 2020. I find that 400,000 excess White deaths would be needed to equal the best mortality ever recorded among Blacks. For White mortality in 2020 to reach levels that Blacks experience outside of pandemics, current COVID-19 mortality levels would need to increase by a factor of nearly 6. Moreover, White life expectancy in 2020 will remain higher than Black life expectancy has ever been unless nearly 700,000 excess White deaths occur. Even amid COVID-19, US White mortality is likely to be less than what US Blacks have experienced every year. I argue that, if Black disadvantage operates every year on the scale of Whites' experience of COVID-19, then so too should the tools we deploy to fight it. Our imagination should not be limited by how accustomed the United States is to profound racial inequality.


Assuntos
Infecções por Coronavirus/etnologia , Infecções por Coronavirus/mortalidade , Pneumonia Viral/etnologia , Pneumonia Viral/mortalidade , Afro-Americanos/estatística & dados numéricos , Betacoronavirus , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Humanos , Expectativa de Vida/etnologia , Expectativa de Vida/tendências , Mortalidade/etnologia , Mortalidade/tendências , Pandemias , Fatores Socioeconômicos , Estados Unidos/epidemiologia
20.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32759379

RESUMO

OBJECTIVES: To evaluate racial and/or ethnic and socioeconomic differences in rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children. METHODS: We performed a cross-sectional study of children tested for SARS-CoV-2 at an exclusively pediatric drive-through and walk-up SARS-CoV-2 testing site from March 21, 2020, to April 28, 2020. We performed bivariable and multivariable logistic regression to measure the association of patient race and/or ethnicity and estimated median family income (based on census block group estimates) with (1) SARS-CoV-2 infection and (2) reported exposure to SARS-CoV-2. RESULTS: Of 1000 children tested for SARS-CoV-2 infection, 20.7% tested positive for SARS-CoV-2. In comparison with non-Hispanic white children (7.3%), minority children had higher rates of infection (non-Hispanic Black: 30.0%, adjusted odds ratio [aOR] 2.3 [95% confidence interval (CI) 1.2-4.4]; Hispanic: 46.4%, aOR 6.3 [95% CI 3.3-11.9]). In comparison with children in the highest median family income quartile (8.7%), infection rates were higher among children in quartile 3 (23.7%; aOR 2.6 [95% CI 1.4-4.9]), quartile 2 (27.1%; aOR 2.3 [95% CI 1.2-4.3]), and quartile 1 (37.7%; aOR 2.4 [95% CI 1.3-4.6]). Rates of reported exposure to SARS-CoV-2 also differed by race and/or ethnicity and socioeconomic status. CONCLUSIONS: In this large cohort of children tested for SARS-CoV-2 through a community-based testing site, racial and/or ethnic minorities and socioeconomically disadvantaged children carry the highest burden of infection. Understanding and addressing the causes of these differences are needed to mitigate disparities and limit the spread of infection.


Assuntos
Infecções por Coronavirus/etnologia , Epidemias , Pneumonia Viral/etnologia , Fatores Raciais/estatística & dados numéricos , Adolescente , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Betacoronavirus , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades em Assistência à Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia
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