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1.
PLoS One ; 15(8): e0238295, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866190

RESUMO

African American breast cancer genetics is less understood compared to European American breast cancer susceptibility. Despite the many advantages of gene panel screening, studies investigating African American inherited breast cancer risk and comparing variant contributions between ethnicities are infrequent. Thus, 97 breast cancer-affected individuals of African and European descent from the Alabama Hereditary Cancer Cohort were screened using the research-based gene-panel, B.O.P. (Breast, Ovarian, and Prostate cancer). Upon sequencing and bioinformatic processing, rare coding variants in 14 cancer susceptibility genes were categorized according to the American College of Medical Genetics guidelines and compared between ethnicities. Overall, 107 different variants were identified, the majority of which were benign/likely benign. A pathogenic/likely pathogenic variant was detected in 8.6% and 6.5% of African American and European American cases, respectively, which was not statistically significant. However, African Americans were more likely to have at least one variant of uncertain significance (VUS; p-value 0.006); they also had significantly more VUSs in BRCA1/2 compared to European Americans (p-value 0.015). Additionally, 51.4% of African Americans and 32.3% of European Americans harbored multiple rare variants, and African Americans were more likely to have at least one VUS and one benign/likely benign variant (p-value 0.032), as well as multiple benign/likely benign variants (p-value 0.089). Moreover, of the 15 variants detected in multiple breast cancer cases, ATM c.2289T>C (p.F763L), a VUS, along with two likely benign variants, BRCA2 c.2926_2927delinsAT (p.S976I) and RAD51D c.251T>A (p.L84H), were determined to be associated with African American breast cancer risk when compared to ethnic-specific controls. Ultimately, B.O.P. screening provides essential insight towards the variant contributions in clinically relevant cancer susceptibility genes and differences between ethnicities, stressing the need for future research to elucidate inherited breast cancer risk.


Assuntos
Neoplasias da Mama/genética , Predisposição Genética para Doença/genética , Variação Genética/genética , Grupos Populacionais/genética , Detecção Precoce de Câncer/métodos , Feminino , Testes Genéticos/métodos , Humanos
2.
BMC Public Health ; 20(1): 1463, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993607

RESUMO

BACKGROUND: Healthcare facilities are notorious for occupational health and safety problems. Multi-level interventions are needed to address interacting exposures and their overlapping origins in work organization features. Worker participation in problem identification and resolution is essential. This study evaluates the CPH-NEW Healthy Workplace Participatory Program (HWPP), a Total Worker Health® protocol to develop effective employee teams for worker safety, health, and wellbeing. METHODS: Six public sector, unionized healthcare facilities are enrolled, in three pairs, matched by agency. The unit of intervention is a workplace health and safety committee, adapted here to a joint labor-management "Design Team" (DT). The DT conducts root cause analyses, prioritizes problems, identifies feasible interventions in light of the constraints and needs of the specific setting, makes business-case presentations to facility leadership, and assists in evaluation. Following a stepped-wedge (cross-over) design, one site in each pair is randomly assigned to "immediate intervention" status, receiving the full coached intervention at baseline; in the "lagged intervention" site, coaching begins about half-way through the study. Program effectiveness and cost-effectiveness outcomes are assessed at both organizational (e.g., workers' compensation claim and absenteeism rates, perceived management support of safety) and individual levels (e.g., self-rated health, sleep quality, leisure-time exercise). Targeted pre-post analyses will also examine specific outcomes appropriate to the topics selected for intervention. Process evaluation outcomes include fidelity of the HWPP intervention, extent of individual DT member activity, expansion of committee scope to include employee well-being, program obstacles and opportunities in each setting, and sustainability (within the available time frame). DISCUSSION: This study aims for a quantitative evaluation of the HWPP over a time period long enough to accomplish multiple intervention cycles in each facility. The design seeks to achieve comparable study engagement and data quality between groups. We will also assess whether the HWPP might be further improved to meet the needs of U.S. public sector healthcare institutions. Potential challenges include difficulty in pooling data across study sites if Design Teams select different intervention topics, and follow-up periods too short for change to be observed. TRIAL REGISTRATION: ClinicalTrials.gov NCT04251429 (retrospectively registered January 29, 2020), protocol version 1.


Assuntos
Promoção da Saúde/métodos , Saúde do Trabalhador/estatística & dados numéricos , Engajamento no Trabalho , Local de Trabalho/organização & administração , Análise Custo-Benefício , Exercício Físico , Humanos , Grupos Populacionais , Avaliação de Programas e Projetos de Saúde/métodos , Estudos Prospectivos , Indenização aos Trabalhadores
3.
BMC Public Health ; 20(1): 1462, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993730

RESUMO

BACKGROUND: Previous studies suggest that immigration may influence the experience of pain. OBJECTIVE: This population-based study examines whether immigration status is associated with chronic pain (CP), chronic widespread pain (CWSP), and severe CP at a two-year follow-up. We also tested mediation by mood status (i.e., anxiety and depression). METHODS: 15, 563 participants from a representative stratified random sample of 34,000 individuals living in south-eastern Sweden completed a postal survey, during 2013-2015, that included the following data: immigration status; presence of CP (pain lasting at least 3 months) and CWSP (a modified classification of widespread pain for use in epidemiological studies); severity of CP based on a numeric rating scale; and depression, anxiety, economic situation, and sociodemographic information. We applied logistic regressions using the generalized estimating equations (GEE), with Swedish-born as the reference group and path analyses models. RESULTS: Compared to the Swedish-born participants (n = 14,093;90%), the immigrants (n = 1470;10%) had an elevated risk of all pain outcomes (CP: odds ratio [OR] = 1.18; 95% confidence interval [CI = 1.04-1.33, CWSP: OR = 1.39; 95% CI: 1.15-1.69 and severe CP: 1.51; 95% CI: 1.23-1.87) after adjustments. Path analyses showed that baseline age, immigrant status, and financial hardship had a significant influence on chronic pain outcomes at follow-up with baseline mood status as the mediator. Immigration status was also associated with age and financial hardship. CONCLUSION: Immigrants may have increased risk of chronic pain, widespread pain, and severe pain and this risk is mediated by mood status. Targeted interventions better tailored to the socio-economic and psychological status of immigrants with chronic pain are warranted.


Assuntos
Dor Crônica/epidemiologia , Emigração e Imigração/estatística & dados numéricos , Adulto , Ansiedade/epidemiologia , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Grupos Populacionais , Inquéritos e Questionários , Suécia
5.
PLoS One ; 15(8): e0236355, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833993

RESUMO

INTRODUCTION: Neonatal infections are a common cause of death in India, but many families cannot access appropriate hospitals for its treatment due to various reasons. We implemented the World Health Organization PSBI management guideline when referral is not feasible within the public health system in Pune, India to evaluate feasibility, barriers and facilitators for its implementation. METHODS: A national-level consultative meeting between government officials and study partners resulted in a consensus on adaptation and implementation in four demonstration sites in selected states in India. At the state and district levels, similar meetings to plan the implementation strategy and roles were held between KEM Hospital Research Centre (KEMHRC) Pune and the public health system Pune, Maharashtra. The public health system was responsible for implementation of the intervention at eight tribal primary health centres (PHC) in Pune district, India, including delivering the intervention and ensuring supplies of all commodities while KEMHRC was responsible for technical support including training of health workers, assistance in PSBI identification and management, data collection and documentation of the implementation strategy. RESULTS: A total of 175 young infants with PSBI were identified and managed. Of these, 34 had critical illness (CI), 46 had clinical severe infection (CSI) and 10 were infants aged 0-6 days with fast breathing (FB) while 85 infants aged 7-59 days had fast breathing. Assuming a 10% incidence of PSBI among all live births, with 3071 live births recorded, the actual incidence of PSBI found in the study was 5.7%, resulting in an actual coverage was of 57%. Among the 90 infants with CI, CSI and FB in 0-6 days, who were advised referral to government tertiary care centre as per the PSBI guideline algorithm, 81 (90%) accepted referral while 9 (10%) refused and were offered treatment at primary health centres (PHC) with a seven-day course of injectable gentamicin and oral amoxicillin. All infants with FB in 7-59 days were offered treatment at PHCs as per the PSBI guideline algorithm with a seven-day course of oral amoxicillin. All except six infants who died and one with FB in 7-59 days, who was lost to follow-up, were successfully cured. Of the six who died, five had CSI and one had CI. Among the 81 infants with CI, CSI and FB in 0-6 days who accepted referral; 48(53%) were successfully referred to government tertiary facility while 33 (36.6%) preferred to visit a private tertiary health facility. The implementation strategy demonstrated a relatively high fidelity, acceptance and intervention penetration. Lack of training and confidence of the public health staff were major challenges faced, which were resolved to a large extent through supportive supervision and re-trainings. CONCLUSION: Management of PSBI is feasible to implement in out-patient facilities in the public health system, but technical support to the health system is required to jump-start the process. Fast breathing in 7-59 days old infants can be managed with oral amoxicillin without referral. A sustainable adoption of this intervention by the health system can lead to decrease in neonatal mortality and morbidity.


Assuntos
Amoxicilina/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Mortalidade Infantil , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Estudos de Viabilidade , Feminino , Gentamicinas/uso terapêutico , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Grupos Populacionais , Organização Mundial da Saúde
6.
PLoS One ; 15(7): e0236924, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735608

RESUMO

BACKGROUND: Soil-transmitted helminth (STH) infections have many negative health outcomes (e.g., diarrhea, nutritional deficiencies) that can also exacerbate poverty. These infections are generally highest among low-income populations, many of which are also undergoing market integration (MI; increased participation in a market-based economy). Yet the direct impact of MI-related social and environmental changes on STH infection patterns is poorly understood, making it unclear which lifestyle factors should be targeted to better control disease spread. This cross-sectional study examines if household infrastructure associated with greater MI is associated with lower STH burdens among Indigenous Ecuadorian Shuar. METHODS: Kato-Katz fecal smears were used to determine STH infection status and intensity (n = 620 participants; 308 females, 312 males, aged 6 months-86 years); Ascaris lumbricoides (ascarid) and Trichuris trichiura (whipworm) were the primary infection types detected. Structured interviews assessing lifestyle patterns (e.g., measures of household infrastructure) measured participant MI. Multilevel regression analyses and zero-inflated negative binomial regression models tested associations between MI measures and STH infection status or intensity, controlling for individual and community characteristics. RESULTS: Participants residing in more market-integrated households exhibited lower infection rates and intensities than those in less market integrated households. Parasite infection status and T. trichiura infection intensity were lower among participants living in houses with wood floors than those with dirt floors, while individuals using well or piped water from a spring exhibited lower A. lumbricoides infection intensities compared to those using river or stream water. Unexpectedly, latrine type was not significantly related to STH infection status or intensity. These results suggest that sources of exposure differ between the two helminth species. CONCLUSIONS: This study documents associations between household measures and STH infection among an Indigenous population undergoing rapid MI. These findings can help healthcare programs better target interventions and reduce STH exposure among at-risk populations.


Assuntos
Fezes/parasitologia , Helmintíase , Pobreza/estatística & dados numéricos , Solo/parasitologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Ascaríase/epidemiologia , Ascaríase/transmissão , Ascaris lumbricoides/isolamento & purificação , Criança , Pré-Escolar , Estudos Transversais , Equador/epidemiologia , Características da Família , Feminino , Helmintíase/epidemiologia , Helmintíase/transmissão , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Grupos Populacionais/estatística & dados numéricos , Prevalência , Fatores de Risco , Saneamento/estatística & dados numéricos , Inquéritos e Questionários , Toaletes/estatística & dados numéricos , Tricuríase/epidemiologia , Tricuríase/transmissão , Trichuris/isolamento & purificação , Adulto Jovem
7.
Am J Hum Genet ; 107(2): 175-182, 2020 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-32763188

RESUMO

Expanded carrier screening (ECS) for recessive monogenic diseases requires prior knowledge of genomic variation, including DNA variants that cause disease. The composition of pathogenic variants differs greatly among human populations, but historically, research about monogenic diseases has focused mainly on people with European ancestry. By comparison, less is known about pathogenic DNA variants in people from other parts of the world. Consequently, inclusion of currently underrepresented Indigenous and other minority population groups in genomic research is essential to enable equitable outcomes in ECS and other areas of genomic medicine. Here, we discuss this issue in relation to the implementation of ECS in Australia, which is currently being evaluated as part of the national Government's Genomics Health Futures Mission. We argue that significant effort is required to build an evidence base and genomic reference data so that ECS can bring significant clinical benefit for many Aboriginal and/or Torres Strait Islander Australians. These efforts are essential steps to achieving the Australian Government's objectives and its commitment "to leveraging the benefits of genomics in the health system for all Australians." They require culturally safe, community-led research and community involvement embedded within national health and medical genomics programs to ensure that new knowledge is integrated into medicine and health services in ways that address the specific and articulated cultural and health needs of Indigenous people. Until this occurs, people who do not have European ancestry are at risk of being, in relative terms, further disadvantaged.


Assuntos
Metagenômica/métodos , Grupos Populacionais/genética , Austrália , Variação Genética/genética , Humanos
9.
Artigo em Espanhol | PAHO-IRIS | ID: phr-52561

RESUMO

[RESUMEN]. Objetivo. Determinar los factores asociados con el tratamiento no exitoso en pacientes diagnosticados con tuberculosis (TB) sensible en Paraguay. Métodos. Estudio de cohorte retrospectivo, con datos recolectados del programa nacional entre enero de 2016 y marzo de 2017. Se definió tratamiento no exitoso como pacientes que se perdieron en el seguimiento, fracasaron en el tratamiento o fallecieron. Los factores asociados con tratamiento no exitoso se determinaron con regresión de Poisson; se estimó el riesgo relativo (RR) y el intervalo de confianza de 95% (IC95%) ajustados por región sanitaria. Resultados. Se estudiaron 3 034 casos: 2 189 (72,1%) tuvieron tratamiento exitoso (curados: 1 221 [40,2%], tratamiento completo: 968 [31,9%]) y 845 (27,9%) presentaron tratamiento no exitoso (fracaso: 40 [1,3%], pérdida de seguimiento: 466 [15,4%] y fallecidos: 339 [11,2%]). Los factores asociados a tratamiento no exitoso fueron hombres 1,28 (1,14- 1,42), indígenas 1,30 (1,09- 1,54), sin reporte de área de residencia 1,27 (1,02- 1,57), coinfección TB/VIH 1,97 (1,63- 2,38), adicción a drogas ilícitas 1,38 (1,16- 1,63), consumo de alcohol 1,25 (1,02- 1,52), ser previamente tratado 1,23 (1,10- 1,38) y sin datos de supervisión del tratamiento 4,92 (3,69- 6,56). Como factores protectores se consideran ser persona privada de libertad 0,65 (0,47- 0,89), así como la comorbilidad TB/diabetes 0,80 (0,67- 0,95). Conclusión. Paraguay presenta un alto porcentaje de tratamiento no exitoso en casi todo el país, sin alcanzar la meta propuesta por la Organización Mundial de la Salud. Los factores de riesgo asociados como infección por el virus de la inmunodeficiencia humana (VIH), consumo de drogas licitas e ilícitas y el ser indígena revela que es necesario revisar las estrategias dirigidas con abordaje interinstitucional.


[ABSTRACT]. Objective. To determine the factors associated with the unsuccessful treatment of patients diagnosed with drug-sensitive tuberculosis (TB) in Paraguay. Methods. Retrospective cohort study, with data collected from the national program between January 2016 and March 2017. Unsuccessful treatment was defined as patients who were lost to follow-up, failed treatment, or died. Factors associated with unsuccessful treatment were determined using Poisson regression; the adjusted relative risk (RR) and 95% confidence interval (95% CI) were estimated by health region. Results. A total of 3 034 cases were studied: 2 189 (72.1%) were successfully treated (cured: 1 221 [40.2%], complete treatment: 968 [31.9%]) and 845 (27.9%) were unsuccessfully treated (treatment failure: 40 [1.3%], loss to follow-up: 466 [15.4%] and deaths: 339 [11.2%]). Factors associated with unsuccessful treatment were masculine sex 1.28 (1.14- 1.42), indigenous descent 1.3 (1.09- 1.54), lack of report of area of residence 1.27 (1.02- 1.57), TB/HIV coinfection 1.97 (1, 63- 2.38), illicit drug addiction 1.38 (1.16- 1.63), alcohol consumption 1.25 (1.02- 1.52), previous treatment 1.23 (1.10- 1.38) and lack of treatment monitoring data 4.92 (3.69- 6.56). Being deprived of liberty 0.65 (0.47- 0.89) and TB/diabetes comorbidity 0.80 (0.67- 0.95) were considered protective factors. Conclusion. Paraguay has a high percentage of unsuccessful treatment in almost the entire country, without reaching the target proposed by the World Health Organization. Associated risk factors such as HIV, consumption of legal and illicit drugs, and being indigenous highlight the need to revise the treatment strategies with an inter-institutional approach.


Assuntos
Fatores de Risco , Tuberculose , HIV , Grupos Populacionais , Paraguai , Fatores de Risco , HIV , Grupos Populacionais , Pesquisa Operacional
10.
Washington; Organización Panamericana de la Salud; jul. 15, 2020. 15 p.
Não convencional em Espanhol | LILACS | ID: biblio-1103391

RESUMO

Ante el incremento de casos y defunciones por COVID-19 en comunidades indígenas en las Américas, la Organización Panamericana de la Salud / Organización Mundial de la Salud (OPS/OMS) insta a los Estados Miembros a redoblar esfuerzos para prevenir el avance de la infección en dichas comunidades, así como también para asegurar el acceso a los servicios de atención de salud y fortalecer el manejo adecuado de casos con enfoque intercultural. Al mismo tiempo, la OPS/OMS urge a implementar medidas preventivas para reducir la mortalidad asociada a la COVID-19 en todos los niveles del sistema de salud.


Assuntos
Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Assistência Integral à Saúde/organização & administração , Grupos Populacionais , Pandemias/estatística & dados numéricos , Betacoronavirus , Serviços de Saúde do Indígena/organização & administração , América/epidemiologia
12.
PLoS One ; 15(7): e0232741, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649699

RESUMO

INTRODUCTION: Inflammation plays a major role in the development of atherosclerosis and cardiovascular morbidity and mortality in chronic kidney disease (CKD) patients. Toll-like receptor-4 (TLR4) is a major receptor for lipopolysaccharides (endotoxin) and other ligands involved in the pathogenesis of inflammation. We determined whether endotoxin levels and the presence of TLR4 polymorphisms are associated with markers of inflammation and atherosclerosis among South African CKD patients. MATERIALS AND METHODS: Endotoxin, lipopolysaccharide binding protein (LBP), serum CD14 (sCD14), interleukin-8 (IL-8), monocyte chemoattractant protein-1 (MCP-1) and carotid intima media thickness (CIMT) were measured in 160 participants (120 CKD patients and 40 controls). Associations between endotoxins and CIMT in the presence of sCD14, IL-8 and MCP-1, were assessed using odds ratios. Participants were screened for the presence of Asp299Gly and Thr399Ile TLR4 polymorphisms, and CIMT and inflammatory markers were compared between subjects with and without TLR4 polymorphisms. RESULTS: Endotoxin levels correlated with sCD14 (r = 0.441, p<0.001) and MCP-1 (r = 0.388, p<0.001) levels while increased CIMT was associated with MCP-1 (r = 0.448, p<0.001), sCD14 levels (r = 0.476, p<0.001), LBP (r = 0.340, p<0.001), and IL-8 (r = 0.395, p<0.001). Atherosclerosis was associated with endotoxin levels (odds ratio: 4.95; 95% confidence interval: 2.52-9.73; p<0.001), and was predicted by higher serum levels of inflammatory markers. Analysis of patients with TLR4 polymorphisms showed reduced serum levels of inflammatory markers and CIMT values compared with the patients carrying the wild type TLR4 alleles. CONCLUSION: The study demonstrated associations between circulating endotoxaemia, systemic inflammation and accelerated atherosclerosis among South African CKD patients, and showed that the atherogenic predictive power of endotoxaemia was significantly increased by the presence of elevated levels of inflammatory markers. Additional findings, which must be confirmed, suggest that TLR4 polymorphisms are associated with low levels of inflammatory markers and CIMT values.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Aterosclerose/complicações , Grupos Populacionais/estatística & dados numéricos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Adulto , Espessura Intima-Media Carotídea , Estudos de Coortes , Suscetibilidade a Doenças , Feminino , Genótipo , Humanos , Inflamação/complicações , Masculino , Polimorfismo Genético , Insuficiência Renal Crônica/genética , Insuficiência Renal Crônica/metabolismo , Risco , Receptor 4 Toll-Like/genética
13.
BMC Evol Biol ; 20(1): 83, 2020 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-32660486

RESUMO

BACKGROUND: We have described the diversity of complete mtDNA sequences from 'relic' groups of the Russian Far East, primarily the Nivkhi (who speak a language isolate with no clear relatedness to any others) and Oroki of Sakhalin, as well as the sedentary Koryak from Kamchatka and the Udegey of Primorye. Previous studies have shown that most of their traditional territory was dramatically reshaped by the expansion of Tungusic-speaking groups. RESULTS: Overall, 285 complete mitochondrial sequences were selected for phylogenetic analyses of published, revised and new mitogenomes. To highlight the likely role of Neolithic expansions in shaping the phylogeographical landscape of the Russian Far East, we focus on the major East Eurasian maternal lineages (Y1a, G1b, D4m2, D4e5, M7a2, and N9b) that are restricted to the coastal area. To obtain more insight into autochthonous populations, we removed from the phylogeographic analysis the G2a, G3a2, M8a1, M9a1, and C4b1 lineages, also found within our samples, likely resulting from admixture between the expanding proto-Tungus and the indigenous Paleoasiatic groups with whom they assimilated. Phylogenetic analysis reveals that unlike the relatively diverse lineage spectrum observed in the Amur estuary and northwestern Sakhalin, the present-day subpopulation on the northeastern coast of the island is relatively homogenous: a sole Y1a sublineage, conspicuous for its nodal mutation at m.16189 T > C!, includes different haplotypes. Sharing of the Y1a-m.16189 T > C! sublineages and haplotypes among the Nivkhi, Ulchi and sedentary Koryak is also evident. Aside from Y1a, the entire tree approach expands our understanding of the evolutionary history of haplogroups G1, D4m, N9b, and M7a2. Specifically, we identified the novel haplogroup N9b1 in Primorye, which implies a link between a component of the Udegey ancestry and the Hokkaido Jomon. CONCLUSIONS: Through a comprehensive dataset of mitochondrial genomes retained in autochthonous populations along the coast between Primorye and the Bering Strait, we considerably extended the sequence diversity of these populations to provide new features based on the number and timing of founding lineages. We emphasize the value of integrating genealogical information with genetic data for reconstructing the population history of indigenous groups dramatically impacted by twentieth century resettlement and social upheavals.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Extinção Biológica , Genoma Mitocondrial , Grupos Populacionais/genética , Envelhecimento/genética , DNA Mitocondrial/genética , Genética Populacional , Geografia , Haplótipos/genética , Humanos , Ilhas , Filogenia , Filogeografia , Federação Russa
16.
Proc Natl Acad Sci U S A ; 117(25): 13873-13875, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32503916
17.
Am J Trop Med Hyg ; 103(2): 609-612, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32524964

RESUMO

The newly discovered SARS-CoV-2 is the cause of COVID-19, including severe respiratory symptoms with an important lethality rate and high dissemination capacity. Considering the indigenous people of Brazil, it is feared that COVID-19 will spread to these communities, causing another stage of decimation. Despite advances in indigenous health care in the country, there are still many challenges due to the social vulnerability of this population, whose lands continue to be illegally exploited. Based on these considerations, this article discusses challenges in caring for the indigenous population in the context of the COVID-19 pandemic in Brazil.


Assuntos
Infecções por Coronavirus/etnologia , Pneumonia Viral/etnologia , Grupos Populacionais , Betacoronavirus , Brasil/epidemiologia , Serviços de Saúde do Indígena , Humanos , Pandemias , Populações Vulneráveis
18.
PLoS Comput Biol ; 16(6): e1007182, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32502148

RESUMO

Group A Streptococcus (GAS) skin infections are caused by a diverse array of strain types and are highly prevalent in disadvantaged populations. The role of strain-specific immunity in preventing GAS infections is poorly understood, representing a critical knowledge gap in vaccine development. A recent GAS murine challenge study showed evidence that sterilising strain-specific and enduring immunity required two skin infections by the same GAS strain within three weeks. This mechanism of developing enduring immunity may be a significant impediment to the accumulation of immunity in populations. We used an agent-based mathematical model of GAS transmission to investigate the epidemiological consequences of enduring strain-specific immunity developing only after two infections with the same strain within a specified interval. Accounting for uncertainty when correlating murine timeframes to humans, we varied this maximum inter-infection interval from 3 to 420 weeks to assess its impact on prevalence and strain diversity, and considered additional scenarios where no maximum inter-infection interval was specified. Model outputs were compared with longitudinal GAS surveillance observations from northern Australia, a region with endemic infection. We also assessed the likely impact of a targeted strain-specific multivalent vaccine in this context. Our model produced patterns of transmission consistent with observations when the maximum inter-infection interval for developing enduring immunity was 19 weeks. Our vaccine analysis suggests that the leading multivalent GAS vaccine may have limited impact on the prevalence of GAS in populations in northern Australia if strain-specific immunity requires repeated episodes of infection. Our results suggest that observed GAS epidemiology from disease endemic settings is consistent with enduring strain-specific immunity being dependent on repeated infections with the same strain, and provide additional motivation for relevant human studies to confirm the human immune response to GAS skin infection.


Assuntos
Dermatopatias/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes , Animais , Austrália/epidemiologia , Austrália/etnologia , Número Básico de Reprodução , Modelos Animais de Doenças , Humanos , Camundongos , Modelos Teóricos , Dinâmica Populacional , Grupos Populacionais , Dermatopatias/imunologia , Dermatopatias/microbiologia , Dermatopatias/prevenção & controle , Infecções Estreptocócicas/imunologia , Infecções Estreptocócicas/prevenção & controle , Vacinas Estreptocócicas
20.
Artigo em Russo | MEDLINE | ID: mdl-32526127

RESUMO

The article presents the analysis of organization of chemical-toxicological service and in the Khanty-Mansi Autonomous Okrug-Yugra. The introduction of three-level system for provision of addiction medical care of population and implementation of the principle of zoning made it possible to organize three-level system of chemical-toxicological service that permitted to achieve equal access to chemical-toxicological and addiction care services in all territories of the region. The investments in chemical-toxicological laboratories, supply of modern equipment, advanced training of laboratory specialists, cooperation with leading research centers and professional communities outside of the region allowed timely and accurately identify psychoactive substances, prompt response in cases of mass poisoning with novel psychoactive substances, and quick introduction of advanced methods of chemical-toxicological examination to the medical organizations of the large industrial northern region of Russia.


Assuntos
Intoxicação Alcoólica , Humanos , Grupos Populacionais , Federação Russa
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