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1.
J Theor Biol ; 556: 111299, 2023 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-36252843

RESUMO

One of the key features of any infectious disease is whether infection generates long-lasting immunity or whether repeated reinfection is common. In the former, the long-term dynamics are driven by the birth of susceptible individuals while in the latter the dynamics are governed by the speed of waning immunity. Between these two extremes a range of scenarios is possible. During the early waves of SARS-CoV-2, the underlying paradigm was for long-lasting immunity, but more recent data and in particular the 2022 Omicron waves have shown that reinfection can be relatively common. Here we investigate reported SARS-CoV-2 cases in England, partitioning the data into four main waves, and consider the temporal distribution of first and second reports of infection. We show that a simple low-dimensional statistical model of random (but scaled) reinfection captures much of the observed dynamics, with the value of this scaling, k, providing information of underlying epidemiological patterns. We conclude that there is considerable heterogeneity in risk of reporting reinfection by wave, age-group and location. The high levels of reinfection in the Omicron wave (we estimate that 18% of all Omicron cases had been previously infected, although not necessarily previously reported infection) point to reinfection events dominating future COVID-19 dynamics. This manuscript was submitted as part of a theme issue on "Modelling COVID-19 and Preparedness for Future Pandemics".


Assuntos
COVID-19 , Reinfecção , Humanos , Reinfecção/epidemiologia , SARS-CoV-2 , COVID-19/epidemiologia , Pandemias , Inglaterra/epidemiologia
2.
PLoS One ; 17(11): e0274389, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36409689

RESUMO

BACKGROUND: The UK National Screening Committee currently recommends against antenatal screening for Hepatitis C virus (HCV) infection in England due to lack of HCV prevalence data and treatment licensed for use in pregnancy. We aimed to produce regional and national estimates of the number and proportion of livebirths to HCV seropositive women in England in 2013 and 2018. METHODS: A logistic regression model fitted in the Bayesian framework estimated probabilities of HCV seropositivity among 24,599 mothers delivering in the North Thames area of England in 2012 adjusted by maternal age and region of birth. These probabilities were applied to the underlying population structures of women delivering livebirths in England in 2013 and 2018 to estimate the number of livebirths to HCV seropositive women in these years nationally and by region. The Bayesian approach allowed the uncertainty associated with all estimates to be properly quantified. RESULTS: Nationally, the estimated number of livebirths to women seropositive for HCV for England was 464 (95% credible interval [CI] 300-692) in 2013 and 481 (95%CI 310-716) in 2018, or 70.0 (95%CI 45.0-104.1) per 100,000 and 76.9 (95%CI 49.5-114.4) per 100,000 in these years respectively. Regions with the highest estimated number of livebirths to HCV seropositive women in 2013 and 2018 included London with 118.5 and 124.4 and the South East with 67.0 and 74.0 per 100,000 livebirths. CONCLUSION: Few previous studies have investigated HCV among pregnant women in England. These findings complement and supplement existing research by providing national and regional estimates for the number of livebirths to HCV seropositive women in England. Bayesian modelling allows future national and regional estimates to be produced and the associated uncertainty to be properly quantified.


Assuntos
Hepacivirus , Hepatite C , Gravidez , Feminino , Humanos , Teorema de Bayes , Hepatite C/epidemiologia , Inglaterra/epidemiologia , Gravidez Múltipla
3.
BMJ Open ; 12(11): e066868, 2022 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-36414311

RESUMO

OBJECTIVES: The North East of England, ranked as having the highest poverty levels and the lowest health outcomes, has the highest cardiovascular disease (CVD) premature mortality. This study aimed to compare CVD-related conditions and risk factors for deprived practice populations with other general practice (GP) populations in Northern England to England overall, before and during COVID-19 to identify changes in recorded CVD-related risk factors and conditions and evidence-based lipid prescribing behaviour. DESIGN: A population-based observational study of aggregated practice-level data obtained from publicly accessible data sets. SETTING: 34 practices that fall into the 15% most deprived practice populations in England were identified as the most deprived communities in the North East and North Cumbria (Deep End). PARTICIPANTS: Patients aged ≥16 registered with GP and diagnosed with any form of CVD. PRIMARY AND SECONDARY OUTCOME MEASURES: CVD-related conditions and risk factors, statin prescribing. RESULTS: Deep End (n=263 830) had a smaller, younger and more deprived population with lower levels of employment and full-time education and higher smoking prevalence. They had some higher recorded CVD-related conditions than England but lower than the non-Deep End. Atrial fibrillation (-0.9, -0.5), hypertension (-3.7, -1.3) and stroke and transient ischaemic attack rates (-0.5, -0.1) appeared to be lower in the Deep End than in the non-Deep End but the optimal statin prescribing rate was higher (3.1, 8.2) than in England. CONCLUSION: Recorded CVD-related risk factors and conditions remained comparable before and during COVID-19. These are higher in the Deep End than in England and similar or lower than the non-Deep End, with a higher optimal statin prescribing rate. However, it was not possible to control for age and sex. More work is needed to estimate the consequences of the pandemic on disadvantaged communities and to compare whether the findings are replicated in other areas of deprivation.


Assuntos
COVID-19 , Doenças Cardiovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases , Humanos , Doenças Cardiovasculares/epidemiologia , COVID-19/epidemiologia , Fatores de Risco , Inglaterra/epidemiologia , Atenção Primária à Saúde
4.
Br Dent J ; 233(9): 787-793, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36369569

RESUMO

Introduction People who present with more advanced stage head and neck cancer (HNC) are associated with poorer outcomes and survival. The burden and trends of advanced stage HNC are not fully known at the population level. The UK national cancer registries routinely collect data on HNC diagnoses.Aims To describe trends in stage of diagnosis of HNCs across the UK before the COVID-19 pandemic.Methods Aggregated HNC incidence data were requested from the national cancer registries of the four UK countries for the ten most recent years of available data by subsite and American Joint Commission on Cancer stage at diagnosis classification. Additionally, data for Scotland were available by age group, sex and area-based socioeconomic deprivation category.Results Across the UK, rates of advanced stage HNC had increased, with 59% of patients having advanced disease at diagnosis from 2016-2018. England had a lower proportion of advanced disease (58%) than Scotland, Wales or Northern Ireland (65-69%) where stage data were available. The completeness of stage data had improved over recent years (87% by 2018).Conclusion Prior to the COVID-19 pandemic, diagnoses of HNC at an advanced stage comprised the majority of HNCs in the UK, representing the major challenge for the cancer healthcare system.


Assuntos
COVID-19 , Neoplasias de Cabeça e Pescoço , Humanos , Estados Unidos , COVID-19/epidemiologia , Pandemias , Neoplasias de Cabeça e Pescoço/epidemiologia , Sistema de Registros , Incidência , Inglaterra/epidemiologia
5.
BMJ Open ; 12(11): e059039, 2022 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-36418123

RESUMO

OBJECTIVES: In 2014/2015, 46% of community pharmacies were commissioned by local authorities to provide emergency hormonal contraception (EHC) free without prescription in England. Commissioning EHC services influences EHC prescribing from General Practice (GP)-greater community pharmacy provision reduces GP prescribing. This study aimed to examine predictors of GP and pharmacy EHC activity, describing them using path analysis. From this, commissioners and policy-makers may understand ways to influence this. STUDY DESIGN: Cross-sectional study of routinely recorded data, obtained through freedom of information requests to local authorities. SETTING: Community pharmacies and general practices in England, UK. PARTICIPANTS: All local authorities in England were included in the study (147 areas). The study population were all girls, adolescents and women aged 12-55. Of the 147 areas, data from 80 local authorities were obtained covering an eligible female population of 9 380 153. PRIMARY AND SECONDARY OUTCOME MEASURES: Correlation between community pharmacy and GP EHC activity. RESULTS: Data from 80 local authorities were analysed, representing 60% of the eligible female population in England. A significant negative correlation was found between rates of community pharmacy provision and GP prescribing (-0.458, p<0.000). Community pharmacy provision and the proportion of pharmacies commissioned were significantly correlated (0.461, p<0.000). A significant correlation was found between increased deprivation and community pharmacy provision (0.287, p=0.010). Standardised total effects on GP prescribing were determined from path analysis including community pharmacy provision (ß=-0.552) and proportion of pharmacies commissioned (ß=-0.299). If all community pharmacies were commissioned to provide EHC, GP EHC prescriptions could decrease by 15%. CONCLUSION: Community pharmacy EHC provision has a significant influence on GP EHC prescribing. Increasing the proportion of commissioned community pharmacies should have a marked impact on GP workload. The methodology affords the possibility of examining relationships surrounding other commissioned service activity across different settings and their impact on linked care settings.


Assuntos
Serviços Comunitários de Farmácia , Medicina Geral , Farmácias , Adolescente , Feminino , Humanos , Contracepção Hormonal , Estudos Transversais , Inglaterra/epidemiologia
7.
J Helminthol ; 96: e81, 2022 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-36321434

RESUMO

A parasitological survey of terrestrial slugs and snails was conducted at popular dog walking locations across the city of Nottingham, with the intensions of finding gastropods infected with parasites of medical (or veterinary) importance such as lungworm (metastrongyloid nematodes) and trematodes. A total of 800 gastropods were collected from 16 sites over a 225 km2 area. The extracted nematodes and trematodes were identified by molecular barcoding. Of the 800 gastropods collected, 227 were infected (172 had nematode infections, 37 had trematode infections and 18 had both nematode and trematode infections). Of the nematode infected gastropods genotyped, seven species were identified, Agfa flexilis, Angiostoma gandavense, Angiostoma margaretae, Cosmocerca longicauda, Phasmarhabditis hermaphrodita, Phasmarhabditis neopapillosa and an unknown Cosmocercidae species. Of the trematode infected gastropods genotyped, four species were identified, Brachylaima arcuate, Brachylaima fuscata, Brachylaima mesostoma and an unknown Plagiorchioidea species. No lungworm species were found within the city of Nottingham. To our knowledge, this study represents the first survey of gastropod-associated nematodes and trematodes in the East midlands of the United Kingdom.


Assuntos
Gastrópodes , Nematoides , Trematódeos , Animais , Cães , Nematoides/classificação , Nematoides/genética , Nematoides/isolamento & purificação , Rhabditoidea/genética , Rhabditoidea/isolamento & purificação , Caramujos/parasitologia , Trematódeos/classificação , Trematódeos/genética , Trematódeos/isolamento & purificação , Infecções por Trematódeos/epidemiologia , Infecções por Trematódeos/parasitologia , Infecções por Trematódeos/veterinária , Inglaterra/epidemiologia , Código de Barras de DNA Taxonômico , Infecções por Nematoides/epidemiologia , Infecções por Nematoides/parasitologia , Infecções por Nematoides/veterinária , Genótipo , Cidades/estatística & dados numéricos , Caminhada , Doenças do Cão/parasitologia , Gastrópodes/parasitologia
9.
PLoS Med ; 19(11): e1004118, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36346784

RESUMO

BACKGROUND: Coronavirus Disease 2019 (COVID-19) deaths are rare in children and young people (CYP). The high rates of asymptomatic and mild infections complicate assessment of cause of death in CYP. We assessed the cause of death in all CYP with a positive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) test since the start of the pandemic in England. METHODS AND FINDINGS: CYP aged <20 years who died within 100 days of laboratory-confirmed SARS-CoV-2 infection between 01 March 2020 and 31 December 2021 in England were followed up in detail, using national databases, surveillance questionnaires, post-mortem reports, and clinician interviews. There were 185 deaths during the 22-month follow-up and 81 (43.8%) were due to COVID-19. Compared to non-COVID-19 deaths in CYP with a positive SARS-CoV-2 test, death due to COVID-19 was independently associated with older age (aOR 1.06 95% confidence interval (CI) 1.01 to 1.11, p = 0.02) and underlying comorbidities (aOR 2.52 95% CI 1.27 to 5.01, p = 0.008), after adjusting for age, sex, ethnicity group, and underlying conditions, with a shorter interval between SARS-CoV-2 testing and death. Half the COVID-19 deaths (41/81, 50.6%) occurred within 7 days of confirmation of SARS-CoV-2 infection and 91% (74/81) within 30 days. Of the COVID-19 deaths, 61 (75.3%) had an underlying condition, especially severe neurodisability (n = 27) and immunocompromising conditions (n = 12). Over the 22-month surveillance period, SARS-CoV-2 was responsible for 1.2% (81/6,790) of all deaths in CYP aged <20 years, with an infection fatality rate of 0.70/100,000 SARS-CoV-2 infections in this age group estimated through real-time, nowcasting modelling, and a mortality rate of 0.61/100,000. Limitations include possible under-ascertainment of deaths in CYP who were not tested for SARS-CoV-2 and lack of direct access to clinical data for hospitalised CYP. CONCLUSIONS: COVID-19 deaths remain extremely rare in CYP, with most fatalities occurring within 30 days of infection and in children with specific underlying conditions.


Assuntos
COVID-19 , Criança , Humanos , Adolescente , Pré-Escolar , SARS-CoV-2 , Teste para COVID-19 , Estudos Prospectivos , Inglaterra/epidemiologia
10.
BMJ Open ; 12(11): e067409, 2022 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-36332948

RESUMO

OBJECTIVES: Postoperative mortality is a widely used quality indicator, but it may be unreliable when procedure numbers and/or mortality rates are low, due to insufficient statistical power. The objective was to investigate the statistical validity of postoperative 30-day mortality as a quality metric for neurosurgical practice across healthcare providers. DESIGN: Retrospective cohort study. SETTING: Hospital Episode Statistics data from all neurosurgical units in England. PARTICIPANTS: Patients who underwent neurosurgical procedures between April 2013 and March 2018. Procedures were grouped using the National Neurosurgical Audit Programme classification. OUTCOMES MEASURED: National 30-day postoperative mortality rates were calculated for elective and non-elective neurosurgical procedural groups. The study estimated the proportion of neurosurgeons and NHS trusts in England that performed sufficient procedures in 3-year and 5-year periods to detect unusual performance (defined as double the national rate of mortality). The actual difference in mortality rates that could be reliably detected based on procedure volumes of neurosurgeons and units over a 5-year period was modelled. RESULTS: The 30-day mortality rates for all elective and non-elective procedures were 0.4% and 6.1%, respectively. Only one neurosurgeon in England achieved the minimum sample size (n=2402) of elective cases in 5 years needed to detect if their mortality rate was double the national average. All neurosurgical units achieved the minimum sample sizes for both elective (n=2402) and non-elective (n=149) procedures. In several neurosurgical subspecialties, approximately 80% of units (or more) achieved the minimum sample sizes needed to detect if their mortality rate was double the national rate, including elective neuro-oncology (baseline mortality rate=2.3%), non-elective neuro-oncology (rate=5.7%), neurovascular (rate=6.7%) and trauma (rate=11%). CONCLUSION: Postoperative mortality lacks statistical power as a measure of individual neurosurgeon performance. Neurosurgical units in England performed sufficient procedure numbers overall and in several subspecialty areas to support the use of mortality as a quality indicator.


Assuntos
Procedimentos Cirúrgicos Eletivos , Procedimentos Neurocirúrgicos , Humanos , Estudos Retrospectivos , Inglaterra/epidemiologia , Período Pós-Operatório
11.
Lancet ; 400 Suppl 1: S74, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36426494

RESUMO

BACKGROUND: Maternal socioeconomic disadvantage and ethnic minority status are linked to increased risk of adverse neonatal outcomes. Neighbourhoods are structural and contextual conditions in which babies are born, but associations between area deprivation and neonatal outcomes in ethnically diverse areas are seldom examined. We examined spatial variations in neonatal outcomes using area deprivation at small-area levels in an ethnically diverse maternal cohort in the east of England. METHODS: This was a retrospective cross-sectional study using routinely collected anonymous data of singleton births between April 1, 2015, and Feb 28, 2022, in a UK National Health Service maternity unit. Primary outcomes were low birthweight (ie, under 2500g) and preterm birth (ie, before 37 weeks of gestation). We did geospatial analyses of maternal residence postcode areas to understand associations between primary outcomes and area deprivation based on 2019 Indices of Multiple Deprivation using generalised linear regression, optimised hotspot, and spatial autocorrelation (Global Moran's I) in ArcGIS Pro 3.0.2. FINDINGS: Of 36 359 singleton births, 12 491 (34·4%) were to mothers from Black Caribbean, Black African, Indian, Pakistani, or Bangladeshi backgrounds. The prevalence of low birthweight (3319 [9·1%] of 36 359) and preterm birth (3147 [8·7%] of 36 359) was higher than the national average (6·8% and 7·4%, respectively). Low birthweight varied across Indices of Multiple Deprivation deciles, from 4 (3·9%) of 103 in the least deprived areas to 48 (10·5%) of 456 in the most deprived areas, with significant clustering in the most deprived areas (Moran's I 0·061; p<0·0001). Mean birthweight differed by 228g between the least (3402g) and most (3174g) deprived areas. An inverse linear association between birthweight and area deprivation was evident (R2 0·18). Preterm birth varied from 7 (6·8%) of 103 in the least deprived areas to 45 (9·9%) of 456 in the most deprived areas, but showed no significant association with area deprivation (R2 0·06). INTERPRETATION: Neonates born to mothers in the most deprived areas of ethnically diverse neighbourhoods are more likely to have adverse outcomes, particularly low birthweight, highlighting the need for targeted primary and secondary interventions. Spatial analysis of routine data can be used to examine health inequalities at the small-area level to inform spatially targeted resources. FUNDING: Wellbeing of Women, in partnership with the Burdett Trust for Nursing (grant reference RG2245).


Assuntos
Nascimento Prematuro , Lactente , Recém-Nascido , Feminino , Humanos , Gravidez , Estudos Transversais , Estudos Retrospectivos , Nascimento Prematuro/epidemiologia , Peso ao Nascer , Etnicidade , Medicina Estatal , Fatores Socioeconômicos , Grupos Minoritários , Inglaterra/epidemiologia , Análise Espacial
12.
BMC Prim Care ; 23(1): 281, 2022 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-36371194

RESUMO

BACKGROUND: Cancer and dementia are common in older people and management of the conditions as comorbidities can be challenging, yet little is known about the size or characteristics of this group. We aimed to estimate the prevalence, characteristics and general practice resource usage of people living with both conditions in England. METHODS: Anonymised electronic healthcare records from 391 National Health Service general practices across England using the TPP SystmOne general practice system were obtained from ResearchOne. Data included demographic and clinical characteristics, and general practice healthcare useage (appointments, prescriptions, referrals and secondary care contacts) for people aged 50 and over with a cancer and/or dementia diagnosis consistent with the Quality and Outcomes Framework between 2005 and 2016. Multi-level negative binomial regression was used to analyse the association between having cancer and/or dementia and the number of general practice appointments. RESULTS: Data from 162,371 people with cancer and/or dementia were analysed; 3616 (2.2%) people were identified as having comorbid cancer and dementia. Of people with cancer, 3.1% also had dementia, rising to 7.5% (1 in 13 people) in those aged 75 and over. Fewer people with both conditions were female (50.7%) compared to those with dementia alone (65.6%) and those with comorbid cancer and dementia were older than those with cancer alone [mean ages 83 (sd = 7), 69 (sd = 12) respectively]. Those with both conditions were less likely to have lung cancer than those with cancer alone (7.5% vs. 10.3%) but more likely to have prostate cancer (20.9% vs. 15.8%). Additional comorbidities were more prevalent for those with both conditions than those with cancer or dementia alone (68.4% vs. 50.2% vs. 54.0%). In the year following the first record of either condition, people with cancer and dementia had 9% more general practice appointments (IRR:1.09, 95% CI:1.01-1.17) than those with cancer alone and 37% more appointments than those with dementia alone (IRR: 1.37, 95% CI: 1.28-1.47). CONCLUSIONS: A significant number of people are living with comorbid cancer and dementia in England. This group have additional comorbidity and higher general practice usage than those with cancer/dementia alone. The needs of this group should be considered in future general practice care planning and research.


Assuntos
Demência , Medicina Geral , Neoplasias , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Estudos Retrospectivos , Demência/epidemiologia , Medicina Estatal , Comorbidade , Inglaterra/epidemiologia , Neoplasias/epidemiologia
13.
Br J Nurs ; 31(20): 1046-1050, 2022 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-36370407

RESUMO

As the COVID-19 pandemic enveloped the globe there was a parallel increase in the incidence of domestic abuse (DA). This has been ascribed to the restrictions in movement and growing tensions during lockdown periods. The Domestic Abuse Act covering England and Wales was about to be passed prior to the COVID-19 outbreak, but progress halted as attention focused on managing infection control and treatment nationally. The unfolding DA 'shadow pandemic' led to pressure groups lobbying for specific changes to the Act which, in its revised form, became law in April 2021. This article sets out the changes in definition, statutory response and prevention of DA and relates these to nursing practice. Health education and promotion theory is considered and linked to nursing practice with those who are both victims/survivors and perpetrators of DA.


Assuntos
COVID-19 , Violência Doméstica , Humanos , País de Gales/epidemiologia , Pandemias , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Inglaterra/epidemiologia
15.
Nat Commun ; 13(1): 6856, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36369151

RESUMO

Infection with SARS-CoV-2 virus is associated with a wide range of symptoms. The REal-time Assessment of Community Transmission -1 (REACT-1) study monitored the spread and clinical manifestation of SARS-CoV-2 among random samples of the population in England from 1 May 2020 to 31 March 2022. We show changing symptom profiles associated with the different variants over that period, with lower reporting of loss of sense of smell or taste for Omicron compared to previous variants, and higher reporting of cold-like and influenza-like symptoms, controlling for vaccination status. Contrary to the perception that recent variants have become successively milder, Omicron BA.2 was associated with reporting more symptoms, with greater disruption to daily activities, than BA.1. With restrictions lifted and routine testing limited in many countries, monitoring the changing symptom profiles associated with SARS-CoV-2 infection and effects on daily activities will become increasingly important.


Assuntos
COVID-19 , Adulto , Humanos , COVID-19/epidemiologia , SARS-CoV-2 , Inglaterra/epidemiologia
17.
BMC Public Health ; 22(1): 1902, 2022 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-36224577

RESUMO

BACKGROUND: The COVID-19 pandemic markedly disrupted people's lives. It caused higher mortality and morbidity amongst individuals from poorer socio-economic position (SEP). It is well-recognised that job loss has a negative impact on health. We hypothesised that health effects of the pandemic on middle-aged people might be different depending on SEP and changes in employment. METHODS: Data are from the Health and Employment After Fifty (HEAF), a cohort recruited 2013-2014 when aged 50-64 through 24 English general practices. At baseline and annually since, participants completed a questionnaire reporting about demographics, employment, health, lifestyle, and finances. In 2021 we sent an e-survey to all contactable HEAF participants, asking about effects of the first lockdown (March-July 2020). Outcomes were participants' perception of worsening of mental, physical health, and self-rated health (SRH) since lockdown. Associations between SEP, COVID-19 related employment changes and health were explored with Poisson regression with robust standard error, with adjustment for age, sex, and pre-pandemic SRH. RESULTS: In total, 2,469 (53%) returned a usable questionnaire, amongst whom 2,344 provided complete information for these analyses (44% men, mean age 65.7 years). Worsening of mental, physical or SRH since lockdown was reported by 21%, 27% and 17% respectively. Mutually adjusted models showed that reporting struggling financially pre-pandemic (versus living comfortably) was associated with an increased risk of deterioration in: mental (RR = 2.0, 95%CI 1.7-2.5), physical health (RR = 2.0, 95%CI 1.6-2.3), and SRH (RR = 1.6, 95%CI 1.2-2.1). Participants working from home during lockdown and those who lost their job (as opposed to those with unchanged employment) were at increased risk of reporting deterioration in mental health and SRH. CONCLUSION: In a cohort of older workers, working from home, job loss and poorer pre-pandemic SEP were all associated with worsening of mental health and SRH since lockdown.


Assuntos
COVID-19 , Pandemias , Idoso , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Status Econômico , Emprego , Inglaterra/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
19.
PLoS One ; 17(10): e0264870, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36240178

RESUMO

Understanding the scale of the threat posed by SARS-CoV2 B.1.1.529, or Omicron, variant formed a key problem in public health in the early part of 2022. Early evidence indicated that the variant was more transmissible and less severe than previous variants. As the virus was expected to spread quickly through the population of England, it was important that some understanding of the immunological landscape of the country was developed. This paper attempts to estimate the number of people with good immunity to the Omicron variant, defined as either recent infection with two doses of vaccine, or two doses of vaccine with a recent booster dose. To achieve this, we use a process of iterative proportional fitting to estimate the cell values of a contingency table, using national immunisation records and real-time model infection estimates as marginal values. Our results indicate that, despite the increased risk of immune evasion with the Omicron variant, a high proportion of England's population had good immunity to the virus, particularly in older age groups. However, low rates of immunity in younger populations may allow endemic infection to persist for some time.


Assuntos
COVID-19 , Vacinas , Idoso , COVID-19/epidemiologia , Inglaterra/epidemiologia , Humanos , RNA Viral , SARS-CoV-2
20.
PLoS Comput Biol ; 18(10): e1010554, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36279279

RESUMO

The COVID-19 pandemic has had high mortality rates in the elderly and frail worldwide, particularly in care homes. This is driven by the difficulty of isolating care homes from the wider community, the large population sizes within care facilities (relative to typical households), and the age/frailty of the residents. To quantify the mortality risk posed by disease, the case fatality risk (CFR) is an important tool. This quantifies the proportion of cases that result in death. Throughout the pandemic, CFR amongst care home residents in England has been monitored closely. To estimate CFR, we apply both novel and existing methods to data on deaths in care homes, collected by Public Health England and the Care Quality Commission. We compare these different methods, evaluating their relative strengths and weaknesses. Using these methods, we estimate temporal trends in the instantaneous CFR (at both daily and weekly resolutions) and the overall CFR across the whole of England, and dis-aggregated at regional level. We also investigate how the CFR varies based on age and on the type of care required, dis-aggregating by whether care homes include nursing staff and by age of residents. This work has contributed to the summary of measures used for monitoring the UK epidemic.


Assuntos
COVID-19 , Humanos , Idoso , COVID-19/epidemiologia , Pandemias , Casas de Saúde , Densidade Demográfica , Inglaterra/epidemiologia
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