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1.
JAMA Netw Open ; 4(6): e2110782, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34061203

RESUMO

Importance: Vaccination against SARS-CoV-2 has the potential to significantly reduce transmission and COVID-19 morbidity and mortality. The relative importance of vaccination strategies and nonpharmaceutical interventions (NPIs) is not well understood. Objective: To assess the association of simulated COVID-19 vaccine efficacy and coverage scenarios with and without NPIs with infections, hospitalizations, and deaths. Design, Setting, and Participants: An established agent-based decision analytical model was used to simulate COVID-19 transmission and progression from March 24, 2020, to September 23, 2021. The model simulated COVID-19 spread in North Carolina, a US state of 10.5 million people. A network of 1 017 720 agents was constructed from US Census data to represent the statewide population. Exposures: Scenarios of vaccine efficacy (50% and 90%), vaccine coverage (25%, 50%, and 75% at the end of a 6-month distribution period), and NPIs (reduced mobility, school closings, and use of face masks) maintained and removed during vaccine distribution. Main Outcomes and Measures: Risks of infection from the start of vaccine distribution and risk differences comparing scenarios. Outcome means and SDs were calculated across replications. Results: In the worst-case vaccination scenario (50% efficacy, 25% coverage), a mean (SD) of 2 231 134 (117 867) new infections occurred after vaccination began with NPIs removed, and a mean (SD) of 799 949 (60 279) new infections occurred with NPIs maintained during 11 months. In contrast, in the best-case scenario (90% efficacy, 75% coverage), a mean (SD) of 527 409 (40 637) new infections occurred with NPIs removed and a mean (SD) of 450 575 (32 716) new infections occurred with NPIs maintained. With NPIs removed, lower efficacy (50%) and higher coverage (75%) reduced infection risk by a greater magnitude than higher efficacy (90%) and lower coverage (25%) compared with the worst-case scenario (mean [SD] absolute risk reduction, 13% [1%] and 8% [1%], respectively). Conclusions and Relevance: Simulation outcomes suggest that removing NPIs while vaccines are distributed may result in substantial increases in infections, hospitalizations, and deaths. Furthermore, as NPIs are removed, higher vaccination coverage with less efficacious vaccines can contribute to a larger reduction in risk of SARS-CoV-2 infection compared with more efficacious vaccines at lower coverage. These findings highlight the need for well-resourced and coordinated efforts to achieve high vaccine coverage and continued adherence to NPIs before many prepandemic activities can be resumed.


Assuntos
Vacinas contra COVID-19/farmacologia , COVID-19 , Controle de Doenças Transmissíveis , Vacinação em Massa , Cobertura Vacinal , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/estatística & dados numéricos , Simulação por Computador , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Vacinação em Massa/organização & administração , Vacinação em Massa/estatística & dados numéricos , Mortalidade , North Carolina/epidemiologia , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , SARS-CoV-2 , Resultado do Tratamento , Cobertura Vacinal/organização & administração , Cobertura Vacinal/estatística & dados numéricos
2.
Sci Total Environ ; 784: 147233, 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34088038

RESUMO

The objective of this study was to analyze at the level of Spain's 52 provinces province level the temporal evolution of minimum mortality temperatures (MMT) from 1983 to 2018, in order to determine whether the increase in MMT would be sufficient to compensate for the increase in environmental temperatures in Spain for the period. It also aimed to analyze whether the rate of evolution of MMT would be sufficient, were it to remain constant, to compensate for the predicted increase in temperatures in an unfavorable (RCP 8.5) emissions scenario for the time horizon 2051-2100. The independent variable was made up of maximum daily temperature data (Tmax) for the summer months in the reference observatories of each province for the 1983-2018 period. The dependent variable was daily mortality rate due to natural causes (ICD 10: A00-R99). For each year and province, MMT was determined using a quadratic or cubic fit (p < 0.05). Based on the annual MMT values, a linear fit was carried out that allowed for determining the time evolution of MMT. These values were compared with the evolution of Tmax registered in each observatory during the 1983-2018 analyzed period and with the predicted values of Tmax obtained for an RCP8.5 scenario for the period 2051-2100. The rate of global variance in Tmax in the summer months in Spain during the 1983-2018 period was 0.41 °C/decade, while MMT across the whole country increased at a rate of 0.64 °C/decade. Variations in the provinces were heterogeneous. For the 2051-2100 time horizon, there was predicted increase in Tmax values of 0.66 °C/decade, with marked geographical differences. Although at the global level it is possible to speak of adaptation, the heterogeneities among the provinces suggest that the local level measures are needed in order to facilitate adaptation in those areas where it is not occurring.


Assuntos
Aclimatação , Temperatura Alta , Mortalidade , Estações do Ano , Espanha/epidemiologia , Temperatura
3.
Sci Rep ; 11(1): 11606, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078929

RESUMO

The devastating trail of Covid-19 is characterized by one of the highest mortality-to-infected ratio for a pandemic. Restricted therapeutic and early-stage vaccination still renders social exclusion through lockdown as the key containment mode.To understand the dynamics, we propose PHIRVD, a mechanistic infection propagation model that Machine Learns (Bayesian Markov Chain Monte Carlo) the evolution of six infection stages, namely healthy susceptible (H), predisposed comorbid susceptible (P), infected (I), recovered (R), herd immunized (V) and mortality (D), providing a highly reliable mortality prediction profile for 18 countries at varying stages of lockdown. Training data between 10 February to 29 June 2020, PHIRVD can accurately predict mortality profile up to November 2020, including the second wave kinetics. The model also suggests mortality-to-infection ratio as a more dynamic pandemic descriptor, substituting reproduction number. PHIRVD establishes the importance of early and prolonged but strategic lockdown to contain future relapse, complementing futuristic vaccine impact.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Número Básico de Reprodução , Teorema de Bayes , COVID-19/etiologia , Controle de Doenças Transmissíveis/métodos , Comorbidade , Suscetibilidade a Doenças , Humanos , Imunidade Coletiva , Índia/epidemiologia , Cinética , Aprendizado de Máquina , Cadeias de Markov , Modelos Teóricos , Método de Monte Carlo , Mortalidade , Reino Unido/epidemiologia
4.
Indian J Tuberc ; 68(3): 401-404, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34099209

RESUMO

BACKGROUD: Coronavirus disease (COVID-19) is a new respiratory infectious disease, and there is no vaccine currently. Previous studies have found that BCG vaccination can provide extensive protection against respiratory infectious diseases. METHODS: Herein, we obtained the latest data from the World Health Organization (WHO) as of August 12, 2020, and determined the relationship between three parameters (including the BCG vaccination coverage, human development index (HDI), and transmission classifications) and the incidence rate and mortality of COVID-19. RESULTS: The results showed that the morbidity and mortality of COVID-19 in countries with BCG vaccination recommendation were significantly lower than these in countries without BCG vaccination recommendation, and countries with lower HDI have lower morbidity and mortality. In addition, we also found that the mode of virus transmission is also related to the morbidity and mortality of COVID-19. CONCLUSIONS: Although our data supports the hypothesis that BCG vaccination is beneficial in reducing the morbidity and mortality of COVID-19, the data supporting this result may be inaccurate due to many confounders such as PCR testing rate, population characteristics, and protection strategies, the reliability of this result still needs to be verified by clinical trials.


Assuntos
Vacina BCG , COVID-19 , Saúde Global/estatística & dados numéricos , Programas de Imunização , Adjuvantes Imunológicos/uso terapêutico , Vacina BCG/imunologia , Vacina BCG/uso terapêutico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Países em Desenvolvimento/estatística & dados numéricos , Eficiência Organizacional , Regulamentação Governamental , Humanos , Programas de Imunização/legislação & jurisprudência , Programas de Imunização/métodos , Mortalidade , Determinação de Necessidades de Cuidados de Saúde , SARS-CoV-2
5.
JAMA ; 325(22): 2294-2306, 2021 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-34100866

RESUMO

Importance: General health checks, also known as general medical examinations, periodic health evaluations, checkups, routine visits, or wellness visits, are commonly performed in adult primary care to identify and prevent disease. Although general health checks are often expected and advocated by patients, clinicians, insurers, and health systems, others question their value. Observations: Randomized trials and observational studies with control groups reported in prior systematic reviews and an updated literature review through March 2021 were included. Among 19 randomized trials (906 to 59 616 participants; follow-up, 1 to 30 years), 5 evaluated a single general health check, 7 evaluated annual health checks, 1 evaluated biannual checks, and 6 evaluated health checks delivered at other frequencies. Twelve of 13 observational studies (240 to 471 415 participants; follow-up, cross-sectional to 5 years) evaluated a single general health check. General health checks were generally not associated with decreased mortality, cardiovascular events, or cardiovascular disease incidence. For example, in the South-East London Screening Study (n = 7229), adults aged 40 to 64 years who were invited to 2 health checks over 2 years, compared with adults not invited to screening, experienced no 8-year mortality benefit (6% vs 5%). General health checks were associated with increased detection of chronic diseases, such as depression and hypertension; moderate improvements in controlling risk factors, such as blood pressure and cholesterol; increased clinical preventive service uptake, such as colorectal and cervical cancer screening; and improvements in patient-reported outcomes, such as quality of life and self-rated health. In the Danish Check-In Study (n = 1104), more patients randomized to receive to a single health check, compared with those randomized to receive usual care, received a new antidepressant prescription over 1 year (5% vs 2%; P = .007). In a propensity score-matched analysis (n = 8917), a higher percentage of patients who attended a Medicare Annual Wellness Visit, compared with those who did not, underwent colorectal cancer screening (69% vs 60%; P < .01). General health checks were sometimes associated with modest improvements in health behaviors such as physical activity and diet. In the OXCHECK trial (n = 4121), fewer patients randomized to receive annual health checks, compared with those not randomized to receive health checks, exercised less than once per month (68% vs 71%; difference, 3.3% [95% CI, 0.5%-6.1%]). Potential adverse effects in individual studies included an increased risk of stroke and increased mortality attributed to increased completion of advance directives. Conclusions and Relevance: General health checks were not associated with reduced mortality or cardiovascular events, but were associated with increased chronic disease recognition and treatment, risk factor control, preventive service uptake, and improved patient-reported outcomes. Primary care teams may reasonably offer general health checks, especially for groups at high risk of overdue preventive services, uncontrolled risk factors, low self-rated health, or poor connection or inadequate access to primary care.


Assuntos
Exame Físico , Atenção Primária à Saúde , Prevenção Primária , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Doença Crônica , Neoplasias Colorretais/diagnóstico , Depressão/diagnóstico , Exercício Físico , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Mortalidade , Estudos Observacionais como Assunto/estatística & dados numéricos , Exame Físico/efeitos adversos , Serviços Preventivos de Saúde/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
7.
MMWR Morb Mortal Wkly Rep ; 70(22): 825-829, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34081687

RESUMO

End-stage renal disease (ESRD) is a condition in which kidney function has permanently declined such that renal replacement therapy* is required to sustain life (1). The mortality rate for patients with ESRD in the United States has been declining since 2001 (2). However, during the COVID-19 pandemic, ESRD patients are at high risk for COVID-19-associated morbidity and mortality, which is due, in part, to weakened immune systems and presence of multiple comorbidities (3-5). The ESRD National Coordinating Center (ESRD NCC) supports the Centers for Medicare & Medicaid Services (CMS) and the ESRD Networks†,§ through analysis of data, dissemination of best practices, and creation of educational materials. ESRD NCC analyzed deaths reported to the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb), a system that facilitates the collection of data and maintenance of information about ESRD patients on chronic dialysis or receiving a kidney transplant who are treated in Medicare-certified dialysis facilities and kidney transplant centers in the United States. Excess death estimates were obtained by comparing observed and predicted monthly numbers of deaths during February 1-August 31, 2020; predicted deaths were modeled based on data from January 1, 2016, through December 31, 2019. The analysis estimated 8.7-12.9 excess deaths per 1,000 ESRD patients, or a total of 6,953-10,316 excess deaths in a population of 798,611 ESRD patients during February 1-August 31, 2020. These findings suggest that deaths among ESRD patients during the early phase of the pandemic exceeded those that would have been expected based on previous years' data. Geographic and temporal patterns of excess mortality, including those among persons with ESRD, should be considered during planning and implementation of interventions, such as COVID-19 vaccination, infection control guidance, and patient education. These findings underscore the importance of data-driven technical assistance and further analyses of the causes and patterns of excess deaths in ESRD patients.


Assuntos
Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Mortalidade/tendências , COVID-19/epidemiologia , COVID-19/mortalidade , Humanos , Medição de Risco , Estados Unidos/epidemiologia
8.
PLoS One ; 16(6): e0252238, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34097694

RESUMO

BACKGROUND: To investigate the excess of deaths by specific causes, in the first half of 2020 in the city of São Paulo-Brazil, during the COVID-19 pandemic. METHODS: Ecological study conducted from 01/01 to 06/30 of 2019 and 2020. Population and mortality data were obtained from DATASUS. The standardized mortality ratio (SMR) by age was calculated by comparing the standardized mortality rate in 2020 to that of 2019, for overall and specific mortality. The ratio between the standardized mortality rate due to COVID-19 in men as compared to women was calculated for 2020. Crude mortality rates were standardized using the direct method. RESULTS: COVID-19 was responsible for 94.4% of the excess deaths in São Paulo. In 2020 there was an increase in overall mortality observed among both men (SMR 1.3, 95% CI 1.17-1.42) and women (SMR 1.2, 95% CI 1.06-1.36) as well as a towards reduced mortality for all cancers. Mortality due to COVID-19 was twice as high for men as for women (SMR 2.1, 95% CI 1.67-2.59). There was an excess of deaths observed in men above 45 years of age, and in women from the age group of 60 to 79 years. CONCLUSION: There was an increase in overall mortality during the first six months of 2020 in São Paulo, which seems to be related to the COVID-19 pandemic. Chronic health conditions, such as cancer and other non-communicable diseases, should not be disregarded.


Assuntos
COVID-19/mortalidade , Mortalidade , Pandemias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Causalidade , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
Washington, D.C.; OPS; 2021-06-21. (OPS/NMH/NV/COVID-19/21-0001).
Não convencional em Espanhol | PAHO-IRIS | ID: phr-54406

RESUMO

Son diversos los factores predisponentes que se han asociado a la enfermedad y la muerte causada por la COVID-19. La estimación del tamaño de los grupos poblacionales con un riesgo alto de muerte por COVID-19 en la Región de las Américas permite conocer la distribución de los riesgos asociados a esos factores y brinda oportunidades de aplicar intervenciones específicas. En este análisis se calcula la distribución del riesgo de mortalidad por COVID-19 mediante el empleo de las estimaciones recientemente publicadas del riesgo asociado a distintos grupos etarios, el sexo, el origen étnico, el nivel de escolaridad y el estado de salud, derivadas de un estudio realizado en el Reino Unido. Dichas estimaciones del riesgo se usan para calcular el tamaño de la población que supera determinados umbrales de riesgo definidos. Los resultados proporcionados por este modelo podrían aportar orientación a los responsables de las políticas locales y nacionales a fin de que puedan planificar los recursos necesarios para las estrategias de protección de los grupos más vulnerables, y de que implementen mejor intervenciones como las de distanciamiento social, planificación de la compra y asignación de las vacunas, mantenimiento de los servicios y del acceso a los medicamentos, y tratamiento de la población con enfermedades crónicas.


Assuntos
COVID-19 , Coronavirus , Infecções por Coronavirus , Doenças não Transmissíveis , Mortalidade , Fatores de Risco
10.
Artigo em Espanhol | PAHO-IRIS | ID: phr-54145

RESUMO

[RESUMEN]. Objetivo. Determinar la proporción de muertes potencialmente evitables en niños menores de cinco años de Colombia, según departamento y municipio de residencia, en el período 2000-2018. Métodos. Se llevó a cabo un estudio ecológico en múltiples grupos y longitudinal. Se analizaron 33 departamentos y 1 118 municipios en 19 años. Se clasificaron y diferenciaron las muertes evitables (tratables, prevenibles y mixtas) de las difícilmente evitables y se calculó la proporción respecto al total. Por último, se crearon conglomerados de municipios y departamentos, representados en mapas coropléticos. Resultados. Entre 2000 y 2018 se registraron en Colombia 228 942 defunciones de niños menores de cinco años, 91,4% de las cuales eran evitables (68,2% tratables, 6,8% prevenibles y 16,5% mixtas) sin diferencias según el sexo. La proporción de evitabilidad pasó del 93,5% al 88,5%. Cesar fue el departamento con mayor proporción de muertes evitables (94,1%) en contraste con Santander, donde se observó la proporción menos alta (89,0%); entre tanto, a nivel municipal, en 99 municipios la totalidad de las defunciones fueron potencialmente evitables, mientras que en Palmar (Santander) se encontró la proporción más baja (33,3%). Conclusiones. Nueve de cada 10 muertes de niños menores de cinco años ocurridas en Colombia entre 2000 y 2018 podrían haberse evitado, principalmente a través de la atención médica oportuna y de calidad, con importantes brechas entre los territorios subnacionales.


[ABSTRACT]. Objective. To determine the proportion of potentially avoidable deaths in children under five in Colombia, by department and municipality of residence, during the period from 2000 through 2018. Methods. A multi-group and longitudinal ecological study was conducted in 33 departments and 1 118 municipalities over a period of 19 years. The deaths were classified as probably unavoidable or avoidable; the latter were then identified as treatable, preventable, or mixed; and a proportion was calculated relative to the total. Finally, clusters were created by municipality and by department and depicted in coropleth maps. Results. Between 2000 and 2018, Colombia reported 228 942 deaths of children under five, of which 91.4% were avoidable (68.2% treatable, 6.8% preventable, and 16.5% mixed) with no difference by sex. At the national level, the proportion of avoidability declined from 93.5% to 88.5% during this period. César was the department with the largest proportion of avoidable deaths (94.1%), compared with Santander, which had the smallest (89.0%). At the municipal level, all the deaths were potentially avoidable in 99 municipalities, whereas Palmar (Santander) had the least (33.3%). Conclusions. Nine out of 10 of the deaths that occurred in children under five in Colombia during 2000-2018 could have been avoided, mainly through early and better quality medical care. Sizable differences were observed between subnational territories.


[RESUMO]. Objetivo. Determinar a proporção de óbitos potencialmente evitáveis em crianças menores de cinco anos na Colômbia, segundo departamento e município de residência, no período de 2000-2018. Métodos. Estudo ecológico longitudinal de múltiplas coortes que analisou dados de 33 departamentos e 1 118 municípios na Colômbia ao longo de 19 anos. Os óbitos foram classificados e diferenciados entre causas evitáveis (tratáveis, preveníveis ou mistas) e dificilmente evitáveis, e a proporção de óbitos foi calculada em relação ao total. Por último, foram criados conglomerados de municípios e departamentos, representados em mapas coropléticos. Resultados. Entre 2000 e 2018, foram registrados 228 942 óbitos em menores de cinco anos na Colômbia, dos quais 91,4% por causas evitáveis (68,2% por causas tratáveis, 6,8% por causas preveníveis e 16,5% por causas mistas), sem diferença por sexo. A proporção de evitabilidade teve uma redução, de 93,5% a 88,5%. A maior proporção de óbitos por causas evitáveis (94,1%) foi observada no departamento de Cesar, e a menor (89,0%), em Santander. Em 99 municípios, todos os óbitos foram potencialmente evitáveis. A menor proporção de óbitos evitáveis (33,3%) foi observada no município de Palmar (departamento de Santander). Conclusões. Nove em cada 10 óbitos de menores de cinco anos ocorridos na Colômbia entre 2000 e 2018 poderiam ter sido evitados, principalmente com atenção médica de qualidade e oportuna. Foi constatada uma grande disparidade entre os territórios subnacionais.


Assuntos
Saúde da Criança , Causas de Morte , Mortalidade Infantil , Mortalidade , Colômbia , Saúde da Criança , Causas de Morte , Mortalidade Infantil , Mortalidade , Saúde da Criança , Causas de Morte , Mortalidade Infantil , Mortalidade
11.
Washington, D.C.; OPS; 2021-06-01.
em Espanhol | PAHO-IRIS | ID: phr-54135

RESUMO

Una de las metas a alcanzar para el 2030 de la Estrategia mundial del sector de la salud contra las hepatitis víricas 2016-202: hacia el fin de las hepatitis víricas es reducir la mortalidad por el virus de la hepatitis B (VHB) y el virus de la hepatitis C (VHC). Para medir este indicador y darle seguimiento, los países requieren poner en funcionamiento un proceso sistemático para generar estimaciones nacionales de mortalidad por hepatitis virales. Esta publicación está dirigida a las instituciones y ministerios encargados de monitorizar los avances en cada país. El objetivo principal de este protocolo es presentar métodos sencillos para estimar la proporción de pacientes con cirrosis y con carcinoma hepatocelular que tienen infección por el VHB y el VHC, para luego calcular la mortalidad nacional por estas secuelas atribuibles a hepatitis virales, de preferencia dentro de un sistema de vigilancia. Además, se proporciona un marco general sobre cómo debe funcionar el sistema de vigilancia, cómo recopilar los datos y consideraciones éticas para tener en cuenta. El sistema de vigilancia se diseña sobre la base de centros centinela donde se recopilará información de pacientes con cirrosis y con carcinoma hepatocelular. Estos datos servirán para estimar la fracción de cirrosis y de carcinoma hepatocelular atribuible a la infección por los virus de las hepatitis B y C. Por otro lado, se recopilarán datos sobre el número de muertes a nivel nacional por cirrosis y por carcinoma hepatocelular. Con esta información, se calculará la mortalidad por cirrosis y por carcinoma hepatocelular atribuible a la infección por el VHB y el VHC.


Assuntos
Hepatite B , Hepatite C , Cirrose Hepática , Carcinoma Hepatocelular , Mortalidade , Vigilância de Evento Sentinela
12.
Popul Health Metr ; 19(1): 27, 2021 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059063

RESUMO

BACKGROUND: The number of deaths attributable to COVID-19 in Spain has been highly controversial since it is problematic to tell apart deaths having COVID as the main cause from those provoked by the aggravation by the viral infection of other underlying health problems. In addition, overburdening of health system led to an increase in mortality due to the scarcity of adequate medical care, at the same time confinement measures could have contributed to the decrease in mortality from certain causes. Our aim is to compare the number of deaths observed in 2020 with the projection for the same period obtained from a sequence of previous years. Thus, this computed mortality excess could be considered as the real impact of the COVID-19 on the mortality rates. METHODS: The population was split into four age groups, namely: (< 50; 50-64; 65-74; 75 and over). For each one, a projection of the death numbers for the year 2020, based on the interval 2008-2020, was estimated using a Bayesian spatio-temporal model. In each one, spatial, sex, and year effects were included. In addition, a specific effect of the year 2020 was added ("outbreak"). Finally, the excess deaths in year 2020 were estimated as the count of observed deaths minus those projected. RESULTS: The projected death number for 2020 was 426,970 people, the actual count being 499,104; thus, the total excess of deaths was 72,134. However, this increase was very unequally distributed over the Spanish regions. CONCLUSION: Bayesian spatio-temporal models have proved to be a useful tool for estimating the impact of COVID-19 on mortality in Spain in 2020, making it possible to assess how the disease has affected different age groups accounting for effects of sex, spatial variation between regions and time trend over the last few years.


Assuntos
COVID-19/mortalidade , Causas de Morte , Pandemias , Adulto , Idoso , Idoso de 80 Anos ou mais , Teorema de Bayes , Surtos de Doenças , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Mortalidade/tendências , SARS-CoV-2 , Espanha/epidemiologia , Análise Espaço-Temporal
13.
MMWR Morb Mortal Wkly Rep ; 70(23): 858-864, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34111059

RESUMO

Throughout the COVID-19 pandemic, older U.S. adults have been at increased risk for severe COVID-19-associated illness and death (1). On December 14, 2020, the United States began a nationwide vaccination campaign after the Food and Drug Administration's Emergency Use Authorization of Pfizer-BioNTech COVID-19 vaccine. The Advisory Committee on Immunization Practices (ACIP) recommended prioritizing health care personnel and residents of long-term care facilities, followed by essential workers and persons at risk for severe illness, including adults aged ≥65 years, in the early phases of the vaccination program (2). By May 1, 2021, 82%, 63%, and 42% of persons aged ≥65, 50-64, and 18-49 years, respectively, had received ≥1 COVID-19 vaccine dose. CDC calculated the rates of COVID-19 cases, emergency department (ED) visits, hospital admissions, and deaths by age group during November 29-December 12, 2020 (prevaccine) and April 18-May 1, 2021. The rate ratios comparing the oldest age groups (≥70 years for hospital admissions; ≥65 years for other measures) with adults aged 18-49 years were 40%, 59%, 65%, and 66% lower, respectively, in the latter period. These differential declines are likely due, in part, to higher COVID-19 vaccination coverage among older adults, highlighting the potential benefits of rapidly increasing vaccination coverage.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/epidemiologia , COVID-19/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , COVID-19/mortalidade , Humanos , Incidência , Pessoa de Meia-Idade , Mortalidade/tendências , Estados Unidos/epidemiologia , Adulto Jovem
14.
BMJ Open ; 11(6): e046359, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34130960

RESUMO

OBJECTIVE: To investigate reported extreme temperature-related catastrophic events and associated mortality on the European continent including the Russian Federation. DESIGN: Cross-sectional respecting Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. SETTINGS: Data source: Emergency Events Database (EM-DAT). PARTICIPANTS: Search criteria: location-European continent including Russian Federation, time-years 1988 until 2019 (close of database 12 July 2019), catastrophic events-extreme temperatures. PRIMARY OUTCOME MEASURES: Numbers of heat waves, cold waves, severe winter conditions and associated number of deaths, overall, and per country and year, respecting STROBE criteria. RESULTS: The most frequent type of the 243 events recorded in EM-DAT were cold waves (54.7%). However, cold waves and severe winter conditions only accounted for 6460 deaths (4.5%), while heat waves were associated with 137 533 deaths (95.5%). The five most severe heat waves in 2003, 2006, 2010, 2013 and 2015 were associated with a total of 135 089 deaths. The most severe heat waves were geographically distributed over the Russian Federation (2010), as well as France, Italy, Spain and Germany, each in 2003. CONCLUSION: Although cold waves are more frequently reported in EM-DAT, heat waves are the major cause for temperature-related deaths. In order to better protect the public, it is important to address resiliency and vulnerability of populations at risk and age groups.


Assuntos
Temperatura Baixa , Temperatura Alta , Estudos Transversais , Europa (Continente)/epidemiologia , França , Alemanha , Humanos , Itália , Mortalidade , Federação Russa , Espanha , Temperatura
15.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48216

RESUMO

De acordo com os dados da pesquisa Covid-19 and Obesity: An Epidemiologic Analysis of the Brazilian Data (Covid-19 e obesidade: uma análise epidemiológica dos dados brasileiros), desenvolvida pela pesquisadora da Universidade Federal de Juiz de Fora (UFJF), Jacy Gameiro, o vírus potencializa que pacientes com obesidade cheguem a óbito mais novos que indivíduos sem a comorbidade. O estudo também mostra que o fator de risco está associado a um aumento na necessidade da internação nas Unidades de Terapia Intensivas (UTIs) e do uso do suporte ventilatório para quem está hospitalizado.


Assuntos
Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Betacoronavirus , Obesidade/mortalidade , Adulto Jovem , Adulto , Mortalidade , Comorbidade
16.
Mayo Clin Proc ; 96(5): 1262-1275, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33958057

RESUMO

To determine the effect of COVID-19 convalescent plasma on mortality, we aggregated patient outcome data from 10 randomized clinical trials, 20 matched control studies, 2 dose-response studies, and 96 case reports or case series. Studies published between January 1, 2020, and January 16, 2021, were identified through a systematic search of online PubMed and MEDLINE databases. Random effects analyses of randomized clinical trials and matched control data demonstrated that patients with COVID-19 transfused with convalescent plasma exhibited a lower mortality rate compared with patients receiving standard treatments. Additional analyses showed that early transfusion (within 3 days of hospital admission) of higher titer plasma is associated with lower patient mortality. These data provide evidence favoring the efficacy of human convalescent plasma as a therapeutic agent in hospitalized patients with COVID-19.


Assuntos
COVID-19/terapia , COVID-19/mortalidade , Humanos , Imunização Passiva/métodos , Mortalidade , SARS-CoV-2/imunologia , Tempo para o Tratamento
17.
Medicine (Baltimore) ; 100(21): e26157, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032773

RESUMO

ABSTRACT: Among the main types of neoplasms in the female population, breast and cervical cancers are the most important due to their high morbidity and mortality rates. The mortality has been proportionally higher in developing countries. Analysis of the trend of cancer mortality in Brazil revealed a considerable difference in the pattern of deaths between the regions.To analyze the trend of mortality due to breast and cervical cancers in women.Retrospective study of a series of death cases, using secondary data from the mortality information system (SIM) of the Ministry of Health. The deaths were identified as the underlying cause of breast and cervical cancers, including malignant neoplasms of the uterus without other specifications, occurring from 1980 to 2014. Thus, the annual standardized age-specific mortality rates by the world population were applied. For trend analysis, regression models were utilized in which the mortality rates were considered dependent variables and years the independent variable. Polynomial regression models and a Prais-Winsten regression model were adopted.Cervical cancer presented a mortality rate ranging from 2.15 to 10.69 per 100,000 women from 1980 to 2014, with a tendency for stability.Breast cancer mortality rate varied from 3.81 to 11.47 per 100,000 women from 1981 to 2014, indicating a growing trend.There is a significant increase in the mortality rate for breast cancer and stability of cervical cancers in the State of Acre from 1980 to 2014, evidencing a concern in their care and monitoring. Above all, guaranteed access, especially to the population of women at social risk, and the search for effective screening should be emphasized in the formation of the care line and the Health Care Network in the State of Acre.


Assuntos
Neoplasias da Mama/mortalidade , Neoplasias do Colo do Útero/mortalidade , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Estudos Epidemiológicos , Feminino , Humanos , Pessoa de Meia-Idade , Mortalidade/tendências , Análise de Regressão , Estudos Retrospectivos , Adulto Jovem
18.
Cochrane Database Syst Rev ; 5: CD012776, 2021 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-34027998

RESUMO

BACKGROUND: Pyrethroid long-lasting insecticidal nets (LLINs) have been important in the large reductions in malaria cases in Africa, but insecticide resistance in Anopheles mosquitoes threatens their impact. Insecticide synergists may help control insecticide-resistant populations. Piperonyl butoxide (PBO) is such a synergist; it has been incorporated into pyrethroid-LLINs to form pyrethroid-PBO nets, which are currently produced by five LLIN manufacturers and, following a recommendation from the World Health Organization (WHO) in 2017, are being included in distribution campaigns. This review examines epidemiological and entomological evidence on the addition of PBO to pyrethroid nets on their efficacy. OBJECTIVES: To compare effects of pyrethroid-PBO nets currently in commercial development or on the market with effects of their non-PBO equivalent in relation to: 1. malaria parasite infection (prevalence or incidence); and 2. entomological outcomes. SEARCH METHODS: We searched the Cochrane Infectious Diseases Group (CIDG) Specialized Register, CENTRAL, MEDLINE, Embase, Web of Science, CAB Abstracts, and two clinical trial registers (ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) up to 25 September 2020. We contacted organizations for unpublished data. We checked the reference lists of trials identified by these methods. SELECTION CRITERIA: We included experimental hut trials, village trials, and randomized controlled trials (RCTs) with mosquitoes from the Anopheles gambiae complex or the Anopheles funestus group. DATA COLLECTION AND ANALYSIS: Two review authors assessed each trial for eligibility, extracted data, and determined the risk of bias for included trials. We resolved disagreements through discussion with a third review author. We analysed data using Review Manager 5 and assessed the certainty of evidence using the GRADE approach. MAIN RESULTS: Sixteen trials met the inclusion criteria: 10 experimental hut trials, four village trials, and two cluster-RCTs (cRCTs). Three trials are awaiting classification, and four trials are ongoing.  Two cRCTs examined the effects of pyrethroid-PBO nets on parasite prevalence in people living in areas with highly pyrethroid-resistant mosquitoes (< 30% mosquito mortality in discriminating dose assays). At 21 to 25 months post intervention, parasite prevalence was lower in the intervention arm (odds ratio (OR) 0.79, 95% confidence interval (CI) 0.67 to 0.95; 2 trials, 2 comparisons; moderate-certainty evidence). In highly pyrethroid-resistant areas, unwashed pyrethroid-PBO nets led to higher mosquito mortality compared to unwashed standard-LLINs (risk ratio (RR) 1.84, 95% CI 1.60 to 2.11; 14,620 mosquitoes, 5 trials, 9 comparisons; high-certainty evidence) and lower blood feeding success (RR 0.60, 95% CI 0.50 to 0.71; 14,000 mosquitoes, 4 trials, 8 comparisons; high-certainty evidence). However, in comparisons of washed pyrethroid-PBO nets to washed LLINs, we do not know if PBO nets had a greater effect on mosquito mortality (RR 1.20, 95% CI 0.88 to 1.63; 10,268 mosquitoes, 4 trials, 5 comparisons; very low-certainty evidence), although the washed pyrethroid-PBO nets did decrease blood-feeding success compared to standard-LLINs (RR 0.81, 95% CI 0.72 to 0.92; 9674 mosquitoes, 3 trials, 4 comparisons; high-certainty evidence). In areas where pyrethroid resistance is moderate (31% to 60% mosquito mortality), mosquito mortality was higher with unwashed pyrethroid-PBO nets compared to unwashed standard-LLINs (RR 1.68, 95% CI 1.33 to 2.11; 751 mosquitoes, 2 trials, 3 comparisons; moderate-certainty evidence), but there was little to no difference in effects on blood-feeding success (RR 0.90, 95% CI 0.72 to 1.11; 652 mosquitoes, 2 trials, 3 comparisons; moderate-certainty evidence). For washed pyrethroid-PBO nets compared to washed standard-LLINs, we found little to no evidence for higher mosquito mortality or reduced blood feeding (mortality: RR 1.07, 95% CI 0.74 to 1.54; 329 mosquitoes, 1 trial, 1 comparison, low-certainty evidence; blood feeding success: RR 0.91, 95% CI 0.74 to 1.13; 329 mosquitoes, 1 trial, 1 comparison; low-certainty evidence). In areas where pyrethroid resistance is low (61% to 90% mosquito mortality), studies reported little to no difference in the effects of unwashed pyrethroid-PBO nets compared to unwashed standard-LLINs on mosquito mortality (RR 1.25, 95% CI 0.99 to 1.57; 948 mosquitoes, 2 trials, 3 comparisons; moderate-certainty evidence), and we do not know if there was any effect on blood-feeding success (RR 0.75, 95% CI 0.27 to 2.11; 948 mosquitoes, 2 trials, 3 comparisons; very low-certainty evidence). For washed pyrethroid-PBO nets compared to washed standard-LLINs, we do not know if there was any difference in mosquito mortality (RR 1.39, 95% CI 0.95 to 2.04; 1022 mosquitoes, 2 trials, 3 comparisons; very low-certainty evidence) or on blood feeding (RR 1.07, 95% CI 0.49 to 2.33; 1022 mosquitoes, 2 trials, 3 comparisons; low-certainty evidence). In areas where mosquito populations are susceptible to insecticides (> 90% mosquito mortality), there may be little to no difference in the effects of unwashed pyrethroid-PBO nets compared to unwashed standard-LLINs on mosquito mortality (RR 1.20, 95% CI 0.64 to 2.26; 2791 mosquitoes, 2 trials, 2 comparisons; low-certainty evidence). This is similar for washed nets (RR 1.07, 95% CI 0.92 to 1.25; 2644 mosquitoes, 2 trials, 2 comparisons; low-certainty evidence). We do not know if unwashed pyrethroid-PBO nets had any effect on the blood-feeding success of susceptible mosquitoes (RR 0.52, 95% CI 0.12 to 2.22; 2791 mosquitoes, 2 trials, 2 comparisons; very low-certainty evidence). The same applies to washed nets (RR 1.25, 95% CI 0.82 to 1.91; 2644 mosquitoes, 2 trials, 2 comparisons; low-certainty evidence). In village trials comparing pyrethroid-PBO nets to LLINs, there was no difference in sporozoite rate (4 trials, 5 comparisons) nor in mosquito parity (3 trials, 4 comparisons). AUTHORS' CONCLUSIONS: In areas of high insecticide resistance, pyrethroid-PBO nets have greater entomological and epidemiological efficacy compared to standard LLINs, with sustained reduction in parasite prevalence, higher mosquito mortality and reduction in mosquito blood feeding rates 21 to 25 months post intervention. Questions remain about the durability of PBO on nets, as the impact of pyrethroid-PBO nets on mosquito mortality was not sustained over 20 washes in experimental hut trials, and epidemiological data on pyrethroid-PBO nets for the full intended three-year life span of the nets is not available. Little evidence is available to support greater entomological efficacy of pyrethroid-PBO nets in areas where mosquitoes show lower levels of resistance to pyrethroids.


Assuntos
Resistência a Inseticidas/efeitos dos fármacos , Mosquiteiros Tratados com Inseticida , Malária/prevenção & controle , Controle de Mosquitos/métodos , Sinergistas de Praguicidas , Butóxido de Piperonila , Piretrinas , África/epidemiologia , Animais , Culicidae , Combinação de Medicamentos , Comportamento Alimentar , Humanos , Malária/epidemiologia , Mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
PLoS One ; 16(5): e0251373, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33989322

RESUMO

We investigate the effectiveness of business shutdowns to contain the Covid-19 disease. In March 2020, Italy shut down operations in selected sectors of its economy. Using a difference-in-differences approach, we find that municipalities with higher exposure to closed sectors experienced subsequently lower mortality rates. The implied life savings exceed 9,400 people over a period of less than a month. We also find that business closures exhibited rapidly diminishing returns and had large effects outside the closed businesses themselves, including spillovers to other municipalities. Overall, the results suggest business shutdowns are effective, but should be selectively implemented and centrally coordinated.


Assuntos
COVID-19/mortalidade , COVID-19/prevenção & controle , Comércio , Mortalidade/tendências , Pandemias/prevenção & controle , Quarentena/métodos , SARS-CoV-2 , COVID-19/epidemiologia , COVID-19/virologia , Humanos , Itália/epidemiologia
20.
BMC Public Health ; 21(1): 831, 2021 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-33931073

RESUMO

BACKGROUND: Despite the implementation of a set of social and health policies, Brazil has experienced a slowdown in the decline of infant mortality, regional disparities and persistent high death levels, raising questions about the determinants of infant mortality after the implementation of these policies. The objective of this article is to propose a methodological approach aiming at identifying the determinants of infant mortality in Brazil after the implementation of those policies. METHOD: A series of multilevel panel data with fixed effect nested within-clusters were conducted supported by the concept of health capabilities based on data from 26 Brazilian states between 2004 and 2015. The dependent variables were the neonatal, the infant and the under-five mortality rates. The independent variables were the employment rate, per capita income, Bolsa Família Program coverage, the fertility rate, educational attainment, the number of live births by prenatal visits, the number of health professionals per thousand inhabitants, and the access to water supply and sewage services. We also used different time lags of employment rate to identify the impact of employment on the infant mortality rates over time, and household income stratified by minimum wages to analyze their effects on these rates. RESULTS: The results showed that in addition to variables associated with infant mortality in previous studies, such as Bolsa Família Program, per capita income and fertility rate, other factors affect child mortality. Educational attainment, quality of prenatal care and access to health professionals are also elements impacting infant deaths. The results also identified an association between employment rate and different infant mortality rates, with employment impacting neonatal mortality up to 3 years and that a family income below 2 minimum wages increases the odds of infant deaths. CONCLUSION: The results proved that the methodology proposed allowed the use of variables based on aggregated data that could hardly be used by other methodologies.


Assuntos
Renda , Mortalidade Infantil , Brasil/epidemiologia , Criança , Escolaridade , Feminino , Humanos , Lactente , Recém-Nascido , Mortalidade , Gravidez , Fatores Socioeconômicos
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