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1.
J Neurosurg Anesthesiol ; 34(1): 152-157, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34870640

RESUMO

BACKGROUND: In the United States, New York State's health care system experienced unprecedented stress as an early epicenter of the coronavirus disease 2019 (COVID-19) pandemic. This study aims to assess the level of hopelessness in New York State physicians working on the frontlines during the first wave of the COVID-19 outbreak. METHODS: A confidential online survey sent to New York State health care workers by the state health commissioner's office was used to gather demographic and hopelessness data as captured by a brief Hopelessness Scale. Adjusted linear regression models were used to assess the associations of physician age, sex, and number of triage decisions made, with level of hopelessness. RESULTS: In total, 1330 physicians were included, of whom 684 were male (51.4%). Their average age was 52.4 years (SD=12.7), with the majority of respondents aged 50 years and older (55.2%). Almost half of the physician respondents (46.3%) worked directly with COVID-19 patients, and 163 (12.3%) were involved in COVID-19-related triage decisions. On adjusted analysis, physicians aged 40 to 49 years had significantly higher levels of hopelessness compared with those aged 50 years or more (µ=0.441, SD=0.152, P=0.004). Those involved in 1 to 5 COVID-19-related triage decisions had a significantly lower mean hopelessness score (µ=-0.572, SD=0.208, P=0.006) compared with physicians involved in none of these decisions. CONCLUSION: Self-reported hopelessness was significantly higher among physicians aged 40 to 49 years and those who had not yet been involved in a life or death triage decision. Further work is needed to identify strategies to support physicians at high risk for adverse mental health outcomes during public health emergencies such as the COVID-19 pandemic.


Assuntos
COVID-19 , Médicos , Idoso , Surtos de Doenças , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Pandemias , SARS-CoV-2 , Inquéritos e Questionários , Estados Unidos
2.
Sci Total Environ ; 807(Pt 1): 150536, 2022 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-34628294

RESUMO

The coronavirus disease 2019 (COVID-19) has had a global impact that has been unevenly distributed among and even within countries. Multiple demographic and environmental factors have been associated with the risk of COVID-19 spread and fatality, including age, gender, ethnicity, poverty, and air quality among others. However, specific contributions of these factors are yet to be understood. Here, we attempted to explain the variability in infection, death, and fatality rates by understanding the contributions of a few selected factors. We compared the incidence of COVID-19 in New York State (NYS) counties during the first wave of infection and analyzed how different demographic and environmental variables associate with the variation observed across the counties. We observed that infection and death rates, two important COVID-19 metrics, to be highly correlated with both being highest in counties located near New York City, considered as one of the epicenters of the infection in the US. In contrast, disease fatality was found to be highest in a different set of counties despite registering a low infection rate. To investigate this apparent discrepancy, we divided the counties into three clusters based on COVID-19 infection, death, or fatality, and compared the differences in the demographic and environmental variables such as ethnicity, age, population density, poverty, temperature, and air quality in each of these clusters. Furthermore, a regression model built on this data reveals PM2.5 and distance from the epicenter are significant risk factors for infection, while disease fatality has a strong association with age and PM2.5. Our results demonstrate that for the NYS, demographic components distinctly associate with specific aspects of COVID-19 burden and also highlight the detrimental impact of poor air quality. These results could help design and direct location-specific control and mitigation strategies.


Assuntos
Poluição do Ar , COVID-19 , Humanos , Incidência , New York/epidemiologia , Cidade de Nova Iorque , SARS-CoV-2
3.
Gac Sanit ; 35 Suppl 2: S604-S609, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34929911

RESUMO

OBJECTIVE: Global society pays huge economic toll and live loss due to COVID-19 (Coronavirus Disease 2019) pandemic. In order to have a better management of this pandemic, many institutions develop their own models to predict number of COVID-19 cases, hospitalizations and mortalities. These models, however, are shown to be unreliable and need to be revised on a daily basis. METHODS: Here, we develop a Bose-Einstein (BE)-based statistical model to predict daily COVID-19 cases up to 14 days in advance. This fat-tailed model is chosen based on three reasons. First, it contains a peak and decaying phase. Second, it also has both accelerated and decelerated phases which are similarly observed in an epidemic curve. Third, the shape of both the BE energy distribution and the epidemic curve is controlled by a set of parameters. The BE model daily predictions are then verified against simulated data and confirmed COVID-19 daily cases from two epidemic centres, i.e. New York and DKI Jakarta. RESULT: Over- predictions occur at the earlier stage of the epidemic for all data sets. Models parameters for both simulated and New York data converge to a certain value only at the latest stage of the epidemic progress. At this stage, model's skill is high for both simulated and New York data, i.e. the predictability is greater than 80% with decreasing RMSE. On the other hand, at that stage, the DKI's model's predictability is still fluctuating with increasing RMSE. CONCLUSION: This implies that New York could leave the stay-at-home order, but DKI Jakarta should continue its large-scale social restriction order. There remains a great challenge in predicting the full course of an epidemic using small data collected during the earlier phase of the epidemic.


Assuntos
COVID-19 , Humanos , Modelos Estatísticos , New York/epidemiologia , Pandemias , SARS-CoV-2
4.
BMJ Open Diabetes Res Care ; 9(Suppl 1)2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34933873

RESUMO

INTRODUCTION: Access to care is essential for patients with diabetes to maintain health and prevent complications, and is important for health equity. New York State's Health Homes (HHs) provide care management services to Medicaid-insured patients with chronic conditions, including diabetes, and aim to improve quality of care and outcomes. There is inconsistent evidence on the impact of HHs, and care management programs more broadly, on access to care. RESEARCH DESIGN AND METHODS: Using a cohort of patients with diabetes derived from electronic health records from the INSIGHT Clinical Research Network, we analyzed Medicaid data for HH enrollees and a matched comparison group of HH non-enrollees. We estimated HH impacts on several access measures using natural experiment methods. RESULTS: We identified and matched 11 646 HH enrollees; patients were largely non-Hispanic Black (29.9%) and Hispanic (48.7%), and had high rates of dual eligibility (33.0%), Supplemental Security Income disability enrollment (49.1%), and multiple comorbidities. In the 12 months following HH enrollment, HH enrollees had one more month of Medicaid coverage (p<0.001) and 4.6 more outpatient visits than expected (p<0.001, evenly distributed between primary and specialty care). There were also positive impacts on the proportions of patients with follow-up visits within 7 days (4 percentage points (pp), p<0.001) and 30 days (6pp, p<0.001) after inpatient care, and on the proportion of patients with follow-up visits within 30 days after emergency department (ED) care (4pp, p<0.001). We did not find meaningful differences in continuity of care. We found small positive impacts on the proportion of patients with an inpatient visit and the proportion with an ED visit. CONCLUSIONS: New York State's HH program improved access to care for Medicaid recipients with diabetes. These findings have implications for New York State Medicaid as well as other providers and care management programs.


Assuntos
Diabetes Mellitus , Seguro Saúde , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Acesso aos Serviços de Saúde , Humanos , Medicaid , New York/epidemiologia , Estados Unidos/epidemiologia
5.
Environ Health Prev Med ; 26(1): 108, 2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34772333

RESUMO

The USA has a high burden of childhood asthma. Previous studies have observed associations between higher blood lead levels and greater hypersensitivity in children. The objective of the present study was to estimate the association between blood lead concentrations during early childhood and an asthma diagnosis between 48 and 72 months of age amongst a cohort with well-characterized blood lead concentrations. Blood lead concentrations were measured at 6, 12, 18, 24, 36, and 48 months of age in 222 children. The presence of an asthma diagnosis between 48 and 72 months was assessed using a questionnaire which asked parents or guardians whether they had been told by a physician, in the past 12 months, that their child had asthma. Crude and adjusted risk ratios (RR) of an asthma diagnosis were estimated for several parameterizations of blood lead exposure including lifetime average (6 to 48 months) and infancy average (6 to 24 months) concentrations. After adjustment for child sex, birthweight, daycare attendance, maternal race, education, parity, breastfeeding, income, and household smoking, age-specific or composite measures of blood lead were not associated with asthma diagnosis by 72 months of age in this cohort.


Assuntos
Asma/diagnóstico , Poluentes Ambientais/sangue , Chumbo/sangue , Asma/epidemiologia , Asma/etiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , New York/epidemiologia
6.
J Zoo Wildl Med ; 52(3): 909-917, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34687507

RESUMO

The tentacled snake (Erpeton tentaculatum) is a viviparous aquatic snake that is a desirable species to exhibit in zoological collections because of its unique appearance and feeding strategies. Despite its presence in zoo collections over the past 50 yr, a comprehensive review of mortality and morbidity in the species has not been published. This study retrospectively reviewed 125 pathology reports from tentacled snakes in a multi-institution zoological collection in New York (The Wildlife Conservation Society's Bronx and Central Park zoos) between 1966 and 2017. Just over half of the deaths were due to infectious disease (n = 67; 53.6%), and of these, over half (n = 40; 59.7%) were due to fungal dermatitis. Fungal histomorphology was consistent with Paranannizziopsis spp. in most cases. Death due to bacterial infection was also relatively common (n = 21; 16.8%), and one-third had intralesional bacilli consistent with Mycobacterium spp. (n = 7; 5.6%). The most common comorbidities included gastrointestinal parasitism (n = 44; 35.2%), renal pathology (n = 31; 24.8%), and lipid accumulation of hepatocytes (n = 13; 10.4%). This retrospective review suggests that managing infectious diseases plays a role in the long-term care and survival of captive tentacled snakes.


Assuntos
Colubridae , Dermatomicoses , Onygenales , Animais , Animais de Zoológico , Dermatomicoses/veterinária , New York/epidemiologia , Estudos Retrospectivos , Serpentes
7.
IEEE Pulse ; 12(5): 2-5, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34714732

RESUMO

In late February 2020, a time when severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, or COVID-19) still felt like an abstraction in the United States, New York City's first infected patient was admitted to Mount Sinai Hospital's emergency room. Working a few doors down was Sean Pinney, the Director of Advanced Heart Failure and Transplantation. Little did he know, but "that night was the beginning of hell," he said.


Assuntos
COVID-19 , Doenças Cardiovasculares/epidemiologia , COVID-19/epidemiologia , Hospitalização , Humanos , Masculino , New York/epidemiologia , SARS-CoV-2
8.
Orthopedics ; 44(5): 313-319, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34590956

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel respiratory virus that has rapidly changed the practice of medicine. The authors sought to evaluate the clinical presentation and clinical outcomes of patients presenting with foot and ankle (F&A) trauma to the emergency department during the first wave of the pandemic. The authors retrospectively studied all patients who presented to an emergency department within their multicenter institution during the first wave of the pandemic in their region from March 1 to June 30, 2020, with F&A trauma. They compared this cohort with a matched control group of patients who presented the prior year. Demographics, perioperative factors, coronavirus disease 2019 (COVID-19) polymerase chain reaction testing/positivity rates, 30-day readmissions, and 30-day mortalities were collected and analyzed. During the pandemic, the authors saw a 62.0% decrease in the total number of patients presenting with F&A trauma. Patients who presented during the pandemic were significantly older and a greater proportion were male. There was a greater proportion of ankle fractures, fewer ankle sprains, and more open fractures presenting during the pandemic. A greater proportion of patients presenting to the emergency department were admitted (18.2% vs 12.5%). The 30-day readmission (n=13 [5.8%] vs n=38 [9.3%]) and mortality (n=4 [1.8%] vs n=3 [0.7%]) rates for admitted patients were similar (P=.114 and P=.232, respectively). The authors found that 9.6% of patients who presented had a positive COVID-19 polymerase chain reaction test result and that these patients had 20% mortality and readmission rates. [Orthopedics. 2021;44(5):313-319.].


Assuntos
Traumatismos do Tornozelo/epidemiologia , COVID-19 , Traumatismos do Pé/epidemiologia , Traumatismos do Tornozelo/diagnóstico , COVID-19/epidemiologia , Traumatismos do Pé/diagnóstico , Humanos , Masculino , New York/epidemiologia , Pandemias , Estudos Retrospectivos , SARS-CoV-2
9.
J Neurooncol ; 154(3): 375-381, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34510329

RESUMO

INTRODUCTION: The Coronavirus disease 2019 (COVID-19) pandemic has uprooted healthcare systems worldwide, disrupting care and increasing dependence on alternative forms of health care delivery. It is yet to be determined how the pandemic affected neuro-oncology patient outcomes, given that the majority of even "elective" neurosurgical oncology procedures are time-sensitive. This study quantifies changes in neuro-oncological care during the height of the pandemic and investigates patient outcomes in 2020 compared to a historical control. METHODS: We performed a retrospective review of patients with malignant brain tumor diagnoses who were seen at our institution between March 13 and May 1 of 2020 and 2019. Alterations in care, including shift from in-person to telehealth, delays in evaluation and intervention, and treatment modifications were evaluated. These variables were analyzed with respect to brain tumor control and mortality. RESULTS: 112 patients from 2020 to 166 patients from 2019 were included. There was no significant difference in outcomes between the cohorts, despite significantly more treatment delays (p = 0.0160) and use of telehealth (p < 0.0001) in 2020. Patients in 2020 who utilized telehealth visits had significantly more stable tumor control than those who had office visits (p = 0.0124), consistent with appropriate use of in-person visits for patients with progression. CONCLUSIONS: Our study showed that use of telehealth and selective alterations in neuro-oncological care during the COVID-19 pandemic did not lead to adverse patient outcomes. This suggests that adaptive physician-led changes were successful and may inform management during the ongoing pandemic, especially with the emergence of the Delta variant.


Assuntos
Neoplasias Encefálicas/epidemiologia , COVID-19/complicações , SARS-CoV-2/isolamento & purificação , Neoplasias Encefálicas/virologia , COVID-19/transmissão , COVID-19/virologia , Atenção à Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Prognóstico , Estudos Retrospectivos , Telemedicina
10.
Acta Obstet Gynecol Scand ; 100(12): 2253-2259, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34546577

RESUMO

INTRODUCTION: Studies directly comparing preterm birth rates in women with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited. Our objective was to determine whether preterm birth was affected by SARS-CoV-2 infection within a large integrated health system in New York with a universal testing protocol. MATERIAL AND METHODS: This retrospective cohort study evaluated data from seven hospitals in New York City and Long Island between March 2020 and June 2021, incorporating both the first and second waves of the coronavirus disease 2019 (COVID-19) pandemic in the USA. All patients with live singleton gestations who had SARS-CoV-2 polymerase chain reaction (PCR) testing at delivery were included. Deliveries before 20 weeks of gestation were excluded. The rate of preterm birth (before 37 weeks) was compared between patients with positive and negative SARS-CoV-2 test results. This analysis was performed separately for resolved prenatal infections and infections at delivery, with the latter group subdivided by symptom status. Multiple logistic regression analysis was used to examine the association between SARS-CoV-2 infection and preterm birth, adjusting for maternal age, race-ethnicity, parity, history of preterm birth, body mass index, marital status, insurance type, medical co-morbidities, month of delivery, and wave of pandemic. RESULTS: A total of 31 550 patients were included and 2473 (7.8%) had laboratory-confirmed infection. Patients with symptomatic COVID-19 at delivery were more likely to deliver preterm (19.0%; adjusted odds ratio 2.76, 95% CI 1.92-3.88) compared with women with asymptomatic infection (8.8%) or without infection (7.1%). Among preterm births associated with symptomatic infection, 72.5% were medically indicated compared with 44.1% among women without infection (p < 0.001). Risk of preterm birth in patients with resolved prenatal infection was unchanged when compared with women without infection. Among women with infection at delivery, preterm birth occurred more frequently during the second wave compared with the first wave (13.6% vs. 8.7%, respectively; p < 0.006). However, this was not significant on multiple regression analysis after adjusting for other explanatory variables. CONCLUSIONS: Pregnant women with symptomatic COVID-19 are more than twice as likely to have a preterm delivery than patients without infection. Asymptomatic infection and resolved prenatal infection are not associated with increased risk.


Assuntos
COVID-19/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Idade Materna , New York/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
11.
PLoS One ; 16(9): e0257052, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34534212

RESUMO

There remains a great challenge to minimize the spread of epidemics, especially in high-density communities such as colleges and universities. This is particularly true on densely populated, residential college campuses. To construct class and residential networks data from a four-year, residential liberal arts college with 5539 students were obtained from SUNY College at Geneseo, a rural, residential, undergraduate institution in western NY, USA. Equal-sized random networks also were created for each day. Different levels of compliance with mask use (none to 100%), mask efficacy (50% to 100%), and testing frequency (daily, or every 2, 3, 7, 14, 28, or 105 days) were assessed. Tests were assumed to be only 90% accurate and positive results were used to isolate individuals. The effectiveness of contact tracing, and the effect of quarantining neighbors of infectious individuals, was tested. The structure of the college course enrollment and residence networks greatly influenced the dynamics of the epidemics, as compared to the random networks. In particular, average path lengths were longer in the college networks compared to random networks. Students in larger majors generally had shorter average path lengths than students in smaller majors. Average transitivity (clustering) was lower on days when students most frequently were in class (MWF). Degree distributions were generally large and right skewed, ranging from 0 to 719. Simulations began by inoculating twenty students (10 exposed and 10 infectious) with SARS-CoV-2 on the first day of the fall semester and ended once the disease was cleared. Transmission probability was calculated based on an R0 = 2.4. Without interventions epidemics resulted in most students becoming infected and lasted into the second semester. On average students in the college networks experienced fewer infections, shorter duration, and lower epidemic peaks when compared to the dynamics on equal-sized random networks. The most important factors in reducing case numbers were the proportion masking and the frequency of testing, followed by contact tracing and mask efficacy. The paper discusses further high-order interactions and other implications of non-pharmaceutical interventions for disease transmission on a residential college campus.


Assuntos
COVID-19/prevenção & controle , Busca de Comunicante/métodos , Máscaras/estatística & dados numéricos , Pandemias/prevenção & controle , Universidades/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Masculino , New York/epidemiologia , Quarentena/métodos , Estudantes , Adulto Jovem
12.
Am J Public Health ; 111(10): 1780-1783, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34529451

RESUMO

Individuals with serious mental illness are particularly vulnerable to COVID-19. The New York State (NYS) Office of Mental Health implemented patient and staff rapid testing, quarantining, and vaccination to limit COVID-19 spread in 23 state-operated psychiatric hospitals between November 2020 and February 2021. COVID-19 infection rates in inpatients and staff decreased by 96% and 71%, respectively, and the NYS population case rate decreased by 6%. Repeated COVID-19 testing and vaccination should be priority interventions for state-operated psychiatric hospitals. (Am J Public Health. 2021;111(10):1780-1783. https://doi.org/10.2105/AJPH.2021.306444).


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Hospitais Psiquiátricos/estatística & dados numéricos , Vacinação em Massa/organização & administração , COVID-19/diagnóstico , Teste para COVID-19 , Humanos , New York/epidemiologia , Quarentena , SARS-CoV-2 , Populações Vulneráveis
13.
MMWR Morb Mortal Wkly Rep ; 70(37): 1306-1311, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34529645

RESUMO

Data from randomized clinical trials and real-world observational studies show that all three COVID-19 vaccines currently authorized for emergency use by the Food and Drug Administration* are safe and highly effective for preventing COVID-19-related serious illness, hospitalization, and death (1,2). Studies of vaccine effectiveness (VE) for preventing new infections and hospitalizations attributable to SARS-CoV-2, the virus that causes COVID-19), particularly as the B.1.617.2 (Delta) variant has become predominant, are limited in the United States (3). In this study, the New York State Department of Health linked statewide immunization, laboratory testing, and hospitalization databases for New York to estimate rates of new laboratory-confirmed COVID-19 cases and hospitalizations by vaccination status among adults, as well as corresponding VE for full vaccination in the population, across all three authorized vaccine products. During May 3-July 25, 2021, the overall age-adjusted VE against new COVID-19 cases for all adults declined from 91.8% to 75.0%. During the same period, the overall age-adjusted VE against hospitalization was relatively stable, ranging from 89.5% to 95.1%. Currently authorized vaccines have high effectiveness against COVID-19 hospitalization, but effectiveness against new cases appears to have declined in recent months, coinciding with the Delta variant's increase from <2% to >80% in the U.S. region that includes New York and relaxation of masking and physical distancing recommendations. To reduce new COVID-19 cases and hospitalizations, these findings support the implementation of a layered approach centered on vaccination, as well as other prevention strategies such as masking and physical distancing.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/diagnóstico , COVID-19/terapia , Hospitalização/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Técnicas de Laboratório Clínico , Humanos , Pessoa de Meia-Idade , New York/epidemiologia , SARS-CoV-2/isolamento & purificação , Adulto Jovem
14.
BMC Health Serv Res ; 21(1): 922, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488741

RESUMO

BACKGROUND: The Collaborative Care Model is a well-established, evidence-based approach to treating depression and other common behavioral health conditions in primary care settings. Despite a robust evidence base, real world implementation of Collaborative Care has been limited and very slow. The goal of this analysis is to better describe and understand the progression of implementation in the largest state-led Collaborative Care program in the nation-the New York State Collaborative Care Medicaid Program. Data are presented using the RE-AIM model, examining the proportion of clinics in each of the model's five steps from 2014 to 2019. METHODS: We used the RE-AIM model to shape our data presentation, focusing on the proportion of clinics moving into each of the five steps of this model over the years of implementation. Data sources included: a New York State Office of Mental Health clinic tracking database, billing applications, quarterly reports, and Medicaid claims. RESULTS: A total of 84% of clinics with which OMH had an initial contact [n = 611clinics (377 FQHCs and 234 non-FQHCs)] received some form of training and technical assistance. Of those, 51% went on to complete a billing application, 41% reported quarterly data at least once, and 20% were able to successfully bill Medicaid. Of clinics that reported data prior to the first quarter of 2019, 79% (n = 130) maintained Collaborative Care for 1 year or more. The receipt of any training and technical assistance was significantly associated with our implementation indices: (completed billing application, data reporting, billing Medicaid, and maintaining Collaborative Care). The average percent of patient improvement for depression and anxiety across 155 clinics that had at least one quarter of data was 44.81%. Training and technical assistance source (Office of Mental Health, another source, or both) and intensity (high/low) were significantly related to implementation indices and were observed in FQHC versus non-FQHC samples. CONCLUSIONS: Offering Collaborative Care training and technical assistance, particularly high intensity training and technical assistance, increases the likelihood of implementation. Other state-wide organizations might consider the provision of training and technical assistance when assisting clinics to implement Collaborative Care.


Assuntos
Medicaid , Atenção Primária à Saúde , Instituições de Assistência Ambulatorial , Humanos , Saúde Mental , New York/epidemiologia , Estados Unidos/epidemiologia
15.
Sci Rep ; 11(1): 17689, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34480062

RESUMO

COVID-19, a global pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 virus, has claimed millions of lives worldwide. Amid soaring contagion due to newer strains of the virus, it is imperative to design dynamic, spatiotemporal models to contain the spread of infection during future outbreaks of the same or variants of the virus. The reliance on existing prediction and contact tracing approaches on prior knowledge of inter- or intra-zone mobility renders them impracticable. We present a spatiotemporal approach that employs a network inference approach with sliding time windows solely on the date and number of daily infection numbers of zones within a geographical region to generate temporal networks capturing the influence of each zone on another. It helps analyze the spatial interaction among the hotspot or spreader zones and highly affected zones based on the flow of network contagion traffic. We apply the proposed approach to the daily infection counts of New York State as well as the states of USA to show that it effectively measures the phase shifts in the pandemic timeline. It identifies the spreaders and affected zones at different time points and helps infer the trajectory of the pandemic spread across the country. A small set of zones periodically exhibit a very high outflow of contagion traffic over time, suggesting that they act as the key spreaders of infection. Moreover, the strong influence between the majority of non-neighbor regions suggests that the overall spread of infection is a result of the unavoidable long-distance trips by a large number of people as opposed to the shorter trips at a county level, thereby informing future mitigation measures and public policies.


Assuntos
COVID-19 , Busca de Comunicante , Bases de Dados Factuais , Pandemias , COVID-19/epidemiologia , COVID-19/transmissão , Humanos , New York/epidemiologia , Saúde Pública , SARS-CoV-2
16.
Int Heart J ; 62(5): 1035-1041, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34544977

RESUMO

Septal reduction therapy (SRT) -i.e. septal myectomy and alcohol septal ablation-has been performed to treat medically refractory hypertrophic cardiomyopathy (HCM) for decades. However, it is largely unknown whether SRT prevents HCM-related cardiovascular events or death. The objective was to examine the effects of SRT on acute cardiovascular events and all-cause mortality in HCM. We performed a propensity score (PS) -matched study using databases that capture all hospitalizations and outpatient visits in New York state. We identified patients with HCM who underwent SRT between 2007 and 2014 (i.e. the SRT group) and those who had never had SRT but had at least one hospitalization for HCM during the same period (i.e. the control group). We performed PS matching at a 1:1 ratio. The primary outcome was a composite of acute cardiovascular events and all-cause mortality during 0-180 days and 181-360 days. The secondary outcome was 180- and 360-day all-cause mortality. We included 846 patients with HCM (423 PS-matched pairs). Patients who underwent SRT had a lower risk of the primary outcome event (0-180 days: odds ratio [OR], 0.54; 95% confidence intervals (CI), 0.37-0.80; P = 0.002 and 181-360 days: OR, 0.33; 95% CI, 0.22-0.51; P < 0.0001). Furthermore, the risk of all-cause mortality was lower at 180 days (OR, 0.37; 95% CI, 0.22-0.63; P = 0.0003) and 360 days post-SRT (OR, 0.32; 95% CI, 0.20-0.51; P < 0.0001). In conclusion, our PS-matched study using population-based datasets demonstrated that SRT was associated with a reduced risk of a composite of acute cardiovascular events and all-cause mortality in HCM during the first post-SRT year.


Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Cardiomiopatia Hipertrófica/terapia , Doenças Cardiovasculares/prevenção & controle , Septos Cardíacos/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Morte , Feminino , Septos Cardíacos/patologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , New York/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Pacientes Ambulatoriais , Prevalência , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco
17.
Nature ; 597(7878): 703-708, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34428777

RESUMO

SARS-CoV-2 infections have surged across the globe in recent months, concomitant with considerable viral evolution1-3. Extensive mutations in the spike protein may threaten the efficacy of vaccines and therapeutic monoclonal antibodies4. Two signature spike mutations of concern are E484K, which has a crucial role in the loss of neutralizing activity of antibodies, and N501Y, a driver of rapid worldwide transmission of the B.1.1.7 lineage. Here we report the emergence of the variant lineage B.1.526 (also known as the Iota variant5), which contains E484K, and its rise to dominance in New York City in early 2021. This variant is partially or completely resistant to two therapeutic monoclonal antibodies that are in clinical use and is less susceptible to neutralization by plasma from individuals who had recovered from SARS-CoV-2 infection or serum from vaccinated individuals, posing a modest antigenic challenge. The presence of the B.1.526 lineage has now been reported in all 50 states in the United States and in many other countries. B.1.526 rapidly replaced earlier lineages in New York, with an estimated transmission advantage of 35%. These transmission dynamics, together with the relative antibody resistance of its E484K sub-lineage, are likely to have contributed to the sharp rise and rapid spread of B.1.526. Although SARS-CoV-2 B.1.526 initially outpaced B.1.1.7 in the region, its growth subsequently slowed concurrently with the rise of B.1.1.7 and ensuing variants.


Assuntos
COVID-19/virologia , SARS-CoV-2/crescimento & desenvolvimento , SARS-CoV-2/isolamento & purificação , Anticorpos Neutralizantes/imunologia , Humanos , Mutação , New York/epidemiologia , Filogenia , Filogeografia , Prevalência , SARS-CoV-2/genética , SARS-CoV-2/imunologia , Glicoproteína da Espícula de Coronavírus/química , Glicoproteína da Espícula de Coronavírus/genética , Glicoproteína da Espícula de Coronavírus/imunologia , Glicoproteína da Espícula de Coronavírus/metabolismo , Estados Unidos/epidemiologia
18.
PLoS One ; 16(8): e0255236, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34347810

RESUMO

Behavioral epidemiology suggests that there is a tight dynamic coupling between the timeline of an epidemic outbreak, and the social response in the affected population (with a typical course involving physical distancing between individuals, avoidance of large gatherings, wearing masks, etc). We study the bidirectional coupling between the epidemic dynamics of COVID-19 and the population social response in the state of New York, between March 1, 2020 (which marks the first confirmed positive diagnosis in the state), until June 20, 2020. This window captures the first state-wide epidemic wave, which peaked to over 11,000 confirmed cases daily in April (making New York one of the US states most severely affected by this first wave), and subsided by the start of June to a count of consistently under 1,500 confirmed cases per day (suggesting temporary state-wide control of the epidemic). In response to the surge in cases, social distancing measures were gradually introduced over two weeks in March, culminating with the PAUSE directive on March 22nd, which mandated statewide shutdown of all nonessential activity. The mandates were then gradually relaxed in stages throughout summer, based on how epidemic benchmarks were met in various New York regions. In our study, we aim to examine on one hand, whether different counties exhibited different responses to the PAUSE centralized measures depending on their epidemic situation immediately preceding PAUSE. On the other hand, we explore whether these different county-wide responses may have contributed in turn to modulating the counties' epidemic timelines. We used the public domain to extract county-wise epidemic measures (such as cumulative and daily incidence of COVID-19), and social mobility measures for different modalities (driving, walking, public transit) and to different destinations. Our correlation analyses between the epidemic and the mobility time series found significant correlations between the size of the epidemic and the degree of mobility drop after PAUSE, as well as between the mobility comeback patterns and the epidemic recovery timeline. In line with existing literature on the role of the population behavioral response during an epidemic outbreak, our results support the potential importance of the PAUSE measures to the control of the first epidemic wave in New York State.


Assuntos
COVID-19/epidemiologia , Comportamentos Relacionados com a Saúde/fisiologia , Controle de Infecções , Surtos de Doenças , Epidemias , História do Século XXI , Atividades Humanas/estatística & dados numéricos , Humanos , Controle de Infecções/legislação & jurisprudência , Controle de Infecções/métodos , Programas Obrigatórios/legislação & jurisprudência , Máscaras , New York/epidemiologia , Distanciamento Físico , Quarentena/psicologia , Quarentena/estatística & dados numéricos , SARS-CoV-2/fisiologia , Fatores de Tempo , Transportes/estatística & dados numéricos
19.
Glob Chang Biol ; 27(21): 5430-5445, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34392584

RESUMO

The effects of climate change on infectious diseases are a topic of considerable interest and discussion. We studied West Nile virus (WNV) in New York (NY) and Connecticut (CT) using a Weather Research and Forecasting (WRF) model climate change scenario, which allows us to examine the effects of climate change and variability on WNV risk at county level. We chose WNV because it is well studied, has caused over 50,000 reported human cases, and over 2200 deaths in the United States. The ecological impacts have been substantial (e.g., millions of avian deaths), and economic impacts include livestock deaths, morbidity, and healthcare-related expenses. We trained two Random Forest models with observational climate data and human cases to predict future levels of WNV based on future weather conditions. The Regional Model used present-day data from NY and CT, whereas the Analog Model was fit for states most closely matching the predicted future conditions in the region. Separately, we predicted changes to mosquito-based WNV risk using a trait-based thermal biology approach (Mosquito Model). The WRF model produced control simulations (present day) and pseudo-global warming simulations (future). The Regional and Analog Models predicted an overall increase in human cases of WNV under future warming. However, the Analog Model did not predict as strong of an increase in the number of human cases as the Regional Model, and predicted a decrease in cases in some counties that currently experience high numbers of WNV cases. The Mosquito Model also predicted a decrease in risk in current high-risk areas, with an overall reduction in the population-weighted relative risk (but an increase in area-weighted risk). The Mosquito Model supports the Analog Model as making more realistic predictions than the Regional Model. All three models predicted a geographic increase in WNV cases across NY and CT.


Assuntos
Culicidae , Febre do Nilo Ocidental , Vírus do Nilo Ocidental , Animais , Mudança Climática , Connecticut/epidemiologia , Humanos , New York/epidemiologia , Estados Unidos , Febre do Nilo Ocidental/epidemiologia
20.
Sci Total Environ ; 797: 149199, 2021 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-34346383

RESUMO

BACKGROUND: There is little work in assessing the impact of storm events combined with power outage (PO). In this study, we evaluated the individual and synergistic impacts of wind events and PO on overall and subtypes of injuries in New York State (NYS) and by demographics. METHODS: The emergency department (ED) visit data were obtained from the NYS Department of Health from November-April 2005-2013 to identify injury cases, length of stay and care costs. Wind event was defined according to high wind, strong wind or thunderstorm wind defined by NOAA. PO occurrence was defined when PO coverage exceeded the 50th percentile of its distribution. By comparing non-event days, we used distributed lag nonlinear models to evaluate the impacts of wind events, PO, and their combined effect on injuries during the cold season over a 0-3-day lag period, while controlling for time-varying confounders. The differences in critical care indicators between event and non-event days were also evaluated. RESULTS: Overall injuries ED visits (16,628,812) significantly increased during the wind events (highest Risk Ratio (RR): 1.05; 95% CI: 1.02-1.08), and were highest when wind events cooccurred with PO (highest RR: 1.14; 95% CI: 1.10-1.18), but not during PO alone (RR: 1.00; 95%CI: 0.96-1.04). The increase was also observed with all subgroups through Day 2 after the event. Greater risks exist for older adults (≥65 years) and those on Medicaid. After the joint occurrences of wind events and PO, average visits are 0.2 days longer, and cost 13% more, compared to no wind/no PO days. CONCLUSION: There is a significant increase in ED visits, length of stay and cost of injuries during wind events, especially when they coupled with PO and especially among older cases and Medicaid holders. Our findings may be used for planning disaster preparedness and recovery efforts.


Assuntos
Planejamento em Desastres , Serviço Hospitalar de Emergência , New York/epidemiologia , Estações do Ano , Estados Unidos , Vento
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