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1.
PLoS One ; 16(1): e0244419, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33406085

RESUMO

We use the UK Household Longitudinal Study and compare pre-COVID-19 pandemic (2017-2019) and during-COVID-19 pandemic data (April 2020) for the same group of individuals to assess and quantify changes in mental health as measured by changes in the GHQ-12 (General Health Questionnaire), among ethnic groups in the UK. We confirm the previously documented average deterioration in mental health for the whole sample of individuals interviewed before and during the COVID-19 pandemic. In addition, we find that the average increase in mental distress varies by ethnicity and gender. Both women -regardless of their ethnicity- and Black, Asian, and minority ethnic (BAME) men experienced a higher average increase in mental distress than White British men, so that the gender gap in mental health increases only among White British individuals. These ethnic-gender specific changes in mental health persist after controlling for demographic and socioeconomic characteristics. Finally, we find some evidence that, among men, Bangladeshi, Indian and Pakistani individuals have experienced the highest average increase in mental distress with respect to White British men.


Assuntos
/psicologia , Grupos Étnicos/psicologia , Saúde Mental/tendências , Adulto , Grupos de Populações Continentais/psicologia , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Reino Unido/epidemiologia
2.
PLoS One ; 16(1): e0244476, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33406101

RESUMO

In confronting the global spread of the coronavirus disease COVID-19 pandemic we must have coordinated medical, operational, and political responses. In all efforts, data is crucial. Fundamentally, and in the possible absence of a vaccine for 12 to 18 months, we need universal, well-documented testing for both the presence of the disease as well as confirmed recovery through serological tests for antibodies, and we need to track major socioeconomic indices. But we also need auxiliary data of all kinds, including data related to how populations are talking about the unfolding pandemic through news and stories. To in part help on the social media side, we curate a set of 2000 day-scale time series of 1- and 2-grams across 24 languages on Twitter that are most 'important' for April 2020 with respect to April 2019. We determine importance through our allotaxonometric instrument, rank-turbulence divergence. We make some basic observations about some of the time series, including a comparison to numbers of confirmed deaths due to COVID-19 over time. We broadly observe across all languages a peak for the language-specific word for 'virus' in January 2020 followed by a decline through February and then a surge through March and April. The world's collective attention dropped away while the virus spread out from China. We host the time series on Gitlab, updating them on a daily basis while relevant. Our main intent is for other researchers to use these time series to enhance whatever analyses that may be of use during the pandemic as well as for retrospective investigations.


Assuntos
/psicologia , Pandemias/estatística & dados numéricos , Mídias Sociais/tendências , Atenção , Infecções por Coronavirus/etiologia , Infecções por Coronavirus/psicologia , Humanos , Idioma , Estudos Retrospectivos , /patogenicidade
3.
PLoS One ; 16(1): e0245137, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33406126

RESUMO

INTRODUCTION: The world has been engulfed with the pandemic of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which have created significant impact in the emergency surgical health delivery including acute appendicitis. The main aim of this study was to compare the demographic and clinical parameters between two cohorts before the onset of lockdown and within the pandemic. METHODS: A retrospective analysis was performed between two groups A and B, who presented with acute appendicitis three months prior to and after initiation of lockdown on March 24 2020 respectively in one of the tertiary centers of Nepal. These two cohorts were compared in demographics, clinicopathological characteristics and surgical aspects of acute appendicitis. RESULTS: There were 42 patients in group A and 50 patients in group B. Mean age of the patients was 31.32±17.18 years with male preponderance in group B (N = 29). Mean duration of pain increased significantly in group B [57.8±25.9(B) vs 42.3±25.0(A) hours, P = 0.004] along with mean duration of surgery [51.06±9.4(B) vs 45.27±11.8(A) minutes, P = 0.015]. There was significant decrease in post-operative hospital stay among group B patients [3.04±1.1(B) vs 3.86±0.67(A) days, P = 0.0001]. Complicated cases increased in group B including appendicular perforation in 10 cases. Similarly, mean duration of presentation to hospital significantly increased in group B patients with perforation [69.6±21.01 vs 51.57±17.63 hours, P = 0.008]. CONCLUSION: During the adversity of the current pandemic, increased number of cases of acute appendicitis can be dealt with surgery as the chances of late presentation and complexity of the lesion exists.


Assuntos
Apendicite/epidemiologia , Apendicite/cirurgia , /complicações , Doença Aguda/epidemiologia , Adulto , Idoso , Apendicectomia/tendências , Controle de Doenças Transmissíveis/métodos , Serviço Hospitalar de Emergência/tendências , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Pandemias/estatística & dados numéricos , Estudos Retrospectivos , /patogenicidade
4.
PLoS One ; 16(1): e0241190, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33406134

RESUMO

Multiple national and international trends and drivers are radically changing what biological security means for the United Kingdom (UK). New technologies present novel opportunities and challenges, and globalisation has created new pathways and increased the speed, volume and routes by which organisms can spread. The UK Biological Security Strategy (2018) acknowledges the importance of research on biological security in the UK. Given the breadth of potential research, a targeted agenda identifying the questions most critical to effective and coordinated progress in different disciplines of biological security is required. We used expert elicitation to generate 80 policy-relevant research questions considered by participants to have the greatest impact on UK biological security. Drawing on a collaboratively-developed set of 450 questions, proposed by 41 experts from academia, industry and the UK government (consulting 168 additional experts) we subdivided the final 80 questions into six categories: bioengineering; communication and behaviour; disease threats (including pandemics); governance and policy; invasive alien species; and securing biological materials and securing against misuse. Initially, the questions were ranked through a voting process and then reduced and refined to 80 during a one-day workshop with 35 participants from a variety of disciplines. Consistently emerging themes included: the nature of current and potential biological security threats, the efficacy of existing management actions, and the most appropriate future options. The resulting questions offer a research agenda for biological security in the UK that can assist the targeting of research resources and inform the implementation of the UK Biological Security Strategy. These questions include research that could aid with the mitigation of Covid-19, and preparation for the next pandemic. We hope that our structured and rigorous approach to creating a biological security research agenda will be replicated in other countries and regions. The world, not just the UK, is in need of a thoughtful approach to directing biological security research to tackle the emerging issues.


Assuntos
Pandemias/prevenção & controle , Medidas de Segurança/tendências , Bioterrorismo/prevenção & controle , Governança Clínica/tendências , Comunicação , Transmissão de Doença Infecciosa/prevenção & controle , Transmissão de Doença Infecciosa/estatística & dados numéricos , Humanos , Pandemias/estatística & dados numéricos , Políticas , Medidas de Segurança/estatística & dados numéricos , Inquéritos e Questionários , Reino Unido/epidemiologia
5.
Artigo em Inglês | MEDLINE | ID: mdl-33431724

RESUMO

Search and find methods*) such as cluster tracing1)-6) or large-scale PCR testing**) of those who exhibit no symptoms or only mild symptoms of COVID-19 is shown by data analysis to be a powerful means to suppress the spread of COVID-19 instead of, or in addition to, lockdown of the entire population. Here we investigate this issue by analyzing the data from some cities and countries and we establish that search and find method is as powerful as lockdown of a city or a country. Moreover, in contrast to lockdown, it neither causes inconvenience to citizens nor does it disrupt the economy. Generally speaking, it is advisable that both social distancing and increased test numbers be employed to suppress spread of the virus. The product of the total test number with the rate of positive cases is the crucial index.


Assuntos
/prevenção & controle , Controle de Doenças Transmissíveis/métodos , África/epidemiologia , Infecções Assintomáticas/epidemiologia , Brasil/epidemiologia , /transmissão , China/epidemiologia , Controle de Doenças Transmissíveis/estatística & dados numéricos , Política de Saúde , Humanos , Imunidade Coletiva , Japão/epidemiologia , Los Angeles/epidemiologia , Modelos Biológicos , Modelos Estatísticos , New York/epidemiologia , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Quarentena , Sensibilidade e Especificidade , Suécia/epidemiologia , Tóquio/epidemiologia , Estados Unidos/epidemiologia
6.
PLoS Comput Biol ; 17(1): e1008470, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33411742

RESUMO

Finding medications or vaccines that may decrease the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could potentially reduce transmission in the broader population. We developed a computational model of the U.S. simulating the spread of SARS-CoV-2 and the potential clinical and economic impact of reducing the infectious period duration. Simulation experiments found that reducing the average infectious period duration could avert a median of 442,852 [treating 25% of symptomatic cases, reducing by 0.5 days, reproductive number (R0) 3.5, and starting treatment when 15% of the population has been exposed] to 44.4 million SARS-CoV-2 cases (treating 75% of all infected cases, reducing by 3.5 days, R0 2.0). With R0 2.5, reducing the average infectious period duration by 0.5 days for 25% of symptomatic cases averted 1.4 million cases and 99,398 hospitalizations; increasing to 75% of symptomatic cases averted 2.8 million cases. At $500/person, treating 25% of symptomatic cases saved $209.5 billion (societal perspective). Further reducing the average infectious period duration by 3.5 days averted 7.4 million cases (treating 25% of symptomatic cases). Expanding treatment to 75% of all infected cases, including asymptomatic infections (R0 2.5), averted 35.9 million cases and 4 million hospitalizations, saving $48.8 billion (societal perspective and starting treatment after 5% of the population has been exposed). Our study quantifies the potential effects of reducing the SARS-CoV-2 infectious period duration.


Assuntos
/tratamento farmacológico , Modelos Biológicos , Pandemias , /epidemiologia , Biologia Computacional , Simulação por Computador , Humanos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Fatores de Tempo , Estados Unidos/epidemiologia , Eliminação de Partículas Virais/efeitos dos fármacos
7.
Hist Philos Life Sci ; 43(1): 4, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33420572

RESUMO

In the ongoing pandemic, death statistics influence people's feelings and government policy. But when does COVID-19 qualify as the cause of death? As philosophers of medicine interested in conceptual clarification, we address the question by analyzing the World Health Organization's rules for the certification of death. We show that for COVID-19, WHO rules take into account both facts (causal chains) and values (the importance of prevention).


Assuntos
/mortalidade , Causas de Morte , Pandemias/estatística & dados numéricos , Filosofia , Organização Mundial da Saúde , Humanos
8.
J Med Libr Assoc ; 109(1): 133-136, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33424475

RESUMO

Internet and communication technologies enable the creation of tremendous amounts of textual, graphic, and pictorial information. User-generated content published through personal web pages, blogs, and social media platforms has not only increased the amount of information available, but also expanded its reach. However, this ubiquity of information and empowerment of its creators leads to potentially controversial, futile, and inaccurate content circulating throughout the world. In the case of the COVID-19 pandemic, this can create false hope, fear, anxiety, harm, and confusion amongst information stakeholders. The World Health Organization recently applied the term "infodemic" to the COVID-19 pandemic. This commentary briefly discusses the current infodemic, its potential consequences, and the role of libraries-specifically health sciences, biomedical, and medical libraries-to help counter the COVID-19 infodemic. The discussion also has relevance for infodemics relating to other health and non-health affairs.


Assuntos
Acesso à Informação , Confiabilidade dos Dados , Guias como Assunto , Bibliotecas Médicas/normas , Pandemias/estatística & dados numéricos , Papel Profissional , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos de Casos Organizacionais , Tennessee
9.
Midwifery ; 92: 102876, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33220602

RESUMO

OBJECTIVE: The rapid pace of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (COVID-19) presents significant challenges to midwives and nurses. This study aimed to explore midwifery and nursing interventions to limit the transmission of COVID-19 among women in their third trimester of pregnancy, to reduce the incidence of nosocomial infection and promote safety of care for women and their infants. METHOD: We completed a retrospective review of medical records from 35 women in their third trimester of pregnancy with SARS-CoV-2, admitted to one hospital in Wuhan, China in January and February 2020. We investigated the clinical characteristics of the COVID-19 infection in pregnancy, and the individualized midwifery and nursing care offered, including environmental protection, prevention of nosocomial infection, maternal observations, monitoring of signs and symptoms of COVID-19, and psychological care. RESULT: Thirty-one women had a caesarean section, and four had vaginal births. Retrospective analysis of midwifery and nursing strategies implemented to care for these women showed no maternal complications or nosocomial infections. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The care strategies we implemented could prevent complications and nosocomial infection in the third trimester of pregnancy, thus ensuring the safety of women and their infants. Further research needs to determine treatment priorities for women infected with COVID-19 during pregnancy and the postnatal period.


Assuntos
/prevenção & controle , Parto Obstétrico/enfermagem , Tocologia/métodos , Complicações Infecciosas na Gravidez/prevenção & controle , Resultado da Gravidez/epidemiologia , Adulto , China , Feminino , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pandemias/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/enfermagem , Terceiro Trimestre da Gravidez , Estudos Retrospectivos
10.
Pediatr Infect Dis J ; 40(1): e39-e41, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33093429

RESUMO

A significant drop was found in the number of hospitalizations due to bacterial infections among children during the first peak period of COVID-19 in Israel. There was a 77% decrease in serious bacterial infections, and ≥50% decrease in most types of bacterial infections, especially osteoarticular and skin infections, followed by pneumonia and ENT infections.


Assuntos
Infecções Bacterianas/epidemiologia , Hospitalização/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Infecções Bacterianas/patologia , Criança , Hospitalização/tendências , Hospitais Pediátricos , Humanos , Incidência , Israel/epidemiologia , Estudos Retrospectivos
11.
J Public Health Manag Pract ; 27 Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward: S43-S56, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32956299

RESUMO

OBJECTIVE: To overcome the absence of national, state, and local public health data on the unequal economic and social burden of COVID-19 in the United States. DESIGN: We analyze US county COVID-19 deaths and confirmed COVID-19 cases and positive COVID-19 tests in Illinois and New York City zip codes by area percent poverty, percent crowding, percent population of color, and the Index of Concentration at the Extremes. SETTING: US counties and zip codes in Illinois and New York City, as of May 5, 2020. MAIN OUTCOME MEASURES: Rates, rate differences, and rate ratios of COVID-19 mortality, confirmed cases, and positive tests by category of county and zip code-level area-based socioeconomic measures. RESULTS: As of May 5, 2020, the COVID-19 death rate per 100 000 person-years equaled the following: 143.2 (95% confidence interval [CI]: 140.9, 145.5) vs 83.3 (95% CI: 78.3, 88.4) in high versus low poverty counties (≥20% vs <5% of persons below poverty); 124.4 (95% CI: 122.7, 126.0) versus 48.2 (95% CI: 47.2, 49.2) in counties in the top versus bottom quintile for household crowding; and 127.7 (95% CI: 126.0, 129.4) versus 25.9 (95% CI: 25.1, 26.6) for counties in the top versus bottom quintile for the percentage of persons who are people of color. Socioeconomic gradients in Illinois confirmed cases and New York City positive tests by zip code-level area-based socioeconomic measures were also observed. CONCLUSIONS: Stark social inequities exist in the United States for COVID-19 outcomes. We recommend that public health departments use these straightforward cost-effective methods to report on social inequities in COVID-19 outcomes to provide an evidence base for policy and resource allocation.


Assuntos
/epidemiologia , Efeitos Psicossociais da Doença , Grupos Étnicos/estatística & dados numéricos , Renda/estatística & dados numéricos , Governo Local , Pandemias/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos , Estudos Transversais , Humanos , Illinois/epidemiologia , Cidade de Nova Iorque/epidemiologia , Fatores Raciais , Estados Unidos/epidemiologia
12.
Med Intensiva ; 45(1): 14-26, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33158594

RESUMO

OBJECTIVE: To describe and compare the demographic characteristics and comorbidities of patients with COVID-19 who died in Spanish hospitals during the 2020 pandemic based on whether they were or were not admitted to an intensive care unit (ICU) prior to death. METHODS: We performed a secondary analysis of COVID-19 patients who died during hospitalization included by 62 Spanish emergency departments in the SIESTA cohort. We collected the demographic characteristics and comorbidities, determined both individually and estimated globally by the Charlson index (ChI). Independent factors related to ICU admission were identified and different analyses of sensitivity were performed to contrast the consistency of the findings of the principal analysis. RESULTS: We included the 338 patients from the SIESTA cohort that died during hospitalization. Of these, 77 (22.8%) were admitted to an ICU before dying. After multivariate adjustment, 3 out of the 20 basal characteristics analyzed in the present study were independently associated with ICU admission: dementia (no patients with dementia who died were admitted to the ICU: OR = 0, 95%CI = not calculable), active cancer (OR = 0.07; 95%CI = 0.02-0.21) and age (< 70 years: OR = 1, reference; 70-74 years: OR = 0.21; 95%CI = 0.08-0.54; 75-79 years: OR = 0.21; 95%CI = 0.08-0.54; ≥ 80 years: OR = 0.02; 95%CI = 0.01-0.05). The probability of ICU admission significantly increased in parallel to the ChI, even after adjustment for age (ChI 0 points: OR = 0, reference; ChI 1 point: OR = 0.36; 95%CI = 0.16-0.83; ChI 2 points: OR = 0.36; 95%CI = 0.16-0.83; ChI >2 points: OR = 0.09; 95%CI = 0.04-0.23). The sensitivity analyses showed no gross differences compared to the principal analysis. CONCLUSIONS: The profile of COVID-19 patients who died without ICU admission is similar to that observed in the usual medical practice before the pandemic. The basal characteristics limiting their admission were age and global burden due to comorbidity, especially dementia and active cancer.


Assuntos
/mortalidade , Mortalidade Hospitalar , Unidades de Terapia Intensiva/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Asma/epidemiologia , Estudos de Coortes , Comorbidade , Intervalos de Confiança , Doença das Coronárias/epidemiologia , Demência/epidemiologia , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Neoplasias/epidemiologia , Razão de Chances , Distribuição por Sexo , Espanha/epidemiologia , Fatores de Tempo
13.
Actas Urol Esp ; 45(1): 39-48, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33168176

RESUMO

PURPOSE: The COVID-19 outbreak has substantially altered residents' training activities. While several new virtual learning programs have been recently implemented, the perspective of urology trainees regarding their usefulness still needs to be investigated. METHODS: A cross-sectional, 30-item, web-based Survey was conducted through Twitter from April 4th, 2020 to April 18th, 2020, aiming to evaluate the urology residents' perspective on smart learning (SL) modalities (pre-recorded videos, webinars, podcasts, and social media [SoMe]), and contents (frontal lessons, clinical case discussions, updates on Guidelines and on clinical trials, surgical videos, Journal Clubs, and seminars on leadership and non-technical skills). RESULTS: Overall, 501 urology residents from 58 countries completed the survey. Of these, 78.4, 78.2, 56.9 and 51.9% of them considered pre-recorded videos, interactive webinars, podcasts and SoMe highly useful modalities of smart learning, respectively. The contents considered as highly useful by the greatest proportion of residents were updates on guidelines (84.8%) and surgical videos (81.0%). In addition, 58.9 and 56.5% of responders deemed seminars on leadership and on non-technical skills highly useful smart learning contents. The three preferred combinations of smart learning modality and content were: pre-recorded surgical videos, interactive webinars on clinical cases, and pre-recorded videos on guidelines. CONCLUSION: Our study provides the first global «big picture¼ of the smart learning modalities and contents that should be prioritized to optimize virtual Urology education. While this survey was conducted during the COVID-19 outbreak, our findings might have even more impact in the future.


Assuntos
/epidemiologia , Educação a Distância/métodos , Internato e Residência , Pandemias/estatística & dados numéricos , Urologia/educação , Adulto , Estudos Transversais , Feminino , Cirurgia Geral/educação , Humanos , Internacionalidade , Internato e Residência/estatística & dados numéricos , Masculino , Inquéritos e Questionários/estatística & dados numéricos , Urologia/estatística & dados numéricos , Webcasts como Assunto
14.
Dtsch Med Wochenschr ; 146(1): e1-e9, 2021 01.
Artigo em Alemão | MEDLINE | ID: mdl-33246350

RESUMO

INTRODUCTION: The effect of non pharmacological interventions (NPIs) during an epidemic disease outbreak is well accepted dating back to historical events. NPIs involve numerous measurements like hygiene rules or contact restriction that are applied during given situations, while so far only limited quantitative data exist to rate the overall effectiveness. METHODS: Using the official counts of Robert Koch Institute in Berlin/Germany, press reports and Twitter messages, the early phase of the current COVID-19/Sars-CoV2 in Bavaria is being reconstructed. RESULTS: The first cases have been observed in Munich by the end of January 2020. While the initial outbreak could be sufficiently covered using isolation and quarantine measurements, the consecutive early spreading falls into three phases, starting with winter school holidays at the end of February, a number of beer festivals in the following week, and general elections on March, 15. The disaster plan on March, 16 indicates the end of the early phase. Using the official case counts, a rather coherent picture evolves although representative epidemiological studies are still missing. The epidemic started with a few cases during the winter holidays, increased exponentially afterwards including significant more cases by beer festivals and another significant excess of cases following the election that occurred in Bavaria only. Compared to other German countries, Bavaria reached the highest prevalence which could not be reversed by even the most restrictive containment measurements. CONCLUSION: To be effective, NPIs need to applied early, if possible even before the beginning of the exponential phase.


Assuntos
Pandemias , /epidemiologia , /prevenção & controle , Alemanha/epidemiologia , História do Século XXI , Férias e Feriados , Humanos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Quarentena
17.
J Theor Biol ; 510: 110539, 2021 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-33242489

RESUMO

Motivated by the current COVID-19 epidemic, this work introduces an epidemiological model in which separate compartments are used for susceptible and asymptomatic "socially distant" populations. Distancing directives are represented by rates of flow into these compartments, as well as by a reduction in contacts that lessens disease transmission. The dynamical behavior of this system is analyzed, under various different rate control strategies, and the sensitivity of the basic reproduction number to various parameters is studied. One of the striking features of this model is the existence of a critical implementation delay (CID) in issuing distancing mandates: while a delay of about two weeks does not have an appreciable effect on the peak number of infections, issuing mandates even slightly after this critical time results in a far greater incidence of infection. Thus, there is a nontrivial but tight "window of opportunity" for commencing social distancing in order to meet the capacity of healthcare resources. However, if one wants to also delay the timing of peak infections - so as to take advantage of potential new therapies and vaccines - action must be taken much faster than the CID. Different relaxation strategies are also simulated, with surprising results. Periodic relaxation policies suggest a schedule which may significantly inhibit peak infective load, but that this schedule is very sensitive to parameter values and the schedule's frequency. Furthermore, we considered the impact of steadily reducing social distancing measures over time. We find that a too-sudden reopening of society may negate the progress achieved under initial distancing guidelines, but the negative effects can be mitigated if the relaxation strategy is carefully designed.


Assuntos
/epidemiologia , Modelos Biológicos , Pandemias , Infecções Assintomáticas/epidemiologia , Número Básico de Reprodução/estatística & dados numéricos , /transmissão , Suscetibilidade a Doenças/epidemiologia , Humanos , Conceitos Matemáticos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Biologia de Sistemas , Fatores de Tempo
18.
Am J Hosp Palliat Care ; 38(2): 191-198, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33021094

RESUMO

Advance care directives (ACDs) are instructions regarding what types of medical treatments a patient desires and/or who they would like to designate as a healthcare surrogate to make important healthcare decisions when the patient is mentally incapacitated. At end-of-life, when faced with poor prognosis for a meaningful health-related quality of life, most patients indicate their preference to abstain from aggressive, life-sustaining treatments. Patients whose wishes are left unsaid often receive burdensome life sustain therapy by default, prolonging patient suffering. The CoVID pandemic has strained our healthcare resources and raised the need for prioritization of life-sustaining therapy. This highlights the urgency of ACDs more than ever. Despite ACDs' potential to provide patients with care that aligns with their values and preferences and reduce resource competition, there has been relatively little conversation regarding the overlap of ACDs and CoVID-19. There is low uptake among patients, lack of training for healthcare professionals, and inequitable adoption in vulnerable populations. However, solutions are forthcoming and may include electronic medical record completion, patient outreach efforts, healthcare worker programs to increase awareness of at-risk minority patients, and restructuring of incentives and reimbursement policies. This review carefully describes the above challenges and unique opportunities to address them in the CoVID-19 era. If solutions are leveraged appropriately, ACDs have the potential to address the described challenges and ethically resolve resource conflicts during the current crisis and beyond.


Assuntos
Planejamento Antecipado de Cuidados/organização & administração , Diretivas Antecipadas/psicologia , Estado Terminal/psicologia , Tomada de Decisões , Humanos , Pandemias/estatística & dados numéricos , Relações Profissional-Paciente , Qualidade de Vida/psicologia
20.
J Public Health Manag Pract ; 27 Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward: S5-S10, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33239557

RESUMO

Two polls were conducted by an independent polling firm in September 2018 and July 2020 to assess public perceptions of public health departments and services among voters in the United States. The poll also sought to uncover changes in perception before and after the onset of COVID-19. A random sample was drawn from state voter files proportional to the national registered voter population by state, with quotas set by specific demographics to ensure representativeness. Overall, 1800 individuals participated between the 2 polls and weights were used in the analysis to adjust for nonresponse. From 2018 to 2020, respondents' familiarity with local public health departments rose 11% and their perception of the importance of the public health department to community health increased by 16%. In addition, support for public health departments and services differed significantly by political affiliation. In 2020, 85% of Democrats perceived the public health department to be very important while only 62% of their Republican counterparts felt similarly. Public health advocates have a unique opportunity to demand sustained funding for public health as American voters are more familiar and supportive of public health departments now than they were before the pandemic. In addition, policy makers, elected officials, and political candidates have the opportunity to leverage these data to fight for the health of their communities.


Assuntos
/prevenção & controle , Pandemias/legislação & jurisprudência , Pandemias/prevenção & controle , Política , Saúde Pública/legislação & jurisprudência , Saúde Pública/normas , Opinião Pública , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/estatística & dados numéricos , Estados Unidos/epidemiologia
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