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1.
Artigo em Inglês | MEDLINE | ID: mdl-33435462

RESUMO

The consequences of the COVID-19 pandemic on behavioral health, including tobacco use, are not fully known. The current study sought to measure the perceived impact of COVID-19 and the resulting stay-at-home orders in Philadelphia, Pennsylvania and Buffalo, New York on smokers enrolled in four smoking cessation trials between March 2020 and July 2020. The survey collected quantitative data regarding life changes due to COVID-19, health/exposure status, and the impact on their cessation attempt (e.g., motivation to quit, change in triggers). The questionnaire collected qualitative data to better understand how such changes could explain changes in smoking behavior. Of the 42 participants surveyed, approximately half indicated that COVID-19 changed their motivation and ability to quit or remain quit. Among those who reported that it was easier to quit following the stay-at-home orders (n = 24), most attributed this to concerns regarding the severity of COVID-19 among smokers. Among those who reported more difficulty quitting (n = 15), most attributed this to their increased stress due to the pandemic and the inability to access activities, places, or people that could help them manage triggers. Given public health warnings of continued surges in COVID-19, these data provide insight into who may benefit from further smoking cessation support should existing restrictions or new stay-at-home orders be enacted.


Assuntos
Motivação , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fumantes , Abandono do Hábito de Fumar/estatística & dados numéricos , Humanos , New York/epidemiologia , Pandemias , Philadelphia/epidemiologia , Inquéritos e Questionários
2.
Spat Spatiotemporal Epidemiol ; 36: 100401, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33509436

RESUMO

Surveillance data obtained by public health agencies for COVID-19 are likely inaccurate due to undercounting and misdiagnosing. Using a Bayesian approach, we sought to reduce bias in the estimates of prevalence of COVID-19 in Philadelphia, PA at the ZIP code level. After evaluating various modeling approaches in a simulation study, we estimated true prevalence by ZIP code with and without conditioning on an area deprivation index (ADI). As of June 10, 2020, in Philadelphia, the observed citywide period prevalence was 1.5%. After accounting for bias in the surveillance data, the median posterior citywide true prevalence was 2.3% when accounting for ADI and 2.1% when not. Overall the median posterior surveillance sensitivity and specificity from the models were similar, about 60% and more than 99%, respectively. Surveillance of COVID-19 in Philadelphia tends to understate discrepancies in burden for the more affected areas, potentially misinforming mitigation priorities.


Assuntos
Teorema de Bayes , Vigilância da População , Análise Espacial , Viés , Humanos , Philadelphia/epidemiologia , Prevalência , Sensibilidade e Especificidade
4.
Artigo em Inglês | MEDLINE | ID: mdl-33352953

RESUMO

This study investigated the geographic variation and the clustering of lung cancer incidence rates in Philadelphia and the surrounding areas using addresses at the time of diagnosis. Using 60,844 cases from Pennsylvania Cancer Registry, we calculated and mapped the age-adjusted incidence rates for five Pennsylvania (PA) counties near Philadelphia between 1998-2007 and 2008-2017. We identified ZIP codes with significantly higher incidence rates than the state rates and examined their demographic and exposure characteristics. Further, we tested for spatial autocorrelation and identified spatial clusters using Moran's I statistic. Our results showed that approximately one in four ZIP codes had an incidence rate that was significantly higher than the PA state rate in each period studied. Clusters of higher incidences were detected in the southeastern part of PA bordering New Jersey. These areas tended to be more populated, of lower socioeconomic status, and closer to manufacturing facilities and major highways. Possibly driven by the community and environmental factors, the observed differences in disease incidence suggest the importance of including residential location in risk assessment tools for lung cancer.


Assuntos
Neoplasias Pulmonares , Análise por Conglomerados , Humanos , Incidência , Neoplasias Pulmonares/epidemiologia , New Jersey/epidemiologia , Philadelphia/epidemiologia
5.
BMC Public Health ; 20(1): 1363, 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32891137

RESUMO

BACKGROUND: Chlamydia screening in high schools offers a way to reach adolescents outside of a traditional clinic setting. Using transmission dynamic modeling, we examined the potential impact of high-school-based chlamydia screening programs on the burden of infection within intervention schools and surrounding communities, under varying epidemiological and programmatic conditions. METHODS: A chlamydia transmission model was calibrated to epidemiological data from three different settings. Philadelphia and Chicago are two high-burden cities with existing school-based screening programs. Rural Iowa does not have an existing program but represents a low-burden setting. We modeled the effects of the two existing programs to analyze the potential influence of program coverage and student participation. All three settings were used to examine a broader set of hypothetical programs with varying coverage levels and time trends in participation. RESULTS: In the modeled Philadelphia program, prevalence among the intervention schools' sexually active 15-18 years old population was 4.34% (95% credible interval 3.75-4.71%)after 12 program years compared to 5.03% (4.39-5.43%) in absence of the program. In the modeled Chicago program, prevalence was estimated as 5.97% (2.60-7.88%) after 4 program years compared to 7.00% (3.08-9.29%) without the program. In the broader hypothetical scenarios including both high-burden and low-burden settings, impact of school-based screening programs was greater in absolute terms in the higher-prevalence settings, and benefits in the community were approximately proportional to population coverage of intervention schools. Most benefits were garnered if the student participation did not decline over time. CONCLUSIONS: Sustained high student participation in school-based screening programs and broad coverage of schools within a target community are likely needed to maximize program benefits in terms of reduced burden of chlamydia in the adolescent population.


Assuntos
Infecções por Chlamydia/prevenção & controle , Chlamydia trachomatis , Programas de Rastreamento , Serviços de Saúde Escolar , Instituições Acadêmicas , Estudantes , Adolescente , Chicago/epidemiologia , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Feminino , Humanos , Iowa/epidemiologia , Masculino , Modelos Teóricos , Aceitação pelo Paciente de Cuidados de Saúde , Philadelphia/epidemiologia , Prevalência
6.
Respir Res ; 21(1): 236, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938445

RESUMO

BACKGROUND: Spontaneous pneumothorax is an uncommon complication of COVID-19 viral pneumonia. The exact incidence and risk factors are still unknown. Herein we review the incidence and outcomes of pneumothorax in over 3000 patients admitted to our institution for suspected COVID-19 pneumonia. METHODS: We performed a retrospective review of COVID-19 cases admitted to our hospital. Patients who were diagnosed with a spontaneous pneumothorax were identified to calculate the incidence of this event. Their clinical characteristics were thoroughly documented. Data regarding their clinical outcomes were gathered. Each case was presented as a brief synopsis. RESULTS: Three thousand three hundred sixty-eight patients were admitted to our institution between March 1st, 2020 and June 8th, 2020 for suspected COVID 19 pneumonia, 902 patients were nasopharyngeal swab positive. Six cases of COVID-19 patients who developed spontaneous pneumothorax were identified (0.66%). Their baseline imaging showed diffuse bilateral ground-glass opacities and consolidations, mostly in the posterior and peripheral lung regions. 4/6 cases were associated with mechanical ventilation. All patients required placement of a chest tube. In all cases, mortality (66.6%) was not directly related to the pneumothorax. CONCLUSION: Spontaneous pneumothorax is a rare complication of COVID-19 viral pneumonia and may occur in the absence of mechanical ventilation. Clinicians should be vigilant about the diagnosis and treatment of this complication.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pneumotórax/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/patogenicidade , Causas de Morte , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Evolução Fatal , Feminino , Interações Hospedeiro-Patógeno , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Philadelphia/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Pneumotórax/diagnóstico , Pneumotórax/terapia , Pneumotórax/virologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
Curr Opin Ophthalmol ; 31(5): 423-426, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32740065

RESUMO

PURPOSE OF REVIEW: The aim of this study was to report characteristics of patients presenting with serious ocular injuries during the COVID-19 stay-at-home orders. RECENT FINDINGS: Of 1058 patients presenting for emergency evaluation during the stay-at-home order, 62 (5.9%) patients [mean (SD) age, 41.1 (19.2) years; 19 (31%) women; 31 (50%) white] presented with severe ocular trauma. The daily mean (SD) number of patients who presented for emergency evaluation decreased from 49.0 (9) to 36.4 (6) during the quarantine (P < 0.001). Patients presenting during the stay-at-home order were less likely to have health insurance [odds ratio (OR), 0.33; 95% confidence interval (95% CI), 0.13-0.90, P = 0.024], more likely to have a delayed presentation (difference, 22.7 h, 95% CI, 5.8-39.5, P < 0.001, more likely to travel farther to seek emergency care (difference, 10.4 miles, 95% CI, 2.6-18.2, P < 0.001) and more likely to have an injury occur at home (OR, 22.8; 95% CI, 9.6-54.2, P < 0.001). Of injuries occurring at home, there was a significant increase in injuries arising from home improvement projects during the stay-at-home order (28 vs. 0%, P = 0.02). SUMMARY: During the COVID-19 pandemic, patients with ocular trauma were more likely to have injuries sustained at home and have additional barriers to care. These changes underscore a need for targeted interventions to optimize emergent eye care during a pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Traumatismos Oculares/epidemiologia , Pneumonia Viral/epidemiologia , Quarentena , Adulto , Assistência à Saúde , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/prevenção & controle , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Philadelphia/epidemiologia , Estudos Retrospectivos , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-32756321

RESUMO

Stress has been shown to adversely affect pregnancy outcomes. Neighborhood crime rates may serve as one publicly available social determinant of health for pregnancy studies that use registry or electronic health record datasets in which individual-level stress data are not available. We sought to determine whether neighborhood violent crime incidents were associated with measured perceived stress in a largely minority, urban pregnancy cohort. We performed a secondary analysis of the 1309 Philadelphia residents participating in the Motherhood and Microbiome cohort (n = 2000) with both neighborhood violent crime and Cohen's Perceived Stress Scale (PSS-14) data. Generalized linear mixed models accounting for confounding variables and geographic clustering demonstrated that, regardless of race, women with the highest quartile of neighborhood violent crime had significantly elevated odds of high stress compared to women with lower crime. We also found that Black women were more likely to have both the highest quartile of neighborhood violent crime and high stress than non-Black women. Overall, this study demonstrates that neighborhood violent crime is associated with perceived stress in pregnancy. Given disparate exposure to crime and prenatal stress by race, future work is warranted to determine whether urban neighborhood violence and/or stress reduction strategies would improve birth outcome racial disparities.


Assuntos
Crime , Características de Residência , Estresse Psicológico , Violência , Adulto , Afro-Americanos , Feminino , Humanos , Philadelphia/epidemiologia , Gravidez/psicologia , Adulto Jovem
9.
J Allergy Clin Immunol Pract ; 8(10): 3378-3387.e11, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32827728

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused dramatic changes in daily routines and health care utilization and delivery patterns in the United States. Understanding the influence of these changes and associated public health interventions on asthma care is important to determine effects on patient outcomes and identify measures that will ensure optimal future health care delivery. OBJECTIVE: We sought to identify changes in pediatric asthma-related health care utilization, respiratory viral testing, and air pollution during the COVID-19 pandemic. METHODS: For the time period January 17 to May 17, 2015 to 2020, asthma-related encounters and weekly summaries of respiratory viral testing data were extracted from Children's Hospital of Philadelphia electronic health records, and pollution data for 4 criteria air pollutants were extracted from AirNow. Changes in encounter characteristics, viral testing patterns, and air pollution before and after Mar 17, 2020, the date public health interventions to limit viral transmission were enacted in Philadelphia, were assessed and compared with data from 2015 to 2019 as a historical reference. RESULTS: After March 17, 2020, in-person asthma encounters decreased by 87% (outpatient) and 84% (emergency + inpatient). Video telemedicine, which was not previously available, became the most highly used asthma encounter modality (61% of all visits), and telephone encounters increased by 19%. Concurrently, asthma-related systemic steroid prescriptions and frequency of rhinovirus test positivity decreased, although air pollution levels did not substantially change, compared with historical trends. CONCLUSIONS: The COVID-19 pandemic in Philadelphia was accompanied by changes in pediatric asthma health care delivery patterns, including reduced admissions and systemic steroid prescriptions. Reduced rhinovirus infections may have contributed to these patterns.


Assuntos
Poluição do Ar/estatística & dados numéricos , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Serviços de Saúde da Criança/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Infecções por Adenovirus Humanos/diagnóstico , Infecções por Adenovirus Humanos/epidemiologia , Adolescente , Corticosteroides/uso terapêutico , Assistência Ambulatorial/estatística & dados numéricos , Asma/fisiopatologia , Betacoronavirus , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Infecções por Coronaviridae/diagnóstico , Infecções por Coronaviridae/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Pediátricos , Humanos , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Masculino , Dióxido de Nitrogênio , Ozônio , Pandemias/prevenção & controle , Infecções por Paramyxoviridae/diagnóstico , Infecções por Paramyxoviridae/epidemiologia , Material Particulado , Philadelphia/epidemiologia , Infecções por Picornaviridae/diagnóstico , Infecções por Picornaviridae/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/epidemiologia , Telemedicina/estatística & dados numéricos , Telefone , Comunicação por Videoconferência
10.
Public Health Rep ; 135(5): 691-699, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32791034

RESUMO

OBJECTIVES: Although many people who use drugs meet criteria for vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV), estimates of susceptibility (ie, lack of immunity) are not well established. This study sought to identify the prevalence of and characteristics associated with HAV and HBV susceptibility among people who use drugs attending an urban syringe services program. METHODS: We initiated this seroprevalence study in 2018 among 438 clients of a syringe services program who met study criteria, including provision of a blood specimen and a self-reported history of drug use. We assessed HAV and HBV susceptibility and infection via serological testing. We examined associations between participant characteristics and serology status by using descriptive statistics and multivariable logistic regression models. RESULTS: Of the initial 438 clients identified, 353 (80.6%) met study criteria. Of 352 participants with conclusive HAV test results, 48.6% (n = 171) were HAV susceptible; of 337 participants with conclusive HBV test results, 32.6% (n = 110) were HBV susceptible, 24.3% (n = 82) showed evidence of past or present HBV infection, and 43.0% (n = 145) had vaccine-derived immunity. Compared with participants born before 1970, participants born during 1980-1989 had 5.90 (95% CI, 2.42-14.40) times the odds of HAV susceptibility and 0.18 (95% CI, 0.06-0.53) times the odds of HBV susceptibility, and participants born during 1990-1999 had 6.31 (95% CI, 2.34-17.00) times the odds of HAV susceptibility. Decreased odds of HAV susceptibility were associated with homelessness (adjusted odds ratio = 0.48; 95% CI, 0.28-0.82). CONCLUSION: Despite applicable HAV and HBV vaccination recommendations, substantial gaps exist in HAV and HBV susceptibility among a population of people who use drugs. These findings highlight the need for increased HAV and HBV vaccination efforts among people who use drugs.


Assuntos
Suscetibilidade a Doenças , Usuários de Drogas/estatística & dados numéricos , Hepatite A/epidemiologia , Hepatite B/epidemiologia , Programas de Troca de Agulhas/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Philadelphia/epidemiologia , Fatores de Risco , População Urbana/estatística & dados numéricos , Adulto Jovem
11.
BMJ Open Respir Res ; 7(1)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32847947

RESUMO

Invasive mechanical has been associated with high mortality in COVID-19. Alternative therapy of high flow nasal therapy (HFNT) has been greatly debated around the world for use in COVID-19 pandemic due to concern for increased healthcare worker transmission.This was a retrospective analysis of consecutive patients admitted to Temple University Hospital in Philadelphia, Pennsylvania, from 10 March 2020 to 24 April 2020 with moderate-to-severe respiratory failure treated with HFNT. Primary outcome was prevention of intubation. Of the 445 patients with COVID-19, 104 met our inclusion criteria. The average age was 60.66 (+13.50) years, 49 (47.12 %) were female, 53 (50.96%) were African-American, 23 (22.12%) Hispanic. Forty-three patients (43.43%) were smokers. Saturation to fraction ratio and chest X-ray scores had a statistically significant improvement from day 1 to day 7. 67 of 104 (64.42%) were able to avoid invasive mechanical ventilation in our cohort. Incidence of hospital-associated/ventilator-associated pneumonia was 2.9%. Overall, mortality was 14.44% (n=15) in our cohort with 13 (34.4%) in the progressed to intubation group and 2 (2.9%) in the non-intubation group. Mortality and incidence of pneumonia was statistically higher in the progressed to intubation group. CONCLUSION: HFNT use is associated with a reduction in the rate of invasive mechanical ventilation and overall mortality in patients with COVID-19 infection.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Associada a Assistência à Saúde/epidemiologia , Hipóxia/terapia , Intubação Intratraqueal/estatística & dados numéricos , Oxigenoterapia/métodos , Pneumonia Viral/terapia , Insuficiência Respiratória/terapia , Corticosteroides/uso terapêutico , Afro-Americanos , Idoso , Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Azitromicina/uso terapêutico , Betacoronavirus , Cânula , Comorbidade , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/epidemiologia , Grupo com Ancestrais do Continente Europeu , Feminino , Cardiopatias/epidemiologia , Hispano-Americanos , Humanos , Hidroxicloroquina/uso terapêutico , Hipertensão/epidemiologia , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Philadelphia/epidemiologia , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Viral/epidemiologia , Pulsoterapia , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fumar/epidemiologia
12.
Sci Immunol ; 5(49)2020 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-32727884

RESUMO

Limited data are available for pregnant women affected by SARS-CoV-2. Serological tests are critically important for determining SARS-CoV-2 exposures within both individuals and populations. We validated a SARS-CoV-2 spike receptor binding domain serological test using 834 pre-pandemic samples and 31 samples from COVID-19 recovered donors. We then completed SARS-CoV-2 serological testing of 1,293 parturient women at two centers in Philadelphia from April 4 to June 3, 2020. We found 80/1,293 (6.2%) of parturient women possessed IgG and/or IgM SARS-CoV-2-specific antibodies. We found race/ethnicity differences in seroprevalence rates, with higher rates in Black/non-Hispanic and Hispanic/Latino women. Of the 72 seropositive women who also received nasopharyngeal polymerase chain reaction testing during pregnancy, 46 (64%) were positive. Continued serologic surveillance among pregnant women may inform perinatal clinical practices and can potentially be used to estimate exposure to SARS-CoV-2 within the community.


Assuntos
Anticorpos Antivirais/sangue , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Disparidades nos Níveis de Saúde , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Afro-Americanos/estatística & dados numéricos , Anticorpos Antivirais/imunologia , Betacoronavirus/imunologia , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Estudos de Coortes , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Pandemias , Philadelphia/epidemiologia , Pneumonia Viral/sangue , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/imunologia , Complicações Infecciosas na Gravidez/virologia , Domínios Proteicos/imunologia , Estudos Soroepidemiológicos , Glicoproteína da Espícula de Coronavírus/imunologia , Adulto Jovem
13.
J Trauma Acute Care Surg ; 89(4): 821-828, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32618967
14.
Ann Surg ; 272(2): e168-e169, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675529

RESUMO

: The spread of COVID-19 has challenged practices across the United States to dramatically change inpatient and outpatient practices to focus on containing spread of the virus and accommodate the anticipated increase in volume of acute illness. Despite this transition, practices will need to continue to accommodate evaluation of newly diagnosed malignancies, routine postoperative visits, and acute postoperative issues. Building on an existing telemedicine framework, we aim to describe rapid transition in our outpatient care to a telehealth model in a general thoracic surgery practice during COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Telemedicina/organização & administração , Cirurgia Torácica , Betacoronavirus , Humanos , Pandemias , Philadelphia/epidemiologia
15.
Stroke ; 51(9): e219-e222, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32684145

RESUMO

BACKGROUND AND PURPOSE: Initial reports suggest a significant risk of thrombotic events, including stroke, in patients hospitalized with coronavirus disease 2019 (COVID-19). However, there is little systematic data on stroke incidence and mechanisms, particularly in racially diverse populations in the United States. METHODS: We performed a retrospective, observational study of stroke incidence and mechanisms in all patients with COVID-19 hospitalized from March 15 to May 3, 2020, at 3 Philadelphia hospitals. RESULTS: We identified 844 hospitalized patients with COVID-19 (mean age 59 years, 52% female, 68% Black); 20 (2.4%) had confirmed ischemic stroke; and 8 (0.9%) had intracranial hemorrhage. Of the ischemic stroke patients, mean age was 64 years, with only one patient (5%) under age 50, and 80% were Black. Conventional vascular risk factors were common, with 95% of patients having a history of hypertension and 60% a history of diabetes mellitus. Median time from onset of COVID symptoms to stroke diagnosis was 21 days. Stroke mechanism was cardioembolism in 40%, small vessel disease in 5%, other determined mechanism in 20%, and cryptogenic in 35%. Of the 11 patients with complete vascular imaging, 3 (27%) had large vessel occlusion. Newly positive antiphospholipid antibodies were present in >75% of tested patients. Of the patients with intracranial hemorrhage, 5/8 (63%) were lobar intraparenchymal hemorrhages, and 3/8 (38%) were subarachnoid hemorrhage; 4/8 (50%) were on extracorporeal membrane oxygenation. CONCLUSIONS: We found a low risk of acute cerebrovascular events in patients hospitalized with COVID-19. Most patients with ischemic stroke had conventional vascular risk factors, and traditional stroke mechanisms were common.


Assuntos
Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Grupo com Ancestrais do Continente Africano , Idoso , Isquemia Encefálica/complicações , Isquemia Encefálica/epidemiologia , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Hipertensão/complicações , Incidência , Pacientes Internados , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Philadelphia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Trombose/complicações , Trombose/epidemiologia
16.
BMC Med Res Methodol ; 20(1): 146, 2020 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-32505172

RESUMO

BACKGROUND: Despite widespread use, the accuracy of the diagnostic test for SARS-CoV-2 infection is poorly understood. The aim of our work was to better quantify misclassification errors in identification of true cases of COVID-19 and to study the impact of these errors in epidemic curves using publicly available surveillance data from Alberta, Canada and Philadelphia, USA. METHODS: We examined time-series data of laboratory tests for SARS-CoV-2 viral infection, the causal agent for COVID-19, to try to explore, using a Bayesian approach, the sensitivity and specificity of the diagnostic test. RESULTS: Our analysis revealed that the data were compatible with near-perfect specificity, but it was challenging to gain information about sensitivity. We applied these insights to uncertainty/bias analysis of epidemic curves under the assumptions of both improving and degrading sensitivity. If the sensitivity improved from 60 to 95%, the adjusted epidemic curves likely falls within the 95% confidence intervals of the observed counts. However, bias in the shape and peak of the epidemic curves can be pronounced, if sensitivity either degrades or remains poor in the 60-70% range. In the extreme scenario, hundreds of undiagnosed cases, even among the tested, are possible, potentially leading to further unchecked contagion should these cases not self-isolate. CONCLUSION: The best way to better understand bias in the epidemic curves of COVID-19 due to errors in testing is to empirically evaluate misclassification of diagnosis in clinical settings and apply this knowledge to adjustment of epidemic curves.


Assuntos
Teorema de Bayes , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Pandemias , Pneumonia Viral , Alberta/epidemiologia , Betacoronavirus/patogenicidade , Viés , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Philadelphia/epidemiologia , Sensibilidade e Especificidade , Incerteza
17.
J Vasc Surg ; 72(4): 1178-1183, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32561268

RESUMO

We established the Co-Operative Vascular Intervention Disease (COVID) Team of Greater Philadelphia because national guidelines may not apply to different geographic areas of the United States owing to varying penetrance of the virus. On April 10, 2020, a 10-question survey regarding issues and strategies dealing with COVID-19 was e-mailed to 58 vascular surgeons (VSs) in the Greater Philadelphia area. Fifty-four VSs in 18 surgical groups covering 28 hospitals responded. All groups accepted transfers because of continued availability of intensive care unit beds. Thirteen groups were asked to "redeploy" if the need arose to function outside of the usual duties of a VS. None imposed age restrictions regarding older VSs continuing clinical hospital work. The majority restricted noninvasive vascular laboratory studies to those studies for which findings might mandate intervention within 2 or 3 weeks, restricted dialysis access operations to urgent revisions of arteriovenous fistulas or grafts that were failing or had ulcerations, converted from in-person to telemedicine clinic interactions, and experienced moderate-severe anxiety or fear about personal COVID-19 exposure in the hospital. The majority of VSs in the Philadelphia area dramatically adjusted their clinical practices before the COVID-19 crisis reached peak levels experienced in other metropolitan areas.


Assuntos
Comportamento Cooperativo , Infecções por Coronavirus/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Controle de Infecções/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/terapia , Regionalização/organização & administração , Procedimentos Cirúrgicos Vasculares/organização & administração , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Pesquisas sobre Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde/organização & administração , Interações Hospedeiro-Patógeno , Humanos , Comunicação Interdisciplinar , Saúde do Trabalhador , Pandemias , Segurança do Paciente , Philadelphia/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia
19.
West J Emerg Med ; 21(3): 684-687, 2020 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-32421520

RESUMO

INTRODUCTION: Mechanical ventilation is a commonly performed procedure in the emergency department (ED). Approximately 240,000 patients per year receive mechanical ventilation in the ED representing 0.23% of ED visits. An ED-based trial published in 2017 showed that a bundle of interventions in mechanically ventilated patients, including low tidal volume ventilation, reduced the development of acute respiratory distress syndrome by nearly 50%. Prior literature has shown that as many as 40% of ED patients do not receive lung protective ventilation. Our goal was to determine whether differences exist between the percent of males vs females who are ventilated at ≥ 8 milliliters per kilogram (mL/kg) of predicted body weight. METHODS: We conducted this study at Temple University Hospital, a tertiary care center located in Philadelphia, Pennsylvania. This was a planned subgroup analysis of study looking at interventions to improve adherence to recommended tidal volume settings. We used a convenience sample of mechanically ventilated patients in our ED between September 1, 2017, and September 30, 2018. All adult patient > 18 years old were eligible for inclusion in the study. Our primary outcome measure was the number of patients who had initial tidal volumes set at > 8 mL/kg of predicted body weight. Our secondary outcome was the number of patients who had tidal volumes set at ≥ 8 mL/kg at 60 minutes after initiation of mechanical ventilation. RESULTS: A total of 130 patients were included in the final analysis. We found that significantly more females were initially ventilated with tidal volumes ≥ 8 mL/kg compared to men: 56% of females vs 9% of males (p=<0.001). Data was available for 107 patients (82%) who were in the ED at 60 minutes after initiation of mechanical ventilation. Again, a significantly larger percentage of females were ventilated with tidal volumes ≥ 8 mL/kg at 60 minutes: 56% of females vs 10% of males (p<0.001). CONCLUSION: The vast majority of tidal volumes ≥ 8 mL/kg during mechanical ventilation occurs in females. We suggest that objective measurements, such as a tape measure and tidal volume card, be used when setting tidal volumes for all patients, especially females.


Assuntos
Respiração Artificial , Volume de Ventilação Pulmonar/fisiologia , Lesão Pulmonar Induzida por Ventilação Mecânica , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Philadelphia/epidemiologia , Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , Respiração Artificial/normas , /terapia , Fatores Sexuais , Centros de Atenção Terciária/estatística & dados numéricos , Lesão Pulmonar Induzida por Ventilação Mecânica/epidemiologia , Lesão Pulmonar Induzida por Ventilação Mecânica/etiologia , Lesão Pulmonar Induzida por Ventilação Mecânica/fisiopatologia , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle
20.
Am J Public Health ; 110(6): 863-867, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32298172

RESUMO

Objectives. To quantify the impact of a citywide bicycle share program on rates of motor vehicle collisions involving a bicycle.Methods. We conducted an interrupted time series analysis, using crash records from the Pennsylvania Department of Transportation for Philadelphia County from 2010 through 2018. We also calculated summary statistics to illustrate annual and monthly trends in rates of motor vehicle crashes involving a bicycle.Results. The baseline rate of bike events was 106% greater (95% confidence interval [CI] = 1.25, 3.38) at the time bicycle share was implemented compared with January 2010. Before bicycle share implementation, the rate of bicycle events decreased 1% (95% CI = 0.95, 1.03) annually. After the bicycle share program started, the rate of bicycle events decreased 13% (95% CI = 0.82, 0.94) annually.Conclusions. In the long term, programs that increase the number of bicycles on the road, such as bike share, may reduce rates of motor vehicle crashes involving a bicycle.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Automóveis/estatística & dados numéricos , Ciclismo/estatística & dados numéricos , Transportes , Acidentes de Trânsito/prevenção & controle , Humanos , Análise de Séries Temporais Interrompida , Philadelphia/epidemiologia , Transportes/métodos , Transportes/estatística & dados numéricos
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