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1.
Nat Med ; 27(1): 136-140, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33442014

RESUMO

Underserved populations experience higher levels of pain. These disparities persist even after controlling for the objective severity of diseases like osteoarthritis, as graded by human physicians using medical images, raising the possibility that underserved patients' pain stems from factors external to the knee, such as stress. Here we use a deep learning approach to measure the severity of osteoarthritis, by using knee X-rays to predict patients' experienced pain. We show that this approach dramatically reduces unexplained racial disparities in pain. Relative to standard measures of severity graded by radiologists, which accounted for only 9% (95% confidence interval (CI), 3-16%) of racial disparities in pain, algorithmic predictions accounted for 43% of disparities, or 4.7× more (95% CI, 3.2-11.8×), with similar results for lower-income and less-educated patients. This suggests that much of underserved patients' pain stems from factors within the knee not reflected in standard radiographic measures of severity. We show that the algorithm's ability to reduce unexplained disparities is rooted in the racial and socioeconomic diversity of the training set. Because algorithmic severity measures better capture underserved patients' pain, and severity measures influence treatment decisions, algorithmic predictions could potentially redress disparities in access to treatments like arthroplasty.


Assuntos
Algoritmos , Dor/fisiopatologia , Populações Vulneráveis , Idoso , Aprendizado Profundo , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Medição da Dor , Fatores Raciais/estatística & dados numéricos , Índice de Gravidade de Doença , Fatores Socioeconômicos , Populações Vulneráveis/estatística & dados numéricos
3.
Int J Equity Health ; 19(1): 224, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334344

RESUMO

BACKGROUND: The COVID-19 crisis in India negatively impacted mental health due to both the disease and the harsh lockdown, yet there are almost no qualitative studies describing mental health impacts or the strategies of resilience used, and in particular, no reports from the most vulnerable groups. This study aimed to examine the acute mental health impacts of the COVID-19 crisis as well as coping strategies employed by disadvantaged community members in North India. METHODS: We used an intersectional lens for this qualitative study set in rural Tehri Garwhal and urban Dehradun districts of Uttarakhand, India. In-depth interviews were conducted in May 2020 during lockdown, by phone and in person using purposive selection, with people with disabilities, people living in slums with psychosocial disabilities and widows (total n = 24). We used the framework method for analysis following steps of transcription and translation, familiarisation, coding, developing and then applying a framework, charting and then interpreting data. FINDINGS: The participants with compounded disadvantage had almost no access to mobile phones, health messaging or health care and experienced extreme mental distress and despair, alongside hunger and loss of income. Under the realms of intrapersonal, interpersonal and social, six themes related to mental distress emerged: feeling overwhelmed and bewildered, feeling distressed and despairing, feeling socially isolated, increased events of othering and discrimination, and experiencing intersectional disadvantage. The six themes summarising coping strategies in the COVID-19 crisis were: finding sense and meaning, connecting with others, looking for positive ways forward, innovating with new practices, supporting others individually and collectively, and engaging with the natural world. CONCLUSIONS: People intersectionally disadvantaged by their social identity experienced high levels of mental distress during the COVID-19 crisis, yet did not collapse, and instead described diverse and innovative strategies which enabled them to cope through the COVID-19 lockdown. This study illustrates that research using an intersectional lens is valuable to design equitable policy such as the need for access to digital resources, and that disaggregated data is needed to address social inequities at the intersection of poverty, disability, caste, religious discrimination and gender inherent in the COVID-19 pandemic in India.


Assuntos
Adaptação Psicológica , Transtornos Mentais/psicologia , Quarentena/psicologia , Estresse Psicológico/psicologia , Populações Vulneráveis/psicologia , Doença Aguda , Adulto , Feminino , Humanos , Índia , Masculino , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Pandemias , Pobreza/psicologia , Pesquisa Qualitativa , Estresse Psicológico/complicações , Populações Vulneráveis/estatística & dados numéricos
4.
Front Public Health ; 8: 604339, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33330343

RESUMO

Context: The human development territories have been severely constrained under the Covid-19 pandemic. A common dynamics has been observed, but its propagation has not been homogeneous over each continent. We aimed at characterizing the non-viral parameters that were most associated with death rate. Methods: We tested major indices from five domains (demography, public health, economy, politics, environment) and their potential associations with Covid-19 mortality during the first 8 months of 2020, through a Principal Component Analysis and a correlation matrix with a Pearson correlation test. Data of all countries, or states in federal countries, showing at least 10 fatality cases, were retrieved from official public sites. For countries that have not yet finished the first epidemic phase, a prospective model has been computed to provide options of death rates evolution. Results: Higher Covid death rates are observed in the [25/65°] latitude and in the [-35/-125°] longitude ranges. The national criteria most associated with death rate are life expectancy and its slowdown, public health context (metabolic and non-communicable diseases (NCD) burden vs. infectious diseases prevalence), economy (growth national product, financial support), and environment (temperature, ultra-violet index). Stringency of the measures settled to fight pandemia, including lockdown, did not appear to be linked with death rate. Conclusion: Countries that already experienced a stagnation or regression of life expectancy, with high income and NCD rates, had the highest price to pay. This burden was not alleviated by more stringent public decisions. Inherent factors have predetermined the Covid-19 mortality: understanding them may improve prevention strategies by increasing population resilience through better physical fitness and immunity.


Assuntos
/epidemiologia , Causas de Morte , Expectativa de Vida , Pandemias/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Saúde Global , Humanos , Análise de Componente Principal , Estudos Prospectivos
5.
Rev. enferm. UERJ ; 28: e39729, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1116093

RESUMO

Objetivo: identificar as principais causas de óbito entre adolescentes de 10 a 19 anos em um município no interior do estado do Rio de Janeiro. Método: estudo descritivo, exploratório de abordagem quantitativa, a partir do levantamento de dados em registros de óbitos do município de Rio das Ostras. O desfecho foi causa básica do óbito. Os dados foram processados no Programa R. Resultados: foram observados 84 (100%) óbitos, com maior prevalência entre adolescentes de 17 a 19 anos, 49 (58,3%), do sexo masculino, 71 (84,5%) e de cor parda, 38 (45,2%). As principais causas de óbitos foram homicídio/perfuração por arma de fogo, 35 (41,7%), e acidentes, 32 (38,1%). Conclusão: o reconhecimento dessa vulnerabilidade configura importante caminho para o enfrentamento e resolução desse grave problema, sobretudo municípios localizados longe de centros urbanos, parece muitas vezes esquecido, no que tange o cumprimento de estatutos e políticas públicas a favor desse grupo etário.


Objective: to identify the main causes of death among adolescents aged 10 to 19 years in a municipality in the state of Rio de Janeiro. Method: in this exploratory, descriptive, quantitative study, based on data collected from death records in the municipality of Rio das Ostras, the basic cause of death was the outcome. The data were processed in the statistics software, R. Results: of the 84 (100%) deaths observed, prevalence was higher among adolescents aged 17 to 19 years (49; 58.3%), males (71; 84.5%), and pardos (38; 45.2%). The main causes of deaths were firearm Injury / homicide (35; 41.7%) and accidents (32; 38.1%). Conclusion: one important step towards confronting and solving this serious problem is to acknowledge this vulnerability, especially in municipalities distant from urban centers, which often seem neglected as regards compliance with statutes and public policies in favor of this age group.


Objetivo: identificar las principales causas de muerte entre adolescentes de 10 a 19 años en un municipio del estado de Río de Janeiro. Método: en este estudio exploratorio, descriptivo, cuantitativo, basado en los datos recopilados de los registros de defunciones en el municipio de Rio das Ostras, la causa básica de la muerte fue el resultado. Los datos se procesaron en el programa estadístico R. Resultados: de las 84 (100%) muertes observadas, la prevalencia fue mayor entre los adolescentes de 17 a 19 años (49; 58.3%), varones (71; 84.5%) y pardos (38; 45,2%). Las principales causas de muerte fueron lesiones por arma de fuego / homicidio (35; 41.7%) y accidentes (32; 38.1%). Conclusión: un paso importante para enfrentar y resolver este grave problema es reconocer esta vulnerabilidad, especialmente en municipios alejados de los centros urbanos, que a menudo parecen descuidados en cuanto al cumplimiento de los estatutos y las políticas públicas a favor de este grupo de edad.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Acidentes/estatística & dados numéricos , Causas de Morte , Populações Vulneráveis/estatística & dados numéricos , Homicídio/estatística & dados numéricos , Brasil , Epidemiologia Descritiva , Fatores Etários , Vulnerabilidade Social , Mortalidade Prematura
6.
Ann Glob Health ; 86(1): 135, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33117656

RESUMO

The intersection of digital health platforms and refugee health in the context of the novel 2019 coronavirus disease (COVID-19) has not yet been explored. We discuss the ability of a novel mobile health (mhealth) platform to be effectively adapted to improve health access for vulnerable displaced populations. In a preliminary analysis of 200 Syrian refugee women, we found positive user feedback and uptake of an mhealth application to increase access to preventive maternal and child health services for Syrian refugees under temporary protection in Turkey. Rapid adaptation of this application was successfully implemented during a global pandemic state to perform symptomatic assessment, disseminate health education, and bolster national prevention efforts. We propose that mhealth interventions can provide an innovative, cost-effective, and user-friendly approach to access the dynamic needs of refugees and other displaced populations, particularly during an emerging infectious disease outbreak.


Assuntos
Infecções por Coronavirus/epidemiologia , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Refugiados/estatística & dados numéricos , Telemedicina/organização & administração , Adulto , Criança , Pré-Escolar , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Feminino , Acesso aos Serviços de Saúde/organização & administração , Humanos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Turquia , Populações Vulneráveis/estatística & dados numéricos
9.
PLoS One ; 15(9): e0239163, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946528

RESUMO

BACKGROUND: Trained community workers (CWs) successfully deliver health and social services, especially due to greater community acceptance. Orphans and vulnerable children (OVC) and their caregivers (CG) often need support from several sectors. We identified CW, program and referral characteristics that were associated with success of referrals provided to OVC and their CG in Tanzania in a cross-sectoral bi-directional referral system. METHODS: Data for this secondary analysis come from the first two years (2017-2018) of the USAID funded Kizazi Kipya project. Referral success was defined as feedback and service received within 90 days post-referral provision. We analyzed factors that are associated with the referral success of HIV related, education, nutrition, parenting, household economic strengthening, and child protection services among OVC and CG, using generalized estimating equations. RESULTS: During the study period, 19,502 CWs in 68 councils provided 146,996 referrals to 132,640 beneficiaries. OVC had much lower referral success for HIV related services (48.1%) than CG (81.2%). Adjusted for other covariates, CW age (26-49 versus 18-25 years, for OVC aOR = 0.83, 95%CI (0.78, 0.87) and CW gender (males versus females, for OVC aOR = 1.12, 95%CI (1.08, 1.16); CG aOR = 0.84, 95%CI (0.78, 0.90)) were associated with referral success. CWs who had worked > 1 year in the project (aOR = 1.52, 95%CI 1.46, 1.58) and those with previous work experience as CW (aOR = 1.57, 95%CI (1.42, 1.74) more successfully referred OVC. Referrals provided to OVC for all other services were more successful compared to HIV referrals, with aORs ranging from 2.99 to 7.22. Longer project duration in the district council was associated with increased referral success for OVC (aOR = 1.16 per month 95%CI 1.15,1.17), but decreased for CG (aOR = 0.96, 95%CI 0.94, 0.97). Referral success was higher for OVC and CGs with multiple (versus single) referrals provided within the past 30 days (aOR = 1.28 95%CI 1.21, 1.36) and (aOR = 1.17, 95%CI (1.06, 1.30)) respectively. CONCLUSION: CW characteristics, referral type and project maturity had different and often contrasting associations with referral success for OVC versus for CG. These findings could help policymakers decide on the recruitment and allocation of CWs in community based multi-sectoral intervention programs to improve referral successes especially for OVC.


Assuntos
Bem-Estar da Criança , Crianças Órfãs/estatística & dados numéricos , Agentes Comunitários de Saúde/organização & administração , Encaminhamento e Consulta/organização & administração , Serviço Social/organização & administração , Populações Vulneráveis/estatística & dados numéricos , Adolescente , Adulto , Cuidadores , Criança , Pré-Escolar , Agentes Comunitários de Saúde/estatística & dados numéricos , Feminino , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Estado Nutricional , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Tanzânia , Adulto Jovem
10.
Sensors (Basel) ; 20(17)2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32887338

RESUMO

COVID-19 has shown a relatively low case fatality rate in young healthy individuals, with the majority of this group being asymptomatic or having mild symptoms. However, the severity of the disease among the elderly as well as in individuals with underlying health conditions has caused significant mortality rates worldwide. Understanding this variance amongst different sectors of society and modelling this will enable the different levels of risk to be determined to enable strategies to be applied to different groups. Long-established compartmental epidemiological models like SIR and SEIR do not account for the variability encountered in the severity of the SARS-CoV-2 disease across different population groups. The objective of this study is to investigate how a reduction in the exposure of vulnerable individuals to COVID-19 can minimise the number of deaths caused by the disease, using the UK as a case study. To overcome the limitation of long-established compartmental epidemiological models, it is proposed that a modified model, namely SEIR-v, through which the population is separated into two groups regarding their vulnerability to SARS-CoV-2 is applied. This enables the analysis of the spread of the epidemic when different contention measures are applied to different groups in society regarding their vulnerability to the disease. A Monte Carlo simulation (100,000 runs) along the proposed SEIR-v model is used to study the number of deaths which could be avoided as a function of the decrease in the exposure of vulnerable individuals to the disease. The results indicate a large number of deaths could be avoided by a slight realistic decrease in the exposure of vulnerable groups to the disease. The mean values across the simulations indicate 3681 and 7460 lives could be saved when such exposure is reduced by 10% and 20% respectively. From the encouraging results of the modelling a number of mechanisms are proposed to limit the exposure of vulnerable individuals to the disease. One option could be the provision of a wristband to vulnerable people and those without a smartphone and contact-tracing app, filling the gap created by systems relying on smartphone apps only. By combining very dense contact tracing data from smartphone apps and wristband signals with information about infection status and symptoms, vulnerable people can be protected and kept safer.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/estatística & dados numéricos , Modelos Teóricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Saúde Pública/métodos , Quarentena/organização & administração , Populações Vulneráveis , Busca de Comunicante/métodos , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/prevenção & controle , Diretrizes para o Planejamento em Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Controle de Infecções/estatística & dados numéricos , Invenções/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/normas , Saúde Pública/estatística & dados numéricos , Administração em Saúde Pública/métodos , Quarentena/métodos , Quarentena/estatística & dados numéricos , Reino Unido/epidemiologia , Populações Vulneráveis/estatística & dados numéricos
11.
Nursing ; 50(10): 48-53, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32956203

RESUMO

A dramatic shift in adolescent risks and behaviors in recent years threatens adolescents' mental well-being more than ever. This article explores vulnerable adolescent populations, describes the importance of nurses in all categories of assessment for adolescent mental health, and identifies assessment strategies and immediate interventions for successful outcomes.


Assuntos
Transtornos Mentais/enfermagem , Avaliação em Enfermagem , Populações Vulneráveis/psicologia , Adolescente , Humanos , Suicídio/prevenção & controle , Populações Vulneráveis/estatística & dados numéricos
12.
S Afr Med J ; 110(7): 629-634, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-32880337

RESUMO

Pandemics challenge clinicians and scientists in many ways, especially when the virus is novel and disease expression becomes variable or unpredictable. Under such circumstances, research becomes critical to inform clinical care and protect future patients. Given that severely ill patients admitted to intensive care units are at high risk of mortality, establishing the cause of death at a histopathological level could prove invaluable in contributing to the understanding of COVID-19. Postmortem examination including autopsies would be optimal. However, in the context of high contagion and limited personal protective equipment, full autopsies are not being conducted in South Africa (SA). A compromise would require tissue biopsies and samples to be taken immediately after death to obtain diagnostic information, which could potentially guide care of future patients, or generate hypotheses for finding needed solutions. In the absence of an advance written directive (including a will or medical record) providing consent for postmortem research, proxy consent is the next best option. However, obtaining consent from distraught family members, under circumstances of legally mandated lockdown when strict infection control measures limit visitors in hospitals, is challenging. Their extreme vulnerability and emotional distress make full understanding of the rationale and consent process difficult either before or upon death of a family member. While it is morally distressing to convey a message of death telephonically, it is inhumane to request consent for urgent research in the same conversation. Careful balancing of the principles of autonomy, non-maleficence and justice becomes an ethical imperative. Under such circumstances, a waiver of consent, preferably followed by deferred proxy consent, granted by a research ethics committee in keeping with national ethics guidance and legislation, would fulfil the basic premise of care and research: first do no harm. This article examines the SA research ethics framework, guidance and legislation to justify support for a waiver of consent followed by deferred proxy consent, when possible, in urgent research after death to inform current and future care to contain the pandemic in the public interest.


Assuntos
Infecções por Coronavirus/epidemiologia , Cuidados Críticos/ética , Estado Terminal/terapia , Mortalidade Hospitalar , Consentimento Livre e Esclarecido/ética , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Causas de Morte , Infecções por Coronavirus/prevenção & controle , Cuidados Críticos/legislação & jurisprudência , Estado Terminal/mortalidade , Países em Desenvolvimento , Feminino , Humanos , Controle de Infecções/organização & administração , Unidades de Terapia Intensiva/ética , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Projetos de Pesquisa , Medição de Risco , África do Sul , Populações Vulneráveis/estatística & dados numéricos
13.
Health Aff (Millwood) ; 39(10): 1812-1821, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32816600

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic continues to devastate US nursing homes. Adequate personal protective equipment (PPE) and staffing levels are critical to protect nursing home residents and staff. Despite the importance of these basic measures, few national data are available concerning the state of nursing homes with respect to these resources. This article presents results from a new national database containing data from 98 percent of US nursing homes. We find that more than one in five nursing homes reports a severe shortage of PPE and any shortage of staff. Rates of both staff and PPE shortages did not meaningfully improve from May to July 2020. Facilities with COVID-19 cases among residents and staff, as well as those serving more Medicaid recipients and those with lower quality scores, were more likely to report shortages. Policies aimed at providing resources to obtain additional direct care staff and PPE for these vulnerable nursing homes, particularly in areas with rising community COVID-19 case rates, are needed to reduce the national COVID-19 death toll.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pessoal de Saúde/estatística & dados numéricos , Casas de Saúde/organização & administração , Casas de Saúde/provisão & distribução , Pandemias/prevenção & controle , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Bases de Dados Factuais , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Humanos , Controle de Infecções/organização & administração , Masculino , Determinação de Necessidades de Cuidados de Saúde , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Gestão da Segurança/métodos , Estados Unidos , Populações Vulneráveis/estatística & dados numéricos
14.
BMJ Glob Health ; 5(8)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32839197

RESUMO

BACKGROUND: Response to the coronavirus disease 2019 (COVID-19) pandemic calls for precision public health reflecting our improved understanding of who is the most vulnerable and their geographical location. We created three vulnerability indices to identify areas and people who require greater support while elucidating health inequities to inform emergency response in Kenya. METHODS: Geospatial indicators were assembled to create three vulnerability indices; Social VulnerabilityIndex (SVI), Epidemiological Vulnerability Index (EVI) and a composite of the two, that is, Social Epidemiological Vulnerability Index (SEVI) resolved at 295 subcounties in Kenya. SVI included 19 indicators that affect the spread of disease; socioeconomic deprivation, access to services and population dynamics, whereas EVI comprised 5 indicators describing comorbidities associated with COVID-19 severe disease progression. The indicators were scaled to a common measurement scale, spatially overlaid via arithmetic mean and equally weighted. The indices were classified into seven classes, 1-2 denoted low vulnerability and 6-7, high vulnerability. The population within vulnerabilities classes was quantified. RESULTS: The spatial variation of each index was heterogeneous across Kenya. Forty-nine northwestern and partly eastern subcounties (6.9 million people) were highly vulnerable, whereas 58 subcounties (9.7 million people) in western and central Kenya were the least vulnerable for SVI. For EVI, 48 subcounties (7.2 million people) in central and the adjacent areas and 81 subcounties (13.2 million people) in northern Kenya were the most and least vulnerable, respectively. Overall (SEVI), 46 subcounties (7.0 million people) around central and southeastern were more vulnerable, whereas 81 subcounties (14.4 million people) were least vulnerable. CONCLUSION: The vulnerability indices created are tools relevant to the county, national government and stakeholders for prioritisation and improved planning. The heterogeneous nature of the vulnerability indices underpins the need for targeted and prioritised actions based on the needs across the subcounties.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Saúde Pública , Populações Vulneráveis , Betacoronavirus , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Quênia/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Fatores Socioeconômicos , Análise Espacial , Populações Vulneráveis/etnologia , Populações Vulneráveis/estatística & dados numéricos
16.
Int J Equity Health ; 19(1): 141, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32819364

RESUMO

An estimated 2 million foreign-born migrants of working age (15-64) were living in South Africa (SA) in 2017. Structural and practical xenophobia has driven asylum-seekers, refugees, and undocumented migrants in SA to abject poverty and misery. The Coronavirus Disease 2019 (COVID-19) containment measures adopted by the SA government through the lockdown of the nation have tremendously deepened the unequal treatment of asylum-seekers and refugees in SA. This can be seen through the South African government's lack of consideration of this marginalized population in economic, poverty, and hunger alleviation schemes. Leaving this category of our society out of the national response safety nets may lead to negative coping strategies causing mental health issues and secondary health concerns. An effective response to the socioeconomic challenges imposed by the COVID-19 pandemic should consider the economic and health impact of the pandemic on asylum-seekers, refugees, and undocumented migrants.


Assuntos
Infecções por Coronavirus/epidemiologia , Disparidades nos Níveis de Saúde , Pneumonia Viral/epidemiologia , Refugiados/estatística & dados numéricos , Imigrantes Indocumentados/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adolescente , Adulto , Infecções por Coronavirus/prevenção & controle , Governo , Humanos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Fatores Socioeconômicos , África do Sul/epidemiologia , Adulto Jovem
17.
Health Aff (Millwood) ; 39(8): 1362-1367, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32744946

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of intensive care unit (ICU) beds in preventing death from the severe respiratory illness associated with COVID-19. However, the availability of ICU beds is highly variable across the US, and health care resources are generally more plentiful in wealthier communities. We examined disparities in community ICU beds by US communities' median household income. We found a large gap in access by income: 49 percent of the lowest-income communities had no ICU beds in their communities, whereas only 3 percent of the highest-income communities had no ICU beds. Income disparities in the availability of community ICU beds were more acute in rural areas than in urban areas. Policies that facilitate hospital coordination are urgently needed to address shortages in ICU hospital bed supply to mitigate the effects of the COVID-19 pandemic on mortality rates in low-income communities.


Assuntos
Infecções por Coronavirus/epidemiologia , Cuidados Críticos/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Unidades de Terapia Intensiva/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Necessidades e Demandas de Serviços de Saúde , Número de Leitos em Hospital , Humanos , Renda , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/terapia , Pobreza/estatística & dados numéricos , Estados Unidos , Populações Vulneráveis/estatística & dados numéricos
18.
J Am Med Dir Assoc ; 21(7): 924-927, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32674820

RESUMO

OBJECTIVES: In the United States, home health agencies (HHAs) provide essential services for patients recovering from post-acute care and older adults who are aging in place. During the COVID-19 pandemic, HHAs may face additional challenges caring for these vulnerable patients. Our objective was to explore COVID-19 preparedness of US HHAs and compare results by urban/rural location. DESIGN: Cross-sectional study. SETTING/PARTICIPANTS: Using a stratified random sample of 978 HHAs, we conducted a 22-item online survey from April 10 to 17, 2020. METHODS: Summary statistics were computed; open-ended narrative responses were synthesized using qualitative methods. RESULTS: Similar to national data, most responding HHAs (n = 121, 12% response rate) were for-profit and located in the South. Most HHAs had infectious disease outbreaks included in their emergency preparedness plan (76%), a staff member in charge of outbreak/disaster preparedness (84%), and had provided their staff with COVID-19 education and training (97%). More urban HHAs had cared for confirmed and recovered COVID-19 patients than rural HHAs, but urban HHAs had less capacity to test for COVID-19 than rural HHAs (9% vs 21%). Most (69%) experienced patient census declines and had a current and/or anticipated supply shortage. Rural agencies were affected less than urban agencies. HHAs have already rationed (69%) or implemented extended use (55%) or limited reuse (61%) of personal protective equipment (PPE). Many HHAs reported accessing supplemental PPE from state/local resources, donations, and do-it-yourself efforts; more rural HHAs had accessed these additional resources compared with urban HHAs. CONCLUSIONS/IMPLICATIONS: This survey reveals challenges that HHAs are having in responding to the COVID-19 pandemic, particularly among urban agencies. Of greatest concern are the declines in patient census, which drastically affect agency revenue, and the shortages of PPE and disinfectants. Without proper protection, HHA clinicians are at risk of self-exposure and viral transmission to patients and vulnerable family members.


Assuntos
Defesa Civil/organização & administração , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/prevenção & controle , Agências de Assistência Domiciliar/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Humanos , Controle de Infecções , Masculino , Pandemias/estatística & dados numéricos , Equipamento de Proteção Individual/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Medição de Risco , População Rural , Estados Unidos , População Urbana , Populações Vulneráveis/estatística & dados numéricos
20.
Clin Med (Lond) ; 20(5): e148-e153, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32709637

RESUMO

BACKGROUND: This retrospective cohort study aims to define the clinical findings and outcomes of every patient admitted to a district general hospital in Surrey with COVID-19 in March 2020, providing a snapshot of the first wave of infection in the UK. This study is the first detailed insight into the impact of frailty markers on patient outcomes and provides the infection rate among healthcare workers. METHODS: Data were obtained from medical records. Outcome measures were level of oxygen therapy, discharge and death. Patients were followed up until 21 April 2020. RESULTS: 108 patients were included. 34 (31%) died in hospital or were discharged for palliative care. 43% of patients aged over 65 died. The commonest comorbidities were hypertension (49; 45%) and diabetes (25; 23%). Patients who died were older (mean difference ±SEM, 13.76±3.12 years; p<0.0001) with a higher NEWS2 score (median 6, IQR 2.5-7.5 vs median 2, IQR 2-6) and worse renal function (median differences: urea 2.7 mmol/L, p<0.01; creatinine 4 µmol/L, p<0.05; eGFR 14 mL/min, p<0.05) on admission compared with survivors. Frailty markers were identified as risk factors for death. Clinical Frailty Scale (CFS) was higher in patients over 65 who died than in survivors (median 5, IQR 4-6 vs 3.5, IQR 2-5; p<0.01). Troponin and creatine kinase levels were higher in patients who died than in those who recovered (p<0.0001). Lymphopenia was common (median 0.8, IQR 0.6-1.2; p<0.005). Every patient with heart failure died (8). 26 (24%) were treated with continuous positive airway pressure (CPAP; median 3 days, IQR 2-7.3) and 9 (8%) were intubated (median 14 days, IQR 7-21). All patients who died after discharge (4; 6%) were care home residents. 276 of 699 hospital staff tested were positive for COVID-19. CONCLUSIONS: This study identifies older patients with frailty as being particularly vulnerable and reinforces government policy to protect this group at all costs.


Assuntos
Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Fragilidade/mortalidade , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Idoso , Estudos de Coortes , Terapia Combinada , Feminino , Fragilidade/fisiopatologia , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Hospitais de Distrito/organização & administração , Hospitais Gerais/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Estudos Retrospectivos , Medição de Risco , Reino Unido , Populações Vulneráveis/estatística & dados numéricos
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