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1.
Am Surg ; 86(9): 1057-1061, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33049163

RESUMO

BACKGROUND: Timely access to emergency general surgery services, including trauma, is a critical aspect of patient care. This study looks to identify resource availability at small rural hospitals in order to improve the quality of surgical care. METHODS: Forty-five nonteaching hospitals in West Virginia were divided into large community hospitals with multiple specialties (LCHs), small community hospitals with fewer specialties (SCHs), and critical access hospitals (CAHs). A 58-question survey on optimal resources for surgery was completed by 1 representative surgeon at each hospital. There were 8 LCHs, 18 SCHs, and 19 CAHs with survey response rates of 100%, 83%, and 89%, respectively. RESULTS: One hundred percent of hospitals surveyed had respiratory therapy and ventilator support, computerized tomography (CT) scanner and ultrasound, certified operating rooms, lab support, packed red blood cells (PRBC), and FFP accessible 24/7. Availability of cryoprecipitate, platelets, tranexamic acid (TXA), and prothrombin complex concentrate (PCC) decreased from LCHs to CAHs. The majority had board-certified general surgeons; however, only 86% LCHs, 53% SCHs, and 50% CAHs had advanced trauma life support (ATLS) certification. One hundred percent of LCHs had operating room (OR) crew on call within 30 minutes, emergency cardiovascular equipment, critical care nursing, on-site pathologist, and biologic/synthetic mesh, whereas fewer SCHs and CAHs had these resources. One hundred percent of LCHs and SCHs had anesthesia availability 24/7 compared to 78% of CAHs. DISCUSSION: Improving access to the aforementioned resources is of utmost importance to patient outcomes. This will enhance rural surgical care and decrease emergency surgical transfers. Further education and research are necessary to support and improve rural trauma systems.


Assuntos
Recursos em Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Hospitais Rurais/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Humanos , Inquéritos e Questionários , Estados Unidos , West Virginia
3.
Rev Epidemiol Sante Publique ; 68(5): 302-305, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32948360

RESUMO

Following the onset of the global COVID-19 pandemic and the alerts issued by the World Health Organization, for several months attention has been focused on Africa as a potentially severely endangered continent. A sizable number of African countries, mainly low and middle income, suffer from limited available resources, especially in critical care, and COVID-19 is liable to overwhelm their already fragile health systems. To effectively manage what is shaping up as a multidimensional crisis, the challenge unquestionably goes beyond the necessary upgrading of public health infrastructures. It is also a matter of anticipating and taking timely action with regard to factors that may mitigate the propagation of SARS-CoV2 and thereby cushion the shock of the pandemic on the African continent. While some of these factors are largely unmanageable (climate, geography…), several others (socio-cultural, religious, audio-visual, and potentially political…) could be more or less effectively dealt with by African governments and populations.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , África/epidemiologia , Vacina BCG/uso terapêutico , Betacoronavirus/fisiologia , Clima , Infecções por Coronavirus/economia , Infecções por Coronavirus/terapia , Recursos em Saúde/organização & administração , Recursos em Saúde/estatística & dados numéricos , Recursos em Saúde/provisão & distribução , História do Século XX , História do Século XXI , Humanos , Controle de Infecções/economia , Controle de Infecções/história , Controle de Infecções/organização & administração , Controle de Infecções/normas , Pandemias/economia , Pandemias/estatística & dados numéricos , Pneumonia Viral/economia , Pneumonia Viral/terapia , Áreas de Pobreza , Papel Profissional , Saúde Pública/economia , Saúde Pública/história , Saúde Pública/estatística & dados numéricos , Mídias Sociais , Responsabilidade Social , Fatores Socioeconômicos , Organização Mundial da Saúde
4.
Phys Ther ; 100(11): 1917-1929, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-32886789

RESUMO

OBJECTIVE: Physical therapists play an important role in responding to pandemic and physical disaster situations. Existing literature can provide guidance to health care leadership teams to appropriately and safely leverage physical therapy resources and skill sets during the COVID-19 pandemic. The purpose of this study was to provide a review of the pandemic and physical disaster management literature to summarize physical therapy-specific operational considerations to assist hospital-based leadership teams in planning and response efforts during the COVID-19 pandemic. METHODS: A rapid review was conducted over a 4-week time frame (April-May 2020). The review team included 3 physical therapist clinician researchers, a health librarian, and a member of the physical therapy leadership team. The initial search strategy identified 303 articles, 80 of which were retained for full-text screening. Twenty articles were included in the review. RESULTS: Five main categories of operational considerations for physical therapy during the COVID-19 pandemic were identified: (1) organizational actions, (2) staffing considerations, (3) physical therapist roles, (4) physical resources, and (5) other considerations. Additional relevant information from physical therapists' experiences in physical disaster situations was also summarized. CONCLUSION: The evidence presented within this review can be used to inform facility-based and regional planning efforts during the current COVID-19 pandemic and in general preparedness planning. IMPACT: Physical therapists have an important role to play in response efforts related to major events that impact health and wellness, including the COVID-19 pandemic. Evidence-informed, facility-based, and regional planning during the current COVID-19 pandemic will help physical therapists enhance their role in treating patients in physical therapy and rehabilitation settings.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Modalidades de Fisioterapia/organização & administração , Fisioterapia/organização & administração , Pneumonia Viral/epidemiologia , Planejamento em Desastres , Recursos em Saúde/organização & administração , Humanos , Pandemias , Admissão e Escalonamento de Pessoal , Fisioterapeutas , Papel Profissional
5.
Neurocrit Care ; 33(2): 338-346, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32794144

RESUMO

BACKGROUND AND PURPOSE: Management of stroke patients in the acute setting is a high-stakes task with several challenges including the need for rapid assessment and treatment, maintenance of high-performing team dynamics, management of cognitive load affecting providers, and factors impacting team communication. Crisis resource management (CRM) provides a framework to tackle these challenges and is well established in other resuscitative disciplines. The current Coronavirus Disease 2019 (COVID-19) pandemic has exposed a potential quality gap in emergency preparedness and the ability to adapt to emergency scenarios in real time. METHODS: Available resources in the literature in other disciplines and expert consensus were used to identify key elements of CRM as they apply to acute stroke management. RESULTS: We outline essential ingredients of CRM as a means to mitigate nontechnical challenges providers face during acute stroke care. These strategies include situational awareness, triage and prioritization, mitigation of cognitive load, team member role clarity, communication, and debriefing. Incorporation of CRM along with simulation is an established tool in other resuscitative disciplines and can be incorporated into acute stroke care. CONCLUSIONS: As stroke care processes evolve during these trying times, the importance of consistent, safe, and efficacious care facilitated by CRM principles offers a unique avenue to alleviate human factors and support high-performing teams.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Recursos em Saúde/organização & administração , Pneumonia Viral/epidemiologia , Acidente Vascular Cerebral/terapia , Humanos , Pandemias
7.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32753371

RESUMO

BACKGROUND AND OBJECTIVES: Although clinical settings are increasingly screening for social determinants of health, essential questions about optimal screening remain. We aimed to assess primary care contexts of individuals choosing not to answer questions about health-related social needs and to compare screening question response with subsequent use of resource information. METHODS: We compared caregiver responses to an electronic survey administered during a child's emergency department visit and through telephone follow-up 2 weeks later by responses to questions about health-related social needs (no social needs endorsed, ≥1 endorsed, none endorsed but ≥1 question not answered). RESULTS: Of 146 respondents, 42 (29%) endorsed ≥1 health-related social need. Additionally, 19 (13%) endorsed no social needs but did not answer ≥1 question. Compared with those denying all social needs and those endorsing ≥1 social need, respondents who did not answer social needs screening questions reported longer duration since their child's last primary care visit, lower perceptions of primary care, and less social support. For the 61 respondents participating in the 2-week follow-up survey, reported use of a community resource packet was 37% among those who had reported a social need, 26% among those who had denied all social needs, and 0% among those who had not answered ≥1 social needs questions. CONCLUSIONS: Clinicians and systems implementing screening for health-related social risks should plan for individuals who choose not to respond to specific items and may also wish to consider strategies that do not rely on screening and disclosure, particularly in communities known to have high prevalence of social needs.


Assuntos
Acesso à Informação , Cuidadores/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Adulto , Cuidadores/psicologia , Distribuição de Qui-Quadrado , Pré-Escolar , Feminino , Seguimentos , Abastecimento de Alimentos/estatística & dados numéricos , Recursos em Saúde/organização & administração , Humanos , Comportamento de Busca de Informação , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Apoio Social , Transportes/estatística & dados numéricos , Adulto Jovem
8.
PLoS One ; 15(7): e0236269, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697791

RESUMO

BACKGROUND: Suicide is one of the most common causes of death among female adolescents. A greater risk is seen among adolescent mothers who become pregnant outside marriage and consider suicide as the solution to unresolved problems. We aimed to investigate the factors associated with suicidal behavior among adolescent pregnant mothers in Kenya. METHODS: A total of 27 Focus Group Discussions (FGDs) and 8 Key Informant Interviews (KIIs) were conducted in a rural setting (Makueni County) in Kenya. The study participants consisted of formal health care workers and informal health care providers (traditional birth attendants and community health workers), adolescent and adult pregnant and post-natal (up to six weeks post-delivery) women including first-time adolescent mothers, and caregivers (husbands and/or mothers-in-law of pregnant women) and local key opinion leaders. The qualitative data was analyzed using Qualitative Solution for Research (QSR) NVivo version 10. RESULTS: Five themes associated with suicidal behavior risk among adolescent mothers emerged from this study. These included: (i) poverty, (ii) intimate partner violence (IPV), (iii) family rejection, (iv) social isolation and stigma from the community, and (v) chronic physical illnesses. Low economic status was associated with hopelessness and suicidal ideation. IPV was related to drug abuse (especially alcohol) by the male partner, predisposing the adolescent mothers to suicidal ideation. Rejection by parents and isolation by peers at school; and diagnosis of a chronic illness such as HIV/AIDS were other contributing factors to suicidal behavior in adolescent mothers. CONCLUSION: Improved social relations, economic and health circumstances of adolescent mothers can lead to reduction of suicidal behaviour. Therefore, concerted efforts by stakeholders including family members, community leaders, health care workers and policy makers should explore ways of addressing IPV, economic empowerment and access to youth friendly health care centers for chronic physical illnesses. Prevention strategies should include monitoring for suicidal behavior risks during pregnancy in both community and health care settings. Additionally, utilizing lay workers in conducting dialogue discussions and early screening could address some of the risk factors and reduce pregnancy- related suicide mortality in LMICs.


Assuntos
Serviços de Saúde do Adolescente/organização & administração , Violência por Parceiro Íntimo/psicologia , Gravidez na Adolescência/psicologia , Gestantes/psicologia , Suicídio/prevenção & controle , Adolescente , Serviços de Saúde do Adolescente/economia , Feminino , Grupos Focais , Recursos em Saúde/organização & administração , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Quênia/epidemiologia , Pobreza , Gravidez , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/organização & administração , Pesquisa Qualitativa , Medição de Risco , Fatores de Risco , População Rural/estatística & dados numéricos , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Adulto Jovem
9.
Nurs Manag (Harrow) ; 27(4): 32-40, 2020 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-32543159

RESUMO

The emergence of coronavirus disease 2019 (COVID-19) has meant that nurse leaders need to respond rapidly and decisively to the demands and challenges of a pandemic in a context of increased staff shortages and limited resources. This article suggests essential leadership skills and characteristics that nurses can use to underpin effective leadership in a crisis, emphasising the importance of decision-making and emotional intelligence. It also addresses two important questions: 'what do leaders in a crisis need to do that differs from any other time?' and 'what does effective leadership look like in a crisis?'


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/enfermagem , Liderança , Enfermeiras Administradoras/psicologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/enfermagem , Tomada de Decisões , Recursos em Saúde/organização & administração , Recursos em Saúde/provisão & distribução , Humanos , Recursos Humanos de Enfermagem/organização & administração , Recursos Humanos de Enfermagem/provisão & distribução
10.
BMC Public Health ; 20(1): 814, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32498676

RESUMO

BACKGROUND: While reducing the burden of mental and substance use disorders is a global challenge, it is played out locally. Mental disorders have early ages of onset, syndromal complexity and high individual variability in course and response to treatment. As most locally-delivered health systems do not account for this complexity in their design, implementation, scale or evaluation they often result in disappointing impacts. DISCUSSION: In this viewpoint, we contend that the absence of an appropriate predictive planning framework is one critical reason that countries fail to make substantial progress in mental health outcomes. Addressing this missing infrastructure is vital to guide and coordinate national and regional (local) investments, to ensure limited mental health resources are put to best use, and to strengthen health systems to achieve the mental health targets of the 2015 Sustainable Development Goals. Most broad national policies over-emphasize provision of single elements of care (e.g. medicines, individual psychological therapies) and assess their population-level impact through static, linear and program logic-based evaluation. More sophisticated decision analytic approaches that can account for complexity have long been successfully used in non-health sectors and are now emerging in mental health research and practice. We argue that utilization of advanced decision support tools such as systems modelling and simulation, is now required to bring a necessary discipline to new national and local investments in transforming mental health systems. CONCLUSION: Systems modelling and simulation delivers an interactive decision analytic tool to test mental health reform and service planning scenarios in a safe environment before implementing them in the real world. The approach drives better decision-making and can inform the scale up of effective and contextually relevant strategies to reduce the burden of mental disorder and enhance the mental wealth of nations.


Assuntos
Técnicas de Apoio para a Decisão , Recursos em Saúde/organização & administração , Serviços de Saúde Mental/organização & administração , Formulação de Políticas , Regionalização , Tomada de Decisões , Reforma dos Serviços de Saúde , Política de Saúde , Humanos , Saúde Mental , Análise de Sistemas
12.
J Pak Med Assoc ; 70(Suppl 3)(5): S25-S29, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32515372

RESUMO

Coronavirus disease 2019 (COVID-19) pandemic has put a huge pressure on healthcare systems across the globe, more so in developing countries. Not only patients of acute febrile illness and respiratory problems but also patients with other acute and chronic diseases are facing challenges while seeking healthcare, getting laboratory investigations done and obtaining medications. Healthcare workers have their challenges including limited resources, lack of personal protective equipments, and fear of contracting COVID-19. Resource husbandry, which refers to the judicious use of available stocks, is a vital concept that needs to be promoted during such challenging times to combat the shortage of medical resources while simultaneously providing effective treatment to the patients. Some easily implementable concepts of resource husbandry can have a significant impact and result in minimising trouble for many patients during a challenging time.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Recursos em Saúde , Pandemias/prevenção & controle , Pneumonia Viral , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pessoal de Saúde , Recursos em Saúde/economia , Recursos em Saúde/organização & administração , Recursos em Saúde/provisão & distribução , Humanos , Administração de Materiais no Hospital , Equipamento de Proteção Individual/economia , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Telemedicina
13.
Anesth Analg ; 131(2): 351-364, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32433248

RESUMO

Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. When a patient requires intubation and invasive ventilation, the outcome is poor, and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks. In this article, the authors review several technological devices, which could support health care providers at the bedside to optimize the care for COVID-19 patients who are sedated, paralyzed, and ventilated. Particular attention is provided to the use of videolaryngoscopes (VL) because these can assist anesthetists to perform a successful intubation outside the ICU while protecting health care providers from this viral infection. Authors will also review processed electroencephalographic (EEG) monitors which are used to better titrate sedation and the train-of-four monitors which are utilized to better administer neuromuscular blocking agents in the view of sparing limited pharmacological resources. COVID-19 can rapidly exhaust human and technological resources too within the ICU. This review features a series of technological advancements that can significantly improve the care of patients requiring isolation. The working conditions in isolation could cause gaps or barriers in communication, fatigue, and poor documentation of provided care. The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas; (b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection; (c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography (TEG); (d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Recursos em Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Controle de Infecções/organização & administração , Pneumonia Viral/terapia , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/prevenção & controle , Saúde do Trabalhador , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Testes Imediatos/organização & administração , Fatores de Risco , Índice de Gravidade de Doença
16.
Diagn Interv Imaging ; 101(6): 347-353, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32360351

RESUMO

The COVID-19 pandemic has deeply impacted the activity of interventional oncology in hospitals and cancer centers. In this review based on official recommendations of different international societies, but also on local solutions found in different expert large-volume centers, we discuss the changes that need to be done for the organization, safety, and patient management in interventional oncology. A literature review of potential solutions in a context of scarce anesthesiologic resources, limited staff and limited access to hospital beds are proposed and discussed based on the literature data.


Assuntos
Betacoronavirus , Institutos de Câncer/organização & administração , Infecções por Coronavirus/epidemiologia , Neoplasias/terapia , Pandemias , Pneumonia Viral/epidemiologia , Aerossóis , Fatores Etários , Anestesia Geral , Anestesiologia/estatística & dados numéricos , Biópsia/efeitos adversos , Biópsia/métodos , Carcinoma Hepatocelular/terapia , Carcinoma de Células Renais/terapia , Quimioembolização Terapêutica/métodos , Técnicas de Laboratório Clínico/métodos , Neoplasias do Colo/patologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Bases de Dados Factuais , Pessoal de Saúde/estatística & dados numéricos , Recursos em Saúde/organização & administração , Recursos em Saúde/provisão & distribução , Número de Leitos em Hospital/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Hipertermia Induzida/métodos , Neoplasias Renais/terapia , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Neoplasias/complicações , Cuidados Paliativos/métodos , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Triagem
18.
J Public Health Manag Pract ; 26(4): 334-344, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32433388

RESUMO

CONTEXT: COVID-19 was characterized as a pandemic by the World Health Organization on March 11, 2020. This research aims to analyze the public health strategies to prevent and control COVID-19 in Shanghai, China, and provide recommendations for public health policy and interventions in the United States. PROGRAM: Based on the Social-Ecological Model, this research collected information for public health strategies from the Shanghai Municipal Health Commission and various Chinese websites. EVALUATION: The daily confirmed new cases of COVID-19 decreased from 27 to 0 in 53 days since the first case of COVID-19 was confirmed in Shanghai on January 20, 2020. DISCUSSION: The pattern of daily confirmed new cases suggests the effectiveness of public health strategies. This research also provides recommendations on the development and improvements of public health strategies in the U.S. by acknowledging the differences in political and social systems between the two countries.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , China/epidemiologia , Serviços de Saúde Comunitária/organização & administração , Educação em Saúde/organização & administração , Recursos em Saúde/organização & administração , Humanos , Meios de Comunicação de Massa , Saúde Pública , Vigilância em Saúde Pública/métodos , Quarentena/organização & administração , Estados Unidos
19.
Tohoku J Exp Med ; 251(1): 47-49, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32461502

RESUMO

The reported number of new cases underestimates the real spread of COVID-19 pandemic because of non-tested asymptomatic people and limited global access to reliable diagnostic tests. In this context, COVID-19 mortality with confirmed diagnosis becomes an attractive source of information to be included in the analysis of perspectives and proposals. Objective data are required to calculate the capacity of resources provided by health systems. New strategies are needed to stabilize or minimize the mortality surge. However, we will not afford this goal until more alternatives were available. We still need an effective treatment, an affordable vaccine, or a collective achievement of sufficient immunity (reaching up to 70% of the whole population). At any time, the arriving waves of the pandemic are testing the capacity of governments. The health services struggle to keep the plateau in a steady-state below 100 deaths per million inhabitants. Therefore, it is necessary to increase the alternatives and supplies based on the current and near-future expected demands imposed by the number of deaths by COVID-19. Estimating COVID-19 mortality in various scenarios with the gradual release of social constraints will help predict the magnitude of those arriving waves.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Monitoramento Epidemiológico , Mortalidade , Pneumonia Viral/mortalidade , População , Betacoronavirus/patogenicidade , Betacoronavirus/fisiologia , Sistemas Computacionais , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Sistemas de Informação Geográfica/organização & administração , Sistemas de Informação Geográfica/normas , Mapeamento Geográfico , Geografia , Recursos em Saúde/organização & administração , Recursos em Saúde/normas , Necessidades e Demandas de Serviços de Saúde , Humanos , Mortalidade/tendências , Pandemias , Pneumonia Viral/epidemiologia , Fatores de Tempo
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