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1.
Sci Total Environ ; 752: 141946, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-32889290

RESUMO

Deaths from the COVID-19 pandemic have disproportionately affected older adults and residents in nursing homes. Although emerging research has identified place-based risk factors for the general population, little research has been conducted for nursing home populations. This GIS-based spatial modeling study aimed to determine the association between nursing home-level metrics and county-level, place-based variables with COVID-19 confirmed cases in nursing homes across the United States. A cross-sectional research design linked data from Centers for Medicare & Medicaid Services, American Community Survey, the 2010 Census, and COVID-19 cases among the general population and nursing homes. Spatial cluster analysis identified specific regions with statistically higher COVID-19 cases and deaths among residents. Multivariate analysis identified risk factors at the nursing home level including, total count of fines, total staffing levels, and LPN staffing levels. County-level or place-based factors like per-capita income, average household size, population density, and minority composition were significant predictors of COVID-19 cases in the nursing home. These results provide a framework for examining further COVID-19 cases in nursing homes and highlight the need to include other community-level variables when considering risk of COVID-19 transmission and outbreaks in nursing homes.


Assuntos
Infecções por Coronavirus , Medicare , Casas de Saúde , Pandemias , Pneumonia Viral , Idoso , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Humanos , Renda , Pneumonia Viral/epidemiologia , Densidade Demográfica , Fatores de Risco , Estados Unidos , Recursos Humanos
2.
Rev. enferm. UERJ ; 28: e49370, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1122754

RESUMO

Objetivos: descrever a média total de independência geral e por domínios de comunicação dos idosos da comunidade e verificar as variáveis sociodemográficas e de saúde associadas à maior média de independência de comunicação entre os idosos. Métodos: estudo transversal e analítico, desenvolvido entre 808 idosos da comunidade. Procederam-se às análises: descritiva, bivariada e regressão linear múltipla (p<0,05). Resultados: verificou-se necessidade mínima de auxílio na comunicação (6,43±0,77); quanto aos domínios obteve maior escore de independência de comunicação nas necessidades básicas (6,88±0,51) e menor na leitura, escrita e conceitos numéricos (5,96±1,63). A maior média de independência de comunicação associou-se à faixa etária 60├80 (p<0,001); ter escolaridade (p<0,001); renda maior que um salário mínimo (p<0,001); à ausência do declínio cognitivo (p<0,001) e do indicativo de sintomas depressivos (p=0,014). Conclusão: a escolaridade, menor idade, maior renda e a ausência do declínio cognitivo e do indicativo de sintomas depressivos contribuíram para maior independência de comunicação.


Objectives: to describe the total mean of independence and communication domains of the elderly in the community, and to verify the sociodemographic and health variables associated with the highest mean of independence of communication among the elderly. Methods: A cross - sectional and analytical study developed among 808 elderly people in the community. The analyzis were: descriptive, bivariate and linearly multiple regression (p<0.05). Results: There was a minimum need for assistance in communication (6.43 ± 0.77); concerning the domains, it obtained a higher score of communication independence in basic needs (6.88 ± 0.51) and lower in reading, writing and numerical concepts (5.96 ± 1.63). The highest average of communication independence was associated with the age group 60├80 (p<0.001); having schooling (p<0.001); income greater than a minimum wage (p<0.001); the absence of cognitive decline (p<0.001) and indicative of depressive symptoms (p=0.014). Conclusion: Schooling, lower age, higher income and the absence of cognitive decline and indicative of depressive symptoms contributed to greater communication independence.


Objetivos: describir el promedio general de independencia y los ámbitos de comunicación de los ancianos de la comunidad y verificar las variables sociodemográficas y de salud asociadas a la mayor media de independencia de comunicación entre los ancianos. Métodos: Estudio transversal y analítico, desarrollado entre 808 ancianos de la comunidad. Se realizaron los análisis: descriptiva, bivariada y regresión linealmente dolara (p<0,05). Resultados: Se verificó la mínima ayuda de comunicación (6,43 ± 0,77); En cuanto a los dominios, una puntuación más alta de independencia de comunicación en necesidades básicas (6,88 ± 0,51) y menor en lectura, escritura y conceptos numéricos (5,96 ± 1,63). Un promedio mayor de independencia de comunicación se asoció a la franja etaria 60├80 (p<0,001); tener escolaridad (p<0,001); el ingreso mayor que un salario mínimo (p<0,001); la ausencia del cognitivo (p<0,001) y del indicativo de síntomas depresivos (p=0,014). Conclusión: La escolaridad, menor edad, menor renta y la ausencia del cognitivo y del indicador de síntomas depresivos contribuyeron a una mayor independencia de comunicación.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Saúde do Idoso , Comunicação , Brasil , Atividades Cotidianas , Demografia , Estudos Transversais , Depressão , Escolaridade , Disfunção Cognitiva , Renda , Cuidados de Enfermagem
3.
Afr J Prim Health Care Fam Med ; 12(1): e1-e3, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33181874

RESUMO

The 2019 corona virus disease (COVID-19) has wreaked havoc on countries, communities and households. Its effect on individuals and their families, although enormous, has not been adequately explored. We thus present a report on the illness experiences of three families in Ghana who had at least one member diagnosed with COVID-19. We interviewed them and recorded their commonest fears, such as death, stigmatisation and collapse of family business. Respondents had a fair idea about symptoms of COVID-19, mode of transmission and safety precautions. Family separation and loss of income were some of the adverse effects expressed. Majority of them were hopeful that family members with COVID-19 would recover and be reunited. The biopsychosocial impact of COVID-19 is tremendous and family physicians and other primary care workers have an essential role to play in addressing this.


Assuntos
Infecções por Coronavirus , Emoções , Características da Família , Família , Pandemias , Pneumonia Viral , Adulto , Betacoronavirus , Criança , Coronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/virologia , Medo , Feminino , Gana/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Esperança , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Ocupações , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Pneumonia Viral/virologia , Estigma Social , Adulto Jovem
4.
Oral Health Prev Dent ; 18(1): 921-928, 2020 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-33215483

RESUMO

OBJECTIVES: This study investigated utilisation behaviour of the dentist compared to general practitioners (GP) and medical specialists in a German cohort under consideration of risk indicators for irregular dental attendance. METHODS: Analysis of the results of the population-based LIFE-Adult-Study (Leipzig, Germany) was performed. A total of 2231 participants of the LIFE-Adult-Study were randomly selected to complete the relevant questionnaire, considering medical attendance behaviour. Associations of self-reported medical conditions, including dentaland medical attendance, sociodemographic factors, as well as self-reported general health status and oral health complaints were determined. RESULTS: Of the 2231 participants who were included in the analysis, 14.2% reported not to have visited the dentist during the preceding 12 months. There could be shown a more selective utilisation behaviour towards medical services in smokers, men, low socioeconomic status and depression. Women were more likely to attend the dentist than men (OR = 1.8, CI = 1.4-2.3). Smoking (OR = 0.7, CI = 0.6-1.0), low socioeconomic status (OR = 0.6, CI = 0.4-0.8) and depression (OR = 0.6, CI = 0.4-0.9) were related to less dental attendance. Additionally, persons who do not visit the dentist regularly showed less attendance of the GP as well as medical specialists (p <0.05). Depression could be shown to be an additional risk factor for unfavourable utilisation behaviour towards the dentist. CONCLUSIONS: The results showed differences in dental and medical attendance, depending on different patient-related factors. Focusing attention towards high-risk groups might improve dental as well as medical utilisation behaviour, and therefore health status as well.


Assuntos
Nível de Saúde , Saúde Bucal , Adulto , Feminino , Alemanha/epidemiologia , Humanos , Renda , Masculino , Inquéritos e Questionários
6.
JAMA ; 324(17): 1755-1764, 2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33141208

RESUMO

Importance: Little is known about the association between industry payments and medical device selection. Objective: To examine the association between payments from device manufacturers to physicians and device selection for patients undergoing first-time implantation of a cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D). Design, Setting, and Participants: In this cross-sectional study, patients who received a first-time ICD or CRT-D device from any of the 4 major manufacturers (January 1, 2016-December 31, 2018) were identified. The data from the National Cardiovascular Data Registry ICD Registry was linked with the Open Payments Program's payment data. Patients were categorized into 4 groups (A, B, C, and D) corresponding to the manufacturer from which the physician who performed the implantation received the largest payment. For each patient group, the proportion of patients who received a device from the manufacturer that provided the largest payment to the physician who performed implantation was determined. Within each group, the absolute difference in proportional use of devices between the manufacturer that made the highest payment and the proportion of devices from the same manufacturer in the entire study cohort (expected prevalence) was calculated. Exposures: Manufacturers' payments to physicians who performed an ICD or CRT-D implantation. Main Outcomes and Measures: The primary outcome of the study was the manufacturer of the device used for the implantation. Results: Over a 3-year period, 145 900 patients (median age, 65 years; 29.6% women) received ICD or CRT-D devices from the 4 manufacturers implanted by 4435 physicians at 1763 facilities. Among these physicians, 4152 (94%) received payments from device manufacturers ranging from $2 to $323 559 with a median payment of $1211 (interquartile range, $390-$3702). Between 38.5% and 54.7% of patients received devices from the manufacturers that had provided physicians with the largest payments. Patients were substantially more likely to receive devices made by the manufacturer that provided the largest payment to the physician who performed implantation than they were from each other individual manufacturer. The absolute differences in proportional use from the expected prevalence were 22.4% (95% CI, 21.9%-22.9%) for manufacturer A; 14.5% (95% CI, 14.0%-15.0%) for manufacturer B; 18.8% (95% CI, 18.2%-19.4%) for manufacturer C; and 30.6% (95% CI, 30.0%-31.2%) for manufacturer D. Conclusions and Relevance: In this cross-sectional study, a large proportion of ICD or CRT-D implantations were performed by physicians who received payments from device manufacturers. Patients were more likely to receive ICD or CRT-D devices from the manufacturer that provided the highest total payment to the physician who performed an ICD or CRT-D implantation than each other manufacturer individually.


Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca/economia , Desfibriladores Implantáveis/economia , Renda , Indústria Manufatureira/economia , Médicos/economia , Idoso , Dispositivos de Terapia de Ressincronização Cardíaca/estatística & dados numéricos , Estudos Transversais , Desfibriladores Implantáveis/estatística & dados numéricos , Feminino , Humanos , Masculino , Indústria Manufatureira/classificação , Sistema de Registros
8.
Dtsch Arztebl Int ; 117(29-30): 493-499, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-33087229

RESUMO

BACKGROUND: Identifying regions with low life expectancy is important to policy makers, in particular for allocating resources in the health system. Life expectancy estimates for small regions are, however, often unreliable and lead to statistical uncertainties when the underlying populations are relatively small. METHODS: We combine the most recent German data available (2015-2017) with a Bayesian model that includes several methodological advances. This allows us to estimate male and female life expectancy with good precision for all 402 German districts and to quantify the uncertainty of those estimates. RESULTS: Across districts, life expectancy varies between 75.8 and 81.2 years for men and from 81.8 to 85.7 years for women. The spatial pattern is similar for women and men. Rural districts in eastern Germany and some districts of the Ruhr region have relatively low life expectancy. Districts with relatively high life expectancies cluster in Baden-Wuerttemberg and southern Bavaria. Exploratory analysis shows that average income, population density, and number of physicians per 100 000 inhabitants are not strongly correlated with life expectancy at district level. In contrast, indicators that point to particularly disadvantaged segments of the population (unemployment rate, welfare benefits) are better predictors of life expectancy. CONCLUSIONS: We do not find a consistent urban-rural gap in life expectancy. Our results suggest that policies that improve living standards for poorer segment of the population are the most likely to reduce the existing differences in life expectancy.


Assuntos
Renda , Expectativa de Vida , Idoso , Idoso de 80 Anos ou mais , Teorema de Bayes , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Fatores Socioeconômicos
9.
PLoS One ; 15(10): e0239683, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031406

RESUMO

BACKGROUND: A routine health information system is one of the essential components of a health system. Interventions to improve routine health information system data quality and use for decision-making in low- and middle-income countries differ in design, methods, and scope. There have been limited efforts to synthesise the knowledge across the currently available intervention studies. Thus, this scoping review synthesised published results from interventions that aimed at improving data quality and use in routine health information systems in low- and middle-income countries. METHOD: We included articles on intervention studies that aimed to improve data quality and use within routine health information systems in low- and middle-income countries, published in English from January 2008 to February 2020. We searched the literature in the databases Medline/PubMed, Web of Science, Embase, and Global Health. After a meticulous screening, we identified 20 articles on data quality and 16 on data use. We prepared and presented the results as a narrative. RESULTS: Most of the studies were from Sub-Saharan Africa and designed as case studies. Interventions enhancing the quality of data targeted health facilities and staff within districts, and district health managers for improved data use. Combinations of technology enhancement along with capacity building activities, and data quality assessment and feedback system were found useful in improving data quality. Interventions facilitating data availability combined with technology enhancement increased the use of data for planning. CONCLUSION: The studies in this scoping review showed that a combination of interventions, addressing both behavioural and technical factors, improved data quality and use. Interventions addressing organisational factors were non-existent, but these factors were reported to pose challenges to the implementation and performance of reported interventions.


Assuntos
Sistemas de Informação em Saúde/economia , Sistemas de Informação em Saúde/normas , Melhoria de Qualidade/tendências , África ao Sul do Saara , Gerenciamento de Dados , Países em Desenvolvimento/economia , Instalações de Saúde/normas , Instalações de Saúde/tendências , Sistemas de Informação em Saúde/estatística & dados numéricos , Humanos , Renda , Melhoria de Qualidade/economia
10.
PLoS One ; 15(10): e0239576, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33113548

RESUMO

In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40-65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.


Assuntos
Betacoronavirus , Doença Crônica/epidemiologia , Infecções por Coronavirus/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Renda/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Análise de Variância , Criança , Pré-Escolar , Doença Crônica/economia , Comorbidade , Infecções por Coronavirus/economia , Países em Desenvolvimento/economia , Pessoas com Deficiência/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Características da Família , Feminino , Alimentos/economia , Humanos , Lactente , Recém-Nascido , Masculino , Indigência Médica/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias/economia , Pneumonia Viral/economia , Pobreza , Fatores Socioeconômicos , Sri Lanka/epidemiologia , Inquéritos e Questionários , Adulto Jovem
11.
J Int AIDS Soc ; 23(10): e25632, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33119183

RESUMO

INTRODUCTION: Key populations at elevated risk to contract or transmit HIV may also be at higher risk of COVID-19 complications and adverse outcomes associated with public health prevention measures. However, the conditions faced by specific populations vary according to social, structural and environmental factors, including stigma and discrimination, criminalization, social and economic safety nets and the local epidemiology of HIV and COVID-19, which determine risk of exposure and vulnerability to adverse health outcomes, as well as the ability to comply with measures such as physical distancing. This commentary identifies common vulnerabilities and cross-cutting themes in terms of the impacts of COVID-19 on key populations before addressing issues and concerns specific to particular populations. DISCUSSION: Cross-cutting themes include direct impacts such as disrupted access to essential medicines, commodities and services such as anti-retroviral treatment, HIV pre-exposure prophylaxis, opioid agonist treatment, viral load monitoring, HIV and sexually transmitted infections testing, condoms and syringes. Indirect impacts include significant collateral damage arising from prevention measures which restrict human rights, increase or impose criminal penalties, and expand police powers to target vulnerable and criminalized populations. Significant heterogeneity in the COVID-19 pandemic, the underlying HIV epidemic and the ability of key populations to protect themselves means that people who inject drugs and sex workers face particular challenges, including indirect impacts as a result of police targeting, loss of income and sometimes both. Geographical variations mean that transgender people and men who have sex with men in regions like Africa and the middle east remain criminalized, as well as stigmatized and discriminated against, increasing their vulnerability to adverse outcomes in relation to COVID-19. CONCLUSIONS: Disruptions to both licit and illicit supply chains, loss of income and livelihoods and changes in behaviour as a result of lockdowns and physical distancing have the potential to exacerbate the impacts of the COVID-19 pandemic on key populations. While these impacts will vary significantly, human-rights approaches to COVID-19 emergency laws and public health prevention measures that are population-specific and sensitive, will be key to reducing adverse health outcomes and ensuring that no one is left behind.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por HIV/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Minorias Sexuais e de Gênero , Populações Vulneráveis , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Feminino , Infecções por HIV/complicações , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Renda , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Profilaxia Pré-Exposição , Prisioneiros , Saúde Pública , Fatores de Risco , Profissionais do Sexo , Doenças Sexualmente Transmissíveis/prevenção & controle , Estigma Social , Carga Viral
12.
Proc Natl Acad Sci U S A ; 117(44): 27277-27284, 2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33046648

RESUMO

The COVID-19 economic crash is idiosyncratic because of its virtual standstill of economic activity. We therefore ask how individual labor market experiences are related to the development of mental health complaints in the spring of 2020. As clinical data collection was compromised during the lockdowns, standardized surveys of the European labor force provide an opportunity to observe mental health complaints as the crisis unfolded. Data are representative of active members of the labor force of six European nations that contained varying levels of COVID-19 burdens in terms of mortality and lockdown measures. We document a steep occupational prestige level gradient on the probability of facing economic hardship during the lockdowns-looming job loss, income loss, and workload decline-which evidently exacerbate socioeconomic inequalities. Analyses indicate a striking positive relationship between instantaneous economic hardships during the COVID-19 lockdown and expressing feelings of depression and health anxiety. Importantly, the magnitude of the association between such hardships and indicators of mental health deterioration is highly dependent on workers' occupational standing, revealing a second layer of exacerbating inequality.


Assuntos
Infecções por Coronavirus/economia , Infecções por Coronavirus/psicologia , Emprego , Saúde Mental , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/psicologia , Fatores Socioeconômicos , Adulto , Ansiedade/epidemiologia , Betacoronavirus , Depressão/epidemiologia , Europa (Continente) , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade
13.
PLoS One ; 15(10): e0239797, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33027272

RESUMO

The current coronavirus pandemic is an unprecedented public health challenge that is having a devastating economic impact on households. Using a sample of 230,540 respondents to an online survey from 17 countries in Latin America and the Caribbean, the study shows that the economic impacts are large and unequal: 45 percent of respondents report that a household member has lost their job and, among households owning small businesses, 59 percent of respondents report that a household member has closed their business. Among households with the lowest income prior to the pandemic, 71 percent report that a household member lost their job and 61 percent report that a household member has closed their business. Declines in food security and health are among the disproportionate impacts. The findings provide evidence that the current public health crisis will exacerbate economic inequality and provides some of the first estimates of the impact of the pandemic on the labor market and well-being in developing countries.


Assuntos
Betacoronavirus , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Países em Desenvolvimento/economia , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Fatores Socioeconômicos , Adulto , Região do Caribe/epidemiologia , Infecções por Coronavirus/virologia , Características da Família , Feminino , Abastecimento de Alimentos , Humanos , Renda , América Latina/epidemiologia , Masculino , Pneumonia Viral/virologia , Pobreza , Inquéritos e Questionários , Desemprego
14.
Isr J Health Policy Res ; 9(1): 54, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33081833

RESUMO

BACKGROUND: The outbreak of a new Coronavirus disease (COVID-19) poses dramatic challenges to public health authorities worldwide. One measure put in place to contain the spread of the disease is self-quarantine of individuals who may have been exposed to the disease. While officials expect the public to comply with such regulation, studies suggest that a major obstacle to compliance for self-quarantine is concern over loss of income or employment due to the prolonged absence from work. METHODS: A cohort study of the adult population of Israel was conducted in two time points during the COVID-19 outbreak, the last week of February and the third week of March 2020, in order to assess public attitudes. In particular, public compliance rates to self-quarantine with and without State-sponsored compensation for lost wages were assessed. RESULTS: The results suggest that public attitudes changed as the threat increased, making people more compliant with regulations. In February 2020, compliance rate for self-quarantine dropped from 94% to less than 57% when monetary compensation for lost wages was removed; however, in March 2020 this drop became more moderate (from 96 to 71%). The multivariate logistic regression revealed that older, non-Jewish, worried over COVID-19, and trusting the Ministry of Health were more likely than their counterparts to comply with self-isolation, even when monetary compensation was not assumed. CONCLUSIONS: Despite the effects of threat on people's obedience with regulations, this study demonstrates that providing people with assurances about their livelihood during absence from work remains an important component in compliance with public health regulations.


Assuntos
Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Renda , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Assistência Pública/estatística & dados numéricos , Quarentena/legislação & jurisprudência , Adolescente , Adulto , Idoso , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Adulto Jovem
15.
Cien Saude Colet ; 25(suppl 2): 4169-4176, 2020 Oct.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33027353

RESUMO

The objective of this study is to show the impact of the early death of the elderly, especially those who are financially responsible for families, on the income of other family members. It is considered to be premature, because death occurs at an age where life expectancy is positive and different from zero. The concern arises from the finding that 74.7% of the deaths recorded by Covid-19 until 8/13/2020 occurred in individuals aged 60 years or older, of which 56.4% were men. For example, at age 60 a male individual could still expect to live another 18.1 years, given the health conditions prevailing in 2018.


Assuntos
Infecções por Coronavirus/mortalidade , Características da Família , Renda , Mortalidade Prematura , Pneumonia Viral/mortalidade , Adulto , Betacoronavirus , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Desemprego/estatística & dados numéricos , Adulto Jovem
16.
PLoS One ; 15(10): e0240009, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002052

RESUMO

OBJECTIVE: Brighter Bites is a school-based health promotion program that delivers fresh produce and nutrition education to low-income children and families. Due to COVID-19-related school closures, states were under "shelter in place" orders, and Brighter Bites administered a rapid assessment survey to identify social needs among their families. The purpose of this study is to demonstrate the methodology used to identify those with greatest social needs during this time ("high risk"), and to describe the response of Brighter Bites to these "high risk" families. METHODS: The rapid assessment survey was collected in April 2020 across Houston, Dallas, Washington DC, and Southwest Florida. The survey consisted of items on disruption of employment status, financial hardship, food insecurity, perceived health status and sociodemographics. The open-ended question "Please share your greatest concern at this time, or any other thoughts you would like to share with us." was asked at the end of each survey to triage "high risk" families. Responses were then used to articulate a response to meet the needs of these high risk families. RESULTS: A total of 1048 families completed the COVID-19 rapid response survey, of which 71 families were triaged and classified as "high risk" (6.8% of survey respondents). During this time, 100% of the "high risk" participants reported being food insecure, 85% were concerned about their financial stability, 82% concerned about the availability of food, and 65% concerned about the affordability of food. A qualitative analysis of the high-risk group revealed four major themes: fear of contracting COVID19, disruption of employment status, financial hardship, and exacerbated food insecurity. In response, Brighter Bites pivoted, created, and deployed a framework to immediately address a variety of social needs among those in the "high risk" category. Administering a rapid response survey to identify the immediate needs of their families can help social service providers tailor their services to meet the needs of the most vulnerable.


Assuntos
Infecções por Coronavirus/epidemiologia , Características da Família , Determinação de Necessidades de Cuidados de Saúde , Pneumonia Viral/epidemiologia , Pobreza , Betacoronavirus , Criança , District of Columbia , Emprego , Florida , Alimentos/economia , Abastecimento de Alimentos , Promoção da Saúde , Humanos , Renda , Pandemias , Serviço Social , Inquéritos e Questionários , Texas
17.
PLoS One ; 15(10): e0240648, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33048967

RESUMO

During an epidemic, metrics such as R0, doubling time, and case fatality rates are important in understanding and predicting the course of an epidemic. However, if collected over country or regional scales, these metrics hide important smaller-scale, local dynamics. We examine how commonly used epidemiological metrics differ for each individual state within the United States during the initial COVID-19 outbreak. We found that the detected case number and trajectory of early detected cases differ considerably between states. We then test for correlations with testing protocols, interventions and population characteristics. We find that epidemic dynamics were most strongly associated with non-pharmaceutical government actions during the early phase of the epidemic. In particular, early social distancing restrictions, particularly on restaurant operations, was correlated with increased doubling times. Interestingly, we also found that states with little tolerance for deviance from enforced rules saw faster early epidemic growth. Together with other correlates such as population density, our results highlight the different factors involved in the heterogeneity in the early spread of COVID-19 throughout the United States. Although individual states are clearly not independent, they can serve as small, natural experiments in how different demographic patterns and government responses can impact the course of an epidemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Monitoramento Epidemiológico , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Renda , Vacinas contra Influenza , Modelos Lineares , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Densidade Demográfica , População Rural , Fatores de Tempo , Estados Unidos/epidemiologia , Vacinação
18.
Artigo em Inglês | MEDLINE | ID: mdl-33053788

RESUMO

Early information on public health behaviors adopted to prevent the spread of coronavirus (COVID-19) may be useful in controlling the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission. The objective of this study was to assess the role of income level (IL) and the perception of older adults, regarding COVID-19 susceptibility and severity, on adopting stay-at-home preventive behavior during the first week of the outbreak in Mexico. Participants in this cross-sectional study were urban community dwellers, aged ≥ 65 years from Mexico City. A total of 380 interviews were conducted over the phone. The mean respondent age was 72.9 years, and 76.1% were women. Over half (54.2%) of the participants perceived their susceptibility to COVID-19 as very low or low. Similarly, 33.4% perceived COVID-19 severity as being very low or low, and 57.6% had decided to stay at home: this behavior was associated with IL (ß = 1.05, p < 0.001), and its total effect was partially mediated (15.1%) by perceived severity. Educational attainment was also associated with staying at home (ß = 0.10, p = 0.018) and its total effect was partially mediated (15.0%) by perceived susceptibility. Interventions aimed at low income and less educated older adults should be developed to improve preventive behaviors in this vulnerable group during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Renda/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Isolamento Social/psicologia , Idoso , Cidades/epidemiologia , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , México/epidemiologia , Pneumonia Viral/epidemiologia , Medição de Risco
19.
PLoS Med ; 17(9): e1003245, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32898152

RESUMO

BACKGROUND: Beverages, especially sugar-sweetened beverages (SSBs), have been increasingly subject to policies aimed at reducing their consumption as part of measures to tackle obesity. However, precision targeting of policies is difficult as information on what types of consumers they might affect, and to what degree, is missing. We fill this gap by creating a typology of beverage consumers in Great Britain (GB) based on observed beverage purchasing behaviour to determine what distinct types of beverage consumers exist, and what their socio-demographic (household) characteristics, dietary behaviours, and weight status are. METHODS AND FINDINGS: We used cross-sectional latent class analysis to characterise patterns of beverage purchases. We used data from the 2016 GB Kantar Fast-Moving Consumer Goods (FMCG) panel, a large representative household purchase panel of food and beverages brought home, and restricted our analyses to consumers who purchase beverages regularly (i.e., >52 l per household member annually) (n = 8,675). Six categories of beverages were used to classify households into latent classes: SSBs; diet beverages; fruit juices and milk-based beverages; beer and cider; wine; and bottled water. Multinomial logistic regression and linear regression were used to relate class membership to household characteristics, self-reported weight status, and other dietary behaviours, derived from GB Kantar FMCG. Seven latent classes were identified, characterised primarily by higher purchases of 1 or 2 categories of beverages: 'SSB' (18% of the sample; median SSB volume = 49.4 l/household member/year; median diet beverage volume = 38.0 l), 'Diet' (16%; median diet beverage volume = 94.4 l), 'Fruit & Milk' (6%; median fruit juice/milk-based beverage volume = 30.0 l), 'Beer & Cider' (7%; median beer and cider volume = 36.3 l; median diet beverage volume = 55.6 l), 'Wine' (18%; median wine volume = 25.5 l; median diet beverage volume = 34.3 l), 'Water' (4%; median water volume = 46.9 l), and 'Diverse' (30%; diversity of purchases, including median SSB volume = 22.4 l). Income was positively associated with being classified in the Diverse class, whereas low social grade was more likely for households in the classes SSB, Diet, and Beer & Cider. Obesity (BMI > 30 kg/m2) was more prevalent in the class Diet (41.2%, 95% CI 37.7%-44.7%) despite households obtaining little energy from beverages in that class (17.9 kcal/household member/day, 95% CI 16.2-19.7). Overweight/obesity (BMI > 25 kg/m2) was above average in the class SSB (66.8%, 95% CI 63.7%-69.9%). When looking at all groceries, households from the class SSB had higher total energy purchases (1,943.6 kcal/household member/day, 95% CI 1,901.7-1,985.6), a smaller proportion of energy from fruits and vegetables (6.0%, 95% CI 5.8%-6.3%), and a greater proportion of energy from less healthy food and beverages (54.6%, 95% CI 54.0%-55.1%) than other classes. A greater proportion of energy from sweet snacks was observed for households in the classes SSB (18.5%, 95% CI 18.1%-19.0%) and Diet (18.8%, 95% CI 18.3%-19.3%). The main limitation of our analyses, in common with other studies, is that our data do not include information on food and beverage purchases that are consumed outside the home. CONCLUSIONS: Amongst households that regularly purchase beverages, those that mainly purchased high volumes of SSBs or diet beverages were at greater risk of obesity and tended to purchase less healthy foods, including a high proportion of energy from sweet snacks. These households might additionally benefit from policies targeting unhealthy foods, such as sweet snacks, as a way of reducing excess energy intake.


Assuntos
Bebidas/economia , Comércio/tendências , Comportamento do Consumidor/economia , Adulto , Animais , Bebidas Adoçadas Artificialmente , Cerveja , Peso Corporal , Comportamento do Consumidor/estatística & dados numéricos , Estudos Transversais , Água Potável , Características da Família , Feminino , Sucos de Frutas e Vegetais , Humanos , Renda , Análise de Classes Latentes , Masculino , Leite , Inquéritos Nutricionais , Obesidade/psicologia , Reino Unido , Vinho
20.
PLoS One ; 15(9): e0236255, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881867

RESUMO

Community Health Workers (CHWs) play a vital role delivering health services to vulnerable populations in low resource settings. In Rwanda, CHWs provide village-level care focused on maternal/child health, control of infectious diseases, and health education, but do not receive salaries for these services. CHWs make up the largest single group involved in health delivery in the country; however, limited information is available regarding the socio-economic circumstances and satisfaction levels of this workforce. Such information can support governments aiming to control infectious diseases and alleviate poverty through enhanced healthcare delivery. The objectives of this study were to (1) evaluate CHW opportunity costs, (2) identify drivers for CHW motivation, job satisfaction and care provision, and (3) report CHW ideas for improving retention and service delivery. In this mixed-methods study, our team conducted in-depth interviews with 145 CHWs from three districts (Kirehe, Kayonza, Burera) to collect information on household economics and experiences in delivering healthcare. Across the three districts, CHWs contributed approximately four hours of volunteer work per day (range: 0-12 hrs/day), which translated to 127 684 RWF per year (range: 2 359-2 247 807 RWF/yr) in lost personal income. CHW out-of-pocket expenditures (e.g. patient transportation) were estimated at 36 228 RWF per year (range: 3 600-364 800 RWF/yr). Participants identified many benefits to being CHWs, including free healthcare training, improved social status, and the satisfaction of helping others. They also identified challenges, such as aging equipment, discrepancies in financial reimbursements, poverty, and lack of formal workspaces or working hours. Lastly, CHWs provided perspectives on reasonable and feasible improvements to village-level health programming that could improve conditions and equity for those providing and using the CHW system.


Assuntos
Agentes Comunitários de Saúde , Adulto , Agentes Comunitários de Saúde/economia , Agentes Comunitários de Saúde/educação , Agentes Comunitários de Saúde/psicologia , Estudos Transversais , Assistência à Saúde/economia , Feminino , Humanos , Renda , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Motivação , Ruanda , Adulto Jovem
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