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2.
Lancet Public Health ; 6(9): e674-e682, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34388389

RESUMO

BACKGROUND: Since the emergence of the COVID-19 pandemic in late 2019, various public health and social measures (PHSMs) have been used to suppress and mitigate the spread of SARS-CoV-2. With mass vaccination programmes against COVID-19 being rolled out in many countries in early 2021, we aimed to evaluate to what extent travel restrictions and other PHSMs can be relaxed without exacerbating the local and global spread of COVID-19. METHODS: We adapted an existing age-structured susceptible-infectious-removed model of SARS-CoV-2 transmission dynamics that can be parameterised with country-specific age demographics and contact patterns to simulate the effect of vaccination and PHSM relaxation on transmission. We varied assumptions by age-specific susceptibility and infectiousness, vaccine uptake, contact patterns, and age structures. We used Hong Kong as a case study and assumed that, before vaccination, the population is completely susceptible to SARS-CoV-2 infection. We applied our model to 304 jurisdictions (27 countries and 277 sub-national administrative regions from eight countries). We assumed that PHSMs have suppressed the effective reproductive number (Re) to fall between 1·0 and 9·0 locally before the commencement of vaccination programmes. We evaluated the levels of PHSMs that should be maintained during the roll-out of COVID-19 vaccination to avoid a large local outbreak of COVID-19, with different assumptions about vaccine efficacy, vaccination coverage, and travel restrictions. We assumed that the maximum capacity of the health system, in terms of daily hospital admissions, is 0·005% of the population size. FINDINGS: At vaccine efficacy of 0·80 in reducing susceptibility to SARS-CoV-2 infection, 0·50 in reducing SARS-CoV-2 infectivity, and 0·95 in reducing symptomatic COVID-19 diseases, vaccination coverage would have to be 100% for all individuals aged 30 or older to avoid an outbreak, when relaxing PHSMs, that would overload the local health-care system, assuming a pre-vaccination Re of 2·5. Testing and quarantine of at least 5 days would have to be maintained for inbound travellers to minimise the risk of reintroducing a local outbreak until high vaccination coverages are attained locally and overseas in most countries. INTERPRETATION: Gradual relaxation of PHSMs should be carefully planned during the roll-out of vaccination programmes, and easing of travel restrictions weighed against risk of reintroducing outbreaks, to avoid overwhelming health systems and minimise deaths related to COVID-19. FUNDING: Health and Medical Research Fund and the General Research Fund.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Programas de Imunização/organização & administração , Pandemias/prevenção & controle , Saúde Pública/legislação & jurisprudência , Viagem/legislação & jurisprudência , COVID-19/epidemiologia , Teste para COVID-19 , Hong Kong/epidemiologia , Humanos , Modelos Teóricos , Quarentena
3.
Traffic Inj Prev ; 22(7): 501-506, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34410833

RESUMO

OBJECTIVE: Little is known about the relationship between Stay-At-Home orders issued by state governments due to the COVID-19 pandemic and their impacts on motor vehicle-related injuries. The purpose of this study was to determine whether the presence of a Stay-At-Home order was associated with lower rates of motor vehicle-related injuries requiring emergency medical treatment among population sub-groups in West Virginia (i.e., males, females, 0-17, 18-25, 26-45, 46-65, ≥66 years old). METHODS: A Stay-At-Home order was in effect in West Virginia from March 23-May 4, 2020. Counts of individuals who incurred motor-vehicle-related injuries that required emergency medical treatment were obtained from the Centers for Disease Control and Prevention's National Syndromic Surveillance Program from January 1 thru September 6 of 2019 and 2020. Counts were obtained by week-year and by population sub-group in West Virginia. The presence of the Stay-At-Home order was binary coded by week. Negative binomial regression was used to assess the relationship between the presence of a Stay-At-Home and injury rates. 2019 population sub-group estimates were obtained from the United States Census Bureau and used as offsets in the models. Models were also adjusted for year and vehicle miles traveled by week-year. RESULTS: There were 23,418 motor-vehicle related injuries during the study period. The presence of the Stay-At-Home order was associated with 44% less injuries overall [Incident Rate Ratio (IRR)=0.56, 95% CI 0.48, 0.64]. Females experienced fewer injuries than males (IRR = 0.49 vs 0.63, respectively) and the number of injuries decreased with age (p-value 0.031) when comparing time periods when the Stay-At-Home was in effect compared to times when it was not. CONCLUSIONS: West Virginia's Stay-At-Home order was associated with lower motor-vehicle injury rates requiring medical treatment across all population sub-groups. Most population sub-groups likely altered their travel behaviors which resulted in lower motor-vehicle injury rates. These findings may inform future policies that impose emergency travel restrictions in populations.


Assuntos
Acidentes de Trânsito , COVID-19 , Pandemias , Saúde Pública , Ferimentos e Lesões , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Saúde Pública/legislação & jurisprudência , West Virginia/epidemiologia , Ferimentos e Lesões/epidemiologia , Adulto Jovem
4.
J Infect Dev Ctries ; 15(7): 918-924, 2021 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-34343116

RESUMO

INTRODUCTION: The ongoing COVID-19 pandemic has claimed hundreds of thousands of lives around the world. Health planners are seeking ways to forecast the evolution of the pandemic. In this study, a mathematical model was proposed for Saudi Arabia, the country with the highest reported number of COVID-19 cases in the Arab world. METHODOLOGY: The proposed model was adapted from the model used for the Middle East respiratory syndrome outbreak in South Korea. Using time-dependent parameters, the model incorporated the effects of both population-wide self-protective measures and government actions. Data before and after the government imposed control policies on 3 March 2020 were used to validate the model. Predictions for the disease's progression were provided together with the evaluation of the effectiveness of the mitigation measures implemented by the government and self-protective measures taken by the population. RESULTS: The model predicted that, if the government had continued to implement its strong control measures, then the scale of the pandemic would have decreased by 99% by the end of June 2020. Under the current relaxed policies, the model predicted that the scale of the pandemic will have decreased by 99% by 10 August 2020. The error between the model's predictions and actual data was less than 6.5%. CONCLUSIONS: Although the proposed model did not capture all of the effects of human behaviors and government actions, it was validated as a result of its time-dependent parameters. The model's accuracy indicates that it can be used by public health policymakers.


Assuntos
COVID-19/epidemiologia , Modelos Teóricos , Saúde Pública/métodos , Previsões/métodos , Implementação de Plano de Saúde/legislação & jurisprudência , Implementação de Plano de Saúde/normas , Humanos , Saúde Pública/legislação & jurisprudência , Saúde Pública/estatística & dados numéricos , Arábia Saudita/epidemiologia
6.
Lancet Diabetes Endocrinol ; 9(7): 446-461, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34097869

RESUMO

China has experienced many drastic social and economic changes and shifts in people's lifestyles since the 1990s, in parallel with the fast rising prevalence of obesity. About half of adults and a fifth of children have overweight or obesity according to the Chinese criteria, making China the country with the highest number of people with overweight or obesity in the world. Assuming that observed time trends would continue in the future, we projected the prevalence of and the number of people affected by overweight and obesity by 2030, and the associated medical costs. The rising incidence of obesity and number of people affected, as well as the related health and economic consequences, place a huge burden on China's health-care system. China has made many efforts to tackle obesity, including the implementation of relevant national policies and programmes. However, these measures are inadequate for controlling the obesity epidemic. In the past decade, China has attached great importance to public health, and the Healthy China 2030 national strategy initiated in 2016 provides a historical opportunity to establish comprehensive national strategies for tackling obesity. China is well positioned to explore an effective model to overcome the obesity epidemic; however, strong commitment and leadership from central and local governments are needed, as well as active participation of all related society sectors and individual citizens. TRANSLATION: For the Chinese translation of the paper see Supplementary Materials section.


Assuntos
Efeitos Psicossociais da Doença , Atenção à Saúde/tendências , Política de Saúde/tendências , Obesidade/epidemiologia , Obesidade/terapia , Saúde Pública/tendências , China/epidemiologia , Atenção à Saúde/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Humanos , Obesidade/diagnóstico , Saúde Pública/legislação & jurisprudência
7.
Artigo em Inglês | MEDLINE | ID: mdl-34074233

RESUMO

Abstract: With COVID-19 affecting millions of people around the globe, quarantine of international arrivals is a critical public health measure to prevent further disease transmission in local populations. This measure has also been applied in the repatriation of citizens, undertaken by several countries as an ethical obligation and legal responsibility. This article describes the process of planning and preparing for the repatriation operation in South Australia during the COVID-19 pandemic. Interagency collaboration, development of a COVID-19 testing and quarantining protocol, implementing infection prevention and control, and building a specialised health care delivery model were essential aspects of the repatriation operational planning, with a focus on maintaining dignity and wellbeing of the passengers as well as on effective prevention of COVID-19 transmission. From April 2020 to mid-February 2021, more than 14,000 international arrivals travellers have been repatriated under the South Australian repatriation operations. This paper has implications to inform ongoing repatriation efforts in Australia and overseas in a pandemic situation.


Assuntos
COVID-19/epidemiologia , Controle de Infecções/legislação & jurisprudência , Saúde Pública/legislação & jurisprudência , Quarentena/legislação & jurisprudência , COVID-19/diagnóstico , COVID-19/transmissão , Teste para COVID-19/métodos , Teste para COVID-19/normas , Atenção à Saúde , Humanos , Controle de Infecções/métodos , Regulamento Sanitário Internacional , Pandemias , Saúde Pública/métodos , Quarentena/métodos , Medição de Risco , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Austrália do Sul/epidemiologia , Viagem
8.
Indian J Med Ethics ; VI(1): 1-10, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34080990

RESUMO

Many states in India have invoked the provisions of the Epidemic Diseases Act, 1897, as a major tool in the fight against the Covid-19 pandemic. The current review attempts to discuss the ethical challenges in implementation of the Epidemic Diseases Act, 1897, to combat Covid-19 in India. Implementation of the Act in India has exposed its major limitations. It remains merely as a "policing" Act with no emphasis on coordinated and scientific responses to outbreaks and without provisions for protecting the rights of citizens. The Epidemic Diseases Act in its current form has the potential to cause more harm than good. Furthermore, the Epidemic Disease (Amendment) Bill, 2020, has not addressed any of these concerns. There is need for a rights-based, people-focused and public health-oriented law in India to deal with epidemics.


Assuntos
COVID-19/prevenção & controle , Surtos de Doenças/legislação & jurisprudência , Surtos de Doenças/prevenção & controle , Pandemias/legislação & jurisprudência , Pandemias/prevenção & controle , Saúde Pública/ética , Saúde Pública/legislação & jurisprudência , COVID-19/epidemiologia , Humanos , Índia/epidemiologia , SARS-CoV-2
9.
Indian J Med Ethics ; VI(1): 1-3, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34080991

RESUMO

Large-scale vaccination with a safe and effective vaccine against Covid-19 is the only way to conquer the ongoing lethal pandemic that has led to extraordinary social and economic upheaval globally. Fortunately, the world is on the verge of developing Covid-19 vaccines in an unprecedentedly short time. More than forty vaccines are in different stages of clinical trials, and a few are in the crucial phase III studies stage. A new demand for emergency use authorisation and rapid deployment of these vaccines before scrutinising phase III trial data is raging in different quarters. Can advancement of the deployment of these vaccines by even a few weeks give us rich public health dividends? Would it be ethical to deploy these novel vaccines based only on the safety and immunogenicity data generated by the phase-I and II clinical trials? Would it be ethical to deny vaccination of vulnerable populations against an untreatable infectious disease despite the availability of reasonably safe and efficacious vaccines for the want of phase III trial data? The answer is not straightforward, as there are many complexities involved. This commentary attempts to discuss some ethical issues involved in a decision to deploy Covid-19 vaccination before phase III trial results are declared.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Serviços Médicos de Emergência/ética , Serviços Médicos de Emergência/legislação & jurisprudência , Princípios Morais , Vacinação/ética , Vacinação/legislação & jurisprudência , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/legislação & jurisprudência , Pandemias/prevenção & controle , Saúde Pública/ética , Saúde Pública/legislação & jurisprudência , SARS-CoV-2
13.
JMIR Public Health Surveill ; 7(6): e27917, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-33975277

RESUMO

BACKGROUND: The United States of America has the highest global number of COVID-19 cases and deaths, which may be due in part to delays and inconsistencies in implementing public health and social measures (PHSMs). OBJECTIVE: In this descriptive analysis, we analyzed the epidemiological evidence for the impact of PHSMs on COVID-19 transmission in the United States and compared these data to those for 10 other countries of varying income levels, population sizes, and geographies. METHODS: We compared PHSM implementation timing and stringency against COVID-19 daily case counts in the United States and against those in Canada, China, Ethiopia, Japan, Kazakhstan, New Zealand, Singapore, South Korea, Vietnam, and Zimbabwe from January 1 to November 25, 2020. We descriptively analyzed the impact of border closures, contact tracing, household confinement, mandated face masks, quarantine and isolation, school closures, limited gatherings, and states of emergency on COVID-19 case counts. We also compared the relationship between global socioeconomic indicators and national pandemic trajectories across the 11 countries. PHSMs and case count data were derived from various surveillance systems, including the Health Intervention Tracking for COVID-19 database, the World Health Organization PHSM database, and the European Centre for Disease Prevention and Control. RESULTS: Implementing a specific package of 4 PHSMs (quarantine and isolation, school closures, household confinement, and the limiting of social gatherings) early and stringently was observed to coincide with lower case counts and transmission durations in Vietnam, Zimbabwe, New Zealand, South Korea, Ethiopia, and Kazakhstan. In contrast, the United States implemented few PHSMs stringently or early and did not use this successful package. Across the 11 countries, national income positively correlated (r=0.624) with cumulative COVID-19 incidence. CONCLUSIONS: Our findings suggest that early implementation, consistent execution, adequate duration, and high adherence to PHSMs represent key factors of reducing the spread of COVID-19. Although national income may be related to COVID-19 progression, a country's wealth appears to be less important in controlling the pandemic and more important in taking rapid, centralized, and consistent public health action.


Assuntos
COVID-19/prevenção & controle , Saúde Global/estatística & dados numéricos , Saúde Pública/legislação & jurisprudência , COVID-19/epidemiologia , COVID-19/transmissão , Bases de Dados Factuais , Humanos , Distanciamento Físico , Quarentena , Instituições Acadêmicas/organização & administração , Estados Unidos/epidemiologia , Local de Trabalho/organização & administração
14.
Psychiatry Res ; 302: 113999, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34038806

RESUMO

This study assesses for the impact of Covid-19 public health quarantine measures on acute care psychiatric admissions, by comparing admission data from the quarantine period to a comparator period. A chart review was conducted for all admissions to an urban acute care psychiatric centre from Mar 22 - June 5 2020 (quarantine) and January 5 - Mar 21 2020 (comparator). Data was collected on the number of admissions, demographics, patients' psychiatric history, characteristics of admissions, discharge information, patients' substance use and social factors. Data was analyzed using a student's t-test for continuous variables and Chi squared analyses for categorical variables. Results demonstrated 185 admissions during quarantine and 190 during the comparator, with no significant differences in the distribution of admissions across time periods. There was a significantly greater frequency of admissions in the 35-44 age bracket and admissions involving substance use during quarantine. Additionally, admissions during quarantine were significantly shorter, with increased frequency of involuntary status and use of seclusion. The data suggests a vulnerability specific to individuals in their 30-40s during quarantine and demonstrates a need to better understand factors impacting this group. It also suggests that quarantine is associated with changes to substance use, potentiating high acuity illness requiring admission.


Assuntos
COVID-19/prevenção & controle , Hospitalização/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Quarentena/psicologia , Adulto , Idoso , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Escócia/epidemiologia , Saúde Pública/legislação & jurisprudência , Estudos Retrospectivos , Adulto Jovem
15.
Am J Public Health ; 111(6): 1095-1098, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33856879

RESUMO

Policy surveillance is critical in examining the ways law functions as a structural and social determinant of health. To date, little policy surveillance research has focused on examining intrastate variations in the structure and health impact of laws. Intrastate policy surveillance poses unique methodological challenges because of the complex legal architecture within states and inefficient curation of local laws.We discuss our experience with these intrastate policy surveillance challenges in Indiana, a state with 92 counties and several populous cities, a complicated history of home rule, systemically underfunded local governments, and variations in demography, geography, and technology adoption. In our case study, we expended significant time and resources to obtain county and city ordinances through online code libraries, jurisdiction Web sites, and (most notably) visits to offices to scan documents ourselves.A concerted effort is needed to ensure that local laws of all kinds are stored online in organized, searchable, and open access systems. Such an effort is vital to achieve the aspirational goals of policy surveillance at the intrastate level.


Assuntos
Epidemiologia Legal , Saúde Pública/legislação & jurisprudência , Indiana
18.
MMWR Morb Mortal Wkly Rep ; 70(14): 514-518, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33830985

RESUMO

COVID-19 has disproportionately affected persons who identify as non-Hispanic American Indian or Alaska Native (AI/AN) (1). The Blackfeet Tribal Reservation, the northern Montana home of the sovereign Blackfeet Nation, with an estimated population of 10,629 (2), detected the first COVID-19 case in the community on June 16, 2020. Following CDC guidance,* and with free testing widely available, the Indian Health Service and Blackfeet Tribal Health Department began investigating all confirmed cases and their contacts on June 25. The relationship between three community mitigation resolutions passed and enforced by the Blackfeet Tribal Business Council and changes in the daily COVID-19 incidence and in the distributions of new cases was assessed. After the September 28 issuance of a strictly enforced stay-at-home order and adoption of a mask use resolution, COVID-19 incidence in the Blackfeet Tribal Reservation decreased by a factor of 33 from its peak of 6.40 cases per 1,000 residents per day on October 5 to 0.19 on November 7. Other mitigation measures the Blackfeet Tribal Reservation used included closing the east gate of Glacier National Park for the summer tourism season, instituting remote learning for public school students throughout the fall semester, and providing a Thanksgiving meal to every household to reduce trips to grocery stores. CDC has recommended use of routine public health interventions for infectious diseases, including case investigation with prompt isolation, contact tracing, and immediate quarantine after exposure to prevent and control transmission of SARS-CoV-2, the virus that causes COVID-19 (3). Stay-at-home orders, physical distancing, and mask wearing indoors, outdoors when physical distancing is not possible, or when in close contact with infected or exposed persons are also recommended as nonpharmaceutical community mitigation measures (3,4). Implementation and strict enforcement of stay-at-home orders and a mask use mandate likely helped reduce the spread of COVID-19 in the Blackfeet Tribal Reservation.


Assuntos
COVID-19/etnologia , COVID-19/prevenção & controle , Índios Norte-Americanos/estatística & dados numéricos , Máscaras , Saúde Pública/legislação & jurisprudência , Quarentena/legislação & jurisprudência , Características de Residência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/transmissão , Criança , Pré-Escolar , Busca de Comunicante , Feminino , Disparidades nos Níveis de Saúde , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Montana/epidemiologia , Adulto Jovem
19.
Methods Mol Biol ; 2249: 517-536, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33871862

RESUMO

There is a growing expectation that research will be used to inform decision-making. It is important for researchers to understand how health policy is developed and the different ways they can influence the development of policy.Public policy is developed to resolve identified problems. Health policy is a subset of public policy and is typically concerned with issues related to the health of populations either from a service delivery perspective or from a broader public health and social determinants of health perspective. The policy planning algorithm is well established and follows the basic decision-making framework: problem identification, policy formulation, implementation, and evaluation. A variety of government and nongovernment stakeholders engage in complex debates to identify and resolve policy issues. In this chapter, we explore how researchers can use their research to influence the development of health policy. Knowledge translation strategies focused on communicating research to policy-makers require considerable thought and planning.


Assuntos
Medicina Baseada em Evidências/legislação & jurisprudência , Formulação de Políticas , Saúde Pública/legislação & jurisprudência , Algoritmos , Tomada de Decisão Clínica , Política de Saúde , Humanos , Comunicação Interdisciplinar , Pesquisadores , Pesquisa Médica Translacional/legislação & jurisprudência
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