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1.
Meat Sci ; 183: 108616, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34481232

RESUMO

This cross-country study investigates the potential to improve pig welfare by exploiting consumer demand, domestically and in export markets, for welfare pork produced in indoor production systems. The analysis is based on questionnaire data collected in 2019 focusing on demand for Danish welfare pork both in Denmark and in two nearby export markets, Sweden and Germany. To reduce hypothetical bias, a willingness-to-pay indicator is combined with an indicator of positive interest in buying a fictive Danish welfare labelled pork. We find that the market potential is relatively weak. Our findings indicate that there is some, albeit limited, potential in Denmark and Germany while demand is practically non-existing in Sweden, probably because the pig welfare guaranteed by Swedish legislation is similar to what is provided by the fictive welfare label employed in the study. Hence, consumer demand alone cannot secure enhanced pig welfare. Moreover, we found national differences in the characteristics of consumers who are interested in Danish welfare pork.


Assuntos
Bem-Estar do Animal , Comportamento do Consumidor/estatística & dados numéricos , Carne de Porco/normas , Adulto , Animais , Comportamento do Consumidor/economia , Estudos Transversais , Dinamarca , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Carne de Porco/economia , Inquéritos e Questionários , Suécia , Suínos
2.
Urol Clin North Am ; 49(1): 153-159, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34776048

RESUMO

Ureteroscopy is the most common surgical modality for stone treatment. Reusable flexible ureteroscopes are delicate instruments that require expensive maintenance and repairs. Multiple single use ureteroscopes have been developed recently to combat the expensive and time-intensive sterilization and repair of ureteroscopes. Although multiple studies have looked at different aspects of reusable and single use ureteroscopes, there is significant heterogeneity in performance measures and cost between the 2 categories, and neither has a clear advantage. Both can be used successfully, and individual and institution level factors should be considered when deciding which ureteroscope to use.


Assuntos
Equipamentos Descartáveis , Meio Ambiente , Contaminação de Equipamentos , Ureteroscópios , Equipamentos Descartáveis/economia , Equipamentos Descartáveis/normas , Humanos , Manutenção/economia , Ureteroscópios/economia , Ureteroscópios/normas , Urolitíase/cirurgia
3.
J Sci Food Agric ; 102(1): 198-205, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34061358

RESUMO

BACKGROUND: Kale and arugula are leafy green vegetables whose sensory properties have not been extensively explored. The objective was to assess the sensory properties and consumer acceptability of commercially available kale and arugula while also discovering drivers of consumer liking and barriers to consumer acceptance. Descriptive analysis and consumer testing were completed. The trained panellists (n = 11) were trained for 15 h to evaluate 11 sensory properties relating to the aroma, taste and texture of the kale and arugula. The consumer testing (n = 108) evaluated the leafy greens for overall liking and their liking of taste, aroma, texture and appearance. RESULTS: Results were analyzed using ANOVA, Tukey's HSD and external preference mapping. Approximately half of the attributes for the kale samples were found to be significantly different. Similarly, significant differences in sensory properties were found in most of the arugula samples. Consumers liked the kale and arugula varieties that were sweet and nutty. Also, they preferred arugula that was described as spicy. CONCLUSION: The majority of consumers preferred sweet and nutty leafy greens. Organic growing methods did not affect consumer liking; however, organic labels do positively affect hedonic ratings of a consumer's overall liking of the product. This study also identified that 'Baby' leafy greens are well liked by consumers, and this area of produce should be expanded. © 2021 Society of Chemical Industry.


Assuntos
Brassica/metabolismo , Brassicaceae/metabolismo , Comportamento do Consumidor , Odorantes/análise , Brassica/química , Brassica/economia , Brassicaceae/química , Preferências Alimentares , Humanos , Folhas de Planta/química , Folhas de Planta/metabolismo , Paladar
4.
PLoS One ; 16(11): e0251683, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34731175

RESUMO

Previous research has shown that the COVID-19 outbreak, social distancing, and lockdown can affect people's psychological well-being. The aims of this study were (1) to estimate the extent to which perceptions and expectations regarding the social, economic, and domestic effects of the COVID-19 outbreak are associated with psychological distress and (2) to identify some demographic, psychosocial, and economic factors associated with increased vulnerability to psychological distress during the COVID-19 outbreak in Chile. 1078 people participated in a telephone survey between May 30 and June 10, 2020. The sample is representative of the Chilean adult population. Psychological distress was assessed through a questionnaire of anxious and depressive symptoms (Patient Health Questionnaire-4). We analyzed the data set using ordinary least-squares regression models, first estimating models for the entire sample, and then stratifying the sample into different groups to explore differences by gender and age. 19.2% of participants displayed significant psychological distress (PHQ-4 ≥ 6), with moderate to severe anxiety-depression symptoms being more prevalent in women than in men (23.9% vs 14.1%, χ2 16.78, p<0.001). The results of this study suggest that being a woman, feeling lonely and isolated, living in the areas hit hardest by the pandemic and lockdown, expecting a lack of income due to having to stop working as a consequence of the pandemic, and having a history of diagnosed mental disorders are significantly associated with psychological distress (p<0.05). The results of this study highlight the need to implement psychosocial programs to guard people's psychological well-being and social policies to address economic uncertainty during the current COVID-19 outbreak in Chile.


Assuntos
COVID-19/psicologia , Efeitos Psicossociais da Doença , Angústia Psicológica , Adolescente , Adulto , COVID-19/economia , Chile , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Pandemias , Adulto Jovem
5.
Lancet Oncol ; 22(11): e474-e487, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34735817

RESUMO

The increasing burden of cancer represents a substantial problem for Latin America and the Caribbean. Two Lancet Oncology Commissions in 2013 and 2015 highlighted potential interventions that could advance cancer care in the region by overcoming existing challenges. Areas requiring improvement included insufficient investment in cancer control, non-universal health coverage, fragmented health systems, inequitable concentration of cancer services, inadequate registries, delays in diagnosis or treatment initiation, and insufficient palliative services. Progress has been made in key areas but remains uneven across the region. An unforeseen challenge, the COVID-19 pandemic, strained all resources, and its negative effect on cancer control is expected to continue for years. In this Series paper, we summarise progress in several aspects of cancer control since 2015, and identify persistent barriers requiring commitment of additional resources to reduce the cancer burden in Latin America and the Caribbean.


Assuntos
COVID-19/epidemiologia , Neoplasias/prevenção & controle , SARS-CoV-2 , Região do Caribe/epidemiologia , Efeitos Psicossociais da Doença , Atenção à Saúde/economia , Detecção Precoce de Câncer , Acesso aos Serviços de Saúde , Humanos , América Latina/epidemiologia , Oncologia/educação , Neoplasias/epidemiologia
7.
Int J Public Health ; 66: 1604073, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744596

RESUMO

Objectives: Guidelines recommend colorectal cancer (CRC) screening by fecal occult blood test (FOBT) or colonoscopy. In 2013, Switzerland introduced reimbursement of CRC screening by mandatory health insurance for 50-69-years-olds, after they met their deductible. We hypothesized that the 2013 reimbursement policy increased testing rate. Methods: In claims data from a Swiss insurance, we determined yearly CRC testing rate among 50-75-year-olds (2012-2018) and the association with socio-demographic, insurance-, and health-related covariates with multivariate-adjusted logistic regression models. We tested for interaction of age (50-69/70-75) on testing rate over time. Results: Among insurees (2012:355'683; 2018:348'526), yearly CRC testing rate increased from 2012 to 2018 (overall: 8.1-9.9%; colonoscopy: 5.0-7.6%; FOBT: 3.1-2.3%). Odds ratio (OR) were higher for 70-75-year-olds (2012: 1.16, 95%CI 1.13-1.20; 2018: 1.05, 95%CI 1.02-1.08). Deductible interacted with changes in testing rate over time (p < 0.001). The increase in testing rate was proportionally higher among 50-69-years-olds than 70-75-year-olds over the years. Conclusions: CRC testing rate in Switzerland increased from 2012 to 2018, particularly among 50-69-years-olds, the target population of the 2013 law. Future studies should explore the effect of encouraging FOBT or waiving deductible.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Idoso , Colonoscopia/economia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/estatística & dados numéricos , Humanos , Formulário de Reclamação de Seguro/estatística & dados numéricos , Seguro Saúde/economia , Pessoa de Meia-Idade , Sangue Oculto , Mecanismo de Reembolso , Suíça
8.
Hematology ; 26(1): 860-869, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34719349

RESUMO

BACKGROUND: Immune thrombocytopenia (ITP) is a rare disease, characterized by increased platelet destruction/suboptimal platelet production, leading to thrombocytopenia and risk of severe bleeding events. METHODS: Interviews with 23 physicians and 12 payors, a survey with 113 physicians and validation using published data were used to define the current treatment paradigm and healthcare resource utilization and to determine the costs associated with managing acute bleeds in six European countries (Germany, Spain, France, Italy, Netherlands, UK). The study estimated a prevalence of 9 to 10 per 100,000 adults in 2020 across all six countries (disease severity split: 34% mild, 32% moderate, 33% severe (due to rounding up some values might not sum up to 100%). RESULTS: Physician feedback showed that most patients with ITP (60%) received first-line treatment or were monitored by their physician; ∼75% of patients relapsed within 3-4 months. Thrombopoietin-receptor agonists (TPO-RAs) and rituximab were used to achieve disease stabilization in patients who relapse; patients could switch to an alternative TPO-RA to control symptoms, manage side-effects or improve adherence. The costs of rescue therapies and hospital services (e.g. surgery and admissions) accounted for the majority of healthcare resources to manage bleeding events. CONCLUSION: Physicians would welcome earlier use of TPO-RAs to help maintain long-term control of ITP bleeds and potentially reduce both hospitalization and therapy costs.


Assuntos
Púrpura Trombocitopênica Idiopática/terapia , Adulto , Gerenciamento Clínico , Europa (Continente)/epidemiologia , Hemorragia/economia , Hemorragia/epidemiologia , Hemorragia/terapia , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Púrpura Trombocitopênica Idiopática/economia , Púrpura Trombocitopênica Idiopática/epidemiologia
10.
Lancet Psychiatry ; 8(12): 1071-1082, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34801129

RESUMO

BACKGROUND: The WHO Comprehensive Mental Health Action Plan 2013-2030 encourages routine collection and reporting of a set of essential mental health indicators, including the availability of psychotropic medicines. The global monitoring of country-level psychotropic medicine consumption trends can provide information on the extent of the availability of psychotropic medicines. The primary objective of this study was to investigate global trends in psychotropic medicines consumption from 2008 to 2019 across 65 countries and regions according to country income level and geographical region. METHODS: In this longitudinal trends study, we used pharmaceutical sales data from the IQVIA-Multinational Integrated Data Analysis System (IQVIA-MIDAS). We analysed monthly sales data of psychotropic medicines between Jan 1, 2008, and Dec 31, 2019. Total psychotropic medicine consumption included sales of antidepressants, antipsychotics, tranquilisers, sedatives or hypnotics, and mood stabilisers. Population estimates of each country or region (eight lower-middle-income countries, 19 upper-middle-income countries, and 38 high-income countries) were based on the UN World Population Prospects 2019 report. Average annual sales trends of psychotropic medicines, expressed as defined daily dose (DDD) per 1000 inhabitants per day, were estimated using a random-effects model adjusted for income level and region. Relative changes in the annual consumption of psychotropic medicines by income, expressed as DDD per 1000 inhabitants per day, were assessed as percentage change for each medicine class. FINDINGS: Psychotropic medicine sales increased from 28·54 DDD per 1000 inhabitants per day in 2008 to 34·77 DDD per 1000 inhabitants per day in 2019, corresponding to a 4·08% (95% CI 2·96-5·21) relative average increase annually. The absolute annual increase was greater in high-income countries (3·31 DDD per 1000 inhabitants per day, 95% CI 3·01-3·61) compared with upper-middle-income countries (1·94 DDD per 1000 inhabitants per day, 1·45-2·44) and low-middle-income countries (0·88 DDD per 1000 inhabitants per day, 0·62-1·13; p<0·0001). The relative average annual increase in psychotropic medicine sales from 2008 to 2019 was greater in upper-middle-income countries (7·88%, 95% CI 6·99-8·77) than in lower-middle-income countries (2·90%, 2·40-3·39) and high-income countries (1·02%, 0·80-1·24). In 2019, the regional consumption of psychotropic medicines varied greatly, with the highest sales of all psychotropic medicine classes reported in northern America (167·54 DDD per 1000 inhabitants per day) and lowest sales reported in Asia (5·59 DDD per 1000 inhabitants per day). 17 countries had very low consumption of psychotropic medicines in 2019, including high-income countries and countries with a high prevalence of mental disorders. INTERPRETATION: The consumption of psychotropic medicines has increased over a 12-year period, and although the absolute growth rate was highest in high-income countries, the relative growth is highest in middle-income countries and especially upper-middle-income countries. Disparities in psychotropic medicine consumption of countries can only partly be explained by geographical location and income. Greater efforts are needed to increase the availability of psychotropic medicines in countries with very low consumption, which is probably due to financial or cultural reasons as well as scarcity of trained health-care professionals to prescribe psychotropic medicines. FUNDING: None.


Assuntos
Uso de Medicamentos , Psicotrópicos , Acesso aos Serviços de Saúde , Humanos , Estudos Longitudinais , Transtornos Mentais/tratamento farmacológico , Psicotrópicos/economia , Psicotrópicos/uso terapêutico
13.
Lancet ; 398(10313): 1837-1850, 2021 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-34774146

RESUMO

Type 1 diabetes is on the rise globally; however, the burden of mortality remains disproportionate in low-income and middle-income countries (LMICs). As 2021 marks 100 years since the discovery of insulin, we revisit progress, global burden of type 1 diabetes trends, and understanding of the pathogenesis and management practices related to the disease. Despite much progress, inequities in access and availability of insulin formulations persist and are reflected in differences in survival and morbidity patterns related to the disease. Some of these inequities have also been exacerbated by health-system challenges during the COVID-19 pandemic. There is a clear opportunity to improve access to insulin and related essential technologies for improved management of type 1 diabetes in LMICs, especially as a part of universal health coverage. These improvements will require concerted action and investments in human resources, community engagement, and education for the timely diagnosis and management of type 1 diabetes, as well as adequate health-care financing. Further research in LMICs, especially those in Africa, is needed to improve our understanding of the burden, risk factors, and implementation strategies for managing type 1 diabetes.


Assuntos
Países em Desenvolvimento , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/patologia , Diabetes Mellitus Tipo 1/terapia , Carga Global da Doença/tendências , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Adolescente , Criança , Pré-Escolar , Gerenciamento Clínico , História do Século XX , História do Século XXI , Humanos , Hipoglicemiantes/economia , Hipoglicemiantes/história , Insulina/economia , Insulina/história , Expectativa de Vida , Cobertura Universal do Seguro de Saúde
14.
BMJ ; 375: e066542, 2021 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-34759002

RESUMO

OBJECTIVE: To evaluate whether a structured exercise programme improved functional and health related quality of life outcomes compared with usual care for women at high risk of upper limb disability after breast cancer surgery. DESIGN: Multicentre, pragmatic, superiority, randomised controlled trial with economic evaluation. SETTING: 17 UK National Health Service cancer centres. PARTICIPANTS: 392 women undergoing breast cancer surgery, at risk of postoperative upper limb morbidity, randomised (1:1) to usual care with structured exercise (n=196) or usual care alone (n=196). INTERVENTIONS: Usual care (information leaflets) only or usual care plus a physiotherapy led exercise programme, incorporating stretching, strengthening, physical activity, and behavioural change techniques to support adherence to exercise, introduced at 7-10 days postoperatively, with two further appointments at one and three months. MAIN OUTCOME MEASURES: Disability of Arm, Hand and Shoulder (DASH) questionnaire at 12 months, analysed by intention to treat. Secondary outcomes included DASH subscales, pain, complications, health related quality of life, and resource use, from a health and personal social services perspective. RESULTS: Between 26 January 2016 and 31 July 2017, 951 patients were screened and 392 (mean age 58.1 years) were randomly allocated, with 382 (97%) eligible for intention to treat analysis. 181 (95%) of 191 participants allocated to exercise attended at least one appointment. Upper limb function improved after exercise compared with usual care (mean DASH 16.3 (SD 17.6) for exercise (n=132); 23.7 (22.9) usual care (n=138); adjusted mean difference 7.81, 95% confidence interval 3.17 to 12.44; P=0.001). Secondary outcomes favoured exercise over usual care, with lower pain intensity at 12 months (adjusted mean difference on numerical rating scale -0.68, -1.23 to -0.12; P=0.02) and fewer arm disability symptoms at 12 months (adjusted mean difference on Functional Assessment of Cancer Therapy-Breast+4 (FACT-B+4) -2.02, -3.11 to -0.93; P=0.001). No increase in complications, lymphoedema, or adverse events was noted in participants allocated to exercise. Exercise accrued lower costs per patient (on average -£387 (€457; $533) (95% confidence interval -£2491 to £1718; 2015 pricing) and was cost effective compared with usual care. CONCLUSIONS: The PROSPER exercise programme was clinically effective and cost effective and reduced upper limb disability one year after breast cancer treatment in patients at risk of treatment related postoperative complications. TRIAL REGISTRATION: ISRCTN Registry ISRCTN35358984.


Assuntos
Terapia Comportamental/métodos , Neoplasias da Mama/reabilitação , Terapia por Exercício/métodos , Mastectomia/reabilitação , Modalidades de Fisioterapia/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Comportamental/economia , Neoplasias da Mama/psicologia , Neoplasias da Mama/cirurgia , Análise Custo-Benefício , Avaliação da Deficiência , Terapia por Exercício/economia , Feminino , Humanos , Mastectomia/economia , Pessoa de Meia-Idade , Qualidade de Vida , Medicina Estatal , Resultado do Tratamento , Reino Unido
15.
Surg Clin North Am ; 101(6): 995-1006, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34774277

RESUMO

Enhanced recovery after surgery (ERAS) protocols are comprehensive perioperative care pathways designed to mitigate the physiologic stressors associated with surgery and, in turn, improve clinical outcomes and lead to health care cost savings. Although individual components may differ, ERAS protocols are typically organized as multimodal care "bundles" that, when followed closely and in their entirety, are meant to generate amplified cumulative benefits. This manuscript examines some of the critical components, describes some areas where the science is weak (but dogma may be strong), and provides some of the evidence or lack thereof behind components of a standard ERAS protocol.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Dor Pós-Operatória/tratamento farmacológico , Pacotes de Assistência ao Paciente , Complicações Pós-Operatórias/prevenção & controle , Protocolos Clínicos/normas , Recuperação Pós-Cirúrgica Melhorada/normas , Humanos , Dor Pós-Operatória/terapia , Pacotes de Assistência ao Paciente/economia , Pacotes de Assistência ao Paciente/normas , Assistência Perioperatória/economia , Assistência Perioperatória/normas , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia
16.
MMWR Morb Mortal Wkly Rep ; 70(46): 1591-1596, 2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34793418

RESUMO

Approximately 20% of U.S. adults are unpaid caregivers (caregivers) (1) who provide support to a family member or friend with a health condition or disability. Although there are benefits to caregiving, it can negatively affect caregivers' physical and mental health (2-4). Much of the assistance caregivers provide, such as administering medications or financial management, relies on cognitive ability, but little is known about caregivers' cognitive functioning. Subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent confusion or memory loss over the past year (5), could affect caregivers' risk for adverse health outcomes and affect the quality of care they provide. CDC analyzed SCD among caregivers aged ≥45 years through a cross-sectional analysis of data from 22 states in the 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS). Among adults aged ≥45 years, SCD was reported by 12.6% of caregivers who provided care to a family member or friend with a health condition or disability in the past 30 days compared with 10.2% of noncaregivers (p<0.001). Caregivers with SCD were more likely to be employed, men, aged 45-64 years, and have chronic health conditions than were noncaregivers with SCD. Caregivers with SCD were more likely to report frequent mental distress, a history of depression, and frequent activity limitations than were caregivers without SCD. SCD among caregivers could adversely affect the quality of care provided to care recipients. Understanding caregivers' cognitive health and the types of care provided is critical to maintaining the health, well-being, and independence of the caregiving dyad. Health care professionals can support patients and their patients' caregivers by increasing awareness among caregivers of the need to monitor their own health. The health care team can work with caregivers to identify potential treatments and access supports that might help them in their caregiving role and compensate for SCD.


Assuntos
Cuidadores/psicologia , Disfunção Cognitiva/epidemiologia , Autoavaliação Diagnóstica , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Cuidadores/economia , Cuidadores/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estados Unidos/epidemiologia
17.
Sci Rep ; 11(1): 21658, 2021 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-34737323

RESUMO

More than one year since Coronavirus disease 2019 (COVID-19) pandemic outbreak, the gold standard technique for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection is still the RT-qPCR. This is a limitation to increase testing capacities, particularly at developing countries, as expensive reagents and equipment are required. We developed a two steps end point RT-PCR reaction with SARS-CoV-2 Nucleocapsid (N) gene and Ribonuclease P (RNase P) specific primers where viral amplicons were verified by agarose gel electrophoresis. We carried out a clinical performance and analytical sensitivity evaluation for this two-steps end point RT-PCR method with 242 nasopharyngeal samples using the CDC RT-qPCR protocol as a gold standard technique. With a specificity of 95.8%, a sensitivity of 95.1%, and a limit of detection of 20 viral RNA copies/uL, this two steps end point RT-PCR assay is an affordable and reliable method for SARS-CoV-2 detection. This protocol would allow to extend COVID-19 diagnosis to basic molecular biology laboratories with a potential positive impact in surveillance programs at developing countries.


Assuntos
Teste de Ácido Nucleico para COVID-19/métodos , COVID-19/diagnóstico , SARS-CoV-2/genética , COVID-19/genética , Teste de Ácido Nucleico para COVID-19/economia , Teste para COVID-19/métodos , Proteínas do Nucleocapsídeo de Coronavírus/genética , Primers do DNA , Eletroforese em Gel de Ágar/métodos , Humanos , Laboratórios , Nasofaringe/virologia , RNA Viral/genética , Ribonuclease P/genética , Ribonuclease P/metabolismo , SARS-CoV-2/patogenicidade , Sensibilidade e Especificidade
18.
Sci Rep ; 11(1): 21707, 2021 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-34737382

RESUMO

We investigate the connection between the choice of transportation mode used by commuters and the probability of COVID-19 transmission. This interplay might influence the choice of transportation means for years to come. We present data on commuting, socioeconomic factors, and COVID-19 disease incidence for several US metropolitan areas. The data highlights important connections between population density and mobility, public transportation use, race, and increased likelihood of transmission. We use a transportation model to highlight the effect of uncertainty about transmission on the commuters' choice of transportation means. Using multiple estimation techniques, we found strong evidence that public transit ridership in several US metro areas has been considerably impacted by COVID-19 and by the policy responses to the pandemic. Concerns about disease transmission had a negative effect on ridership, which is over and above the adverse effect from the observed reduction in employment. The COVID-19 effect is likely to reduce the demand for public transport in favor of lower density alternatives. This change relative to the status quo will have implications for fuel use, congestion, accident frequency, and air quality. More vulnerable communities might be disproportionally affected as a result. We point to the need for additional studies to further quantify these effects and to assist policy in planning for the post-COVID-19 transportation future.


Assuntos
COVID-19/transmissão , Transportes/economia , Transportes/estatística & dados numéricos , Cidades , Emprego/tendências , Humanos , Veículos Automotores/economia , Veículos Automotores/estatística & dados numéricos , Pandemias , Densidade Demográfica , Dinâmica Populacional/tendências , SARS-CoV-2/patogenicidade , Fatores Socioeconômicos , Transportes/métodos , Estados Unidos/epidemiologia
19.
BMJ ; 375: e066576, 2021 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-34732464

RESUMO

OBJECTIVE: To identify all known ties between the medical product industry and the healthcare ecosystem. DESIGN: Scoping review. METHODS: From initial literature searches and expert input, a map was created to show the network of medical product industry ties across parties and activities in the healthcare ecosystem. Through a scoping review, the ties were then verified, cataloged, and characterized, with data abstracted on types of industry ties (financial, non-financial), applicable policies for conflict of interests, and publicly available data sources. MAIN OUTCOME MEASURES: Presence and types of medical product industry ties to activities and parties, presence of policies for conflict of interests, and publicly available data. RESULTS: A map derived through synthesis of 538 articles from 37 countries shows an extensive network of medical product industry ties to activities and parties in the healthcare ecosystem. Key activities include research, healthcare education, guideline development, formulary selection, and clinical care. Parties include non-profit entities, the healthcare profession, the market supply chain, and government. The medical product industry has direct ties to all parties and some activities through multiple pathways; direct ties extend through interrelationships among parties and activities. The most frequently identified parties were within the healthcare profession, with individual professionals described in 422 (78%) of the included studies. More than half (303, 56%) of the publications documented medical product industry ties to research, with clinical care (156, 29%), health professional education (145, 27%), guideline development (33, 6%), and formulary selection (8, 1%) appearing less often. Policies for conflict of interests exist for some financial and a few non-financial ties; publicly available data sources seldom describe or quantify these ties. CONCLUSIONS: An extensive network of medical product industry ties to activities and parties exists in the healthcare ecosystem. Policies for conflict of interests and publicly available data are lacking, suggesting that enhanced oversight and transparency are needed to protect patient care from commercial influence and to ensure public trust.


Assuntos
Conflito de Interesses , Indústria Farmacêutica/ética , Setor de Assistência à Saúde/ética , Conflito de Interesses/economia , Indústria Farmacêutica/economia , Saúde Global , Setor de Assistência à Saúde/economia , Política de Saúde , Humanos , Mapas como Assunto
20.
Sci Rep ; 11(1): 21460, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-34728759

RESUMO

Population screening played a substantial role in safely reopening the economy and avoiding new outbreaks of COVID-19. PCR-based pooled screening makes it possible to test the population with limited resources by pooling multiple individual samples. Our study compared different population-wide screening methods as transmission-mitigating interventions, including pooled PCR, individual PCR, and antigen screening. Incorporating testing-isolation process and individual-level viral load trajectories into an epidemic model, we further studied the impacts of testing-isolation on test sensitivities. Results show that the testing-isolation process could maintain a stable test sensitivity during the outbreak by removing most infected individuals, especially during the epidemic decline. Moreover, we compared the efficiency, accuracy, and cost of different screening methods during the pandemic. Our results show that PCR-based pooled screening is cost-effective in reversing the pandemic at low prevalence. When the prevalence is high, PCR-based pooled screening may not stop the outbreak. In contrast, antigen screening with sufficient frequency could reverse the epidemic, despite the high cost and the large numbers of false positives in the screening process.


Assuntos
Teste de Ácido Nucleico para COVID-19/métodos , COVID-19/diagnóstico , SARS-CoV-2/genética , Antígenos Virais/genética , Antígenos Virais/metabolismo , COVID-19/epidemiologia , COVID-19/virologia , Teste de Ácido Nucleico para COVID-19/economia , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Pandemias , Reação em Cadeia da Polimerase/economia , Reprodutibilidade dos Testes , SARS-CoV-2/isolamento & purificação , Carga Viral
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