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1.
Cell ; 178(5): 1057-1071.e11, 2019 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-31442400

RESUMO

The Zika epidemic in the Americas has challenged surveillance and control. As the epidemic appears to be waning, it is unclear whether transmission is still ongoing, which is exacerbated by discrepancies in reporting. To uncover locations with lingering outbreaks, we investigated travel-associated Zika cases to identify transmission not captured by reporting. We uncovered an unreported outbreak in Cuba during 2017, a year after peak transmission in neighboring islands. By sequencing Zika virus, we show that the establishment of the virus was delayed by a year and that the ensuing outbreak was sparked by long-lived lineages of Zika virus from other Caribbean islands. Our data suggest that, although mosquito control in Cuba may initially have been effective at mitigating Zika virus transmission, such measures need to be maintained to be effective. Our study highlights how Zika virus may still be "silently" spreading and provides a framework for understanding outbreak dynamics. VIDEO ABSTRACT.


Assuntos
Epidemias , Genômica/métodos , Infecção por Zika virus/epidemiologia , Aedes/virologia , Animais , Cuba/epidemiologia , Humanos , Incidência , Controle de Mosquitos , Filogenia , RNA Viral/química , RNA Viral/metabolismo , Análise de Sequência de RNA , Viagem , Índias Ocidentais/epidemiologia , Zika virus/classificação , Zika virus/genética , Zika virus/isolamento & purificação , Infecção por Zika virus/transmissão , Infecção por Zika virus/virologia
2.
BMC Genomics ; 25(1): 433, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38693476

RESUMO

BACKGROUND: The increasing burden of dengue virus on public health due to more explosive and frequent outbreaks highlights the need for improved surveillance and control. Genomic surveillance of dengue virus not only provides important insights into the emergence and spread of genetically diverse serotypes and genotypes, but it is also critical to monitor the effectiveness of newly implemented control strategies. Here, we present DengueSeq, an amplicon sequencing protocol, which enables whole-genome sequencing of all four dengue virus serotypes. RESULTS: We developed primer schemes for the four dengue virus serotypes, which can be combined into a pan-serotype approach. We validated both approaches using genetically diverse virus stocks and clinical specimens that contained a range of virus copies. High genome coverage (>95%) was achieved for all genotypes, except DENV2 (genotype VI) and DENV 4 (genotype IV) sylvatics, with similar performance of the serotype-specific and pan-serotype approaches. The limit of detection to reach 70% coverage was 10-100 RNA copies/µL for all four serotypes, which is similar to other commonly used primer schemes. DengueSeq facilitates the sequencing of samples without known serotypes, allows the detection of multiple serotypes in the same sample, and can be used with a variety of library prep kits and sequencing instruments. CONCLUSIONS: DengueSeq was systematically evaluated with virus stocks and clinical specimens spanning the genetic diversity within each of the four dengue virus serotypes. The primer schemes can be plugged into existing amplicon sequencing workflows to facilitate the global need for expanded dengue virus genomic surveillance.


Assuntos
Vírus da Dengue , Genoma Viral , Sorogrupo , Sequenciamento Completo do Genoma , Vírus da Dengue/genética , Vírus da Dengue/isolamento & purificação , Vírus da Dengue/classificação , Sequenciamento Completo do Genoma/métodos , Humanos , Genótipo , Dengue/virologia , Dengue/diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala/métodos , RNA Viral/genética
3.
Emerg Infect Dis ; 30(6): 1214-1217, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38662728

RESUMO

During May-July 2023, a cluster of 7 patients at local hospitals in Florida, USA, received a diagnosis of Plasmodium vivax malaria. Whole-genome sequencing of the organism from 4 patients and phylogenetic analysis with worldwide representative P. vivax genomes indicated probable single parasite introduction from Central/South America.


Assuntos
Malária Vivax , Filogenia , Plasmodium vivax , Humanos , Malária Vivax/epidemiologia , Malária Vivax/parasitologia , Malária Vivax/diagnóstico , Florida/epidemiologia , Plasmodium vivax/genética , Masculino , Sequenciamento Completo do Genoma , Feminino , Adulto , Pessoa de Meia-Idade
4.
Emerg Infect Dis ; 30(2): 376-379, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38232709

RESUMO

During May 2022-April 2023, dengue virus serotype 3 was identified among 601 travel-associated and 61 locally acquired dengue cases in Florida, USA. All 203 sequenced genomes belonged to the same genotype III lineage and revealed potential transmission chains in which most locally acquired cases occurred shortly after introduction, with little sustained transmission.


Assuntos
Vírus da Dengue , Dengue , Humanos , Vírus da Dengue/genética , Dengue/epidemiologia , Florida/epidemiologia , Viagem , Sequência de Bases , Genótipo , Sorogrupo , Filogenia
5.
MMWR Morb Mortal Wkly Rep ; 73(35): 769-773, 2024 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-39236058

RESUMO

Beginning in late 2023, Oropouche virus was identified as the cause of large outbreaks in Amazon regions with known endemic transmission and in new areas in South America and the Caribbean. The virus is spread to humans by infected biting midges and some mosquito species. Although infection typically causes a self-limited febrile illness, reports of two deaths in patients with Oropouche virus infection and vertical transmission associated with adverse pregnancy outcomes have raised concerns about the threat of this virus to human health. In addition to approximately 8,000 locally acquired cases in the Americas, travel-associated Oropouche virus disease cases have recently been identified in European travelers returning from Cuba and Brazil. As of August 16, 2024, a total of 21 Oropouche virus disease cases were identified among U.S. travelers returning from Cuba. Most patients initially experienced fever, myalgia, and headache, often with other symptoms including arthralgia, diarrhea, nausea or vomiting, and rash. At least three patients had recurrent symptoms after the initial illness, a common characteristic of Oropouche virus disease. Clinicians and public health jurisdictions should be aware of the occurrence of Oropouche virus disease in U.S. travelers and request testing for suspected cases. Travelers should prevent insect bites when traveling, and pregnant persons should consider deferring travel to areas experiencing outbreaks of Oropouche virus disease.


Assuntos
Infecções por Bunyaviridae , Humanos , Estados Unidos/epidemiologia , Feminino , Adulto , Masculino , Infecções por Bunyaviridae/epidemiologia , Pessoa de Meia-Idade , Idoso , Orthobunyavirus/isolamento & purificação , Viagem , Adulto Jovem , Doença Relacionada a Viagens , Surtos de Doenças , Cuba/epidemiologia
6.
Emerg Infect Dis ; 29(8): 1643-1647, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37385262

RESUMO

We report a dengue outbreak in Key Largo, Florida, USA, from February through August 2020, during the COVID-19 pandemic. Successful community engagement resulted in 61% of case-patients self-reporting. We also describe COVID-19 pandemic effects on the dengue outbreak investigation and the need to increase clinician awareness of dengue testing recommendations.


Assuntos
COVID-19 , Dengue , Humanos , COVID-19/epidemiologia , Dengue/epidemiologia , Florida/epidemiologia , Pandemias , Surtos de Doenças
8.
MMWR Morb Mortal Wkly Rep ; 72(36): 973-978, 2023 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-37676839

RESUMO

Eight cases of locally acquired, mosquito-transmitted (i.e., autochthonous) Plasmodium vivax malaria, which has not been reported in the United States since 2003, were reported to CDC from state health departments in Florida and Texas during May 18-July 17, 2023. As of August 4, 2023, case surveillance, mosquito surveillance and control activities, and public outreach and education activities continue in both states. U.S. clinicians need to consider a malaria diagnosis in patients with unexplained fever, especially in areas where autochthonous malaria has been recently reported, although the risk for autochthonous malaria in the United States remains very low. Prompt diagnosis and treatment of malaria can prevent severe disease or death and limit ongoing transmission to local Anopheles mosquitoes and other persons. Preventing mosquito bites and controlling mosquitoes at home can prevent mosquitoborne diseases, including malaria. Before traveling internationally to areas with endemic malaria, travelers should consult with a health care provider regarding recommended malaria prevention measures, including potentially taking malaria prophylaxis. Malaria is a nationally notifiable disease; continued reporting of malaria cases to jurisdictional health departments and CDC will also help ensure robust surveillance to detect and prevent autochthonous malaria in the United States.


Assuntos
Surtos de Doenças , Malária , Animais , Humanos , Texas/epidemiologia , Florida/epidemiologia , Malária/epidemiologia , Malária/prevenção & controle , Pessoal de Saúde
9.
J Emerg Nurs ; 49(2): 236-243, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36604284

RESUMO

INTRODUCTION: This study compared the effectiveness of comic-based with text-based concussion discharge instructions on improving caregiver knowledge. This study also examined the role of social determinants of health on comprehension instructions. METHODS: This was an observational study of the caregivers of pediatric concussion patients. Caregivers' health literacy and demographics related socioeconomic factors were obtained. After the patients' evaluation in the emergency department, caregivers were given printed comic-based concussion discharge instructions. Caregivers were contacted 3 days later and tested overall knowledge of discharge instructions' content. These survey results were compared with historical controls who received text-based instructions. RESULTS: A total of 120 participants were recruited, and 86 participants completed follow-up procedures. When comparing the caregivers' recall ability with a comic-based vs traditional text-based instructions, caregivers with comic-based content were more likely to accurately recall overall discharge instructions (77.5% vs 44%, P < .001), particularly physical rest and activity restrictions (86.5% vs 63%, P < .001). Caregivers also were less likely to misidentify a red flag symptom (7.5% vs 19%, P < .04). Comic-based instructions did not increase recall of cognitive rest instructions or postconcussive symptoms. When examining demographic factors, caregivers who could not recall 3 postconcussive symptoms were more likely to be Hispanic or Black, less likely to be college educated, and more likely to have low health literacy. DISCUSSION: Novel methods should be explored to adequately prepare caregivers for continuing postconcussive care at home. Discharge instructions must be tailored to address caregivers' baseline health literacy and how caregivers digest and retain information.


Assuntos
Concussão Encefálica , Letramento em Saúde , Humanos , Criança , Alta do Paciente , Cuidadores , Serviço Hospitalar de Emergência
10.
Emerg Infect Dis ; 27(5): 1296-1300, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33900178

RESUMO

Zika virus diagnostic testing and laboratory research increased considerably when Zika virus began spreading through the Americas in 2015, increasing the risk for potential Zika virus exposure of laboratory workers and biomedical researchers. We report 4 cases of laboratory-associated Zika virus disease in the United States during 2016-2019. Of these, 2 were associated with needlestick injuries; for the other 2 cases, the route of transmission was undetermined. In laboratories in which work with Zika virus is performed, good laboratory biosafety practices must be implemented and practiced to reduce the risk for infection among laboratory personnel.


Assuntos
Infecção por Zika virus , Zika virus , América , Humanos , Laboratórios , Pesquisa , Estados Unidos
12.
MMWR Morb Mortal Wkly Rep ; 69(19): 587-590, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32407300

RESUMO

An estimated 2.1 million U.S. adults are housed within approximately 5,000 correctional and detention facilities† on any given day (1). Many facilities face significant challenges in controlling the spread of highly infectious pathogens such as SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Such challenges include crowded dormitories, shared lavatories, limited medical and isolation resources, daily entry and exit of staff members and visitors, continual introduction of newly incarcerated or detained persons, and transport of incarcerated or detained persons in multiperson vehicles for court-related, medical, or security reasons (2,3). During April 22-28, 2020, aggregate data on COVID-19 cases were reported to CDC by 37 of 54 state and territorial health department jurisdictions. Thirty-two (86%) jurisdictions reported at least one laboratory-confirmed case from a total of 420 correctional and detention facilities. Among these facilities, COVID-19 was diagnosed in 4,893 incarcerated or detained persons and 2,778 facility staff members, resulting in 88 deaths in incarcerated or detained persons and 15 deaths among staff members. Prompt identification of COVID-19 cases and consistent application of prevention measures, such as symptom screening and quarantine, are critical to protecting incarcerated and detained persons and staff members.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Prisões , COVID-19 , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/mortalidade , Pneumonia Viral/prevenção & controle , Prevalência , SARS-CoV-2 , Estados Unidos/epidemiologia
13.
Pediatr Emerg Care ; 36(4): e192-e198, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30624425

RESUMO

OBJECTIVES: The aim of this study was to determine the (1) feasibility, (2) demand, (3) acceptability, and (4) usefulness of a mobile health (mHealth) application (app) compared with a written intervention distributed in a pediatric emergency department (ED). METHODS: This was a randomized controlled trial with parents of children 12 years or younger presenting to the ED for nonurgent complaints. Parents were randomized to receive a (1) low literacy pediatric health book with video, (2) pediatric mHealth app, (3) both 1 and 2, or (4) car-seat safety video and handout (control). Demand, acceptability, and usefulness were assessed at 1-, 3-, and 6-month follow-ups. Modified intention-to-treat analysis was completed for proportional data. RESULTS: Ninety-eight parents completed randomization (83% approached). One or more follow-up was completed for 80.6% of parents. Only 57.1% downloaded the app. Parents used the app less than the book (35.1% vs 73.0%, P < 0.01), found the app to be harder to understand (26.0% vs 94.6%, P < 0.001) and less useful (37.8% vs 70.3%, P < 0.01), and were less likely to recommend the app to others (48.7% vs 100%, P < 0.01). No parent who received both book and app would prefer to have only the app; 88.9% of parents wanted either the book or both. CONCLUSIONS: There was low demand for an mHealth app with parents who prefer, accept, and use the book more. Giving written health information to vulnerable populations in a pediatric ED has the capacity to empower parents with knowledge to care for a child and potentially decrease future nonurgent ED use with translation into a larger study.


Assuntos
Doença Aguda/terapia , Serviço Hospitalar de Emergência , Educação em Saúde/métodos , Aplicativos Móveis , Pais/educação , Adulto , Livros , Criança , Pré-Escolar , Compreensão , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Educação de Pacientes como Assunto , Projetos Piloto , Inquéritos e Questionários , Telemedicina
15.
Pediatr Rev ; 40(6): 263-277, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31152099

RESUMO

Health literacy is an important issue to consider in the provision of health-care to children. Similar to the adult population, most parents face health literacy challenges. Of particular concern, 1 in 4 parents have low health literacy, greatly affecting their ability to use health information to make health decisions for their child. High expectations are placed on parents and children to achieve effective disease management and positive health outcomes in the context of complex health-care systems and disease treatment regimens. Low health literacy affects parent acquisition of knowledge, attitudes, and behaviors, as well as child health outcomes across the domains of disease prevention, acute illness care, and chronic illness care. The effect of low health literacy is wide ranging, including 1) poor nutrition knowledge and behaviors, 2) higher obesity rates, 3) more medication errors, 4) more emergency department use, and 5) poor asthma knowledge, behaviors, and outcomes. Health-care providers can mitigate the effects of health literacy by seeking to align health-care demands with the health literacy skills of families. Effective health literacy-informed interventions provide insights into methods that can be used by providers and health systems to improve health outcomes. Health literacy-informed communication strategies should be used with all families in a "universal precautions approach" because all parents likely benefit from clear communication. As scientific advances are made in disease prevention and management, unless families understand how to follow provider recommendations, the benefit of these advances will not be realized and disparities in outcomes will be exacerbated.


Assuntos
Saúde da Criança , Letramento em Saúde , Criança , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pais
16.
Pediatr Blood Cancer ; 65(4)2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29230919

RESUMO

OBJECTIVE: To determine the association between health literacy, medication knowledge, and pain treatment skills with emergency department (ED) use of parents of children with sickle cell disease (SCD). METHODS: Parents of children 1- to 12-years-old with SCD were enrolled. Health literacy was assessed using the Newest Vital Sign. Parents completed a structured interview assessing knowledge of the dosage and frequency of home pain medications and an applied skills task requiring them to dose a prescribed pain medication. Underdosage was defined by too small a dose (dosage error) or too infrequent a dose (frequency error). The association between medication knowledge and applied skills with ED visits for pain over the past year was evaluated using Poisson regression adjusting for genotype. RESULTS: One hundred parent/child pairs were included; 50% of parents had low health literacy. Low health literacy was associated with more underdose frequency errors (38% vs. 19%, P = 0.02) on the skills task. On medication knowledge, underdose dosage errors (adjusted incidence rate ratio [aIRR] 2.0, 95% confidence interval [CI] 1.3-3.0) and underdose frequency errors (aIRR, 1.7, 95% CI 1.2-2.6) were associated with a higher rate of ED visits for pain. On the skills task, underdose dosage errors (aIRR 1.6, 95% CI 1.1-2-.4) and underdose frequency errors were associated with more ED visits (aIRR 1.5, 95% CI 1.1-2.1). CONCLUSIONS: For medication knowledge and skills tasks, children of parents who underdosed pain medication had a higher rate of ED visits for pain. Health literate strategies to improve parents' medication skills may improve pain treatment at home and decrease healthcare utilization.


Assuntos
Anemia Falciforme/tratamento farmacológico , Serviço Hospitalar de Emergência , Letramento em Saúde , Dor/tratamento farmacológico , Pais , Anemia Falciforme/complicações , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Dor/etiologia
17.
J Pediatr ; 166(4): 1037-41.e1, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25596100

RESUMO

OBJECTIVE: To test the hypothesis that the effect of race/ethnicity on decreased radiologic testing in the pediatric emergency department (ED) varies by caregiver health literacy. STUDY DESIGN: This was a secondary analysis of a cross-sectional study of caregivers accompanying children ≤ 12 years to a pediatric ED. Caregiver health literacy was measured using the Newest Vital Sign. A blinded chart review determined whether radiologic testing was utilized. Bivariate and multivariate analyses, adjusting for ED triage level, child insurance, and chronic illness were used to determine the relationship between race/ethnicity, health literacy, and radiologic testing. Stratified analyses by caregiver health literacy were conducted. RESULTS: Five hundred four caregivers participated; the median age was 31 years, 47% were white, 37% black, 10% Hispanic, and 49% had low health literacy. Black race and low health literacy were associated with less radiologic testing (P < .01). In stratified analysis, minority race was associated with less radiologic testing only if a caregiver had low health literacy (aOR 0.5; 95% CI 0.3-0.9), and no difference existed in those with adequate health literacy (aOR 0.7; 95% CI 0.4-1.3). CONCLUSIONS: Caregiver low health literacy modifies whether minority race/ethnicity is associated with decreased radiologic testing, with only children of minority caregivers with low health literacy receiving fewer radiologic studies. Future interventions to eliminate disparities in healthcare resource utilization should consider health literacy as a mutable factor.


Assuntos
Cuidadores/normas , Serviços de Saúde da Criança/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Educação em Saúde , Letramento em Saúde , Radiologia/métodos , Triagem/métodos , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
18.
Acad Pediatr ; 24(8): 1182-1188, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38959997

RESUMO

OBJECTIVE: Children of caregivers with limited health literacy are at risk of poorer health outcomes. Thus, health literacy-informed communication tools are critical to achieving a more equitable health system. However, there is no agreement on the health literacy skills pediatric residents should attain. We used Delphi methodology to establish consensus on health literacy objectives to inform development of a pediatric resident curriculum. METHODS: Our Delphi panel participated in three rounds of anonymous surveys to rank the importance of health literacy objectives in pediatric resident education. Consensus was defined as ≥70% of panelists identifying an objective as essential or 100% agreeing an objective was recommended or essential. RESULTS: Thirteen pediatric health literacy experts comprised a racially, geographically, and professionally-diverse panel. After three survey rounds, 27 of the initial 65 objectives met consensus. All final objectives aligned with Accreditation Council for Graduate Medical Education (ACGME) core competencies. CONCLUSIONS: A panel of pediatric health literacy experts established consensus on health literacy objectives specific to pediatric resident training. These prioritized objectives align with ACGME core competencies, as well as evidence-based strategies like teach-back, and newer considerations like addressing organizational health literacy. They should inform future health literacy curricula and assessment within pediatric residency programs.


Assuntos
Currículo , Técnica Delphi , Letramento em Saúde , Internato e Residência , Pediatria , Humanos , Pediatria/educação , Educação de Pós-Graduação em Medicina/métodos , Feminino , Masculino , Consenso , Competência Clínica , Adulto
19.
CJEM ; 2024 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-39331337

RESUMO

OBJECTIVE: Caregivers with low health literacy are more likely to overestimate illness severity and have poor adherence with health-promoting behaviors. Our primary objective was to relate caregiver health literacy to the urgency of emergency department (ED) utilization. The secondary objective was to explore the relationship between social and demographic characteristics, health literacy, and urgency of ED use. METHODS: This sub-study was a descriptive cross-sectional survey with health record review. Data were collected from ten Canadian pediatric EDs. Study variables included demographics, visit details, and the Newest Vital Sign measurement of health literacy. ED visits were classified as urgent or non-urgent based on the resource utilization method. RESULTS: The response rate was 97.6% (n = 2005). Mean (SD) caregiver age was 37.0 (7.7) years, 74.3% (n = 1950) were mothers, 72.6% (n = 1953) spoke English as a primary language, 51.0% (n = 1946) had a university degree, and 45.1% (n = 1699) had a household income greater than $100,000. The mean (SD) age of the children was 5.9 (5.0) years and 48.1% (n = 1956) were female. 43.7% (n = 1957) of caregivers had low health literacy. Being a caregiver with a child < 2 years old [aOR 1.83 (1.35, 2.48)] and low health literacy [aOR 1.56 (1.18, 2.05)] were associated with greater non-urgent pediatric ED use. Interprovincial variation was evident: Quebec caregivers were less likely to use the pediatric ED for non-urgent presentations compared to Alberta, while those in Nova Scotia, Manitoba, British Columbia, and Ontario were more likely compared to Alberta. CONCLUSION: Almost half of caregivers presenting to Canadian pediatric EDs have low health literacy, which may limit their ability to make appropriate healthcare decisions for their children. Low caregiver health literacy is a modifiable factor associated with increased non-urgent ED utilization. Efforts to address this may positively influence ED utilization.


RéSUMé: OBJECTIF: Les soignants ayant une faible littératie en santé sont plus susceptibles de surestimer la gravité de la maladie et d'avoir un manque d'adhésion aux comportements favorisant la santé. Notre objectif principal était de faire le lien entre la littératie en santé des soignants et l'urgence d'utiliser les services d'urgence (SU). L'objectif secondaire était d'explorer la relation entre les caractéristiques sociales et démographiques, la littératie en santé et l'urgence de l'utilisation du traitement. MéTHODES: Cette sous-étude était une enquête transversale descriptive avec examen du dossier de santé. Les données ont été recueillies auprès de dix ED pédiatriques canadiens. Les variables étudiées comprenaient la démographie, les détails des visites et la mesure du dernier signe vital de la littératie en santé. Les visites de DS ont été classées en urgence ou non selon la méthode d'utilisation des ressources. RéSULTATS: Le taux de réponse était de 97,6 % (n=2005). L'âge moyen des aidants naturels était de 37,0 (7,7) ans, 74,3 % (n=1950) étaient des mères, 72,6 % (n=1953) parlaient l'anglais comme langue principale, 51,0 % (n=1946) avaient un diplôme universitaire et 45,1 % (n=1699) avaient un revenu familial supérieur à 100 000 $. L'âge moyen (SD) des enfants était de 5,9 (5,0) ans et 48,1 % (n=1956) étaient des femmes. 43,7 % (n=1957) des aidants avaient une faible littératie en santé. Le fait d'être un aidant naturel avec un enfant de moins de 2 ans [aOR 1,83 (1,35, 2,48)] et une faible littératie en santé [aOR 1,56 (1,18, 2,05)] étaient associés à une utilisation plus importante de l'ES pédiatrique non urgente. La variation interprovinciale était évidente : les aidants naturels du Québec étaient moins susceptibles d'utiliser le DE pédiatrique pour des présentations non urgentes comparativement à l'Alberta, tandis que ceux de la Nouvelle-Écosse, du Manitoba, de la Colombie-Britannique et de l'Ontario étaient plus susceptibles d'utiliser le DE pédiatrique pour des présentations non urgentes. CONCLUSION: Près de la moitié des aidants naturels qui se présentent aux ÉE pédiatriques au Canada ont une faible littératie en santé, ce qui peut limiter leur capacité à prendre les décisions appropriées en matière de soins de santé pour leurs enfants. Le faible niveau de connaissances en santé des aidants est un facteur modifiable associé à une utilisation accrue de l'ES non urgente. Les efforts déployés pour remédier à cette situation peuvent influencer positivement l'utilisation de la DE.

20.
Nat Commun ; 15(1): 3508, 2024 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-38664380

RESUMO

Dengue is the most prevalent mosquito-borne viral disease in humans, and cases are continuing to rise globally. In particular, islands in the Caribbean have experienced more frequent outbreaks, and all four dengue virus (DENV) serotypes have been reported in the region, leading to hyperendemicity and increased rates of severe disease. However, there is significant variability regarding virus surveillance and reporting between islands, making it difficult to obtain an accurate understanding of the epidemiological patterns in the Caribbean. To investigate this, we used travel surveillance and genomic epidemiology to reconstruct outbreak dynamics, DENV serotype turnover, and patterns of spread within the region from 2009-2022. We uncovered two recent DENV-3 introductions from Asia, one of which resulted in a large outbreak in Cuba, which was previously under-reported. We also show that while outbreaks can be synchronized between islands, they are often caused by different serotypes. Our study highlights the importance of surveillance of infected travelers to provide a snapshot of local introductions and transmission in areas with limited local surveillance and suggests that the recent DENV-3 introductions may pose a major public health threat in the region.


Assuntos
Vírus da Dengue , Dengue , Surtos de Doenças , Sorogrupo , Viagem , Vírus da Dengue/genética , Vírus da Dengue/classificação , Vírus da Dengue/isolamento & purificação , Dengue/epidemiologia , Dengue/virologia , Dengue/transmissão , Humanos , Região do Caribe/epidemiologia , Viagem/estatística & dados numéricos , Filogenia , Monitoramento Epidemiológico
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