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1.
BMJ Open ; 12(5): e057484, 2022 05 06.
Article in English | MEDLINE | ID: covidwho-1832457

ABSTRACT

OBJECTIVE: To explore the barriers to and options for improving access to quality healthcare for the urban poor in Nairobi, Kenya. DESIGN AND PARTICIPANTS: This was a qualitative approach. In-depth interviews (n=12), focus group discussions with community members (n=12) and key informant interviews with health providers and policymakers (n=25) were conducted between August 2019 and September 2020. Four feedback and validation workshops were held in December 2019 and April-June 2021. SETTING: Korogocho and Viwandani urban slums in Nairobi, Kenya. RESULTS: The socioe-conomic status of individuals and their families, such as poverty and lack of health insurance, interact with community-level factors like poor infrastructure, limited availability of health facilities and insecurity; and health system factors such as limited facility opening hours, health providers' attitudes and skills and limited public health resources to limit healthcare access and perpetuate health inequities. Limited involvement in decision-making processes by service providers and other key stakeholders was identified as a major challenge with significant implications on how limited health system resources are managed. CONCLUSION: Despite many targeted interventions to improve the health and well-being of the urban poor, slum residents are still unable to obtain quality healthcare because of persistent and new barriers due to the COVID-19 pandemic. In a devolved health system, paying attention to health services managers' abilities to assess and respond to population health needs is vital. The limited use of existing accountability mechanisms requires attention to ensure that the mechanisms enhance, rather than limit, access to health services for the urban slum residents. The uniqueness of poor urban settings also requires in-depth and focused attention to social determinants of health within these contexts. To address individual, community and system-level barriers to quality healthcare in this and related settings and expand access to health services for all, multisectoral strategies tailored to each population group are needed.


Subject(s)
COVID-19 , Population Groups , Health Facilities , Health Services Accessibility , Humans , Kenya , Pandemics , Qualitative Research
2.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz ; 65(6): 650-657, 2022 Jun.
Article in German | MEDLINE | ID: covidwho-1826365

ABSTRACT

BACKGROUND AND AIM: Germany has a federal state system. Pandemic response teams are key instruments of pandemic management. The aim of this article is to describe the structures and powers of pandemic response teams that were explored during a study on the care of the critically ill and dying in times of a pandemic (PallPan). The focus is on health-related pandemic response teams on the national state level (macrolevel) and federal and community level (mesolevel) as well as pandemic response teams in healthcare facilities (microlevel). METHODS: Members of pandemic response teams took part in qualitative semi-structured interviews (October 2020-February 2021). The evaluation was carried out by means of qualitative structuring content analysis. RESULTS: Forty-two persons reported on 43 crisis teams from 14 federal states. Response teams in healthcare facilities and public administration differ primarily with regard to their competencies. Officially predetermined regulations regarding the initiation, personal composition, tasks, responsibilities, and competencies of pandemic response teams are not predefined in Germany. The macrolevel defined the legal and financial conditions for pandemic management. Meso- and microlevel pandemic response teams bear responsibility for maintaining the provision of healthcare. The defaults of local public health authorities are decisive for the pandemic response team's work. Main tasks and measures were the provision of information and the procurement and distribution of resources. DISCUSSION: In terms of preparing for future pandemic situations, the knowledge gained will help to address concerns about maintaining healthcare for specific population groups, such as seriously ill and dying people, to the locally differing responsible bodies, even under pandemic conditions.


Subject(s)
COVID-19 , COVID-19/epidemiology , Germany/epidemiology , Health Facilities , Humans , Pandemics , Population Groups
3.
BMJ Open ; 12(2): e060266, 2022 Feb 17.
Article in English | MEDLINE | ID: covidwho-1703652

ABSTRACT

INTRODUCTION: The existing literature demonstrates that international students face a variety of stressors and barriers that can heighten the risk of suicide. However, up to now, no research has sought to summarise the available literature on the prevention strategies for suicide for international students in tertiary education. This document provides a scoping review protocol that aims to systematically chart and synthesise the published, unpublished and grey literature on the prevention strategies for suicide in the international student community. METHODS AND ANALYSIS: The enhanced six-stage methodological framework for scoping reviews of Arksey and O'Malley will be used. Two main research questions guide the review: (1) What is the extent, range and nature of the evidence regarding suicide prevention for international students? and (2) What suicide prevention strategies are promising for targeting international students? Peer-reviewed and non-peer-reviewed articles, reports and policy documents will be eligible to be included in the review with no limits on publication date. Electronic searches of the CINAHL, ERIC, Medline, PsycInfo and ProQuest will be conducted to identify relevant academic publications. Grey literature searches will be undertaken on relevant databases as well as government and organisational websites. The reporting of the review will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Criteria for evidence inclusion and exclusion will be used during literature screening and mapping. Screening and data charting of the published and grey literature will be conducted by three reviewers. Relevant stakeholders and experts will be consulted regarding the findings and their input will be integrated into the final report. ETHICS AND DISSEMINATION: The study will be disseminated through a peer-reviewed journal, conference presentations and consultations with relevant stakeholders in policy and professional settings. Ethical approval is not required for this review.


Subject(s)
Suicide , Educational Status , Humans , Peer Review , Population Groups , Research Design , Review Literature as Topic , Students , Suicide/prevention & control , Systematic Reviews as Topic
4.
BMC Infect Dis ; 22(1): 153, 2022 Feb 14.
Article in English | MEDLINE | ID: covidwho-1686007

ABSTRACT

BACKGROUND: COVID-19 vaccine has been available in China since the beginning of the 2021, however, certain numbers of people are reluctant for some reasons to vaccinate. The high vaccine coverage is crucial for controlling disease transmission, however, the vaccine hesitancy might be a barrier to the establishment of sufficient herd immunization. This study aims to investigate the prevalence of the COVID-19 vaccine hesitancy among different population groups, and explore common barriers and facilitators to vaccination decisions. METHODS: The current survey was performed among Chinese students, public health professionals, medical workers and general population from January to March 2021 from seven cities in China. The questionnaire contained sociodemographic information, concerns about infection with COVID-19, general vaccination behaviors and attitudes, the General Vaccine Hesitancy Scale, the COVID-19 Vaccine Hesitancy Scale and other potential factors. Univariate analysis was conducted by chi-squared test, and variables significant at P < 0.10 were then included in a multivariable regression model. RESULTS: The prevalence of COVID-19 vaccine hesitancy was 15.6% in our study, and 23.9% of students, 21.2% of the general population, 13.1% of medical workers, and 10.4% of public health professionals had vaccine hesitancy. The results of multivariate analysis indicated that participants who had received negative information of COVID-19 vaccine (OR: 1.563, 95% CI: 1.229-1.986) and who had doubts about the information source (OR: 2.157, 95% CI: 1.697-2.742) were more likely to have vaccine hesitancy. While those who needed transparent information about COVID-19 vaccine (OR: 0.722, 95% CI: 0.535-0.973) and who would get COVID-19 vaccine if doctors recommended (OR: 0.176, 95% CI: 0.132-0.234) were less likely to have COVID-19 vaccine hesitancy. CONCLUSIONS: Given recommendations from medical workers about vaccination can motivate people to accept COVID-19 vaccination, appropriate training in knowledge about vaccines and communication skills are necessary for them to increase public's willingness of vaccination. Reducing the spread of misinformation and disseminating facts in a timely and accurate way will likely reduce vaccine hesitancy. Moreover, to establish suitable communication strategies and information exchange platforms between the government and the public and a warning system on infodemic would be helpful to improve public's confidence in vaccination.


Subject(s)
COVID-19 Vaccines , COVID-19 , China/epidemiology , Cross-Sectional Studies , Humans , Population Groups , SARS-CoV-2 , Vaccination
5.
J Equine Vet Sci ; 112: 103895, 2022 05.
Article in English | MEDLINE | ID: covidwho-1676809

ABSTRACT

The COVID-19 pandemic has increased the availability of virtual horse showing opportunities. The objectives of this study were to describe survey participants' personal characteristics and participation in virtual and in-person horse shows, level of satisfaction, attitude toward technology and motivation to participate, and internal and external factors influencing the decision to participate in virtual horse shows. A survey was distributed to a target audience of adult horse show participants and/or adults supporting youth horse show participants via Qualtrics (n = 251). A majority of respondents (91.2%) reported benefits to participating in virtual horse shows, and 59.8% plan to continue showing virtually when in-person shows resume. The opportunity to show virtually has resulted in 76.1% of respondents anticipating increasing their participation in showing (in-person or virtual). An improvement in attitude toward technology (M =1.6; SD = 0.4; Range = 1.0-2.3) and an increase in motivation to participate, ride and show (M = 1.4; SD = 0.4; Range = 1.0-2.8) was also reported. In addition, respondents indicated they were somewhat likely to be influenced to participate in virtual shows by internal factors such as their budget and ability to record the ride. External factors such as feedback from judges, available divisions, and awards were extremely likely to influence their decision to participate. In conclusion, virtual horse shows have provided a satisfactory outlet to keep people engaged in the industry. Additional research should be done to determine if the current popularity of virtual horse showing persists once in-person shows have fully resumed.


Subject(s)
COVID-19 , Horse Diseases , Animals , COVID-19/epidemiology , COVID-19/veterinary , Horses , Humans , Motivation , Pandemics , Population Groups , Surveys and Questionnaires
6.
BMJ Open ; 12(2): e055692, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1673441

ABSTRACT

INTRODUCTION: The instituted elderly in nursing home need professional support targeting to maintain their daily activities and quality of life. Social support affects the health of elderly through its influence as a stress buffering or main effects on emotions, cognitions and behaviour that improve health outcomes. Understanding and identifying available interventions for the elderly in the literature related to integrating social support into interventions will be benefits to guide future practice, research and policy. METHODS AND ANALYSIS: A scoping review designed by Arksey and O'Malley has been used in this study. Key words, inclusion and exclusion criteria were elaborated to search the primary articles that published in English from 2010 to 2021 mainly from PubMed, Science Direct, Public Library of Science, SocioHub, Wiley Online Library and PsycINFO databases targeting to reach the selected articles and combined the results with reference lists and hand searches. The Mixed Methods Appraisal Tool version 2018 will be used to identify the quality of the studies. Authors developed the Data Extraction Form for data extraction and analysis. The Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews tool will be employed for reporting guideline. ETHICS AND DISSEMINATION: Authors forecast to obtain relevant studies reporting integrating specific dimensions of supportive functions into interventions for the elderly in nursing home. This finding will benefit in quality improvement of supportive interventions in nursing home and to continue the further experimental study. The findings will be disseminated via electronic and hard copy through peer-reviewed publications, conference presentations and internal organisation meeting.


Subject(s)
Quality of Life , Social Support , Aged , Humans , Nursing Homes , Peer Review , Population Groups , Research Design , Review Literature as Topic , Systematic Reviews as Topic
7.
EBioMedicine ; 74: 103695, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1596202

ABSTRACT

BACKGROUND: The heterogeneity in symptomatology and phenotypic profile attributable to COVID-19 is widely unknown. The objective of this manuscript is to conduct a trans-ancestry genome wide association study (GWAS) meta-analysis of COVID-19 severity to improve the understanding of potentially causal targets for SARS-CoV-2. METHODS: This cross-sectional study recruited 646 participants in the UAE that were divided into two phenotypic groups based on the severity of COVID-19 phenotypes, hospitalized (n=482) and non-hospitalized (n=164) participants. Hospitalized participants were COVID-19 patients that developed acute respiratory distress syndrome (ARDS), pneumonia or progression to respiratory failure that required supplemental oxygen therapy or mechanical ventilation support or had severe complications such as septic shock or multi-organ failure. We conducted a trans-ancestry meta-analysis GWAS of European (n=302), American (n=102), South Asian (n=99), and East Asian (n=107) ancestry populations. We also carried out comprehensive post-GWAS analysis, including enrichment of SNP associations in tissues and cell-types, expression quantitative trait loci and differential expression analysis. FINDINGS: Eight genes demonstrated a strong association signal: VWA8 gene in locus 13p14·11 (SNP rs10507497; p=9·54 x10-7), PDE8B gene in locus 5q13·3 (SNP rs7715119; p=2·19 x10-6), CTSC gene in locus 11q14·2 (rs72953026; p=2·38 x10-6), THSD7B gene in locus 2q22·1 (rs7605851; p=3·07x10-6), STK39 gene in locus 2q24·3 (rs7595310; p=4·55 x10-6), FBXO34 gene in locus 14q22·3 (rs10140801; p=8·26 x10-6), RPL6P27 gene in locus 18p11·31 (rs11659676; p=8·88 x10-6), and METTL21C gene in locus 13q33·1 (rs599976; p=8·95 x10-6). The genes are expressed in the lung, associated to tumour progression, emphysema, airway obstruction, and surface tension within the lung, as well as an association to T-cell-mediated inflammation and the production of inflammatory cytokines. INTERPRETATION: We have discovered eight highly plausible genetic association with hospitalized cases in COVID-19. Further studies must be conducted on worldwide population genetics to facilitate the development of population specific therapeutics to mitigate this worldwide challenge. FUNDING: This review was commissioned as part of a project to study the host cell receptors of coronaviruses funded by Khalifa University's CPRA grant (Reference number 2020-004).


Subject(s)
Genetic Predisposition to Disease/genetics , Quantitative Trait Loci/genetics , Quantitative Trait, Heritable , Respiratory Distress Syndrome/genetics , Severity of Illness Index , Adolescent , Adult , Aged , COVID-19/mortality , COVID-19/pathology , Cross-Sectional Studies , Female , Genome-Wide Association Study , Hospitalization/statistics & numerical data , Humans , Inflammation/genetics , Lung/pathology , Male , Middle Aged , Polymorphism, Single Nucleotide/genetics , Population Groups/genetics , Respiratory Distress Syndrome/pathology , SARS-CoV-2 , T-Lymphocytes/immunology , Treatment Outcome , United Arab Emirates , Young Adult
8.
Med Lav ; 112(6): 436-443, 2021 Dec 23.
Article in English | MEDLINE | ID: covidwho-1599009

ABSTRACT

BACKGROUND: The Covid-19 pandemic in Italy has been characterized by three waves of infection during 2020. Vaccination of healthcare workers started in January 2021, earlier than that of other population groups. The main aim of this study is to compare the spread of the pandemic between HCW and the general population focusing on potential effects of the vaccination. METHODS: The study consisted of a retrospective analysis of results of RT-PCR tests performed between 6 March 2020 and 4 April 2021 among HCWs from Bologna, Italy, and those of the general population of Emilia Romagna region. We calculated the crude proportion of positive RT-PCR tests over total tests and the crude prevalence of positive test in population; then, we conducted joinpoint analyses using the Joinpoint Regression Program of the National Cancer Institute. RESULTS: The results of the joinpoint analysis show that both φ and ψ ratio indicators have a similar pattern, with a sharp increase during the early phase of the pandemic, and a strong decrease at the end of the first wave around week 15. In both indicators there are no significant changes in the trend after week 25. Pandemic spread among HCWs appeared earlier than in the general population, but it otherwise appeared to have comparable features. A decline in infection was apparent among HCWs after vaccination. CONCLUSIONS: Surveillance of HCWs would inform on the epidemic in the general population. The apparent effectiveness of the anti-SarsCoV2 vaccine will likely occur in the general population.


Subject(s)
COVID-19 , Pandemics , Health Personnel , Humans , Pandemics/prevention & control , Population Groups , Retrospective Studies , SARS-CoV-2 , Vaccination
9.
BMJ Open ; 11(12): e049752, 2021 12 07.
Article in English | MEDLINE | ID: covidwho-1561929

ABSTRACT

INTRODUCTION: Asymptomatic infection of SARS-CoV-2 may lead to silent community transmission and compromise the COVID-19 pandemic control measures. We aimed to estimate the rate of asymptomatic COVID-19 from published studies and compare this rate among different regions and patient groups. METHODS: In this systematic review and meta-analysis, electronic databases including Medline, Embase, PubMed and three Chinese electronic databases (Chinese National Knowledge Infrastructure [CNKI], WanFang Data and China Science, and Technology Journal Database [VIP]) were searched for literature published from 1 November 2019 to 31 December 2020. Original investigations with sample size (or number of subjects) not less than five were included for further analyses. Subgroup analyses were conducted according to different study types, study periods, geographical regions and patient demographics. The STATA (V.14.0) command 'metaprop' was implemented to conduct a meta-analysis of the pooled rate estimates of asymptomatic infections with exact binomial and score test-based 95% confidence interval (CI). RESULTS: A total of 130 123 ascertained COVID-19 infections from 241 studies were included in this meta-analysis, including 31 411 asymptomatic infections. The overall rate of asymptomatic infections was 23.6% (18.5%-29.1%) and 21.7% (16.8%-27.0%) before and after excluding presymptomatic cases, respectively. Subgroup analysis showed that significantly higher in pregnant women (48.8%, 28.9%-68.9%), children (32.1%, 24.2%-40.5%), and studies reporting screening programmes (36.0%, 24.6%-48.1%) conducted on or after 1 March 2020 (42.5%, 33.4%-51.9%). In terms of geographical region, the rate was the highest in Africa (64.3%, 56.7%-71.6%), followed by America (40.0%, 27.4%-53.3%), Europe (28.1%, 19.0%-38.1%) and Asia (18.1%, 13.2%-23.5%). CONCLUSION: We approximated that one-fifth of COVID-19 infections are asymptomatic throughout the course of infection. Public health policies targeting these high-risk groups may be recommended to achieve early identification and more stringent containment of the pandemic.


Subject(s)
COVID-19 , Asymptomatic Infections/epidemiology , Child , Female , Humans , Pandemics , Population Groups , Pregnancy , SARS-CoV-2
10.
Sci Total Environ ; 812: 151431, 2022 Mar 15.
Article in English | MEDLINE | ID: covidwho-1500242

ABSTRACT

SARS-CoV-2 was discovered among humans in late 2019 and rapidly spread across the world. Although the virus is transmitted by respiratory droplets, most infected persons also excrete viral particles in their feces. This fact prompted a range of studies assessing the usefulness of wastewater surveillance to determine levels of infection and transmission and produce early warnings of outbreaks in local communities, independently of human testing. In this study, we collected samples of wastewater from 13 locations across Oklahoma City, representing different population types, twice per week from November 2020 to end of March 2021. Wastewater samples were collected and analyzed for the presence and concentration of SARS-CoV-2 RNA using RT-qPCR. The concentration of SARS-CoV-2 in the wastewater showed notable peaks, preceding the number of reported COVID-19 cases by an average of one week (ranging between 4 and 10 days). The early warning lead-time for an outbreak or increase in cases was significantly higher in areas with larger Hispanic populations and lower in areas with a higher household income or higher proportion of persons aged 65 years or older. Using this relationship, we predicted the number of cases with an accuracy of 81-92% compared to reported cases. These results confirm the validity and timeliness of using wastewater surveillance for monitoring local disease transmission and highlight the importance of differences in population structures when interpreting surveillance outputs and planning preventive action.


Subject(s)
COVID-19 , Humans , Oklahoma/epidemiology , Population Groups , RNA, Viral , SARS-CoV-2 , Waste Water , Wastewater-Based Epidemiological Monitoring
11.
Trials ; 22(1): 656, 2021 Sep 26.
Article in English | MEDLINE | ID: covidwho-1440949

ABSTRACT

BACKGROUND: To achieve higher effectiveness in population-based SARS-CoV-2 surveillance and to reliably predict the course of an outbreak, screening, and monitoring of infected individuals without major symptoms (about 40% of the population) will be necessary. While current testing capacities are also used to identify such asymptomatic cases, this rather passive approach is not suitable in generating reliable population-based estimates of the prevalence of asymptomatic carriers to allow any dependable predictions on the course of the pandemic. METHODS: This trial implements a two-factorial, randomized, controlled, multi-arm, prospective, interventional, single-blinded design with cluster sampling and four study arms, each representing a different SARS-CoV-2 testing and surveillance strategy based on individuals' self-collection of saliva samples which are then sent to and analyzed by a laboratory. The targeted sample size for the trial is 10,000 saliva samples equally allocated to the four study arms (2500 participants per arm). Strategies differ with respect to tested population groups (individuals vs. all household members) and testing approach (without vs. with pre-screening survey). The trial is complemented by an economic evaluation and qualitative assessment of user experiences. Primary outcomes include costs per completely screened person, costs per positive case, positive detection rate, and precision of positive detection rate. DISCUSSION: Systems for active surveillance of the general population will gain more importance in the context of pandemics and related disease prevention efforts. The pandemic parameters derived from such active surveillance with routine population monitoring therefore not only enable a prospective assessment of the short-term course of a pandemic, but also a more targeted and thus more effective use of local and short-term countermeasures. TRIAL REGISTRATION: ClinicalTrials.gov DRKS00023271 . Registered November 30, 2020, with the German Clinical Trials Register (Deutsches Register Klinischer Studien).


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19 Testing , Cost-Benefit Analysis , Humans , Population Groups , Prospective Studies , Randomized Controlled Trials as Topic , Treatment Outcome
13.
Acad Radiol ; 28(7): 950-952, 2021 07.
Article in English | MEDLINE | ID: covidwho-1375876
15.
Am Surg ; 87(11): 1704-1712, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1367605

ABSTRACT

In the United States, the nation's health is not an organic outcome. It is not a coincidence that certain groups of people living in the United States experience higher premature death rates or poorer health outcomes than others. For centuries, racial and ethnic as well as geographic differences in health outcomes have been part of the American landscape, so entrenched in society that many people fail to recognize that health inequities were intentionally derived. A national crisis tends to magnify inequities in our society, but even more alarming is the fact that as the country becomes more racially and ethnically diverse in the coming years, the health inequities are projected to worsen if we do not proactively and immediately address them. As we continue to grapple with the lasting impact of the pandemic, it is of vital importance that we utilize this time to acknowledge, understand, and seriously address the health inequities that have historically plagued the country for over 400 years. As the United States works overtime to stem the tide of the COVID-19 pandemic, it must also work equally hard to move in a more equitable, inclusive, and healthier direction, not only because of the more than 83 000 Americans dying prematurely each year but also because of the economic and national security toll it will have if not effectively addressed.


Subject(s)
COVID-19 , Health Equity , Physician's Role , Racism , COVID-19/epidemiology , Health Equity/statistics & numerical data , Humans , Pandemics , Politics , Population Groups/statistics & numerical data , Racism/prevention & control , Racism/statistics & numerical data , SARS-CoV-2 , Social Determinants of Health/statistics & numerical data , Surgeons , United States/epidemiology
16.
Ann Epidemiol ; 62: 30-35, 2021 10.
Article in English | MEDLINE | ID: covidwho-1336216

ABSTRACT

PURPOSE: Our aim was to verify the incidence of physical inactivity and excessive screen time during the first wave of the COVID-19 pandemic among Brazilian adults, as well as to identify subgroups that are more affected by the quarantine actions. METHODS: The data of 39,693 Brazilian adults were collected through an online questionnaire between April 24th and May 24th, 2020. Information about physical activity (weekly frequency and daily duration), TV viewing, and computer/tablet use (daily duration) before and during the pandemic period were reported. The correlates adopted were sex, age group, highest academic achievement, skin color, per capita income, country macro region, working status during the quarantine, and adherence to the quarantine. Logistic regression models were used. RESULTS: The incidence of physical inactivity (<150 min/week), high TV viewing (≥4 h/d), and computer/tablet use (≥4 h/d), were, respectively, 70.4%, 31.4%, and 37.9% during the COVID-19 pandemic. The younger age group showed higher incidences of physical inactivity (78%) and high computer/tablet use (59%), while middle-age adults (30-59 years) showed a higher incidence of TV viewing (34%). People who adhered to stricter measures of quarantine presented a higher incidence of excessive screen time. CONCLUSION: High incidences of physical inactivity and excessive screen time were identified in specific population subgroups during the first wave of the COVID-19 pandemic in Brazil.


Subject(s)
COVID-19 , Pandemics , Adult , Brazil/epidemiology , Humans , Incidence , Middle Aged , Population Groups , SARS-CoV-2 , Screen Time , Sedentary Behavior
17.
PLoS One ; 16(7): e0254633, 2021.
Article in English | MEDLINE | ID: covidwho-1315889

ABSTRACT

BACKGROUND: Almost 200,000 deaths from COVID-19 were reported in Brazil in 2020. The case fatality rate of a new infectious disease can vary by different risk factors and over time. We analysed the trends and associated factors of COVID-19 case fatality rates in Brazilian public hospital admissions during the first wave of the pandemic. METHODS: A retrospective cohort of all COVID-19-related admissions between epidemiological weeks 10-40 in the Brazilian Public Health System (SUS) was delimited from available reimbursement records. Smoothing time series and survival analyses were conducted to evaluate the trends of hospital case fatality rates (CFR) and the probability of death according to factors such as sex, age, ethnicity, comorbidities, length of stay and ICU use. RESULTS: With 398,063 admissions and 86,452 (21.7%) deaths, the overall age-standardized hospital CFR trend decreased throughout the period, varying from 31.8% (95%CI: 31.2 to 32.5%) in week 10 to 18.2% (95%CI: 17.6 to 18.8%) in week 40. This decreasing trend was observed in all sex, age, ethnic groups, length of stay and ICU admissions. Consistently, later admission (from July to September) was an independent protective factor. Patients 80+ year old had a hazard ratio of 8.18 (95% CI: 7.51 to 8.91). Ethnicity, comorbidities, and ICU need were also associated with the death risk. Although also decreasing, the CFR was always around 40-50% in people who needed an ICU admission. CONCLUSIONS: The overall hospital CFR of COVID-19 has decreased in Brazilian public hospitals during the first wave of the pandemic in 2020. Nevertheless, during the entire period, the CFR was still very high, suggesting the need for improving COVID-19 hospital care in Brazil.


Subject(s)
COVID-19/mortality , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Brazil , COVID-19/epidemiology , Comorbidity , Female , Hospitals, Public/statistics & numerical data , Humans , Male , Middle Aged , Mortality/trends , Patient Admission/statistics & numerical data , Population Groups/statistics & numerical data , Sex Factors , Socioeconomic Factors
18.
PLoS One ; 16(7): e0254635, 2021.
Article in English | MEDLINE | ID: covidwho-1311289

ABSTRACT

BACKGROUND: Statins have anti-inflammatory and immunomodulatory effects that may reduce the severity of coronavirus disease 2019 (COVID-19), in which organ dysfunction is mediated by severe inflammation. Large studies with diverse populations evaluating statin use and outcomes in COVID-19 are lacking. METHODS AND RESULTS: We used data from 10,541 patients hospitalized with COVID-19 through September 2020 at 104 US hospitals enrolled in the American Heart Association's COVID-19 Cardiovascular Disease (CVD) Registry to evaluate the associations between statin use and outcomes. Prior to admission, 42% of subjects (n = 4,449) used statins (7% on statins alone, 35% on statins plus anti-hypertensives). Death (or discharge to hospice) occurred in 2,212 subjects (21%). Outpatient use of statins, either alone or with anti-hypertensives, was associated with a reduced risk of death (adjusted odds ratio [aOR] 0.59, 95% CI 0.50-0.69), adjusting for demographic characteristics, insurance status, hospital site, and concurrent medications by logistic regression. In propensity-matched analyses, use of statins and/or anti-hypertensives was associated with a reduced risk of death among those with a history of CVD and/or hypertension (aOR 0.68, 95% CI 0.58-0.81). An observed 16% reduction in odds of death among those without CVD and/or hypertension was not statistically significant. CONCLUSIONS: Patients taking statins prior to hospitalization for COVID-19 had substantially lower odds of death, primarily among individuals with a history of CVD and/or hypertension. These observations support the continuation and aggressive initiation of statin and anti-hypertensive therapies among patients at risk for COVID-19, if these treatments are indicated based upon underlying medical conditions.


Subject(s)
Antihypertensive Agents/administration & dosage , COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Registries/statistics & numerical data , Adult , Age Factors , Aged , American Heart Association , Antihypertensive Agents/therapeutic use , COVID-19/mortality , Cardiovascular Diseases/drug therapy , Drug Utilization/statistics & numerical data , Female , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Male , Middle Aged , Mortality/trends , Population Groups/statistics & numerical data , United States
19.
Int J Environ Res Public Health ; 18(14)2021 Jul 09.
Article in English | MEDLINE | ID: covidwho-1308339

ABSTRACT

INTRODUCTION: Of the serious problems that characterise the current crisis in Spain, the most alarming and revealing is unemployment, which, despite being so common, continues to be quite a negative experience for most people, often with serious negative effects on their biopsychosocial health. The perpetuation of this situation has given rise to a new syndrome of the unemployed. If these effects of economic downsizing are accompanied by the magnitude of the current situation brought about by COVID-19, the results can be devastating for the individuals and families experiencing it. OBJECTIVE: To compare the symptoms of the unemployed syndrome in three population groups. METHOD: Three groups were studied: short-term unemployed (n = 91), long-term unemployed (n = 150), and those unemployed during the COVID-19 pandemic (n = 94). Unemployment syndrome was assessed with the Unemployment Syndrome Scale (USS). The three population groups were contacted through web pages, social networks, etc. and answered the instruments online in a single session. Once the responses were obtained, their information was encoded in a database and analysed through the SPSS v. 21 program. Population groups were compared using the ANOVA analysis and the Bonferroni post hoc test. RESULTS: The unemployed individuals who lost their job during the pandemic reported higher scores in the symptoms of the Unemployed Syndrome Scale compared to the long- and short-term unemployed individuals. ANOVA analyses for symptoms of USS were all significant in the different groups considering a significance level of <0.005. Participants who were unemployed for less than one year had lower scores in the USS than the long-term unemployed participants and those unemployed during the COVID-19 pandemic that reported a significantly higher number of symptoms in the USS.


Subject(s)
COVID-19 , Unemployment , Humans , Pandemics , Population Groups , SARS-CoV-2 , Spain/epidemiology
20.
MEDICC Rev ; 22(3): 20-23, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-1305049

ABSTRACT

Dr Héctor Javier Sánchez specializes in public health and research methodology and holds a master's degree in epidemiology. He is a senior researcher in the Society, Culture and Health Department at El Colegio de la Frontera Sur, Mexico. The Colegio is a public research institu-tion concentrating on environmental, economic and social issues related to a sustainable future for Mexico's southern border area, and belongs to the National Council of Science and Technol-ogy (CONACYT). In Chiapas State, the country's poorest region and home to many indigenous peoples, Dr Sánchez has carried out studies on TB, poverty and health, domestic violence, hu-man rights, maternal-child health and the effect of agrochemicals on human health.


Subject(s)
Human Rights , Public Health , COVID-19 , Delivery of Health Care , Economic Recession , Humans , Mexico , Pandemics , Population Groups , SARS-CoV-2 , Universal Health Care
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