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Szwarcwald CL, Almeida WS, Boccolini CS, Soares Filho AM, Malta DC. The unequal impact of the pandemic at subnational levels and educational attainment-related inequalities in COVID-19 mortality, Brazil, 2020-2021. Public Health 2024; 231:39-46. [PMID: 38615470 DOI: 10.1016/j.puhe.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES We estimated COVID-19 mortality indicators in 2020-2021 to show the epidemic's impact at subnational levels and to analyze educational attainment-related inequalities in COVID-19 mortality in Brazil. STUDY DESIGN This was an ecological study with secondary mortality information. METHODS Crude and age-standardized COVID-19 mortality rates were calculated by gender, major regions, and states. The COVID-19 proportional mortality (percentage) was estimated by gender and age in each region. Measures of education-related inequalities in COVID-19 mortality were calculated per state, in each of which the COVID-19 maternal mortality rate (MMR) was estimated by the number of COVID-19 maternal deaths per 100,000 live births (LBs). RESULTS The analysis of mortality rates at subnational levels showed critical regional differences. The North region proved to be the most affected by the pandemic, followed by the Center-West, with age-standardized COVID-19 mortality rates above 2 per 1000 inhabitants. The peak of COVID-19 mortality occurred in mid-March/April 2021 in all regions. Great inequality by educational level was found, with the illiterate population being the most negatively impacted in all states. The proportional mortality showed that males and females aged 50-69 years were the most affected. The MMR reached critical values (>100/100,000 LB) in several states of the North, Northeast, Southeast, and Center-West regions. CONCLUSIONS This study highlights stark regional and educational disparities in COVID-19 mortality in Brazil. Exacerbated by the pandemic, these inequalities reveal potential areas for intervention to reduce disparities. The results also revealed high MMRs in certain states, underscoring pre-existing healthcare access challenges that worsened during the pandemic.
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Affiliation(s)
- C L Szwarcwald
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | - W S Almeida
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - C S Boccolini
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - A M Soares Filho
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - D C Malta
- School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Pacheco-García U, Serafín-López J. Indirect Dispersion of SARS-CoV-2 Live-Attenuated Vaccine and Its Contribution to Herd Immunity. Vaccines (Basel) 2023; 11:655. [PMID: 36992239 PMCID: PMC10055900 DOI: 10.3390/vaccines11030655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
It has been 34 months since the beginning of the SARS-CoV-2 coronavirus pandemic, which causes the COVID-19 disease. In several countries, immunization has reached a proportion near what is required to reach herd immunity. Nevertheless, infections and re-infections have been observed even in vaccinated persons. That is because protection conferred by vaccines is not entirely effective against new virus variants. It is unknown how often booster vaccines will be necessary to maintain a good level of protective immunity. Furthermore, many individuals refuse vaccination, and in developing countries, a large proportion of the population has not yet been vaccinated. Some live-attenuated vaccines against SARS-CoV-2 are being developed. Here, we analyze the indirect dispersion of a live-attenuated virus from vaccinated individuals to their contacts and the contribution that this phenomenon could have to reaching Herd Immunity.
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Affiliation(s)
- Ursino Pacheco-García
- Department of Cardio-Renal Pathophysiology, Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico City 14080, Mexico
| | - Jeanet Serafín-López
- Department of Immunology, Escuela Nacional de Ciencias Biológicas (ENCB), Instituto Politécnico Nacional (IPN), Mexico City 11340, Mexico
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Raj A, Sharma V, Shukla DM, Sharma P. Advancing supply chain management from agility to hyperagility: a dynamic capability view. ANNALS OF OPERATIONS RESEARCH 2023:1-32. [PMID: 36619697 PMCID: PMC9807984 DOI: 10.1007/s10479-022-05158-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Research and practice emphasize the criticality of supply chain agility in responding to external disruptions. However, many organizations struggled to respond at enhanced speed to the global supply chain shocks caused by the COVID-19 pandemic. Organizations need hyperagile supply chains to survive and remain competitive in an environment characterized by unexpected and sudden disruptions such as the COVID-19 pandemic. We propose that supply chain hyperagility (SCH) is a distinctive organization-specific capability. It enables organizations to effectively manage demand shocks at extreme speeds and under extreme time pressures. We advance the concept of supply chain hyperagility and establish its antecedents, taking the dynamic capability perspective. This study operationalizes the SCH construct for the first time and investigates its antecedents using structural equation modeling. The results highlight the significance of data analytical capabilities, market orientation, entrepreneurial orientation, and supply chain integration in shaping supply chain hyperagility. The study offers practical insights for managers regarding designing supply chains that can navigate hyperagile environments and benefit from the opportunities presented by such environments.
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Affiliation(s)
- Alok Raj
- Department of Production, Operations and Decision Sciences, XLRI Xavier School of Management, Jamshedpur, India
| | - Varun Sharma
- Department of Operations and Decision Science, T A Pai Management Institute, Manipal Academy of Higher Education, Manipal, India
| | | | - Prateek Sharma
- Finance and Accounting, Indian Institute of Management Udaipur, Udaipur, India
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Weekly Nowcasting of New COVID-19 Cases Using Past Viral Load Measurements. Viruses 2022; 14:v14071414. [PMID: 35891394 PMCID: PMC9317659 DOI: 10.3390/v14071414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022] Open
Abstract
The rapid spread of the coronavirus disease COVID-19 has imposed clinical and financial burdens on hospitals and governments attempting to provide patients with medical care and implement disease-controlling policies. The transmissibility of the disease was shown to be correlated with the patient’s viral load, which can be measured during testing using the cycle threshold (Ct). Previous models have utilized Ct to forecast the trajectory of the spread, which can provide valuable information to better allocate resources and change policies. However, these models combined other variables specific to medical institutions or came in the form of compartmental models that rely on epidemiological assumptions, all of which could impose prediction uncertainties. In this study, we overcome these limitations using data-driven modeling that utilizes Ct and previous number of cases, two institution-independent variables. We collected three groups of patients (n = 6296, n = 3228, and n = 12,096) from different time periods to train, validate, and independently validate the models. We used three machine learning algorithms and three deep learning algorithms that can model the temporal dynamic behavior of the number of cases. The endpoint was 7-week forward number of cases, and the prediction was evaluated using mean square error (MSE). The sequence-to-sequence model showed the best prediction during validation (MSE = 0.025), while polynomial regression (OLS) and support vector machine regression (SVR) had better performance during independent validation (MSE = 0.1596, and MSE = 0.16754, respectively), which exhibited better generalizability of the latter. The OLS and SVR models were used on a dataset from an external institution and showed promise in predicting COVID-19 incidences across institutions. These models may support clinical and logistic decision-making after prospective validation.
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Chamieh A, Zgheib R, El-Sawalhi S, Yammine L, El-Hajj G, Zmerli O, Afif C, Rolain JM, Azar E. Trends of Multidrug-Resistant Pathogens, Difficult to Treat Bloodstream Infections, and Antimicrobial Consumption at a Tertiary Care Center in Lebanon from 2015-2020: COVID-19 Aftermath. Antibiotics (Basel) 2021; 10:antibiotics10081016. [PMID: 34439065 PMCID: PMC8388970 DOI: 10.3390/antibiotics10081016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction: We studied the trend of antimicrobial resistance and consumption at Saint George Hospital University Medical Center (SGHUMC), a tertiary care center in Beirut, Lebanon, with a focus on the SARS-CoV-2 pandemic. Materials and Methods: We calculated the isolation density/1000 patient-days (PD) of the most isolated organisms from 1 January 2015–31 December 2020 that included: E. coli (Eco), K. pneumoniae (Kp), P. aeruginosa (Pae), A. baumannii (Ab), S. aureus (Sau), and E. faecium (Efm). We considered March–December 2020 a surrogate of COVID-19. We considered one culture/patient for each antimicrobial susceptibility and excluded Staphylococcus epidermidis, Staphylococcus coagulase-negative, and Corynebacterium species. We analyzed the trends of the overall isolates, the antimicrobial susceptibilities of blood isolates (BSI), difficult-to-treat (DTR) BSI, carbapenem-resistant Enterobacteriaceae (CRE) BSI, and restricted antimicrobial consumption as daily-defined-dose/1000 PD. DTR implies resistance to carbapenems, beta-lactams, fluoroquinolones, and additional antimicrobials where applicable. Results and Discussion: After applying exclusion criteria, we analyzed 1614 blood cultures out of 8314 cultures. We isolated 85 species, most commonly Eco, at 52%. The isolation density of total BSI in 2020 decreased by 16%: 82 patients were spared from bacteremia, with 13 being DTR. The isolation density of CRE BSI/1000 PD decreased by 64% from 2019 to 2020, while VREfm BSI decreased by 34%. There was a significant decrease of 80% in Ab isolates (p-value < 0.0001). During COVID-19, restricted antimicrobial consumption decreased to 175 DDD/1000 PD (p-value < 0.0001). Total carbapenem consumption persistently decreased by 71.2% from 108DDD/1000 PD in 2015–2019 to 31 DDD/1000 PD in 2020. At SGHUMC, existing epidemics were not worsened by the pandemic. We attribute this to our unique and dynamic collaboration of antimicrobial stewardship, infection prevention and control, and infectious disease consultation.
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Affiliation(s)
- Amanda Chamieh
- Department of Infectious Diseases, Saint George Hospital University Medical Center, Beirut 11002807, Lebanon; (A.C.); (L.Y.); (O.Z.); (C.A.)
- Institut de Recherche pour le Développement (IRD), UMR Microbes Evolution Phylogeny and Infections (MEPHI), Aix-Marseille Université, 13007 Marseille, France;
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France;
| | - Rita Zgheib
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France;
- Institut de Recherche pour le Développement (IRD), Service de Santé des Armées, AP-HM, UMR Vecteurs Infections Tropicales et Méditerranéennes (VITROME), Aix Marseille Université, 13007 Marseille, France
| | - Sabah El-Sawalhi
- Institut de Recherche pour le Développement (IRD), UMR Microbes Evolution Phylogeny and Infections (MEPHI), Aix-Marseille Université, 13007 Marseille, France;
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France;
| | - Laure Yammine
- Department of Infectious Diseases, Saint George Hospital University Medical Center, Beirut 11002807, Lebanon; (A.C.); (L.Y.); (O.Z.); (C.A.)
| | - Gerard El-Hajj
- Department of Medical Imaging, Saint George Hospital University Medical Center, Beirut 11002807, Lebanon;
| | - Omar Zmerli
- Department of Infectious Diseases, Saint George Hospital University Medical Center, Beirut 11002807, Lebanon; (A.C.); (L.Y.); (O.Z.); (C.A.)
| | - Claude Afif
- Department of Infectious Diseases, Saint George Hospital University Medical Center, Beirut 11002807, Lebanon; (A.C.); (L.Y.); (O.Z.); (C.A.)
| | - Jean-Marc Rolain
- Institut de Recherche pour le Développement (IRD), UMR Microbes Evolution Phylogeny and Infections (MEPHI), Aix-Marseille Université, 13007 Marseille, France;
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France;
- Correspondence: (J.-M.R.); (E.A.)
| | - Eid Azar
- Department of Infectious Diseases, Saint George Hospital University Medical Center, Beirut 11002807, Lebanon; (A.C.); (L.Y.); (O.Z.); (C.A.)
- Correspondence: (J.-M.R.); (E.A.)
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Khalil A, Dhingra R, Al-Mulki J, Hassoun M, Alexis N. Questioning the sex-specific differences in the association of smoking on the survival rate of hospitalized COVID-19 patients. PLoS One 2021; 16:e0255692. [PMID: 34351990 PMCID: PMC8341532 DOI: 10.1371/journal.pone.0255692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/21/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction In the absence of a universally accepted association between smoking and COVID-19 health outcomes, we investigated this relationship in a representative cohort from one of the world’s highest tobacco consuming regions. This is the first report from the Middle East and North Africa that tackles specifically the association of smoking and COVID-19 mortality while demonstrating a novel sex-discrepancy in the survival rates among patients. Methods Clinical data for 743 hospitalized COVID-19 patients was retrospectively collected from the leading centre for COVID-19 testing and treatment in Lebanon. Logistic regression, Kaplan-Meier survival curves and Cox proportional hazards model adjusted for age and stratified by sex were used to assess the association between the current cigarette smoking status of patients and COVID-19 outcomes. Results In addition to the high smoking prevalence among our hospitalized COVID-19 patients (42.3%), enrolled smokers tended to have higher reported ICU admissions (28.3% vs 16.6%, p<0.001), longer length of stay in the hospital (12.0 ± 7.8 vs 10.8 days, p<0.001) and higher death incidences as compared to non-smokers (60.5% vs 39.5%, p<0.001). Smokers had an elevated odds ratio for death (OR = 2.3, p<0.001) and for ICU admission (OR = 2.0, p<0.001) which remained significant in a multivariate regression model. Once adjusted for age and stratified by sex, our data revealed that current smoking status reduces survival rate in male patients ([HR] = 1.9 [95% (CI), 1.029–3.616]; p = 0.041) but it does not affect survival outcomes among hospitalized female patients([HR] = 0.79 [95% CI = 0.374–1.689]; p = 0.551). Conclusion A high smoking prevalence was detected in our hospitalized COVID-19 cohort combined with worse prognosis and higher mortality rate in smoking patients. Our study was the first to highlight potential sex-specific consequences for smoking on COVID-19 outcomes that might further explain the higher vulnerability to death from this disease among men.
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Affiliation(s)
- Athar Khalil
- Clinical Research Unit, Rafik Hariri University Hospital, Beirut, Lebanon
- * E-mail: (AK); (MH)
| | - Radhika Dhingra
- Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Institute for Environmental Health Solutions, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Jida Al-Mulki
- Department of Pulmonary and Intensive Care Unit, Rafik Hariri University Hospital, Beirut, Lebanon
| | - Mahmoud Hassoun
- Department of Pulmonary and Intensive Care Unit, Rafik Hariri University Hospital, Beirut, Lebanon
- * E-mail: (AK); (MH)
| | - Neil Alexis
- Center for Environmental Medicine Asthma and Lung Biology, University of North Carolina, Chapel Hill, North Carolina, United States of America
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