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Boylan S, Arsenault C, Barreto M, Bozza FA, Fonseca A, Forde E, Hookham L, Humphreys GS, Ichihara MY, Le Doare K, Liu XF, McNamara E, Mugunga JC, Oliveira JF, Ouma J, Postlethwaite N, Retford M, Reyes LF, Morris AD, Wozencraft A. Data challenges for international health emergencies: lessons learned from ten international COVID-19 driver projects. Lancet Digit Health 2024; 6:e354-e366. [PMID: 38670744 DOI: 10.1016/s2589-7500(24)00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 04/28/2024]
Abstract
The COVID-19 pandemic highlighted the importance of international data sharing and access to improve health outcomes for all. The International COVID-19 Data Alliance (ICODA) programme enabled 12 exemplar or driver projects to use existing health-related data to address major research questions relating to the pandemic, and developed data science approaches that helped each research team to overcome challenges, accelerate the data research cycle, and produce rapid insights and outputs. These approaches also sought to address inequity in data access and use, test approaches to ethical health data use, and make summary datasets and outputs accessible to a wider group of researchers. This Health Policy paper focuses on the challenges and lessons learned from ten of the ICODA driver projects, involving researchers from 19 countries and a range of health-related datasets. The ICODA programme reviewed the time taken for each project to complete stages of the health data research cycle and identified common challenges in areas such as data sharing agreements and data curation. Solutions included provision of standard data sharing templates, additional data curation expertise at an early stage, and a trusted research environment that facilitated data sharing across national boundaries and reduced risk. These approaches enabled the driver projects to rapidly produce research outputs, including publications, shared code, dashboards, and innovative resources, which can all be accessed and used by other research teams to address global health challenges.
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Affiliation(s)
| | - Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Marcos Barreto
- Center for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Fernando A Bozza
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Adalton Fonseca
- Center for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | | | | | | | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Kirsty Le Doare
- St George's, University of London, London, UK; Makerere University John's Hopkins University Research Collaboration, Kampala, Uganda
| | - Xiao Fan Liu
- Department of Media and Communication, City University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Jean Claude Mugunga
- Partners in Health, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Juliane F Oliveira
- Center for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil; Department of Mathematics, Centre of Mathematics of the University of Porto, Porto, Portugal
| | - Joseph Ouma
- Makerere University John's Hopkins University Research Collaboration, Kampala, Uganda
| | | | | | - Luis Felipe Reyes
- Nuffield School of Medicine, University of Oxford, Oxford, UK; Universidad de La Sabana, Chia, Colombia
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de Sarges KML, Póvoa da Costa F, dos Santos EF, Cantanhede MHD, da Silva R, Veríssimo ADOL, Viana MDNDSDA, Rodrigues FBB, Leite MDM, Torres MKDS, Bentes da Silva C, de Brito MTFM, da Silva ALS, Henriques DF, Vallinoto IMVC, Viana GMR, Queiroz MAF, Vallinoto ACR, dos Santos EJM. Association of the IFNG +874T/A Polymorphism with Symptomatic COVID-19 Susceptibility. Viruses 2024; 16:650. [PMID: 38675991 PMCID: PMC11053931 DOI: 10.3390/v16040650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/14/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Tumor necrosis factor (TNF) and interferon-gamma (IFNγ) are important inflammatory mediators in the development of cytokine storm syndrome (CSS). Single nucleotide polymorphisms (SNPs) regulate the expression of these cytokines, making host genetics a key factor in the prognosis of COVID-19. In this study, we investigated the associations of the TNF -308G/A and IFNG +874T/A polymorphisms with COVID-19. We analyzed the frequencies of the two polymorphisms in the control groups (CG: TNF -308G/A, n = 497; IFNG +874T/A, n = 397), a group of patients with COVID-19 (CoV, n = 222) and among the subgroups of patients with nonsevere (n = 150) and severe (n = 72) COVID-19. We found no significant difference between the genotypic and allelic frequencies of TNF -308G/A in the groups analyzed; however, both the frequencies of the high expression genotype (TT) (CoV: 13.51% vs. CG: 6.30%; p = 0.003) and the *T allele (CoV: 33.56% vs. CG: 24. 81%; p = 0.001) of the IFNG +874T/A polymorphism were higher in the COVID-19 group than in the control group, with no differences between the subgroups of patients with nonsevere and severe COVID-19. The *T allele of IFNG +874T/A (rs2430561) is associated with susceptibility to symptomatic COVID-19. These SNPs provided valuables clues about the potential mechanism involved in the susceptibility to developing symptomatic COVID-19.
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Affiliation(s)
- Kevin Matheus Lima de Sarges
- Laboratory of Genetics of Complex Diseases, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil; (K.M.L.d.S.); (F.P.d.C.); (E.F.d.S.); (M.H.D.C.); (R.d.S.); (M.d.N.d.S.d.A.V.); (F.B.B.R.); (M.d.M.L.); (C.B.d.S.); (M.T.F.M.d.B.); (A.L.S.d.S.)
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belem 66000-000, Brazil; (M.K.d.S.T.); (I.M.V.C.V.); (M.A.F.Q.); (A.C.R.V.)
| | - Flávia Póvoa da Costa
- Laboratory of Genetics of Complex Diseases, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil; (K.M.L.d.S.); (F.P.d.C.); (E.F.d.S.); (M.H.D.C.); (R.d.S.); (M.d.N.d.S.d.A.V.); (F.B.B.R.); (M.d.M.L.); (C.B.d.S.); (M.T.F.M.d.B.); (A.L.S.d.S.)
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belem 66000-000, Brazil; (M.K.d.S.T.); (I.M.V.C.V.); (M.A.F.Q.); (A.C.R.V.)
| | - Erika Ferreira dos Santos
- Laboratory of Genetics of Complex Diseases, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil; (K.M.L.d.S.); (F.P.d.C.); (E.F.d.S.); (M.H.D.C.); (R.d.S.); (M.d.N.d.S.d.A.V.); (F.B.B.R.); (M.d.M.L.); (C.B.d.S.); (M.T.F.M.d.B.); (A.L.S.d.S.)
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belem 66000-000, Brazil; (M.K.d.S.T.); (I.M.V.C.V.); (M.A.F.Q.); (A.C.R.V.)
| | - Marcos Henrique Damasceno Cantanhede
- Laboratory of Genetics of Complex Diseases, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil; (K.M.L.d.S.); (F.P.d.C.); (E.F.d.S.); (M.H.D.C.); (R.d.S.); (M.d.N.d.S.d.A.V.); (F.B.B.R.); (M.d.M.L.); (C.B.d.S.); (M.T.F.M.d.B.); (A.L.S.d.S.)
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belem 66000-000, Brazil; (M.K.d.S.T.); (I.M.V.C.V.); (M.A.F.Q.); (A.C.R.V.)
| | - Rosilene da Silva
- Laboratory of Genetics of Complex Diseases, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil; (K.M.L.d.S.); (F.P.d.C.); (E.F.d.S.); (M.H.D.C.); (R.d.S.); (M.d.N.d.S.d.A.V.); (F.B.B.R.); (M.d.M.L.); (C.B.d.S.); (M.T.F.M.d.B.); (A.L.S.d.S.)
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belem 66000-000, Brazil; (M.K.d.S.T.); (I.M.V.C.V.); (M.A.F.Q.); (A.C.R.V.)
| | | | - Maria de Nazaré do Socorro de Almeida Viana
- Laboratory of Genetics of Complex Diseases, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil; (K.M.L.d.S.); (F.P.d.C.); (E.F.d.S.); (M.H.D.C.); (R.d.S.); (M.d.N.d.S.d.A.V.); (F.B.B.R.); (M.d.M.L.); (C.B.d.S.); (M.T.F.M.d.B.); (A.L.S.d.S.)
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belem 66000-000, Brazil; (M.K.d.S.T.); (I.M.V.C.V.); (M.A.F.Q.); (A.C.R.V.)
| | - Fabíola Brasil Barbosa Rodrigues
- Laboratory of Genetics of Complex Diseases, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil; (K.M.L.d.S.); (F.P.d.C.); (E.F.d.S.); (M.H.D.C.); (R.d.S.); (M.d.N.d.S.d.A.V.); (F.B.B.R.); (M.d.M.L.); (C.B.d.S.); (M.T.F.M.d.B.); (A.L.S.d.S.)
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belem 66000-000, Brazil; (M.K.d.S.T.); (I.M.V.C.V.); (M.A.F.Q.); (A.C.R.V.)
| | - Mauro de Meira Leite
- Laboratory of Genetics of Complex Diseases, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil; (K.M.L.d.S.); (F.P.d.C.); (E.F.d.S.); (M.H.D.C.); (R.d.S.); (M.d.N.d.S.d.A.V.); (F.B.B.R.); (M.d.M.L.); (C.B.d.S.); (M.T.F.M.d.B.); (A.L.S.d.S.)
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belem 66000-000, Brazil; (M.K.d.S.T.); (I.M.V.C.V.); (M.A.F.Q.); (A.C.R.V.)
| | - Maria Karoliny da Silva Torres
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belem 66000-000, Brazil; (M.K.d.S.T.); (I.M.V.C.V.); (M.A.F.Q.); (A.C.R.V.)
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil
| | - Christiane Bentes da Silva
- Laboratory of Genetics of Complex Diseases, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil; (K.M.L.d.S.); (F.P.d.C.); (E.F.d.S.); (M.H.D.C.); (R.d.S.); (M.d.N.d.S.d.A.V.); (F.B.B.R.); (M.d.M.L.); (C.B.d.S.); (M.T.F.M.d.B.); (A.L.S.d.S.)
| | - Mioni Thieli Figueiredo Magalhães de Brito
- Laboratory of Genetics of Complex Diseases, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil; (K.M.L.d.S.); (F.P.d.C.); (E.F.d.S.); (M.H.D.C.); (R.d.S.); (M.d.N.d.S.d.A.V.); (F.B.B.R.); (M.d.M.L.); (C.B.d.S.); (M.T.F.M.d.B.); (A.L.S.d.S.)
- Graduate Program in Clinical Analysis, Federal University of Pará, Belem 66000-000, Brazil
| | - Andréa Luciana Soares da Silva
- Laboratory of Genetics of Complex Diseases, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil; (K.M.L.d.S.); (F.P.d.C.); (E.F.d.S.); (M.H.D.C.); (R.d.S.); (M.d.N.d.S.d.A.V.); (F.B.B.R.); (M.d.M.L.); (C.B.d.S.); (M.T.F.M.d.B.); (A.L.S.d.S.)
- Graduate Program in Clinical Analysis, Federal University of Pará, Belem 66000-000, Brazil
| | - Daniele Freitas Henriques
- Section of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Health Surveillance Secretariat, Brazilian Ministry of Health, Ananindeua 67000-000, Brazil;
| | - Izaura Maria Vieira Cayres Vallinoto
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belem 66000-000, Brazil; (M.K.d.S.T.); (I.M.V.C.V.); (M.A.F.Q.); (A.C.R.V.)
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil
| | - Giselle Maria Rachid Viana
- Malaria Basic Research Laboratory, Parasitology Section, Evandro Chagas Institute, Health Surveillance Secretariat, Brazilian Ministry of Health, Ananindeua 67000-000, Brazil;
| | - Maria Alice Freitas Queiroz
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belem 66000-000, Brazil; (M.K.d.S.T.); (I.M.V.C.V.); (M.A.F.Q.); (A.C.R.V.)
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil
| | - Antonio Carlos Rosário Vallinoto
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belem 66000-000, Brazil; (M.K.d.S.T.); (I.M.V.C.V.); (M.A.F.Q.); (A.C.R.V.)
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil
| | - Eduardo José Melo dos Santos
- Laboratory of Genetics of Complex Diseases, Institute of Biological Sciences, Federal University of Pará, Belem 66000-000, Brazil; (K.M.L.d.S.); (F.P.d.C.); (E.F.d.S.); (M.H.D.C.); (R.d.S.); (M.d.N.d.S.d.A.V.); (F.B.B.R.); (M.d.M.L.); (C.B.d.S.); (M.T.F.M.d.B.); (A.L.S.d.S.)
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará, Belem 66000-000, Brazil; (M.K.d.S.T.); (I.M.V.C.V.); (M.A.F.Q.); (A.C.R.V.)
- Graduate Program in Clinical Analysis, Federal University of Pará, Belem 66000-000, Brazil
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da Costa Miranda AL, da Paixão ART, Pedroso AO, do Espírito Santo Lima L, Parente AT, Botelho EP, Polaro SHI, de Oliveira E Silva AC, Reis RK, Ferreira GRON. Demographic, social, and clinical aspects associated with access to COVID-19 health care in Pará province, Brazilian Amazon. Sci Rep 2024; 14:8776. [PMID: 38627601 PMCID: PMC11021420 DOI: 10.1038/s41598-024-59461-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
Internal social disparities in the Brazilian Amazon became more evident during the COVID-19 pandemic. The aim of this work was to examine the demographic, social and clinical factors associated with access to COVID-19 health care in Pará Province in the Brazilian Amazon. This was an observational, cross-sectional, analytical study using a quantitative method through an online survey conducted from May to August 2023. People were eligible to participate if they were current residents of Pará, 18-years-old or older, with self-reported diagnoses of COVID-19 through rapid or laboratory tests. Participants completed an electronic survey was developed using Research Electronic Data Capture (REDCap) software-The adapted questionnaire "COVID-19 Global Clinical Platform: Case Report Form for Post-COVID Condition". Questions focused on access to COVID-19 treatment, demographic characteristics, COVID-19 vaccine and clinical characteristics. Respondent-driven sampling was applied to recruit participants. Multiple logistic regression was utilized to identify the associated factors. Overall, a total of 638 participants were included. The average age was 31.1 years. Access to COVID-19 health care was 68.65% (438/638). The participants most likely to access health care were those with moderate or severe COVID-19 (p = 0.000; OR: 19.8) and females (p = 0.001; OR: 1.99). Moreover, participants who used homemade tea or herbal medicines were less likely to receive health care for COVID-19 in health services (p = 0.002; OR: 0.54). Ensuring access to healthcare is important in a pandemic scenario.
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Grants
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program – Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
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Affiliation(s)
| | | | - Andrey Oeiras Pedroso
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 14040-092, Brasil
| | | | | | - Eliã Pinheiro Botelho
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal Do Pará, Belém, 66075-110, Brasil
| | | | | | - Renata Karina Reis
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 14040-092, Brasil
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Contreras M, Gomes Naveca F, Carvajal-Cortes JJ, Faviero GF, Saavedra J, Ruback dos Santos E, Alves do Nascimento V, Costa de Souza V, Oliveira do Nascimento F, Silva e Silva D, Luz SLB, Romero Vesga KN, Grisales Nieto JC, Avelino-Silva VI, Benzaken AS. Implementing a provisional overarching intervention for COVID-19 monitoring and control in the Brazil-Colombia-Peru frontier. Front Public Health 2024; 11:1330347. [PMID: 38259793 PMCID: PMC10801231 DOI: 10.3389/fpubh.2023.1330347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction he challenge was to provide comprehensive health resources to a remote and underserved population living in the Brazil-Colombia-Peru border, amid the most disruptive global crisis of the century. Methods In August 2021, Fundação Oswaldo Cruz Amazonia (FIOCRUZ Amazônia) and partner collaborators implemented an overarching provisional program for SARS-CoV-2 detection and lineages characterization, training of laboratory personnel and healthcare providers, donation of diagnostic supplies and personal protective equipment, and COVID-19 vaccination. The expedition was conducted at the Port of Tabatinga, a busy terminal with an intense flux of people arriving and departing in boats of all sizes, located in the Amazon River basin. Local government, non-profit organizations, private companies, and other stakeholders supported the intervention. Results The expedition was accomplished in a convergence point, where migrant workers, traders, army personnel, people living in urban areas, and people from small villages living in riversides and indigenous territories are in close and frequent contact, with widespread cross-border movement. Using a boat as a provisional lab and storage facility, the intervention provided clinical and laboratory monitoring for 891 participants; vaccination for 536 individuals; personal protective equipment for 200 healthcare providers; diagnostic supplies for 1,000 COVID-19 rapid tests; training for 42 community health agents on personal protection, rapid test execution, and pulse oximeter management; and hands-on training for four lab technicians on molecular diagnosis. Discussion Our experience demonstrates that multilateral initiatives can counterweigh the scarcity of health resources in underserved regions. Moreover, provisional programs can have a long-lasting effect if investments are also provided for local capacity building.
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Affiliation(s)
- Matilde Contreras
- Instituto Leônidas and Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
| | | | | | - Guilherme F. Faviero
- AHF Global Public Health Institute at the University of Miami, Miami, FL, United States
| | - Jorge Saavedra
- AHF Global Public Health Institute, Fort Lauderdale, FL, United States
| | | | | | | | | | | | | | | | | | - Vivian I. Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- AIDS Healthcare Foundation, Los Angeles, CA, United States
| | - Adele Schwartz Benzaken
- Instituto Leônidas and Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
- AIDS Healthcare Foundation, Los Angeles, CA, United States
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D'Carmo Sodré MM, Dos Santos UR, Povoas HP, Guzmán JL, Junqueira C, Trindade TO, Gadelha SR, Romano CC, da Conceição AO, Gross E, Silva A, Rezende RP, Fontana R, da Mata CPSM, Marin LJ, de Carvalho LD. Relationship between clinical-epidemiological parameters and outcomes of patients with COVID-19 admitted to the intensive care unit: a report from a Brazilian hospital. Front Public Health 2023; 11:1241444. [PMID: 37808991 PMCID: PMC10556466 DOI: 10.3389/fpubh.2023.1241444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
Background People in low-income countries, especially those with low socio-economic conditions, are likelier to test positive for SARS-CoV-2. The unequal conditions of public health systems also increase the infection rate and make early identification and treatment of at-risk patients difficult. Here, we aimed to characterize the epidemiological profile of COVID-19 patients in intensive care and identify laboratory and clinical markers associated with death. Materials and methods We conducted an observational, descriptive, and cross-sectional study in a reference hospital for COVID-19 treatment in the Southern Region of Bahia State, in Brazil, to evaluate the epidemiological, clinical, and laboratory characteristics of COVID-19 patients admitted to the intensive care unit (ICU). Additionally, we used the area under the curve (AUC) to classify survivors and non-survivors and a multivariate logistic regression analysis to assess factors associated with death. Data was collected from the hospital databases between April 2020 and July 2021. Results The use of bladder catheters (OR 79.30; p < 0.0001) and central venous catheters (OR, 45.12; p < 0.0001) were the main factors associated with death in ICU COVID-19 patients. Additionally, the number of non-survivors increased with age (p < 0.0001) and prolonged ICU stay (p < 0.0001). Besides, SAPS3 presents a higher sensibility (77.9%) and specificity (63.1%) to discriminate between survivors and non-survivor with an AUC of 0.79 (p < 0.0001). Conclusion We suggest that multi-laboratory parameters can predict patient prognosis and guide healthcare teams toward more assertive clinical management, better resource allocation, and improved survival of COVID-19 patients admitted to the ICU.
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Affiliation(s)
| | | | | | | | - Caroline Junqueira
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | | | - Sandra Rocha Gadelha
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, Bahia, Brazil
| | - Carla Cristina Romano
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, Bahia, Brazil
| | | | - Eduardo Gross
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, Bahia, Brazil
| | - Aline Silva
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, Bahia, Brazil
| | - Rachel Passos Rezende
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, Bahia, Brazil
| | - Renato Fontana
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, Bahia, Brazil
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Dantas-Silva A, Santiago SM, Surita FG. Racism as a Social Determinant of Health in Brazil in the COVID-19 Pandemic and Beyond. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:221-224. [PMID: 37339640 PMCID: PMC10281767 DOI: 10.1055/s-0043-1770135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
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Pereira FAC, Filho FMHS, de Azevedo AR, de Oliveira GL, Flores-Ortiz R, Valencia LIO, Rodrigues MS, Ramos PIP, da Silva NB, de Oliveira JF. Profile of COVID-19 in Brazil-risk factors and socioeconomic vulnerability associated with disease outcome: retrospective analysis of population-based registers. BMJ Glob Health 2022; 7:bmjgh-2022-009489. [PMID: 36517111 PMCID: PMC9755904 DOI: 10.1136/bmjgh-2022-009489] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/23/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To classify the most up-to-date factors associated with COVID-19 disease outcomes in Brazil. DESIGN Retrospective study. SETTING Nationwide Brazilian COVID-19 healthcare registers. PARTICIPANTS We used healthcare data of individuals diagnosed with mild/moderate (n=70 056 602) or severe (n=2801 380) COVID-19 disease in Brazil between 26 February 2020 and 15 November 2021. MAIN OUTCOME MEASURES Risk of hospitalisation and mortality affected by demographic, clinical and socioeconomic variables were estimated. The impacts of socioeconomic inequalities on vaccination rates, cases and deaths were also evaluated. RESULTS 15.6 million SARS-CoV-2 infection cases and 584 761 COVID-19-related deaths occurred in Brazil between 26 February 2020 and 15 November 2021. Overall, men presented a higher odds of death than women (OR=1.14, 95% CI 1.13 to 1.15), but postpartum patients admitted to hospital wards were at increased odds of dying (OR=1.23, 95% CI 1.13 to 1.34) compared with individuals without reported comorbidities. Death in younger age groups was notably higher in most deprived municipalities and also among individuals <40 years belonging to indigenous backgrounds compared with white patients, as shown by descriptive analysis. Ethnic/racial backgrounds exhibited a continuum of decreasing survival chances of mixed-race (OR=1.11, 95% CI 1.10 to 1.12), black (OR=1.34, 95% CI 1.32 to 1.36) and indigenous (OR=1.42, 95% CI 1.31 to 1.54) individuals, while those in most deprived municipalities also presented an increased odds of death (OR=1.38, 95% CI 1.36 to 1.40). Deprivation levels also affect the prompt referral of patients to adequate care. Our results show that the odds of death of individuals hospitalised for less than 4 days is more than double that of patients with close-to-average hospital stays (OR=2.07, 95% CI 2.05 to 2.10). Finally, negative vaccination status also increased the odds of dying from the disease (OR=1.29, 95% CI 1.28 to 1.31). CONCLUSIONS The data provide evidence that the patterns of COVID-19 mortality in Brazil are influenced by both individual-level health and social risk factors, as well as municipality-level deprivation. In addition, these data suggest that there may be inequalities in the timely provision of appropriate healthcare that are related to municipality-level deprivation.
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Affiliation(s)
- Felipe A C Pereira
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Fábio M H S Filho
- Rondônia Oswaldo Cruz Foundatio, Oswaldo Cruz Foundation, Porto Velho, Rondônia, Brazil
| | - Arthur R de Azevedo
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Guilherme L de Oliveira
- Federal Center for Technological Education of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Renzo Flores-Ortiz
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Luis Iván O Valencia
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Moreno S Rodrigues
- Rondônia Oswaldo Cruz Foundatio, Oswaldo Cruz Foundation, Porto Velho, Rondônia, Brazil
| | - Pablo Ivan P Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Nívea B da Silva
- Department of Statistics, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Juliane Fonseca de Oliveira
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Bahia, Brazil,Center of Mathematics of University of Porto (CMUP), University of Porto, Porto, Portugal
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