scholarly journals COVID-19 healthcare demand and mortality in Sweden in response to non-pharmaceutical mitigation and suppression scenarios

2020 ◽  
Vol 49 (5) ◽  
pp. 1443-1453 ◽  
Author(s):  
Henrik Sjödin ◽  
Anders F Johansson ◽  
Åke Brännström ◽  
Zia Farooq ◽  
Hedi Katre Kriit ◽  
...  
Keyword(s):  
Intensive Care ◽  
Excess Mortality ◽  
Compartmental Model ◽  
Health Care Demand ◽  
Radiation Model ◽  
The Usa ◽  
Community Transmission ◽  
Health Demands ◽  
Health Demand ◽  
The Impact

Abstract Background While the COVID-19 outbreak in China now appears suppressed, Europe and the USA have become the epicentres, both reporting many more deaths than China. Responding to the pandemic, Sweden has taken a different approach aiming to mitigate, not suppress, community transmission, by using physical distancing without lockdowns. Here we contrast the consequences of different responses to COVID-19 within Sweden, the resulting demand for care, intensive care, the death tolls and the associated direct healthcare related costs. Methods We used an age-stratified health-care demand extended SEIR (susceptible, exposed, infectious, recovered) compartmental model for all municipalities in Sweden, and a radiation model for describing inter-municipality mobility. The model was calibrated against data from municipalities in the Stockholm healthcare region. Results Our scenario with moderate to strong physical distancing describes well the observed health demand and deaths in Sweden up to the end of May 2020. In this scenario, the intensive care unit (ICU) demand reaches the pre-pandemic maximum capacity just above 500 beds. In the counterfactual scenario, the ICU demand is estimated to reach ∼20 times higher than the pre-pandemic ICU capacity. The different scenarios show quite different death tolls up to 1 September, ranging from 5000 to 41 000, excluding deaths potentially caused by ICU shortage. Additionally, our statistical analysis of all causes excess mortality indicates that the number of deaths attributable to COVID-19 could be increased by 40% (95% confidence interval: 0.24, 0.57). Conclusion The results of this study highlight the impact of different combinations of non-pharmaceutical interventions, especially moderate physical distancing in combination with more effective isolation of infectious individuals, on reducing deaths, health demands and lowering healthcare costs. In less effective mitigation scenarios, the demand on ICU beds would rapidly exceed capacity, showing the tight interconnection between the healthcare demand and physical distancing in the society. These findings have relevance for Swedish policy and response to the COVID-19 pandemic and illustrate the importance of maintaining the level of physical distancing for a longer period beyond the study period to suppress or mitigate the impacts from the pandemic.

scholarly journals The Impact of Chronic Kidney Disease on Outcomes of Patients with COVID-19 Admitted to the Intensive Care Unit

Nephron ◽  
2021 ◽  
pp. 1-5
Author(s):  
Maureen Brogan ◽  
Michael J. Ross
Keyword(s):  
Chronic Kidney Disease ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Kidney Disease ◽  
Altered Mental Status ◽  
Multicenter Cohort Study ◽  
Icu Admission ◽  
Increased Risk ◽  
The Usa ◽  
The Impact

<b><i>Context:</i></b> Coronavirus disease 2019 (COVID-19) disproportionately impacts patients with chronic kidney disease (CKD), especially those with kidney failure requiring replacement therapy (KFRT). Patients with KFRT have increased risk of developing COVID-19, and though initial reports suggested that mortality of these patients in the intensive care unit (ICU) setting is prohibitively high, those studies suffered from significant limitations. <b><i>Subject of Review:</i></b> The Study of the Treatment and Outcomes in Critically Ill Patients With COVID-19 (STOP-COVID) is a multicenter cohort study that enrolled adults with COVID-19 admitted to ICUs in 68 medical centers across the USA. STOP-COVID investigators compared characteristics at the time of ICU admission and clinical outcomes in 143 patients with KFRT, 521 with nondialysis-dependent CKD (ND-CKD), and 3,600 patients without CKD. Patients with KFRT were less likely to have typical COVID-19 symptoms but more likely to have altered mental status at the time of ICU admission and were less likely to require mechanical ventilation during hospitalization than those without kidney disease. Approximately, 50% of patients with KFRT and ND-CKD died within 28 days of ICU admission, and in fully adjusted models, patients with KFRT and ND-CKD had 1.41- and 1.25-fold higher risk of 28-day mortality than those without CKD. Patients with KFRT and ND-CKD were also less likely to receive emerging therapies for COVID-19 than those without CKD. <b><i>Second Opinion:</i></b> This study provides important new data demonstrating differences in clinical presentation in patients with KFRT and ND-CKD with COVID-19. Alhough patients with severe CKD had higher mortality than those without CKD, approximately half survived after 28 days, demonstrating that patients with COVID-19 and severe CKD can benefit from ICU care. The markedly lower use of emerging COVID-19 treatments in patients with severe CKD highlights the need to include these patients in clinical trials of new COVID-19 therapies and for clinicians to ensure equal access to care in patients with severe CKD and COVID-19.

The ‘Modernisation’ of Scotland and its Impact on Glasgow, 1955–1979: ‘Unwanted Side Effects’ and Vulnerabilities

2016 ◽  
Vol 25 (3) ◽  
pp. 294-316 ◽  
Author(s):  
Chik Collins ◽  
Ian Levitt
Keyword(s):  
Side Effects ◽  
Government Policy ◽  
Regional Policy ◽  
Excess Mortality ◽  
Policy Agenda ◽  
Policy Makers ◽  
Uk Government ◽  
1960S And 1970S ◽  
The 1960S ◽  
The Impact

This article reports findings of research into the far-reaching plan to ‘modernise’ the Scottish economy, which emerged from the mid-late 1950s and was formally adopted by government in the early 1960s. It shows the growing awareness amongst policy-makers from the mid-1960s as to the profoundly deleterious effects the implementation of the plan was having on Glasgow. By 1971 these effects were understood to be substantial with likely severe consequences for the future. Nonetheless, there was no proportionate adjustment to the regional policy which was creating these understood ‘unwanted’ outcomes, even when such was proposed by the Secretary of State for Scotland. After presenting these findings, the paper offers some consideration as to their relevance to the task of accounting for Glasgow's ‘excess mortality’. It is suggested that regional policy can be seen to have contributed to the accumulation of ‘vulnerabilities’, particularly in Glasgow but also more widely in Scotland, during the 1960s and 1970s, and that the impact of the post-1979 UK government policy agenda on these vulnerabilities is likely to have been salient in the increase in ‘excess mortality’ evident in subsequent years.

SCENARIOS FOR AN EXPANDING DEMAND OF TOURISM ON THE COASTS OF CUBA

2017 ◽  
Author(s):  
Oscar Gutiérrez-Bolívar ◽  
Oscar Gutiérrez-Bolívar ◽  
Pedro Fernández Carrasco ◽  
Pedro Fernández Carrasco
Keyword(s):  
United States ◽  
The Other ◽  
Sudden Increase ◽  
Tourist Destination ◽  
Other Hand ◽  
The Usa ◽  
The Impact

The opening of relationships between United States and Cuba could be a drive for a huge increase in the affluence of tourism to Cuba and especially to the coast areas. Cuba has been for many years an important tourist destination for people from many countries, but almost forbidden for US citizens. The proximity of the USA, its amount of population as well as their great acquisition power will increase in a very substantial way the demand for accommodation and other uses in the proximity of the coasts. There will be a need to implement a package of measures that reduce the impact of such sudden increase in the coastal line. On the other hand that augment in tourism could be an opportunity to improve the standard of life of Cubans. The consideration of different possibilities of such development, the analysis of the damages that each one could cause as well as the measures that could avoid, ameliorate or compensate such effects are the goals that are going to be presented in this paper.

Socio-Technological Aspects of Automation in Public Works Activities

1987 ◽  
Vol 19 (3-4) ◽  
pp. 633-643
Author(s):  
William F. Garber
Keyword(s):  
Industrial Revolution ◽  
Work Force ◽  
Public Works ◽  
Human Society ◽  
Training Problem ◽  
Total Employment ◽  
The Usa ◽  
History Of ◽  
Complete Automation ◽  
The Impact

The history of human society is replete with examples of advances in technology overrunning the ability of societal organizations to efficiently handle the resulting massive societal dislocations. The social impacts of the “Industrial Revolution of the 18th and 19th Centuries” illustrate how profound such effects can be. The automation-computer-robotics revolution now underway also has the potential for serious societal changes. In this regard public works activities are subject to increasing amounts of automation with impacts upon current and net total employment and training needs. To evaluate the present status of automation in the USA, questionnaires were sent to public works authorities in 110 cities or agencies. The current degree of automation, the impact upon employment and the skills now needed by public works employers were queried. It was found that in most cases automation was just starting; but that as complete automation as was possible was inevitable given the increasing complexity of the tasks, the demands of the public and the long term prospects for public works funding. In many cases the candidates now in the work force were not properly trained for automation needs. Retraining and changes in the educational system appeared necessary if the employees now needed were to be continuously available. Public works management as well as several labor organizations appeared to be aware of this need and were organizing to handle the training problem and the changes in employment qualifications now necessary. It appeared to be a consensus that the larger societal effects of automation should be handled by society as a whole.

scholarly journals Crisis Management in Higher Education in the Time of Covid-19: The Case of Actor Training

2021 ◽  
Vol 11 (3) ◽  
pp. 132
Author(s):  
Anna McNamara
Keyword(s):  
Higher Education ◽  
Crisis Management ◽  
High Frequency ◽  
High Reliability ◽  
Actor Training ◽  
Management Actions ◽  
The Usa ◽  
The Uk ◽  
The Impact ◽  
High Frequency Words

The impact of Covid-19 placed Higher Education leadership in a state of crisis management, where decision making had to be swift and impactful. This research draws on ethea of mindfulness, actor training techniques, referencing high-reliability organisations (HRO). Interviews conducted by the author with three leaders of actor training conservatoires in Higher Education institutions in Australia, the UK and the USA reflect on crisis management actions taken in response to the impact of Covid-19 on their sector, from which high-frequency words are identified and grouped thematically. Reflecting on these high-frequency words and the thematic grouping, a model of mindful leadership is proposed as a positive tool that may enable those in leadership to recognise and respond efficiently to wider structural frailties within Higher Education, with reference to the capacity of leaders to operate with increased mindfulness, enabling a more resilient organisation that unlocks the locus of control.

scholarly journals Comprehensive Overview of Sleep Disorders in Patients with Chronic Liver Disease

2021 ◽  
Vol 11 (2) ◽  
pp. 142
Author(s):  
Oana-Mihaela Plotogea ◽  
Madalina Ilie ◽  
Simona Bungau ◽  
Alexandru Laurentiu Chiotoroiu ◽  
Ana Maria Alexandra Stanescu ◽  
...  
Keyword(s):  
Sleep Disorders ◽  
Daily Practice ◽  
Chronic Liver ◽  
Asian Countries ◽  
Chronic Liver Diseases ◽  
Comprehensive Overview ◽  
The Usa ◽  
The Impact ◽  
Reliable Methods

The impact of sleep disorders (SDs) on patients with chronic liver diseases (CLD) is tremendous. SDs are frequently encountered among these patients and interfere with their quality of life. This review aims to present the data available so far about the prevalence, phenotypes, and proposed pathophysiological mechanisms of SDs in CLD. Moreover, we proposed to search the literature regarding the most reliable methods to assess SDs and the possible therapeutic options in patients with CLD. The main results of this review show that when it comes to prevalence, the percentages reported vary widely between studies performed among populations from the USA or Europe and those coming from Asian countries. Furthermore, it has been proven that SDs may also be present in the absence of neurocognitive disorders attributable to hepatic encephalopathy (HE), which contradicts traditional suppositions where SDs were considered part of the clinical scenario of HE. Currently, there are no specific recommendations or protocols to assess SDs in CLD patients and data about the therapeutic management are limited. Taking into consideration their impact, a protocol for diagnosing and managing SDs should be developed and included in the daily practice of hepatologists.

Sign in / Sign up

Export Citation Format

Share Document