Country-level determinants of the severity of the first global wave of the COVID-19 pandemic: an ecological study

ObjectiveWe aimed to identify the country-level determinants of the severity of the first wave of the COVID-19 pandemic.DesignEcological study of publicly available data. Countries reporting >25 COVID-19 related deaths until 8 June 2020 were included. The outcome was log mean mortality rate from COVID-19, an estimate of the country-level daily increase in reported deaths during the ascending phase of the epidemic curve. Potential determinants assessed were most recently published demographic parameters (population and population density, percentage population living in urban areas, population >65 years, average body mass index and smoking prevalence); economic parameters (gross domestic product per capita); environmental parameters (pollution levels and mean temperature (January–May); comorbidities (prevalence of diabetes, hypertension and cancer); health system parameters (WHO Health Index and hospital beds per 10 000 population); international arrivals; the stringency index, as a measure of country-level response to COVID-19; BCG vaccination coverage; UV radiation exposure; and testing capacity. Multivariable linear regression was used to analyse the data.Primary outcomeCountry-level mean mortality rate: the mean slope of the COVID-19 mortality curve during its ascending phase.ParticipantsThirty-seven countries were included: Algeria, Argentina, Austria, Belgium, Brazil, Canada, Chile, Colombia, the Dominican Republic, Ecuador, Egypt, Finland, France, Germany, Hungary, India, Indonesia, Ireland, Italy, Japan, Mexico, the Netherlands, Peru, the Philippines, Poland, Portugal, Romania, the Russian Federation, Saudi Arabia, South Africa, Spain, Sweden, Switzerland, Turkey, Ukraine, the UK and the USA.ResultsOf all country-level determinants included in the multivariable model, total number of international arrivals (beta 0.033 (95% CI 0.012 to 0.054)) and BCG vaccination coverage (−0.018 (95% CI −0.034 to –0.002)), were significantly associated with the natural logarithm of the mean death rate.ConclusionsInternational travel was directly associated with the mortality slope and thus potentially the spread of COVID-19. Very early restrictions on international travel should be considered to control COVID-19 outbreaks and prevent related deaths.

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Country-level Determinants of the Severity of the First Global Wave of the COVID-19 Pandemic: An Ecological Study

10.1101/2020.05.13.20100677 ◽

2020 ◽

Cited By ~ 1

Author(s):

Tiberiu A Pana ◽

Sohinee Bhattacharya ◽

David T Gamble ◽

Zahra Pasdar ◽

Weronika A Szlachetka ◽

...

Keyword(s):

Mortality Rate ◽

Study Design ◽

Vaccination Coverage ◽

Death Rate ◽

Ecological Study ◽

The Philippines ◽

International Travel ◽

Bcg Vaccination ◽

Country Level ◽

The Mean

ABSTRACTObjectiveWe aimed to identify the country-level determinants of the severity of the first wave of the COVID-19 pandemic.DesignAn ecological study design of publicly available data was employed. Countries reporting >25 COVID-related deaths until 08/06/2020 were included. The outcome was log mean mortality rate from COVID-19, an estimate of the country-level daily increase in reported deaths during the ascending phase of the epidemic curve. Potential determinants assessed were most recently published demographic parameters (population and population density, percentage population living in urban areas, median age, average body mass index, smoking prevalence), Economic parameters (Gross Domestic Product per capita); environmental parameters: pollution levels, mean temperature (January-May)), co-morbidities (prevalence of diabetes, hypertension and cancer), health system parameters (WHO Health Index and hospital beds per 10,000 population); international arrivals, the stringency index, as a measure of country-level response to COVID-19, BCG vaccination coverage, UV radiation exposure and testing capacity. Multivariable linear regression was used to analyse the data.Primary OutcomeCountry-level mean mortality rate: the mean slope of the COVID-19 mortality curve during its ascending phase.ParticipantsThirty-seven countries were included: Algeria, Argentina, Austria, Belgium, Brazil, Canada, Chile, Colombia, the Dominican Republic, Ecuador, Egypt, Finland, France, Germany, Hungary, India, Indonesia, Ireland, Italy, Japan, Mexico, the Netherlands, Peru, the Philippines, Poland, Portugal, Romania, the Russian Federation, Saudi Arabia, South Africa, Spain, Sweden, Switzerland, Turkey, Ukraine, the United Kingdom and the United States.ResultsOf all country-level predictors included in the multivariable model, total number of international arrivals (beta 0.033 (95% Confidence Interval 0.012,0.054)) and BCG vaccination coverage (−0.018 (−0.034,-0.002)), were significantly associated with the mean death rate.ConclusionsInternational travel was directly associated with the mortality slope and thus potentially the spread of COVID-19. Very early restrictions on international travel should be considered to control COVID outbreak and prevent related deaths.ARTICLE SUMMARYStrengths and limitationsA comparable and relevant outcome variable quantifying country-level increases in the COVID-19 death rate was derived which is largely independent of different testing policies adopted by each countryOur multivariable regression models accounted for public health and economic measures which were adopted by each country in response to the COVID-19 pandemic by adjusting for the Stringency IndexThe main limitation of the study stems from the ecological study design which does not allow for conclusions to be drawn for individual COVID-19 patientsOnly countries that had reported at least 25 daily deaths over the analysed period were included, which reduced our sample and consequently the power.

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Determinants of BCG vaccination coverage in Ethiopia: a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2018-023634 ◽

2019 ◽

Vol 9 (2) ◽

pp. e023634 ◽

Cited By ~ 3

Author(s):

Asmamaw Ketemaw Tsehay ◽

Getasew Tadesse Worku ◽

Yihun Mulugeta Alemu

Keyword(s):

Vaccination Coverage ◽

Rural Areas ◽

Urban Areas ◽

Wealth Index ◽

Outcome Variable ◽

Antenatal Visit ◽

Sampling Frame ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Bcg Vaccination

ObjectiveThe objective of this study is to assess the determinants of BCG vaccination in Ethiopia from 2016 Ethiopia Demographic and Health Survey (EDHS).SettingSince Ethiopia has nine regional states and two administrative cities, sample was taken from all the divisions. The population-based sample was intended to provide estimates of key indicators for the country.ParticipantThe sampling frame used for the 2016 EDHS is the Ethiopia Population and Housing Census. From 15 683 women recorded in EDHS dataset, women with no child (n=10 379) were excluded from the study. Therefore, the total sample size for this study was 5304 women. The outcome variable was BCG immunisation status of children.ResultOut of the study participants (n=5304), the majority were in between 20 and 34 years of age (73.8%). The median age of the respondents was 28.4 (SD=±6.5) years old. Prevalence of BCG vaccination was 63.6% (n=3373) and BCG vaccination coverage in urban residents was higher (88%) than rural residents (57.3%). Mothers’ age between 20 up to 34 (Adjusted odds ratio (AOR)=1.48; 95% CI: 1.13 to 1.93) and between 35 up to 49 (AOR=1.83; 95% CI: 1.35 to 2.46) were more likely to vaccinate their child’s than those mothers’ age less than 20. Mothers settled in urban areas were two times more likely to vaccinate their child’s than those living in rural areas (AOR=1.94; 95% CI: 1.45 to 2.60). Mothers with greater antenatal visits show higher BCG vaccination, Antenatal Care (ANC) 4 and above (AOR=3.48; 95% CI: 2.91 to 4.15). BCG vaccination is higher for mothers delivered at non-governmental organisation health facility than home (AOR=2.9; 95% CI: 1.69 to 4.96). Maternal occupation and wealth index also had a significant association with BCG vaccination.ConclusionBCG vaccination coverage, in this study, was lower and determinant factors for BCG vaccination were residence, mother’s age, place of delivery, mother’s antenatal visit, wealth index and mother’s occupation.

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Deaths of Irish Civilians Abroad: Analysis of National Mortality Data, 2016-2018

International Journal of Travel Medicine and Global Health ◽

10.15171/ijtmgh.2018.27 ◽

2018 ◽

Vol 6 (4) ◽

pp. 149-153 ◽

Cited By ~ 1

Author(s):

Milad Darrat ◽

Gerard T. Flaherty

Keyword(s):

Causes Of Death ◽

Healthcare Professionals ◽

International Travel ◽

Foreign Affairs ◽

Mortality Data ◽

Medical Interventions ◽

Country Level ◽

Age Related ◽

National Mortality ◽

The Mean

Introduction: International travel is increasing, yet few studies have reported on country-level death rates among international travelers. The data regarding the death profiles of overseas Irish travelers are insufficient. The current study examined data obtained from the Irish Department of Foreign Affairs and Trade to profile these deaths. Methods: Data on Irish civilian citizen deaths occurring abroad were obtained from the Consular Division of the Irish Department of Foreign Affairs and Trade and analyzed based on age, gender, time of death, travel destination, and recorded cause of death. Results: Between January 2016 and April 2018, the Consular Division received 654 reports of Irish civilians dying abroad, of which 72% (n=469) were males and 23% (n=149) were females; in 6% (n=36) the sex was not recorded. The mean age at death was 58 ±5 years old (range from 1 to 110, median 62 years). Recorded causes of death were illness (25%; n=162), traumatic deaths including homicides and suicides (24%; n=151), and natural (age-related) (3%; n=19); the rest were classified as unidentified cause (47%; n=309). The majority of deaths (63%; n=309) occurred in European destinations followed by Asia (16%; n=102) and the Americas (12%; n=75). Conclusion: At least 25% of Irish deaths abroad can be considered preventable. More tailored pre-travel medical interventions may prevent further deaths. In the collection of data, consular services miss the opportunity to acquire valuable information for both travelers and healthcare professionals. The authors recommend the creation of a comprehensive database of international traveler deaths.

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The global dynamics of stochastic Holling type II predator-prey models with non constant mortality rate

Filomat ◽

10.2298/fil1718811z ◽

2017 ◽

Vol 31 (18) ◽

pp. 5811-5825

Author(s):

Xinhong Zhang

Keyword(s):

Mortality Rate ◽

Stochastic Model ◽

Sufficient Conditions ◽

Positive Periodic Solution ◽

Global Dynamics ◽

Type Ii ◽

Predator Prey ◽

Persistence In The Mean ◽

The Mean ◽

Predator Prey Models

In this paper we study the global dynamics of stochastic predator-prey models with non constant mortality rate and Holling type II response. Concretely, we establish sufficient conditions for the extinction and persistence in the mean of autonomous stochastic model and obtain a critical value between them. Then by constructing appropriate Lyapunov functions, we prove that there is a nontrivial positive periodic solution to the non-autonomous stochastic model. Finally, numerical examples are introduced to illustrate the results developed.

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COVID-19 Infection and Previous BCG Vaccination Coverage in the Ecuadorian Population

Vaccines ◽

10.3390/vaccines9020091 ◽

2021 ◽

Vol 9 (2) ◽

pp. 91

Author(s):

Daniel Garzon-Chavez ◽

Jackson Rivas-Condo ◽

Adriana Echeverria ◽

Jhoanna Mozo ◽

Emmanuelle Quentin ◽

...

Keyword(s):

Vaccination Coverage ◽

Vaccine Coverage ◽

National Level ◽

Kendall Test ◽

Amino Acid Sequences ◽

Bcg Vaccination ◽

High Prevalence ◽

Health Organization ◽

Low Coverage ◽

Homologous Amino Acid

The Bacillus Calmette–Guérin (BCG) is a well-known vaccine with almost a century of use, with the apparent capability to improve cytokine production and epigenetics changes that could develop a better response to pathogens. It has been postulated that BCG protection against SARS-CoV-2 has a potential role in the pandemic, through the presence of homologous amino acid sequences. To identify a possible link between BCG vaccination coverage and COVID-19 cases, we used official epidemic data and Ecuadorian Ministry of Health and Pan American Health Organization vaccination information. BCG information before 1979 was available only at a national level. Therefore, projections based on the last 20 years were performed, to compare by specific geographic units. We used a Mann–Kendall test to identify BCG coverage variations, and mapping was conducted with a free geographic information system (QGIS). Nine provinces where BCG vaccine coverage was lower than 74.25% show a significant statistical association (χ2 Pearson’s = 4.800, df = 1, p = 0.028), with a higher prevalence of cases for people aged 50 to 64 years than in younger people aged 20 to 49 years. Despite the availability of BCG vaccination data and the mathematical models needed to compare these data with COVID-19 cases, our results show that, in geographic areas where BCG coverage was low, 50% presented a high prevalence of COVID-19 cases that were young; thus, low-coverage years were more affected.

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Early mortality in hip fracture patients admitted during first wave of the COVID-19 pandemic in Northern Italy: a multicentre study

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00577-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Dante Dallari ◽

Luigi Zagra ◽

Pietro Cimatti ◽

Nicola Guindani ◽

Rocco D’Apolito ◽

...

Keyword(s):

Hip Fracture ◽

Mortality Rate ◽

Multicentre Study ◽

Proximal Femur ◽

Femur Fracture ◽

Northern Italy ◽

Proximal Femur Fracture ◽

Time To Surgery ◽

Fracture Management ◽

The Mean

Abstract Background Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1 month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1 month on the basis of type of fracture and type of surgical treatment. Materials and methods For this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+ group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C− group) were asymptomatic and tested negative for SARS-CoV-2. The two groups were compared for differences in time to surgery, survival rate and complications rate. The follow-up period was 1 month. Results Of the 1390 patients admitted for acute care for any reason, 477 had a proximal femur fracture; 53 were C+ but only 12/53 were diagnosed as such at admission. The mean age was > 80 years, and the mean American Society of Anesthesiologists (ASA) score was 3 in both groups. There was no substantial difference in time to surgery (on average, 2.3 days for the C+ group and 2.8 for the C− group). As expected, a higher mortality rate was recorded for the C+ group but not associated with the type of hip fracture or treatment. No correlation was found between early treatment (< 48 h to surgery) and better outcome in the C+ group. Conclusions Hip fracture in COVID-19-positive patients accounted for 11% of the total. On average, the time to surgery was > 48 h, which reflects the difficulty of maintaining normal workflow during a medical emergency such as the present pandemic and notwithstanding the suspension of non-urgent procedures. Hip fracture was associated with a higher 30-day mortality rate in COVID-19-positive patients than in COVID-19-negative patients. This fact should be considered when communicating with patients and/or their family. Our data suggest no substantial difference in hip fracture management between patients with or without COVID-19 infection. In this sample, the COVID-19-positive patients were generally asymptomatic at admission; therefore, routine screening is recommended. Level of evidence Therapeutic study, level 4.

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Salt intake and blood pressure in Iranian children and adolescents: a population-based study

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01876-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mohammad Hassan Emamian ◽

Hossein Ebrahimi ◽

Hassan Hashemi ◽

Akbar Fotouhi

Keyword(s):

Blood Pressure ◽

Rural Areas ◽

Urban Areas ◽

Salt Intake ◽

Daily Intake ◽

Population Based ◽

World Health ◽

Second Phase ◽

Salt Consumption ◽

The Mean

Abstract Background Previous studies have reported a high prevalence of hypertension in Iranian students, especially in rural areas. The aim of this study was to investigate the daily intake of salt in students and its association with high blood pressure. Methods A random sub-sample was selected from the participants of the second phase of Shahroud schoolchildren eye cohort study and then a random urine sample was tested for sodium, potassium and creatinine. Urine electrolyte esexcretion and daily salt intake were calculated by Tanaka et al.’s formula. Results Among 1455 participants (including 230 participants from rural area and 472 girls), the mean age was 12.9 ± 1.7 year and the mean daily salt intake was 9.7 ± 2.6 g (95% CI 9.5–9.8). The mean salt consumption in rural areas [10.8 (95% CI 10.4–11.2)] was higher than urban areas [9.4 (95% CI 9.3–9.6)], in people with hypertension [10.8 (95% CI 10.3–11.3)] was more than people with normal blood pressure [9.4 (95% CI 9.3–9.6)], and in boys [9.8 (95% CI 9.7–10.0)] was more than girls [9.3 (95% CI 9.1–9.6)]. Higher age, BMI z-score, male sex and rural life, were associated with increased daily salt intake. Increased salt intake was associated with increased systolic and diastolic blood pressure. Conclusion Daily salt intake in Iranian adolescents was about 2 times the recommended amount of the World Health Organization, was higher in rural areas and was associated with blood pressure. Reducing salt intake should be considered as an important intervention, especially in rural areas.

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Asynchrony of Gambierdiscus spp. Abundance and Toxicity in the U.S. Virgin Islands: Implications for Monitoring and Management of Ciguatera

Toxins ◽

10.3390/toxins13060413 ◽

2021 ◽

Vol 13 (6) ◽

pp. 413

Author(s):

Justin D. Liefer ◽

Mindy L. Richlen ◽

Tyler B. Smith ◽

Jennifer L. DeBose ◽

Yixiao Xu ◽

...

Keyword(s):

Harmful Algal Blooms ◽

Algal Blooms ◽

Environmental Parameters ◽

Virgin Islands ◽

Coastal Communities ◽

Trophic Levels ◽

Us Virgin Islands ◽

Benthic Dinoflagellates ◽

The Mean ◽

The U.S

Ciguatera poisoning (CP) poses a significant threat to ecosystem services and fishery resources in coastal communities. The CP-causative ciguatoxins (CTXs) are produced by benthic dinoflagellates including Gambierdiscus and Fukuyoa spp., and enter reef food webs via grazing on macroalgal substrates. In this study, we report on a 3-year monthly time series in St. Thomas, US Virgin Islands where Gambierdiscus spp. abundance and Caribbean-CTX toxicity in benthic samples were compared to key environmental factors, including temperature, salinity, nutrients, benthic cover, and physical data. We found that peak Gambierdiscus abundance occurred in summer while CTX-specific toxicity peaked in cooler months (Feb–May) when the mean water temperatures were approximately 26–28 °C. These trends were most evident at deeper offshore sites where macroalgal cover was highest year-round. Other environmental parameters were not correlated with the CTX variability observed over time. The asynchrony between Gambierdiscus spp. abundance and toxicity reflects potential differences in toxin cell quotas among Gambierdiscus species with concomitant variability in their abundances throughout the year. These results have significant implications for monitoring and management of benthic harmful algal blooms and highlights potential seasonal and highly-localized pulses in reef toxin loads that may be transferred to higher trophic levels.

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A hospital-based study on clinical data, demographic data and visual function of keratoconus patients in Central China

Scientific Reports ◽

10.1038/s41598-021-87291-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kaili Yang ◽

Liyan Xu ◽

Qi Fan ◽

Yuwei Gu ◽

Bo Zhang ◽

...

Keyword(s):

Clinical Data ◽

Rural Areas ◽

Visual Function ◽

Urban Areas ◽

Demographic Data ◽

Corneal Thickness ◽

Positive Family History ◽

Education Level ◽

Central China ◽

The Mean

AbstractChina is a populous country but lacks epidemiological data on keratoconus (KC). The present study aimed to investigate the clinical data, demographic data, and visual function (VF) data of KC patients in Central China. A total of 524 KC eyes in 307 KC patients (217 bilateral and 90 unilateral) from Henan Eye Hospital were included in the current study. Demographic and VF data were assessed with questionnaires administered by well-trained staff during face-to-face interviews. Visual acuity value was examined by a qualified optometrist, and the clinical data were measured by professional clinicians. The distributions of sex, residence and education level of KC patients were compared by Chi-square tests, and the ratios of people wearing glasses and rigid gas permeable (RGP) lenses were compared by McNemar tests. General linear models/Chi-squared tests were used to compare the clinical and demographic data according to KC severity. Spearman’s correlation analysis was used to test the associations between the data and KC severity. The mean age at diagnosis was 20.98 ± 6.06 years, and males had a higher ratio of KC than females (P < 0.001). Patients in rural areas had a higher rate of KC than those in urban areas (P = 0.039), and the proportion of KC patients with a higher education level (above high school) was high (P < 0.001). A total of 68.40% of the patients reported eye rubbing and 3.52% had a positive family history. The percentage of people wearing glasses was higher than that of patients wearing RGP lenses (P < 0.001). The total VF score of KC patients was 69.35 ± 15.25. The thinnest corneal thickness (TCT) and stiffness parameter at the first applanation (SP-A1) values were inversely correlated with KC severity (P < 0.05). The mean, steep, and max keratometry (Km, Ks and Kmax) values, the RGP lens use and keratoplasty were positively correlated with KC severity (all P < 0.05). The total VF score of the eye with better VA decreased as the severity increased (r = − 0.21, P = 0.002). The present study comprehensively describes various associated features of KC patients from a tertiary hospital in Central China, providing a reference for understanding the characteristics of KC patients in China.

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Vaccination Coverage for Routine Vaccines and Herd Immunity Levels against Measles and Pertussis in the World in 2019

Vaccines ◽

10.3390/vaccines9030256 ◽

2021 ◽

Vol 9 (3) ◽

pp. 256

Author(s):

Pedro Plans-Rubió

Keyword(s):

Vaccination Coverage ◽

Action Plan ◽

Herd Immunity ◽

World Health ◽

Immunization Programs ◽

National Immunization ◽

The World ◽

Measles Vaccination ◽

The Mean ◽

Health Organization

In 2012, the World Health Organization (WHO) established the Global Vaccine Action Plan with the objective to promote essential vaccinations in all countries and achieve at least 90% vaccination coverage for all routine vaccines by 2020. The study assessed the mean percentages of vaccination coverage in 2019 for 13 routine vaccines, vaccination coverage variation from 2015 to 2019, and herd immunity levels against measles and pertussis in 2019 in countries and regions of WHO. In 2019, the mean percentages of vaccination coverage were lower than 90% for 10 (78.9%) routine vaccines. The mean percentages of vaccination coverage also decreased from 2015 to 2019 for six (46.2%) routine vaccines. The prevalence of individuals with vaccine-induced measles immunity in the target measles vaccination population was 88.1%, and the prevalence of individuals with vaccine-induced pertussis immunity in the target pertussis vaccination population was 81.1%. Herd immunity against measles viruses with Ro = 18 was established in 63 (32.5%) countries but not established in any region. Herd immunity against pertussis agents was not established in any country and in any region of WHO. National immunization programs must be improved to achieve ≥90% vaccination coverage in all countries and regions. Likewise, it is necessary to achieve ≥95% vaccination coverage with two doses of measles vaccines and three doses of pertussis vaccines in all countries and regions.

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