scholarly journals COVID-19 among the inhabitants of the slums in the city of Buenos Aires: a population-based study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e044592
Author(s):  
Alejandro Macchia ◽  
Daniel Ferrante ◽  
Gabriel Battistella ◽  
Javier Mariani ◽  
Fernán González Bernaldo de Quirós

ObjectiveTo summarise the unfolding of the COVID-19 epidemic among slum dwellers and different social strata in the city of Buenos Aires during the first 20 weeks after the first reported case.DesignObservational study using a time-series analysis. Natural experiment in a big city.SettingPopulation of the city of Buenos Aires and the integrated health reporting system records of positive RT-PCR for COVID-19 tests.ParticipantsRecords from the Argentine Integrated Health Reporting System for all persons with suspected and RT-PCR-confirmed diagnosis of COVID-19 between 31 January and 14 July 2020.OutcomesTo estimate the effects of living in a slum on the standardised incidence rate of COVID-19, corrected Poisson regression models were used. Additionally, the impact of socioeconomic status was performed using an ecological analysis at the community level.ResultsA total of 114 052 people were tested for symptoms related with COVID-19. Of these, 39 039 (34.2%) were RT-PCR positive. The incidence rates for COVID-19 towards the end of the 20th week were 160 (155 to 165) per 100 000 people among the inhabitants who did not reside in the slums (n=2 841 997) and 708 (674 to 642) among slums dwellers (n=233 749). Compared with the better-off socioeconomic quintile (1.00), there was a linear gradient on incidence rates: 1.36 (1.25 to 1.46), 1.61 (1.49 to 1.74), 1.86 (1.72 to 2.01), 2.94 (2.74 to 3.16) from Q2 to Q5, respectively. Slum dwellers were associated with an incidence rate of 14.3 (13.4 to 15.4).ConclusionsThe distribution of the epidemic is socially conditioned. Slum dwellers are at a much higher risk than the rest of the community. Slum dwellers should not be considered just another risk category but an entirely different reality that requires policies tailored to their needs.

Author(s):  
Milou Ohm ◽  
Susan J M Hahné ◽  
Arie van der Ende ◽  
Elizabeth A M Sanders ◽  
Guy A M Berbers ◽  
...  

Abstract Background In response to the recent serogroup W invasive meningococcal disease (IMD-W) epidemic in the Netherlands, meningococcal serogroup C (MenC) conjugate vaccination for 14-month-olds was replaced with a MenACWY conjugate vaccination, and a mass campaign targeting 14-18 year-olds was executed. We investigated the impact of MenACWY vaccination implementation in 2018-2020 on incidence rates and estimated vaccine effectiveness (VE). Methods We extracted all IMD cases diagnosed between July 2014 and December 2020 from the national surveillance system. We calculated age group-specific incidence rate ratios by comparing incidence rates before (July 2017-March 2018) and after (July 2019-March 2020) MenACWY vaccination implementation. We estimated VE in vaccine-eligible cases using the screening method. Results Overall, IMD-W incidence rate lowered by 61% (95%CI 40-74). It declined by 82% (95%CI 18-96) in vaccine-eligible age group (15-36 month-olds and 14-18 year-olds) and by 57% (95%CI 34-72) in vaccine non-eligible age groups. VE was 92% (95%CI -20-99.5) against IMD-W vaccine-eligible toddlers. No IMD-W cases were reported in vaccine-eligible teenagers after the campaign. Conclusions The MenACWY vaccination programme was effective in preventing IMD-W in the target population. The IMD-W incidence reduction in vaccine non-eligible age groups may be caused by indirect effects of the vaccination programme. However, disentangling natural fluctuation from vaccine-effect was not possible. Our findings encourage the use of toddler- and teenager MenACWY vaccination in national immunization programmes especially when implemented together with a teenager mass campaign during an epidemic.


2007 ◽  
Vol 15 (spe) ◽  
pp. 762-767 ◽  
Author(s):  
Maria de Lourdes Sperli Geraldes Santos ◽  
Silvia Helena Figueiredo Vendramini ◽  
Claudia Eli Gazetta ◽  
Sonia Aparecida Cruz Oliveira ◽  
Tereza Cristina Scatena Villa

This study aimed to evaluate the epidemiological status of Tuberculosis regarding to the socioeconomic characteristics of São José do Rio Preto between 1998 and 2004. Indexes estimated for 432 urban census tracts from the demographic census of 2000, sorted systematically according to the values of socioeconomic factors and grouped into quartiles were taken into account. The socioeconomic characterization was outlined based on Schooling, Income, and Number of Residents. The incidence rates were considered for 1998, 1999, 2003, and 2004. The socioeconomic factor accounted for 87% of the total variation. The disease prevalence is higher in the poorest areas. The incidence rate and the risk of being infected by TB in the poorest areas declined in 2003 and 2004. The results confirm that TB is determined by the population's living conditions in the city studied. It strengthens the relevance of understanding the TB conditional social factors to transform the worrisome scenario in which this population is inserted.


2021 ◽  
Author(s):  
Arjun Puranik ◽  
AJ Venkatakrishnan ◽  
Colin Pawlowski ◽  
Bharathwaj Raghunathan ◽  
Eshwan Ramudu ◽  
...  

Real world evidence studies of mass vaccination across health systems have reaffirmed the safety1 and efficacy2,3 of the FDA-authorized mRNA vaccines for COVID-19. However, the impact of vaccination on community transmission remains to be characterized. Here, we compare the cumulative county-level vaccination rates with the corresponding COVID-19 incidence rates among 87 million individuals from 580 counties in the United States, including 12 million individuals who have received at least one vaccine dose. We find that cumulative county-level vaccination rate through March 1, 2021 is significantly associated with a concomitant decline in COVID-19 incidence (Spearman correlation ρ = −0.22, p-value = 8.3e-8), with stronger negative correlations in the Midwestern counties (ρ = −0.37, p-value = 1.3e-7) and Southern counties (ρ = −0.33, p-value = 4.5e-5) studied. Additionally, all examined US regions demonstrate significant negative correlations between cumulative COVID-19 incidence rate prior to the vaccine rollout and the decline in the COVID-19 incidence rate between December 1, 2020 and March 1, 2021, with the US western region being particularly striking (ρ = −0.66, p-value = 5.3e-37). However, the cumulative vaccination rate and cumulative incidence rate are noted to be statistically independent variables, emphasizing the need to continue the ongoing vaccination roll out at scale. Given confounders such as different coronavirus restrictions and mask mandates, varying population densities, and distinct levels of diagnostic testing and vaccine availabilities across US counties, we are advancing a public health resource to amplify transparency in vaccine efficacy monitoring (https://public.nferx.com/covid-monitor-lab/vaccinationcheck). Application of this resource highlights outliers like Dimmit county (Texas), where infection rates have increased significantly despite higher vaccination rates, ostensibly owing to amplified travel as a “vaccination hub”; as well as Henry county (Ohio) which encountered shipping delays leading to postponement of the vaccine clinics. This study underscores the importance of tying the ongoing vaccine rollout to a real-time monitor of spatio-temporal vaccine efficacy to help turn the tide of the COVID-19 pandemic.


2005 ◽  
Vol 20 (3) ◽  
pp. 423 ◽  
Author(s):  
Pedro Pírez

El presente artículo se refiere a la ausencia de respuesta institucional en Argentina, como consecuencia de la falta de reconocimiento de la ciudad como objeto real de gobierno. Se entiende que lo metropolitano es el resultado de la intersección de una dimensión urbano territorial (crecimiento y expansión de la ciudad) y otra político territorial (la organización territorial del estado).La configuración metropolitana, desde que se iniciaron los procesos de expansión propios de la industrialización sustitutiva de importaciones hasta que se resintió el impacto de la reestructuración y la globalización, ha transformado el territorio acentuando las diferencias y las desigualdades, las fragmentaciones y las zonas excluyentes que pese a todo se complementan.Esas desigualdades se concretan en tres contradicciones fundamentales; la primera entre el ámbito territorial de los problemas y el relativo al gobierno y a la gestión local; la segunda entre el ámbito territorial de las necesidades y el de la representación política; y la última entre el ámbito territorial de las necesidades y el de los recursos. Tales contradicciones en tanto no son resueltas tienden a configurar desigualdades que se polarizan territorialmente.La cuestión metropolitana se convierte en un asunto de gobernabilidad como falta de orientación o conducción gubernamental, que deriva en problemas metropolitanos como la “ilimitada” expansión urbana, las desiguales condiciones de la calidad de vida urbana y de la seguridad ciudadana, la distribución no equitativa de los recursos financieros, la mala gestión de los servicios, las dificultades para la gestión ambiental, y la falta de un ejercicio democrático que legitime las decisiones que afectan el ámbito metropolitano.Frente a esos problemas existen alternativas institucionales que, desde la fragmentación hasta la consolidación, intentan una gobernabilidad metropolitana. No todas esas formas tienen conexión con las condiciones reales del Área Metropolitana de Buenos Aires. Su complejidad político institucional y su peso (demográfico, económico y político) en el contexto nacional, relativizan una posible solución hacia la consolidación. Frente a esas dificultades, procesos de centralización estatal y de transferencia de decisiones al mercado caracterizan la gestión urbana en esa Área Metropolitana, fortaleciendo sus contradicciones y dificultando la gobernabilidad. AbstractThis article concerns to the lack of institutional response in Argentina, as a result of the failure to recognize the city as the real object of government. Metropolitan affairs are understood to be the result of the intersection between a territorial urban dimension (growth and expansion of the city) and a territorial, political dimension (the territorial organization of the state).From the time when the processes of expansion characteristic of import- substitution industrialization began until the impact of restructuring and globalization was felt, the metropolitan configuration has transformed the territory by accentuating differences and inequalities, fragmentation and the exclusive zones which, nonetheless complement each other. These inequalities are expressed in three fundamental contradictions: the first between the territorial sphere of problems and that of government and local management, the second between the territorial sphere of needs and that of political representation and the last between the territorial sphere of needs and that of resources. As long as these contradictions remain unresolved, they tend to configure inequalities that become territorially polarized.The metropolitan issue becomes a matter of governance in the sense of the lack of government orientation or management, which leads to metropolitan problems such as “unlimited” urban expansion, unequal conditions as regards the quality of urban life and safety on the streets, the unfair distribution of financial resources, poor administra­tion of services, difficulties in environmental management and the lack of a democratic exercise legitimizing the decisions that affect the metropolitan environment.In order to deal with these problems, institutional alternatives have been created which, from fragmentation to consolidation, attempt metropolitan governance. Not all these methods, however, are linked to the actual conditions of the Buenos Aires Metro­politan Zone. Its institutional and political complexity and its demographic, economic and political importance within the national context limit possible solutions to consolida­tion. Given these difficulties, processes of state centralization and the transferal of decisions to the market characterize urban management in this metropolitan area, reinforcing its contradictions and hindering governance.


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Garlasco ◽  
M C Ottino ◽  
E Rainero ◽  
A Argentero ◽  
C M Zotti

Abstract Background Needlestick injuries represent a major occupational hazard for healthcare workers as they lead to exposure to biological fluids, with higher risk of bloodborne pathogen infections. In order to minimise this risk, safety-engineered devices (SEDs) have been developed and introduced into the daily hospital practice. An annual survey, conducted by the Department of Public Health Sciences of the University of Turin since 1999, has been evaluating the number of percutaneous accidents in the hospitals of Piedmont (Italy), assessing also the impact of the introduction of SEDs on the injury incidence rate. The aim of this study is therefore to evaluate the efficacy of SEDs in preventing needlestick injuries. Methods Data about percutaneous injuries and needle consumption were obtained from 42 hospitals of Piedmont for the years 2014-2017, concerning all the types of needles and sharps most commonly used in the departments. After considering the overall trend of percutaneous events, standardised rates for 100000 needles were computed for both SEDs and conventional devices. The same analysis was performed considering all sharps except standard needles, which are mainly used for procedures not involving contact with patients (e.g. drug dilution). Results The comparison between the incidence rates with SEDs and conventional devices showed a slightly protective effect of SEDs in 2014, 2016 and 2017, with an incidence rate ratio ranging from 0.78 to 0.97. However, by removing the confounding effect of standard needles, the analysis yielded strong statistical evidence of the protective effect of SEDs for all years (RR = 0.28-0.63). Moreover, the total number of percutaneous events shows a trend of general decrease. Conclusions Safety devices have proved to be significantly effective in the prevention of needlestick injuries, and their introduction into the daily practice is one of the factors who could contribute to a reduction of percutaneous events. Key messages Safety-engineered devices are a very important tool in the prevention of injuries in healthcare workers, and their introduction into hospital practice has reduced the number of percutaneous injuries. Safety-engineered devices are significantly protective against percutaneous injuries compared to conventional ones, especially for procedures involving contact with patients (therefore at high risk).


2017 ◽  
Vol 77 (5) ◽  
pp. 684-689 ◽  
Author(s):  
René Lindholm Cordtz ◽  
Samuel Hawley ◽  
Daniel Prieto-Alhambra ◽  
Pil Højgaard ◽  
Kristian Zobbe ◽  
...  

ObjectivesTo study the impact of the introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) and associated rheumatoid arthritis (RA) management guidelines on the incidence of total hip (THR) and knee replacements (TKR) in Denmark.MethodsNationwide register-based cohort and interrupted time-series analysis. Patients with incident RA between 1996 and 2011 were identified in the Danish National Patient Register. Patients with RA were matched on age, sex and municipality with up to 10 general population comparators (GPCs). Standardised 5-year incidence rates of THR and TKR per 1000 person-years were calculated for patients with RA and GPCs in 6-month periods. Levels and trends in the pre-bDMARD (1996–2001) were compared with the bDMARD era (2003–2016) using segmented linear regression interrupted by a 1-year lag period (2002).ResultsWe identified 30 404 patients with incident RA and 297 916 GPCs. In 1996, the incidence rate of THR and TKR was 8.72 and 5.87, respectively, among patients with RA, and 2.89 and 0.42 in GPCs. From 1996 to 2016, the incidence rate of THR decreased among patients with RA, but increased among GPCs. Among patients with RA, the incidence rate of TKR increased from 1996 to 2001, but started to decrease from 2003 and throughout the bDMARD era. The incidence of TKR increased among GPCs from 1996 to 2016.ConclusionWe report that the incidence rate of THR and TKR was 3-fold and 14-fold higher, respectively among patients with RA compared with GPCs in 1996. In patients with RA, introduction of bDMARDs was associated with a decreasing incidence rate of TKR, whereas the incidence of THR had started to decrease before bDMARD introduction.


2020 ◽  
Vol 42 (4) ◽  
pp. 698-703 ◽  
Author(s):  
Jose Miguel Baena-Díez ◽  
María Barroso ◽  
Sara Isabel Cordeiro-Coelho ◽  
Jorge L Díaz ◽  
María Grau

Abstract Background The impact of the 2019 coronavirus disease (COVID-19) has many facets. This ecological study analysed age-standardized incidence rates by economic level in Barcelona. Methods We evaluated confirmed cases of COVID-19 in Barcelona (Spain) between 26 February 2020 and 19 April 2020. Districts were classified according to most recent (2017) mean income data. The reference for estimating age-standardized cumulative incidence rates was the 2018 European population. The association between incidence rate and mean income by district was estimated with the Spearman rho. Results The lower the mean income, the higher the COVID-19 incidence (Spearman rho = 0.83; P value = 0.003). Districts with the lowest mean income had the highest incidence of COVID-19 per 10 000 inhabitants; in contrast, those with the highest income had the lowest incidence. Specifically, the district with the lowest income had 2.5 times greater incidence of the disease, compared with the highest-income district [70 (95% confidence interval 66–73) versus 28 (25–31), respectively]. Conclusions The incidence of COVID-19 showed an inverse socioeconomic gradient by mean income in the 10 districts of the city of Barcelona. Beyond healthcare for people with the disease, attention must focus on a health strategy for the whole population, particularly in the most deprived areas.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Z M Yaqub ◽  
T S G Sehested ◽  
A N Bonde ◽  
J B Olesen ◽  
C Torp-Pedersen ◽  
...  

Abstract Introduction The incidence rate of atrial fibrillation (AF) has increased substantially throughout the last decades. Socioeconomic factors such as income and education are well known to be associated with the development of cardiovascular disease, however, the impact on long-term trends of AF incidence rates is yet to be described. Purpose This nationwide cohort study examined the temporal trends of AF incidence rates over a span of 30 years (from 1987 to 2016) in Denmark. Furthermore, the impact of income and education was outlined. Method Patients were identified through linkage across Danish national registries from 1987 to 2016. We extracted data on the total number of inhabitants in Denmark aged ≥18 years, and used their age, sex, civil status, income and educational level for each calendar year. Data on socio economics were available from 1994. Income was defined by the average income over the prior 5 years and grouped into low (<q1),>Q3). Educational level was divided into primary school, high school, bachelor's degree, or master's degree. We defined incident AF as all first-time in- and outpatient diagnoses of AF. The incidence rates of AF were age-standardized per 1000 person-years for each calendar year and calculated for men and women separately. Results A total of 6,968,997 Danish inhabitants aged ≥18 years contributed to the study population from 1987 to 2016, and 393,183 (6%) developed AF over the study period. The age-standardized incidence rates of AF per 1000 person-years increased from 1.23 (CI 1.15:1.30) to 4.05 (CI 3.93:4.17) for men and from 1.13 (CI 1.06:1.30) to 3.56 (CI 3.44:3.68) for women from 1987 to 2016. Income status and educational level influenced the age-standardized incidence rates more significantly in women than men. The incidence rate from 1994 to 2016 for women with low income increased by a factor of 2.1 from 2.0 (CI 1.89:2.21) to 4.36 (CI 4.03:4.73). However, the high income group increased by a factor of 1.6 (from 1.74 (CI 1.10:3.32) to 2.83 (CI 2.29:3.55) per 1000 person-years). Moreover, the incidence rate for women with low educational level increased from 1.60 (CI 0.95:5.97) to 4.01 (CI 3.80:4.23) per 1000 person-years. The high educational group increased only by 1.2 (from 2.55 (CI 0.77:10.38) to 3.1 (CI 3.32:4.11) per 1000 person-years). Conclusion In a nationwide population, the incidence rate of AF continued to increase during a 30-year period. All socioeconomic subgroups experienced an increase in AF incidence, but the impact of low socioeconomic status was more significant among women than among men. The progressive growth in AF incidence has significant public health implications. Acknowledgement/Funding Danish Heart Foundation


Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 659
Author(s):  
Luca Coppeta ◽  
Ottavia Balbi ◽  
Zaira Grattagliano ◽  
Grazia Genga Mina ◽  
Antonio Pietroiusti ◽  
...  

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than one hundred million people since the beginning of the worldwide pandemic. In this study, data from a large hospital in central Italy was used to evaluate the impact of the first dose of the BNT162b2 mRNA vaccine on SARS-CoV-2 infections in terms of the prevalence of symptomatic cases, symptom duration, and viral clearance timing. All vaccinated Healthcare Workers (HCWs) with positive RT-PCR by nasopharyngeal (NP) swabs were divided into two cohorts (positive RT-PCR within day 12 and positive RT-PCR between day 13 and day 21 after first dose administration) and compared for the presence and duration of symptoms and the timing of viral clearance. The same variables were evaluated across HCWs with positive RT-PCR within 6 days after first dose administration and non-vaccinated HCWs with positive RT-PCR between 1 October 2020 and 28 February 2021. Eighteen HCWs tested positive on RT-PCR by NP swab from day 1 to day 12 after the 1st dose administration (incidence rate 6.2 × 10−4) and 5 HCWs from day 13 to day 21 (incidence rate 2.3 × 10−4). Symptom duration and viral clearance timing are significantly shorter in the cohort of HCWs with positive RT-PCR 12 days after the first dose of the BNT162b2 mRNA vaccine. The administration of the first dose proved effective in reducing presence, symptom duration, and viral clearance even in HCWs vaccinated for less than 6 days. These results could have implications on public health and post-exposure prophylaxis.


Author(s):  
Lysien I. Zambrano ◽  
Walter O. Vasquez-Bonilla ◽  
Itzel Carolina Fuentes-Barahona ◽  
José Cláudio da Silva ◽  
Jorge Alberto Valle-Reconco ◽  
...  

Background: Zika virus (ZIKV) infection has affected significantly Latin America in 2015–2017. However, most studies have been reported from Brazil and Colombia, but few of them in Central America. For these reasons we analyzed the incidence, incidence rates and evolution of cases of Honduras during 2016–2017. Methods: Using epidemiological weeks (EW) surveillance data on the ZIKV epidemics in Honduras, we estimated incidence rates (cases/100,000 population), and developed maps at national, departments and municipal levels. Results: From January 1, 2016 to December 31, 2017, a total of 32,607 cases of Zika were reported (98.5% in 2016 for an incidence rate of 36.85 cases/100,000 pop; 1% confirmed by RT-PCR). The highest peak was reached on the EW 6°, 2016 (2,559 cases; 29.34 cases/100,000 pop). The department with the highest number of cases and incidence rate was Cortés (13,128 cases, 791.08 cases/100,000 pop in 2016). Discussion: Pattern and evolution of Zika in Honduras has been like those that occurred for chikungunya in 2015, that we analyzed and previously reported, affecting predominantly the central and capital area of the country, reaching also high incidences there >750 cases/100,000 pop. Studies using geographical information systems, to map its epidemiology, as well on the clinical aspects linked to, are necessary in this country, as well for the assessment of risk for travelers who visit specific areas in a destination country.


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