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Trends in Spatiotemporal Exposure to Air Pollutants and Adult Cardiovascular Emergency Room Visits in the Greater Pittsburgh, Pennsylvania, USA 美国宾夕法尼亚州大匹兹堡地区空气污染物时空暴露与成人心血管急诊室就诊趋势
Pub Date : 2022-12-30 DOI: 10.17140/epoj-7-128
Chunzhe Duan, R. Bilonick, Judith R. Rager, T. Xue, E. Talbott
Introduction The acute effects of air pollution and cardiovascular disease (CVD) have been studied, but very few studies have focused on spatiotemporally modeled exposure to air pollutants at the population level. This study aims to examine the short-term association of fine particulate matter (PM2.5), Ozone (O3), Nitrogen Dioxide (NO2) and Sulfur Dioxide (SO2) and CVD emergency room visits (ERV) in Allegheny County for a 13-year period using a case-crossover study design. Aim We sought to estimate the effects of acute exposure to these four pollutants adjusting for temperature on CVD ERV and to compare outcomes in 1999-2005 compared to 2006-2011. Methods Land-use regression was used to model the ground level exposures to PM2.5, O3, NO2 and SO2. CVD ER visits were requested from the local hospitals of the two health networks in Allegheny County, which operate the majority of the ER services. The discharge International Classification of Diseases-9 (ICD-9) codes were used to identify the CVD cases and CVD subgroups. We linked the Zone Improvement Plan (ZIP) code level air pollution data with the patients’ ZIP code (residence) to determine the individual level exposure estimation of both case days and control days. Conditional logistic regression with multi-pollutant and distributed lags of 0-3-days was applied to estimate the effect of acute exposure of these pollutants to CVD ER visits (ERV), adjusting for temperature. Results In the overall analyses, for every interquartile increase of O3 exposure (25.52 ppb), there was a 6.6% (95% CI: 0.8%-12.7%) increase in the odds of an acute myocardial infarction ERV. This was consistent across both time periods. Among women and Black ERV, we observed an association of PM2.5 with acute myocardial infarction, and with ischemic heart disease. Some of these associations persisted in the later years of the study period. The gaseous pollutants (NO2, SO2 and O3) were shown to increase risk of cardiovascular events in both time periods. Conclusion We found an association of PM2.5 and NO2 with CVD ER visits, and this association persisted in the stratified analyses, as well as in the later years with lower exposure levels. The findings suggest that further actions to reduce the pollution level in this area should be taken. Ozone and NO2 were related to increased risk for all CVD, ischemic heart disease (IHD) and acute myocardial infarction (AMI) underscoring the importance of gaseous pollutants and their effect on coronary heart disease (CHD) risk.
空气污染和心血管疾病(CVD)的急性效应已经得到了研究,但很少有研究集中在人口水平上模拟空气污染物的时空暴露。本研究旨在采用病例交叉研究设计,研究阿勒格尼县13年期间细颗粒物(PM2.5)、臭氧(O3)、二氧化氮(NO2)和二氧化硫(SO2)与心血管疾病急诊室就诊(ERV)的短期关系。我们试图估计急性暴露于这四种污染物调整温度对CVD ERV的影响,并比较1999-2005年与2006-2011年的结果。方法采用土地利用回归模型对PM2.5、O3、NO2和SO2的地表暴露进行模拟。阿勒格尼县两个保健网络的当地医院要求进行心血管疾病急诊检查,这两个保健网络提供大部分急诊服务。采用出院国际疾病分类-9 (ICD-9)代码对CVD病例和CVD亚组进行识别。我们将区域改善计划(ZIP)编码水平的空气污染数据与患者的邮政编码(居住地)联系起来,以确定病例日和对照日的个人水平暴露估计。采用多污染物和分布滞后0-3天的条件logistic回归来估计这些污染物的急性暴露对CVD ER就诊(ERV)的影响,并调整温度。结果在总体分析中,O3暴露每增加四分位数(25.52 ppb),急性心肌梗死ERV的几率增加6.6% (95% CI: 0.8%-12.7%)。这在两个时期都是一致的。在女性和黑色ERV中,我们观察到PM2.5与急性心肌梗死和缺血性心脏病的关联。其中一些关联在研究后期仍然存在。气态污染物(NO2、SO2和O3)在两个时间段内都增加了心血管事件的风险。结论:我们发现PM2.5和NO2与心血管疾病ER就诊存在关联,这种关联在分层分析中持续存在,并且在较低暴露水平的晚年也存在。调查结果表明,应该采取进一步的措施来降低该地区的污染水平。臭氧和NO2与所有CVD、缺血性心脏病(IHD)和急性心肌梗死(AMI)的风险增加有关,强调了气态污染物的重要性及其对冠心病(CHD)风险的影响。
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引用次数: 0
Factors Affecting Access to E-Learning during the Coronavirus Disease 2019 Pandemic Among Rural-Based Pharmacy Students in Zambia: A Qualitative Study 在2019冠状病毒大流行期间影响赞比亚农村药学学生获得电子学习的因素:一项定性研究
Pub Date : 2021-10-21 DOI: 10.17140/epoj-6-124
Kennedy Mwila, S. Mudenda, M. Kampamba, W. Mufwambi, E. Lufungulo, M. Phiri, C. Hikaambo
Background The coronavirus disease 2019 (COVID-19) pandemic has negatively affected the education sector globally. This has resulted in learning institutions adopting e-learning techniques. E-learning implementation in higher education continues to gain prominence in both developed and developing countries. Most universities are exploring different ways of using information and communications technology (ICT). However, ICT remains a challenge more especially for students who come from rural areas. Aim This study was aimed at exploring the factors that affect access to e-learning among rural-based pharmacy students in Zambia. Methods A qualitative case study was conducted among ten (10) purposively sampled pharmacy students at the University of Zambia. The study participants were from the Manying, a district of North-Western Province, the Sinda district of Eastern Province, the Nalolo district of Western Province, the Chipili district of Luapula Province and the Mbala district of Northern Province. Semistructured interviews were used to collect data from the respondents. Data were analyzed using the framework analysis. The sociodemographic characteristics indicate that ten (10) respondents were drawn from Zambia’s five (5) provinces. Six qualitative themes were generated these included devices used for e-learning; the effectiveness of the devices; student performance; internet connectivity; and electrification of the houses. Key findings suggest that the most commonly used device was a smartphone, which posed challenges to effective learner participation in e-learning. Poor internet connectivity, non-electrification of students’ houses, electricity outages, and costs-associated with internet use negatively affected students in accessing online learning and could adversely affect their academic activities and performance. Conclusion The COVID-19 pandemic has negatively affected access to e-learning among rural pharmacy students in Zambia. The implications of the challenges faced by the rural pharmacy students are that their academic activities and performance were negatively affected. Therefore, this posed a threat to the rights to universal access to education of the rural students who were mostly venerable.
2019冠状病毒病(COVID-19)大流行给全球教育部门带来了负面影响。这导致了学习机构采用电子学习技术。高等教育中电子学习的实施在发达国家和发展中国家都日益突出。大多数大学都在探索使用信息通信技术(ICT)的不同方式。然而,信息通信技术仍然是一个挑战,特别是对于来自农村地区的学生。目的本研究旨在探讨影响赞比亚农村药学专业学生在线学习的因素。方法对10名赞比亚大学药学专业学生进行定性个案研究。研究参与者来自西北省的Manying区、东部省的Sinda区、西部省的Nalolo区、卢阿普拉省的Chipili区和北部省的Mbala区。采用半结构化访谈收集受访者的数据。数据采用框架分析法进行分析。社会人口特征表明,十(10)名受访者来自赞比亚的五(5)个省。产生了六个定性主题,包括用于电子学习的设备;器械的有效性;学生成绩;网络连接;还有房子的电气化。主要发现表明,最常用的设备是智能手机,这对学习者有效参与电子学习构成了挑战。互联网连通性差、学生房屋未通电、停电以及与互联网使用相关的成本对学生访问在线学习产生了负面影响,并可能对他们的学术活动和成绩产生不利影响。结论2019冠状病毒病疫情对赞比亚农村药学学生在线学习产生了负面影响。农村药学专业学生面临的挑战是其学业活动和成绩受到负面影响。因此,这对大多数受人尊敬的农村学生普遍接受教育的权利构成了威胁。
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引用次数: 5
A Review of the Antiviral Activity of Ivermectin and Its Use in the Treatment of Coronavirus Disease-2019 伊维菌素抗病毒活性及其在冠状病毒病-2019治疗中的应用综述
Pub Date : 2021-10-21 DOI: 10.17140/epoj-6-125
C. Hikaambo, M. Kampamba, F. Bwalya, Mutenje Mweemba, Chipo Siamutwe, W. Mufwambi, Tadious Chimombe, M. Banda, S. Mudenda
Background The coronavirus disease-2019 (COVID-19) originated in China and was declared a pandemic by the World Health Organization (WHO) on 11th March 2020. Since its emergence in December 2019, there have been challenges in developing drugs that are effective against the virus. Currently, COVID-19 is managed using symptomatic and supportive therapies, antiviral agents, cellular and immunotherapy. Besides, most of the treatment modalities are still under investigation and treatment guidelines vary from one country to another. Ivermectin is among the drugs that are being used as part of treatment guidelines in certain countries like the Republic of Peru. However, the WHO recommends that ivermectin only be used in clinical trials. Aim The authors conducted this review to explore published studies on the possible therapeutic effects of ivermectin against active infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a causative agent of COVID-19. Methods A literature search was conducted using Google Scholar, PubMed and EMBASE for articles published from 2016 to 2021. Search words used included ivermectin, antiviral, COVID-19, efficacy, safety, dosing, lower mortality rate, hospitalised patients and the Boolean operator ‘AND’. Results A few clinical trials have shown that ivermectin is safe for use in humans at specific doses and reduces the severity of the infection. Ivermectin was seen to reduce the signs and symptoms associated with COVID-19 in some studies while others showed no significant reduction. However, more studies must be conducted to ascertain its use in treating COVID-19. Conclusion Since many clinical trials are being conducted on the use of ivermectin to treat COVID-19, full evidence will be used to support its use in humans. Currently, some countries that are using ivermectin for treating COVID-19 have reported it to be effective and reduces morbidity and mortality associated with the disease. Therefore, countries should collaborate and provide full evidence for the use of ivermectin in humans to manage COVID-19.
2019冠状病毒病(COVID-19)起源于中国,于2020年3月11日被世界卫生组织宣布为大流行。自2019年12月出现以来,在开发有效对抗该病毒的药物方面一直存在挑战。目前,COVID-19的管理使用对症和支持性疗法、抗病毒药物、细胞和免疫疗法。此外,大多数治疗方式仍在调查中,治疗指南因国家而异。在秘鲁共和国等某些国家,伊维菌素是作为治疗指南一部分使用的药物之一。然而,世界卫生组织建议伊维菌素仅用于临床试验。目的对已发表的有关伊维菌素治疗COVID-19病原体SARS-CoV-2活动性感染的可能疗效的研究进行综述。方法采用Google Scholar、PubMed和EMBASE对2016 - 2021年发表的文献进行检索。搜索词包括伊维菌素、抗病毒药物、COVID-19、疗效、安全性、剂量、较低死亡率、住院患者和布尔运算符“and”。结果一些临床试验表明,伊维菌素在特定剂量下对人类使用是安全的,并可降低感染的严重程度。在一些研究中,伊维菌素可以减少与COVID-19相关的体征和症状,而其他研究则没有显着减少。然而,必须进行更多的研究以确定其在治疗COVID-19中的用途。由于正在就使用伊维菌素治疗COVID-19进行许多临床试验,因此将使用充分的证据来支持其在人类中的使用。目前,一些正在使用伊维菌素治疗COVID-19的国家报告说,伊维菌素有效,并降低了与该疾病相关的发病率和死亡率。因此,各国应开展合作,并为在人体内使用伊维菌素以管理COVID-19提供充分证据。
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引用次数: 1
Using MapMCDA Tool for the Spatial Epidemiology of Animal Rabies in Morocco: How to Improve the Rationality of a Qualitative Risk Assessment 利用MapMCDA工具分析摩洛哥动物狂犬病的空间流行病学:如何提高定性风险评估的合理性
Pub Date : 2021-10-21 DOI: 10.17140/epoj-6-123
M. Khayli, Mehdi Kechna, K. Zro, F. Kichou, Jaouad Berradae, M. Bouslikhane
Objective The objective behind this article is to better characterize spatial distribution of animal rabies in Morocco through qualitative risk assessment framework. In Morocco, the occurrence of the disease is neither clearly distributed nor complete. Therefore, risk assessment methods become strongly recommended to cope with distorted geographic patterns. Methods Based on data collection set from 168 counties, qualitative changes on spatial epidemiology of rabies were analysed by mapMCDA tool covering a period from 2004 to 2017 and including information on determinants of the geographic distribution of animal rabies in Morocco defined in previous work. Results To validate the risk assessment model, the results were compared to rabies cases reported during the study period. The clustering of the rabies risk estimates is decisive and highly reliable. A significant alignment was shown between the very high and high-risk estimates. Conclusion This study is the first attempt that has been made for using MapMCDA for rabies. For a normative process aiming to avoid subjectivity related to expert-opinions, authors suggest conducting initially a statistical multiple component analysis that will provide quantified estimates of risk factors. It would be an advisable decision-making tool that helps to design oriented surveillance and allows better referral of actions to control the disease.
本文的目的是通过定性风险评估框架更好地表征摩洛哥动物狂犬病的空间分布。在摩洛哥,该病的发生既不明确分布,也不完全。因此,强烈建议采用风险评估方法来应对扭曲的地理格局。方法基于来自168个县的数据收集集,利用mapMCDA工具分析2004 - 2017年期间摩洛哥狂犬病空间流行病学的质变,包括先前工作中定义的摩洛哥动物狂犬病地理分布决定因素信息。结果为验证风险评估模型,将结果与研究期间报告的狂犬病病例进行比较。狂犬病风险估计的聚类具有决定性和高可靠性。在非常高和高风险的估计之间显示出显著的一致性。结论本研究首次尝试将MapMCDA应用于狂犬病。对于旨在避免与专家意见相关的主观性的规范过程,作者建议首先进行统计多成分分析,以提供风险因素的量化估计。这将是一个明智的决策工具,有助于设计有针对性的监测,并允许更好地转诊控制疾病的行动。
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引用次数: 0
Nothing is Simple 没有什么是简单的
Pub Date : 2021-10-21 DOI: 10.17140/epoj-6-e002
Mark C. Wesson
The emergence of the coronavirus disease-2019 (COVID-19) pandemic has given an unrequested, rare, and prominent moment to the discipline of Epidemiology. The rigors and tools of epidemiology are critical in such situations, as public health threats progress from misunderstood or poorly understood to managed to possible eradication. Those trained well can hold the dual levers of scientific knowledge and public office at the same moment and steer societies from fear and suspicion when outbreaks occur to a sense of calm accomplishment and resumption of “life as normal.” In these moments epidemiology’s true influence over the last 200 years is evident. However, no force can act alone.
冠状病毒病-2019 (COVID-19)大流行的出现给流行病学学科带来了一个意想不到的、罕见的、突出的时刻。在这种情况下,流行病学的严谨性和工具至关重要,因为公共卫生威胁从被误解或理解不足到得到管理,再到可能根除。那些训练有素的人可以同时掌握科学知识和公职的双重杠杆,并在疫情发生时引导社会从恐惧和怀疑转向平静的成就感和恢复“正常生活”。在这些时刻,流行病学在过去200年的真正影响是显而易见的。然而,任何力量都不能单独行动。
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引用次数: 0
Strategies and Challenges in the Development of Coronavirus Disease-2019 Vaccine 冠状病毒病-2019疫苗研制的策略与挑战
Pub Date : 2021-10-21 DOI: 10.17140/epoj-6-122
Pratibha Gupta
The novel coronavirus infection (coronavirus disease-2019 (COVID-19)) emerged from Wuhan in the Hubei Province of China in late 2019. Millions of people were infected with COVID-19 pandemic due to the long incubation period of the virus inside the human body and the dearth of available treatments or vaccines. High transmission rates created havoc, which highlighted the urgent need for effective interventions to stop the spread and clinical impact of the virus on patients and populations. Previous research on severe acute respiratory syndrome coronavirus (SARS-CoV) provides information on vaccination strategies that could inform how governments approach the elimination of this novel coronavirus. Numerous efforts have been made to develop vaccines against Middle East respiratory syndrome (MERS) and SARS. The spike glycoprotein or S protein is the critical target for most of the drugs and vaccines against coronavirus. The virus uses the spike (S) protein for entering the host cell, by interacting with the receptor called angiotensin converting enzyme-2 (ACE2). Various vaccine platforms are available such as nucleic acid vaccine, protein-based vaccines, virus-vectored vaccines and live or attenuated vaccines, with each having their advantages and disadvantages. This review focuses on the overview of different vaccine candidates used, those currently in development, and the challenges encountered while developing effective vaccines.
新型冠状病毒感染(冠状病毒病-2019 (COVID-19))于2019年底在中国湖北省武汉市出现。由于病毒在人体内潜伏期长,缺乏可用的治疗或疫苗,数百万人感染了COVID-19大流行。高传播率造成了严重破坏,这突出表明迫切需要采取有效干预措施,以阻止病毒的传播和对患者和人群的临床影响。以前对严重急性呼吸综合征冠状病毒(SARS-CoV)的研究提供了有关疫苗接种策略的信息,可以为各国政府如何消除这种新型冠状病毒提供信息。为研制对抗中东呼吸综合征和非典型肺炎的疫苗作出了大量努力。刺突糖蛋白或S蛋白是大多数抗冠状病毒药物和疫苗的关键靶点。病毒利用刺突蛋白(S)进入宿主细胞,通过与受体血管紧张素转换酶-2 (ACE2)相互作用。核酸疫苗、蛋白疫苗、病毒载体疫苗、活疫苗或减毒疫苗等疫苗平台多种多样,各有优缺点。本综述的重点是概述使用的不同候选疫苗、目前正在开发的候选疫苗以及开发有效疫苗时遇到的挑战。
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引用次数: 0
The Potential of Amniotic Fluid-Derived Extracellular Vesicles to Treat Severe Acute Respiratory Syndrome Coronavirus 2 Infection Versus Hydroxychloroquine in Human Patients 羊水来源的细胞外囊泡与羟氯喹治疗人类严重急性呼吸综合征冠状病毒2型感染的潜力
Pub Date : 2020-12-31 DOI: 10.17140/EPOJ-5-118
Ian A. White
Recently a lot of attention has been focused on fast-tracking repurposed drugs for the treatment of a novel coronavirus; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent leading to the devastating coronavirus disease-2019 (Covid-19). One of the first and most well-known examples is hydroxychloroquine (HCQ), which has been used for years as a treatment for malaria, rheumatoid arthritis and lupus. HCQ was rolled out as a miracle treatment for Covid-19, which was inexpensive, effective and causing few side-effects. However, its effectiveness in treating Covid-19 has recently been questioned leaving doctors and patients confused and desperate. Here the proposed mechanisms of action of HCQ are discussed and compared with an inexpensive, safe and effective alternative, which is derived from natural, healthy amniotic fluid.
最近,很多注意力都集中在治疗新型冠状病毒的快速再利用药物上;严重急性呼吸综合征冠状病毒2 (SARS-CoV-2),是导致破坏性冠状病毒病2019 (Covid-19)的病原体。最早也是最著名的例子之一是羟氯喹(HCQ),多年来一直被用于治疗疟疾、类风湿性关节炎和狼疮。HCQ是一种治疗Covid-19的神奇疗法,价格便宜、有效、副作用小。然而,其治疗Covid-19的有效性最近受到质疑,这让医生和患者感到困惑和绝望。本文讨论了HCQ的作用机制,并与一种廉价、安全、有效的天然、健康羊水替代品进行了比较。
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引用次数: 1
Challenges Related to Antimalarial Abuse in Coronavirus Disease-2019 Treatment in the Democratic Republic of Congo 与冠状病毒病滥用抗疟疾药物相关的挑战-2019年在刚果民主共和国的治疗
Pub Date : 2020-12-31 DOI: 10.17140/EPOJ-5-121
Anselme Manyong, Ange Landela
Malaria is endemic to many African countries and geographies and remains the leading cause of morbidity and mortality on the continent. Ongoing efforts by health authorities to reverse the scale of malaria are often faced to the challenges of drug resistance often generated by therapeutic abuses relating to self-medication, sub-therapeutic under dosages and poor storage and handling of drugs throughout the pharmacy supply chain system.
疟疾是非洲许多国家和地区的地方病,仍然是非洲大陆发病和死亡的主要原因。卫生当局为扭转疟疾蔓延规模而正在进行的努力往往面临耐药性的挑战,耐药性往往是由于整个药房供应链系统中与自我药疗有关的治疗滥用、剂量不足以及药物储存和处理不当造成的。
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引用次数: 0
Review of the article on "The Rate of Underascertainment of Novel Coronavirus (2019-nCoV) Infection: Estimation Using Japanese Passergers Data On Evacuation Flights" 《新型冠状病毒(2019-nCoV)感染未确定率:利用日本疏散航班上的乘客数据估计》论文综述
Pub Date : 2020-12-31 DOI: 10.17140/EPOJ-5-120
E. Lin, San Pedro Ca Usa N W Capitol Drive
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引用次数: 0
Halting Coronavirus Replication 阻止冠状病毒复制
Pub Date : 2020-12-31 DOI: 10.17140/EPOJ-5-119
Kira Smith
Sirtuin 1 (SIRT1) inhibitors can reduce replication of many viruses with certain characteristics similar to those of coronaviruses, while the p53 protein is another important factor in the down-regulation of viral growth. Tenovin is a class of small molecules that inhibit Sirtuin 1 and 2, in addition to activating the p53 protein, by means of regulating the interactions used by coronaviruses as a self-defense mechanism. By blocking virus growth and continuous replication, with already tested antiviral medicines, the promise of coronavirus disease 2019 (COVID-19) eradication exists.
Sirtuin 1 (SIRT1)抑制剂可以减少许多具有与冠状病毒相似特征的病毒的复制,而p53蛋白是下调病毒生长的另一个重要因素。Tenovin是一类抑制Sirtuin 1和2的小分子,除了激活p53蛋白外,还通过调节冠状病毒使用的相互作用作为自卫机制。通过阻断病毒生长和持续复制,加上已经测试过的抗病毒药物,2019冠状病毒病(COVID-19)根除的希望是存在的。
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引用次数: 0
期刊
Open Journal of Epidemiology
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