2020-06-22/23 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: NM Highlights: Balloon Fiesta postponed. Robot to sanitize ABQ International Sunport. NMSU plan for fall 2020. NM public schools reopening plan. Fewer hospitalizations for COVID-19. NM case update. US Highlights: Visa restrictions. International Highlights: Second wave in South Korea. Epidemiology: Lockdown can suppress COVID-19. Case fatality rate associated with incidence. Predictors of ICU care and ventilators. Anxiety and depression from COVID-19. Asymptomatic patients as source of infection. Heterogeneous populations affect herd immunity. Healthcare Policy Recommendations: New FDA guidance on clinical trials conduct. Practice Guidelines: The guidelines are provided on COVID-19 diagnostics (Infectious Diseases Society of America), respiratory support for COVID-19 patients and optimizing mental care delivery during COVID-19 pandemic. Drugs, Vaccines, Therapies, Clinical Trials: Antithrombotic therapy systematic review. Drug repurposing. 58 new trials. Other Science: Safety of antihypertensives (ACEs and ARBs). Low testosterone linked to escalation of care. Neurological findings and hypercoagulability

Esophageal Cancer in Korea: Epidemiology and Treatment Patterns

According to statistics from 2017, esophageal cancer is the fifteenth most common cancer and the eleventh most common cause of cancer-related death in Korea. The most common pathology is esophageal squamous cell carcinoma. Moreover, the incidence of esophageal cancer has been gradually decreasing in Korea, and the percentage of early-stage cases has gradually increased to the point that it is higher than that of other countries. The 5-year relative survival rate has improved over time. Approximately 800 esophagectomy procedures are performed annually. Using a cut-off number of 21 cases per 2 years to define high-volume centers, it was found that 70% of esophagectomies were performed by a few high-volume centers. Unfortunately, there is no nationwide registry or database on esophageal cancer and esophagectomy in Korea. Efforts to establish a nationwide database on esophageal cancer and esophagectomy should be made.ope

Estimating daily nitrogen dioxide level: Exploring traffic effects

Data used to assess acute health effects from air pollution typically have good temporal but poor spatial resolution or the opposite. A modified longitudinal model was developed that sought to improve resolution in both domains by bringing together data from three sources to estimate daily levels of nitrogen dioxide ($\mathrm {NO}_2$) at a geographic location. Monthly $\mathrm {NO}_2$ measurements at 316 sites were made available by the Study of Traffic, Air quality and Respiratory health (STAR). Four US Environmental Protection Agency monitoring stations have hourly measurements of $\mathrm {NO}_2$. Finally, the Connecticut Department of Transportation provides data on traffic density on major roadways, a primary contributor to $\mathrm {NO}_2$ pollution. Inclusion of a traffic variable improved performance of the model, and it provides a method for estimating exposure at points that do not have direct measurements of the outcome. This approach can be used to estimate daily variation in levels of $\mathrm {NO}_2$ over a region.Comment: Published in at http://dx.doi.org/10.1214/13-AOAS642 the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

Risk of asthmatic episodes in children exposed to sulfur dioxide stack emissions from a refinery point source in Montreal, Canada.

BACKGROUND: Little is known about the respiratory effects of short-term exposures to petroleum refinery emissions in young children. This study is an extension of an ecologic study that found an increased rate of hospitalizations for respiratory conditions among children living near petroleum refineries in Montreal (Canada). METHODS: We used a time-stratified case-crossover design to assess the risk of asthma episodes in relation to short-term variations in sulfur dioxide levels among children 2-4 years of age living within 0.5-7.5 km of the refinery stacks. Health data used to measure asthma episodes included emergency department (ED) visits and hospital admissions from 1996 to 2004. We estimated daily levels of SO2 at the residence of children using a) two fixed-site SO2 monitors located near the refineries and b) the AERMOD (American Meteorological Society/Environmental Protection Agency Regulatory Model) atmospheric dispersion model. We used conditional logistic regression to estimate odds ratios associated with an increase in the interquartile range of daily SO2 mean and peak exposures (31.2 ppb for AERMOD peaks). We adjusted for temperature, relative humidity, and regional/urban background air pollutant levels. RESULTS: The risks of asthma ED visits and hospitalizations were more pronounced for same-day (lag 0) SO2 peak levels than for mean levels on the same day, or for other lags: the adjusted odds ratios estimated for same-day SO2 peak levels from AERMOD were 1.10 [95% confidence interval (CI), 1.00-1.22] and 1.42 (95% CI, 1.10-1.82), over the interquartile range, for ED visits and hospital admissions, respectively. CONCLUSIONS: Short-term episodes of increased SO2 exposures from refinery stack emissions were associated with a higher number of asthma episodes in nearby children

Race, Culture & Abuse of Persons with Disabilities

This chapter will explore how race and culture influence the lives of persons with disabilities who are experiencing abuse. The discussion will be framed by an intersectional lens and will be informed by cultural humility and critical race theory. Practitioners need to remain open to the idea that they cannot and will not know all there is to know about any given culture, and they should be open to hearing about their clients’ understanding and experiences of culture. Rather than knowing certain pieces of “knowledge” about a cultural group, it is more important to understand what pieces of culture the clients embrace or reject. This chapter will conclude with a composite client case example of a female, middle-aged, Korean immigrant with Multiple Sclerosis, who is very active in her Christian church, and who is being abused by her husband. Discussion of this case will highlight the intersectional context of the client’s experience and how they may influence her decision to seek help (and from whom) as well as her experience of receiving help. The case discussion also highlights the practitioner’s values and behaviors that are consistent with cultural humility and critical race theory

Highly Pathogenic Avian Influenza A(H5N1) Virus Outbreak in New England Seals, United States

We report the spillover of highly pathogenic avian influenza A(H5N1) into marine mammals in the northeastern United States, coincident with H5N1 in sympatric wild birds. Our data indicate monitoring both wild coastal birds and marine mammals will be critical to determine pandemic potential of influenza A viruses

PROFILE OF CHRONIC HEPATITIS B IN LIVER AND NON LIVER MALIGNANCIES AT DR. SAIFUL ANWAR MALANG GENERAL HOSPITAL

Background: Hepatitis B virus (HBV) infection is a worldwide problem associated with morbidity and mortality. Hepatitis B virus (HBV) was identified as a major risk factor for carcinoma, one of them is associated with hepatocellular carcinoma. Aim: This study aims to determine the profile of hepatitis B patients with malignancy at the Gastroenterohepatology Outpatient Polyclinic at Saiful Anwar Regional General Hospital. Methods: This research is an observational study with a cross-sectional design. Data was collected from 2013 to 2018. The chronic hepatitis B patients were found in the Gastroenterohepatology polyclinic. Data was collected in the form of secondary data, including patient demographic data including age, sex, and type of drug. The results are described descriptively and presented in tables/percentages. Results: From the results of the study, the total number of chronic hepatitis B patients with malignancy in was 218 people. Most of the patients were aged 20-60 years with an average age of 49.7 ± 12.6 years. Most of the subjects were male, 78.0%. Most of the therapy given to patients was tenofovir 300 mg (93.2%). Cases were dominated by liver malignancy (52.8%). Most of the patients who had non-liver malignancy were diagnosed with ca mammae (37.0%). Conclusion:  Chronic hepatitis B virus infection may have the potential to damage liver tissue which can lead to malignancy. The prevalence of liver and non-liver malignancies in chronic hepatitis B patients in this study were 52.8% and 47.3%, respectively

Pendekatan Pemodelan Matematika Dinamis Dalam Analisis Prediksi COVID-19 Sebagai Masukan Kebijakan Pemerintah Indonesia

World Health Organization has declared Coronavirus Disease 2019 (COVID-19) as pandemic on March 11, 2020. It becomes a global health issue since all countries over the world including Indonesia are fighting against the disease. In order to minimize the impact of COVID-19, the government need to implement the right policy. One of the important elements in deciding the policy is by having the estimation of the COVID-19 cases using the modeling simulation. The objective of this community service activity was to provide the analysis the COVID-19 cases in Indonesia using a dynamic modeling approach. Two basic scenarios of with and without the policy implementation was simulated simultaneously with Monte Carlo method. The model results demonstrated that it needs to implement Large Scale Social Restriction (LSSR) policy to reduce the contact rate in order to reduce the spread of transmission and to extend the period of LSSR until the peak of pandemic in Indonesia is passed. The peak of pandemic under LSSR policy scenario will be reached in the middle of July. Those result were presented twice to government party. Unfortunately, the LSSR was relaxed soon after the second presentation. A precise prediction by the model was occurred when the relaxation of LSRR was implemented, then the peak of COVID-19 pandemic was shift to the uncertain time. It is suggested that the stakeholders especially the policy maker should consider the modeling analysis as a tool for helping in the policy arrangement of COVID-19 countermeasure.   Keywords: COVID-19, Dynamics Modeling, High Leverage Policy, Social Restriction   Abstrak   Organisasi Kesehatan Dunia (WHO) telah menetapkan Coronavirus Disease 2019 (COVID-19) sebagai pandemi pada 11 Maret 2020. COVID-19 menjadi isu kesehatan secara global karena semua negara di dunia termasuk Indonesia sedang berjuang melawannya. Untuk meminimalisir dampak COVID-19, pemerintah perlu menerapkan kebijakan yang tepat. Salah satu elemen penting dalam pengambilan keputusan adalah dengan melakukan estimasi kasus COVID-19 dengan menggunakan pemodelan. Kegiatan pengabdian kepada masyarakat ini bertujuan untuk menyediakan analisis kasus COVID-19 di Indonesia dengan menggunakan pendekatan pemodelan dinamis. Dua buah basis skenario yaitu dengan dan tanpa implementasi kebijakan disimulasikan secara bersamaan dengan metode Monte Carlo. Hasil keluaran model menunjukkan perlunya penerapan kebijakan Pembatasan Sosial Berskala Besar (PSBB) untuk mengurangi laju kontak (contact rate) dengan penderita guna mengurangi penyebaran penularan dan memperpanjang periode PSBB hingga puncak pandemi COVID-19 di Indonesia terlampaui. Puncak pandemi dalam skenario kebijakan PSBB akan terjadi pada pertengahan Juli. Hasil pemodelan tersebut sudah dua kali dipresentasikan kepada pihak pemerintah. Sayangnya, PSBB diperlonggar diimplementasikan oleh pemerintah setelah presentasi kedua. Prediksi yang tepat secara kuantitatif oleh model terjadi pada saat PSBB diperlonggar diimplementasikan oleh karenanya puncak pandemi COVID-19 bergeser ke waktu yang belum dapat dipastikan. Untuk itu disarankan agar para pemangku kepentingan terutama pembuat kebijakan dapat mempertimbangkan analisis pemodelan sebagai alat bantu dalam menyusun kebijakan untuk tindakan penanggulangan COVID-19.   Kata kunci: COVID-19, Modeling, Kebijakan Berpengaruh Tinggi, Pembatasan Sosia

Underweight is independently associated with mortality in post-operative and non-operative patients admitted to the intensive care unit: a retrospective study

BACKGROUND: Low and high body mass index (BMI) have been recently shown to be associated with increased and decreased mortality after ICU admission, respectively. The objective of this study was to determine the impact of BMI on mortality and length of stay in patients admitted to the intensive care unit (ICU). METHODS: In this retrospective cohort study, the Acute Physiology and Chronic Health Evaluation (APACHE) III database of patients admitted to the ICUs of a tertiary academic medical center, from January 1997 to September 2002, was crossed with a Hospital Rule-based Systems database to obtain the height and weight of the patients on admission to the ICU. The cohort was divided in post-operative and non-operative groups. We created the following five subgroups based on the BMI: <18.5, 18.5 to 24.9, 25 to 29.9, 30.0 to 39.9, ≥ 40.0 Kg/m(2). A multiple logistic regression analysis was used to determine the independent impact of BMI on hospital mortality. The ICU length of stay ratio was defined as the ratio of the observed to the predicted LOS. P-value < 0.05 was considered significant. The 95% confidence interval (CI) was calculated for the odds ratio (OR). RESULTS: BMI was available in 19,669 of the 21,790 patients in the APACHE III database; 11,215 (57%) of the patients were admitted post-operatively. BMI < 18.5 was associated with increased mortality in both post-operative (OR = 2.14, 95% CI, 1.39 to 3.28) and non-operative (OR = 1.51, 95% CI, 1.13 to 2.01) patients. Post-operative patients with a BMI between 30.0 to 39.9 had a lower mortality rate (OR = 0.68, 95% CI, 0.49 to 0.94). Post-operative patients with BMI <18.5 or BMI ≥ 40 had an ICU length of stay ratio significantly higher than patients with BMI between 18.5 to 24.9. The addition of BMI < 18.5 did not improve significantly the accuracy of our prognostic model in predicting hospital mortality. CONCLUSIONS: Low BMI is associated with higher mortality in both post- and non-operative patients admitted to the ICU. LOS is increased in post-operative patients with low and high BMIs