Epidemiologia

Over the past years there is a substantial wave of migrants and refugees all over the world. Europe accepts approximately one-third of the international migrant population with Greece, in particular, having received large numbers of refugees and migrants by land and sea since the beginning of the civil war in Syria. Diabetes, a non-communicable disease, is a global health problem, affecting people in developing countries, refugees and migrants, and its basic treatment tool includes self-management and education. In this pilot study, we organized educational, interactive group sessions for diabetic refugees, based on culture, health, and nutritional needs according to a questionnaire developed for the study. The sessions were weekly, for two months, in the context of primary healthcare, organized by a dietitian. Nine individuals completed the sessions, five of nine were diagnosed in Greece and seven of nine needed diabetes education. Their waist circumference was above normal and they were all cooking at home. Their nutritional habits improved by attending the sessions and the interaction helped their social integration. They all found the sessions useful, and felt more self-confident regarding diabetes control and healthier. Full article

As other nations around the world, Bangladesh is facing enormous challenges with the novel coronavirus (COVID-19) epidemic. To design a prevention and control strategy for this new infectious disease, it is essential to first understand people’s knowledge, attitudes, and practices (KAP) regarding COVID-19. This study sought to determine KAP among rural and urban residents as well as predictors of preventive practices associated with COVID-19 in Bangladesh. A social media-based (Facebook) cross-sectional survey was conducted to explore these variables among Bangladeshi adults. Of 1520 respondents who completed the questionnaire, low level of good or sufficient knowledge of COVID-19 (70.8%) and practices associated with COVID-19 (73.8%) were found. Despite the low level of knowledge and practices, respondents’ attitude (78.9%) towards COVID-19 was relatively high. Results suggest that compared to urban, rural residents are at a particularly high risk of COVID-19 because they were found to have significantly lower knowledge (p = 0.001) and practice levels (p = 0.002) than were urban residents. Multivariable logistic regression analysis identified gender, education, knowledge of COVID-19 transmission, signs and symptoms, and sources of information as factors significantly associated with preventive practices against COVID-19. Further attention and effort should be directed toward increasing both knowledge and practices targeting the general population in Bangladesh, particularly the rural and less educated residents. Findings from this study provide baseline data that can be used to promote integrated awareness of and effective health education programs about COVID-19 prevention and control strategies in Bangladesh, and similar COVID-19 endemic countries. Full article

(1) Background: This study aims to identify the factors of underweight and overweight/obesity among reproductive age (15–49 years) women in Myanmar, and assess the level of inequity in the double burden of malnutrition. (2) Methods: The study used Myanmar Demographic and Health Survey 2015–2016 data. Multinomial logistic regression models were fitted to identify the factors affecting underweight and overweight/obesity; and concentration indices (CI) were estimated to assess socioeconomic inequalities. (3) Results: A total of 12,643 reproductive age women were included in the analysis. Higher risk of underweight was found in women aged 20–29 years, aged 30–39 years, and 40–49 years compared to women aged 15–19 years; women who were unemployed or had manual occupation relative to those in non-manual employment. Women aged 40–49 years (compared to those who were 15–29 years); had primary education, and secondary education (compared to those who had no education); being married, and widowed/divorced/separated (compared to being never married); belonging to the poor quintile, middle quintile, richer, richest quintile (compared to the poorest quintile); having residence in urban areas (compared to rural areas) and in Kachin, Taninthayi, Yangon province (than those who lived in Naypytiaw province) had a higher risk of being overweight/obese. Socioeconomic inequalities were detected, with overweight/obesity strongly concentrated (CI: 0.19) amongst the higher quintiles and underweight concentrated (CI: −0.060) amongst the poorest. (4) Conclusions: Equity oriented nutrition interventions with a focus on improving the socioeconomic status of poor households may benefit undernourished women, while richer households should be focused to curb the overweight/obesity problem. Full article

The 1918 influenza pandemic, the deadliest pandemic on record, affected approximately 1/3rd of the population worldwide. The impact of this pandemic on stillbirth risk has not been studied in depth. In this study, we assessed the stillbirth risk during the 1918 influenza pandemic in Arizona, USA. We carried out a retrospective study using 21,334 birth records for Maricopa County, Arizona, for the period 1915–1925. We conducted logistic regression analyses to assess the effect of that pandemic on stillbirth risk. Though we did not find a statistically significant impact on stillbirth risk during the pandemic, there was a higher risk of stillbirth in July 1919 (42 stillbirths/1000 births), 9 months after the peak pandemic mortality, and a stillbirth risk of 1.42 (95% CI: 1.17, 1.72) in women ≥35 years compared to the women aged <35 years. The risk of stillbirth was lowest if the mother’s age was approximately 26 years at the time of birth. We also report peaks in stillbirth risk 9–10 months after the peak pandemic mortality. Our findings add to our current understanding of the link between pandemic influenza and stillbirth risk. Full article

The COVID-19 outbreak was declared a national emergency in the U.S. in March 2020, and in April 2020, the U.S. government authorities issued recommendations on the use of masks and gloves as protective measures. Despite such recommendations, popular media reports highlighted a lack of compliance. However, no systematic study has examined the use of protective strategies (e.g., wearing a mask) by the American public to prevent the spread of COVID-19 during early stages of the pandemic. The purpose of this study was to conduct a rapid national assessment of public behaviors to prevent COVID-19 spread during the early stages of the pandemic and to assess how these behaviors may have differed based on selected sociodemographic characteristics. A total of 835 adult Americans nationwide took a multi-item survey and were asked about wearing masks, gloves, and their demographic background. The majority of the study participants reported wearing a mask more often during the pandemic (76%), but the majority did not wear gloves more often during the pandemic (30%). Significant differences (p < 0.05) for wearing masks were found based on sex, age, ethnicity, marital status, living arrangements, and employment status. For gloves, significant differences were found based on sex, age, marital status, and employment. While the pandemic continues to unfold and with recent reports of a surge in cases in the U.S., public health practitioners and policymakers must emphasize COVID-19 prevention strategies for the general public and explore pragmatic options to increase compliance of protective behaviors among the general public. Full article

SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) causes a variety of responses in those who contract the virus, ranging from asymptomatic infections to acute respiratory failure and death. While there are likely multiple mechanisms triggering severe disease, one potential cause of severe disease is the size of the initial inoculum. For other respiratory diseases, larger initial doses lead to more severe outcomes. We investigate whether there is a similar link for SARS-CoV-2 infections using the combination of an agent-based model (ABM) and a partial differential equation model (PDM). We use the model to examine the viral time course for different sizes of initial inocula, generating dose-response curves for peak viral load, time of viral peak, viral growth rate, infection duration, and area under the viral titer curve. We find that large initial inocula lead to short infections, but with higher viral titer peaks; and that smaller initial inocula lower the viral titer peak, but make the infection last longer. Full article