The control of highly contagious disease spreading in campuses is a critical challenge.In residential universities,students attend classes according to a curriculum schedule,and mainly pack into classrooms,dining hall...The control of highly contagious disease spreading in campuses is a critical challenge.In residential universities,students attend classes according to a curriculum schedule,and mainly pack into classrooms,dining halls and dorms.They move from one place to another.To simulate such environments,we propose an agent-based susceptible–infected–recovered model with time-varying heterogeneous contact networks.In close environments,maintaining physical distancing is the most widely recommended and encouraged non-pharmaceutical intervention.It can be easily realized by using larger classrooms,adopting staggered dining hours,decreasing the number of students per dorm and so on.Their real-world influence remains uncertain.With numerical simulations,we obtain epidemic thresholds.The effect of such countermeasures on reducing the number of disease cases is also quantitatively evaluated.展开更多
Neonatal pain management is an important issue which should have great attention.More and more researches have proved that neonates can feel pain when undergoes painful procedures such as vaccination,heel stick,and so...Neonatal pain management is an important issue which should have great attention.More and more researches have proved that neonates can feel pain when undergoes painful procedures such as vaccination,heel stick,and so on,and it will result in shortterm and long-term outcomes.So it is very important to manage neonatal pain.This article summarized some non-pharmaceutical interventions,including sucrose or glucose,non-nutritional sucking(NNS),breastfeeding,facilitated tucking(FT),kangaroo mother care(KMC),swaddling,heel warming,sensorial saturation(SS),and music therapy,which showed obvious effects for neonatal pain.In addition,this article summarized the progress of neonatal pain intervention in various countries and showed that many countries have not paid enough attention to this problem,while some countries have carried out promotion programs for neonatal pain management which give some clinical enlightenment to our country that we need to pay more attention to this problem.展开更多
<span style="font-family:Verdana;">For Madagascar, with the uncertainty over vaccines against the novel coronavirus 2019 and its variants, non-pharmaceutical approach is widely used. Our objective is t...<span style="font-family:Verdana;">For Madagascar, with the uncertainty over vaccines against the novel coronavirus 2019 and its variants, non-pharmaceutical approach is widely used. Our objective is to propose a mathematical control model which will serve as a tool to help decision-makers in the strategy to be implemented to better face the pandemic</span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> By separating asymptomatic cases which are often not reported and symptomatic who are hospitalized after tests;we develop a mathematical model of the propagation of covid-19 in Madagascar, by integrating control strategies. We study the stability of the model by expressing the basic reproduction number using the next-generation matrix. Simulation with different parameters shows the effects of non-pharmaceutical measures on the speed of the disease spread. By integrating a control parameter linked to compliance with barrier measures in the virus propagation equation, we were able to show the impacts of the implementation of social distancing measures on the basic reproduction number. The strict application of social distancing measures and total confinement </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">is</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> unfavorable for economic situation even if they allow the contamination to be reduced quickly. Without any restrictions, the disease spreads at high speed and the peak is reached fairly quickly. In this condition, hospitals are overwhelmed and the death rate increases rapidly. With 50% respect for non-pharmaceutical strategies such as rapid detection and isolation of positive cases and barrier gestures;the basic reproduction number </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">R</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><sub><span style="font-family:Verdana;">0</span></sub></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> can go down from 3 to 1.7. The pressures on the economic and social situation are rather viable. It is the most suitable for the Malagasy health system. The results proposed are a way to control the spread of the disease and limit its devastation in a country like Madagascar.</span></span></span>展开更多
Background Non-pharmaceutical interventions(NPIs)have been implemented worldwide to suppress the spread of coronavirus disease 2019(COVID-19).However,few studies have evaluated the effect of NPIs on other infectious d...Background Non-pharmaceutical interventions(NPIs)have been implemented worldwide to suppress the spread of coronavirus disease 2019(COVID-19).However,few studies have evaluated the effect of NPIs on other infectious diseases and none has assessed the avoided disease burden associated with NPIs.We aimed to assess the effect of NPIs on the incidence of infectious diseases during the COVID-19 pandemic in 2020 and evaluate the health economic benefits related to the reduction in the incidence of infectious diseases.Methods Data on 10 notifiable infectious diseases across China during 2010–2020 were extracted from the China Information System for Disease Control and Prevention.A two-stage controlled interrupted time-series design with a quasi-Poisson regression model was used to examine the impact of NPIs on the incidence of infectious diseases.The analysis was first performed at the provincial-level administrative divisions(PLADs)level in China,then the PLAD-specific estimates were pooled using a random-effect meta-analysis.Results A total of 61,393,737 cases of 10 infectious diseases were identified.The implementation of NPIs was associated with 5.13 million(95%confidence interval[CI]3.45‒7.42)avoided cases and USD 1.77 billion(95%CI 1.18‒2.57)avoided hospital expenditures in 2020.There were 4.52 million(95%CI 3.00‒6.63)avoided cases for children and adolescents,corresponding to 88.2%of total avoided cases.The top leading cause of avoided burden attributable to NPIs was influenza[avoided percentage(AP):89.3%;95%CI 84.5‒92.6].Socioeconomic status and population density were effect modifiers.Conclusions NPIs for COVID-19 could effectively control the prevalence of infectious diseases,with patterns of risk varying by socioeconomic status.These findings have important implications for informing targeted strategies to prevent infectious diseases.展开更多
The outbreak of the novel coronavirus disease 2019(COVID-19),caused by the novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has caused global transmission,and been spread all over the world.For those ...The outbreak of the novel coronavirus disease 2019(COVID-19),caused by the novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has caused global transmission,and been spread all over the world.For those regions that are currently free of infected cases,it is an urgent issue to prevent and control the local outbreak of COVID-19 when there are sporadic cases.To evaluate the effects of non-pharmaceutical interventions against local transmission of COVID-19,and to forecast the epidemic dynamics after local outbreak of diseases under different control measures,we developed an individual-based model(IBM)to simulate the transmission dynamics of COVID-19 from a microscopic perspective of individual-to-individual contacts to heterogenous among individuals.Based on the model,we simulated the effects of different levels of non-pharmaceutical interventions in controlling disease transmission after the appearance of sporadic cases.Simulations shown that isolation of infected cases and quarantine of close contacts alone would not eliminate the local transmission of COVID-19,and there is a risk of a second wave epidemics.Quarantine the second-layer close contacts can obviously reduce the size of outbreak.Moreover,to effectively eliminate the daily new infections in a short time,it is necessary to reduce the individual-to-individual contacts.IBM provides a numerical representation for the local transmission of infectious diseases,and extends the compartmental models to include individual heterogeneity and the close contacts network.Our study suggests that combinations of self-isolation,quarantine of close contacts,and social distancing would be necessary to block the local transmission of COVID-19.展开更多
The epidemiological characteristics and distributions of two epidemics in Fujian Province of Southeast China were attributed to the complex interactions among variant,host,and non-pharmaceutical interventions(NPIs).Al...The epidemiological characteristics and distributions of two epidemics in Fujian Province of Southeast China were attributed to the complex interactions among variant,host,and non-pharmaceutical interventions(NPIs).All reported cases in the Putian epidemic(September 8–October 2,2021,Delta variant B.1.617.2)and Fuzhou epidemic(October 22–November 18,2022,Omicron variant BA.5.2)were classified by sex,age group,occupation,and location in this study.Using surveillance data from the Fujian Provincial Center for Disease Control and Prevention,we established a virus-oriented SVEIR(Susceptible–Vaccinated–Exposed–Infected–Recovered)model to investigate the dynamic evolution features of these two variants and the effects of NPIs.The optimal simulations were carried out with variants and scenario investigations.The scenario investigations showed that NPIs significantly reduced the transmission risk and infection scales of COVID-19,and that the Omicron variant was more infectious than the Delta variant.Moreover,the dynamic investigations revealed the increasing tendencies from Delta to Omicron,such as the basic reproduction number,infection rate,percentage of high-risk cases,and the growth rate.Decreasing tendencies were also identified,such as the average recovery period,the awareness delay,and the percentage of symptomatic cases.This study highlighted that NPIs played critical roles in successfully containing the two epidemics.Such interventions are strongly recommended to public health policymakers.展开更多
The world has faced the COVID-19 pandemic for over two years now,and it is time to revisit the lessons learned from lockdown measures for theoretical and practical epidemiological improvements.The interlink between th...The world has faced the COVID-19 pandemic for over two years now,and it is time to revisit the lessons learned from lockdown measures for theoretical and practical epidemiological improvements.The interlink between these measures and the resulting change in mobility(a predictor of the disease transmission contact rate)is uncertain.We thus propose a new method for assessing the efficacy of various non-pharmaceutical interventions(NPI)and examine the aptness of incorporating mobility data for epidemiological modelling.Facebook mobility maps for the United Arab Emirates are used as input datasets from the first infection in the country to mid-Oct 2020.Dataset was limited to the pre-vaccination period as this paper focuses on assessing the different NPIs at an early epidemic stage when no vaccines are available and NPIs are the only way to reduce the reproduction number(R_(0)).We developed a travel network density parameterβ_(t)to provide an estimate of NPI impact on mobility patterns.Given the infection-fatality ratio and time lag(onset-to-death),a Bayesian probabilistic model is adapted to calculate the change in epidemic development withβt.Results showed that the change inβ_(t)clearly impacted R_(0).The three lockdowns strongly affected the growth of transmission rate and collectively reduced R_(0)by 78%before the restrictions were eased.The model forecasted daily infections and deaths by 2%and 3%fractional errors.It also projected what-if scenarios for different implementation protocols of each NPI.The developed model can be applied to identify the most efficient NPIs for confronting new COVID-19 waves and the spread of variants,as well as for future pandemics.展开更多
In this paper,based on the classic Kermack-McKendrick SIR model,we propose an ordinary differential equation model to re-examine the COVID-19 epidemics in Wuhan where this disease initially broke out.The focus is on t...In this paper,based on the classic Kermack-McKendrick SIR model,we propose an ordinary differential equation model to re-examine the COVID-19 epidemics in Wuhan where this disease initially broke out.The focus is on the impact of all those major nonpharmaceutical interventions(NPIs)implemented by the local public healthy authorities and government during the epidemics.We use the data publicly available and the nonlinear least-squares solver lsqnonlin built in MATLAB to estimate the model parameters.Then we explore the impact of those NPIs,particularly the timings of these interventions,on the epidemics.The results can help people review the responses to the outbreak of the COVID-19 inWuhan,while the proposed model also offers a framework for studying epidemics of COVID-19 and/or other similar diseases in other places,and accordingly helping people better prepare for possible future outbreaks of similar diseases.展开更多
Governments worldwide have implemented non-pharmaceutical interventions(NPIs)to control the spread of coronavirus disease 2019(COVID-19),and it is crucial to accurately assess the effectiveness of such measures.Many s...Governments worldwide have implemented non-pharmaceutical interventions(NPIs)to control the spread of coronavirus disease 2019(COVID-19),and it is crucial to accurately assess the effectiveness of such measures.Many studies have quantified the risk of infection transmission and used simulations to compare the risk before and after the implementation of NPIs to judge policies’effectiveness.However,the choice of metric used to quantify the risk can lead to different conclusions regarding the effectiveness of a policy.In this study,we analyze the correlation between different transmission-risk metrics,pedestrian environments,and types of infectious diseases using simulation-generated data.Our findings reveal conflicting results among five different metric types in specific environments.More specifically,we observe that,when the randomness of pedestrian trajectories in indoor spaces is low,the closeness centrality exhibits a higher correlation coefficient with infection-based metrics than with contact-based metrics.Furthermore,even within the same pedestrian environment,the likelihood of discrepancies between infection-based metrics and other metrics increases for infectious diseases with low transmission rates.These results highlight the variability in the measured effectiveness of NPIs depending on the chosen metric.To evaluate NPIs accurately,facility managers should consider the type of facility and infectious disease and not solely rely on a single metric.This study provides a simulation model as a tool for future research and improves the reliability of pedestrian-simulation-based NPI effectiveness analysis methods.展开更多
At present,the situation of global fight against COVID-19 is serious.WHO(World Health Organization)-China Joint Mission fully confirms the success of"China’s model"against COVID-19 in their report.In fact,o...At present,the situation of global fight against COVID-19 is serious.WHO(World Health Organization)-China Joint Mission fully confirms the success of"China’s model"against COVID-19 in their report.In fact,one particular power in"China’s model"is acupuncture and moxibustion of traditional Chinese medicine.To better apply"non-pharmaceutic measures"-the external technique of traditional Chinese medicine,in the article,the main content of Guidance for acupuncture and moxibustion interventions on COVID-19(Second edition)issued by China Association of Acupuncture-Moxibution is introduced and the discussion is stressed on the selection of moxibustion device and the duration of its exertion.展开更多
Coronavirus disease 2019(COVID-19)deaths per million population in the countries of the West had often exceeded those in the countries of the East by factor of 100 by May 2021.In this paper,we refer to the West as rep...Coronavirus disease 2019(COVID-19)deaths per million population in the countries of the West had often exceeded those in the countries of the East by factor of 100 by May 2021.In this paper,we refer to the West as represented by the United States plus the five most populous countries of Western Europe(France,Germany,Italy,Spain,and the United Kingdom),and the East as the 15 countries in East Asia and Oceania that are members of the Regional Comprehensive Economic Partnership,RCEP(Australia,Brunei,Cambodia,China,Indonesia,Japan,the Republic of Korea,Laos,Malaysia,Myanmar,New Zealand,Philippines,Singapore,Thailand,and Vietnam).This paper argues that currently available information points to the factors most responsible for the East–West divide.Warnings by early January 2020 about an atypical viral pneumonia in Wuhan,China,prompted rapid responses in many jurisdictions in East Asia.Publication of the virus’s genome on 10 January 2020 provided essential information for making diagnostic tests and launching vaccine development.China’s lockdown of Wuhan on 23 January 2020 provided a final,decisive signal of the danger of the new disease.By late March 2020,China had fully controlled its epidemic,and many other RCEP countries had taken early and decisive measures,including restrictions on travel,that aborted serious outcomes.Inaction during the critical month of February 2020 in the United States and most other Western countries allowed the disease to take hold and spread.In both the East and the West,stringent population-wide non-pharmaceutical interventions were widely implemented at great cost to societies,economies,and school systems.Without these measures,the outcomes could have been even worse.Most countries in the East also implemented tightly focused policies to isolate infectious individuals.Even today,most countries in the West allow infectious individuals to mingle with their families,coworkers,and communities.Much of the East–West divide plausibly results from failure in the West to implement the basic public health policies of early action and the isolation of infectious individuals.Widespread immunization in some RCEP and high-income countries will soon attenuate their outbreaks,while the slow rollout of vaccines in lower income countries is replacing the East–West divide in outcomes with a North–South one.The South is thus replacing the West as the breeding ground for more dangerous variants as exemplified by the highly contagious Delta variant,which may undermine hitherto successful control strategies in many countries.展开更多
Objective:To systematically evaluate the effects of acupuncture,auricular point sticking,acupoint catgut embedding,cupping and other non-pharmaceutical Chinese medicine therapies on sex hormone as well as glucose and ...Objective:To systematically evaluate the effects of acupuncture,auricular point sticking,acupoint catgut embedding,cupping and other non-pharmaceutical Chinese medicine therapies on sex hormone as well as glucose and lipid metabolism in patients with obese polycystic ovary syndrome.Method:The databases such as China National Knowledge Infrastructure were searched by computer to collect the literature on the treatment of obese polycystic by non-pharmaceutical Chinese medicine therapy combined with western medicine or lifestyle change,and the literature quality of the included literature was evaluated,and finally the data were analyzed.A total of 15 randomized controlled trial(RCT)literature were included in this study,with a total of 1263 patients.Results:Non-pharmaceutical Chinese medicine therapy combined with metformin or lifestyle can reduce body mass index,insulin resistance index,fasting plasma insulin,fasting blood glucose,luteinizing hormone,ratio of luteinizing hormone to follicle stimulating hormone,testosterone,but it has no obvious advantage over follicle stimulating hormone(FSH).Conclusion:Compared with simple application of metformin or lifestyle change,traditional Chinese medicine non drug therapy combined with metformin or lifestyle change can better improve sex hormone and blood glucose metabolism in obese PCOS patients.展开更多
Background:The public knowledge and adherence to the established coronavirus disease 2019(COVID-19)precautionary measures are crucial to Nigeria’s war against the pandemic.Public health education on its preventive pr...Background:The public knowledge and adherence to the established coronavirus disease 2019(COVID-19)precautionary measures are crucial to Nigeria’s war against the pandemic.Public health education on its preventive practices at the grassroots level was initially crucial to achieving a lower COVID-19 incidence in Kwara State,Nigeria.Methods:We assessed the knowledge of,and adherence to COVID-19 precautionary measures at the community level among 795 respondents from the three senatorial zones of Kwara State.Results:54.5%(433/795)of the respondents were aged between 21 and 40 years,and 45.9%(365/795)of the respondents had a bachelor’s degree or higher.Study participants had a good knowledge of COVID-19,its symptoms,and its mode of transmission.91.8%of the respondents(730/795)had a positive perception of the COVID19 preventive measures while 96.1%(763/795)of the respondents agreed that maintaining social distance was important in curbing the COVID-19 pandemic.However,only 38%(302/795)of them used face masks and only 25.7%(204/795)of the respondents used hand sanitizers.In addition,only 31.9%(253/795)of the respondents isolated themselves when they were ill.Multi-variable logistic regression analysis revealed that education,occupation,gender,and ethnicity were significantly associated with positive COVID-19 preventive practices among residents of Kwara State.Civil servants were more likely(AOR:3.14;95%confidence interval[CI]:0.67 to 14.82;P=0.034)to have positive preventive attitudes than other respondents.Study participants with tertiary education and those that were Yoruba(ethnicity)were 14.81 times more likely(95%CI:4.29 to 51.05;P=0.001)and 5.19 times more likely(95%CI:1.82 to 14.84;P=0.007)to have positive attitudes towards the laid-down COVID-19 preventive measures respectively.Conclusion:The poor community adherence to the COVID-19 preventive practices could pre-dispose Kwara to more COVID-19 cases.More community engagement activities are needed to fully curb the spread of the COVID19.Public health education should focus on preventive measures,vaccine acceptance,and community monitoring of COVID-19.展开更多
COVID-19, a contagious respiratory disease, presents immediate and unforeseen challenges to people worldwide. Moreover, its transmission rapidly extends globally due to its viral transmissibility, emergence of novel s...COVID-19, a contagious respiratory disease, presents immediate and unforeseen challenges to people worldwide. Moreover, its transmission rapidly extends globally due to its viral transmissibility, emergence of novel strains (variants), absence of immunity, and human unawareness. This framework introduces a revised epidemic model, drawing upon mathematical principles. This model incorporates a modified vaccination and lockdown approach to comprehensively depict an epidemics transmission, containment, and decision-making processes within a community. This study aims to provide policymakers with precise information on real-world situations to assist them in making informed decisions about the implementation of lockdown strategies, maintenance variables, and vaccine availability. The suggested model has conducted stability analysis, strength number analysis, and first and second-order derivative analysis of the Lyapunov function and has established the existence and uniqueness of solutions of the proposed models. We examine the combined effects of an effective vaccination campaign and non-pharmaceutical measures such as lockdowns and states of emergency. We rely on the results of this research to assist policymakers in various countries in eradicating the illness by developing more innovative measures to control the outbreak.展开更多
Objective:Due to a lack of available effective treatments for atopic eczema (AE),non-pharmaceutical therapy such as Tuina has been frequently sought after as an alternative treatment.We evaluated the benefits and harm...Objective:Due to a lack of available effective treatments for atopic eczema (AE),non-pharmaceutical therapy such as Tuina has been frequently sought after as an alternative treatment.We evaluated the benefits and harms of Tuina for children with AE under 14 years of age.Methods:We searched for randomized controlled trials (RCTs) on Tuina in seven Chinese and English databases from their inception to June 2018.We included children under 14 years of age with AE received Tuina alone or combined with conventional medicine.Two authors independently extracted data and used the Cochrane 'Risk of bias' tool to assess the methodological quality.Effects were presented as relative risk with 95% confidence interval using RevMan 5.3.Data not suitable for statistical pooling were synthesized qualitatively.Results:Nine RCTs involving 1246 children with AE were included.The trials were at unclear or high risk of bias.Tuina manipulation in each trial was different.Compared to usual care,three trials showed greater effects of Tuina alone or combined with usual care for global symptoms and signs improvement,such as itching,and skin lesions.Four trials showed that Tuina had >50% improvement in symptoms and signs.Due to clinical heterogeneity,meta-analysis was not possible.At follow-up of between 4 weeks and 6 months,five trials of Tuina alone or Tuina combined with usual care showed lower rates of relapse compared to usual care alone.Four trials reported no occurrence of severe adverse events.Conclusions:Limited evidence demonstrates that Tuina may improve symptoms and signs of AE and reduce relapse rate in children <14 yrs with AE.Tuina is generally acceptable in these trials.Further well-designed RCTs are warranted to confirm these benefits and to explore safety further.展开更多
COVID-19 is a disease caused by the novel coronavirus SARS-CoV-2 that emerged at the end of December 2019 and has since spread globally.In Kenya,the virus was first detected on 13^(th) March 2020.Soon after,the Kenyan...COVID-19 is a disease caused by the novel coronavirus SARS-CoV-2 that emerged at the end of December 2019 and has since spread globally.In Kenya,the virus was first detected on 13^(th) March 2020.Soon after,the Kenyan government implemented non-pharmaceutical interventions(NPIs)to slow the spread of the disease.The pandemic continued to spread and it evolved into several waves over the years despite the discovery of vaccines and treatment.Mathematical models have been developed to help analyse,predict and simulate the dynamics of the pandemic.These models have largely been confined to single waves,without ready extension to multiple waves.In this paper,we develop a mathematical and computational model that can be extended to multiple waves using various concepts.Among these is the application of computational techniques that convert infection curves with negative gradients to those with positive gradients,in the neighbourhood of the change point,namely,where transition occurs from one wave to the next.This effectively generates a new wave.We then introduce a jump mechanism for the susceptible fraction,allowing further computation to align itself with the observed infection curve.To commence the process,we solved the system of governing ordinary differential equations for the period the epidemic spread without intervention and obtained values for the transmission,recovery and death rates that yielded the basic reproduction number,R_(0)=2.76,which is consistent with other related research.We then applied our model to COVID-19 in Kenya and the computation successfully replicated all the waves and also identified the change points located within the months when COVID-19 variants became dominant.The findings strengthen the proposition that the dominant COVID-19 variants were the major drivers of the waves.The techniques can be extended to new strains of COVID-19,influenza and other respiratory viruses.展开更多
In the early stage of an infectious disease outbreak,public health strategies tend to gravitate towards non-pharmaceutical interventions(NPIs)given the time required to develop targeted treatments and vaccines.One of ...In the early stage of an infectious disease outbreak,public health strategies tend to gravitate towards non-pharmaceutical interventions(NPIs)given the time required to develop targeted treatments and vaccines.One of the most common NPIs is Test-Trace-Isolate(TTI).One of the factors determining the effectiveness of TTI is the ability to identify contacts of infected individuals.In this study,we propose a multi-layer temporal contact network to model transmission dynamics and assess the impact of different TTI implementations,using SARS-CoV-2 as a case study.The model was used to evaluate TTI effectiveness both in containing an outbreak and mitigating the impact of an epidemic.We estimated that a TTI strategy based on home isolation and testing of both primary and secondary contacts can contain outbreaks only when the reproduction number is up to 1.3,at which the epidemic prevention potential is 88.2%(95%CI:87.9%e88.5%).On the other hand,for higher value of the reproduction number,TTI is estimated to noticeably mitigate disease burden but at high social costs(e.g.,over a month in isolation/quarantine per person for reproduction numbers of 1.7 or higher).We estimated that strategies considering quarantine of contacts have a larger epidemic prevention potential than strategies that either avoid tracing contacts or require contacts to be tested before isolation.Combining TTI with other social distancing measures can improve the likelihood of successfully containing an outbreak but the estimated epidemic prevention potential remains lower than 50%for reproduction numbers higher than 2.1.In conclusion,our model-based evaluation highlights the challenges of relying on TTIs to contain an outbreak of a novel pathogen with characteristics similar to SARS-CoV-2,and that the estimated effectiveness of TTI depends on the way contact patterns are modeled,supporting the relevance of obtaining comprehensive data on human social interactions to improve preparedness.展开更多
Face mask use by the general public for limiting the spread of the COVID-19 pandemic is controversial,though increasingly recommended,and the potential of this intervention is not well understood.We develop a compartm...Face mask use by the general public for limiting the spread of the COVID-19 pandemic is controversial,though increasingly recommended,and the potential of this intervention is not well understood.We develop a compartmental model for assessing the communitywide impact of mask use by the general,asymptomatic public,a portion of which may be asymptomatically infectious.Model simulations,using data relevant to COVID-19 dynamics in the US states of New York and Washington,suggest that broad adoption of even relatively ineffective face masks may meaningfully reduce community transmission of COVID-19 and decrease peak hospitalizations and deaths.Moreover,mask use decreases the effective transmission rate in nearly linear proportion to the product of mask effectiveness(as a fraction of potentially infectious contacts blocked)and coverage rate(as a fraction of the general population),while the impact on epidemiologic outcomes(death,hospitalizations)is highly nonlinear,indicating masks could synergize with other nonpharmaceutical measures.Notably,masks are found to be useful with respect to both preventing illness in healthy persons and preventing asymptomatic transmission.Hypothetical mask adoption scenarios,for Washington and New York state,suggest that immediate near universal(80%)adoption of moderately(50%)effective masks could prevent on the order of 17e45%of projected deaths over two months in New York,while decreasing the peak daily death rate by 34e58%,absent other changes in epidemic dynamics.Even very weak masks(20%effective)can still be useful if the underlying transmission rate is relatively low or decreasing:InWashington,where baseline transmission is much less intense,80%adoption of such masks could reduce mortality by 24e65%(and peak deaths 15e69%),compared to 2e9%mortality reduction in New York(peak death reduction 9e18%).Our results suggest use of face masks by the general public is potentially of high value in curtailing community transmission and the burden of the pandemic.The community-wide benefits are likely to be greatest when face masks are used in conjunction with other non-pharmaceutical practices(such as social-distancing),and when adoption is nearly universal(nation-wide)and compliance is high.展开更多
Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2.Kenya reported its first case on March 13,2020 and by March 16,2020 she instituted physical distancing strategies to reduce transmi...Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2.Kenya reported its first case on March 13,2020 and by March 16,2020 she instituted physical distancing strategies to reduce transmission and flatten the epidemic curve.An age-structured compartmental model was developed to assess the impact of the strategies on COVID-19 severity and burden.Contacts between different ages are incorporated via contact matrices.Simulation results show that 45%reduction in contacts for 60-days period resulted to 11.5e13%reduction of infections severity and deaths,while for the 190-days period yielded 18.8e22.7%reduction.The peak of infections in the 60-days mitigation was higher and happened about 2 months after the relaxation of mitigation as compared to that of the 190-days mitigation,which happened a month after mitigations were relaxed.Low numbers of cases in children under 15 years was attributed to high number of asymptomatic cases.High numbers of cases are reported in the 15e29 years and 30e59 years age bands.Two mitigation periods,considered in the study,resulted to reductions in severe and critical cases,attack rates,hospital and ICU bed demands,as well as deaths,with the 190-days period giving higher reductions.展开更多
The novel coronavirus(COVID-19)pandemic that emerged from Wuhan city in December 2019 overwhelmed health systems and paralyzed economies around the world.It became the most important public health challenge facing man...The novel coronavirus(COVID-19)pandemic that emerged from Wuhan city in December 2019 overwhelmed health systems and paralyzed economies around the world.It became the most important public health challenge facing mankind since the 1918 Spanish flu pandemic.Various theoretical and empirical approaches have been designed and used to gain insight into the transmission dynamics and control of the pandemic.This study presents a primer for formulating,analysing and simulating mathematical models for understanding the dynamics of COVID-19.Specifically,we introduce simple compartmental,Kermack-McKendrick-type epidemic models with homogeneously-and heterogeneously-mixed populations,an endemic model for assessing the potential population-level impact of a hypothetical COVID-19 vaccine.We illustrate how some basic non-pharmaceutical interventions against COVID-19 can be incorporated into the epidemic model.A brief overview of other kinds of models that have been used to study the dynamics of COVID-19,such as agent-based,network and statistical models,is also presented.Possible extensions of the basic model,as well as open challenges associated with the formulation and theoretical analysis of models for COVID-19 dynamics,are suggested.展开更多
基金Project supported by the National Natural Science Foundation of China(Grant No.61871234).
文摘The control of highly contagious disease spreading in campuses is a critical challenge.In residential universities,students attend classes according to a curriculum schedule,and mainly pack into classrooms,dining halls and dorms.They move from one place to another.To simulate such environments,we propose an agent-based susceptible–infected–recovered model with time-varying heterogeneous contact networks.In close environments,maintaining physical distancing is the most widely recommended and encouraged non-pharmaceutical intervention.It can be easily realized by using larger classrooms,adopting staggered dining hours,decreasing the number of students per dorm and so on.Their real-world influence remains uncertain.With numerical simulations,we obtain epidemic thresholds.The effect of such countermeasures on reducing the number of disease cases is also quantitatively evaluated.
文摘Neonatal pain management is an important issue which should have great attention.More and more researches have proved that neonates can feel pain when undergoes painful procedures such as vaccination,heel stick,and so on,and it will result in shortterm and long-term outcomes.So it is very important to manage neonatal pain.This article summarized some non-pharmaceutical interventions,including sucrose or glucose,non-nutritional sucking(NNS),breastfeeding,facilitated tucking(FT),kangaroo mother care(KMC),swaddling,heel warming,sensorial saturation(SS),and music therapy,which showed obvious effects for neonatal pain.In addition,this article summarized the progress of neonatal pain intervention in various countries and showed that many countries have not paid enough attention to this problem,while some countries have carried out promotion programs for neonatal pain management which give some clinical enlightenment to our country that we need to pay more attention to this problem.
文摘<span style="font-family:Verdana;">For Madagascar, with the uncertainty over vaccines against the novel coronavirus 2019 and its variants, non-pharmaceutical approach is widely used. Our objective is to propose a mathematical control model which will serve as a tool to help decision-makers in the strategy to be implemented to better face the pandemic</span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> By separating asymptomatic cases which are often not reported and symptomatic who are hospitalized after tests;we develop a mathematical model of the propagation of covid-19 in Madagascar, by integrating control strategies. We study the stability of the model by expressing the basic reproduction number using the next-generation matrix. Simulation with different parameters shows the effects of non-pharmaceutical measures on the speed of the disease spread. By integrating a control parameter linked to compliance with barrier measures in the virus propagation equation, we were able to show the impacts of the implementation of social distancing measures on the basic reproduction number. The strict application of social distancing measures and total confinement </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">is</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> unfavorable for economic situation even if they allow the contamination to be reduced quickly. Without any restrictions, the disease spreads at high speed and the peak is reached fairly quickly. In this condition, hospitals are overwhelmed and the death rate increases rapidly. With 50% respect for non-pharmaceutical strategies such as rapid detection and isolation of positive cases and barrier gestures;the basic reproduction number </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">R</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><sub><span style="font-family:Verdana;">0</span></sub></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> can go down from 3 to 1.7. The pressures on the economic and social situation are rather viable. It is the most suitable for the Malagasy health system. The results proposed are a way to control the spread of the disease and limit its devastation in a country like Madagascar.</span></span></span>
基金supported by Chinese Major Grant for the Prevention and Control of Infectious Diseases(2018ZX10713003)the Australian Research Council(DP210102076)+4 种基金the Australian National Health and Medical Research Council(GNT2000581)WY and BW were supported by China Scholarship Council(number 202006010044 for YW and 202006010043 for BW)SL is supported by an Emerging Leader Fellowship of the Australian National Health and Medical Research Council(NHMRCGNT2009866)YG is supported by NHMRC Career Development Fellowship(GNT1163693)and Leader Fellowship(GNT2008813).
文摘Background Non-pharmaceutical interventions(NPIs)have been implemented worldwide to suppress the spread of coronavirus disease 2019(COVID-19).However,few studies have evaluated the effect of NPIs on other infectious diseases and none has assessed the avoided disease burden associated with NPIs.We aimed to assess the effect of NPIs on the incidence of infectious diseases during the COVID-19 pandemic in 2020 and evaluate the health economic benefits related to the reduction in the incidence of infectious diseases.Methods Data on 10 notifiable infectious diseases across China during 2010–2020 were extracted from the China Information System for Disease Control and Prevention.A two-stage controlled interrupted time-series design with a quasi-Poisson regression model was used to examine the impact of NPIs on the incidence of infectious diseases.The analysis was first performed at the provincial-level administrative divisions(PLADs)level in China,then the PLAD-specific estimates were pooled using a random-effect meta-analysis.Results A total of 61,393,737 cases of 10 infectious diseases were identified.The implementation of NPIs was associated with 5.13 million(95%confidence interval[CI]3.45‒7.42)avoided cases and USD 1.77 billion(95%CI 1.18‒2.57)avoided hospital expenditures in 2020.There were 4.52 million(95%CI 3.00‒6.63)avoided cases for children and adolescents,corresponding to 88.2%of total avoided cases.The top leading cause of avoided burden attributable to NPIs was influenza[avoided percentage(AP):89.3%;95%CI 84.5‒92.6].Socioeconomic status and population density were effect modifiers.Conclusions NPIs for COVID-19 could effectively control the prevalence of infectious diseases,with patterns of risk varying by socioeconomic status.These findings have important implications for informing targeted strategies to prevent infectious diseases.
基金This work was supported by the National Natural Science Foundation of China under grant No.11831015,11871179,11771374,11971023.
文摘The outbreak of the novel coronavirus disease 2019(COVID-19),caused by the novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has caused global transmission,and been spread all over the world.For those regions that are currently free of infected cases,it is an urgent issue to prevent and control the local outbreak of COVID-19 when there are sporadic cases.To evaluate the effects of non-pharmaceutical interventions against local transmission of COVID-19,and to forecast the epidemic dynamics after local outbreak of diseases under different control measures,we developed an individual-based model(IBM)to simulate the transmission dynamics of COVID-19 from a microscopic perspective of individual-to-individual contacts to heterogenous among individuals.Based on the model,we simulated the effects of different levels of non-pharmaceutical interventions in controlling disease transmission after the appearance of sporadic cases.Simulations shown that isolation of infected cases and quarantine of close contacts alone would not eliminate the local transmission of COVID-19,and there is a risk of a second wave epidemics.Quarantine the second-layer close contacts can obviously reduce the size of outbreak.Moreover,to effectively eliminate the daily new infections in a short time,it is necessary to reduce the individual-to-individual contacts.IBM provides a numerical representation for the local transmission of infectious diseases,and extends the compartmental models to include individual heterogeneity and the close contacts network.Our study suggests that combinations of self-isolation,quarantine of close contacts,and social distancing would be necessary to block the local transmission of COVID-19.
基金supported by Consultancy Project by the Chinese Academy of Engineering(2022-JB-06)supported by Special Projects of the Central Government Guiding Local Science and Technology Development(2021L3018)+2 种基金supported by the Natural Science Foundation of Fujian ProvinceProvince of China(2021J01621)supported by Fujian Science and Technology Innovation Platform Construction Project(2019Y2001)Health Science and Technology Project of Fujian Province(2020GGB019).
文摘The epidemiological characteristics and distributions of two epidemics in Fujian Province of Southeast China were attributed to the complex interactions among variant,host,and non-pharmaceutical interventions(NPIs).All reported cases in the Putian epidemic(September 8–October 2,2021,Delta variant B.1.617.2)and Fuzhou epidemic(October 22–November 18,2022,Omicron variant BA.5.2)were classified by sex,age group,occupation,and location in this study.Using surveillance data from the Fujian Provincial Center for Disease Control and Prevention,we established a virus-oriented SVEIR(Susceptible–Vaccinated–Exposed–Infected–Recovered)model to investigate the dynamic evolution features of these two variants and the effects of NPIs.The optimal simulations were carried out with variants and scenario investigations.The scenario investigations showed that NPIs significantly reduced the transmission risk and infection scales of COVID-19,and that the Omicron variant was more infectious than the Delta variant.Moreover,the dynamic investigations revealed the increasing tendencies from Delta to Omicron,such as the basic reproduction number,infection rate,percentage of high-risk cases,and the growth rate.Decreasing tendencies were also identified,such as the average recovery period,the awareness delay,and the percentage of symptomatic cases.This study highlighted that NPIs played critical roles in successfully containing the two epidemics.Such interventions are strongly recommended to public health policymakers.
文摘The world has faced the COVID-19 pandemic for over two years now,and it is time to revisit the lessons learned from lockdown measures for theoretical and practical epidemiological improvements.The interlink between these measures and the resulting change in mobility(a predictor of the disease transmission contact rate)is uncertain.We thus propose a new method for assessing the efficacy of various non-pharmaceutical interventions(NPI)and examine the aptness of incorporating mobility data for epidemiological modelling.Facebook mobility maps for the United Arab Emirates are used as input datasets from the first infection in the country to mid-Oct 2020.Dataset was limited to the pre-vaccination period as this paper focuses on assessing the different NPIs at an early epidemic stage when no vaccines are available and NPIs are the only way to reduce the reproduction number(R_(0)).We developed a travel network density parameterβ_(t)to provide an estimate of NPI impact on mobility patterns.Given the infection-fatality ratio and time lag(onset-to-death),a Bayesian probabilistic model is adapted to calculate the change in epidemic development withβt.Results showed that the change inβ_(t)clearly impacted R_(0).The three lockdowns strongly affected the growth of transmission rate and collectively reduced R_(0)by 78%before the restrictions were eased.The model forecasted daily infections and deaths by 2%and 3%fractional errors.It also projected what-if scenarios for different implementation protocols of each NPI.The developed model can be applied to identify the most efficient NPIs for confronting new COVID-19 waves and the spread of variants,as well as for future pandemics.
基金Research partially supported by NSERC of Canada(No.RGPIN-2016-04665)CP was supported by the”Short-term Study Abroad Program for PhD Students”of Northeast Normal University(China).
文摘In this paper,based on the classic Kermack-McKendrick SIR model,we propose an ordinary differential equation model to re-examine the COVID-19 epidemics in Wuhan where this disease initially broke out.The focus is on the impact of all those major nonpharmaceutical interventions(NPIs)implemented by the local public healthy authorities and government during the epidemics.We use the data publicly available and the nonlinear least-squares solver lsqnonlin built in MATLAB to estimate the model parameters.Then we explore the impact of those NPIs,particularly the timings of these interventions,on the epidemics.The results can help people review the responses to the outbreak of the COVID-19 inWuhan,while the proposed model also offers a framework for studying epidemics of COVID-19 and/or other similar diseases in other places,and accordingly helping people better prepare for possible future outbreaks of similar diseases.
基金supported by the National Research Foundation of Korea(NRF)grant funded by the Ministry of Science and ICT(MSIT),Republic of Korea(1711185759).
文摘Governments worldwide have implemented non-pharmaceutical interventions(NPIs)to control the spread of coronavirus disease 2019(COVID-19),and it is crucial to accurately assess the effectiveness of such measures.Many studies have quantified the risk of infection transmission and used simulations to compare the risk before and after the implementation of NPIs to judge policies’effectiveness.However,the choice of metric used to quantify the risk can lead to different conclusions regarding the effectiveness of a policy.In this study,we analyze the correlation between different transmission-risk metrics,pedestrian environments,and types of infectious diseases using simulation-generated data.Our findings reveal conflicting results among five different metric types in specific environments.More specifically,we observe that,when the randomness of pedestrian trajectories in indoor spaces is low,the closeness centrality exhibits a higher correlation coefficient with infection-based metrics than with contact-based metrics.Furthermore,even within the same pedestrian environment,the likelihood of discrepancies between infection-based metrics and other metrics increases for infectious diseases with low transmission rates.These results highlight the variability in the measured effectiveness of NPIs depending on the chosen metric.To evaluate NPIs accurately,facility managers should consider the type of facility and infectious disease and not solely rely on a single metric.This study provides a simulation model as a tool for future research and improves the reliability of pedestrian-simulation-based NPI effectiveness analysis methods.
文摘At present,the situation of global fight against COVID-19 is serious.WHO(World Health Organization)-China Joint Mission fully confirms the success of"China’s model"against COVID-19 in their report.In fact,one particular power in"China’s model"is acupuncture and moxibustion of traditional Chinese medicine.To better apply"non-pharmaceutic measures"-the external technique of traditional Chinese medicine,in the article,the main content of Guidance for acupuncture and moxibustion interventions on COVID-19(Second edition)issued by China Association of Acupuncture-Moxibution is introduced and the discussion is stressed on the selection of moxibustion device and the duration of its exertion.
基金supported through grants from the Trond Mohn Foundation,Norway(BF2019MT02)the Norwegian Agency for Development Cooperation(Norad),Norway(RAF-18/0009)the Bergen Centre for Ethics and Priority Setting.
文摘Coronavirus disease 2019(COVID-19)deaths per million population in the countries of the West had often exceeded those in the countries of the East by factor of 100 by May 2021.In this paper,we refer to the West as represented by the United States plus the five most populous countries of Western Europe(France,Germany,Italy,Spain,and the United Kingdom),and the East as the 15 countries in East Asia and Oceania that are members of the Regional Comprehensive Economic Partnership,RCEP(Australia,Brunei,Cambodia,China,Indonesia,Japan,the Republic of Korea,Laos,Malaysia,Myanmar,New Zealand,Philippines,Singapore,Thailand,and Vietnam).This paper argues that currently available information points to the factors most responsible for the East–West divide.Warnings by early January 2020 about an atypical viral pneumonia in Wuhan,China,prompted rapid responses in many jurisdictions in East Asia.Publication of the virus’s genome on 10 January 2020 provided essential information for making diagnostic tests and launching vaccine development.China’s lockdown of Wuhan on 23 January 2020 provided a final,decisive signal of the danger of the new disease.By late March 2020,China had fully controlled its epidemic,and many other RCEP countries had taken early and decisive measures,including restrictions on travel,that aborted serious outcomes.Inaction during the critical month of February 2020 in the United States and most other Western countries allowed the disease to take hold and spread.In both the East and the West,stringent population-wide non-pharmaceutical interventions were widely implemented at great cost to societies,economies,and school systems.Without these measures,the outcomes could have been even worse.Most countries in the East also implemented tightly focused policies to isolate infectious individuals.Even today,most countries in the West allow infectious individuals to mingle with their families,coworkers,and communities.Much of the East–West divide plausibly results from failure in the West to implement the basic public health policies of early action and the isolation of infectious individuals.Widespread immunization in some RCEP and high-income countries will soon attenuate their outbreaks,while the slow rollout of vaccines in lower income countries is replacing the East–West divide in outcomes with a North–South one.The South is thus replacing the West as the breeding ground for more dangerous variants as exemplified by the highly contagious Delta variant,which may undermine hitherto successful control strategies in many countries.
文摘Objective:To systematically evaluate the effects of acupuncture,auricular point sticking,acupoint catgut embedding,cupping and other non-pharmaceutical Chinese medicine therapies on sex hormone as well as glucose and lipid metabolism in patients with obese polycystic ovary syndrome.Method:The databases such as China National Knowledge Infrastructure were searched by computer to collect the literature on the treatment of obese polycystic by non-pharmaceutical Chinese medicine therapy combined with western medicine or lifestyle change,and the literature quality of the included literature was evaluated,and finally the data were analyzed.A total of 15 randomized controlled trial(RCT)literature were included in this study,with a total of 1263 patients.Results:Non-pharmaceutical Chinese medicine therapy combined with metformin or lifestyle can reduce body mass index,insulin resistance index,fasting plasma insulin,fasting blood glucose,luteinizing hormone,ratio of luteinizing hormone to follicle stimulating hormone,testosterone,but it has no obvious advantage over follicle stimulating hormone(FSH).Conclusion:Compared with simple application of metformin or lifestyle change,traditional Chinese medicine non drug therapy combined with metformin or lifestyle change can better improve sex hormone and blood glucose metabolism in obese PCOS patients.
基金The ethical approval of this study was obtained from the Kwara State Ministry of Health(MOH/KS/EHC/777/502).
文摘Background:The public knowledge and adherence to the established coronavirus disease 2019(COVID-19)precautionary measures are crucial to Nigeria’s war against the pandemic.Public health education on its preventive practices at the grassroots level was initially crucial to achieving a lower COVID-19 incidence in Kwara State,Nigeria.Methods:We assessed the knowledge of,and adherence to COVID-19 precautionary measures at the community level among 795 respondents from the three senatorial zones of Kwara State.Results:54.5%(433/795)of the respondents were aged between 21 and 40 years,and 45.9%(365/795)of the respondents had a bachelor’s degree or higher.Study participants had a good knowledge of COVID-19,its symptoms,and its mode of transmission.91.8%of the respondents(730/795)had a positive perception of the COVID19 preventive measures while 96.1%(763/795)of the respondents agreed that maintaining social distance was important in curbing the COVID-19 pandemic.However,only 38%(302/795)of them used face masks and only 25.7%(204/795)of the respondents used hand sanitizers.In addition,only 31.9%(253/795)of the respondents isolated themselves when they were ill.Multi-variable logistic regression analysis revealed that education,occupation,gender,and ethnicity were significantly associated with positive COVID-19 preventive practices among residents of Kwara State.Civil servants were more likely(AOR:3.14;95%confidence interval[CI]:0.67 to 14.82;P=0.034)to have positive preventive attitudes than other respondents.Study participants with tertiary education and those that were Yoruba(ethnicity)were 14.81 times more likely(95%CI:4.29 to 51.05;P=0.001)and 5.19 times more likely(95%CI:1.82 to 14.84;P=0.007)to have positive attitudes towards the laid-down COVID-19 preventive measures respectively.Conclusion:The poor community adherence to the COVID-19 preventive practices could pre-dispose Kwara to more COVID-19 cases.More community engagement activities are needed to fully curb the spread of the COVID19.Public health education should focus on preventive measures,vaccine acceptance,and community monitoring of COVID-19.
文摘COVID-19, a contagious respiratory disease, presents immediate and unforeseen challenges to people worldwide. Moreover, its transmission rapidly extends globally due to its viral transmissibility, emergence of novel strains (variants), absence of immunity, and human unawareness. This framework introduces a revised epidemic model, drawing upon mathematical principles. This model incorporates a modified vaccination and lockdown approach to comprehensively depict an epidemics transmission, containment, and decision-making processes within a community. This study aims to provide policymakers with precise information on real-world situations to assist them in making informed decisions about the implementation of lockdown strategies, maintenance variables, and vaccine availability. The suggested model has conducted stability analysis, strength number analysis, and first and second-order derivative analysis of the Lyapunov function and has established the existence and uniqueness of solutions of the proposed models. We examine the combined effects of an effective vaccination campaign and non-pharmaceutical measures such as lockdowns and states of emergency. We rely on the results of this research to assist policymakers in various countries in eradicating the illness by developing more innovative measures to control the outbreak.
文摘Objective:Due to a lack of available effective treatments for atopic eczema (AE),non-pharmaceutical therapy such as Tuina has been frequently sought after as an alternative treatment.We evaluated the benefits and harms of Tuina for children with AE under 14 years of age.Methods:We searched for randomized controlled trials (RCTs) on Tuina in seven Chinese and English databases from their inception to June 2018.We included children under 14 years of age with AE received Tuina alone or combined with conventional medicine.Two authors independently extracted data and used the Cochrane 'Risk of bias' tool to assess the methodological quality.Effects were presented as relative risk with 95% confidence interval using RevMan 5.3.Data not suitable for statistical pooling were synthesized qualitatively.Results:Nine RCTs involving 1246 children with AE were included.The trials were at unclear or high risk of bias.Tuina manipulation in each trial was different.Compared to usual care,three trials showed greater effects of Tuina alone or combined with usual care for global symptoms and signs improvement,such as itching,and skin lesions.Four trials showed that Tuina had >50% improvement in symptoms and signs.Due to clinical heterogeneity,meta-analysis was not possible.At follow-up of between 4 weeks and 6 months,five trials of Tuina alone or Tuina combined with usual care showed lower rates of relapse compared to usual care alone.Four trials reported no occurrence of severe adverse events.Conclusions:Limited evidence demonstrates that Tuina may improve symptoms and signs of AE and reduce relapse rate in children <14 yrs with AE.Tuina is generally acceptable in these trials.Further well-designed RCTs are warranted to confirm these benefits and to explore safety further.
文摘COVID-19 is a disease caused by the novel coronavirus SARS-CoV-2 that emerged at the end of December 2019 and has since spread globally.In Kenya,the virus was first detected on 13^(th) March 2020.Soon after,the Kenyan government implemented non-pharmaceutical interventions(NPIs)to slow the spread of the disease.The pandemic continued to spread and it evolved into several waves over the years despite the discovery of vaccines and treatment.Mathematical models have been developed to help analyse,predict and simulate the dynamics of the pandemic.These models have largely been confined to single waves,without ready extension to multiple waves.In this paper,we develop a mathematical and computational model that can be extended to multiple waves using various concepts.Among these is the application of computational techniques that convert infection curves with negative gradients to those with positive gradients,in the neighbourhood of the change point,namely,where transition occurs from one wave to the next.This effectively generates a new wave.We then introduce a jump mechanism for the susceptible fraction,allowing further computation to align itself with the observed infection curve.To commence the process,we solved the system of governing ordinary differential equations for the period the epidemic spread without intervention and obtained values for the transmission,recovery and death rates that yielded the basic reproduction number,R_(0)=2.76,which is consistent with other related research.We then applied our model to COVID-19 in Kenya and the computation successfully replicated all the waves and also identified the change points located within the months when COVID-19 variants became dominant.The findings strengthen the proposition that the dominant COVID-19 variants were the major drivers of the waves.The techniques can be extended to new strains of COVID-19,influenza and other respiratory viruses.
基金supported by the National Natural Science Foundation of China(No.62373264)the Major Program of National Fund of Philosophy and Social Science of China(No.20&ZD112)the 111 Project under grant agreement B21044.
文摘In the early stage of an infectious disease outbreak,public health strategies tend to gravitate towards non-pharmaceutical interventions(NPIs)given the time required to develop targeted treatments and vaccines.One of the most common NPIs is Test-Trace-Isolate(TTI).One of the factors determining the effectiveness of TTI is the ability to identify contacts of infected individuals.In this study,we propose a multi-layer temporal contact network to model transmission dynamics and assess the impact of different TTI implementations,using SARS-CoV-2 as a case study.The model was used to evaluate TTI effectiveness both in containing an outbreak and mitigating the impact of an epidemic.We estimated that a TTI strategy based on home isolation and testing of both primary and secondary contacts can contain outbreaks only when the reproduction number is up to 1.3,at which the epidemic prevention potential is 88.2%(95%CI:87.9%e88.5%).On the other hand,for higher value of the reproduction number,TTI is estimated to noticeably mitigate disease burden but at high social costs(e.g.,over a month in isolation/quarantine per person for reproduction numbers of 1.7 or higher).We estimated that strategies considering quarantine of contacts have a larger epidemic prevention potential than strategies that either avoid tracing contacts or require contacts to be tested before isolation.Combining TTI with other social distancing measures can improve the likelihood of successfully containing an outbreak but the estimated epidemic prevention potential remains lower than 50%for reproduction numbers higher than 2.1.In conclusion,our model-based evaluation highlights the challenges of relying on TTIs to contain an outbreak of a novel pathogen with characteristics similar to SARS-CoV-2,and that the estimated effectiveness of TTI depends on the way contact patterns are modeled,supporting the relevance of obtaining comprehensive data on human social interactions to improve preparedness.
基金One of the authors(ABG)acknowledge the support,in part,of the Simons Foundation(Award#585022)the National Science Foundation(Award 1917512).
文摘Face mask use by the general public for limiting the spread of the COVID-19 pandemic is controversial,though increasingly recommended,and the potential of this intervention is not well understood.We develop a compartmental model for assessing the communitywide impact of mask use by the general,asymptomatic public,a portion of which may be asymptomatically infectious.Model simulations,using data relevant to COVID-19 dynamics in the US states of New York and Washington,suggest that broad adoption of even relatively ineffective face masks may meaningfully reduce community transmission of COVID-19 and decrease peak hospitalizations and deaths.Moreover,mask use decreases the effective transmission rate in nearly linear proportion to the product of mask effectiveness(as a fraction of potentially infectious contacts blocked)and coverage rate(as a fraction of the general population),while the impact on epidemiologic outcomes(death,hospitalizations)is highly nonlinear,indicating masks could synergize with other nonpharmaceutical measures.Notably,masks are found to be useful with respect to both preventing illness in healthy persons and preventing asymptomatic transmission.Hypothetical mask adoption scenarios,for Washington and New York state,suggest that immediate near universal(80%)adoption of moderately(50%)effective masks could prevent on the order of 17e45%of projected deaths over two months in New York,while decreasing the peak daily death rate by 34e58%,absent other changes in epidemic dynamics.Even very weak masks(20%effective)can still be useful if the underlying transmission rate is relatively low or decreasing:InWashington,where baseline transmission is much less intense,80%adoption of such masks could reduce mortality by 24e65%(and peak deaths 15e69%),compared to 2e9%mortality reduction in New York(peak death reduction 9e18%).Our results suggest use of face masks by the general public is potentially of high value in curtailing community transmission and the burden of the pandemic.The community-wide benefits are likely to be greatest when face masks are used in conjunction with other non-pharmaceutical practices(such as social-distancing),and when adoption is nearly universal(nation-wide)and compliance is high.
文摘Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2.Kenya reported its first case on March 13,2020 and by March 16,2020 she instituted physical distancing strategies to reduce transmission and flatten the epidemic curve.An age-structured compartmental model was developed to assess the impact of the strategies on COVID-19 severity and burden.Contacts between different ages are incorporated via contact matrices.Simulation results show that 45%reduction in contacts for 60-days period resulted to 11.5e13%reduction of infections severity and deaths,while for the 190-days period yielded 18.8e22.7%reduction.The peak of infections in the 60-days mitigation was higher and happened about 2 months after the relaxation of mitigation as compared to that of the 190-days mitigation,which happened a month after mitigations were relaxed.Low numbers of cases in children under 15 years was attributed to high number of asymptomatic cases.High numbers of cases are reported in the 15e29 years and 30e59 years age bands.Two mitigation periods,considered in the study,resulted to reductions in severe and critical cases,attack rates,hospital and ICU bed demands,as well as deaths,with the 190-days period giving higher reductions.
基金One of the authors(ABG)acknowledge the support,in part,of the Simons Foundation(Award#585022)the National Science Foundation(Award#1917512)CNN acknowledges the support of the Simons Foundation(Award#627346).
文摘The novel coronavirus(COVID-19)pandemic that emerged from Wuhan city in December 2019 overwhelmed health systems and paralyzed economies around the world.It became the most important public health challenge facing mankind since the 1918 Spanish flu pandemic.Various theoretical and empirical approaches have been designed and used to gain insight into the transmission dynamics and control of the pandemic.This study presents a primer for formulating,analysing and simulating mathematical models for understanding the dynamics of COVID-19.Specifically,we introduce simple compartmental,Kermack-McKendrick-type epidemic models with homogeneously-and heterogeneously-mixed populations,an endemic model for assessing the potential population-level impact of a hypothetical COVID-19 vaccine.We illustrate how some basic non-pharmaceutical interventions against COVID-19 can be incorporated into the epidemic model.A brief overview of other kinds of models that have been used to study the dynamics of COVID-19,such as agent-based,network and statistical models,is also presented.Possible extensions of the basic model,as well as open challenges associated with the formulation and theoretical analysis of models for COVID-19 dynamics,are suggested.
