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          ABSTRACT Objective: To analyze the epidemiological transition of fractures in patients who were treated in a tertiary hospital which is reference in traumatology during the COVID-19 pandemic to assess the changes in trauma service. Methods: This is a retrospective and descriptive analysis of data on orthopedics lesions treated at Instituto Doutor Jose Frota between December 16, 2019 and June 16, 2020 (three months before and after the first case of COVID-19 in Ceará). Results: In total, we evaluated 913 patients, 28.5% of which were women and 71.5%, men. We found a significative reduction (p < 0.05) in the proportion of female patients operated in the analyzed time. We also observed an increase in patients’ mean age, 35.4 years before the pandemic, and 38.48 (p = 0.04) during the consecutive period. Trauma mechanisms significantly changed (p < 0.05), with a proportional increase of high-energy traumas and reduction of instances of falling. We found a 11.9% reduction in orthopedic surgeries, from 655 to 577 at the time after the first case of COVID-19 (p = 0.071). Mean hospitalization length (p < 0.001) and time until surgeries decreased (p < 0.001). Conclusion: We observed the impact of lockdown in this hospital of trauma especially via the decreased number of operated cases and the change in patients’ profile and trauma mechanism. Level of Evidence III, Retrospective Comparative Study.

          Translated abstract

          RESUMO Objetivo: Analisar a transição do perfil epidemiológico de fraturas de pacientes atendidos em um hospital terciário referência em traumatologia durante a pandemia de COVID-19, a fim de verificar mudanças no atendimento traumatológico. Métodos: Análise retrospectiva e descritiva dos dados de lesões ortopédicas admitidas no Instituto Doutor José Frota entre 16 de dezembro de 2019 e 16 de junho de 2020 (três meses antes e depois do primeiro caso de COVID-19 no Ceará). Resultados: Dos 913 pacientes avaliados, 28,5% eram mulheres e 71,5% homens. Houve redução significativa (p < 0,05) nas proporções de mulheres operadas no tempo analisado. Houve aumento na média da idade, sendo 35,40 anos pré-pandemia, e 38,48 (p = 0,04) no período seguinte. Os mecanismos de trauma mudaram significativamente (p < 0,05), com aumento proporcional de fraturas por alta energia e redução no número daquelas por queda ao solo. A quantidade de cirurgias ortopédicas reduziu em 11,9%, de 655 antes do primeiro caso de COVID-19 para 577 posteriormente (p = 0,071). A média do número de dias diminuiu para duração do internamento (p < 0,001) e para o tempo até a realização da cirurgia (p < 0,001). Conclusão: O impacto do lockdown neste hospital de trauma se deu principalmente pela diminuição na quantidade de casos operados e pela mudança do perfil e mecanismo de trauma dos pacientes. Nível de Evidência III, Estudo Retrospectivo Comparativo.

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          Changes in contact patterns shape the dynamics of the COVID-19 outbreak in China

          Intense non-pharmaceutical interventions were put in place in China to stop transmission of the novel coronavirus disease (COVID-19). As transmission intensifies in other countries, the interplay between age, contact patterns, social distancing, susceptibility to infection, and COVID-19 dynamics remains unclear. To answer these questions, we analyze contact surveys data for Wuhan and Shanghai before and during the outbreak and contact tracing information from Hunan Province. Daily contacts were reduced 7-8-fold during the COVID-19 social distancing period, with most interactions restricted to the household. We find that children 0-14 years are less susceptible to SARS-CoV-2 infection than adults 15-64 years of age (odd ratio 0.34, 95%CI 0.24-0.49), while in contrast, individuals over 65 years are more susceptible to infection (odd ratio 1.47, 95%CI: 1.12-1.92). Based on these data, we build a transmission model to study the impact of social distancing and school closure on transmission. We find that social distancing alone, as implemented in China during the outbreak, is sufficient to control COVID-19. While proactive school closures cannot interrupt transmission on their own, they can reduce peak incidence by 40-60% and delay the epidemic.
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            Variation in volumes and characteristics of trauma patients admitted to a level one trauma centre during national level 4 lockdown for COVID-19 in New Zealand.

            The aims of this study were to describe the variation in volumes and types of injuries admitted to a level one trauma centre in New Zealand over two 14-day periods before and during the national level 4 lockdown for COVID-19; and highlight communities at risk of preventable injury that may impact negatively on hospital resources.
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              Mask or no mask for COVID-19: A public health and market study

              Efficient strategies to contain the coronavirus disease 2019 (COVID-19) pandemic are peremptory to relieve the negatively impacted public health and global economy, with the full scope yet to unfold. In the absence of highly effective drugs, vaccines, and abundant medical resources, many measures are used to manage the infection rate and avoid exhausting limited hospital resources. Wearing masks is among the non-pharmaceutical intervention (NPI) measures that could be effectively implemented at a minimum cost and without dramatically disrupting social practices. The mask-wearing guidelines vary significantly across countries. Regardless of the debates in the medical community and the global mask production shortage, more countries and regions are moving forward with recommendations or mandates to wear masks in public. Our study combines mathematical modeling and existing scientific evidence to evaluate the potential impact of the utilization of normal medical masks in public to combat the COVID-19 pandemic. We consider three key factors that contribute to the effectiveness of wearing a quality mask in reducing the transmission risk, including the mask aerosol reduction rate, mask population coverage, and mask availability. We first simulate the impact of these three factors on the virus reproduction number and infection attack rate in a general population. Using the intervened viral transmission route by wearing a mask, we further model the impact of mask-wearing on the epidemic curve with increasing mask awareness and availability. Our study indicates that wearing a face mask can be effectively combined with social distancing to flatten the epidemic curve. Wearing a mask presents a rational way to implement as an NPI to combat COVID-19. We recognize our study provides a projection based only on currently available data and estimates potential probabilities. As such, our model warrants further validation studies.

                Author and article information

                Acta Ortopédica Brasileira
                Acta ortop. bras.
                ATHA EDITORA (São Paulo, SP, Brazil )
                : 30
                : 5
                : e252472
                [3] Fortaleza Ceará orgnameUniversidade Federal do Ceará orgdiv1Faculty of Medicine Brazil
                [4] Fortaleza Ceará orgnameCentro Universitário Christus orgdiv1Department of Odontology Brazil
                [2] Fortaleza Ceará orgnameHospital Geral de Fortaleza orgdiv1Department of Orthopedic Surgery and Traumatology Brazil
                [1] Fortaleza CE orgnameInstituto Doutor José Frota orgdiv1Department of Orthopedic Surgery and Traumatology Brazil
                S1413-78522022002500211 S1413-7852(22)03000500211

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                : 22 May 2021
                : 12 August 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 25, Pages: 0

                SciELO Brazil

                Original Article

                COVID-19,Traumatology,Fractures,Bone,Epidemiology,Traumatologia,Fraturas Ósseas,Epidemiologia


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