RESUMO
We investigated SARS-CoV-2 transmission dynamics in Italy, one of the countries hit hardest by the pandemic, using phylodynamic analysis of viral genetic and epidemiological data. We observed the co-circulation of multiple SARS-CoV-2 lineages over time, which were linked to multiple importations and characterized by large transmission clusters concomitant with a high number of infections. Subsequent implementation of a three-phase nationwide lockdown strategy greatly reduced infection numbers and hospitalizations. Yet we present evidence of sustained viral spread among sporadic clusters acting as "hidden reservoirs" during summer 2020. Mathematical modelling shows that increased mobility among residents eventually catalyzed the coalescence of such clusters, thus driving up the number of infections and initiating a new epidemic wave. Our results suggest that the efficacy of public health interventions is, ultimately, limited by the size and structure of epidemic reservoirs, which may warrant prioritization during vaccine deployment.
Assuntos
COVID-19/transmissão , Controle de Doenças Transmissíveis/métodos , Genoma Viral/genética , Mutação , Saúde Pública/métodos , SARS-CoV-2/genética , COVID-19/epidemiologia , COVID-19/virologia , Geografia , Humanos , Itália/epidemiologia , Pandemias , Filogenia , Saúde Pública/tendências , SARS-CoV-2/classificação , SARS-CoV-2/fisiologiaRESUMO
In the present article, we introduce an ethical evaluation methodology for clinical cases. Although rejecting proceduralism as a system, we develop a procedure that eventually could be formalized as a flow chart to help carry out an ethical evaluation for clinical cases. We clarify the elements that constitute an ethical evaluation: aim (patient's health), integration (action interconnections), and how the action is performed. We leave aside the aspect of intentions, focusing on the object of a medical action, arguing that the internal aim of a clinical action carries a moral value per se. Our evaluation system takes into account only objects and circumstances and their intrinsic morality, since we are dealing with the evaluation of a clinical case, and not with a personal and complete clinical action.
En el presente artículo se introduce una metodología de evaluación ética de los casos clínicos. Aunque se rechaza el procedimentalismo como sistema, se ha desarrollado un procedimiento que podría llegar a ser formalizado como un diagrama de flujo para ayudar a llevar a cabo una evaluación ética de los casos clínicos. Se aclaran los elementos que constituyen una evaluación ética: el objetivo (la salud del paciente), la integración de interconexiones (acción) y cómo se realiza la acción. Se dejan a un lado las intenciones para centrarse en el objeto de una acción médica; se argumenta que el objetivo interno de una acción clínica tiene un valor moral en sí. El sistema de evaluación tiene en cuenta solamente los objetos y las circunstancias y su moral intrínseca, ya que se trata de la evaluación de un caso clínico, y no de una acción clínica personal y completa.
No presente artigo, introduz-se uma metodologia de avaliação ética dos casos clínicos. Embora rejeitemos o procedimentalismo como sistema, desenvolvemos um procedimento que poderia chegar a ser formalizado como um diagrama de fluxo para ajudar a realizar uma avaliação ética dos casos clínicos. Esclarecemos os elementos que constituem uma avaliação ética: o objetivo (a saúde do paciente), a integração de interconexões (ação) e como se realiza a ação. Deixamos de lado o aspecto das intenções e centralizamo-nos no objeto de uma ação médica, argumentando que o objetivo interno de uma ação clínica tem um valor moral em si. Nosso sistema de avaliação considera somente os objetos e as circunstâncias e sua moral intrínseca, visto que se trata da avaliação de um caso clínico, e não de uma ação clínica pessoal e completa.
Assuntos
Humanos , Saúde , Metodologia como Assunto , Ética , Jurisprudência , Princípios MoraisRESUMO
We performed a multicenter comparative survey on undergraduate medical education regarding the care of dying patients at medical schools in three countries. We enrolled 380 first- and sixth-year medical students from Universidad Austral (Argentina), Universidad de Navarra (Spain), and Università Campus Biomedico di Roma (Italy). Answers to the questions were similar among the three universities. Students acknowledged interacting directly with dying patients in all cases. Attitudes toward dying patients were highly positive. Students spontaneously requested more training in end-of-life care. Some attitudes and wishes varied significantly from course to course. Students perceived that this issue received more attention in humanistic rather than in clinical subjects. Ninety-eight percent of students considered that death and helping patients to have a good death should be included in their training. Students' attitudes revealed high interest and poor training in end-of-life issues. Medical curricula should be improved to adequately address these issues.