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PURPOSE: Fifty percent of cranial CT scans performed achieve no benefit and entail risks. Our aim is to determine the yield of non-traumatic urgent cranial-CT and develop a pretest clinical probability scale approach. METHODS: Adult patients seen in our emergency department between 2017-2021 and referred for urgent cranial-CT for non-traumatic reasons were retrospectively recruited and randomly selected. Presenting complaint (PC), demographic variables, Relevant radiological findings (RRF) on the urgent cranial-CT and Relevant clinical-radiological findings (RCRF: admission need or RRF detection on the urgent cranial-CT or cranial CT/MRI in the following three months) were recruited. RESULTS: We recruited 702 patients, with median age 62 [47-76] years, 363 (51.7%) females. RCRF were observed in 404 (57.55%); of these, 352 (50.1%) required admission. RRF were detected in 190 (27.06%): 36 acute ischemic and 27 acute hemorrhagic lesions, 115 masses, 9 edema, and 27 hydrocephalus. Predictive PC for urgent cranial-CT were motor, speech, sensory deficits, sudden alteration of mental status, epileptic seizure, cognitive impairment, neurological symptoms in cancer patients, acute headache without a prior history and with meningeal signs; nausea, vomiting, or hypertensive crisis; visual deficits, and dizziness. This algorithm provided sensitivity, specificity, positive predictive value, and negative predictive value (NPV, 95%CI in brackets) of 92.1% (89-94.5%), 27.5% (22.5-33.0%), 63.3% (59.2-67.2%), and 71.9% (62.7-80.0%), to diagnose RCRF, and 97.4% (93.4-99.1%), 21.3% (17.8-25.1%), 31.5% (27.7-35.4%), and 95.6% (90.1-98.6%), to diagnose RRF. In patients not requiring admission (n = 350), the NPV for RRF was 98.8% (93.6-100%); the negative likelihood ratio 0.08 (0.01-0.57), and sensitivity remained at 97.8% (82.2-99.9%). Applying it would have avoided performing 85/350 urgent cranial-CT (24.29%). To find one RRF, we would have gone from performing 7.8 (350/45) to 5.9 (265/45) CTs, failing to diagnose 1/45 (2.2%) RRF. CONCLUSIONS: This proposed clinical scale could potentially decrease 24% of urgent cranial-CT.
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BACKGROUND: Studying transmission within the home is essential to understand the transmission dynamics of numerous infectious diseases. For Coronavirus Disease-2019 (COVID-19), transmission within the home constitutes the majority exposure context. The risk of infection in this setting can be quantified by the household/intra-family secondary attack rate (SAR). In the literature, there are discrepancies in these values and little information about its social determinants. The aim of this study was to investigate transmission in the home by analyzing the influence of occupational social class, country of origin and gender/sex. METHODS: This was a retrospective cohort study of a population registry of cohabiting contacts with COVID-19 cases diagnosed from 15 June to 23 December 2020, in the Murcia Region. The household SAR was analyzed considering the characteristics of the primary case (sex, age, symptoms, occupational social class, country of origin and number of people in the household) and contact (age and sex) using a multilevel binary logistic regression model. RESULTS: Among the 37 727 contacts included, the intra-family SAR was 39.1%. The contacts of confirmed primary cases in the migrant population (Africa and Latin America) had higher attack rates, even after adjusting for the other variables. Older age and female sex were independent risk factors for contracting Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) within the home. CONCLUSION: There was greater intra-domiciliary transmission among immigrants, likely related to the conditions of the home and situation of social vulnerability. Women were more likely to be infected by transmission from a cohabiting infected individual.
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COVID-19 , SARS-CoV-2 , Determinantes Sociales de la Salud , Humanos , COVID-19/transmisión , COVID-19/epidemiología , Masculino , Femenino , Adulto , Estudios Retrospectivos , Persona de Mediana Edad , Factores de Riesgo , Adolescente , Composición Familiar , Anciano , Adulto Joven , Factores Sexuales , Niño , España/epidemiología , PreescolarRESUMEN
Objetivo: La rápida progresión de la neumonía COVID-19 puede implicar la necesidad de recurrir a sistemas de respiración asistida, como la ventilación mecánica no invasiva o la intubación endotraqueal. La introducción de herramientas que detecten la neumonía COVID-19 puede mejorar la atención sanitaria de los pacientes. Nuestro objetivo es evaluar la eficacia y la eficiencia de la herramienta de inteligencia artificial (IA) Thoracic Care Suite de GE Healthcare (que incorpora Lunit Insight CXR) para predecir la necesidad de recurrir a la respiración asistida en función de la progresión de la neumonía en la COVID-19 en radiografías torácicas consecutivas. Métodos: Se incluyó a pacientes ambulatorios con infección por SARS-CoV-2 confirmada, con hallazgos probables o indeterminados de neumonía COVID-19 en la radiografía torácica (RXT) y que necesitaron una segunda RXT debido a la evolución clínica desfavorable. En las 2RXT se evaluaron el número de campos pulmonares afectados mediante la herramienta de IA. Resultados: Se incluyó a 114 pacientes (57,4±14,2 años; 65 de ellos varones, el 57%) de forma retrospectiva; 15 pacientes (el 13,2%) precisaron respiración asistida. La progresión de la diseminación neumónica ≥0,5 campos pulmonares al día en comparación con el inicio de la neumonía, detectada mediante la herramienta TCS, cuadruplicó el riesgo de precisar respiración asistida. El análisis de los resultados de IA precisó 26 segundos. Conclusiones: Aplicar la herramienta de IA, Thoracic Care Suite, a la RXT de pacientes con neumonía COVID-19 nos permite predecir la necesidad de recurrir a la respiración asistida en menos de medio minuto.(AU)
Objective: Rapid progression of COVID-19 pneumonia may put patients at risk of requiring ventilatory support, such as non-invasive mechanical ventilation or endotracheal intubation. Implementing tools that detect COVID-19 pneumonia can improve the patient's healthcare. We aim to evaluate the efficacy and efficiency of the artificial intelligence (AI) tool GE Healthcare's Thoracic Care Suite (featuring Lunit Insight CXR, TCS) to predict the ventilatory support need based on pneumonic progression of COVID-19 on consecutive chest X-rays. Methods: Outpatients with confirmed SARS-CoV-2 infection, with chest X-ray (CXR) findings probable or indeterminate for COVID-19 pneumonia, who required a second CXR due to unfavorable clinical course, were collected. The number of affected lung fields for the 2CXRs was assessed using the AI tool. Results: One hundred fourteen patients (57.4±14.2 years; 65 of them were men, 57%) were retrospectively collected; and 15 (13.2%) required ventilatory support. Progression of pneumonic extension ≥ 0.5 lung fields per day compared to pneumonia onset, detected using the TCS tool, increased the risk of requiring ventilatory support by 4-fold. Analyzing the AI output required 26seconds of radiological time. Conclusions: Applying the AI tool, Thoracic Care Suite, to CXR of patients with COVID-19 pneumonia allows us to anticipate ventilatory support requirements requiring less than half a minute.(AU)
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Humanos , Masculino , Femenino , Inteligencia Artificial , Neumonía/diagnóstico por imagen , /diagnóstico por imagen , Radiografía Torácica , Tecnología Biomédica , Atención Ambulatoria , Radiología , Servicio de Radiología en Hospital , TecnologíaRESUMEN
FUNDAMENTOS: El conocimiento de los determinantes sociales y de género que influyen en el ámbito de exposición al SARS-CoV-2 puede ser relevante en el planteamiento de estrategias preventivas y de control de la transmisión. No se han encontrado estudios previos que evalúen cómo influyen la clase social ocupacional y el país de origen en el ámbito de exposición del SARS-CoV-2. El objetivo de estetrabajo fue conocer el contexto en que se contagiaron los casos de COVID-19 (ámbito: hogar, trabajo, sanitario, sociosanitario y social-ocio) según país de origen, clase social ocupacional y género, lo cual es esencial para orientar estrategias de Salud Pública. MÉTODOS: Se realizó un estudio descriptivo de un registro epidemiológico de 56.628 casos incidentes de COVID-19 en los que seestudió el ámbito de exposición/contagio en función de las variables anteriormente indicadas entre el 15 de junio y el 23 de diciembre de 2020 en la Región de Murcia. Se utilizó una prueba exacta de Fisher para el estudio de la distribución de los casos de COVID-19 en función de las variables anteriores. RESULTADOS: La incidencia acumulada fue mayor en personas procedentes de África (5.133,5 casos por cada 100.000 habitantes) y Latinoamérica (11.351,1) que en no inmigrantes (3.145,7) y superior en mujeres (3.885,6) que en hombres (3.572,6). Es destacable que el 53,3% de los casos COVID-19 con empleo registrado eran operarios en industria o construcción, artesanos, trabajadores agrarios ocon ocupaciones elementales (15 de junio y el 23 de diciembre de 2020). En contraste, el 41,3% de la población ocupada en la Región de Murcia realizaba dichos empleos (promedio 3º y 4º trimestre de 2020). El hogar fue el principal ámbito de contagio (56,5% de los casos con ámbito conocido), seguido del social-ocio (20,7%) y el laboral (18,2%). Este último tuvo mayor peso en personas procedentes de África (28,4%) y Latinoamérica (35,7%) que en no inmigrantes (12%), a la inversa que el socialcio...(AU)
BACKGROUND: Knowledge of social and gender determinants, which influence the places where people are exposed to COVID-19, may be relevant in the development of preventive and control strategies. The aim of this paper was to determine the context in which COVID-19 cases were infected (household, work/labor, health, social-health, and social-leisure settings) according to country of origin, occupational social class and gender, which is essential in order to designing public health strategies.METHODS: A cross-sectional study of an epidemiological registry of 56,628 COVID-19 incident cases was made, whose exposure/contagion setting was studied according to the previous variables from June 15 to December 23, 2020, in the Region of Murcia (Spain). An exact Fisher test was used to study the distribution of COVID-19 cases based on the above variables.RESULTS: The cumulative incidence was higher in people from Africa (5,133.5 cases/100,000 inhabitants) and Latin America (11,351.1) than in non-immigrants (3,145.7). It was also higher in women (3,885.6) than in men (3,572.6). It is noteworthy, that 53.3% of the cases with employment were workers in industry or construction, artisans, agricultural workers, or elementary occupations. In contrast, during the second semester of 2020, 41.3% of the employed population in the Region of Murcia performed such jobs. The household was the main exposure setting (56.5% of cases with a known setting), followed by social-leisure (20.7%) and work/labor (18.2%). The labor settings were more important in immigrants from Africa (28.4%) and Latin America (35.7%) than in non-immigrants (12%), inversely to social-leisure settings. Labor context was more important in women (19.6%) than in men (16.5%) and in manual workers (44.1%) than in non-manual workers (26.6%)...(AU)
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Humanos , Masculino , Femenino , Infecciones por Coronavirus/epidemiología , Pandemias , Clase Social , Emigración e Inmigración , 50334 , Región Mediterránea , Epidemiología Descriptiva , EspañaRESUMEN
Fundamentos: Las desigualdades de género en salud han sido ampliamente documentadas. El principal objetivo es evaluar si existen diferencias de género en salud percibida y utilización de servicios sanitarios, y su relación con la doble carga de trabajo, en una muestra representativa de población inmigrante y autóctona de la Región de Murcia (RM). Métodos: Se utilizaron datos de la ENS 2006 y el Estudio Salud y Culturas, 1.303 inmigrantes y 1.303 españoles residentes en la RM. La combinación del trabajo reproductivo y remunerado se consideró «doble carga» (DC). Se estimó la razón de prevalencia (RP) de la percepción positiva de salud, morbilidad crónica, limitación de actividad, visitas al médico, hospitalización, visitas a urgencias y consumo de fármacos, en cada grupo de origen, mediante métodos de regresión. Se construyeron dos modelos, añadiendo el ajuste por DC al modelo ajustado por variables sociodemográficas. Se realizó análisis inter e intrasexo. Resultados: Al ajustar por DC no se observaron cambios en las diferencias entre sexos [RP mujeres/hombres de percepción positiva salud: 0,70 (0,54-0,89) europeos Este; 0,87 (0,79-0,95) autóctonos / morbilidad crónica: 1,44 (1,14-1,82) hispanoamericanos; 1,36 (1,19-1,55) autóctonos / limitación actividad: 2,23 (1,29-3,83) hispanoamericanos; 1,45 (1,01-2,10) autóctonos / consulta médico: 1,93 (1,50-2,48) hispanoamericanos; 1,74 (1,06-2,86) marroquíes; 1,32 (1,09-1,59) autóctonos / hospitalización: 1,80 (1,02-3,17) hispanoamericanos], casi los mismos que sin ajustar. Las mujeres consumieron más fármacos que los hombres. Entre sexos, hombres (1,19; 1,06-1,33) y mujeres (1,18; 1,01-1,40) de la RM con DC compartida declararon mayor percepción positiva de salud que aquellos sin DC; hombres hispanoamericanos con DC sin ayuda: 0,67 (0,47-0,94). Conclusiones: Las mujeres presentan peores indicadores de salud y mayor uso de servicios sanitarios independientemente del origen. La doble carga no modifica las desigualdades de género en salud(AU)
Background: Gender inequalities in health have been largely documented. The main objective of this study is to assess whether there are gender differences in perceived health and health services utilization, and their relation with double workload in a representative sample of immigrants and Murcian natives. Methods: We used data from the NHS 2006 and Health and Culture Study, 1,303 immigrants and 1,303 Spanish, both residents in the Region of Murcia. With the combination of reproductive work and paid work we built up the variable double workload (DW). We estimated the prevalence ratio (PR) for positive self-perceived health, chronic morbidity, activity limitation, doctors visits, hospitalization, emergency and drug use, by origin, using regression methods. Two models were constructed by adding double burden to the basic model adjusted by sociodemographic variables. Analyses were performed between and within sex. Results: After adjusting for DW, no changes were seen in the differences by gender [RP women/men of positive perception health: 0.70 (0.54-0.89) East European; 0.87 (0.79-0.95) autochthonous / chronic morbidity: 1.44 (1.14-1.82) Hispanic; 1.36 (1.19-1.55) autochthonous / activity limitation: 2.23 (1.29-3.83) Hispanic; 1.45 (1.01-2.10) autochthonous / doctors visits: 1.93 (1.50-2.48) Hispanic; 1.74 (1.06-2.86) Moroccan; 1.32 (1.09-1.59) autochthonous / hospitalization: 1.80 (1.02-3.17) Hispanic], almost the same than unadjusted. Women used more drugs than men. Within sexes, both autochthonous men (1.19; 1.06-1.33) and women (1.18; 1.01-1.40) with shared DW had more positive self-perceived health than those without DW. Hispanic men with DW without assistance: 0.67 (0.47-0.94). Conclusions: Women have worse health indicators and greater use of health services regardless of origin. Consideration of the double workload does not explain gender inequalities in health(AU)