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1.
Transl Psychiatry ; 10(1): 339, 2020 10 06.
Artículo en Inglés | MEDLINE | ID: mdl-33024072

RESUMEN

There were several studies about the psychiatric and mental health issues related to the severe adult respiratory syndrome (SARS) outbreak in 2003, however, the association between SARS and the overall risk of psychiatric disorders and suicides has, as yet, to be studied in Taiwan. The aim of this study is to examine as to whether SARS is associated with the risk of psychiatric disorders and suicide. A total of 285 patients with SARS and 2850 controls without SARS (1:10) matched for sex, age, insurance premium, comorbidities, residential regions, level of medical care, and index date were selected between February 25 and June 15, 2003 from the Inpatient Database Taiwan's National Health Insurance Research Database. During the 12-year follow-up, in which 79 in the SARS cohort and 340 in the control group developed psychiatric disorders or suicide (4047.41 vs. 1535.32 per 100,000 person-years). Fine and Gray's survival analysis revealed that the SARS cohort was associated with an increased risk of psychiatric disorders and suicide, and the adjusted subdistribution HR (sHR) was 2.805 (95% CI: 2.182-3.605, p < 0.001) for psychiatric disorders and suicide. The SARS cohort was associated with anxiety, depression, sleep disorders, posttraumatic stress disorder/acute stress disorder (PTSD/ASD), and suicide. The sensitivity analysis revealed that the SARS group was associated with anxiety, depression, sleep disorders, PTSD/ASD, and suicide after the individuals with a diagnosis of psychiatric disorders and suicide were excluded within the first year, and with anxiety, depression, and sleep disorders, while those in the first five years were excluded. In conclusion, SARS was associated with the increased risk of psychiatric disorders and suicide.


Asunto(s)
Infecciones por Coronavirus , Trastornos Mentales , Salud Mental/estadística & datos numéricos , Pandemias , Neumonía Viral , Síndrome Respiratorio Agudo Grave , Suicidio/estadística & datos numéricos , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Bases de Datos Factuales , Femenino , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Trastornos Mentales/virología , Persona de Mediana Edad , Pandemias/prevención & control , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Medición de Riesgo , Factores de Riesgo , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/psicología , Síndrome Respiratorio Agudo Grave/terapia , Taiwán/epidemiología
2.
Medicine (Baltimore) ; 99(40): e22547, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019465

RESUMEN

BACKGROUND: chronic low back pain (CLBP) are common symptoms bothering people in daily life. Traditional Chinese medicine (TCM) nonpharmacological interventions are gaining an increasing popularity for CLBP. Nevertheless, the evidence of efficacy and safety of random controlled trials (RCTs) remains controversial. This study aims to evaluate the efficacy and acceptability of different TCM nonpharmacological therapies by systematic review and network meta-analysis. METHODS: According to the strategy, The authors will retrieve a total of 7 electronic databases by September 2020, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chongqing VIP, and Wan-fang databases After a series of screening, 2 researchers will use Aggregate Data Drug Information System and Stata software to analyze the data extracted from the randomized controlled trials of TCM nonpharmacological interventions for CLBP. The primary outcome will be the improvement of Pain intensity and functional status/disability and the secondary outcomes will include lobal improvement, health-related quality of life, satisfaction with treatment, and adverse events. Both classical meta-analysis and network meta-analysis will be implemented to investigate direct and indirect evidences on this topic. The quality of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation instrument. RESULTS: This study will provide a reliable evidence for the selection of TCM nonpharmacological therapies in the treatment of CLBP. CONCLUSION: This study will generate evidence for different TCM nonpharmacological therapies for CLBP and provide a decision-making reference for clinical research. ETHICS AND DISSEMINATION: This study does not require ethical approval. The results will be disseminated through a peer-reviewed publication. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/4H3Y9.


Asunto(s)
Dolor de la Región Lumbar/terapia , Medicina China Tradicional/métodos , Metaanálisis en Red , Acupresión/métodos , Terapia por Acupuntura/métodos , Toma de Decisiones Clínicas , Terapia con Ventosas/métodos , Bases de Datos Factuales , Humanos , Dolor de la Región Lumbar/psicología , Medicina China Tradicional/efectos adversos , Medicina China Tradicional/tendencias , Moxibustión/métodos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Seguridad , Tai Ji/métodos , Resultado del Tratamiento
3.
Medicine (Baltimore) ; 99(40): e22623, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019485

RESUMEN

PURPOSE: To identify the 100 most cited research articles on cervical cancer radiotherapy. METHODS: The Web of Science and Scopus databases were searched to identify the 100 most cited articles on cervical cancer radiotherapy as of September 29, 2019. Articles were ranked based on the total citations received from 2 databases. One hundred articles about radiotherapy for cervical cancer were identified. The following important information was extracted: author, journal, year and month of publication, country or region, and radiotherapy technologies. RESULTS: The 100 most cited articles on cervical cancer radiotherapy were published between 1964 and 2016, and the total citations from 2 databases ranged from 3478 to 211, including a total of 49,262 citations as of September 29, 2019. The index of citations per year ranged from 170.4 to 13.1. These articles were from 16 countries or regions, with most publications being from the United States (n = 38), followed by Austria (n = 15), Canada (n = 8), France (n = 8) and the United Kingdom (n = 7). The International Journal of Radiation Oncology, Biology, Physics produced the most articles (n = 42), followed by Radiotherapy and Oncology (n = 13), Cancer (n = 8) and Journal of Clinical Oncology (n = 7). These articles were categorized as original studies (n = 86), recommendations (n = 5), guidelines (n = 5) and reviews (n = 4). Of the 100 most cited articles, intracavitary brachytherapy (n = 50) and 3-dimensional conformal radiotherapy (n = 34) were the most commonly used treatment techniques. CONCLUSION: To the best of our knowledge, this is the first report and analysis of the most cited articles on cervical cancer radiotherapy. This bibliographic study presents the history of technological development in external radiation therapy and brachytherapy. Brachytherapy is an indispensable part of radiotherapy for cervical cancer. The International Journal of Radiation Oncology Biology Physics is the journal with the most publications related to cervical cancer radiotherapy.


Asunto(s)
Braquiterapia/métodos , Publicaciones/estadística & datos numéricos , Neoplasias del Cuello Uterino/radioterapia , Austria/epidemiología , Bibliometría , Biología/estadística & datos numéricos , Canadá/epidemiología , Bases de Datos Factuales , Femenino , Francia/epidemiología , Humanos , Oncología Médica/estadística & datos numéricos , Persona de Mediana Edad , Física/estadística & datos numéricos , Publicaciones/tendencias , Oncología por Radiación/estadística & datos numéricos , Reino Unido/epidemiología , Estados Unidos/epidemiología
4.
BMJ Open Respir Res ; 7(1)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33020114

RESUMEN

INTRODUCTION: Smoking causes inflammation of the lung epithelium by releasing cytokines and impairing mucociliary clearance. Some studies have linked smoking with severity of illness of COVID-19 whereas others have found no such association. METHODS: This was a retrospective analysis of all adults hospitalised with COVID-19 from 9 March to 18 May 2020. RESULTS: 1173 patients met the study criteria. 837 patients never smoked whereas 336 patients were either current smokers or past smoker and were grouped together in smokers group. Patients in smokers group were more likely to be male and had higher incidence of underlying chronic obstructive pulmonary disease (19% vs 6%, p<0.001), HIV infection (11% vs 5%,p<0.001), cancer (11% vs 6%, p=0.005), congestive heart failure (15% vs 8%, p<0.001), coronary artery disease (15% vs 9%, p=0.3), chronic kidney disease (11% vs 8%, p=0.037) and end-stage renal disease (10% vs 6%, p=0.009) compared with non-smokers. Outcome analysis showed that smokers were more likely to develop critical illness requiring mechanical ventilation (47% vs 37% p=0.005). Univariate Cox model for survival analysis by smoking status showed that among smokers only current smokers had higher risk of death compared with never smokers (HR 1.61, 95% CI 1.22 to 2.12, p<0.001). In the multivariate approach, Cox model for the survival, female sex, young age, low serum lactate dehydrogenase and systemic steroid use were associated with overall improved survival. CONCLUSION: In our large single-centre retrospective database of patients hospitalised with COVID-19, smoking was associated with development of critical illness and higher likelihood of death.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Pacientes Internos/estadística & datos numéricos , Evaluación del Resultado de la Atención al Paciente , Neumonía Viral/epidemiología , Respiración Artificial/estadística & datos numéricos , Fumar/epidemiología , Anciano , Bases de Datos Factuales , Femenino , Hospitalización , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Pandemias , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Análisis de Supervivencia
5.
J Drugs Dermatol ; 19(10): 960-967, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33026775

RESUMEN

BACKGROUND: Growing evidence suggests a possible sex disparity in COVID-19 disease related outcomes. OBJECTIVE: To explore the sex disparity in COVID-19 cases and outcomes using New York City (NYC) population level data. SETTING: NYC surveillance data from February 29 to June 12, 2020. PARTICIPANTS: Individuals tested for COVID-19 in metropolitan NYC.Outcome Measurements and Statistical Analysis: Outcomes of interest included rates of COVID-19 case positivity, hospitalization and death. Relative risks and case fatality rates were computed for all outcomes based on sex and were stratified by age groups. RESULTS AND LIMITATIONS: 911,310 individuals were included, of whom 434,273 (47.65%) were male and 477,037 (52.35%) were female. Men represented the majority of positive cases (n=106,275, 51.36%), a majority of hospitalizations (n=29,847, 56.44%), and a majority of deaths (n=13,054, 59.23%). Following population level adjustments for age and sex, testing rates of men and women were equivalent. The majority of positive cases and hospitalizations occurred in men for all age groups except age >75 years, and death was more likely in men of all age groups. Men were at a statistically significant greater relative risk of case positivity, hospitalization, and death across all age groups except those <18 years of age. The most significant difference for case positivity was observed in the 65–74 age group (RR 1.22, 95%CI 1.19–1.24), for hospitalization in the 45–65 age group (RR 1.85, 95% 1.80–1.90), and for death in the 18–44 age group (RR 3.30, 95% CI 2.82–3.87). Case fatality rates were greater for men in all age-matched comparisons to women. Limitations include the use of an evolving surveillance data set and absence of further demographic characteristics such as ethnographic data. CONCLUSION: Men have higher rates of COVID-19 positivity, hospitalization, and death despite greater testing of women; this trend remains after stratification by age. J Drugs Dermatol. 2020;19(10):960-967. doi:10.36849/JDD.2020.5590.


Asunto(s)
Causas de Muerte , Infecciones por Coronavirus/epidemiología , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Adulto , Anciano , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Estudios de Cohortes , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Bases de Datos Factuales , Femenino , Mortalidad Hospitalaria/tendencias , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Evaluación de Resultado en la Atención de Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales
6.
Infect Dis Poverty ; 9(1): 139, 2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028400

RESUMEN

BACKGROUND: Health workers (HWs) are at increased risk for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection and a possible source of nosocomial transmission clusters. Despite the increased risk, the best surveillance strategy and management of exposed HWs are not yet well known. The aim of this review was to summarize and critically analyze the existing evidence related to this topic in order to support public health strategies aimed at protecting HWs in the hospital setting. MAIN TEXT: A comprehensive computerized literature research from 1 January 2020 up to 22 May 2020 was made to identify studies analyzing the burden of infection, risk assessment, surveillance and management of HWs exposed to SARS-CoV-2. Among 1623 citation identified using MEDLINE, Embase, Google Scholar and manual search, we included 43 studies, 14 webpages and 5 ongoing trials. Health workers have a high risk of acquiring infection while caring for coronavirus disease 2019 (COVID-19) patients. In particular, some types exposures and their duration, as well as the inadequate or non-use of personal protective equipment (PPE) are associated with increased infection risk. Strict infection prevention and control procedures (IPC), adequate training programs on the appropriate use of PPE and close monitoring of HWs with symptom surveillance and testing are essential to significantly reduce the risk. At the moment there is not enough evidence to provide precise indications regarding pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). CONCLUSIONS: During the spread of COVID-19 outbreak, numerous published papers investigated the epidemiology, risk assessment and prevention and control of SARS-CoV-2. However, more high-quality studies are needed to provide valid recommendations for better management and for the clinical and microbiological surveillance of healthcare personnel.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Personal de Salud/estadística & datos numéricos , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Bases de Datos Factuales , Manejo de la Enfermedad , Monitoreo Epidemiológico , Hospitales , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Profilaxis Posexposición , Vigilancia en Salud Pública , Medición de Riesgo/métodos , Factores de Riesgo
7.
Zootaxa ; 4852(2): zootaxa.4852.2.1, 2020 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-33056421

RESUMEN

We describe four new species of the diving beetle genus Liodessus Guignot from the high Andean regions of Peru: Liodessus alpinus sp. nov. from Junín, L. hauthi sp. nov. from Huánuco and Churubamba, L. rhigos sp. nov. from Junín, and L. thespesios sp. nov. from Cusco. We delineate the species using morphological structures and provide a 5' mitochondrial cytochrome c oxidase 1 database on the Barcode of Life Data System (BOLD). We also provide taxonomic notes on Liodessus acollensis Guignot, 1955 and L. andinus Guignot, 1957, described from the high Andes of Peru and Bolivia. These species occur at higher altitudes above 3,400 m and up to 4,900 m, and were collected in shallow, exposed peatland pools and puddles, mostly in steppes and high Andean Puna. The known distribution and habitat preferences of each species are outlined briefly.


Asunto(s)
Escarabajos , Animales , Bases de Datos Factuales , Ecosistema , Perú
8.
Nat Commun ; 11(1): 4961, 2020 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-32999287

RESUMEN

The ongoing coronavirus disease 2019 (COVID-19) pandemic has heightened discussion of the use of mobile phone data in outbreak response. Mobile phone data have been proposed to monitor effectiveness of non-pharmaceutical interventions, to assess potential drivers of spatiotemporal spread, and to support contact tracing efforts. While these data may be an important part of COVID-19 response, their use must be considered alongside a careful understanding of the behaviors and populations they capture. Here, we review the different applications for mobile phone data in guiding and evaluating COVID-19 response, the relevance of these applications for infectious disease transmission and control, and potential sources and implications of selection bias in mobile phone data. We also discuss best practices and potential pitfalls for directly integrating the collection, analysis, and interpretation of these data into public health decision making.


Asunto(s)
Teléfono Celular , Infecciones por Coronavirus/epidemiología , Aplicaciones Móviles , Pandemias , Neumonía Viral/epidemiología , Conducta , Betacoronavirus , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Bases de Datos Factuales , Toma de Decisiones , Humanos , Control de Infecciones/métodos , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Salud Pública , Factores de Riesgo
9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1568-1571, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33018292

RESUMEN

There is growing evidence that the use of stringent and dichotomic diagnostic categories in many medical disciplines (particularly 'brain sciences' as neurology and psychiatry) is an oversimplification. Although clear diagnostic boundaries remain useful for patients, families, and their access to dedicated NHS and health care services, the traditional dichotomic categories are not helpful to describe the complexity and large heterogeneity of symptoms across many and overlapping clinical phenotypes. With the advent of 'big' multimodal neuroimaging databases, data-driven stratification of the wide spectrum of healthy human physiology or disease based on neuroimages is theoretically become possible. However, this conceptual framework is hampered by severe computational constraints. In this paper we present a novel, deep learning based encode-decode architecture which leverages several parameter efficiency techniques generate latent deep embedding which compress the information contained in a full 3D neuroimaging volume by a factor 1000 while still retaining anatomical detail and hence rendering the subsequent stratification problem tractable. We train our architecture on 1003 brain scan derived from the human connectome project and demonstrate the faithfulness of the obtained reconstructions. Further, we employ a data driven clustering technique driven by a grid search in hyperparameter space to identify six different strata within the 1003 healthy community dwelling individuals which turn out to correspond to highly significant group differences in both physiological and cognitive data. Indicating that the well-known relationships between such variables and brain structure can be probed in an unsupervised manner through our novel architecture and pipeline. This opens the door to a variety of previously inaccessible applications in the realm of data driven stratification of large cohorts based on neuroimaging data.Clinical Relevance -With our approach, each person can be described and classified within a multi-dimensional space of data, where they are uniquely classified according to their individual anatomy, physiology and disease-related anatomical and physiological alterations.


Asunto(s)
Conectoma , Aprendizaje Profundo , Neuroimagen , Encéfalo , Análisis por Conglomerados , Bases de Datos Factuales , Humanos
10.
Medicine (Baltimore) ; 99(40): e22441, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019427

RESUMEN

It has been suggested that herpes zoster may increase the risk of subsequent prostate cancer (PCa). We aimed to assess the risk of PCa following herpes zoster by the population-based follow-up study.This is a retrospective study and data are from the Taiwan National Health Insurance Research Database (NHIRD). The study cohort comprised all patients with a diagnosis of herpes zoster (International Classification of Diseases, 9th Revision, Clinical Modification code 053.0-053.9) and followed for PCa from 1997 to 2013 (n = 11,376). Subjects younger than 20 years of age were excluded. The match-control cohort was identified from the Registry of Beneficiaries of the NHIRD and randomly selected by matching with the study cohort at a 3:1 ratio based on age (every 5-year span), and year of herpes zoster diagnosis (n = 34,128). We used Cox proportional hazards regression models to estimate the hazard ratios (HRs) for subsequent PCa, after controlling for potential cormobidities.Men with and without herpes zoster had similar age and comorbidity distributions. Among the 45,504 sampled patients, 1011 (2.22%) developed PCa during the 10 years of follow-up, 276 (2.43%) from the study cohort and 735 (2.15%) from the match-control cohort and the incidence rate was 3.13 and 2.72 per 1000 person years respectively. Patients with herpes zoster were more likely to develop PCa than patients in the match-control cohort (HR = 1.15; 95% confidence interval (CI) = 1.00-1.32, P value = .045). After adjusting for age and comorbidities, herpes zoster was associated with a 1.15 increased risk of PCa (adjusted HR = 1.15, 95% CI = 0.99-1.32, P value = .054).Our study indicates that preceding herpes zoster infection is a suggestive risk marker for subsequent PCa after controlling for potential confounders. Further prospective studies are needed to determine the relationship between herpes zoster and PCa.


Asunto(s)
Herpes Zóster/epidemiología , Neoplasias de la Próstata/epidemiología , Adulto , Anciano , Estudios de Casos y Controles , Causalidad , Bases de Datos Factuales , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Taiwán/epidemiología
12.
BMJ ; 370: m3342, 2020 09 23.
Artículo en Inglés | MEDLINE | ID: mdl-32967856

RESUMEN

OBJECTIVE: To compare the risk of cardiovascular events between sodium glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors among people with type 2 diabetes in a real world context of clinical practice. DESIGN: Multi-database retrospective cohort study using a prevalent new user design with subsequent meta-analysis. SETTING: Canadian Network for Observational Drug Effect Studies (CNODES), with administrative healthcare databases from seven Canadian provinces and the United Kingdom, 2013-18. POPULATION: 209 867 new users of a SGLT2 inhibitor matched to 209 867 users of a DPP-4 inhibitor on time conditional propensity score and followed for a mean of 0.9 years. MAIN OUTCOME MEASURES: The primary outcome was major adverse cardiovascular events (MACE, a composite of myocardial infarction, ischaemic stroke, or cardiovascular death). Secondary outcomes were the individual components of MACE, heart failure, and all cause mortality. Cox proportional hazards models were used to estimate site specific adjusted hazards ratios and 95% confidence intervals, comparing use of SGLT2 inhibitors with use of DPP-4 inhibitors in an as treated approach. Site specific results were pooled using random effects meta-analysis. RESULTS: Compared with DPP-4 inhibitors, SGLT2 inhibitors were associated with decreased risks of MACE (incidence rate per 1000 person years: 11.4 v 16.5; hazard ratio 0.76, 95% confidence interval 0.69 to 0.84), myocardial infarction (5.1 v 6.4; 0.82, 0.70 to 0.96), cardiovascular death (3.9 v 7.7; 0.60, 0.54 to 0.67), heart failure (3.1 v 7.7; 0.43, 0.37 to 0.51), and all cause mortality (8.7 v 17.3; 0.60, 0.54 to 0.67). SGLT2 inhibitors had more modest benefits for ischaemic stroke (2.6 v 3.5; 0.85, 0.72 to 1.01). Similar benefits for MACE were observed with canagliflozin (0.79, 0.66 to 0.94), dapagliflozin (0.73, 0.63 to 0.85), and empagliflozin (0.77, 0.68 to 0.87). CONCLUSIONS: In this large observational study conducted in a real world clinical practice context, the short term use of SGLT2 inhibitors was associated with a decreased risk of cardiovascular events compared with the use of DPP-4 inhibitors. TRIAL REGISTRATION: ClinicalTrials.gov NCT03939624.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Canadá , Bases de Datos Factuales , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Reino Unido , Adulto Joven
13.
Medicine (Baltimore) ; 99(33): e21676, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-32872035

RESUMEN

Hip fractures in older patients requiring dialysis are associated with high mortality. The primary aim of this study was to evaluate the specific burden of dialysis on 30-day mortality following hip fracture surgery. The secondary aim was to determine the burden of dialysis on overall survival as well as several postoperative complications.A retrospective cohort study was conducted using data from the Korean National Health Insurance Research Database. Patients were aged ≥65 years and underwent hip fracture surgery during the period from 2009 to 2015. To construct a matched cohort, each dialysis patient was matched to 4 non-dialysis patients based on age, sex, hospital type, anesthesia type, and comorbidities. Survival status was determined 30 days after surgery and at the end of the study period.In total, 96,289 patients were identified. Among them, 1614 dialysis patients were included and matched to 6198 non-dialysis patients. During the 30-day postoperative period, there were 102 mortality events in the dialysis group and 127 in the non-dialysis group, for an adjusted hazard ratio of 3.12 (95% confidence interval, 2.42-4.09). Overall, by the end of the study period, there were 1120 mortality events in the dialysis group and 2731 in the non-dialysis group, for an adjusted hazard ratio of 1.97 (95% confidence interval, 1.83-2.1). These findings may be limited by the characteristics of the administrative database.The 30-day mortality rate was 3-fold higher in the dialysis group than in the non-dialysis group, while the overall mortality rate was approximately 2-fold higher in the dialysis group than in the non-dialysis group. These findings suggest that caution in the perioperative period is required in dialysis patients undergoing hip fracture surgery. The results of our study represent only an association between dialysis and mortality. Further studies are necessary to investigate the possible causal effect of dialysis on mortality and complications after hip fracture surgery.


Asunto(s)
Fracturas de Cadera/mortalidad , Complicaciones Posoperatorias/epidemiología , Diálisis Renal/mortalidad , Anciano , Estudios de Casos y Controles , Bases de Datos Factuales , Femenino , Fracturas de Cadera/cirugía , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo
14.
Medicine (Baltimore) ; 99(33): e21703, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-32872044

RESUMEN

Studies have shown that peptic ulcer disease (PUD) increases the risk of dementia via the mechanism of systemic inflammation. We examined the association between PUD and the risk of dementia using a population-based national sample cohort from South Korea.Using the national cohort study from the Korean National Health Insurance Service, we extracted data for patients with dementia (n = 11,434) and for 1:4 matched control participants (n = 45,736) and then analyzed the previous histories of PUD from 2002 to 2013 using conditional logistic regression analyses. The controls were matched to the patients according to age, sex, income, region of residence, and past medical history. Subgroup analyses were performed based on age and sex.There was no statistically significant difference in the incidence of PUD between the dementia and control groups (18.0% vs 17.4%, P = .107). The adjusted odds ratio (OR) for PUD was 0.92 (95% confidence interval [CI] = 0.88-0.97, P = .002). In the subgroup analysis based on age, the adjusted ORs for PUD were 0.93 (95% CI = 0.88-0.99) in the <80-year-old group and 0.90 (95% CI = 0.82-1.00) in the ≥80-year-old group (each P < .05). In the subgroup analysis based on sex, the adjusted ORs for PUD were 0.89 (95% CI = 0.81-0.97; P < .05) in men and 0.94 (95% CI = 0.89-1.00; P = .06) in women.PUD does not increase the risk of dementia at any age or in either sex after adjusting for age and the history of hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, stroke, and depression.


Asunto(s)
Enfermedad de Alzheimer/epidemiología , Úlcera Péptica/epidemiología , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Causalidad , Bases de Datos Factuales , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , República de Corea/epidemiología , Medición de Riesgo
16.
S Afr Med J ; 110(7): 617-620, 2020 06 04.
Artículo en Inglés | MEDLINE | ID: mdl-32880334

RESUMEN

In response to the COVID-19 pandemic, South Africa (SA) has established a Tracing Database, collecting both aggregated and individualised mobility and locational data on COVID-19 cases and their contacts. There are compelling public health reasons for this development, since the database has the potential to assist with policy formulation and with contact tracing. While potentially demonstrating the rapid facilitation through technology of an important public service, the Tracing Database does, however, infringe immediately upon constitutional rights to privacy and heightens the implications of ethical choices facing medical professionals. The medical community should be aware of this surveillance innovation and the risks and rewards it raises. To deal with some of these risks, including the potential for temporary rights- infringing measures to become permanent, there are significant safeguards designed into the Tracing Database, including a strict duration requirement and reporting to a designated judge. African states including SA should monitor this form of contact tracing closely, and also encourage knowledge-sharing among cross-sectoral interventions such as the Tracing Database in responding to the COVID-19 pandemic.


Asunto(s)
Control de Enfermedades Transmisibles/organización & administración , Confidencialidad/ética , Trazado de Contacto/ética , Infecciones por Coronavirus/prevención & control , Bases de Datos Factuales/ética , Pandemias/prevención & control , Neumonía Viral/prevención & control , Trazado de Contacto/métodos , Infecciones por Coronavirus/epidemiología , Países en Desarrollo , Femenino , Humanos , Masculino , Pandemias/estadística & datos numéricos , Rol del Médico , Neumonía Viral/epidemiología , Salud Pública , Medición de Riesgo , Sudáfrica
17.
S Afr Med J ; 110(7): 635-639, 2020 06 05.
Artículo en Inglés | MEDLINE | ID: mdl-32880338

RESUMEN

Research is imperative in addressing the COVID-19 epidemic, both in the short and long term. Informed consent is a key pillar of research and should be central to the conduct of COVID-19 research. Yet a range of factors, including physical distancing requirements, risk of exposure and infection to research staff, and multiple pressures on the healthcare environment, have added layers of challenges to the consent process in COVID-19 patients. Internationally, the recognition that consent for COVID-19 research may be imperfect has led to a range of suggestions to ensure that research remains ethical. Drawing on these guidelines, we propose a consent process for COVID-19 research in the South African context that combines individual consent with delayed and proxy consent for individuals who may be temporarily incapacitated, combined with key principles that should be considered in the design of a consent process for COVID-19 research.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Bases de Datos Factuales/ética , Guías como Asunto , Consentimiento Informado/ética , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Control de Enfermedades Transmisibles/normas , Infecciones por Coronavirus/prevención & control , Países en Desarrollo , Femenino , Humanos , Masculino , Pandemias/prevención & control , Neumonía Viral/prevención & control , Proyectos de Investigación , Sudáfrica
18.
Nat Commun ; 11(1): 4704, 2020 09 17.
Artículo en Inglés | MEDLINE | ID: mdl-32943637

RESUMEN

Many public health responses and modeled scenarios for COVID-19 outbreaks caused by SARS-CoV-2 assume that infection results in an immune response that protects individuals from future infections or illness for some amount of time. The presence or absence of protective immunity due to infection or vaccination (when available) will affect future transmission and illness severity. Here, we review the scientific literature on antibody immunity to coronaviruses, including SARS-CoV-2 as well as the related SARS-CoV, MERS-CoV and endemic human coronaviruses (HCoVs). We reviewed 2,452 abstracts and identified 491 manuscripts relevant to 5 areas of focus: 1) antibody kinetics, 2) correlates of protection, 3) immunopathogenesis, 4) antigenic diversity and cross-reactivity, and 5) population seroprevalence. While further studies of SARS-CoV-2 are necessary to determine immune responses, evidence from other coronaviruses can provide clues and guide future research.


Asunto(s)
Anticuerpos Antivirales/inmunología , Betacoronavirus/inmunología , Infecciones por Coronavirus/inmunología , Neumonía Viral/inmunología , Infecciones por Coronavirus/terapia , Reacciones Cruzadas , Bases de Datos Factuales , Humanos , Inmunización Pasiva , Isotipos de Inmunoglobulinas/inmunología , Coronavirus del Síndrome Respiratorio de Oriente Medio/inmunología , Pandemias , Neumonía Viral/terapia , Estudios Seroepidemiológicos
19.
Phys Biol ; 17(6): 065001, 2020 09 22.
Artículo en Inglés | MEDLINE | ID: mdl-32959788

RESUMEN

Epidemiological models usually contain a set of parameters that must be adjusted based on available observations. Once a model has been calibrated, it can be used as a forecasting tool to make predictions and to evaluate contingency plans. It is customary to employ only point estimators of model parameters for such predictions. However, some models may fit the same data reasonably well for a broad range of parameter values, and this flexibility means that predictions stemming from them will vary widely, depending on the particular values employed within the range that gives a good fit. When data are poor or incomplete, model uncertainty widens further. A way to circumvent this problem is to use Bayesian statistics to incorporate observations and use the full range of parameter estimates contained in the posterior distribution to adjust for uncertainties in model predictions. Specifically, given an epidemiological model and a probability distribution for observations, we use the posterior distribution of model parameters to generate all possible epidemic curves, whose information is encapsulated in posterior predictive distributions. From these, one can extract the worst-case scenario and study the impact of implementing contingency plans according to this assessment. We apply this approach to the evolution of COVID-19 in Mexico City and assess whether contingency plans are being successful and whether the epidemiological curve has flattened.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Epidemias , Neumonía Viral/epidemiología , Teorema de Bayes , Infecciones por Coronavirus/mortalidad , Bases de Datos Factuales , Epidemias/estadística & datos numéricos , Humanos , Conceptos Matemáticos , México/epidemiología , Modelos Biológicos , Modelos Estadísticos , Pandemias , Neumonía Viral/mortalidad , Probabilidad , Factores de Tiempo , Incertidumbre
20.
Phys Biol ; 17(6): 065005, 2020 09 23.
Artículo en Inglés | MEDLINE | ID: mdl-32966241

RESUMEN

Error analysis and data visualization of positive COVID-19 cases in 27 countries have been performed up to August 8, 2020. This survey generally observes a progression from early exponential growth transitioning to an intermediate power-law growth phase, as recently suggested by Ziff and Ziff. The occurrence of logistic growth after the power-law phase with lockdowns or social distancing may be described as an effect of avoidance. A visualization of the power-law growth exponent over short time windows is qualitatively similar to the Bhatia visualization for pandemic progression. Visualizations like these can indicate the onset of second waves and may influence social policy.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , China/epidemiología , Infecciones por Coronavirus/transmisión , Bases de Datos Factuales , Progresión de la Enfermedad , Humanos , Análisis de los Mínimos Cuadrados , Modelos Lineales , Modelos Logísticos , Conceptos Matemáticos , Modelos Biológicos , Pandemias/estadística & datos numéricos , Neumonía Viral/transmisión , Factores de Tiempo
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