Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.262
Filtrar
1.
Lancet Glob Health ; 9(4): e409-e417, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33662320

RESUMEN

BACKGROUND: The global health community is devoting considerable attention to adolescents and young people, but risk of death in this population is poorly measured. We aimed to reconstruct global, regional, and national mortality trends for youths aged 15-24 years between 1990 and 2019. METHODS: In this systematic analysis, we used all publicly available data on mortality in the age group 15-24 years for 195 countries, as compiled by the UN Inter-agency Group for Child Mortality Estimation. We used nationally representative vital registration data, estimated the completeness of death registration, and extracted mortality rates from surveys with sibling histories, household deaths reported in censuses, and sample registration systems. We used a Bayesian B-spline bias-reduction model to generate trends in 10q15, the probability that an adolescent aged 15 years would die before reaching age 25 years. This model treats observations of the 10q15 probability as the product of the actual risk of death and an error multiplier that varies depending on the data source. The main outcome that we assessed was the levels of and trends in youth mortality and the global and regional mortality rates from 1990 to 2019. FINDINGS: Globally, the probability of an individual dying between age 15 years and 24 years was 11·2 deaths (90% uncertainty interval [UI] 10·7-12·5) per 1000 youths aged 15 in 2019, which is about 2·5 times less than infant mortality (28·2 deaths [27·2-30·0] by age 1 year per 1000 live births) but is higher than the risk of dying from age 1 to 5 (9·7 deaths [9·1-11·1] per 1000 children aged 1 year). The probability of dying between age 15 years and 24 years declined by 1·4% per year (90% UI 1·1-1·8) between 1990 and 2019, from 17·1 deaths (16·5-18·9) per 1000 in 1990; by contrast with this total decrease of 34% (27-41), under-5 mortality declined by 59% (56-61) in this period. The annual number of deaths declined from 1·7 million (90% UI 1·7-1·9) in 1990 to 1·4 million (1·3-1·5) in 2019. In sub-Saharan Africa, the number of deaths increased by 20·8% from 1990 to 2019. Although 18·3% of the population aged 15-24 years were living in sub-Saharan Africa in 2019, the region accounted for 37·9% (90% UI 34·8-41·9) of all worldwide deaths in youth. INTERPRETATION: It is urgent to accelerate progress in reducing youth mortality. Efforts are particularly needed in sub-Saharan Africa, where the burden of mortality is increasingly concentrated. In the future, a growing number of countries will see youth mortality exceeding under-5 mortality if current trends continue. FUNDING: UN Children's Fund, Bill & Melinda Gates Foundation, United States Agency for International Development.


Asunto(s)
Salud del Adolescente/tendencias , Salud Global/tendencias , Modelos Estadísticos , Mortalidad/tendencias , Adolescente , Salud del Adolescente/estadística & datos numéricos , Teorema de Bayes , Bases de Datos Factuales/estadística & datos numéricos , Geografía , Salud Global/estadística & datos numéricos , Humanos , Organización Mundial de la Salud , Adulto Joven
2.
Medicine (Baltimore) ; 100(10): e25090, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725901

RESUMEN

ABSTRACT: Inflammatory bowel disease (IBD) has emerged in the Asia-Pacific area over the past 2 decades. There is a paucity of clinical data regarding real-world experience of patients with IBD from low endemic area such as Taiwan. Therefore, the present study aimed to review the clinical features of patients with IBD form a tertiary center from Taiwan.A total of 163 patients with IBD were identified from the electronic clinical database of Changhua Christian Hospital. Demographic data of the patients and clinical features of the disease pattern were retrospectively reviewed.There was a higher proportion (62.6%) of patients diagnosed with ulcerative colitis (UC). Patients with Crohn disease (CD) and UC had male predominance. The median age of diagnosis was younger in patients with CD than in patients with UC (CD vs UC: 31 vs 40 years, P = .0423). The disease distribution of UC was as follows: E1 (15.7%), E2 (47.1%), and E3 (37.3%). The disease distribution of CD was as follows: L1 (36.1%), L2 (14.8%), L3 (42.6%), and L4 (6.5%). The majority of patients with CD had a complicated presentation with B2 (32.8%) and B3 (32.8%). Patients with CD had a higher bowel resection rate than patients with UC. Patients with CD were more likely to be treated with immunomodulator and biologics and those with UC were more likely to be treated with 5-aminosalicylic acid (5-ASA). A trend of decreased bowel resection for patients with IBD and less severe phenotype of patients with CD were observed after 2015.UC with male predominance was the predominant type of IBD in the study. Patients with CD are likely to have a complicated disease course, requiring a higher demand of biologic therapy than patients with UC.


Asunto(s)
Colectomía/estadística & datos numéricos , Colitis Ulcerosa/epidemiología , Enfermedad de Crohn/epidemiología , Factores Inmunológicos/uso terapéutico , Adulto , Factores de Edad , Factores Biológicos/uso terapéutico , Colitis Ulcerosa/diagnóstico , Colitis Ulcerosa/terapia , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/terapia , Bases de Datos Factuales/estadística & datos numéricos , Progresión de la Enfermedad , Femenino , Humanos , Incidencia , Masculino , Mesalamina/uso terapéutico , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Taiwán/epidemiología , Resultado del Tratamiento
3.
J Prev Med Public Health ; 54(1): 8-16, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33618494

RESUMEN

This article aims to introduce the inception and operation of the COVID-19 International Collaborative Research Project, the world's first coronavirus disease 2019 (COVID-19) open data project for research, along with its dataset and research method, and to discuss relevant considerations for collaborative research using nationwide real-world data (RWD). COVID-19 has spread across the world since early 2020, becoming a serious global health threat to life, safety, and social and economic activities. However, insufficient RWD from patients was available to help clinicians efficiently diagnose and treat patients with COVID-19, or to provide necessary information to the government for policy-making. Countries that saw a rapid surge of infections had to focus on leveraging medical professionals to treat patients, and the circumstances made it even more difficult to promptly use COVID-19 RWD. Against this backdrop, the Health Insurance Review and Assessment Service (HIRA) of Korea decided to open its COVID-19 RWD collected through Korea's universal health insurance program, under the title of the COVID-19 International Collaborative Research Project. The dataset, consisting of 476 508 claim statements from 234 427 patients (7590 confirmed cases) and 18 691 318 claim statements of the same patients for the previous 3 years, was established and hosted on HIRA's in-house server. Researchers who applied to participate in the project uploaded analysis code on the platform prepared by HIRA, and HIRA conducted the analysis and provided outcome values. As of November 2020, analyses have been completed for 129 research projects, which have been published or are in the process of being published in prestigious journals.


Asunto(s)
/prevención & control , Aseguradoras/estadística & datos numéricos , Internacionalidad , /transmisión , Bases de Datos Factuales/estadística & datos numéricos , Humanos , Evaluación de Resultado en la Atención de Salud/normas , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud/estadística & datos numéricos , República de Corea
4.
Radiology ; 299(1): E204-E213, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33399506

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic is a global health care emergency. Although reverse-transcription polymerase chain reaction testing is the reference standard method to identify patients with COVID-19 infection, chest radiography and CT play a vital role in the detection and management of these patients. Prediction models for COVID-19 imaging are rapidly being developed to support medical decision making. However, inadequate availability of a diverse annotated data set has limited the performance and generalizability of existing models. To address this unmet need, the RSNA and Society of Thoracic Radiology collaborated to develop the RSNA International COVID-19 Open Radiology Database (RICORD). This database is the first multi-institutional, multinational, expert-annotated COVID-19 imaging data set. It is made freely available to the machine learning community as a research and educational resource for COVID-19 chest imaging. Pixel-level volumetric segmentation with clinical annotations was performed by thoracic radiology subspecialists for all COVID-19-positive thoracic CT scans. The labeling schema was coordinated with other international consensus panels and COVID-19 data annotation efforts, the European Society of Medical Imaging Informatics, the American College of Radiology, and the American Association of Physicists in Medicine. Study-level COVID-19 classification labels for chest radiographs were annotated by three radiologists, with majority vote adjudication by board-certified radiologists. RICORD consists of 240 thoracic CT scans and 1000 chest radiographs contributed from four international sites. It is anticipated that RICORD will ideally lead to prediction models that can demonstrate sustained performance across populations and health care systems.


Asunto(s)
/diagnóstico por imagen , Bases de Datos Factuales/estadística & datos numéricos , Salud Global/estadística & datos numéricos , Pulmón/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Humanos , Internacionalidad , Radiografía Torácica , Radiología , Sociedades Médicas , Tomografía Computarizada por Rayos X/estadística & datos numéricos
5.
Cancer Causes Control ; 32(3): 211-220, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33392903

RESUMEN

PURPOSE: SEER data are widely used to study rural-urban disparities in cancer. However, no studies have directly assessed how well the rural areas covered by SEER represent the broader rural United States. METHODS: Public data sources were used to calculate county level measures of sociodemographics, health behaviors, health access and all cause cancer incidence. Driving time from each census tract to nearest Commission on Cancer certified facility was calculated and analyzed in rural SEER and non-SEER areas. RESULTS: Rural SEER and non-SEER counties were similar with respect to the distribution of age, race, sex, poverty, health behaviors, provider density, and cancer screening. Overall cancer incidence was similar in rural SEER vs non-SEER counties. However, incidence for White, Hispanic, and Asian patients was higher in rural SEER vs non-SEER counties. Unadjusted median travel time was 53 min (IQR 34-82) in rural SEER tracts and 54 min (IQR 35-82) in rural non-SEER census tracts. Linear modeling showed shorter travel times across all levels of rurality in SEER vs non-SEER census tracts when controlling for region (Large Rural: 13.4 min shorter in SEER areas 95% CI 9.1;17.6; Small Rural: 16.3 min shorter 95% CI 9.1;23.6; Isolated Rural: 15.7 min shorter 95% CI 9.9;21.6). CONCLUSIONS: The rural population covered by SEER data is comparable to the rural population in non-SEER areas. However, patients in rural SEER regions have shorter travel times to care than rural patients in non-SEER regions. This needs to be considered when using SEER-Medicare to study access to cancer care.


Asunto(s)
Bases de Datos Factuales/estadística & datos numéricos , Neoplasias/epidemiología , Población Rural/estadística & datos numéricos , Adulto , Anciano , Grupo de Ascendencia Continental Asiática , Grupo de Ascendencia Continental Europea , Femenino , Hispanoamericanos , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/etnología , Estados Unidos/epidemiología , Adulto Joven
6.
J Surg Oncol ; 123(4): 949-956, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33400841

RESUMEN

BACKGROUND: The main surgical approach to patients with localized intrahepatic cholangiocarcinoma (ICC) is hepatectomy, but transplantation has been described. A comparison of outcomes between these surgical approaches is necessary to determine if one is preferable. METHODS: Patients with ICC were identified using the National Cancer Database (2010-2016). Patients were grouped based on operation and matched 1:1 by propensity score. Pathologic and postoperative outcomes, as well as overall survival were analyzed. RESULTS: There were 1879 hepatectomy and 74 liver transplantation patients. Before matching, transplantation patients were younger and more often treated at academic centers. More patients who underwent a transplantation received neoadjuvant chemotherapy (70.3% vs. 12.8%). Patients who underwent transplantation had more pathologic T0 (7.7% vs. 0.4%) and T1 (47.7% vs. 42.1%) tumors (p < .001). There were no differences in length of stay, unplanned readmissions, 30/90-day mortality, or median survival between groups (36.1 vs. 36.1 months, p = .34). After matching (n = 57/group), there were no differences in postoperative outcomes or survival between transplantation or hepatectomy (36.1 vs. 33.6 months, p = .57). CONCLUSION: Among patients with ICC, hepatectomy and liver transplantation were associated with similar postoperative outcomes and survival. In light of the resources and chronic immunosuppression required for transplantation, hepatectomy seems preferable for localized ICC.


Asunto(s)
Neoplasias de los Conductos Biliares/cirugía , Colangiocarcinoma/cirugía , Bases de Datos Factuales/estadística & datos numéricos , Hepatectomía/mortalidad , Trasplante de Hígado/mortalidad , Neoplasias de los Conductos Biliares/patología , Colangiocarcinoma/patología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Puntaje de Propensión , Tasa de Supervivencia
7.
Spine (Phila Pa 1976) ; 46(6): 401-407, 2021 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-33394982

RESUMEN

STUDY DESIGN: Retrospective observational study. OBJECTIVE: The aim of this study was to evaluate whether there are any differences in outcomes and costs for elective one- to three-level anterior cervical fusions (ACFs) performed at US News and World Report (USNWR) ranked and unranked hospitals. SUMMARY OF BACKGROUND DATA: Although the USNWR rankings are advertised by media and are routinely used by patients as a guide in seeking care, evidence regarding whether these rankings are reflective of actual clinical outcome remains limited. METHODS: The 2010-2014 USNWR hospital rankings were used to identify ranked hospitals in "Neurosurgery" and "Orthopedics." The 2010-2014 100% Medicare Standard Analytical Files (SAF100) were used to identify patients undergoing elective ACFs at ranked and unranked hospitals. Multivariable logistic regression and generalized linear regression analyses were used to assess for differences in 90-day outcomes and costs between ranked and unranked hospitals. RESULTS: A total of 110,520 patients undergoing elective one- to three-level ACFs were included in the study, of which 10,289 (9.3%) underwent surgery in one of the 100 ranked hospitals. Following multivariate analysis, there were no significant differences between ranked versus unranked hospitals with regards to wound complications (1.2% vs. 1.1%; P = 0.907), cardiac complications (12.9% vs. 11.9%; P = 0.055), pulmonary complications (3.7% vs. 6.7%; P = 0.654), urinary tract infections (7.3% vs. 5.8%; P = 0.120), sepsis (9.3% vs. 7.9%; P = 0.847), deep venous thrombosis (1.9% vs. 1.3%; P = 0.077), revision surgery (0.3% vs. 0.3%; P = 0.617), and all-cause readmissions (4.7% vs. 4.4%; P = 0.266). Ranked hospitals, as compared to unranked hospitals, had a slightly lower odds of experiencing renal complications (7.0% vs. 4.9%; P = 0.047), but had significantly higher risk-adjusted 90-day charges (+$17,053; P < 0.001) and costs (+ $1695; P < 0.001). CONCLUSION: Despite the higher charges and costs of care at ranked hospitals, these facilities appear to have similar outcomes as compared to unranked hospitals following elective ACFs.Level of Evidence: 3.


Asunto(s)
Vértebras Cervicales/cirugía , Estudios de Evaluación como Asunto , Hospitales/normas , Medicare , Complicaciones Posoperatorias/prevención & control , Fusión Vertebral/normas , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Masculino , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Reoperación/normas , Estudios Retrospectivos , Resultado del Tratamiento , Estados Unidos/epidemiología
8.
JCO Glob Oncol ; 7: 46-55, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33434066

RESUMEN

PURPOSE: The COVID-19 pandemic remains a public health emergency of global concern. Determinants of mortality in the general population are now clear, but specific data on patients with cancer remain limited, particularly in Latin America. MATERIALS AND METHODS: A longitudinal multicenter cohort study of patients with cancer and confirmed COVID-19 from Oncoclínicas community oncology practice in Brazil was conducted. The primary end point was all-cause mortality after isolation of the SARS-CoV-2 by Real-Time Polymerase Chain Reaction (RT-PCR) in patients initially diagnosed in an outpatient environment. We performed univariate and multivariable logistic regression analysis and recursive partitioning modeling to define the baseline clinical determinants of death in the overall population. RESULTS: From March 29 to July 4, 2020, 198 patients with COVID-19 were prospectively registered in the database, of which 167 (84%) had solid tumors and 31 (16%) had hematologic malignancies. Most patients were on active systemic therapy or radiotherapy (77%), largely for advanced or metastatic disease (64%). The overall mortality rate was 16.7% (95% CI, 11.9 to 22.7). In univariate models, factors associated with death after COVID-19 diagnosis were age ≥ 60 years, current or former smoking, coexisting comorbidities, respiratory tract cancer, and management in a noncurative setting (P < .05). In multivariable logistic regression and recursive partitioning modeling, only age, smoking history, and noncurative disease setting remained significant determinants of mortality, ranging from 1% in cancer survivors under surveillance or (neo)adjuvant therapy to 60% in elderly smokers with advanced or metastatic disease. CONCLUSION: Mortality after COVID-19 in patients with cancer is influenced by prognostic factors that also affect outcomes of the general population. Fragile patients and smokers are entitled to active preventive measures to reduce the risk of SARS-CoV-2 infection and close monitoring in the case of exposure or COVID-19-related symptoms.


Asunto(s)
/mortalidad , Supervivientes de Cáncer/estadística & datos numéricos , Neoplasias/mortalidad , /aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , /virología , Causas de Muerte , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Fragilidad/epidemiología , Humanos , Estudios Longitudinales , Masculino , Oncología Médica/estadística & datos numéricos , Persona de Mediana Edad , Neoplasias/complicaciones , Pronóstico , Estudios Prospectivos , ARN Viral/aislamiento & purificación , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Fumar/epidemiología , Adulto Joven
9.
J Med Libr Assoc ; 109(1): 75-83, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33424467

RESUMEN

Objective: There are concerns about nonscientific and/or unclear information on the coronavirus disease 2019 (COVID-19) that is available on the Internet. Furthermore, people's ability to understand health information varies and depends on their skills in reading and interpreting information. This study aims to evaluate the readability and creditability of websites with COVID-19-related information. Methods: The search terms "coronavirus," "COVID," and "COVID-19" were input into Google. The websites of the first thirty results for each search term were evaluated in terms of their credibility and readability using the Health On the Net Foundation code of conduct (HONcode) and Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), Gunning Fog, and Flesch Reading Ease Score (FRE) scales, respectively. Results: The readability of COVID-19-related health information on websites was suitable for high school graduates or college students and, thus, was far above the recommended readability level. Most websites that were examined (87.2%) had not been officially certified by HONcode. There was no significant difference in the readability scores of websites with and without HONcode certification. Conclusion: These results suggest that organizations should improve the readability of their websites and provide information that more people can understand. This could lead to greater health literacy, less health anxiety, and the provision of better preventive information about the disease.


Asunto(s)
/enfermería , Comprensión , Información de Salud al Consumidor/métodos , Exactitud de los Datos , Bases de Datos Factuales/estadística & datos numéricos , Alfabetización en Salud/métodos , Internet , Autocuidado/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad
10.
Am Heart J ; 233: 109-121, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33358690

RESUMEN

BACKGROUND: In patients with atrial fibrillation, incomplete adherence to anticoagulants increases risk of stroke. Non-warfarin oral anticoagulants (NOACs) are expensive; we evaluated whether higher copayments are associated with lower NOAC adherence. METHODS: Using a national claims database of commercially-insured patients, we performed a cohort study of patients with atrial fibrillation who newly initiated a NOAC from 2012 to 2018. Patients were stratified into low (<$35), medium ($35-$59), or high (≥$60) copayments and propensity-score weighted based on demographics, insurance characteristics, comorbidities, prior health care utilization, calendar year, and the NOAC received. Follow-up was 1 year, with censoring for switching to a different anticoagulant, undergoing an ablation procedure, disenrolling from the insurance plan, or death. The primary outcome was adherence, measured by proportion of days covered (PDC). Secondary outcomes included NOAC discontinuation (no refill for 30 days after the end of NOAC supply) and switching anticoagulants. We compared PDC using a Kruskal-Wallis test and rates of discontinuation and switching using Cox proportional hazards models. RESULTS: After weighting patients across the 3 copayment groups, the effective sample size was 17,558 patients, with balance across 50 clinical and demographic covariates (standardized differences <0.1). Mean age was 62 years, 29% of patients were female, and apixaban (43%), and rivaroxaban (38%) were the most common NOACs. Higher copayments were associated with lower adherence (P < .001), with a PDC of 0.82 (Interquartile range [IQR] 0.36-0.98) among those with high copayments, 0.85 (IQR 0.41-0.98) among those with medium copayments, and 0.88 (IQR 0.41-0.99) among those with low copayments. Compared to patients with low copayments, patients with high copayments had higher rates of discontinuation (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.08-1.19; P < .001). CONCLUSIONS: Among atrial fibrillation patients newly initiating NOACs, higher copayments in commercial insurance were associated with lower adherence and higher rates of discontinuation in the first year. Policies to lower or limit cost-sharing of important medications may lead to improved adherence and better outcomes among patients receiving NOACs.


Asunto(s)
Fibrilación Atrial/complicaciones , Deducibles y Coseguros/economía , Cumplimiento de la Medicación/estadística & datos numéricos , Accidente Cerebrovascular/prevención & control , Anticoagulantes/economía , Anticoagulantes/uso terapéutico , Antitrombinas/economía , Antitrombinas/uso terapéutico , Estudios de Cohortes , Dabigatrán/economía , Dabigatrán/uso terapéutico , Bases de Datos Factuales/estadística & datos numéricos , Deducibles y Coseguros/estadística & datos numéricos , Costos de los Medicamentos , Inhibidores del Factor Xa/economía , Inhibidores del Factor Xa/uso terapéutico , Femenino , Humanos , Masculino , Medicare Part C/estadística & datos numéricos , Persona de Mediana Edad , Pirazoles/economía , Pirazoles/uso terapéutico , Piridinas/economía , Piridinas/uso terapéutico , Piridonas/economía , Piridonas/uso terapéutico , Rivaroxabán/economía , Rivaroxabán/uso terapéutico , Tamaño de la Muestra , Accidente Cerebrovascular/etiología , Tiazoles/economía , Tiazoles/uso terapéutico , Estados Unidos , Warfarina/economía , Warfarina/uso terapéutico
11.
Am Heart J ; 234: 133-135, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33347871

RESUMEN

Clinical trials provide the foundational evidence that guide many patient-facing decisions; however, the therapeutic effect and safety of an intervention is best evaluated when compared to a control group. We used ClinicalTrials.gov to describe the proportion of registered Phase III and IV cardiovascular clinical trials that contain a control group from 2009 through 2019. Of 1,677 registered Phase III and IV cardiovascular clinical trials, 81.2% contain a control group, and the annual prevalence remained unchanged between 2009 and 2019.


Asunto(s)
Enfermedades Cardiovasculares/terapia , Ensayos Clínicos Fase III como Asunto/estadística & datos numéricos , Ensayos Clínicos Fase IV como Asunto/estadística & datos numéricos , Grupos Control , Bases de Datos Factuales/estadística & datos numéricos , National Library of Medicine (U.S.)/estadística & datos numéricos , Humanos , Estados Unidos
12.
J Surg Res ; 257: 161-166, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32829000

RESUMEN

BACKGROUND: Full-thickness chest wall resection (FTCWR) is an underused modality for treating locally advanced primary or recurrent breast cancer invading the chest wall, for which little data exist regarding morbidity and mortality. We examined the postoperative complication rates in breast cancer patients undergoing FTCWR using a large multinational surgical outcomes database. METHODS: A retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. All patients undergoing FTCWR for breast cancer between 2007 and 2016 were identified (n = 137). Primary outcome measures included 30-d postoperative morbidity, composite respiratory complications, and hospital length of stay (LOS). The secondary aim was to compare the postoperative morbidity of FTCWR to those of patients undergoing mastectomy. One-to-one coarsened exact matching was conducted between two groups, which were then compared with respect to morbidity, mortality, reoperations, readmissions, and LOS. RESULTS: The overall rate of postoperative morbidity was 11.7%. Two patients (1.5%) had respiratory complications requiring intubation. Median hospital LOS was 2 d. In the coarsened exact matching analysis, 122 patients were included in each of the two groups. Comparison of matched cohorts demonstrated an overall morbidity for the FTCWR group of 11.5% compared with 8.2% for the mastectomy group (8.2%) (P = 0.52). CONCLUSIONS: FTCWR for the local treatment of breast cancer can be performed with relatively low morbidity and respiratory complications. This is the largest study looking at postoperative complications for FTCWR in the treatment of breast cancer. Future studies are needed to determine the long-term outcomes of FTCWR in this patient population.


Asunto(s)
Neoplasias de la Mama/cirugía , Mastectomía/efectos adversos , Recurrencia Local de Neoplasia/cirugía , Complicaciones Posoperatorias/epidemiología , Pared Torácica/cirugía , Anciano , Neoplasias de la Mama/patología , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Mastectomía/métodos , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/patología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Reoperación/efectos adversos , Reoperación/métodos , Estudios Retrospectivos , Pared Torácica/patología , Estados Unidos/epidemiología
13.
PLoS One ; 15(12): e0244438, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33362242

RESUMEN

BACKGROUND: Intoxicated patients were frequently managed in the emergency departments (ED) with few studies at national level. The study aimed to reveal the incidence, outcomes of intoxications and trend in Taiwan. METHODS: Adults admitted to an ED due to an intoxication event between 2006 and 2013 were identified using the Taiwan National Health Insurance Research Database. The rate of intoxication and severe intoxication events, mortality rate, hospital length of stay (LOS), and daily medical costs of these patients were analyzed. Changes over time were analyzed using Joinpoint models. Multivariable generalized regressions with GEE were used to assess the effect of sex, age, and presence of prior psychiatric illness. RESULTS: A total of 20,371 ED admissions due to intoxication events were identified during the study period, and the incidence decreased with annual percentage change of 4.7% from 2006 to 2013. The mortality rate, hospital LOS, and daily medical costs were not decreased over time. Males and geriatric patients had more severe intoxication events, greater mortality rates, and greater daily medical costs. Patients with psychiatric illnesses had higher mortality rates and a longer hospital LOS, but lower daily medical expenses. CONCLUSION: From 2006 to 2013, there was a decline in the incidence of ED admission for intoxication events in Taiwan. Males, geriatric patients, and those with psychiatric illnesses had greater risks for severe intoxication and mortality.


Asunto(s)
Costo de Enfermedad , Trastornos Mentales/epidemiología , Envenenamiento/epidemiología , Adulto , Factores de Edad , Anciano , Comorbilidad , Bases de Datos Factuales/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Costos de Hospital/estadística & datos numéricos , Mortalidad Hospitalaria , Humanos , Incidencia , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Admisión del Paciente/economía , Admisión del Paciente/estadística & datos numéricos , Envenenamiento/diagnóstico , Envenenamiento/economía , Envenenamiento/terapia , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Taiwán/epidemiología , Resultado del Tratamiento , Adulto Joven
14.
JAMA Netw Open ; 3(12): e2030072, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33315115

RESUMEN

Importance: Resource limitations because of pandemic or other stresses on infrastructure necessitate the triage of time-sensitive care, including cancer treatments. Optimal time to treatment is underexplored, so recommendations for which cancer treatments can be deferred are often based on expert opinion. Objective: To evaluate the association between increased time to definitive therapy and mortality as a function of cancer type and stage for the 4 most prevalent cancers in the US. Design, Setting, and Participants: This cohort study assessed treatment and outcome information from patients with nonmetastatic breast, prostate, non-small cell lung (NSCLC), and colon cancers from 2004 to 2015, with data analyzed January to March 2020. Data on outcomes associated with appropriate curative-intent surgical, radiation, or medical therapy were gathered from the National Cancer Database. Exposures: Time-to-treatment initiation (TTI), the interval between diagnosis and therapy, using intervals of 8 to 60, 61 to 120, 121 to 180, and greater than 180 days. Main Outcomes and Measures: 5-year and 10-year predicted all-cause mortality. Results: This study included 2 241 706 patients (mean [SD] age 63 [11.9] years, 1 268 794 [56.6%] women, 1 880 317 [83.9%] White): 1 165 585 (52.0%) with breast cancer, 853 030 (38.1%) with prostate cancer, 130 597 (5.8%) with NSCLC, and 92 494 (4.1%) with colon cancer. Median (interquartile range) TTI by cancer was 32 (21-48) days for breast, 79 (55-117) days for prostate, 41 (27-62) days for NSCLC, and 26 (16-40) days for colon. Across all cancers, a general increase in the 5-year and 10-year predicted mortality was associated with increasing TTI. The most pronounced mortality association was for colon cancer (eg, 5 y predicted mortality, stage III: TTI 61-120 d, 38.9% vs. 181-365 d, 47.8%), followed by stage I NSCLC (5 y predicted mortality: TTI 61-120 d, 47.4% vs 181-365 d, 47.6%), while survival for prostate cancer was least associated (eg, 5 y predicted mortality, high risk: TTI 61-120 d, 12.8% vs 181-365 d, 14.1%), followed by breast cancer (eg, 5 y predicted mortality, stage I: TTI 61-120 d, 11.0% vs. 181-365 d, 15.2%). A nonsignificant difference in treatment delays and worsened survival was observed for stage II lung cancer patients-who had the highest all-cause mortality for any TTI regardless of treatment timing. Conclusions and Relevance: In this cohort study, for all studied cancers there was evidence that shorter TTI was associated with lower mortality, suggesting an indirect association between treatment deferral and mortality that may not become evident for years. In contrast to current pandemic-related guidelines, these findings support more timely definitive treatment for intermediate-risk and high-risk prostate cancer.


Asunto(s)
Protocolos Antineoplásicos , Neoplasias de la Mama , Neoplasias del Colon , Neoplasias Pulmonares , Neoplasias de la Próstata , Tiempo de Tratamiento , Anciano , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , /prevención & control , Estudios de Cohortes , Neoplasias del Colon/mortalidad , Neoplasias del Colon/patología , Neoplasias del Colon/terapia , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/terapia , Masculino , Persona de Mediana Edad , Mortalidad , Estadificación de Neoplasias , Pronóstico , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/terapia , Tiempo de Tratamiento/normas , Tiempo de Tratamiento/estadística & datos numéricos , Estados Unidos/epidemiología
15.
BMJ ; 371: m3731, 2020 10 20.
Artículo en Inglés | MEDLINE | ID: mdl-33082154

RESUMEN

OBJECTIVE: To derive and validate a risk prediction algorithm to estimate hospital admission and mortality outcomes from coronavirus disease 2019 (covid-19) in adults. DESIGN: Population based cohort study. SETTING AND PARTICIPANTS: QResearch database, comprising 1205 general practices in England with linkage to covid-19 test results, Hospital Episode Statistics, and death registry data. 6.08 million adults aged 19-100 years were included in the derivation dataset and 2.17 million in the validation dataset. The derivation and first validation cohort period was 24 January 2020 to 30 April 2020. The second temporal validation cohort covered the period 1 May 2020 to 30 June 2020. MAIN OUTCOME MEASURES: The primary outcome was time to death from covid-19, defined as death due to confirmed or suspected covid-19 as per the death certification or death occurring in a person with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the period 24 January to 30 April 2020. The secondary outcome was time to hospital admission with confirmed SARS-CoV-2 infection. Models were fitted in the derivation cohort to derive risk equations using a range of predictor variables. Performance, including measures of discrimination and calibration, was evaluated in each validation time period. RESULTS: 4384 deaths from covid-19 occurred in the derivation cohort during follow-up and 1722 in the first validation cohort period and 621 in the second validation cohort period. The final risk algorithms included age, ethnicity, deprivation, body mass index, and a range of comorbidities. The algorithm had good calibration in the first validation cohort. For deaths from covid-19 in men, it explained 73.1% (95% confidence interval 71.9% to 74.3%) of the variation in time to death (R2); the D statistic was 3.37 (95% confidence interval 3.27 to 3.47), and Harrell's C was 0.928 (0.919 to 0.938). Similar results were obtained for women, for both outcomes, and in both time periods. In the top 5% of patients with the highest predicted risks of death, the sensitivity for identifying deaths within 97 days was 75.7%. People in the top 20% of predicted risk of death accounted for 94% of all deaths from covid-19. CONCLUSION: The QCOVID population based risk algorithm performed well, showing very high levels of discrimination for deaths and hospital admissions due to covid-19. The absolute risks presented, however, will change over time in line with the prevailing SARS-C0V-2 infection rate and the extent of social distancing measures in place, so they should be interpreted with caution. The model can be recalibrated for different time periods, however, and has the potential to be dynamically updated as the pandemic evolves.


Asunto(s)
Algoritmos , Reglas de Decisión Clínica , Infecciones por Coronavirus , Hospitalización/estadística & datos numéricos , Mortalidad , Pandemias , Neumonía Viral , Medición de Riesgo , Adulto , Anciano de 80 o más Años , Betacoronavirus/aislamiento & purificación , Estudios de Cohortes , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Bases de Datos Factuales/estadística & datos numéricos , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Pronóstico , Reproducibilidad de los Resultados , Medición de Riesgo/métodos , Medición de Riesgo/normas
16.
Pediatrics ; 146(5)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33082284

RESUMEN

BACKGROUND AND OBJECTIVES: Road traffic accidents are a leading cause of child deaths in the United States. Although this has been examined at the national and state levels, there is more value in acquiring information at the county level to guide local policies. We aimed to estimate county-specific child mortality from road traffic accidents in the United States. METHODS: We queried the Fatality Analysis Reporting System database, 2010-2017, for road traffic accidents that resulted in a death within 30 days of the auto crash. We included all children <15 years old who were fatally injured. We estimated county-specific age- and sex-standardized mortality. We evaluated the impact of the availability of trauma centers and urban-rural classification of counties on mortality. RESULTS: We included 9271 child deaths. Among those, 45% died at the scene. The median age was 7 years. The overall mortality was 1.87 deaths per 100 000 children. County-specific mortality ranged between 0.25 and 21.91 deaths per 100 000 children. The availability of a trauma center in a county was associated with decreased mortality (adult trauma center [odds ratio (OR): 0.59; 95% credibility interval (CI), 0.52-0.66]; pediatric trauma center [OR: 0.56; 95% CI, 0.46-0.67]). Less urbanized counties were associated with higher mortality, compared with large central metropolitan counties (noncore counties [OR: 2.33; 95% CI, 1.85-2.91]). CONCLUSIONS: There are marked differences in child mortality from road traffic accidents among US counties. Our findings can guide targeted public health interventions in high-risk counties with excessive child mortality and limited access to trauma care.


Asunto(s)
Accidentes de Tránsito/mortalidad , Mortalidad del Niño , Centros Traumatológicos/provisión & distribución , Adolescente , Teorema de Bayes , Niño , Preescolar , Bases de Datos Factuales/estadística & datos numéricos , Escolaridad , Femenino , Humanos , Renta , Gobierno Local , Masculino , Oportunidad Relativa , Distribución de Poisson , Población Rural/estadística & datos numéricos , Distribución por Sexo , Análisis de Área Pequeña , Centros Traumatológicos/clasificación , Estados Unidos/epidemiología , Población Urbana/estadística & datos numéricos
17.
JAMA ; 324(16): 1640-1650, 2020 10 27.
Artículo en Inglés | MEDLINE | ID: mdl-33107944

RESUMEN

Importance: Current guidelines recommend ticagrelor as the preferred P2Y12 platelet inhibitor for patients with acute coronary syndrome (ACS), primarily based on a single large randomized clinical trial. The benefits and risks associated with ticagrelor vs clopidogrel in routine practice merits attention. Objective: To determine the association of ticagrelor vs clopidogrel with ischemic and hemorrhagic events in patients undergoing percutaneous coronary intervention (PCI) for ACS in clinical practice. Design, Setting, and Participants: A retrospective cohort study of patients with ACS who underwent PCI and received ticagrelor or clopidogrel was conducted using 2 United States electronic health record-based databases and 1 nationwide South Korean database from November 2011 to March 2019. Patients were matched using a large-scale propensity score algorithm, and the date of final follow-up was March 2019. Exposures: Ticagrelor vs clopidogrel. Main Outcomes and Measures: The primary end point was net adverse clinical events (NACE) at 12 months, composed of ischemic events (recurrent myocardial infarction, revascularization, or ischemic stroke) and hemorrhagic events (hemorrhagic stroke or gastrointestinal bleeding). Secondary outcomes included NACE or mortality, all-cause mortality, ischemic events, hemorrhagic events, individual components of the primary outcome, and dyspnea at 12 months. The database-level hazard ratios (HRs) were pooled to calculate summary HRs by random-effects meta-analysis. Results: After propensity score matching among 31 290 propensity-matched pairs (median age group, 60-64 years; 29.3% women), 95.5% of patients took aspirin together with ticagrelor or clopidogrel. The 1-year risk of NACE was not significantly different between ticagrelor and clopidogrel (15.1% [3484/23 116 person-years] vs 14.6% [3290/22 587 person-years]; summary HR, 1.05 [95% CI, 1.00-1.10]; P = .06). There was also no significant difference in the risk of all-cause mortality (2.0% for ticagrelor vs 2.1% for clopidogrel; summary HR, 0.97 [95% CI, 0.81-1.16]; P = .74) or ischemic events (13.5% for ticagrelor vs 13.4% for clopidogrel; summary HR, 1.03 [95% CI, 0.98-1.08]; P = .32). The risks of hemorrhagic events (2.1% for ticagrelor vs 1.6% for clopidogrel; summary HR, 1.35 [95% CI, 1.13-1.61]; P = .001) and dyspnea (27.3% for ticagrelor vs 22.6% for clopidogrel; summary HR, 1.21 [95% CI, 1.17-1.26]; P < .001) were significantly higher in the ticagrelor group. Conclusions and Relevance: Among patients with ACS who underwent PCI in routine clinical practice, ticagrelor, compared with clopidogrel, was not associated with significant difference in the risk of NACE at 12 months. Because the possibility of unmeasured confounders cannot be excluded, further research is needed to determine whether ticagrelor is more effective than clopidogrel in this setting.


Asunto(s)
Síndrome Coronario Agudo/cirugía , Clopidogrel/efectos adversos , Intervención Coronaria Percutánea , Antagonistas del Receptor Purinérgico P2Y/efectos adversos , Ticagrelor/efectos adversos , Síndrome Coronario Agudo/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Aspirina/administración & dosificación , Estudios de Casos y Controles , Causas de Muerte , Clopidogrel/administración & dosificación , Bases de Datos Factuales/estadística & datos numéricos , Disnea/inducido químicamente , Femenino , Hemorragia/inducido químicamente , Humanos , Isquemia/inducido químicamente , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Metaanálisis en Red , Puntaje de Propensión , Antagonistas del Receptor Purinérgico P2Y/administración & dosificación , Recurrencia , República de Corea , Estudios Retrospectivos , Accidente Cerebrovascular/epidemiología , Ticagrelor/administración & dosificación , Estados Unidos
18.
Artículo en Inglés | MEDLINE | ID: mdl-32872616

RESUMEN

This study used the Korean National Health Insurance (NHI) claims database from 2011 to 2017 to estimate the incidence and the incidence-based cost of cervical cancer and carcinoma in situ of cervix uteri (CIS) in Korea. The primary outcome was the direct medical cost per patient not diagnosed with cervical cancer (C53) or CIS (D06) 2 years prior to the index date in the first year after diagnosis. A regression analysis was conducted to adjust for relevant covariates. The incidence of cervical cancer tended to decrease from 2013 to 2016, while that of CIS increased. In particular, the incidence rate of CIS in women in their 20 s and 30 s increased by 56.8% and 28.4%, respectively, from 2013 to 2016. The incidence-based cost of cervical cancer and CIS was USD 13,058 and USD 2695 in 2016, respectively, which increased from 2013. Multivariate regression analysis suggested that age was the most influential variable of the cost in both patient groups, and the cost was highest in those aged over 60, i.e., the medical cost was significantly lower in younger women than their older counterparts. These findings suggest that targeting younger women in cervical cancer prevention is a reasonable option from both economic and public health perspectives.


Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Neoplasias del Cuello Uterino , Adulto , Factores de Edad , Carcinoma in Situ/economía , Carcinoma in Situ/epidemiología , Costo de Enfermedad , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Incidencia , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/estadística & datos numéricos , Lesiones Precancerosas/economía , Lesiones Precancerosas/epidemiología , República de Corea/epidemiología , Proyectos de Investigación , Neoplasias del Cuello Uterino/economía , Neoplasias del Cuello Uterino/epidemiología , Adulto Joven
19.
IEEE J Biomed Health Inform ; 24(10): 2806-2813, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32915751

RESUMEN

The pandemic of coronavirus disease 2019 (COVID-19) has lead to a global public health crisis spreading hundreds of countries. With the continuous growth of new infections, developing automated tools for COVID-19 identification with CT image is highly desired to assist the clinical diagnosis and reduce the tedious workload of image interpretation. To enlarge the datasets for developing machine learning methods, it is essentially helpful to aggregate the cases from different medical systems for learning robust and generalizable models. This paper proposes a novel joint learning framework to perform accurate COVID-19 identification by effectively learning with heterogeneous datasets with distribution discrepancy. We build a powerful backbone by redesigning the recently proposed COVID-Net in aspects of network architecture and learning strategy to improve the prediction accuracy and learning efficiency. On top of our improved backbone, we further explicitly tackle the cross-site domain shift by conducting separate feature normalization in latent space. Moreover, we propose to use a contrastive training objective to enhance the domain invariance of semantic embeddings for boosting the classification performance on each dataset. We develop and evaluate our method with two public large-scale COVID-19 diagnosis datasets made up of CT images. Extensive experiments show that our approach consistently improves the performanceson both datasets, outperforming the original COVID-Net trained on each dataset by 12.16% and 14.23% in AUC respectively, also exceeding existing state-of-the-art multi-site learning methods.


Asunto(s)
Betacoronavirus , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/diagnóstico , Aprendizaje Profundo , Pandemias , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/diagnóstico , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Biología Computacional , Sistemas de Computación , Infecciones por Coronavirus/clasificación , Bases de Datos Factuales/estadística & datos numéricos , Humanos , Aprendizaje Automático , Pandemias/clasificación , Neumonía Viral/clasificación , Interpretación de Imagen Radiográfica Asistida por Computador/estadística & datos numéricos
20.
IEEE J Biomed Health Inform ; 24(10): 2776-2786, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32750973

RESUMEN

Fast and accurate diagnosis is essential for the efficient and effective control of the COVID-19 pandemic that is currently disrupting the whole world. Despite the prevalence of the COVID-19 outbreak, relatively few diagnostic images are openly available to develop automatic diagnosis algorithms. Traditional deep learning methods often struggle when data is highly unbalanced with many cases in one class and only a few cases in another; new methods must be developed to overcome this challenge. We propose a novel activation function based on the generalized extreme value (GEV) distribution from extreme value theory, which improves performance over the traditional sigmoid activation function when one class significantly outweighs the other. We demonstrate the proposed activation function on a publicly available dataset and externally validate on a dataset consisting of 1,909 healthy chest X-rays and 84 COVID-19 X-rays. The proposed method achieves an improved area under the receiver operating characteristic (DeLong's p-value < 0.05) compared to the sigmoid activation. Our method is also demonstrated on a dataset of healthy and pneumonia vs. COVID-19 X-rays and a set of computerized tomography images, achieving improved sensitivity. The proposed GEV activation function significantly improves upon the previously used sigmoid activation for binary classification. This new paradigm is expected to play a significant role in the fight against COVID-19 and other diseases, with relatively few training cases available.


Asunto(s)
Algoritmos , Betacoronavirus , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Pandemias , Neumonía Viral/diagnóstico , Teorema de Bayes , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Biología Computacional , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/epidemiología , Bases de Datos Factuales/estadística & datos numéricos , Aprendizaje Profundo , Humanos , Redes Neurales de la Computación , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/epidemiología , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/estadística & datos numéricos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...