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3.
BMJ ; 373: n379, 2021 04 12.
Artículo en Inglés | MEDLINE | ID: mdl-33846159

RESUMEN

Atrial fibrillation is a common chronic disease seen in primary care offices, emergency departments, inpatient hospital services, and many subspecialty practices. Atrial fibrillation care is complicated and multifaceted, and, at various points, clinicians may see it as a consequence and cause of multi-morbidity, as a silent driver of stroke risk, as a bellwether of an acute medical illness, or as a primary rhythm disturbance that requires targeted treatment. Primary care physicians in particular must navigate these priorities, perspectives, and resources to meet the needs of individual patients. This includes judicious use of diagnostic testing, thoughtful use of novel therapeutic agents and procedures, and providing access to subspecialty expertise. This review explores the epidemiology, screening, and risk assessment of atrial fibrillation, as well as management of its symptoms (rate and various rhythm control options) and stroke risk (anticoagulation and other treatments), and offers a model for the integration of the components of atrial fibrillation care.


Asunto(s)
Fibrilación Atrial/diagnóstico , Tamizaje Masivo/normas , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/normas , Accidente Cerebrovascular/prevención & control , Antiarrítmicos/administración & dosificación , Anticoagulantes/uso terapéutico , Fibrilación Atrial/complicaciones , Fibrilación Atrial/epidemiología , Fibrilación Atrial/terapia , Cateterismo Cardíaco , Electrocardiografía , Carga Global de Enfermedades , Estilo de Vida Saludable , Frecuencia Cardíaca/efectos de los fármacos , Frecuencia Cardíaca/fisiología , Humanos , Incidencia , Tamizaje Masivo/métodos , Prevalencia , Atención Primaria de Salud/métodos , Medición de Riesgo/métodos , Factores de Riesgo , Accidente Cerebrovascular/etiología
4.
Artículo en Inglés | MEDLINE | ID: mdl-33806629

RESUMEN

The HIV/AIDS incidence rates have decreased in African countries although the rates are still high in Sub-Saharan Africa. Our study aimed to examine the long-term trend of the overall HIV/AIDS incidence rates in four countries of the central region of Africa, using data from the Global Burden of Diseases (GBD) 2019 study. The Age-Period-Cohort statistical model analysis was used to measure the trends of HIV/AIDS incidence rates in each of the four countries. HIV/AIDS incidence rates decreased slowly in Cameroon (CAM), Chad, and Central African Republic (CAR), but considerably in the Democratic Republic of the Congo (DRC) from 1990-2019. HIV/AIDS incidence rates in the four countries were at their peaks in the age group of 25-29 years. According to the age relative risks, individuals aged between 15 and 49 years old are at high risk of HIV/AIDS incidence in the four countries. The period and cohort relative risks have decreased in all four countries. Although CAM recorded an increase of 59.6% in the period relative risks (RRs) between 1990 and 1999, HIV/AIDS incidence has decreased dramatically in all four countries, especially after 2000. The decrease of the period RRs (relative risk) by nearly 20.6-folds and the decrease of the cohort RRs from 147.65 to almost 0.0034 in the DRC made it the country with the most significant decrease of the period and cohort RRs compared to the rest. HIV/AIDS incidence rates are decreasing in each of the four countries. Our study findings could provide solid ground for policymakers to promptly decrease HIV/AIDS incidence by strengthening the prevention policies to eliminate the public health threat of HIV/AIDS by 2030 as one of the targets of the Sustainable Development Goals (SDGs).


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Adolescente , Adulto , África del Sur del Sahara/epidemiología , Camerún , Carga Global de Enfermedades , Infecciones por VIH/epidemiología , Humanos , Incidencia , Persona de Mediana Edad , Adulto Joven
5.
Arq Gastroenterol ; 58(1): 100-106, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33909787

RESUMEN

BACKGROUND: In the world, around 450,000 new cases of esophageal cancer are diagnosed each year. OBJECTIVE: To evaluate the trend of esophageal cancer mortality rates in Brazil between 1990-2017. METHODS: A time series study using data on mortality from esophageal cancer in residents ≥30 years in Brazil from 1990 to 2017. Data was estimated by the Global Burden of Disease (GBD) study and analyzed according to sex, age group and federal unit of Brazil. The standardized rates according to age were calculated by the direct method using the standard GBD world population. Annual average percentage change and 95% confidence interval (95% CI) were calculated for mortality by Joinpoint regression. RESULTS: The age-standardized mortality rate in males was 20.6 in 1990 and 17.6/100,000 in 2017, increasing according to age, being 62.4 (1990) and 54.7 (2017) for ≥70 years. In women, the age-standardized mortality rate was 5.9 in 1990 and 4.2/100,000 in 2017. There was a reduction in mortality rates in all age groups and both sexes with great variation among the states. CONCLUSION: Despite the high mortality rates for esophageal cancer in Brazil, the trend was decreasing, but with regional differences. Mortality was around four times higher in men.


Asunto(s)
Neoplasias Esofágicas , Carga Global de Enfermedades , Anciano , Brasil/epidemiología , Femenino , Humanos , Masculino
8.
Biomed Environ Sci ; 34(2): 101-109, 2021 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-33685568

RESUMEN

Objective: To assess the association of socioeconomic status with the burden of cataract blindness in terms of year lived with disability (YLD) rates and to determine whether ultraviolet radiation (UVR) levels modify the effect of socioeconomic status on this health burden. Methods: National and subnational age-standardized YLD rates associated with cataract-related blindness were derived from the Global Burden of Disease (GBD) study 2017. The human development index (HDI) from the Human Development Report was used as a measure of socioeconomic status. Estimated ground-level UVR exposure was obtained from the Ozone Monitoring Instrument (OMI) dataset of the National Aeronautics and Space Administration (NASA). Results: Across 185 countries, socioeconomic status was inversely associated with the burden of cataract blindness. Countries with a very high HDI had an 84% lower age-standardized YLD rate [95% confidence interval ( CI): 60%-93%, P < 0.001] than countries with a low HDI; for high-HDI countries, the proportion was 76% (95% CI: 53%-88%, P < 0.001), and for medium-HDI countries, the proportion was 48% (95% CI: 15%-68%, P = 0.010; P for trend < 0.001). The interaction analysis showed that UVR exposure played an interactive role in the association between socioeconomic status and cataract blindness burden ( P value for interaction = 0.047). Conclusion: Long-term high-UVR exposure amplifies the association of poor socioeconomic status with the burden of cataract-related blindness. The findings emphasize the need for strengthening UVR exposure protection interventions in developing countries with high-UVR exposure.


Asunto(s)
Ceguera/epidemiología , Catarata/epidemiología , Carga Global de Enfermedades , Rayos Ultravioleta/efectos adversos , Ceguera/etiología , Catarata/etiología , Femenino , Carga Global de Enfermedades/estadística & datos numéricos , Humanos , Masculino , Años de Vida Ajustados por Calidad de Vida , Clase Social , Factores Socioeconómicos
10.
Lancet Psychiatry ; 8(4): 320-328, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33675688

RESUMEN

BACKGROUND: Anorexia nervosa and bulimia nervosa are the only eating disorders included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, yet binge-eating disorder and other specified feeding or eating disorder (OSFED) are more prevalent. This study sought to estimate the prevalence and burden of binge-eating disorder and OSFED globally and present a case for their inclusion in GBD. METHODS: We sourced studies from the GBD 2019 anorexia nervosa and bulimia nervosa epidemiological databases, two systematic reviews that included studies with epidemiological estimates of binge-eating disorder and OSFED, and experts in the field. Studies, published between Jan 1, 1998, and March 1, 2019, were included if they reported non-zero prevalence of two or more eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder, or OSFED) and diagnosed cases according to DSM-IV or DSM-5. The proportions of total eating disorder cases that met diagnostic criteria for each individual eating disorder were estimated via network meta-regression and simulation using studies reporting eating disorder prevalence. The global cases unrepresented in GBD 2019 were estimated using the proportions from the simulation and the GBD 2019 eating disorder prevalence. Disability weights for binge-eating disorder and OSFED were then estimated along with disability-adjusted life-years (DALYs). Estimates are presented with 95% uncertainty intervals (UIs). FINDINGS: 54 studies, of which 36 were from high-income countries, were included in the analysis. The number of global eating disorder cases in 2019 that were unrepresented in GBD 2019 was 41·9 million (95% UI 27·9-59·0), and consisted of 17·3 million (11·3-24·9) people with binge-eating disorder and 24·6 million (14·7-39·7) people with OSFED (vs 13·6 million [10·2-17·5] people with eating disorders in GBD 2019). Together, binge-eating disorder and OSFED caused 3·7 million (95% UI 2·0-6·5) DALYs globally, bringing the total eating disorder DALYs to 6·6 million (3·8-10·6) in 2019. INTERPRETATION: Binge-eating disorder and OSFED accounted for the majority of eating disorder cases and DALYs globally. These findings warrant the inclusion of binge-eating disorder and OSFED in future iterations of GBD, which will bring the burden experienced by people living with these disorders to the attention of policy makers with the means to target this burden. FUNDING: Queensland Health, Australian National Health and Medical Research Council, and Bill & Melinda Gates Foundation.


Asunto(s)
Trastorno por Atracón/epidemiología , Carga Global de Enfermedades , Personas con Discapacidad/estadística & datos numéricos , Femenino , Humanos , Masculino , Prevalencia , Años de Vida Ajustados por Calidad de Vida
12.
Psychiatry Res ; 299: 113855, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33721788

RESUMEN

The COVID-19 pandemic has caused unprecedented isolation and mental health effects; few studies have characterized this in sexual and gender (SGM) minority young people, a particularly vulnerable population. This cross-sectional study sought to analyze the mental health outcomes of SGM young people (18-30 years) during the early stages of the pandemic in the United States (April 13-June 18, 2020) and to explore how factors related to SGM identity impact mental health, such as lifetime discrimination, family support, and pre-existing mental health conditions. An online survey collected socio-demographic information and assessed for both mental health (depression (PHQ-8), anxiety (GAD-7), PTSD (PCL-C)) and COVID-19-related outcomes (COVID-19-related worries and COVID-19-related grief). Out of 981 participants, 320 (32.6%) identified as SGM. SGM had significantly higher levels of depression and PTSD symptoms as well as COVID-19-related worries and grief than non-SGM, even after controlling for family support, lifetime discrimination, and pre-existing mental health diagnoses. These findings suggest that not only has the COVID-19 pandemic disproportionately impacted SGM mental health, but that minority stress factors cannot fully explain this impact. Thus, clinicians and societal stakeholders (schools, employers, policymakers) must think beyond traditional minority stress factors (family support, discrimination) and pre-pandemic disparities to support this vulnerable population as the pandemic progresses.


Asunto(s)
/psicología , Carga Global de Enfermedades , Salud Mental/estadística & datos numéricos , Factores Sexuales , Conducta Sexual/psicología , Minorías Sexuales y de Género/psicología , Adolescente , Ansiedad/psicología , Estudios Transversales , Femenino , Humanos , Masculino , Pandemias , Cuestionario de Salud del Paciente , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Adulto Joven
13.
Lancet ; 397(10283): 1505-1518, 2021 04 17.
Artículo en Inglés | MEDLINE | ID: mdl-33773612

RESUMEN

Migraine is a highly disabling neurological disorder that directly affects more than 1 billion individuals worldwide. Available treatment options differ between countries and include acute, preventive, and non-pharmacological therapies. Because of major progress in the understanding of migraine pathogenesis, novel mechanism-based medications have emerged and expanded the armamentarium of treatments. We provide a comprehensive overview of the current standard of care that will enable informed clinical management. First, we discuss the efficacy, tolerability, and safety profile of various pharmacological therapies for acute and preventive treatment of migraine. Second, we review the current knowledge on non-pharmacological therapies, such as neuromodulation and biobehavioural approaches, which can be used for a multidisciplinary approach to clinical management. Third, we emphasise that any effective treatment strategy starts with building a therapeutic plan tailored to individual clinical characteristics, preferences, and needs. Finally, we explore the outlook of emerging mechanism-based treatments that could address unmet challenges in clinical management of migraine.


Asunto(s)
Carga Global de Enfermedades , Trastornos Migrañosos/epidemiología , Femenino , Humanos , Masculino , Trastornos Migrañosos/terapia , Prevalencia , Atención Primaria de Salud/métodos
14.
Sci Total Environ ; 775: 145839, 2021 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-33631580

RESUMEN

Exposure to household air pollution from solid fuels (HAP) is associated with stroke. However, few studies have assessed stroke burden attributable to HAP globally and made comparisons across countries. We aimed to estimate the spatiotemporal trends in stroke burden and mortality attributable to household air pollution from solid fuels (HAP) in 204 countries and territories from 1990 to 2019. Data on stroke burden and mortality attributable to HAP from 1990 to 2019 were obtained from Global Burden of Disease Study 2019. We estimated the numbers and age-standardized rates (ASRs) of stroke disability-adjusted life years (DALYs) and mortality (ASDR and ASMR) by sex, age, and subtype, at global, regional, and national levels. Estimated annual percentage change (EAPC) was calculated to evaluate the temporal trends in ASDR and ASMR from 1990 to 2019. In 2019, globally, 14.7 million DALYs and 0.6 million deaths were caused by stroke attributable to HAP. The corresponding ASDR and ASMR increased with age, were highest in males and for intracerebral hemorrhage, with highest ASRs in the low sociodemographic index (SDI) regions and Solomon Islands, and varied greatly at the national level. From 1990 to 2019, the corresponding EAPCs in ASDR and ASMR were -4.00 (95% confidence interval [CI]: -4.21 to -3.80) and -4.12 (95% CI: -4.37 to -3.87), respectively. Stroke burden attributable to HAP decreased in all age groups. Females had a lower decreasing trend in ASDR and ASMR, compared with males. The decline was more significant for subarachnoid hemorrhage, while proportions of ischemic stroke in the numbers of stroke burden increased worldwide and in all SDI regions. Although most of countries and territories were in a decreasing trend in ASRs over the past three decades, Zimbabwe and Philippines showed an undesirable increased trend. Stroke burden attributable to HAP is still pronounced in males, old-age populations, low-income countries, and for intracerebral hemorrhage. Despite its decreasing spatiotemporal trends in most countries, continued efforts on HAP control are needed to reduce related stroke burden, especially in those countries with increased trends.


Asunto(s)
Contaminación del Aire , Accidente Cerebrovascular , Femenino , Carga Global de Enfermedades , Humanos , Masculino , Melanesia , Filipinas , Años de Vida Ajustados por Calidad de Vida , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Zimbabwe
15.
Lancet Glob Health ; 9(4): e489-e551, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33607016
16.
JAMA Netw Open ; 4(2): e2037530, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33599775

RESUMEN

Importance: Occupational exposure to carcinogens has been shown to pose a serious disease burden at the global, regional, and national levels. Based on epidemiologic studies and clinical observations, working environment appears to have important effects on the occurrence of human malignant tumors; however, to date, no systematic articles have been published that specifically investigated cancer burden due to occupational exposure in an individual and collective manner. Objective: To estimate the degree of exposure and evaluate the cancer burden attributable to occupational carcinogens (OCs) individually and collectively by sex, age, year, and location. Design, Setting, and Participants: Cross-sectional study including data on 195 countries from the Global Burden of Diseases, Injuries, and Risk Factors Study from January 1, 1990, to December 31, 2017. Data were analyzed from June 24, 2020, to July 20, 2020. Exposures: Thirteen OCs (ie, arsenic, asbestos, benzene, beryllium, cadmium, chromium, diesel engine exhaust, formaldehyde, nickel, polycyclic aromatic hydrocarbons, silica, sulfuric acid, and trichloroethylene). Main Outcomes and Measures: The degree and change patterns of exposure as well as the attributable cancer burden, including deaths and disability-adjusted life years (DALYs), by sex, age, year, and location for 13 OCs. The calculation of the population-attributable fraction was based on past exposure in the population and relative risks. Results: Based on the GBD 2017 study, 13 OCs attributable to 7 cancer types were included. Most summary exposure values for the 13 OCs, particularly those of diesel engine exhaust (35.6% increase; 95% uncertainty interval [UI], 32.4%-38.5%) and trichloroethylene (30.3% increase; 95% UI, 27.3%-33.5%), increased from 1990 to 2017. Only exposure to asbestos decreased by 13.8% (95% UI, -26.7% to 2.2%). In 2017, 319 000 (95% UI, 256 000-382 000) cancer deaths and 6.42 million (95% UI, 5.15 million to 7.76 million) DALYs were associated with OCs combined, accounting for 61.0% (95% UI, 59.6%-62.4%) of the total cancer deaths and 48.3% (46.3% to 50.2%) of the DALYs. Among the 13 OCs, the 3 leading risk factors for cancer burden were asbestos (71.8%), silica (15.4%), and diesel engine exhaust (5.6%). For most OCs, the attributed cancer outcome was tracheal, bronchial, and lung cancer, which accounted for 89.0% of attributable cancer deaths. China (61 644 cancer deaths), the US (42 848), and Japan (20 748) accounted for the largest number of attributable cancer deaths in 2017; for DALYs, China (1.47 million), the US (0.71 million), and India (0.37 million) were the 3 leading countries. Conclusions and Relevance: Results of this study suggest that although OC exposure levels have decreased, the overall cancer burden is continuously increasing.


Asunto(s)
Carcinógenos , Carga Global de Enfermedades , Neoplasias/mortalidad , Exposición Profesional/estadística & datos numéricos , Años de Vida Ajustados por Calidad de Vida , Adolescente , Adulto , Anciano , Arsénico , Asbestos , Benceno , Berilio , Cadmio , China/epidemiología , Cromo , Estudios Transversales , Femenino , Formaldehído , Humanos , India/epidemiología , Japón/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Níquel , Hidrocarburos Policíclicos Aromáticos , Dióxido de Silicio , Ácidos Sulfúricos , Tricloroetileno , Estados Unidos/epidemiología , Emisiones de Vehículos , Adulto Joven
19.
Genet Test Mol Biomarkers ; 25(2): 85-101, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33596144

RESUMEN

Coronavirus disease 2019 (COVID-19) displays a broad spectrum of clinical presentations ranging from lack of symptoms to severe multiorgan system complications and death. Various laboratory assays have been employed in the diagnosis of COVID-19, including: nucleic acid-based tests; antigen tests; and serum testing for anti-severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibodies. The disease can also be diagnosed based on suggestive clinical features and radiological findings. Until now, remdesivir is the only medication approved for the treatment of COVID-19 by the U.S. Food and Drug Administration (FDA); however, it is anticipated that several anti-SARS-CoV-2 monoclonal antibodies will gain soon approval. Other methods of treatment include supportive care directed toward treating the symptoms. Nevertheless, many studies have recently emerged, showing controversial preliminary results with the off-label medication hydroxychloroquine. Given that all results are still preliminary, including those seen by remdesivir, additional evidence and research are required to identify effective medications that are broadly effective and well tolerated. Importantly, two RNA-based vaccines have recently gained approval from Pfizer and Moderna, with many others still in clinical trials. This article reviews various aspects of COVID-19, including its epidemiology; its evolution and mutational spectrum; and its clinical dynamics, symptoms and complications, diagnosis, and treatment.


Asunto(s)
Carga Global de Enfermedades/estadística & datos numéricos , Pandemias/estadística & datos numéricos , /patogenicidad , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Antivirales/uso terapéutico , /tratamiento farmacológico , /terapia , /métodos , Ensayos Clínicos como Asunto , Evolución Molecular , Humanos , Hidroxicloroquina/uso terapéutico , Mutación , Uso Fuera de lo Indicado , Pandemias/prevención & control , ARN Viral/genética , ARN Viral/aislamiento & purificación , /inmunología , Índice de Severidad de la Enfermedad
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