Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 51.011
Filtrar
1.
Rev. enferm. UERJ ; 28: e39729, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1116093

RESUMEN

Objetivo: identificar as principais causas de óbito entre adolescentes de 10 a 19 anos em um município no interior do estado do Rio de Janeiro. Método: estudo descritivo, exploratório de abordagem quantitativa, a partir do levantamento de dados em registros de óbitos do município de Rio das Ostras. O desfecho foi causa básica do óbito. Os dados foram processados no Programa R. Resultados: foram observados 84 (100%) óbitos, com maior prevalência entre adolescentes de 17 a 19 anos, 49 (58,3%), do sexo masculino, 71 (84,5%) e de cor parda, 38 (45,2%). As principais causas de óbitos foram homicídio/perfuração por arma de fogo, 35 (41,7%), e acidentes, 32 (38,1%). Conclusão: o reconhecimento dessa vulnerabilidade configura importante caminho para o enfrentamento e resolução desse grave problema, sobretudo municípios localizados longe de centros urbanos, parece muitas vezes esquecido, no que tange o cumprimento de estatutos e políticas públicas a favor desse grupo etário.


Objective: to identify the main causes of death among adolescents aged 10 to 19 years in a municipality in the state of Rio de Janeiro. Method: in this exploratory, descriptive, quantitative study, based on data collected from death records in the municipality of Rio das Ostras, the basic cause of death was the outcome. The data were processed in the statistics software, R. Results: of the 84 (100%) deaths observed, prevalence was higher among adolescents aged 17 to 19 years (49; 58.3%), males (71; 84.5%), and pardos (38; 45.2%). The main causes of deaths were firearm Injury / homicide (35; 41.7%) and accidents (32; 38.1%). Conclusion: one important step towards confronting and solving this serious problem is to acknowledge this vulnerability, especially in municipalities distant from urban centers, which often seem neglected as regards compliance with statutes and public policies in favor of this age group.


Objetivo: identificar las principales causas de muerte entre adolescentes de 10 a 19 años en un municipio del estado de Río de Janeiro. Método: en este estudio exploratorio, descriptivo, cuantitativo, basado en los datos recopilados de los registros de defunciones en el municipio de Rio das Ostras, la causa básica de la muerte fue el resultado. Los datos se procesaron en el programa estadístico R. Resultados: de las 84 (100%) muertes observadas, la prevalencia fue mayor entre los adolescentes de 17 a 19 años (49; 58.3%), varones (71; 84.5%) y pardos (38; 45,2%). Las principales causas de muerte fueron lesiones por arma de fuego / homicidio (35; 41.7%) y accidentes (32; 38.1%). Conclusión: un paso importante para enfrentar y resolver este grave problema es reconocer esta vulnerabilidad, especialmente en municipios alejados de los centros urbanos, que a menudo parecen descuidados en cuanto al cumplimiento de los estatutos y las políticas públicas a favor de este grupo de edad.


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto Joven , Accidentes/estadística & datos numéricos , Causas de Muerte , Poblaciones Vulnerables/estadística & datos numéricos , Homicidio/estadística & datos numéricos , Brasil , Epidemiología Descriptiva , Factores de Edad , Vulnerabilidad Social , Mortalidad Prematura
2.
Colomb Med (Cali) ; 51(2): e4270, 2020 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-33012885

RESUMEN

Introduction: The COVID-19 disease pandemic is a health emergency. Older people and those with chronic noncommunicable diseases are more likely to develop serious illnesses, require ventilatory support, and die from complications. Objective: To establish deaths from respiratory infections and some chronic non-communicable diseases that occurred in Cali, before the SARS-CoV-2 disease pandemic. Methods: During the 2003-2019 period, 207,261 deaths were registered according to the general mortality database of the Municipal Secretary of Health of Cali. Deaths were coded with the International Classification of Diseases and causes of death were grouped according to WHO guidelines. Rates were standardized by age and are expressed per 100,000 people-year. Results: A direct relationship was observed between aging and mortality from respiratory infections and chronic non-communicable diseases. Age-specific mortality rates were highest in those older than 80 years for all diseases evaluated. Seasonal variation was evident in respiratory diseases in the elderly. Comments: Estimates of mortality rates from respiratory infections and chronic non-communicable diseases in Cali provide the baseline that will serve as a comparison to estimate the excess mortality caused by the COVID-19 pandemic. Health authorities and decision makers should be guided by reliable estimates of mortality and of the proportion of infected people who die from SARS-CoV-2 virus infection.


Asunto(s)
Causas de Muerte/tendencias , Enfermedades no Transmisibles/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Colombia/epidemiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Humanos , Enfermedades no Transmisibles/mortalidad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Infecciones del Sistema Respiratorio/mortalidad , Factores de Riesgo , Estaciones del Año
3.
Mayo Clin Proc ; 95(10): 2110-2124, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33012342

RESUMEN

OBJECTIVE: To address the issue of limited national data on the prevalence and distribution of underlying conditions among COVID-19 deaths between sexes and across age groups. PATIENTS AND METHODS: All adult (≥18 years) deaths recorded in England and Wales (March 1, 2020, to May 12, 2020) were analyzed retrospectively. We compared the prevalence of underlying health conditions between COVID and non-COVID-related deaths during the COVID-19 pandemic and the age-standardized mortality rate (ASMR) of COVID-19 compared with other primary causes of death, stratified by sex and age group. RESULTS: Of 144,279 adult deaths recorded during the study period, 36,438 (25.3%) were confirmed COVID deaths. Women represented 43.2% (n=15,731) of COVID deaths compared with 51.9% (n=55,980) in non-COVID deaths. Overall, COVID deaths were younger than non-COVID deaths (82 vs 83 years). ASMR of COVID-19 was higher than all other common primary causes of death, across age groups and sexes, except for cancers in women between the ages of 30 and 79 years. A linear relationship was observed between ASMR and age among COVID-19 deaths, with persistently higher rates in men than women across all age groups. The most prevalent reported conditions were hypertension, dementia, chronic lung disease, and diabetes, and these were higher among COVID deaths. Pre-existing ischemic heart disease was similar in COVID (11.4%) and non-COVID (12%) deaths. CONCLUSION: In a nationwide analysis, COVID-19 infection was associated with higher age-standardized mortality than other primary causes of death, except cancer in women of select age groups. COVID-19 mortality was persistently higher in men and increased with advanced age.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Disparidades en Atención de Salud/estadística & datos numéricos , Mortalidad Hospitalaria/tendencias , Neumonía Viral/mortalidad , Adulto , Distribución por Edad , Factores de Edad , Anciano , Causas de Muerte , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , Distribución por Sexo , Factores Socioeconómicos , Gales/epidemiología
5.
Medwave ; 20(8): e8031, 2020 Sep 25.
Artículo en Español | MEDLINE | ID: mdl-33017383

RESUMEN

Objective: To compare excess mortality by district quintiles according to the Human Development Index (HDI) in Metropolitan Lima, the capital of Peru, and analyze the socioeconomic factors associated with excess mortality within the context of COVID-19. Methods: Retrospective cross-sectional analysis of the mortality records from non-violent causes registered in the National Death Information System in the 50 districts of Metropolitan Lima of the first 24 weeks of the years 2019 and 2020. Descriptive analysis was performed using contingency tables and time series graphs by sex, age group, and quintile of the district of residence according to the HDI. Negative binomial regression analysis was performed to identify possible explanatory factors for excess mortality. Results: An excess of 20 093 non-violent deaths and 2,979 confirmed deaths from COVID-19 were registered in Metropolitan Lima during the study period. The increase was observed primarily in men and adults aged 60 and over. Residents in the districts belonging to the fifth quintile, according to HDI, presented, in most cases, the lowest rates. Multivariate analysis revealed that a higher HDI level (p = 0.009) and a higher proportion of inhabitants living in extreme poverty (p = 0.014) decreased the excess mortality. Conclusion: Excess of non-violent deaths in Metropolitan Lima is higher in the quintiles with the lowest HDI, in men, and the age group from 60 to more years of age. The study of social and economic health determinants in Peru is crucial for the design of measures to be taken by the government against the COVID-19 pandemic.


Asunto(s)
Causas de Muerte , Infecciones por Coronavirus/epidemiología , Mortalidad/tendencias , Neumonía Viral/epidemiología , Adolescente , Adulto , Distribución por Edad , Niño , Preescolar , Infecciones por Coronavirus/mortalidad , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pandemias , Perú/epidemiología , Neumonía Viral/mortalidad , Pobreza , Estudios Retrospectivos , Distribución por Sexo , Factores Socioeconómicos , Adulto Joven
6.
Open Heart ; 7(2)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33020258

RESUMEN

BACKGROUND: Cardiac involvement with COVID-19 is increasingly being recognised. Clinical characteristics and outcomes of patients with COVID-19 complicated by secondary Takotsubo cardiomyopathy (TC) is poorly understood. METHODS: This retrospective case series was conducted between March and April 2020 at four hospitals of Steward Health Care Network of Massachusetts, USA. Seven patients out of 169 who had echocardiogram were identified to have features of TC. Demographic, clinical, laboratory, management and outcome were gathered from their electronic medical records. We also reviewed all the published cases of COVID-19 and TC in the literature to recognise their common clinical characteristics, risk factors and outcomes. RESULTS: In our series of seven patients, three typical, two inverted, one biventricular and one global TC were recognised. Three were females and four were males. The mean age was 71±11 years. In-hospital death was observed in 57% of patients. Patients who belonged to the high-risk group and had high-risk echocardiographic features in our series had a 100% mortality rate. CONCLUSIONS: COVID-19 complicated by TC has a high mortality rate. Early identification of patients with COVID-19 who are at higher risk for developing secondary TC is important for the prevention of complications, and thus improved outcomes.


Asunto(s)
Causas de Muerte , Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades/estadística & datos numéricos , Neumonía Viral/epidemiología , Cardiomiopatía de Takotsubo/diagnóstico por imagen , Cardiomiopatía de Takotsubo/epidemiología , Distribución por Edad , Anciano , Estudios de Cohortes , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Ecocardiografía/métodos , Electrocardiografía/métodos , Femenino , Corazón Auxiliar , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Massachusetts , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Prevalencia , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Cardiomiopatía de Takotsubo/terapia
7.
Arkh Patol ; 82(5): 5-15, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33054027

RESUMEN

To date, descriptive results of a clinical and morphological study of novel coronavirus COVID-19 infection, mainly of the lungs, have appeared. However, in other organs, primarily in the cardiovascular system, there are substantial structural changes that lead to multiple organ dysfunction and contribute to death. OBJECTIVE: To analyze the thanatogenetic significance of novel coronavirus COVID-19 infection in different age and gender groups and to describe the main morphopathological manifestations in various organs. MATERIAL AND METHODS: The investigators carried out a comprehensive analysis of 700 autopsies of people disease from the novel coronavirus COVID-19 infection, which included an examination of gross changes reflected in the autopsy protocols and forensic medical examination reports, as well as that of microscopic changes detected during histological examination of organs. Immunohistochemistry (IHC) using mouse or rabbit antibodies to CD34, CD68, EMA, Ki67, caspase-3, and VEGF was employed in some observations. RESULTS: The novel coronavirus COVID-19 infection was the primary cause of death. Acute respiratory and pulmonary heart failure and multiple organ dysfunction became the leading thanatogenetic mechanisms in COVID-19. Cardiovascular disease, diabetes mellitus, and obesity were the most common diseases in patients with COVID-19. The most pronounced lung changes in COVID-19 were determined with a predominance of multiple total bilateral lesions of the lower lobes of the lungs, which was manifested by virus-induced changes in the parenchyma and stroma, as well as by microcirculation disorders. Acute dyscirculatory and ischemic changes in the parenchymal organs dominated in tissue damage caused by the virus. CONCLUSION: The changes in different organs of those who have died from the new coronavirus COVID-19 infection are stereotyped and include the manifestations of virus-induced action and a systemic inflammatory response with mainly microvasculature alteration, which leads to the development of coagulopathies and, accordingly, to total hypoxia.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/patología , Neumonía Viral/patología , Autopsia , Causas de Muerte , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Humanos , Pandemias , Neumonía Viral/mortalidad , Neumonía Viral/virología
8.
BMJ ; 371: m3464, 2020 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-32998909

RESUMEN

OBJECTIVE: To evaluate whether irregular or long menstrual cycles throughout the life course are associated with all cause and cause specific premature mortality (age <70 years). DESIGN: Prospective cohort study. SETTING: Nurses' Health Study II (1993-2017). PARTICIPANTS: 79 505 premenopausal women without a history of cardiovascular disease, cancer, or diabetes and who reported the usual length and regularity of their menstrual cycles at ages 14-17 years, 18-22 years, and 29-46 years. MAIN OUTCOME MEASURES: Hazard ratios and 95% confidence intervals for all cause and cause specific premature mortality (death before age 70 years) were estimated from multivariable Cox proportional hazards models. RESULTS: During 24 years of follow-up, 1975 premature deaths were documented, including 894 from cancer and 172 from cardiovascular disease. Women who reported always having irregular menstrual cycles experienced higher mortality rates during follow-up than women who reported very regular cycles in the same age ranges. The crude mortality rate per 1000 person years of follow-up for women reporting very regular cycles and women reporting always irregular cycles were 1.05 and 1.23 for cycle characteristics at ages 14-17 years, 1.00 and 1.37 for cycle characteristics at ages 18-22 years, and 1.00 and 1.68 for cycle characteristics at ages 29-46 years. The corresponding multivariable adjusted hazard ratios for premature death during follow-up were 1.18 (95% confidence interval 1.02 to 1.37), 1.37 (1.09 to 1.73), and 1.39 (1.14 to 1.70), respectively. Similarly, women who reported that their usual cycle length was 40 days or more at ages 18-22 years and 29-46 years were more likely to die prematurely than women who reported a usual cycle length of 26-31 days in the same age ranges (1.34, 1.06 to 1.69; and 1.40, 1.17 to 1.68, respectively). These relations were strongest for deaths related to cardiovascular disease. The higher mortality associated with long and irregular menstrual cycles was slightly stronger among current smokers. CONCLUSIONS: Irregular and long menstrual cycles in adolescence and adulthood are associated with a greater risk of premature mortality (age <70 years). This relation is slightly stronger among women who smoke.


Asunto(s)
Ciclo Menstrual , Trastornos de la Menstruación/epidemiología , Mortalidad Prematura , Salud Reproductiva/estadística & datos numéricos , Adolescente , Adulto , Enfermedades Cardiovasculares/epidemiología , Causas de Muerte , Estudios de Cohortes , Femenino , Humanos , Persona de Mediana Edad , Neoplasias/epidemiología , Medición de Riesgo , Factores de Riesgo , Autoinforme , Fumar/epidemiología , Estados Unidos/epidemiología
9.
BMJ ; 371: m3485, 2020 10 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028588

RESUMEN

OBJECTIVE: To evaluate the effect of five years of supervised exercise training compared with recommendations for physical activity on mortality in older adults (70-77 years). DESIGN: Randomised controlled trial. SETTING: General population of older adults in Trondheim, Norway. PARTICIPANTS: 1567 of 6966 individuals born between 1936 and 1942. INTERVENTION: Participants were randomised to two sessions weekly of high intensity interval training at about 90% of peak heart rate (HIIT, n=400), moderate intensity continuous training at about 70% of peak heart rate (MICT, n=387), or to follow the national guidelines for physical activity (n=780; control group); all for five years. MAIN OUTCOME MEASURE: All cause mortality. An exploratory hypothesis was that HIIT lowers mortality more than MICT. RESULTS: Mean age of the 1567 participants (790 women) was 72.8 (SD 2.1) years. Overall, 87.5% of participants reported to have overall good health, with 80% reporting medium or high physical activity levels at baseline. All cause mortality did not differ between the control group and combined MICT and HIIT group. When MICT and HIIT were analysed separately, with the control group as reference (observed mortality of 4.7%), an absolute risk reduction of 1.7 percentage points was observed after HIIT (hazard ratio 0.63, 95% confidence interval 0.33 to 1.20) and an absolute increased risk of 1.2 percentage points after MICT (1.24, 0.73 to 2.10). When HIIT was compared with MICT as reference group an absolute risk reduction of 2.9 percentage points was observed (0.51, 0.25 to 1.02) for all cause mortality. Control participants chose to perform more of their physical activity as HIIT than the physical activity undertaken by participants in the MICT group. This meant that the controls achieved an exercise dose at an intensity between the MICT and HIIT groups. CONCLUSION: This study suggests that combined MICT and HIIT has no effect on all cause mortality compared with recommended physical activity levels. However, we observed a lower all cause mortality trend after HIIT compared with controls and MICT. TRIAL REGISTRATION: ClinicalTrials.gov NCT01666340.


Asunto(s)
Envejecimiento , Ejercicio Físico , Frecuencia Cardíaca/fisiología , Entrenamiento de Intervalos de Alta Intensidad/métodos , Rendimiento Físico Funcional , Anciano , Envejecimiento/fisiología , Envejecimiento/psicología , Causas de Muerte , Ejercicio Físico/fisiología , Ejercicio Físico/psicología , Femenino , Humanos , Masculino , Mortalidad , Evaluación de Resultado en la Atención de Salud , Aptitud Física , Conducta de Reducción del Riesgo
10.
PLoS One ; 15(10): e0240286, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33035253

RESUMEN

In this study we present the first comprehensive analysis of the spatio-temporal differences in excess mortality during the COVID-19 pandemic in Italy. We used a population-based design on all-cause mortality data, for the 7,904 Italian municipalities. We estimated sex-specific weekly mortality rates for each municipality, based on the first four months of 2016-2019, while adjusting for age, localised temporal trends and the effect of temperature. Then, we predicted all-cause weekly deaths and mortality rates at municipality level for the same period in 2020, based on the modelled spatio-temporal trends. Lombardia showed higher mortality rates than expected from the end of February, with 23,946 (23,013 to 24,786) total excess deaths. North-West and North-East regions showed one week lag, with higher mortality from the beginning of March and 6,942 (6,142 to 7,667) and 8,033 (7,061 to 9,044) total excess deaths respectively. We observed marked geographical differences also at municipality level. For males, the city of Bergamo (Lombardia) showed the largest percent excess, 88.9% (81.9% to 95.2%), at the peak of the pandemic. An excess of 84.2% (73.8% to 93.4%) was also estimated at the same time for males in the city of Pesaro (Central Italy), in stark contrast with the rest of the region, which does not show evidence of excess deaths. We provided a fully probabilistic analysis of excess mortality during the COVID-19 pandemic at sub-national level, suggesting a differential direct and indirect effect in space and time. Our model can be used to help policy-makers target measures locally to contain the burden on the health-care system as well as reducing social and economic consequences. Additionally, this framework can be used for real-time mortality surveillance, continuous monitoring of local temporal trends and to flag where and when mortality rates deviate from the expected range, which might suggest a second wave of the pandemic.


Asunto(s)
Causas de Muerte/tendencias , Infecciones por Coronavirus/epidemiología , Bases de Datos Factuales , Neumonía Viral/epidemiología , Teorema de Bayes , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Femenino , Humanos , Italia/epidemiología , Masculino , Modelos Teóricos , Pandemias , Neumonía Viral/mortalidad , Neumonía Viral/virología
11.
Cochrane Database Syst Rev ; 10: CD013600, 2020 10 12.
Artículo en Inglés | MEDLINE | ID: mdl-33044747

RESUMEN

BACKGROUND: Convalescent plasma and hyperimmune immunoglobulin may reduce mortality in patients with viral respiratory diseases, and are currently being investigated in trials as potential therapy for coronavirus disease 2019 (COVID-19). A thorough understanding of the current body of evidence regarding the benefits and risks is required.  OBJECTIVES: To continually assess, as more evidence becomes available, whether convalescent plasma or hyperimmune immunoglobulin transfusion is effective and safe in treatment of people with COVID-19. SEARCH METHODS: We searched the World Health Organization (WHO) COVID-19 Global Research Database, MEDLINE, Embase, Cochrane COVID-19 Study Register, Centers for Disease Control and Prevention COVID-19 Research Article Database and trial registries to identify completed and ongoing studies on 19 August 2020. SELECTION CRITERIA: We followed standard Cochrane methodology. We included studies evaluating convalescent plasma or hyperimmune immunoglobulin for people with COVID-19, irrespective of study design, disease severity, age, gender or ethnicity. We excluded studies including populations with other coronavirus diseases (severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS)) and studies evaluating standard immunoglobulin. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methodology. To assess bias in included studies, we used the Cochrane 'Risk of bias' 2.0 tool for randomised controlled trials (RCTs), the Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tool for controlled non-randomised studies of interventions (NRSIs), and the assessment criteria for observational studies, provided by Cochrane Childhood Cancer for non-controlled NRSIs. We rated the certainty of evidence using the GRADE approach for the following outcomes: all-cause mortality at hospital discharge, mortality (time to event), improvement of clinical symptoms (7, 15, and 30 days after transfusion), grade 3 and 4 adverse events (AEs), and serious adverse events (SAEs). MAIN RESULTS: This is the second living update of our review. We included 19 studies (2 RCTs, 8 controlled NRSIs, 9 non-controlled NRSIs) with 38,160 participants, of whom 36,081 received convalescent plasma. Two completed RCTs are awaiting assessment (published after 19 August 2020). We identified a further 138 ongoing studies evaluating convalescent plasma or hyperimmune immunoglobulin, of which 73 are randomised (3 reported in a study registry as already being completed, but without results). We did not identify any completed studies evaluating hyperimmune immunoglobulin. We did not include data from controlled NRSIs in data synthesis because of critical risk of bias. The overall certainty of evidence was low to very low, due to study limitations and results including both potential benefits and harms.  Effectiveness of convalescent plasma for people with COVID-19  We included results from two RCTs (both stopped early) with 189 participants, of whom 95 received convalescent plasma. Control groups received standard care at time of treatment without convalescent plasma. We are uncertain whether convalescent plasma decreases all-cause mortality at hospital discharge (risk ratio (RR) 0.55, 95% confidence interval (CI) 0.22 to 1.34; 1 RCT, 86 participants; low-certainty evidence).  We are uncertain whether convalescent plasma decreases mortality (time to event) (hazard ratio (HR) 0.64, 95% CI 0.33 to 1.25; 2 RCTs, 189 participants; low-certainty evidence). Convalescent plasma may result in little to no difference in improvement of clinical symptoms (i.e. need for respiratory support) at seven days (RR 0.98, 95% CI 0.30 to 3.19; 1 RCT, 103 participants; low-certainty evidence). Convalescent plasma may increase improvement of clinical symptoms at up to 15 days (RR 1.34, 95% CI 0.85 to 2.11; 2 RCTs, 189 participants; low-certainty evidence), and at up to 30 days (RR 1.13, 95% CI 0.88 to 1.43; 2 studies, 188 participants; low-certainty evidence).  No studies reported on quality of life.  Safety of convalescent plasma for people with COVID-19 We included results from two RCTs, eight controlled NRSIs and nine non-controlled NRSIs assessing safety of convalescent plasma. Reporting of safety data and duration of follow-up was variable. The controlled studies reported on AEs and SAEs only in participants receiving convalescent plasma. Some, but not all, studies included death as a SAE.  The studies did not report the grade of AEs. Fourteen studies (566 participants) reported on AEs of possible grade 3 or 4 severity. The majority of these AEs were allergic or respiratory events. We are very uncertain whether convalescent plasma therapy affects the risk of moderate to severe AEs (very low-certainty evidence).  17 studies (35,944 participants) assessed SAEs for 20,622 of its participants. The majority of participants were from one non-controlled NRSI (20,000 participants), which reported on SAEs within the first four hours and within an additional seven days after transfusion. There were 63 deaths, 12 were possibly and one was probably related to transfusion. There were 146 SAEs within four hours and 1136 SAEs within seven days post-transfusion. These were predominantly allergic or respiratory, thrombotic or thromboembolic and cardiac events. We are uncertain whether convalescent plasma therapy results in a clinically relevant increased risk of SAEs (low-certainty evidence). AUTHORS' CONCLUSIONS: We are uncertain whether convalescent plasma is beneficial for people admitted to hospital with COVID-19. There was limited information regarding grade 3 and 4 AEs to determine the effect of convalescent plasma therapy on clinically relevant SAEs. In the absence of a control group, we are unable to assess the relative safety of convalescent plasma therapy.  While major efforts to conduct research on COVID-19 are being made, recruiting the anticipated number of participants into these studies is problematic. The early termination of the first two RCTs investigating convalescent plasma, and the lack of data from 20 studies that have completed or were due to complete at the time of this update illustrate these challenges. Well-designed studies should be prioritised. Moreover, studies should report outcomes in the same way, and should consider the importance of maintaining comparability in terms of co-interventions administered in all study arms.  There are 138 ongoing studies evaluating convalescent plasma and hyperimmune immunoglobulin, of which 73 are RCTs (three already completed). This is the second living update of the review, and we will continue to update this review periodically. Future updates may show different results to those reported here.


Asunto(s)
Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Sesgo , Causas de Muerte , Infecciones por Coronavirus/mortalidad , Humanos , Inmunización Pasiva/efectos adversos , Inmunización Pasiva/métodos , Inmunización Pasiva/estadística & datos numéricos , Ensayos Clínicos Controlados no Aleatorios como Asunto/estadística & datos numéricos , Pandemias , Neumonía Viral/mortalidad , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Resultado del Tratamiento
12.
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
13.
Tex Med ; 116(9): 4, 2020 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-33023284

RESUMEN

While the World Health Organization estimates that climate change will cause approximately 250,000 additional deaths per year worldwide from malnutrition, malaria, diarrhea, and heat stress, these estimates are based on assumptions using models that have not been validated using real world, observational data.


Asunto(s)
Cambio Climático , Exposición a Riesgos Ambientales/efectos adversos , Calentamiento Global , Educación en Salud , Salud , Causas de Muerte , Diarrea , Respuesta al Choque Térmico , Calor/efectos adversos , Humanos , Malaria , Desnutrición , Texas
14.
Nat Commun ; 11(1): 5097, 2020 10 09.
Artículo en Inglés | MEDLINE | ID: mdl-33037218

RESUMEN

As global deaths from COVID-19 continue to rise, the world's governments, institutions, and agencies are still working toward an understanding of who is most at risk of death. In this study, data on all recorded COVID-19 deaths in Sweden up to May 7, 2020 are linked to high-quality and accurate individual-level background data from administrative registers of the total population. By means of individual-level survival analysis we demonstrate that being male, having less individual income, lower education, not being married all independently predict a higher risk of death from COVID-19 and from all other causes of death. Being an immigrant from a low- or middle-income country predicts higher risk of death from COVID-19 but not for all other causes of death. The main message of this work is that the interaction of the virus causing COVID-19 and its social environment exerts an unequal burden on the most disadvantaged members of society.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Betacoronavirus , Causas de Muerte , Estudios de Cohortes , Femenino , Humanos , Masculino , Pandemias , Factores de Riesgo , Factores Socioeconómicos , Suecia/epidemiología
15.
Sci Rep ; 10(1): 16384, 2020 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-33009426

RESUMEN

The COVID-19 outbreak is becoming a public health emergency. Data are limited on the clinical characteristics and causes of death. A retrospective analysis of COVID-19 deaths were performed for patients' clinical characteristics, laboratory results, and causes of death. In total, 56 patients (72.7%) of the decedents (male-female ratio 51:26, mean age 71 ± 13, mean survival time 17.4 ± 8.4 days) had comorbidities. Acute respiratory failure (ARF) and sepsis were the main causes of death. Increases in C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer and lactic acid and decreases in lymphocytes were common laboratory results. Intergroup analysis showed that (1) most female decedents had cough and diabetes. (2) The proportion of young- and middle-aged deaths was higher than elderly deaths for males, while elderly decedents were more prone to myocardial injury and elevated CRP. (3) CRP and LDH increased and cluster of differentiation (CD) 4+ and CD8+ cells decreased significantly in patients with hypertension. The majority of COVID-19 decedents are male, especially elderly people with comorbidities. The main causes of death are ARF and sepsis. Most female decedents have cough and diabetes. Myocardial injury is common in elderly decedents. Patients with hypertension are prone to an increased inflammatory index, tissue hypoxia and cellular immune injury.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Sepsis/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Proteína C-Reactiva/análisis , Causas de Muerte , China , Comorbilidad , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/patología , Diabetes Mellitus/epidemiología , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Cardiopatías/epidemiología , Humanos , L-Lactato Deshidrogenasa/sangre , Ácido Láctico/sangre , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/patología , Sepsis/etiología , Síndrome Respiratorio Agudo Grave/etiología
16.
Sci Total Environ ; 741: 140465, 2020 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-32887012

RESUMEN

BACKGROUND: Long-term exposure to air pollution is linked with increased risk of adverse health outcomes, but the evidence for the association between nitrogen dioxide (NO2) and mortality is weak because of the inadequate adjustment of potential confounders and limited spatial resolution of the exposure assessment. Moreover, there are concerns about the independent effects of NO2. Therefore, we examined the association between NO2 long-term exposure and all-cause and cause-specific mortality. METHODS: We included participants who were enrolled in health checkups in Okayama City, Japan, in 2006 or 2007 and were followed until 2016. We used a land-use regression model to estimate the average NO2 concentrations from 2006 to 2007 and allocated them to the participants. We estimated hazard ratios (HRs) for a 10-µg/m3 increase in NO2 levels for all-cause or cause-specific mortality using Cox proportional hazard models. RESULTS: After excluding the participants who were assigned with outlier exposures, a total of 73,970 participants were included in the analyses. NO2 exposure was associated with increased risk of mortality and the HRs and their confidence intervals were 1.06 (95% CI: 1.02, 1.11) for all-cause, 1.02 (0.96, 1.09) for cardiopulmonary, and 1.36 (1.14, 1.63) for lung cancer mortality. However, the elevated risks became equivocal after the adjustment for fine particulate matter except lung cancer. CONCLUSION: Long-term exposure to NO2 was associated with increased risk of all-cause, cardiopulmonary, and lung cancer mortality. The elevated risk for lung cancer was still observable even after adjustment for fine particulate matter.


Asunto(s)
Contaminantes Atmosféricos/análisis , Contaminación del Aire , Causas de Muerte , Contaminantes Atmosféricos/toxicidad , Exposición a Riesgos Ambientales/análisis , Humanos , Japón , Dióxido de Nitrógeno/análisis , Material Particulado/análisis
17.
Crit Care Resusc ; 22(3): 200-211, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32900326

RESUMEN

OBJECTIVE: Describe characteristics, daily care and outcomes of patients with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). DESIGN: Case series of 73 patients. SETTING: Large tertiary hospital in Milan. PARTICIPANTS: Mechanically ventilated patients with confirmed COVID-19 admitted to the intensive care unit (ICU) between 20 February and 2 April 2020. MAIN OUTCOME MEASURES: Demographic and daily clinical data were collected to identify predictors of early mortality. RESULTS: Of the 73 patients included in the study, most were male (83.6%), the median age was 61 years (interquartile range [IQR], 54-69 years), and hypertension affected 52.9% of patients. Lymphocytopenia (median, 0.77 x 103 per mm3; IQR, 0.58-1.00 x 103 per mm3), hyperinflammation with C-reactive protein (median, 184.5 mg/dL; IQR, 108.2-269.1 mg/dL) and pro-coagulant status with D-dimer (median, 10.1 µg/m; IQR, 5.0-23.8 µg/m) were present. Median tidal volume was 6.7 mL/kg (IQR, 6.0-7.5 mL/kg), and median positive end-expiratory pressure was 12 cmH2O (IQR, 10-14 cmH2O). In the first 3 days, prone positioning (12-16 h) was used in 63.8% of patients and extracorporeal membrane oxygenation in five patients (6.8%). After a median follow-up of 19.0 days (IQR, 15.0-27.0 days), 17 patients (23.3%) had died, 23 (31.5%) had been discharged from the ICU, and 33 (45.2%) were receiving invasive mechanical ventilation in the ICU. Older age (odds ratio [OR], 1.12; 95% CI, 1.04-1.22; P = 0.004) and hypertension (OR, 6.15; 95% CI, 1.75-29.11; P = 0.009) were associated with mortality, while early improvement in arterial partial pressure of oxygen (PaO2) to fraction of inspired oxygen (FiO2) ratio was associated with being discharged alive from the ICU (P = 0.002 for interaction). CONCLUSIONS: Despite multiple advanced critical care interventions, COVID-19 ARDS was associated with prolonged ventilation and high short term mortality. Older age and pre-admission hypertension were key mortality risk factors. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04318366.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Respiración Artificial , Síndrome de Dificultad Respiratoria del Adulto/mortalidad , Factores de Edad , Anciano , Betacoronavirus , Causas de Muerte , Infecciones por Coronavirus/terapia , Femenino , Humanos , Hipertensión/complicaciones , Italia , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/terapia , Síndrome de Dificultad Respiratoria del Adulto/terapia , Síndrome de Dificultad Respiratoria del Adulto/virología , Factores de Riesgo
18.
Medicine (Baltimore) ; 99(35): e21897, 2020 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-32871921

RESUMEN

Allogeneic red blood cell transfusion (ABT) is 1 of the poor prognostic factors for morbidity and mortality in patients with hip fracture, particularly among elderly patients. This study aimed to investigate the risk factors for ABT and 1-year mortality in elderly patients undergoing surgery for femoral neck fracture.A total of 225 elderly patients who underwent femoral neck fracture surgery between May 2013 and November 2015 at a tertiary medical center were retrospectively recruited. Medical records were analyzed.The median patient age was 80 years and 28.4% were men. A total of 113 patients received ABT (50.2%). Multivariate logistic regression analysis showed that female sex (odds ratio [OR] 2.606, 95% confidence interval [CI] 1.283-5.295, P = .008), malignancy (OR 5.098, 95% CI 1.725-15.061, P = .003), chronic kidney disease stage ≥ 3 (OR 3.258, 95% CI 1.603-6.622, P = .001), and anemia (hemoglobin < 12 g/dL) (OR 4.684, 95% CI 2.230-9.837, P < .001) were significantly associated with ABT. The 1-year mortality rate after surgery was 15.1%. Male sex (OR 2.477, 95% CI 1.101-5.575, P = .028), ABT (OR 2.367, 95% CI 1.036-5.410, P = .041), and intensive care unit admission (OR 5.564, 95% CI 1.457-21.249, P = .012) were significantly associated with 1-year mortality.In this study, underlying comorbidities such as chronic kidney disease and malignancy were associated with ABT. Furthermore, ABT was a significant independent risk factor for 1-year mortality. These findings suggest that underlying comorbidities and the need for ABT should be considered in the risk assessment of elderly patients with femoral neck fracture to improve the outcomes after surgery.


Asunto(s)
Causas de Muerte , Transfusión de Eritrocitos , Fracturas del Cuello Femoral/cirugía , Factores de Edad , Anciano , Anciano de 80 o más Años , Anemia/complicaciones , Femenino , Fracturas del Cuello Femoral/complicaciones , Humanos , Masculino , Modelos Estadísticos , Neoplasias/complicaciones , Insuficiencia Renal Crónica/complicaciones , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores Sexuales
19.
Medicine (Baltimore) ; 99(33): e21623, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-32872020

RESUMEN

BACKGROUND: Prediabetes is an abnormal metabolic state that develops prior to the onset of diabetes with proven to common comorbid states of coronary artery disease. However, whether prediabetes worsens prognosis after percutaneous coronary intervention remains controversial. The aim of this study is to summarize previous cohort studies and to specify the impact of prediabetes on the long-term outcomes after percutaneous coronary intervention. METHODS: This meta-analysis will be performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines for conducting and reporting meta-analysis data. Pubmed, Embase and Google scholar will be systematically searched, and supplemented with manual searches of the included reference lists to identify cohort studies. Pooled effects on the discontinuous variables will be expressed by adjusted hazard ratios with 95% confidence intervals. All analyses will be performed with Stata 15.0 (StataCorp LP, College Station, TX). RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: This systematic review will provide new information and help enhance clinical decision-making on management of these patients. REGISTRATION NUMBER: INPLASY202060079.


Asunto(s)
Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Estado Prediabético/epidemiología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Humanos , Estado Prediabético/mortalidad , Pronóstico , Proyectos de Investigación , Factores de Riesgo
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA