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2.
Ren Fail ; 43(1): 1115-1123, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34233570

RESUMEN

INTRODUCTION: Acute kidney injury (AKI) in coronavirus disease 2019 (COVID-19) patients is associated with poor prognosis. Early prediction and intervention of AKI are vital for improving clinical outcome of COVID-19 patients. As lack of tools for early AKI detection in COVID-19 patients, this study aimed to validate the USCD-Mayo risk score in predicting hospital-acquired AKI in an extended multi-center COVID-19 cohort. METHODS: Five hundred seventy-two COVID-19 patients from Wuhan Tongji Hospital Guanggu Branch, Wuhan Leishenshan Hospital, and Wuhan No. Ninth Hospital was enrolled for this study. Patients who developed AKI or reached an outcome of recovery or death during the study period were included. Predictors were evaluated according to data extracted from medical records. RESULTS: Of all patients, a total of 44 (8%) developed AKI. The UCSD-Mayo risk score achieved excellent discrimination in predicting AKI with the C-statistic of 0.88 (95%CI: 0.84-0.91). Next, we determined the UCSD-Mayo risk score had good overall performance (Nagelkerke R2 = 0.32) and calibration in our cohort. Further analysis showed that the UCSD-Mayo risk score performed well in subgroups defined by gender, age, and several chronic comorbidities. However, the discrimination of the UCSD-Mayo risk score in ICU patients and patients with mechanical ventilation was not good which might be resulted from different risk factors of these patients. CONCLUSIONS: We validated the performance of UCSD-Mayo risk score in predicting hospital-acquired AKI in COVID-19 patients was excellent except for patients from ICU or patients with mechanical ventilation.


Asunto(s)
Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , COVID-19/complicaciones , Índice de Severidad de la Enfermedad , Lesión Renal Aguda/mortalidad , Adulto , Anciano , COVID-19/mortalidad , China/epidemiología , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2
3.
Ren Fail ; 43(1): 1104-1114, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34238117

RESUMEN

BACKGROUND: The clinical use of serum creatine (sCr) and cystatin C (CysC) in kidney function evaluation of critically ill patients has been in continuous discussion. The difference between estimated glomerular filtration rate calculated by sCr (eGFRcr) and CysC (eGFRcysc) of critically ill COVID-19 patients were investigated in this study. METHODS: This is a retrospective, single-center study of critically ill patients with COVID-19 admitted in intensive care unit (ICU) at Wuhan, China. Control cases were moderate COVID-19 patients matched in age and sex at a ratio of 1:1. The eGFRcr and eGFRcysc were compared. The association between eGFR and death were analyzed in critically ill cases. The potential factors influencing the divergence between eGFRcr and eGFRcysc were explored. RESULTS: A total of 76 critically ill COVID-19 patients were concluded. The mean age was 64.5 ± 9.3 years. The eGFRcr (85.45 (IQR 60.58-99.23) ml/min/1.73m2) were much higher than eGFRcysc (60.6 (IQR 34.75-79.06) ml/min/1.73m2) at ICU admission. About 50 % of them showed eGFRcysc < 60 ml/min/1.73 m2 while 25% showed eGFRcr < 60 ml/min/1.73 m2 (χ2 = 10.133, p = 0.001). This divergence was not observed in moderate group. The potential factors influencing the divergence included serum interleukin-6 (IL-6), tumor necrosis factor (TNF-α) level as well as APACHEII, SOFA scores. Reduced eGFRcr (<60 mL/min/1.73 m2) was associated with death (HR = 1.939, 95%CI 1.078-3.489, p = 0.027). CONCLUSIONS: The eGFRcr was generally higher than eGFRcysc in critically ill COVID-19 cases with severe inflammatory state. The divergence might be affected by inflammatory condition and illness severity. Reduced eGFRcr predicted in-hospital death. In these patients, we advocate for caution when using eGFRcysc.


Asunto(s)
COVID-19/fisiopatología , Creatina/sangre , Cistatina C/sangre , Tasa de Filtración Glomerular , Insuficiencia Renal Crónica/diagnóstico , Anciano , Biomarcadores/sangre , COVID-19/complicaciones , COVID-19/mortalidad , China/epidemiología , Enfermedad Crítica/terapia , Femenino , Mortalidad Hospitalaria , Humanos , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/etiología , Estudios Retrospectivos , Análisis de Supervivencia
4.
Infect Dis Poverty ; 10(1): 97, 2021 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-34238368

RESUMEN

BACKGROUND: Little attention has been paid to the comparison of COVID-19 pandemic responses and related factors in BRICS (Brazil, Russia, India, China, and South Africa) countries. We aimed at evaluating the association of daily new COVID-19 cases with socio-economic and demographic factors, health vulnerability, resources, and policy response in BRICS countries. METHODS: We conducted a cross-sectional study using data on the COVID-19 pandemic and other indicators of BRICS countries from February 26, 2020 to April 30, 2021. We compared COVID-19 epidemic in BRICS countries and analyzed related factors by log-linear Generalized Additive Model (GAM) models. RESULTS: In BRICS countries, India had the highest totally of confirmed cases with 18.76 million, followed by Brazil (14.45 million), Russia (4.81 million), and South Africa (1.58 million), while China (0.10 million) had the lowest figure. South Africa had the lowest rate of administered vaccine doses (0.18 million) among BRICS countries as of April 30, 2021. In the GAM model, a 1 unit increase in population density and policy stringency index was associated with a 5.17% and 1.95% growth in daily new COVID-19 cases (P < 0.001), respectively. Exposure-response curves for the effects of policy stringency index on daily new cases showed that there was a rapid surge in number of daily new COVID-19 cases when the index ranged from 0 to 45. The number of infections climbed slowly when the index ranged from 46 to 80, and decreased when the index was above 80 (P < 0.001). In addition, daily new COVID-19 cases (all P < 0.001) were also correlated with life expectancy at birth (-1.61%), extreme poverty (8.95%), human development index (-0.05%), GDP per capita (-0.18%), diabetes prevalence (0.66%), proportion of population aged 60 and above (2.23%), hospital beds per thousand people (-0.08%), proportion of people with access to improved drinking water (-7.40%), prevalence of open defecation (0.69%), and annual tourist/visitor arrivals (0.003%), after controlling other confounders. Different lag structures showed similar results in the sensitivity analysis. CONCLUSIONS: Strong policy response is crucial to control the pandemic, such as effective containment and case management. Our findings also highlighted the importance of reducing socio-economic inequalities and strengthening the resilience of health systems to better respond to public health emergencies globally.


Asunto(s)
COVID-19/epidemiología , Brasil/epidemiología , China/epidemiología , Estudios Transversales , Demografía , Diabetes Mellitus/epidemiología , Recursos en Salud , Humanos , India/epidemiología , Políticas , Pobreza , Federación de Rusia/epidemiología , Sudáfrica/epidemiología , Poblaciones Vulnerables
5.
BMC Infect Dis ; 21(1): 682, 2021 Jul 14.
Artículo en Inglés | MEDLINE | ID: mdl-34261441

RESUMEN

BACKGROUND: Norovirus (NoV) is a major cause of viral acute gastroenteritis (AGE) in children worldwide. Epidemiological analysis with respect to the virus strains is limited in China. This study aimed to investigate the prevalence, patterns, and molecular characteristics of NoV infection among children with AGE in China. METHODS: A total 4848 stool samples were collected from children who were admitted with AGE in Tianjin Children's Hospital from August 2018 to July 2020. NoV was preliminarily detected using real-time reverse transcription polymerase chain reaction (RT-PCR). Partial sequences of the RNA-dependent RNA polymerase (RdRp) and capsid genes of positive samples were amplified by conventional RT-PCR and then sequenced. The NoV genotype was determined by online Norovirus Typing Tool Version 2.0, and phylogenetic analysis was conducted using MEGA 6.0. RESULTS: The prevalence of NoV was 26.4% (1280/4848). NoV was detected in all age groups, with the 7-12 months group having the highest detection rate (655/2014, 32.5%). NoV was detected during most part of the year with higher frequency in winter than other seasons. Based on the genetic analysis of RdRp, GII. Pe was the most predominant genotype detected at 70.7% (381/539) followed by GII.P12 at 25.4% (137/539). GII.4 was the most predominant capsid genotype detected at 65.3% (338/518) followed by GII.3 at 26.8% (139/518). Based on the genetic analysis of RdRp and capsid sequences, the strains were clustered into 10 RdRp-capsid genotypes: GII.Pe-GII.4 Sydney 2012 (65.5%), GII.P12-GII.3 (27.2%), GII.P16-GII.2 (1.8%), GII.P12-GII.2 (0.2%), GII.P17-GII.17 (1.1%), GII.Pe-GII.3 (1.8%), GII.Pe-GII.2 (1.1%), GII.Pe-GII.1 (0.4%), GII.16-GII.4 Sydney 2012 (0.7%), and GII.P7-GII.6 (0.2%). The predominant NoV genotypes changed from GII.Pe-GII.4 Sydney 2012 and GII.P12-GII.3 between August 2018 and July 2019 to GII.Pe-GII.4 Sydney 2012 and GII.P16-GII.2 between August 2019 and July 2020. The patients with GII.Pe-GII.4 Sydney 2012 genotype were more likely to suffer from vomiting symptom than those with GII.P12-GII.3. CONCLUSIONS: NoV is an important pathogen responsible for viral AGE among children in China. GII.Pe-GII.4 Sydney 2012 and GII.P12-GII.3 were major recombinant genotypes. Knowledge of circulating genotypes and seasonal trends is of great importance for disease prevention and surveillance.


Asunto(s)
Infecciones por Caliciviridae , Gastroenteritis , Norovirus , Infecciones por Caliciviridae/diagnóstico , Infecciones por Caliciviridae/epidemiología , Infecciones por Caliciviridae/fisiopatología , Proteínas de la Cápside/genética , Niño , China/epidemiología , Femenino , Gastroenteritis/diagnóstico , Gastroenteritis/epidemiología , Gastroenteritis/virología , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Masculino , Norovirus/clasificación , Norovirus/genética , Norovirus/aislamiento & purificación , Norovirus/fisiología , Prevalencia , ARN Viral/aislamiento & purificación
6.
Maturitas ; 150: 7-13, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34274077

RESUMEN

OBJECTIVES: The independent role of muscular strength in the prevention of chronic disease is increasingly being recognized. However, no cohort study has assessed the relationship between handgrip strength and the incidence of hypertension among the middle-aged and older population. The aim of this prospective cohort study was to investigate whether handgrip strength is related to incident hypertension among people aged 40 years and over. STUDY DESIGN: This prospective cohort study (n = 8,480) was performed between 2013 and 2019 as part of the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) Cohort Study, Tianjin, China. MAIN OUTCOME MEASURES: Participants without baseline hypertension were followed up for ~6 years (median 4.0 years). Hypertension was defined according to the JNC7 criteria. Handgrip strength was measured using a hydraulic handheld dynamometer. Adjusted Cox proportional hazards regression models were used to assess the relationships between weight-adjusted handgrip strength and the risk of incident hypertension. RESULTS: The incidence rate of hypertension per 1000 person-years was 70. The fully adjusted hazards ratios (95% confidence interval) of the incidence of hypertension for increasing quartiles of weight-adjusted handgrip strength were: 1.00(reference), 0.84 (0.75-0.95), 0.78 (0.69-0.88), and 0.66 (0.58-0.75) (P for trend<0.0001). Moreover, the adjusted hazards ratio (95% confidence interval) of incident hypertension for per unit increase in weight-adjusted handgrip strength was 0.17 (0.10-0.27) (P<0.0001). Similar results were observed in males and females. CONCLUSIONS: The present cohort study is the first to find that high weight-adjusted handgrip strength, but not absolute handgrip strength, is significantly and independently related to low risk of incident hypertension among the middle-aged and older population.


Asunto(s)
Fuerza de la Mano/fisiología , Hipertensión/diagnóstico , Hipertensión/epidemiología , Fuerza Muscular/fisiología , Adulto , China/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
7.
Artículo en Inglés | MEDLINE | ID: mdl-34198481

RESUMEN

Current evidence and research of the life course approach on the association between life experiences and health in old age are fragmentary. This paper empirically examines the "long arm" effect of the childhood circumstances on mental health in later life using a large longitudinal dataset (CHARLS) conducted in 2014 and 2015. We operationalize the childhood circumstances as family economic conditions, community environment, and peer network to include the meaningful content and understand their interaction. The SEM results indicate that effects of those factors contributing to older people's mental health are unequal and vary among age groups and genders. Of those, peer network in childhood determines to a large extent the mental health through the whole life course, while economic conditions and community environment are weakly associated with mental health. Furthermore, we find a distinct interaction mechanism linking those variables. The peer network completely mediates the effect of the community environment on the mental health of older adults and has a partial mediating effect on the economic conditions. Those findings suggest that social policies aimed at promoting older people's mental health in the context of the active ageing and health ageing strategy should go beyond the old age stage and target social conditions early in childhood.


Asunto(s)
Envejecimiento Saludable , Salud Mental , Anciano , Envejecimiento , China/epidemiología , Femenino , Humanos , Masculino , Encuestas y Cuestionarios
8.
Artículo en Inglés | MEDLINE | ID: mdl-34200619

RESUMEN

Background: The disease burden of seasonal influenza is substantial in China, while there is still a lack of nationwide economic burden estimates. This study aims to examine influenza-like illness (ILI) prevalence, healthcare-seeking behaviors, economic impact of ILI, and its influencing factors among three priority groups during the 2018-19 influenza season. Methods: From August to October 2019, 6668 children's caregivers, 1735 chronic disease patients, and 3849 elderly people were recruited from 10 provinces in China to participate in an on-site survey. The economic burden of ILI consisted of direct (medical or non-medical) and indirect burdens, and a two-part model was adopted to predict the influencing factors of total economic burden. Results: There were 45.73% children, 16.77% chronic disease patients, and 12.70% elderly people reporting ILI, and most participants chose outpatient service or over-the-counter (OTC) medication after ILI. The average economic burden was CNY 1647 (USD 237.2) for children, CNY 951 (USD 136.9) for chronic disease patients, and CNY 1796 (USD 258.6) for the elderly. Two-part regression showed that age, gender, whether the only child in the family, region, and household income were important predictors of ILI economic burden among children, while age, region, place of residence, basic health insurance, and household income were significant predictors of ILI economic burden among chronic disease patients and the elderly. Conclusions: A large economic burden of ILI was highlighted, especially among the elderly with less income and larger medical burdens, as well as children, with higher prevalence and higher self-payment ratio. It is important to adopt targeted interventions for high-risk groups, and this study can help national-level decision-making on the introduction of influenza vaccination as a public health project.


Asunto(s)
Gripe Humana , Anciano , Niño , China/epidemiología , Enfermedad Crónica , Costo de Enfermedad , Estudios Transversales , Humanos , Gripe Humana/epidemiología
9.
BMC Med ; 19(1): 163, 2021 07 14.
Artículo en Inglés | MEDLINE | ID: mdl-34256745

RESUMEN

BACKGROUND: Few studies had described the health consequences of patients with coronavirus disease 2019 (COVID-19) especially in those with severe infections after discharge from hospital. Moreover, no research had reported the health consequences in health care workers (HCWs) with COVID-19 after discharge. We aimed to investigate the health consequences in HCWs with severe COVID-19 after discharge from hospital in Hubei Province, China. METHODS: We conducted an ambidirectional cohort study in "Rehabilitation Care Project for Medical Staff Infected with COVID-19" in China. The participants were asked to complete three physical examinations (including the tests of functional fitness, antibodies to SARS-CoV-2 and immunological indicators) at 153.4 (143.3, 164.8), 244.3 (232.4, 259.1), and 329.4 (319.4, 339.3) days after discharge, respectively. Mann-Whitney U test, Kruskal-Wallis test, t test, one-way ANOVA, χ2, and Fisher's exact test were used to assess the variance between two or more groups where appropriate. RESULTS: Of 333 HCWs with severe COVID-19, the HCWs' median age was 36.0 (31.0, 43.0) years, 257 (77%) were female, and 191 (57%) were nurses. Our research found that 70.4% (114/162), 48.9% (67/137), and 29.6% (37/125) of the HCWs with severe COVID-19 were considered to have not recovered their functional fitness in the first, second, and third functional fitness tests, respectively. The HCWs showed improvement in muscle strength, flexibility, and agility/dynamic balance after discharge in follow-up visits. The seropositivity of IgM (17.0% vs. 6.6%) and median titres of IgM (3.0 vs. 1.4) and IgG (60.3 vs. 45.3) in the third physical examination was higher than that in the first physical examination. In the third physical examination, there still were 42.1% and 45.9% of the HCWs had elevated levels of IL-6 and TNF-α, and 11.9% and 6.3% of the HCWs had decreased relative numbers of CD3+ T cells and CD4+ T cells. CONCLUSION: The HCWs with severe COVID-19 showed improvement in functional fitness within 1 year after discharge, active intervention should be applied to help their recovery if necessary. It is of vital significance to continue monitoring the functional fitness, antibodies to SARS-CoV-2 and immunological indicators after 1 year of discharge from hospital in HCWs with severe COVID-19.


Asunto(s)
Anticuerpos Antivirales/sangre , Prueba Serológica para COVID-19 , COVID-19 , Prueba de Esfuerzo , Personal de Salud/estadística & datos numéricos , SARS-CoV-2/inmunología , Adulto , COVID-19/epidemiología , COVID-19/inmunología , COVID-19/fisiopatología , COVID-19/rehabilitación , Prueba Serológica para COVID-19/métodos , Prueba Serológica para COVID-19/estadística & datos numéricos , China/epidemiología , Prueba de Esfuerzo/métodos , Prueba de Esfuerzo/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Estado Funcional , Humanos , Interleucina-6/sangre , Masculino , Alta del Paciente/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Factor de Necrosis Tumoral alfa/sangre
10.
Clin Interv Aging ; 16: 1265-1274, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34262266

RESUMEN

Purpose: Elderly people represent a growing stroke population with different pathophysiological states than younger. Whether intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) is beneficial for elderly patients remains unclear. This study compared the efficacy and safety between elderly patients treated with MT alone and those treated with both IVT and MT. Patients and Methods: Patients aged ≥65 years who were eligible for IVT within 4.5 h from symptom onset were selected from the ANGEL-ACT (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke) registry, a prospective registry program for patients with endovascular treatment from 111 Chinese stroke centers. The primary efficacy outcome was the 90-day modified Rankin Scale score. We compared efficacy and safety outcomes using ordinal or binary logistic regression or a generalized linear model. Results: In total, 482 elderly patients were included: 187 (38.8%) received IVT and MT (bridging MT) and 295 (61.2%) received MT alone (direct MT). There was no significant difference in the 90-day modified Rankin Scale score between the two groups (median: 4 vs 4 points, respectively; adjusted ß=-0.048, P=0.822). The direct MT group had a shorter onset-to-puncture time (225 vs 255 min, respectively; adjusted ß=-55.074, P=0.002) and a lower rate of parenchymal hemorrhage type 2 within 24 h (2.80% vs 6.63%, respectively; adjusted odds ratio [OR]=0.287, 95% confidence interval [CI]=0.096-0.856, P=0.025). In addition, the direct MT group showed a trend toward a lower incidence of sICH (5.67% vs 10.06%, adjusted OR=0.453, P=0.061), procedure-related complications (7.12% vs 12.30%, adjusted OR=0.499, P=0.052) and distal or new territorial embolization (4.07% vs 6.95%, adjusted OR=0.450, P=0.093). Conclusion: Direct MT had similar efficacy to bridging MT in terms of the 90-day functional outcome in elderly patients, whereas bridging MT had a longer onset-to-puncture time and increased risk of hemorrhagic transformation and procedure-related complications.


Asunto(s)
Hemorragia Cerebral , Trastornos Cerebrovasculares , Accidente Cerebrovascular Isquémico , Trombectomía , Administración Intravenosa , Anciano , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiología , Trastornos Cerebrovasculares/complicaciones , Trastornos Cerebrovasculares/diagnóstico , Trastornos Cerebrovasculares/terapia , China/epidemiología , Estudios de Cohortes , Femenino , Humanos , Accidente Cerebrovascular Isquémico/tratamiento farmacológico , Accidente Cerebrovascular Isquémico/etiología , Accidente Cerebrovascular Isquémico/cirugía , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Mejoramiento de la Calidad , Trombectomía/efectos adversos , Trombectomía/métodos , Terapia Trombolítica/métodos , Flujo de Trabajo
11.
BMC Health Serv Res ; 21(1): 707, 2021 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-34275449

RESUMEN

BACKGROUND: Underutilization of health services among chronic non-communicable disease sufferers, especially for hypertension (HBP) and diabetes mellitus (DM), was considered as a significant contributing factor to substantial cases in terms of both avoidable morbidity and mortality. However, evidence on health services underutilization and its associated factors in poverty-stricken areas remain scarce based on previous literature. This study aims to describe health services underutilization for people diagnosed with chronic diseases in impoverished regions and to identify its associated factors, which are expected to provide practical implications for the implementations of interventions tailored to the specific needs of disadvantaged residents in rural China to achieve effective utilization of health services in a timely manner. METHODS: Data were collected from a cross-sectional survey conducted through face-to-face interviews among 2413 patients from six counties in rural central China in 2019. The Anderson behavioral model was adopted to explore the associated factors. A two-level logistic model was employed to investigate the association strengths reflected by adjusted odds ratios (AOR) and 95% confidence intervals in forest plots. RESULTS: On average, 17.58% of the respondents with HBP and 14.87% with DM had experienced health services underutilization during 1 month before the survey. Multilevel logistic regression indicated that predisposing factors (age), enabling factors (income and a regular source of care), and need factors (self-reported health score) were the common predictors of health service underutilization both for hypertensive and diabetic patients in impoverished areas, among which obtaining a regular source of care was found to be relatively determinant as a protective factor for health services underutilization after controlling for other covariates. CONCLUSIONS: Our results suggested that the implementation of a series of comprehensive strategies should be addressed throughout policy-making procedures to improve the provision of regular source of care as a significant determinant for reducing health services underutilization, thus ultimately achieving equal utilization of health services in impoverished regions, especially among chronic disease patients. Our findings are expected to provide practical implications for other developing countries confronted with similar challenges resulting from underdeveloped healthcare systems and aging population structures.


Asunto(s)
Servicios de Salud , Pobreza , Anciano , China/epidemiología , Enfermedad Crónica , Estudios Transversales , Humanos , Análisis Multinivel , Población Rural
12.
Front Cell Infect Microbiol ; 11: 663884, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34277466

RESUMEN

Background: The pandemic of Coronavirus Disease 2019 (COVID-19) brings new challenges for pediatricians, especially in the differentiation with non-COVID-19 pneumonia in the peak season of pneumonia. We aimed to compare the clinical characteristics of pediatric patients with COVID-19 and other respiratory pathogens infected pneumonias. Methods: We conducted a multi-center, cross-sectional study of pediatric inpatients in China. Based on pathogenic test results, pediatric patients were divided into three groups, including COVID-19 pneumonia group, Non-COVID-19 viral (NCV) pneumonia group and Non-viral (NV) pneumonia group. Their clinical characteristics were compared by Kruskal-Wallis H test or chi-square test. Results: A total of 636 pediatric pneumonia inpatients, among which 87 in COVID-19 group, 194 in NCV group, and 355 in NV group, were included in analysis. Compared with NCV and NV patients, COVID-19 patients were older (median age 6.33, IQR 2.00-12.00 years), and relatively fewer COVID-19 patients presented fever (63.2%), cough (60.9%), shortness of breath (1.1%), and abnormal pulmonary auscultation (18.4%). The results were verified by the comparison of COVID-19, respiratory syncytial virus (RSV) and influenza A (IFA) pneumonia patients. Approximately 42.5%, 44.8%, and 12.6% of the COVID-19 patients presented simply ground-glass opacity (GGO), simply consolidation, and the both changes on computed tomography (CT) scans, respectively; the proportions were similar as those in NCV and NV group (p>0.05). Only 47.1% of COVID-19 patients had both lungs pneumonia, which was significantly lower than that proportion of nearly 80% in the other two groups. COVID-19 patients presented lower proportions of increased white blood cell count (16.5%) and abnormal procalcitonin (PCT) (10.7%), and a higher proportion of decreased lymphocyte count (44.0%) compared with the other two groups. Conclusion: Majority clinical characteristics of pediatric COVID-19 pneumonia patients were milder than non-COVID-19 patients. However, lymphocytopenia remained a prominent feature of COVID-19 pediatric pneumonia.


Asunto(s)
COVID-19 , Neumonía , Niño , China/epidemiología , Estudios Transversales , Humanos , Pulmón/diagnóstico por imagen , Neumonía/epidemiología , Estudios Retrospectivos , SARS-CoV-2
13.
Front Public Health ; 9: 650672, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34277536

RESUMEN

Reemergent local outbreaks of coronavirus disease 2019 (COVID-19) have occurred in China, yet few Chinese response strategies and its evaluation have been reported. This study presents a preliminary assessment of Chinese strategy in controlling reemergent local outbreaks of COVID-19. Time course of accumulative and daily new cases and time-varying reproductive numbers (Rt) of outbreak areas were presented. The asymptomatic rate, days required to control the outbreaks, seeding time (ST), and doubling time (DT) of areas with over 96 reemergent cases were calculated. National and local year-on-year growth rates of gross domestic product (GDP) were presented. Accumulative numbers of 30, 8, 11, 430, 15, 139, 1,067, 382, 42, and 94 confirmed reemergent COVID-19 cases were diagnosed in Hulun Buir, Shanghai, Tianjin, Kashgar, Qingdao, Dalian, Urumchi, Beijing, Jilin, and Harbin, respectively. Among them, maximum rate of asymptomatic infections was 81.9%. Time required to control the local outbreaks in the areas given above varied from 29 to 51 days. After activation of outbreak responses, the late-stage DTs of Kashgar, Urumchi, Beijing, and Dalian were apparently lengthened compared to the early-stage DTs. Although the year-on-year GDP growth rate of Urumchi was slightly affected, the GDP growth rate of Dalian, Beijing, Jilin, and Harbin kept rising during the reemergence. Moreover, the year-on-year GDP growth rate of Mainland China turned positive regardless of the reemergent local outbreaks. In general, the Chinese strategy to maintain the status of no or minimal transmission was effective in balancing the control of COVID-19 reemergent local outbreak and the recovery of economy.


Asunto(s)
COVID-19 , Beijing , China/epidemiología , Brotes de Enfermedades/prevención & control , Humanos , SARS-CoV-2
14.
Front Public Health ; 9: 679178, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34277545

RESUMEN

Background: The coronavirus disease 2019 (COVID-19)-related quarantine has had unique psychological challenges for medical students, particularly loneliness. In this study, we demonstrated the patterns and predictors of loneliness in medical students since post-lockdown to new normal with COVID-19. Methods: A convenience sampling method was used in this study. Face-to-face online questionnaires of UCLA Loneliness Scale and psychological characteristics scales were completed by 1,478 participants. Latent profile analysis and multinominal logistic regressions were performed. Results: Three latent profile models were identified in this study: low loneliness (52.3%), interpersonal sensitivity loneliness (3.5%), and high loneliness (44.1%). Sophomore (Est = 1.937; p < 0.05) and junior students (Est = 2.939; p < 0.05), neuroticism (Est = 2.475; p < 0.05), high arousal symptoms (Est = 2.618; p < 0.01), and the quality of support from friends (Est = 2.264; p < 0.05) were the risk factors for high loneliness profile. In addition, sophomore (Est = 2.065; p < 0.05) and junior students (Est = 2.702; p < 0.01), openness (Est = 2.303; p < 0.05), and conscientiousness personality (Est = -2.348; p < 0.05) were the predictors of an interpersonal sensitive loneliness profile. Good peer relationship (Est = -2.266; p < 0.05) and other support (Est = -2.247; p < 0.05) were protective factors for low loneliness profile. Limitations: Participants were selected from one medical university; the generalizability is limited. Conclusions: Timely loneliness-focused interventions should be targeted on the different profiles and predictors of loneliness in medical students.


Asunto(s)
COVID-19 , Estudiantes de Medicina , China/epidemiología , Control de Enfermedades Transmisibles , Humanos , Soledad , SARS-CoV-2
15.
BMC Infect Dis ; 21(1): 632, 2021 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-34210275

RESUMEN

BACKGROUND: Infection with Salmonella enterica usually results in diarrhea, fever, and abdominal cramps, but some people become asymptomatic or chronic carrier as a source of infection for others. This study aimed to analyze the difference in serotype, antimicrobial resistance, and genetic profiles between Salmonella strains isolated from patients and those from asymptomatic people in Nantong city, China. METHODS: A total of 88 Salmonella strains were collected from patients and asymptomatic people from 2017 to 2018. Serotyping, antimicrobial susceptibility testing, and PFGE analysis were performed to analyze the characteristics of these strains. RESULTS: Twenty serotypes belonging to 8 serogroups were identified in the 88 Salmonella strains. S. Typhimurium remained to be the predominant serotype in strains from both patients and asymptomatic people. Among the 27 strains from patients, S. Enteritidis and S. Rissen were shown as the other two major serotypes, while S. London, S. Derby, and S. Meleagridis were demonstrated as the other significant serotypes among the 61 strains from asymptomatic people. Antimicrobial resistance testing revealed that 84.1% of strains from both resources were multi-drug resistant. PFGE displayed a highly discriminative ability to differentiate strains belonging to S. Derby, S. Typhimurium, etc., but could not efficiently differentiate serotypes like S. Enteritidis. CONCLUSIONS: This study's results demonstrated that S. Typhimurium could cause human infection in both symptomatic and asymptomatic state; S. London, S. Derby, and S. Meleagridis usually cause asymptomatic infection, while S. Enteritidis infection mainly results in human diseases. The high multi-drug resistance rate detected in the antimicrobial resistance and diverse PFGE profiles of these strains implied that the strains were isolated from different sources, and the increased surveillance of Salmonella from both patients and asymptomatic people should be taken to control the disease.


Asunto(s)
Salmonella/clasificación , Salmonella/genética , Salmonella/aislamiento & purificación , Serogrupo , Adolescente , Adulto , Anciano , Infecciones Asintomáticas/epidemiología , Niño , Preescolar , China/epidemiología , Farmacorresistencia Bacteriana Múltiple , Electroforesis en Gel de Campo Pulsado , Femenino , Humanos , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Infecciones por Salmonella/epidemiología , Serotipificación
16.
BMC Infect Dis ; 21(1): 629, 2021 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-34210287

RESUMEN

BACKGROUND: Along with the medical development, organ transplant patients increase dramatically. Since these transplant patients take immunosuppressants for a long term, their immune functions are in a suppressed state, prone to all kinds of opportunistic infections and cancer. However, it is rarely reported that the kidney transplant recipients (KTRs) have pulmonary tuberculosis and lung cancer simultaneously. CASE PRESENTATION: A 60-year-old male was admitted because of persistent lung shadow for 2 years without any obvious symptom 8 years after renal transplant. T-SPOT test was positive but other etiological examinations for Mycobacterium tuberculosis were negative. Chest CT scan revealed two pulmonary lesions in the right upper and lower lobe respectively. 18F-fluorodesoxyglucose positron-emission tomography (FDG-PET) CT found FDG intake increased in both pulmonary consolidation lesions. CT-guided percutaneous transthoracic needle biopsy revealed lung adenocarcinoma and tuberculosis. The video-assisted thoracoscopic surgery was operated to resect the malignancy lesions. The patient received specific anti-tuberculosis therapy and was discharged. At the follow-up of 6 months post drug withdrawal, the patient was recovered very well. CONCLUSIONS: We for the first time reported co-existence of smear-negative pulmonary TB and lung adenocarcinoma in a KTR, which highlighted the clinical awareness of co-occurrence of TB and malignancy after renal transplant and emphasized the value of biopsy and 18F-FDG-PET in early diagnosis of TB and cancer.


Asunto(s)
Adenocarcinoma/complicaciones , Trasplante de Riñón , Neoplasias Pulmonares/complicaciones , Tuberculosis Pulmonar/complicaciones , Adenocarcinoma/cirugía , China/epidemiología , Etambutol/uso terapéutico , Fluorodesoxiglucosa F18 , Humanos , Biopsia Guiada por Imagen , Isoniazida/uso terapéutico , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/cirugía , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Moxifloxacino/uso terapéutico , Mycobacterium tuberculosis/aislamiento & purificación , Tomografía Computarizada por Tomografía de Emisión de Positrones , Cirugía Torácica Asistida por Video , Resultado del Tratamiento , Tuberculosis Pulmonar/tratamiento farmacológico
17.
Medicine (Baltimore) ; 100(27): e26589, 2021 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-34232207

RESUMEN

ABSTRACT: The study aimed to evaluate the prevalence and possible factors associated with burnout (BO) among undergraduates in a university setting in Dali.This cross-sectional study involved students enrolled in different specialties. The method of stratified random sampling was used to conduct the investigation. The questionnaire included Maslach Burnout Inventory and the influencing factors. The data were analyzed using SPSS 16.0 (SPSS Inc., Chicago, IL). The quantitative data were compared using t tests or ANOVA. Multiple linear regression was used to assess the relationship between BO risk and relevant influencing factors.The prevalence of study BO was 38.1%. Significant differences of the mean scores on BO and low personal efficacy were observed between men and women, with women obtaining a higher score (t = -2.588, P = .010; t = -2.929, P = .003; respectively). The scores of overall BO, emotional exhaustion (EE), and cynicism were low, whereas that of professional efficacy was higher for students with excellent marks (P = .000). Students majoring in liberal arts obtained low scores of overall BO, EE, and cynicism. Nevertheless, their score for professional efficacy was higher than those from other specializations (P < .05). Total BO, as the dependent variable, revealed that 3 predictors (social factors, school factors, and interpersonal communication) accounted for 30.8% of the variance (R2 = 0.308). A regression analysis of EE as the dependent variable identified that 2 variables (social and school factors) explained 45.8% of the variance (R2 = 0.458).BO among undergraduates is present in a university setting in Dali. A variety of factors including social factors, school factors, and interpersonal communication can influence the prevalence of BO. Therefore, society should strengthen employment and further understand psychology; schools and families must pay attention to the psychological development of college students.


Asunto(s)
Agotamiento Profesional/epidemiología , Estudiantes de Medicina/psicología , Universidades , China/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Prevalencia , Estudios Retrospectivos , Encuestas y Cuestionarios
18.
Medicine (Baltimore) ; 100(27): e26615, 2021 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-34232218

RESUMEN

ABSTRACT: The aim of the study is to investigate the levels of affective commitment, occupational stressors and calling in psychiatrists in Shanghai and try to find the relationship among 3 variables in the participants.We enrolled 81 participants using a survey with a combination of demographic information, affective part of organizational commitment questionnaire, portion of the scale for occupational stressors on clinicians and the calling and vocation questionnaire. Correlation analysis and multiple linear regression analysis were applied to probe into the relationship among the three variables. t Test and nonparametric test were utilized to compare the differences between the groups of individuals who were divided according to the demographic information.The mean score of the affective commitment, occupational stressors and calling of Shanghai psychiatrists were all at a moderate level. The scores in affective commitment had a significantly negative relationship with that of the occupational stressors, especially in the respect of organization and management, occupational interest, and development of work. Whereas the scores of calling revealed a remarkably positive connection with affective commitment. In addition, demographic groups under comparison, individuals who were >35 years' old, male, or have worked for >10 years are more likely to suffer from higher occupational development and interpersonal relationship stress.We found that the levels of affective commitment, occupational stressors and calling in psychiatrists in Shanghai were all moderate. These people who were men, >35 years' old, and had >10 years of work experiences had suffered from higher levels of occupational stressors, especially occupational development and interpersonal relationship stress. The affective commitment was positively correlated to the calling while negatively associated to the occupational stressors in Shanghai psychiatrists. For stronger bond for the psychiatrists, strengthen the calling and lessen the occupational stressors are required. These results provide some ideas for enhancing the occupational commitment of psychiatrists and conducting psychological interventions in a timely manner henceforth more effectively.


Asunto(s)
Actitud del Personal de Salud , Satisfacción en el Trabajo , Estrés Laboral/psicología , Psiquiatría , Adulto , China/epidemiología , Estudios Transversales , Femenino , Humanos , Incidencia , Relaciones Interpersonales , Masculino , Estrés Laboral/epidemiología , Estrés Laboral/etiología , Encuestas y Cuestionarios
19.
Ann Palliat Med ; 10(6): 6678-6686, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34237971

RESUMEN

BACKGROUND: Frailty is a common biological syndrome in elderly people, and the aging process regulates thyroid function. The present study aimed to determine the prevalence of frailty in an older inpatient cohort using the FRAIL scale and to evaluate the association of frailty with thyroid hormone levels. METHODS: This cross-sectional study was performed in the Department of Geriatrics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China. From November 2019 to April 2020, 146 inpatients aged ≥65 years were recruited for the study and demographic data, frailty, geriatric assessment, and thyroid hormone levels were evaluated. Frailty was determined by the FRAIL scale, and geriatric assessment was based on activities of daily living (ADL) and instrumental activities of daily living (IADL). The data were analyzed using appropriate parametric and nonparametric statistical tests. RESULTS: At enrollment, 31 (21.23%) of the total participants were robust, 31 (21.23%) were pre-frail, and 84 (57.53%) were frail. The frail patients were significantly older than the robust patients and pre-frail patients (P<0.001 for both). The percentages of ADL disability differed significantly among the patients for frail versus robust, frail versus pre-frail, and pre-frail versus robust, as did the percentages of IADL disability among patients for frail versus robust and frail versus pre-frail (P<0.01 for all). In binary logistic regression analyses adjusted for age, sex, body mass index, HbA1c (%), and smoking, frailty was significantly associated with serum thyroid stimulating hormone (TSH) concentration [odds ratio (OR): 1.704], T3 concentration (OR: 0.102), ADL score (OR: 0.793), and IADL score (OR: 0.413). CONCLUSIONS: In our study population, the prevalence of frailty was higher in older geriatric inpatients in China than other studies. Inpatients with high TSH levels were at increased risk of frailty. Conduction of future longitudinal studies is warranted to determine the relationship between thyroid hormone levels and frailty.


Asunto(s)
Fragilidad , Pacientes Internos , Actividades Cotidianas , Anciano , China/epidemiología , Estudios Transversales , Anciano Frágil , Fragilidad/epidemiología , Humanos , Glándula Tiroides , Hormonas Tiroideas
20.
World J Surg Oncol ; 19(1): 204, 2021 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-34238303

RESUMEN

BACKGROUND: Postoperative infectious complications (ICs) after surgery for colorectal cancer (CRC) increase in-hospital deaths and decrease long-term survival. However, the methodology for IC preoperative and intraoperative risk assessment has not yet been established. We aimed to construct a risk model for IC after surgery for CRC. METHODS: Between January 2016 and June 2020, a total of 593 patients who underwent curative surgery for CRC in Chengdu Second People's Hospital were enrolled. Preoperative and intraoperative factors were obtained retrospectively. The least absolute shrinkage and selection operator (LASSO) method was used to screen out risk factors for IC. Then, based on the results of LASSO regression analysis, multivariable logistic regression analysis was performed to establish the prediction model. Bootstraps with 300 resamples were performed for internal validation. The performance of the model was evaluated with its calibration and discrimination. The clinical usefulness was assessed by decision curve analysis (DCA). RESULTS: A total of 95 (16.0%) patients developed ICs after surgery for CRC. Chronic pulmonary diseases, diabetes mellitus, preoperative and/or intraoperative blood transfusion, and longer operation time were independent risk factors for IC. A prediction model was constructed based on these factors. The concordance index (C-index) of the model was 0.761. The calibration curve of the model suggested great agreement. DCA showed that the model was clinically useful. CONCLUSION: Several risk factors for IC after surgery for CRC were identified. A prediction model generated by these risk factors may help in identifying patients who may benefit from perioperative optimization.


Asunto(s)
Neoplasias Colorrectales , Nomogramas , China/epidemiología , Neoplasias Colorrectales/cirugía , Humanos , Pronóstico , Estudios Retrospectivos
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