Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 13.023
Filtrar
1.
Biomedica ; 40(Supl. 2): 73-76, 2020 10 30.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33152190

RESUMEN

Amid the global pandemic crisis, international concern has centered on the control and prevention measures aimed at reducing the speed of the virus transmission while a more radical sanitary measure, such as vaccines, is achieved. Governmental and social efforts have had great impact on various sectors of society and their consequences have exceeded the sphere of health. This essay discusses the scope of specific measures in the sense of the appropriation of risk control measures and proposes the epidemiological method as an alternative that goes beyond the quantification of risks and the attribution of responsibilities. To conclude, the emphasis is placed on the need to promote information about socialization processes to better understand the consequences of individual acts favoring alternatives other than pandemic control based on the use of coercive measures.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Autocuidado , Cambio Social , Responsabilidad Social , Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Humanos , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Salud Pública , Política Pública , Conducta de Reducción del Riesgo , Determinantes Sociales de la Salud , Factores Socioeconómicos
2.
Trials ; 21(1): 846, 2020 Oct 13.
Artículo en Inglés | MEDLINE | ID: mdl-33050924

RESUMEN

OBJECTIVES: To assess the efficacy of several repurposed drugs to prevent hospitalisation or death in patients aged 65 or more with recent symptomatic SARS-CoV-2 infection (COVID-19) and no criteria for hospitalisation. TRIAL DESIGN: Phase III, multi-arm (5) and multi-stage (MAMS), randomized, open-label controlled superiority trial. Participants will be randomly allocated 1:1:1:1:1 to the following strategies: Arm 1: Control arm Arms 2 to 5: Experimental treatment arms Planned interim analyses will be conducted at regular intervals. Their results will be reviewed by an Independent Data and Safety Monitoring Board. Experimental arms may be terminated for futility, efficacy or toxicity before the end of the trial. New experimental arms may be added if new evidence suggests that other treatments should be tested. A feasibility and acceptability substudy as well as an immunological substudy will be conducted alongside the trial. PARTICIPANTS: Inclusion criteria are: 65-year-old or more; Positive test for SARS-CoV-2 on a nasopharyngeal swab; Symptoms onset within 3 days before diagnosis; No hospitalisation criteria; Signed informed consent; Health insurance. Exclusion criteria are: Inability to make an informed decision to participate (e.g.: dementia, guardianship); Rockwood Clinical Frailty Scale ≥7; Long QT syndrome; QTc interval > 500 ms; Heart rate <50/min; Kalaemia >5.5 mmol/L or <3.5 mmol/L; Ongoing treatment with piperaquine, halofantrine, dasatinib, nilotinib, hydroxyzine, domperidone, citalopram, escitalopram, potent inhibitors or inducers of cytochrome P450 CYP3A4 isoenzyme, repaglinide, azathioprine, 6-mercaptopurine, theophylline, pyrazinamide, warfarin; Known hypersensitivity to any of the trial drugs or to chloroquine and other 4-aminoquinolines, amodiaquine, mefloquine, glafenine, floctafenine, antrafenine, ARB; Hepatic porphyria; Liver failure (Child-Pugh stage ≥B); Stage 4 or 5 chronic kidney disease (GFR <30 mL/min/1.73 m²); Dialysis; Hypersentivity to lactose; Lactase deficiency; Abnormalities in galactose metabolism; Malabsorption syndrome; Glucose-6-phosphate dehydrogenase deficiency; Symptomatic hyperuricemia; Ileus; Colitis; Enterocolitis; Chronic hepatitis B virus disease. The trial is being conducted in France in the Bordeaux, Corse, Dijon, Nancy, Paris and Toulouse areas as well as in the Grand Duchy of Luxembourg. Participants are recruited either at home, nursing homes, general practices, primary care centres or hospital outpatient consultations. INTERVENTION AND COMPARATOR: The four experimental treatments planned in protocol version 1.2 (April 8th, 2020) are: (1) Hydroxychloroquine 200 mg, 2 tablets BID on day 0, 2 tablets QD from day 1 to 9; (2) Imatinib 400 mg, 1 tablet QD from day 0 to 9; (3) Favipiravir 200 mg, 12 tablets BID on day 0, 6 tablets BID from day 1 to 9; (4) Telmisartan 20 mg, 1 tablet QD from day 0 to 9. The comparator is a complex of vitamins and trace elements (AZINC Forme et Vitalité®), 1 capsule BID for 10 days, for which there is no reason to believe that they are active on the virus. In protocol version 1.2 (April 8th, 2020): People in the control arm will receive a combination of vitamins and trace elements; people in the experimental arms will receive hydroxychloroquine, or favipiravir, or imatinib, or telmisartan. MAIN OUTCOME: The primary outcome is the proportion of participants with an incidence of hospitalisation and/or death between inclusion and day 14 in each arm. RANDOMISATION: Participants are randomized in a 1:1:1:1:1 ratio to each arm using a web-based randomisation tool. Participants not treated with an ARB or ACEI prior to enrolment are randomized to receive the comparator or one of the four experimental drugs. Participants already treated with an ARB or ACEI are randomized to receive the comparator or one of the experimental drugs except telmisartan (i.e.: hydroxychloroquine, imatinib, or favipiravir). Randomisation is stratified on ACEI or ARBs treatment at inclusion and on the type of residence (personal home vs. nursing home). BLINDING (MASKING): This is an open-label trial. Participants, caregivers, investigators and statisticians are not blinded to group assignment. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): A total of 1057 participants will be enrolled if all arms are maintained until the final analysis and no additional arm is added. Three successive futility interim analyses are planned, when the number of participants reaches 30, 60 and 102 in the control arm. Two efficacy analyses (interim n°3 and final) will be performed successively. TRIAL STATUS: This describes the Version 1.2 (April 8th, 2020) of the COVERAGE protocol that was approved by the French regulatory authority and ethics committee. The trial was opened for enrolment on April 15th, 2020 in the Nouvelle Aquitaine region (South-West France). Given the current decline of the COVID-19 pandemic in France and its unforeseeable dynamic in the coming months, new trial sites in 5 other French regions and in Luxembourg are currently being opened. A revised version of the protocol was submitted to the regulatory authority and ethics committee on June 15th, 2020. It contains the following amendments: (i) Inclusion criteria: age ≥65 replaced by age ≥60; time since first symptoms <3 days replaced by time since first symptoms <5 days; (ii) Withdrawal of the hydroxychloroquine arm (due to external data); (iii) increase in the number of trial sites. TRIAL REGISTRATION: The trial was registered on Clinical Trials.gov on April 22nd, 2020 (Identifier: NCT04356495): and on EudraCT on April 10th, 2020 (Identifier: 2020-001435-27). FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).


Asunto(s)
Betacoronavirus/genética , Infecciones por Coronavirus/tratamiento farmacológico , Pacientes Ambulatorios/estadística & datos numéricos , Neumonía Viral/tratamiento farmacológico , Terapias en Investigación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Amidas/uso terapéutico , Antihipertensivos/uso terapéutico , Antimaláricos/uso terapéutico , Antivirales/uso terapéutico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Tolerancia a Medicamentos , Estudios de Factibilidad , Francia/epidemiología , Hospitalización/tendencias , Humanos , Hidroxicloroquina/uso terapéutico , Mesilato de Imatinib/uso terapéutico , Luxemburgo/epidemiología , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/virología , Inhibidores de Proteínas Quinasas/uso terapéutico , Pirazinas/uso terapéutico , Conducta de Reducción del Riesgo , Telmisartán/uso terapéutico , Resultado del Tratamiento
3.
Trials ; 21(1): 867, 2020 Oct 20.
Artículo en Inglés | MEDLINE | ID: mdl-33081817

RESUMEN

BACKGROUND: There is an urgent need for treatments that can shorten hospitalization and lower the risk of secondary infection and death in patients with corona disease. The ProPac-COVID trial evaluates whether combination therapy with macrolide azithromycin and hydroxychloroquine via anti-inflammation/immune modulation, antiviral efficacy, and pre-emptive treatment of supra-infections can shorten hospitalization duration and reduce the risk of non-invasive ventilation, treatment in the intensive care unit, and death in patients with acute hospital admission and a positive test for 2019-nCoV and symptoms of COVID-19 disease. METHODS: The ProPAC-COVID is a multi-center, randomized, placebo-controlled, double-blinded clinical trial. The primary outcome is number of days spent alive and out of hospital within 14 days from randomization. Randomization will be in blocks of unknown size, and the final allocation will be stratified for age, site of recruitment, and whether the patient has any chronic lung diseases. Data is analyzed using intention-to-treat (ITT) principles, and main analyses will also be subject to modified ITT analysis and per protocol analysis. DISCUSSION: This paper describes the detailed statistical analysis plan for the evaluation of primary and secondary endpoints of the ProPAC-COVID study. Enrolment of patients to the ProPAC-COVID study is still ongoing. The purpose of this paper is to provide primary publication of study results to prevent selective reporting of outcomes, data-driven analysis, and to increase transparency. TRIAL REGISTRATION: ClinicalTrials.gov NCT04322396 . Registered on 26 March 2020.


Asunto(s)
Antibacterianos/uso terapéutico , Antimaláricos/uso terapéutico , Azitromicina/uso terapéutico , Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus/prevención & control , Hidroxicloroquina/uso terapéutico , Pandemias/prevención & control , Neumonía Viral/prevención & control , Anciano , Antibacterianos/efectos adversos , Profilaxis Antibiótica/métodos , Antimaláricos/efectos adversos , Azitromicina/efectos adversos , Betacoronavirus/genética , Estudios de Casos y Controles , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Dinamarca/epidemiología , Método Doble Ciego , Quimioterapia Combinada , Femenino , Mortalidad Hospitalaria/tendencias , Hospitalización/estadística & datos numéricos , Humanos , Hidroxicloroquina/efectos adversos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Análisis de Intención de Tratar/métodos , Masculino , Ventilación no Invasiva/efectos adversos , Placebos/administración & dosificación , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Neumonía Viral/virología , Conducta de Reducción del Riesgo
4.
J Foot Ankle Res ; 13(1): 63, 2020 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-33059721

RESUMEN

BACKGROUND: The arrival of the novel coronavirus (SARS-CoV-2) has impacted the many aspects of modern life, especially, in the immediate term, the delivery of healthcare. CONTEXT: This commentary examines the profession of podiatry and how it has adapted and responded to the emerging crisis. It focusses on but is not exclusive to the position in the United Kingdom (UK) and the edicts and direction from the UK Government. PODIATRY ROLES DURING THE PANDEMIC: It describes the role of podiatry in the pandemic and highlights the deployment of podiatry resources to fight the pandemic beyond traditional podiatric practice. It also looks at the shift from conventional consultation to digital solutions for managing patients in an effort to achieve the goals of maintenance of foot health whilst reducing the spread of the virus. The commentary summarises the emerging data related to a possible foot related presentation of the coronavirus. CONCLUSION: The podiatry profession proved its flexibility and adaptability during the pandemic, to adjust rapidly to ensure that patients were able to access treatment to reduce risk of infection, ulceration and amputation. Dermatological presentations on the feet have been associated with Covid-19 in adolescents as is often the case in viral infections. CPD webinars to support clinicians and manage and prevent the spread of Covid-19 have been widely disseminated along with algorithms to ensure that patients that need treatment are being treated appropriately. Podiatrists have embraced remote technology to ensure that patients are correctly and safely triaged and, signposted and given appropriate self-care advice. MSK podiatrists have the ability to play an intrinsic role within the post discharge rehabilitation pathway.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud/estadística & datos numéricos , Neumonía Viral/epidemiología , Podiatría/organización & administración , Anciano , Anciano de 80 o más Años , Tecnología Biomédica/métodos , Tecnología Biomédica/estadística & datos numéricos , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/virología , Prestación de Atención de Salud/tendencias , Enfermedades del Pie/prevención & control , Humanos , Pandemias/prevención & control , Docilidad , Neumonía Viral/prevención & control , Neumonía Viral/virología , Podiatría/estadística & datos numéricos , Conducta de Reducción del Riesgo , Reino Unido/epidemiología
5.
Medicine (Baltimore) ; 99(44): e22883, 2020 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-33126337

RESUMEN

People living in the same area are more likely to experience similar socioeconomic characteristics, which leads to cluster effect and influences the generalizability of data regarding metabolic syndrome (MetS). However, previous studies did not consider or adjust for the cluster effect of living circumstances. The aim of this study was to determine the prevalence of MetS and associated lifestyle factors in Chinese adults 18 to 80 years of age, using multi-level generalized estimation equation (GEE).The participants came from a large-scale cross-sectional population survey. A total of 28,062 participants underwent all the blood tests. Participants meeting at least 3 of the 5 diagnostic criteria were defined as having MetS. Multi-level GEE was used to evaluate the relationship between MetS and lifestyle covariates to control the cluster effect of living circumstances. Odds ratios (ORs) and their 95% confidence intervals (CIs) were used to assess the strength of each relationship.A total of 65.70% of the participants had at least 1 clinical feature of MetS, and 2926 were diagnosed with MetS (prevalence 14.03%). 32.74%, 18.93%, 10.25%, 3.25%, and 0.53% of the participants had 1, 2, 3, 4, and 5 components, respectively. The prevalence of MetS in men (12.31%) was lower than in women (15.57%). After controlling for the cluster effect of living circumstances, many demographic and lifestyle characteristics were associated with MetS. Overweight (OR = 1.670, 95%CI: 1.600-1.743), obesity (OR = 2.287, 95% CI: 2.136-2.449), current alcohol consumption (OR = 1.053, 95% CI: 1.020-1.086), physical labor (OR=1.070, 95% CI: 1.040-1.101), a high-salt diet (OR=1.040, 95% CI: 1.009-1.071), hyperuricemia (OR=1.264, 95% CI: 1.215-1.316), short sleep duration (OR=1.032, 95% CI: 1.009-1.055), and a family history of cardiovascular disease (OR=1.065, 95% CI: 1.019-1.113), or cerebrovascular disease (OR=1.055, 95% CI: 1.007-1.104) increased the risk of MetS. The risk of MetS increased 6.9% (OR = 1.069, 95% CI: 1.053-1.085) with each 5% increase in body fat percentage.MetS has become a serious public health challenge in China. Many lifestyle factors have been found to be closely associated with MetS, including obesity, a high-salt diet, alcohol consumption, and short sleep duration. Therefore, changes in lifestyle are very important for adults to reduce the prevalence of MetS.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Estilo de Vida , Síndrome Metabólico , Obesidad/epidemiología , Servicios Preventivos de Salud , Condiciones Sociales/estadística & datos numéricos , China/epidemiología , Análisis por Conglomerados , Estudios Transversales , Femenino , Humanos , Masculino , Síndrome Metabólico/sangre , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/epidemiología , Síndrome Metabólico/psicología , Persona de Mediana Edad , Datos de Salud Generados por el Paciente/estadística & datos numéricos , Prevalencia , Factores de Riesgo , Conducta de Reducción del Riesgo
6.
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
11.
Emerg Infect Dis ; 26(11): 2607-2616, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32931726

RESUMEN

We evaluated effectiveness of personal protective measures against severe acute respiratory disease coronavirus 2 (SARS-CoV-2) infection. Our case-control study included 211 cases of coronavirus disease (COVID-19) and 839 controls in Thailand. Cases were defined as asymptomatic contacts of COVID-19 patients who later tested positive for SARS-CoV-2; controls were asymptomatic contacts who never tested positive. Wearing masks all the time during contact was independently associated with lower risk for SARS-CoV-2 infection compared with not wearing masks; wearing a mask sometimes during contact did not lower infection risk. We found the type of mask worn was not independently associated with infection and that contacts who always wore masks were more likely to practice social distancing. Maintaining >1 m distance from a person with COVID-19, having close contact for <15 minutes, and frequent handwashing were independently associated with lower risk for infection. Our findings support consistent wearing of masks, handwashing, and social distancing to protect against COVID-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Transmisión de Enfermedad Infecciosa/prevención & control , Máscaras/estadística & datos numéricos , Pandemias/prevención & control , Equipo de Protección Personal/estadística & datos numéricos , Neumonía Viral/prevención & control , Adulto , Anciano , Estudios de Casos y Controles , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Femenino , Desinfección de las Manos , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Factores de Riesgo , Conducta de Reducción del Riesgo , Tailandia/epidemiología
12.
Trials ; 21(1): 809, 2020 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-32993779

RESUMEN

BACKGROUND: Early reports indicate that COVID-19 may require intensive care unit (ICU) admission in 5-26% and overall mortality can rise to 11% of the recognised cases, particularly affecting the elderly. There is a lack of evidence-based targeted pharmacological therapy for its prevention and treatment. We aim to compare the effects of a World Health Organization recommendation-based education and a personalised complex preventive lifestyle intervention package (based on the same WHO recommendation) on the outcomes of the COVID-19. METHODS: PROACTIVE-19 is a pragmatic, randomised controlled clinical trial with adaptive "sample size re-estimation" design. Hungarian population over the age of 60 years without confirmed COVID-19 will be approached to participate in a telephone health assessment and lifestyle counselling voluntarily. Volunteers will be randomised into two groups: (A) general health education and (B) personalised health education. Participants will go through questioning and recommendation in 5 fields: (1) mental health, (2) smoking habits, (3) physical activity, (4) dietary habits, and (5) alcohol consumption. Both groups A and B will receive the same line of questioning to assess habits concerning these topics. Assessment will be done weekly during the first month, every second week in the second month, then monthly. The composite primary endpoint will include the rate of ICU admission, hospital admission (longer than 48 h), and mortality in COVID-19-positive cases. The estimated sample size is 3788 subjects per study arm. The planned duration of the follow-up is a minimum of 1 year. DISCUSSION: These interventions may boost the body's cardiovascular and pulmonary reserve capacities, leading to improved resistance against the damage caused by COVID-19. Consequently, lifestyle changes can reduce the incidence of life-threatening conditions and attenuate the detrimental effects of the pandemic seriously affecting the older population. TRIAL REGISTRATION: The study has been approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (IV/2428- 2 /2020/EKU) and has been registered at clinicaltrials.gov ( NCT04321928 ) on 25 March 2020.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/prevención & control , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Conducta de Reducción del Riesgo , Ensayos Clínicos Adaptativos como Asunto , Factores de Edad , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/efectos adversos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Ejercicio Físico , Conducta Alimentaria , Femenino , Estado de Salud , Interacciones Huésped-Patógeno , Humanos , Hungría , Masculino , Salud Mental , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/virología , Ensayos Clínicos Pragmáticos como Asunto , Factores Protectores , Medición de Riesgo , Factores de Riesgo , Fumar/efectos adversos
16.
J Am Dent Assoc ; 151(10): 726-734, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32979952

RESUMEN

BACKGROUND: The National Commission on Radiation Protection and Measurements has reinforced its recommendation for the use of rectangular collimation for intraoral radiography in its Report No. 177 published in 2019. This study compared effective dose (E) using circular and rectangular collimator (RC) modalities. METHODS: The authors exposed 18 projections for adult and 12 projections for child full-mouth series using an original equipment 6 centimeter diameter circular collimator (circular), original equipment rectangular positioning indicator device (Focus-RC), and 5 universal RC modalities (JadRad-RC, Rinn-RC, Durr-RC, DEXshield-RC, and TruAlign-RC) for adult and child phantoms. The authors acquired dosimetry using optically stimulated luminescence dosimeters. Exposures were made with a Focus (Instrumentarium) intraoral source using 70 peak kilovoltage and total milliamperes of 5.34 (adult) and 2.7 (child). RESULTS: Adult E was lowest for Focus-RC (54 microsieverts), which also produced the greatest exposure area reduction (51%) compared with circular, followed by JadRad-RC (55 µSv), Durr-RC (58 µSv), Rinn-RC (62 µSv), DEXshield-RC (70 µSv), TruAlign-RC (85 µSv), and circular (86 µSv). Child E followed a similar trend: Focus-RC (44 µSv), JadRad-RC (44 µSv), Durr-RC (45 µSv), Rinn-RC (48 µSv), DEXshield-RC (53 µSv), TruAlign-RC (85 µSv), and circular (89 µSv). When used with thyroid shielding, circular collimation thyroid dose was reduced by as much as 59%. CONCLUSIONS: Focus-RC techniques yielded the greatest dose reduction compared with alternative RC and circular. In addition to shape, collimator dimensions should be considered as significant factors affecting patient E. RC alone yielded a greater reduction in thyroid dose than did circular with thyroid shielding. PRACTICAL IMPLICATIONS: This study's findings underscore the updated recommendations of the National Commission on Radiation Protection and Measurements Report No.177, which emphasized the benefits and important practical considerations of RC with intraoral imaging.


Asunto(s)
Protección Radiológica , Glándula Tiroides , Adulto , Niño , Humanos , Dosis de Radiación , Radiografía , Conducta de Reducción del Riesgo
17.
BMJ Open ; 10(9): e040951, 2020 09 09.
Artículo en Inglés | MEDLINE | ID: mdl-32912958

RESUMEN

OBJECTIVES: To assess the experience of people with long-term respiratory conditions regarding the impact of measures to reduce risk of COVID-19. DESIGN: Analysis of data (n=9515) from the Asthma UK and British Lung Foundation partnership COVID-19 survey collected online between 1 and 8 April 2020. SETTING: Community. PARTICIPANTS: 9515 people with self-reported long-term respiratory conditions. 81% female, age ranges from ≤17 years to 80 years and above, from all nations of the UK. Long-term respiratory conditions reported included asthma (83%), chronic obstructive pulmonary disease (10%), bronchiectasis (4%), interstitial lung disease (2%) and 'other' (<1%) (eg, lung cancer and pulmonary endometriosis). OUTCOME MEASURES: Study responses related to impacts on key elements of healthcare, as well as practical, psychological and social consequences related to the COVID-19 pandemic and social distancing measures. RESULTS: 45% reported disruptions to care, including cancellations of appointments, investigations, pulmonary rehabilitation, treatment and monitoring. Other practical impacts such as difficulty accessing healthcare services for other issues and getting basic necessities such as food were also common. 36% did not use online prescriptions, and 54% had not accessed online inhaler technique videos. Psychosocial impacts including anxiety, loneliness and concerns about personal health and family were prevalent. 81% reported engaging in physical activity. Among the 11% who were smokers, 48% reported they were planning to quit smoking because of COVID-19. CONCLUSIONS: COVID-19 and related social distancing measures are having profound impacts on people with chronic respiratory conditions. Urgent adaptation and signposting of services is required to mitigate the negative health consequences of the COVID-19 response for this group.


Asunto(s)
Infecciones por Coronavirus , Ejercicio Físico , Pandemias , Neumonía Viral , Salud Pública , Enfermedades Respiratorias , Automanejo , Aislamiento Social/psicología , Adolescente , Adulto , Anciano de 80 o más Años , Ansiedad/prevención & control , Betacoronavirus , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/psicología , Estudios Transversales , Ejercicio Físico/fisiología , Ejercicio Físico/psicología , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Soledad/psicología , Masculino , Pandemias/prevención & control , Neumonía Viral/fisiopatología , Neumonía Viral/prevención & control , Neumonía Viral/psicología , Salud Pública/métodos , Salud Pública/normas , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/fisiopatología , Enfermedades Respiratorias/psicología , Conducta de Reducción del Riesgo , Automanejo/métodos , Automanejo/psicología , Automanejo/tendencias , Reino Unido
18.
Artículo en Inglés | MEDLINE | ID: mdl-32872367

RESUMEN

Health-promoting behaviors help prevent chronic illness. Health-promoting behaviors of nursing students can affect not only their own health, but also the health of their future patients, for whom they can act as role models. Nursing students should participate in health-promoting behaviors; however, nursing students often have unhealthy behaviors. This study aimed to investigate the factors affecting health-promoting behaviors in nursing students. A descriptive, self-report survey of 304 nursing students from three universities in South Korea was conducted. Subjects' general characteristics, health perceptions, health concerns, and health-promoting behaviors were collected. Of the total participants, 90.1% were female and the mean age was 20.4 years. The mean score for health-promoting behaviors was 2.47, higher than the midpoint. The mean for the subscale of physical activity among health-promoting behaviors was the lowest. The main factors affecting health-promoting behaviors were gender, health perceptions, health concern, and time per week spent searching online for health-related information. The main factors affecting physical activity were gender, health concern, and time per week spent searching online for health-related information. Based on the study findings, it is recommended that a program to empower nursing students to perform health-promoting behaviors be incorporated into the nursing education curriculum with regard to unique needs based on gender. Specifically, it would be effective to develop programs that are easily accessible via the Internet.


Asunto(s)
Actitud Frente a la Salud , Conductas Relacionadas con la Salud , Promoción de la Salud , Estudiantes de Enfermería/psicología , Adulto , Educación en Enfermería , Ejercicio Físico , Femenino , Humanos , Masculino , Motivación , República de Corea , Conducta de Reducción del Riesgo , Encuestas y Cuestionarios , Adulto Joven
20.
Am J Cardiol ; 133: 7-14, 2020 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-32828524

RESUMEN

According to the latest European Society of Cardiology Guidelines for the diagnosis and management of chronic coronary syndromes, patients who suffered an acute coronary syndrome fall into a chronic stable phase after 1 year. In these patients, the estimated 10-year risk for recurrent cardiovascular events varies considerably. We applied the SMART (Second Manifestations of Arterial Disease) risk score in 281 patients 1 year after an acute coronary syndrome to estimate the 10-year risk for recurrent cardiovascular events (subsequent nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death). We assessed the distribution of the estimated risk and the potential risk reduction that might be achieved with optimal guideline-directed management of modifiable risk factors (systolic blood pressure, low-density lipoprotein cholesterol, smoking, and body mass index). In our cohort, the median SMART score was 16.1% (interquartile range [IQR] 9.7 to 27.3), particularly increased in patients with older age, diabetes, polyvascular disease or chronic kidney disease (median 28.6%, IQR 20.8 to 52.9; 23.8%, 4.8 to 41.6; 29.4%, 18.8 to 49.7; 53.8%, 26.5 to 71.6, respectively). If all modifiable risk factors met guideline-recommended targets, the median SMART risk score would be 9.6% (IQR 6.3 to 20.9), with 51% of the patients at a 10-year risk <10%, while 11% and 15% at 20% to 30% and >30% risk, respectively. In conclusion, the SMART score had a wide distribution in patients with chronic coronary syndromes. A quarter of patients remained at a >20% 10-year risk, even with optimal risk factor management, clearly underlining that residual risk is an unmet clinical challenge.


Asunto(s)
Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/terapia , Síndrome Coronario Agudo/diagnóstico , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Medición de Riesgo , Factores de Riesgo , Conducta de Reducción del Riesgo , Factores de Tiempo
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA