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1.
Epidemiol Psychiatr Sci ; 29: e86, 2020 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-31915100

RESUMEN

With cancer incidence increasing over time worldwide, attention to the burden of psychiatric and psychosocial consequences of the disease is now mandatory for both cancer and mental health care professionals. Psychiatric disorders have been shown to affect at least 30-35% of cancer patients during all phases of the disease trajectory, and differ in nature according to stage and type of cancer. Other clinically relevant distressing psychosocial and existential conditions (e.g. demoralisation, health anxiety, loss of meaning and existential distress) not included as 'disorders' in the usual diagnostic and nosological systems (i.e. meta-diagnostic conditions) have also been shown to be present in another 15-20% of cancer patients. In this editorial, we will present a summary of the extensive literature regarding the epidemiology of the several psychosocial disorders affecting cancer patients as a cause of distress and burden to be taken into consideration and addressed in cancer care through evidence-based intervention.


Asunto(s)
Trastornos Mentales/complicaciones , Salud Mental , Neoplasias/psicología , Estrés Psicológico/psicología , Ansiedad/etiología , Disfunción Cognitiva/etiología , Costo de Enfermedad , Depresión/etiología , Humanos , Trastornos Mentales/psicología , Neoplasias/complicaciones , Neoplasias/diagnóstico , Psicooncología , Calidad de Vida , Estrés Psicológico/diagnóstico , Estrés Psicológico/etiología
3.
Can J Surg ; 63(1): E52-E56, 2020 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-31995337

RESUMEN

Background: Periprosthetic joint infection (PJI) is the third leading cause of total hip arthroplasty (THA) failure. Although controversial, 2-stage revision remains the gold standard treatment for PJI in most situations. To date, there have been few studies describing the economic impact of PJI in today's health care environment. The purpose of the current study was to obtain an accurate estimate of the institutional cost associated with the management of PJI in THA and to assess the economic burden of PJI compared with primary uncomplicated THA. Methods: We conducted a review of primary THA cases and 2-stage revision THA for PJI at our institution. Patients were matched for age and body mass index. All costs associated with each procedure were recorded. Descriptive statistics were used to summarize the collected data. Mean costs, length of stay, clinic visits and readmission rates associated with the 2 cohorts were compared. Results: Fifty consecutive cases of revision THA were matched with 50 cases of uncomplicated primary THA between 2006 and 2014. Compared with the primary THA cohort, PJI was associated with a significant increase in mean length of hospital stay (26.5 v. 2.0 d, p < 0.001), mean number of clinic visits (9.2 v. 3.8, p < 0.001), number of readmissions (12 v. 1, p < 0.001) and average overall cost (Can$38 107 v. Can$6764, t = 8.3, p < 0.001). Conclusion: Treatment of PJI is a tremendous economic burden. Our data suggest a 5-fold increase in hospital expenditure in the management of PJI compared with primary uncomplicated THA.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/economía , Costo de Enfermedad , Infecciones Relacionadas con Prótesis/economía , Costos de Hospital , Humanos , Falla de Prótesis , Infecciones Relacionadas con Prótesis/etiología , Estudios Retrospectivos
4.
Life Sci ; 240: 117069, 2020 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31751582

RESUMEN

AIM: Intraluminal thrombus (ILT) is presented in most abdominal aortic aneurysms (AAAs) and is suggested to promote AAA expansion. D-dimer, a breakdown product in the thrombus remodeling, may have prognostic value for AAA. This study investigated the interrelation between plasma D-dimer level, ILT volume, AAA size and progression. MAIN METHODS: This was a retrospective observational study that involved 181 patients with infra-renal AAA. They were divided into small and large AAA groups according to AAA diameter. 24 of them had repeated abdominal computed tomography angiography (CTA) scan and were divided into slow-growing and fast-growing AAA groups according to the median value of AAA growth rate. Baseline and follow-up plasma D-dimer level, maximum diameter of AAA, total infra-renal aortic volume and ILT volume were analyzed. KEY FINDINGS: Plasma D-dimer level was positively correlated with ILT volume (R = 0.382, P < 0.001) and maximum diameter of AAA (R = 0.442, P < 0.001). Increasing value of plasma D-dimer was positively associated with the accelerated growth rate of AAA (R = 0.720, P < 0.01). ILT volume showed positive correlation with maximum diameter (R = 0.859, P < 0.001) and growth rate of AAA (R = 0.490, P < 0.05). After adjusting the baseline ILT volume, the positive correlations remained to be statistically significant between plasma D-dimer level and AAA size (R = 0.200, P < 0.05), as well as increasing value of plasma D-dimer and growth rate of AAA (R = 0.642, P < 0.05). SIGNIFICANCE: Plasma D-dimer level reflected ILT burden in AAAs. Plasma D-dimer level and ILT volume were positively correlated with AAA size. Increasing value of plasma D-dimer and baseline ILT volume could be predictors of AAA progression.


Asunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/etiología , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Trombosis/complicaciones , Trombosis/diagnóstico , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/sangre , Costo de Enfermedad , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Fumar/epidemiología , Trombosis/sangre , Tomografía Computarizada por Rayos X
6.
Int J Cancer ; 146(3): 874-883, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-31107541

RESUMEN

Substantial changes in the prevalence of the principal kidney and bladder cancer risk factors, smoking (both cancers) and body fatness (kidney cancer), have occurred but the contemporary cancer burden attributable to these factors has not been evaluated. We quantified the kidney and bladder cancer burden attributable to individual and joint exposures and assessed whether these burdens differ between population subgroups. We linked pooled data from seven Australian cohorts (N = 367,058) to national cancer and death registries and estimated the strength of the associations between exposures and cancer using adjusted proportional hazards models. We estimated exposure prevalence from representative contemporaneous health surveys. We combined these estimates to calculate population attributable fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death, and compared PAFs for population subgroups. During the first 10-year follow-up, 550 kidney and 530 bladder cancers were diagnosed and over 21,000 people died from any cause. Current levels of overweight and obesity explain 28.8% (CI = 17.3-38.7%), current or past smoking 15.5% (CI = 6.0-24.1%) and these exposures jointly 39.6% (CI = 27.5-49.7%) of the kidney cancer burden. Current or past smoking explains 44.4% (CI = 35.4-52.1%) of the bladder cancer burden, with 24.4% attributable to current smoking. Ever smoking explains more than half (53.4%) of the bladder cancer burden in men, and the burden potentially preventable by quitting smoking is highest in men (30.4%), those aged <65 years (28.0%) and those consuming >2 standard alcoholic drinks/day (41.2%). In conclusion, large fractions of kidney and bladder cancers in Australia are preventable by behavior change.


Asunto(s)
Terapia Conductista , Costo de Enfermedad , Neoplasias Renales/epidemiología , Neoplasias de la Vejiga Urinaria/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Australia/epidemiología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Predicción , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Neoplasias Renales/prevención & control , Estilo de Vida , Masculino , Persona de Mediana Edad , Sobrepeso/complicaciones , Sobrepeso/epidemiología , Prevalencia , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiología , Fumar/terapia , Cese del Hábito de Fumar , Neoplasias de la Vejiga Urinaria/prevención & control , Adulto Joven
7.
J Surg Res ; 245: 529-536, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31470333

RESUMEN

BACKGROUND: Gun violence among children and teenagers in the United States occurs at a magnitude many times that of other industrialized countries. The trends of injury in this age group relative to the adult population are not well studied. This study seeks to measure trends in pediatric firearm injuries in the United States. METHODS: Data from the National Trauma Data Bank (2010-2016) were used in selecting patients evaluated for firearm injury. Patients were classified as children and teenagers (<20 y) or adults (≥20 y). Changes in the proportion of firearm injuries among children and teenagers relative to the overall population (pediatric component) were determined using trend analyses. RESULTS: There were 240,510 firearm injuries with children and teenagers accounting for 45,075 of these injuries (pediatric component of 18.7%). Pediatric firearm injury was mostly among males (87.4%), Blacks (60.7%), and victims of assault (76.0%). The pediatric component of firearm injuries decreased from 21.7% in 2010 to 18.2% in 2016 (P-trend < 0.001). Although there was a decrease from 22.7% to 17.6% in the pediatric component of assault (P-trend < 0.001), there was an increase from 8.7% to 10.1% in the pediatric component of self-inflicted injuries (P-trend = 0.028). Substratification by race/ethnicity showed decrease in the pediatric component of firearm injuries among all groups (P-trend < 0.001) except Whites (P-trend = 0.847). CONCLUSIONS: Despite reductions in the pediatric component of firearm injuries, there remains a significant burden of injury in this group. Continued public health efforts are necessary to ensure safety and reduce firearm injuries among children and teenagers in the United States.


Asunto(s)
Costo de Enfermedad , Violencia/tendencias , Heridas por Arma de Fuego/epidemiología , Adolescente , Niño , Víctimas de Crimen/estadística & datos numéricos , Bases de Datos Factuales , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Estados Unidos/epidemiología , Violencia/prevención & control , Violencia/estadística & datos numéricos , Heridas por Arma de Fuego/diagnóstico , Heridas por Arma de Fuego/etiología , Adulto Joven
8.
Med Clin North Am ; 104(1): 157-176, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31757234

RESUMEN

Atopic dermatitis (AD) was once thought to be a benign childhood disease that remitted with increasing age. However, recent studies have transformed the understanding of AD, particularly in adult patients. AD is common in adults and can lead to substantial disability by negatively affecting sleep, mental health, and quality of life. There seem to be different genetic, immunologic, and epidemiologic risk factors for AD in adults than in children. This article examines the pathophysiology, epidemiology, heterogeneous clinical presentation, burden, diagnosis, and treatment of adult AD.


Asunto(s)
Dermatitis Atópica , Adulto , Costo de Enfermedad , Humanos , Factores de Riesgo
9.
Gesundheitswesen ; 82(1): 30-39, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31863443

RESUMEN

BACKGROUND: Dementia is an age-specific disease with increasing care needs over the course of the disease. Care is predominantly conducted by caregivers. Caregiver burden is a core criterion for the evaluation of the care situation. The aims of this examination are to identify predictors of caregiver burden and to analyze the course of the caregiver burden over a 12 months period. METHODS: The Bavarian Dementia Survey (BayDem) is a supra-regional, longitudinal study carried out at 3 different sites in Bavaria, Germany. Participants were people with dementia (pwd) as defined by ICD-10 and their informal caregivers. Data was collected by standardized face-to-face interviews in cooperation with local actors. For statistical analysis, a multiple regression as well as a mixed ANOVA (Analysis of Variance) and repeated measures ANOVAs were used. RESULTS: In this analysis, 295 pwd and 276 caregivers were studied. Key factors influencing caregiver burden were gender of the pwd, behavioral and psychological symptoms and a decline of everyday functioning of the pwd as well as gender of the informal caregivers, their relation to the pwd and if they live at the same household as the pwd. Analysis showed a significant main effect of time over the course of the caregiver burden. CONCLUSION: A permanent high caregiver burden can cause health problems for the caregivers. However, caregivers can be supported according to the specific factors of the caregiver burden. One approach in order to support caregivers could be a combination of pharmacological and non-pharmacological interventions for the treatment of disease-specific symptoms and an empowerment as well as the provision of support services for the caregivers. Furthermore, tailored services for specific target groups can be meaningful.


Asunto(s)
Cuidadores , Demencia , Costo de Enfermedad , Demencia/enfermería , Alemania , Humanos , Estudios Longitudinales , Calidad de Vida , Encuestas y Cuestionarios
10.
Gesundheitswesen ; 82(1): 50-58, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31863445

RESUMEN

BACKGROUND: Dementia is usually a life-limiting disease. However, evidence-based guidelines for palliative care for people with dementia (PwD) are currently lacking. One reason for this is the dearth of reliable empirical data on PwD at the end of life. The aim of this study is to describe the symptom burden, causes of death, places of death and the use of various health services for PwD at the end of life. METHODS: The Bavarian Dementia Survey (BayDem) was a multi-center, longitudinal study at 3 different sites in Bavaria, Germany (Dachau, Kronach, Erlangen). Participants were PwD defined by ICD-10 and their informal caregivers. Data were collected in standardized face-to-face interviews in cooperation with local actors. In order to obtain comparable groups, deceased and non-deceased PwD were matched using 1:1 propensity score matching. For the statistical analyses, McNemar tests as well as paired t-tests were used. RESULTS: In this analysis, 58 deceased and 58 non-deceased PwD were studied (n=116). In most cases, PwD died at home (36.2%), in hospital (25.9%) or in a nursing home (19.0%), but no one in palliative care. The most common causes of death were respiratory (13.8%) and cardiovascular complications (12.1%) as well as stroke (12.1%). PwD at the end of life showed more pronounced physical comorbidities than the other PwD (Charlson-Index: M=2.75 vs. M=1.80; p=0.030, Cohen's d=0.425) and were therefore admitted to hospital (46.6 vs. 12.1%, p<0.001, OR=6.250) or emergency departments (22.4 vs. 3.4%, p=0.007, OR=6.500) more frequently. Behavioral and psychological symptoms were very pronounced (NPI Score: M=31.67 vs. M=24.77, p=0.118, Cohen's d=0.303). Nevertheless, the utilization of outpatient health services was low. CONCLUSION: The results underline the need to develop evidence-based guidelines to provide palliative care specifically adapted to the needs of PwD at the end of life. In this context, the high incidence of behavioral and psychological symptoms should be taken into account, as should the high incidence of physical comorbidities. Considering the frequent hospital admissions, special attention should also be paid to the development of recommendations for the inpatient sector (acute hospital and palliative care unit).


Asunto(s)
Causas de Muerte , Demencia , Utilización de Instalaciones y Servicios , Cuidado Terminal , Cuidadores , Costo de Enfermedad , Demencia/mortalidad , Demencia/terapia , Alemania/epidemiología , Humanos , Estudios Longitudinales , Calidad de Vida , Encuestas y Cuestionarios
12.
Epidemiol Psychiatr Sci ; 29: e81, 2019 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-31839018

RESUMEN

AIMS: Patients with severe mental disorders in low-resource settings have limited access to services, resulting in overwhelming caregiving burden for families. In extreme cases, this has led to the long-term restraining of patients in their homes. China underwent a nationwide initiative to unlock patients and provide continued treatment. This study aims to quantify household economic burden in families after unlocking and treatment, and to identify factors associated with increased burden due to schizophrenia. METHODS: A total of 264 subjects were enrolled from three geographically diverse provinces in 2012. Subjects were patients with schizophrenia who were previously put under restraints and had participated in the 'unlocking and treatment' intervention. The primary outcome was the current household economic burden, obtained from past year financial information collected through on-site interview. Patient disease characteristics, treatment, outcomes and family caregiving burden were collected as well. Univariate and multivariate linear regression were used to construct risk factor models for indirect economic burden. RESULTS: After participating in the intervention, 85% of patients continued to receive mental health services, 70% used medication as prescribed and 80% were never relocked. Family members reported significantly decreased caregiving burden after receiving the intervention. Mean direct and indirect household economic burdens were CNY963 (US$31.7) and CNY11 724 (US$1670) per year, respectively, while family total income was on average CNY12 108 (US$1913) per year. Greater disease severity and poorer patient psychosocial function at time of study were found to be independent factors related to increased indirect burden. CONCLUSIONS: The 'unlocking and treatment' intervention has improved the lives of patients and families. Indirect burden due to disease is still a major economic issue that needs to be addressed, potentially through improving treatment and patient functioning. Our findings contribute to the unravelling and eventual elimination of chronic restraining of mentally ill patients in low-resource settings.


Asunto(s)
Cuidadores/psicología , Costo de Enfermedad , Costos de la Atención en Salud , Gastos en Salud , Servicios de Salud Mental/economía , Esquizofrenia/terapia , Adolescente , Adulto , China/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Esquizofrenia/economía , Psicología del Esquizofrénico , Encuestas y Cuestionarios , Adulto Joven
13.
Bone Joint J ; 101-B(12): 1542-1549, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31786996

RESUMEN

AIMS: Spinal tuberculosis (TB) remains an important concern. Although spinal TB often has sequelae such as myelopathy after treatment, the predictive factors affecting such unfavourable outcomes are not yet established. We investigated the clinical manifestations and predictors of unfavourable treatment outcomes in patients with spinal TB. PATIENTS AND METHODS: We performed a multicentre retrospective cohort study of patients with spinal TB. Unfavourable outcome was defined according to previous studies. The prognostic factors for unfavourable outcomes as the primary outcome were determined using multivariable logistic regression analysis and a linear mixed model was used to compare time course of inflammatory markers during treatment. A total of 185 patients were included, of whom 59 patients had unfavourable outcomes. RESULTS: In multivariate regression analysis, the factors associated with unfavourable outcome were old age (odds ratio (OR) 2.51; 95% confidence interval (CI) 1.07 to 5.86; p = 0.034), acid-fast bacilli (AFB) smear positivity in specimens obtained through biopsy (OR 3.05; 95% CI 1.06 to 8.80; p = 0.039), and elevated erythrocyte sedimentation rate (ESR) at the end of treatment (OR 3.85; 95% CI 1.62 to 9.13; p = 0.002). Patients with unfavourable outcomes had a significant trend toward higher ESR during treatment compared with patients with favourable outcome (p = 0.009). Duration of anti-TB and surgical treatment did not affect prognosis. CONCLUSION: Elevated ESR at the end of treatment could be used as a marker to identify spinal TB patients with a poor prognosis. Patients whose ESR is not normalized during treatment, as well as those with old age and AFB smear positivity, should be aware of unfavourable outcomes. Cite this article: Bone Joint J 2019;101-B:1542-1549.


Asunto(s)
Antituberculosos/uso terapéutico , Procedimientos Ortopédicos , Tuberculosis de la Columna Vertebral/diagnóstico , Tuberculosis de la Columna Vertebral/terapia , Adulto , Anciano , Biomarcadores/sangre , Sedimentación Sanguínea , Terapia Combinada , Costo de Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Modelos Lineales , Modelos Logísticos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , Pronóstico , República de Corea , Estudios Retrospectivos , Resultado del Tratamiento , Tuberculosis de la Columna Vertebral/sangre
17.
BMC Public Health ; 19(1): 1465, 2019 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-31694683

RESUMEN

BACKGROUND: Ischemic heart disease (IHD) is one of the leading causes of deaths worldwide and causes a tremendous disease burden. Temperature is an important environmental determinant among the many risk factors for IHD. However, the emerging temperature-related health risks of IHD in the elderly is limited because of the lack of estimates that integrate global warming and demographic change. METHODS: Data on daily IHD deaths in the elderly aged ≥65 years and meteorological conditions were collected in Tianjin, a megacity of China, from 2006 to 2011. First, the baseline relationship between the temperature and years of life lost (YLL) from IHD was established. Then, future assessments were performed in combination with temperature projections for 19 global-scale climate models (GCMs) under 3 representative concentration pathways (RCPs) for the 2050s and 2070s. RESULTS: Increased YLL from IHD in the elderly was found to be associated with future ambient temperatures. The annual temperature-related YLL from IHD in the 2050s and 2070s were higher than the baseline. For instance, increases of 4.5, 14.9 and 38.3% were found under the RCP2.6, RCP4.5 and RCP8.5 scenarios, respectively, in the 2070s. The most significant increases occurred in warm season months. The increase in heat-related YLL will not be completely offset, even with the 25% adaptation assumed. When considering demographic change, the temperature-related disease burden of IHD in the elderly will be exacerbated by 158.4 to 196.6% under 3 RCPs in the 2050s and 2070s relative to the baseline. CONCLUSIONS: These findings have significant meaning for environmental and public health policy making and interventions towards the important issue of the health impacts of global warming on the elderly.


Asunto(s)
Predicción , Calentamiento Global , Isquemia Miocárdica/mortalidad , Adaptación Fisiológica , Anciano , Anciano de 80 o más Años , China/epidemiología , Clima , Costo de Enfermedad , Femenino , Humanos , Masculino , Isquemia Miocárdica/etiología , Factores de Riesgo , Estaciones del Año , Temperatura Ambiental
18.
Medicine (Baltimore) ; 98(45): e17671, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31702619

RESUMEN

INTRODUCTION: Injuries among children and adolescents remain a major public health problem in China. In the present study, we undertook a systematic review and meta-analysis of the published literature of epidemiological studies investigating injuries among children and adolescents in China and aimed to describe the status of injury among children and adolescents (aged 0-19 years) in China nationwide. A random-effects meta-analysis model was used to calculate the pooled prevalence of injury with 95% confidence intervals (CIs) across studies. The potential heterogeneity moderators were identified by subgroup and sensitivity analysis. A total of 775,615 children and adolescents were included in this study. Overall, the pooled injury prevalence among children and adolescents aged 0 to 19 years was 23.0% (95% CI 20.0%-27.0%) in studies using 1996 version of injury definition, and 13.0% (95% CI 10.0%-17.0%) in studies using 2004 version of injury definition. Relevant heterogeneity moderators have been identified by subgroup analysis. Sensitivity analysis yielded consistent results. CONCLUSION: Our study shows a moderately high injury prevalence among children and adolescents aged 0 to 19 years in China, more prevention policies and programs should be urgently developed to decrease the occurrence of child and adolescent injury.


Asunto(s)
Costo de Enfermedad , Heridas y Traumatismos/epidemiología , Adolescente , Niño , Preescolar , China/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Prevalencia , Salud Pública
19.
J Water Health ; 17(5): 801-812, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31638030

RESUMEN

Well water around the world can be contaminated with arsenic, a naturally occurring geological element that has been associated with myriad adverse health effects. Persons obtaining their drinking water from private wells are often responsible for well testing and water treatment. High levels of arsenic have been reported in well water-supplied areas of the United States. We quantified - in cases and dollars - the potential burden of disease associated with the ingestion of arsenic through private well drinking water supplies in the United States. To estimate cancer and cardiovascular disease burden, we developed a Monte Carlo model integrating three input streams: (1) regional concentrations of arsenic in drinking water wells across the United States; (2) dose-response relationships in the form of cancer slope factors and hazard ratios; and (3) economic cost estimates developed for morbidity endpoints using 'cost-of-illness' methods and for mortality using 'value per statistical life' estimates. Exposure to arsenic in drinking water from U.S. domestic wells is modeled to contribute 500 annual premature deaths from ischemic heart disease and 1,000 annual cancer cases (half of them fatal), monetized at $10.9 billion (2017 USD) annually. These considerable public health burden estimates can be compared with the burdens of other priority public health issues to assist in decision-making.


Asunto(s)
Arsénico/análisis , Costo de Enfermedad , Agua Potable/química , Contaminantes Químicos del Agua/análisis , Purificación del Agua , Pozos de Agua , Estados Unidos , Abastecimiento de Agua
20.
Sleep Med Clin ; 14(4): 423-429, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31640870

RESUMEN

Driving while sleepy on a regular basis may be due to sleep restriction associated with work schedules or with poor sleep hygiene. It also may be associated with sleep disorders or with sedative drugs. This review assesses the potential consequences of driving sleepy on a regular basis from a societal point of view. Driving while sleepy on a regular basis increases the risk of motor vehicle accidents (MVAs), impairs the ability to work, has an impact on productivity, and probably also has an impact on the risk of non-MVA occupational accidents and on public disasters.


Asunto(s)
Accidentes de Tránsito/economía , Conducción de Automóvil , Costo de Enfermedad , Sueño/fisiología , Somnolencia , Humanos , Trastornos del Inicio y del Mantenimiento del Sueño/economía , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatología , Vigilia/fisiología
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