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1.
BMJ ; 369: m1186, 2020 04 29.
Artículo en Inglés | MEDLINE | ID: mdl-32349963

RESUMEN

OBJECTIVE: To assess the association between use of sodium-glucose co-transporter 2 (SGLT2) inhibitors and risk of serious renal events in data from routine clinical practice. DESIGN: Cohort study using an active comparator, new user design and nationwide register data. SETTING: Sweden, Denmark, and Norway, 2013-18. PARTICIPANTS: Cohort of 29 887 new users of SGLT2 inhibitors (follow-up time: dapagliflozin 66.1%; empagliflozin 32.6%; canagliflozin 1.3%) and 29 887 new users of an active comparator, dipeptidyl peptidase-4 inhibitors, matched 1:1 on the basis of a propensity score with 57 variables. Mean follow-up time was 1.7 (SD 1.0) years. EXPOSURES: SGLT2 inhibitors versus dipeptidyl peptidase-4 inhibitors, defined by filled prescriptions and analysed according to intention to treat. MAIN OUTCOME MEASURES: The main outcome was serious renal events, a composite including renal replacement therapy, death from renal causes, and hospital admission for renal events. Secondary outcomes were the individual components of the main outcome. RESULTS: The mean age of the study population was 61.3 (SD 10.5) years; 11 108 (19%) had cardiovascular disease, and 1974 (3%) had chronic kidney disease. Use of SGLT2 inhibitors, compared with dipeptidyl peptidase-4 inhibitors, was associated with a reduced risk of serious renal events (2.6 events per 1000 person years versus 6.2 events per 1000 person years; hazard ratio 0.42 (95% confidence interval 0.34 to 0.53); absolute difference -3.6 (-4.4 to -2.8) events per 1000 person years). In secondary outcome analyses, the hazard ratio for use of SGLT2 inhibitors versus dipeptidyl peptidase-4 inhibitors was 0.32 (0.22 to 0.47) for renal replacement therapy, 0.41 (0.32 to 0.52) for hospital admission for renal events, and 0.77 (0.26 to 2.23) for death from renal causes. In sensitivity analyses in each of the Swedish and Danish parts of the cohort, the model was further adjusted for glycated haemoglobin and estimated glomerular filtration rate (Sweden and Denmark) and for blood pressure, body mass index, and smoking (Sweden only); in these analyses, the hazard ratio moved from 0.41 (0.26 to 0.66) to 0.50 (0.31 to 0.81) in Sweden and from 0.42 (0.32 to 0.56) to 0.55 (0.41 to 0.74) in Denmark. CONCLUSIONS: In this analysis using nationwide data from three countries, use of SGLT2 inhibitors, compared with dipeptidyl peptidase-4 inhibitors, was associated with a significantly reduced risk of serious renal events.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Enfermedades Renales/epidemiología , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Lesión Renal Aguda/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Compuestos de Bencidrilo/uso terapéutico , Canagliflozina/uso terapéutico , Enfermedades Cardiovasculares/epidemiología , Estudios de Casos y Controles , Estudios de Cohortes , Comorbilidad , Dinamarca/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Glucósidos/uso terapéutico , Hospitalización/estadística & datos numéricos , Humanos , Enfermedades Renales/mortalidad , Enfermedades Renales/terapia , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Modelos de Riesgos Proporcionales , Insuficiencia Renal Crónica/epidemiología , Terapia de Reemplazo Renal/estadística & datos numéricos , Suecia/epidemiología
3.
Dan Med J ; 67(5)2020 Apr 27.
Artículo en Inglés | MEDLINE | ID: mdl-32351196

RESUMEN

INTRODUCTION: The coronavirus disease 2019 (COVID-19)pandemic reached Denmark in early 2020. This paper presents initial intensive-care unit (ICU) experiences with COVID-19 patients at Roskilde Hospital, which was the primary recipient of COVID-19 patients in need of intensive care in the Zealand Region, Denmark. METHODS: An evaluation was conducted of the COVID-19 patients admitted to the ICU due to respiratory failure from 11 March 2020 to 01 April 2020. The number of ICU beds was increased from eight to 22 beds during this period. RESULTS: Sixteen patients (four women) were evaluated. The median age was 69.5 years (range: 56-84 years). All the patients were admitted to the ICU for hypoxemic respiratory failure and all needed mechanical ventilation by orotracheal intubation. By 16 April, six patients were still admitted to the ICU, four patients had been discharged from the ICU and seven had died. At present, the average length of ICU stay is 14 ± 9 days (mean ± standard deviation). One patient has remained on ventilatory support for 31 days. The evaluation revealed four key themes. COVID-19 patients 1) had greatly increased C-reactive protein levels, 2) needed a significant inspiratory O2fraction, 3) were highly positive end-expiratory pressure (PEEP) dependent on ventilatory support and 4) suffered highly fluctuating respiratory failure requiring ventilatory support for a significantly longer period of time than non-COVID-19 patients. CONCLUSIONS: COVID-19 patients have characteristic reproducible laboratory findings and present a major challenge due to their illness severity and required treatment length. FUNDING: none. TRIAL REGISTRATION: not relevant.


Asunto(s)
Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Respiración Artificial , Insuficiencia Respiratoria/terapia , Anciano , Anciano de 80 o más Años , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Dinamarca/epidemiología , Femenino , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pandemias , Alta del Paciente , Neumonía Viral/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento
4.
N Engl J Med ; 382(18): 1721-1731, 2020 04 30.
Artículo en Inglés | MEDLINE | ID: mdl-32348643

RESUMEN

BACKGROUND: Persons with mental disorders are at a higher risk than the general population for the subsequent development of certain medical conditions. METHODS: We used a population-based cohort from Danish national registries that included data on more than 5.9 million persons born in Denmark from 1900 through 2015 and followed them from 2000 through 2016, for a total of 83.9 million person-years. We assessed 10 broad types of mental disorders and 9 broad categories of medical conditions (which encompassed 31 specific conditions). We used Cox regression models to calculate overall hazard ratios and time-dependent hazard ratios for pairs of mental disorders and medical conditions, after adjustment for age, sex, calendar time, and previous mental disorders. Absolute risks were estimated with the use of competing-risks survival analyses. RESULTS: A total of 698,874 of 5,940,299 persons (11.8%) were identified as having a mental disorder. The median age of the total population was 32.1 years at entry into the cohort and 48.7 years at the time of the last follow-up. Persons with a mental disorder had a higher risk than those without such disorders with respect to 76 of 90 pairs of mental disorders and medical conditions. The median hazard ratio for an association between a mental disorder and a medical condition was 1.37. The lowest hazard ratio was 0.82 for organic mental disorders and the broad category of cancer (95% confidence interval [CI], 0.80 to 0.84), and the highest was 3.62 for eating disorders and urogenital conditions (95% CI, 3.11 to 4.22). Several specific pairs showed a reduced risk (e.g., schizophrenia and musculoskeletal conditions). Risks varied according to the time since the diagnosis of a mental disorder. The absolute risk of a medical condition within 15 years after a mental disorder was diagnosed varied from 0.6% for a urogenital condition among persons with a developmental disorder to 54.1% for a circulatory disorder among those with an organic mental disorder. CONCLUSIONS: Most mental disorders were associated with an increased risk of a subsequent medical condition; hazard ratios ranged from 0.82 to 3.62 and varied according to the time since the diagnosis of the mental disorder. (Funded by the Danish National Research Foundation and others; COMO-GMC ClinicalTrials.gov number, NCT03847753.).


Asunto(s)
Enfermedad/etiología , Trastornos Mentales/complicaciones , Adulto , Enfermedades Cardiovasculares/etiología , Estudios de Cohortes , Dinamarca/epidemiología , Femenino , Enfermedades Urogenitales Femeninas/etiología , Humanos , Masculino , Enfermedades Urogenitales Masculinas/etiología , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/etiología , Neoplasias/etiología , Riesgo , Esquizofrenia/complicaciones , Factores Sexuales
6.
Medicine (Baltimore) ; 99(17): e19984, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32332684

RESUMEN

Susceptibility to infectious disease may be a marker of immunodeficiency caused by unrecognized cancer. To test the hypothesis, the risk of incident primary cancer was estimated among survivors of Staphylococcus aureus bacteremia (SAB) and compared to a random population cohort.Nation-wide population-based matched cohort study. Cases of SAB were identified from a national database and incident primary cancers were ascertained by record linkage. Incidence rate (IR) and ratio (IRR) with 95% confidence interval (CI) of 27 cancers was calculated by Poisson regression.During the first year of follow-up, 165 and 943 incident cases of cancer occurred in the case cohort (n = 12,918 (1.3%)) and the population cohort (n = 117,465 (0.8%)) for an IR of 3.78 (3.22-4.40) and 2.28 (2.14-2.43) per 100,000 person-years. The IRR was 1.65 (1.40-1.95). Of 27 cancers, 7 cancers occurred more frequently amongst cases than controls: cervical cancer (IRR 37.83 (4.23-338.47)), multiple myeloma (IRR 6.31 (2.58-15.44)), leukemia (IRR 4.73 (2.21-10.10)), sarcoma (IRR 4.73 (1.18-18.91)), liver cancer (IRR 3.64 (1.30-10.21)), pancreatic cancer (IRR 2.8 (1.27-6.16)), and urinary tract cancer (IRR 2.58 (1.23-5.39)). Compared to the control population, the risk of cancer was higher for those without comorbidity and with younger age. The overall risk of cancer during 2 to 5 years of follow-up was not increased (IRR 0.99 (95% CI: 0.89-1.11). However, the risk of pharyngeal cancer was increased (IRR 1.88 (1.04-3.39)) and the risk of liver cancer remained increased (IRR 3.93 (2.36-6.55)).The risk of primary incident cancer was 65% higher in the SAB cohort compared to the population cohort during the first year of follow-up and included 7 specific cancers. The risk was higher for those without comorbidity and with younger age. Screening for these specific cancers in selected populations may allow for earlier detection.


Asunto(s)
Bacteriemia/etiología , Hallazgos Incidentales , Neoplasias/diagnóstico , Staphylococcus aureus/patogenicidad , Adolescente , Adulto , Anciano , Bacteriemia/sangre , Bacteriemia/epidemiología , Niño , Preescolar , Estudios de Cohortes , Dinamarca/epidemiología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Distribución de Poisson , Factores de Riesgo , Staphylococcus aureus/efectos de los fármacos
8.
Ugeskr Laeger ; 182(16)2020 04 13.
Artículo en Danés | MEDLINE | ID: mdl-32286214

RESUMEN

During the SARS-CoV-2 pandemic, testing of suspected cases in Denmark has recently been limited to those who were critically ill. This has left an increasing number of unregistered infections in the society, obscured quantification and impacted lived lives. This case story reports a possible mild SARS-CoV-2 infection in a healthy young man in his twenties. Due to strategic guidelines, he was never tested for SARS-CoV-2, but the medical record was highly suspicious for infection. Besides the well-known symptoms of SARS-CoV-2, this case also reports total anosmia and ageusia.


Asunto(s)
Ageusia , Infecciones por Coronavirus/complicaciones , Trastornos del Olfato , Neumonía Viral/complicaciones , Ageusia/virología , Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Dinamarca , Humanos , Masculino , Trastornos del Olfato/virología , Pandemias , Neumonía Viral/diagnóstico , Adulto Joven
9.
Euro Surveill ; 25(14)2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32290902

RESUMEN

The World Health Organization has declared COVID-19 caused by the newly discovered SARS-CoV-2 a pandemic. Due to growing demand for reagents and/or kits to extract SARS-CoV-2 RNA for subsequent RT-qPCR diagnostics, there is a worldwide risk of shortages. With a detection sensitivity of 97.4% (95% CI: 86.2-99.9%), we describe a simple, fast, alternative workflow for molecular detection of SARS-CoV-2, where samples are simply heat-processed for 5 min at 98 °C before a commonly-used RT-qPCR procedure.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Coronavirus/genética , Coronavirus/aislamiento & purificación , Orofaringe/virología , Neumonía Viral/diagnóstico , ARN Viral/análisis , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Betacoronavirus , Dinamarca , Humanos , Pandemias , ARN Viral/genética , ARN Viral/aislamiento & purificación , Sensibilidad y Especificidad , Síndrome Respiratorio Agudo Grave/diagnóstico , Flujo de Trabajo
10.
Hum Genet ; 139(5): 593-604, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32152699

RESUMEN

Gastrointestinal infections can be life threatening, but not much is known about the host's genetic contribution to susceptibility to gastrointestinal infections or the latter's association with psychiatric disorders. We utilized iPSYCH, a genotyped population-based sample of individuals born between 1981 and 2005 comprising 65,534 unrelated Danish individuals (45,889 diagnosed with mental disorders and 19,645 controls from a random population sample) in which all individuals were linked utilizing nationwide population-based registers to estimate the genetic contribution to susceptibility to gastrointestinal infections, identify genetic variants associated with gastrointestinal infections, and examine the link between gastrointestinal infections and psychiatric and neurodevelopmental disorders. The SNP heritability of susceptibility to gastrointestinal infections ranged from 3.7% to 6.4% on the liability scale. Significant correlations were found between gastrointestinal infections and the combined group of mental disorders (OR = 2.09; 95% CI: 1.82-2.4, P = 1.87 × 10-25). Correlations with autism spectrum disorder, attention deficit hyperactivity disorder, and depression were also significant. We identified a genome-wide significant locus associated with susceptibility to gastrointestinal infections (OR = 1.13; 95% CI: 1.08-1.18, P = 2.9 × 10-8), where the top SNP was an eQTL for the ABO gene. The risk allele was associated with reduced ABO expression, providing, for the first time, genetic evidence to support previous studies linking the O blood group to gastrointestinal infections. This study also highlights the importance of integrative work in genetics, psychiatry, infection, and epidemiology on the road to translational medicine.


Asunto(s)
Enfermedades Gastrointestinales/epidemiología , Marcadores Genéticos , Predisposición Genética a la Enfermedad , Trastornos Mentales/fisiopatología , Trastornos del Neurodesarrollo/fisiopatología , Estudios de Casos y Controles , Estudios de Cohortes , Dinamarca/epidemiología , Femenino , Enfermedades Gastrointestinales/genética , Enfermedades Gastrointestinales/microbiología , Estudio de Asociación del Genoma Completo , Genotipo , Humanos , Incidencia , Masculino , Polimorfismo de Nucleótido Simple , Sitios de Carácter Cuantitativo
11.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 18-23, Jan.-Mar. 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1090550

RESUMEN

Abstract Introduction Cholesteatomas are benign tumors consisting of skin, and growing inside a retraction pocket in the tympanic membrane. Cholesteatomas can occupy the entirety of the middle ear, and are known for their osteolytic capabilities. Surgery is the only curative treatment for cholesteatomas. Objective To describe the risk of recurrence after first-time surgically-treated middle- ear cholesteatoma (STMEC1) on the island of Funen from 1983 to 2015. Methods Cases of STMEC1 were identified in the Danish National Hospital Register. The medical records were reviewed. Time-to-event analyses were applied. The ears were followed from STMEC1 to a secondary cholesteatoma, emigration, death, or end of follow-up. Results Records from 1,006 patients with STMEC1 were reviewed. A total of 54 patients were submitted to surgery on both ears. The total sample consisted of 1,060 ears with STMEC1; 300 were children's (< 16 years) ears, and 760 were adult's ears. The total observation time was of 12,049 years. The overall estimated proportion with recurrence 5 years after surgery was of 37% in children and of 15% in adults. The older the child was at the first surgery, the risk decreased by 7% per year. In children, canal wall up (CWU) mastoidectomy without obliteration was associated with a hazard ratio for recurrence of 1.9 (95% confidence interval [95%CI]: 1.2-3.0) compared with CWU with obliteration. Conclusion Compared with adults, children were had 2.6 times more risk of recurrence. Procedures performed without mastoidectomy had the lowest risk of recurrence. In children, obliteration was associated with a significantly lower risk of recurrence. However, patients were not randomized regarding the surgical approach; thus, the association between approach and risk of recurrence was likely influenced by confounding factors.


Asunto(s)
Humanos , Niño , Adolescente , Adulto , Neoplasias del Oído/cirugía , Colesteatoma del Oído Medio/cirugía , Recurrencia Local de Neoplasia/epidemiología , Factores de Tiempo , Modelos de Riesgos Proporcionales , Análisis de Supervivencia , Registros Médicos , Análisis Multivariante , Estudios Retrospectivos , Segunda Cirugía , Dinamarca , Mastoidectomía/métodos
12.
J Environ Manage ; 264: 110408, 2020 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-32217310

RESUMEN

More than two thirds of large rivers worldwide are fragmented, threatening freshwater biodiversity, river integrity, and the services that freshwater ecosystems provide for human populations around the globe. In an effort to alleviate the impacts of barriers, engineered solutions have been developed, though with somewhat underwhelming results. River restoration, especially dam removal, is viewed as the optimal option though seldom the go-to approach. In this study, we evaluated the effects of a large restoration project (pseudo dam removal) in River Kolding, Southern Jutland, Denmark, via a before-after-control-impact (BACI) approach. Using a large dataset of electrofishing data from 74 sites (including downstream unaffected sites, reconnected sites and upstream regulated sites), we found that habitat connectivity was restored successfully, with a large increase in young-of-the-year brown trout (Salmo trutta) at reconnected sites, reaching similar densities to downstream (non-affected) sites. We further observed a decrease in length at reconnected sites, suggesting that natural spawning and rearing habitats were successfully restored too.


Asunto(s)
Ecosistema , Ríos , Animales , Dinamarca , Humanos , Trucha
14.
BMC Health Serv Res ; 20(1): 83, 2020 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-32013962

RESUMEN

BACKGROUND: In Denmark, reporting of tuberculosis (TB) treatment outcome is voluntary and data incomplete. In the European Centre for Disease Prevention and Control most recent report presenting data from 2017, only 53.9% of Danish pulmonary TB cases had a reported outcome. Monitoring of TB treatment outcome is not feasible based on such limited results. In this retrospective study from 2009 to 2014, we present complete treatment outcome data and describe characteristics of cases lost to follow up. METHODS: All cases notified from 2009 through 2014 were reviewed. Hospital records were examined, and TB treatment outcome was categorized according to the World Health Organization's (WHO) definitions. RESULTS: A total of 2131 TB cases were included. Treatment outcome was reported to the Surveillance Unit in 1803 (84.6%) cases, of which 468 (26.0%) were reclassified. For pulmonary TB, 339 (28.9%) cases were reclassified between cured and treatment completed. Overall, the proportion of cases who achieved successful treatment outcome increased from 1488 (70.4%) to 1748 (81.8%). CONCLUSION: A high number of cases were reclassified during the review process. Increased focus on correct treatment outcome reporting is necessary in Denmark. A more comprehensive and exhaustive categorization of TB treatment outcome could be beneficial, especially for cases where collection of sputum or tissue towards the end of treatment is challenging.


Asunto(s)
Tuberculosis/terapia , Dinamarca , Humanos , Perdida de Seguimiento , Estudios Retrospectivos , Resultado del Tratamiento , Tuberculosis Pulmonar/terapia
15.
Am J Psychiatry ; 177(4): 335-341, 2020 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-32046532

RESUMEN

OBJECTIVE: Previous studies have suggested that infections increase the risk of schizophrenia. In this study, the authors aimed to investigate 1) whether infections increase the risk of substance-induced psychosis, and 2) whether infections increase the risk of converting from substance-induced psychosis to schizophrenia. METHODS: The study data were drawn from the combined nationwide Danish registers and included all people born in Denmark since 1981. The authors used Cox proportional hazards regression with infections as time-varying covariates, estimating hazard ratios and 95% confidence intervals. Infections were operationalized both as any infection and by the site of infection. RESULTS: The study included 2,256,779 individuals, for whom 3,618 cases of incident substance-induced psychosis were recorded. Any infection increased the risk of substance-induced psychosis (hazard ratio=1.30, 95% CI=1.22-1.39). For the first 2 years, the risk was doubled. Hepatitis was the infection most strongly associated with substance-induced psychosis (hazard ratio=3.42, 95% CI=2.47-4.74). Different types of infections were linked with different types of substance-induced psychosis. Most associations remained significant after controlling for potential confounders, such as substance use disorders. Only hepatitis predicted conversion to schizophrenia after substance-induced psychosis (hazard ratio=1.87, 95% CI=1.07- 3.26). CONCLUSIONS: The study results support the hypothesis of an immunological component to psychosis.


Asunto(s)
Infecciones/epidemiología , Psicosis Inducidas por Sustancias/epidemiología , Esquizofrenia/epidemiología , Adolescente , Adulto , Infecciones del Sistema Nervioso Central/epidemiología , Dinamarca/epidemiología , Progresión de la Enfermedad , Femenino , Gastroenteritis/epidemiología , Hepatitis/epidemiología , Humanos , Incidencia , Masculino , Pronóstico , Modelos de Riesgos Proporcionales , Infecciones del Sistema Genital/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Factores de Riesgo , Sepsis/epidemiología , Enfermedades Cutáneas Infecciosas/epidemiología , Infecciones Urinarias/epidemiología , Adulto Joven
16.
Am J Psychiatry ; 177(4): 318-326, 2020 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-32098486

RESUMEN

OBJECTIVE: Psychotic experiences affect more than 10% of children and often co-occur with nonpsychotic mental disorders. However, longitudinal studies of the outcome of psychotic experiences based on unbiased information on mental health service use and psychotropic medications are scarce. The authors investigated whether psychotic experiences at ages 11-12 predicted a psychiatric diagnosis or treatment with psychotropic medications by ages 16-17. METHODS: In a longitudinal register-based follow-up study of the Copenhagen Child Cohort 2000, a total of 1,632 children ages 11-12 were assessed for psychotic experiences in face-to-face interviews. The children were also assessed for mental disorders and IQ. National registries provided information on perinatal and sociodemographic characteristics, on psychiatric disorders diagnosed at child and adolescent mental health services, and on prescribed psychotropic medications through ages 16-17. RESULTS: Among children who had not been previously diagnosed, and after adjustment for sociodemographic and perinatal adversities and IQ, psychotic experiences at ages 11-12 predicted receiving a psychiatric diagnosis in child and adolescent mental health services before ages 16-17 (adjusted hazard ratio=3.13, 95% CI=1.93, 5.07). The risk was increased if the child met criteria for a co-occurring mental disorder (not diagnosed in mental health settings) at baseline compared with no psychotic experiences or diagnosis at baseline (adjusted hazard ratio=7.85, 95% CI=3.94, 15.63), but having psychotic experiences alone still marked a significantly increased risk of later psychiatric diagnoses (adjusted hazard ratio=2.76, 95% CI=1.48, 5.13). Similar patterns were found for treatment with psychotropic medications. CONCLUSIONS: Psychotic experiences in childhood predict mental health service use and use of psychotropic medications during adolescence. The study findings provide strong evidence that psychotic experiences in preadolescence index a transdiagnostic vulnerability for diagnosed psychopathology in adolescence.


Asunto(s)
Deluciones/epidemiología , Alucinaciones/epidemiología , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/epidemiología , Servicios de Salud Mental/estadística & datos numéricos , Psicotrópicos/uso terapéutico , Adolescente , Niño , Dinamarca/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Modelos de Riesgos Proporcionales , Escalas de Wechsler
17.
PLoS One ; 15(2): e0228425, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32027676

RESUMEN

BACKGROUND: Hospital performance, presented as the comparison of average measurements, dismisses that hospital outcomes may vary across types of patients. We aim at drawing out the relevance of accounting for patient heterogeneity when reporting on hospital performance. METHODS: An observational study on administrative data from virtually all 2009 hospital admissions for Acute Myocardial Infarction (AMI) discharged in Denmark, Portugal, Slovenia, Spain, and Sweden. Hospital performance was proxied using in-hospital risk-adjusted mortality. Multilevel Regression Modelling (MLRM) was used to assess differences in hospital performance, comparing the estimates of random intercept modelling (capturing hospital general contextual effects (GCE)), and random slope modelling (capturing hospital contextual effects for patients with and without congestive heart failure -CHF). The weighted Kappa Index (KI) was used to assess the agreement between performance estimates. RESULTS: We analysed 46,875 admissions of AMI, 6,314 with coexistent CHF, discharged from 107 hospitals. The overall in-hospital mortality rate was 5.2%, ranging from 4% in Sweden to 6.9% in Portugal. The MLRM with random slope outperformed the model with only random intercept, highlighting a much higher GCE in CHF patients [VPC = 8.34 (CI95% 4.94 to 13.03) and MOR = 1.69 (CI95% 1.62 to 2.21) vs. VPC = 3.9 (CI95% 2.4 to 5.9), MOR of 1.42 (CI95% 1.31 to 1.54) without CHF]. No agreement was observed between estimates [KI = -0,02 (CI95% -0,08 to 0.04]. CONCLUSIONS: The different GCE in AMI patients with and without CHF, along with the lack of agreement in estimates, suggests that accounting for patient heterogeneity is required to adequately characterize and report on hospital performance.


Asunto(s)
Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Infarto del Miocardio/mortalidad , Alta del Paciente/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Demografía , Dinamarca/epidemiología , Europa (Continente)/epidemiología , Femenino , Hospitales Generales/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Portugal/epidemiología , Proyectos de Investigación/estadística & datos numéricos , Eslovenia/epidemiología , España/epidemiología , Suecia/epidemiología , Resultado del Tratamiento
18.
Sci Total Environ ; 710: 134597, 2020 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-32050364

RESUMEN

Although organic cropping systems are promoted for their environmental benefits, little is known about their long-term impact on nitrogen (N) fate in the soil-plant-atmosphere system. In this paper, we analyze two long-term experiments: DOK in Switzerland (39-yr) and Foulum organic in Denmark (19-yr). Four treatments were considered in each experiment: two conventional treatments with (CONFYM) or without manure (CONMIN), organic with manure (BIOORG) and unfertilized treatment (NOFERT) at DOK; conventional (CGL-CC+IF) and three organic treatments, one with cover crops only (OGL+CC-M) and two including cover crops and grass-clover with (OGC+CC+M) or without manure (OGC+CC-M), at Foulum. STICS model was used to simulate crop production, N surplus, nitrate leaching, gaseous N losses and changes in soil organic N. It was calibrated in the conventional treatments and tested in organic systems. The crop production, N surplus and soil organic N stocks were satisfactorily predicted. The mean N surplus greatly differed between treatments at DOK, from -58 (NOFERT) to +21 kg N ha-1 yr-1 (CONFYM), but only from -9 (OGL+CC-M) to +21 kg N ha-1 yr-1 (OGC+CC+M) in Foulum. Soil N pools declined continuously in both sites and treatments at a rate varying from -18 to -78 kg N ha-1 yr-1, depending on fertilization and crop rotation. The decline was consistent with the observed N surpluses. Although not all simulations could be tested against field observations and despite of prediction uncertainties, simulations confirm the hypothesis that environmental performances resulting from C and N cycles depend more on specificities of individual than nominal treatments. Significant correlations appeared between long-term N surplus and soil N storage and between total N fertilization and total N gaseous losses. Results showed in both experiments that arable organic systems do not systematically have lower N surplus and N losses than conventional ones, providing opportunity for increasing N use efficiency of these systems.


Asunto(s)
Agricultura , Dinamarca , Fertilizantes , Nitrógeno , Suelo , Suiza
19.
PLoS One ; 15(2): e0228635, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32012190

RESUMEN

BACKGROUND: The association between vitamin D and incidence of colorectal cancer has been thoroughly investigated, but the results are conflicting. The objectives in this study were to investigate whether two functional polymorphisms in GC and CYP2R1, respectively, previously shown to predict vitamin D concentrations, were associated with risk of colorectal cancer; and further, to assess gene-environment interaction between the polymorphisms and intake of vitamin D through diet and supplementation in relation to risk of colorectal cancer. METHODS: A nested case-cohort study of 920 colorectal cancer cases and 1743 randomly selected participants from the Danish prospective "Diet, Cancer and Health" study was performed. Genotypes CYP2R1/rs10741657 and GC/rs4588 were determined by PCR-based KASP™ genotyping assay. Vitamin D intake from supplements and diet was assessed from a validated food frequency questionnaire. Incidence rate ratios were estimated by the Cox proportional hazards model, and interactions between polymorphisms in GC and CYP2R1 and vitamin D intake in relation to risk of colorectal cancer were assessed. RESULTS: Neither of the two polymorphisms was associated with risk of colorectal cancer per se. Heterozygote carriage of CYP2R1/rs10741657 and GC/rs4588, and carriage of two risk alleles (estimated by a genetic risk score) were weakly associated with 9-12% decreased risk of colorectal cancer per 3 µg intake of vitamin D per day (IRRCYP2R1/rs10741657 = 0.88, 95% CI: 0.79-0.97; IRRGC/rs4588 = 0.91, 95% CI: 0.82-1.01, IRRGRS2 = 0.90, 95% CI: 0.81-0.99). CONCLUSIONS: The results suggest that genetic variation in vitamin D metabolising genes may influence the association between vitamin D intake, through food and supplementation, and risk of colorectal cancer. CLINICAL TRIAL REGISTRY: NCT03370432. Registered 12 December 2017 (retrospectively registered).


Asunto(s)
Colestanotriol 26-Monooxigenasa/genética , Neoplasias Colorrectales/genética , Familia 2 del Citocromo P450/genética , Polimorfismo de Nucleótido Simple , Proteína de Unión a Vitamina D/genética , Vitamina D/sangre , Neoplasias Colorrectales/sangre , Dinamarca , Suplementos Dietéticos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vitamina D/administración & dosificación
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