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1.
Int J Public Health ; 66: 1604076, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34483809

RESUMEN

Objectives: Benefits of school attendance have been debated against SARS-CoV-2 contagion risks. This study examined the trends of contagion before and after schools reopened across 26 countries in the European Union. Methods: We compared the average values of estimated R t before and after school reopening, identifying any significant increase with a one-sample t-test. A meta-analysis and meta-regression analysis were performed to calculate the overall increase in R t for countries in the EU and to search for relationships between R t before schools reopened and the average increase in R t afterward. Results: The mean reproduction number increased in 16 out of 26 countries. The maximum increase in R t was reached after a mean 28 days. We found a negative relationship between the R t before school reopening and its increasing after that event. By 45 days after the first day of school reopening, the overall average increase in R t for the European Union was 23%. Conclusion: We observed a significant increase in the mean reproduction number in most European countries, a public health issue that needs strategies to contain the spread of COVID-19.


Asunto(s)
COVID-19 , Instituciones Académicas , COVID-19/epidemiología , COVID-19/transmisión , Europa (Continente)/epidemiología , Humanos , Instituciones Académicas/organización & administración
3.
Artículo en Inglés | MEDLINE | ID: mdl-34501767

RESUMEN

BACKGROUND: The disruption in healthcare provision due to the COVID-19 pandemic forced many non-urgent medical treatments and appointments to be postponed or denied, which is expected to have huge impact on non-acute health conditions, especially in vulnerable populations such as older people. Attention should be paid to equity issues related to unmet needs during the pandemic. METHODS: We calculated concentration indices to identify income-related inequalities and horizontal inequity in unmet needs due to postponed and denied healthcare in people over 50 during COVID-19, using data from the Survey on Health, Ageing and Retirement in Europe (SHARE). RESULTS: Very few countries show significant income-related inequalities in postponed, rescheduled or denied treatments and medical appointments, usually favouring the rich. Only Estonia, Italy and Romania show a significant horizontal inequity (HI) in postponed healthcare, which apparently favours the poor. Significant pro-rich inequity in denied healthcare is found in Italy, Poland and Greece. CONCLUSIONS: Although important income-related horizontal inequity in unmet needs of European older adults during the early waves of the COVID-19 pandemic is not evident for most countries, some of them have to carefully monitor barriers to healthcare access. Delays in diagnosis and treatments may ultimately translate into adverse health outcomes, reduced quality of life and, even, widen socio-economic health inequalities among older people.


Asunto(s)
COVID-19 , Anciano , Europa (Continente)/epidemiología , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Humanos , Pandemias , Calidad de Vida , SARS-CoV-2 , Factores Socioeconómicos
4.
Pharmaceut Med ; 35(4): 203-213, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34453703

RESUMEN

The Emergency Use Authorization (EUA) originated in 2004 because of the need for emergency medical countermeasures (MCMs) against potential bioterrorist attacks. The EUA also proved useful in dealing with subsequent pandemics and has emerged as a critical regulatory pathway for therapeutics and vaccines throughout the Coronavirus Disease 2019 (COVID-19) pandemic. With the EUA process in the USA, we witnessed emergency authorizations, their expansions, as well as withdrawal of previously authorized products, which exemplifies the dynamic nature of scientific review of EUA products. EUAs proved vital for the first group of COVID-19 vaccines, including the temporary pause of one vaccine while emergency safety issues were evaluated. Although this review on the EUA is primarily focused on the USA, distinctions were made with other jurisdictions such as Europe and Canada with respect to the emergency authorizations of the vaccines. Finally, we discuss some important differences following EUA and formal new drug/vaccine application (NDA/BLA) approvals.


Asunto(s)
Antivirales/normas , Vacunas contra la COVID-19/normas , COVID-19/prevención & control , Aprobación de Drogas/legislación & jurisprudencia , Urgencias Médicas/historia , Antivirales/administración & dosificación , Antivirales/efectos adversos , Bioterrorismo/historia , Bioterrorismo/prevención & control , COVID-19/tratamiento farmacológico , COVID-19/epidemiología , Vacunas contra la COVID-19/administración & dosificación , Vacunas contra la COVID-19/efectos adversos , Canadá/epidemiología , Defensa Civil/historia , Aprobación de Drogas/historia , Urgencias Médicas/epidemiología , Europa (Continente)/epidemiología , Historia del Siglo XXI , Humanos , Pandemias/prevención & control , Estados Unidos/epidemiología
5.
Epidemiol Mikrobiol Imunol ; 70(2): 131-138, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34412489

RESUMEN

Non-O1/non-O139 vibrios refer to all vibrios except toxin producing Vibrio cholerae serogroups O1 and O139. The prevalence of illness caused by non-O1/non-O139 vibrios steadily increases all over the world in the last 20 years, which is very probably related to global warming. These infections are reported year-round from tropical and subtropical climate zones, but they were also detected in the mild climate zone of the United States of America and Europe. In mild climate, they have markedly seasonal occurrence, typically peaking in May to October. A human can be infected after ingestion of contaminated food, especially seafood and fish, or water or while bathing. In Europe, non-O1/non-O139 vibrios were detected in the Baltic Sea, North Sea and Mediterranean Sea but also in ponds and rivers. Depending on the pathogen entry route, the clinical manifestation may appear as gastroenteritis, otitis, wound infection or severe up to fatal illness, predominantly in immunocompromised patients. There is no specific prevention. Non-specific prevention includes good personal and food handling hygiene practices and avoiding contact of unhealed wounds with sea or surface swimming water. Given the severity and increasing frequency of infections caused by non-O1/non-O139 vibrios, they should be considered in differential diagnosis of gastrointestinal and wound infections, especially in patients with a history of consumption of fish and seafood or with a history of contact of unhealed wounds with sea or other open swimming water.


Asunto(s)
Vibriosis/epidemiología , Vibrio , Europa (Continente)/epidemiología , Calentamiento Global , Humanos , Estados Unidos/epidemiología , Vibrio/clasificación , Vibrio/crecimiento & desarrollo , Vibriosis/prevención & control
6.
PLoS One ; 16(8): e0253843, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34407073

RESUMEN

BACKGROUND: Knowing the true infected and symptomatic case fatality ratios (IFR and CFR) for COVID-19 is of high importance for epidemiological model projections. Early in the pandemic many locations had limited testing and reporting, so that standard methods for determining IFR and CFR required large adjustments for missed cases. We present an alternate approach, based on results from the countries at the time that had a high test to positive case ratio to estimate symptomatic CFR. METHODS: We calculated age specific (0-69, 70-79, 80+ years old) time corrected crude symptomatic CFR values from 7 countries using two independent time to fatality correction methods. Data was obtained through May 7, 2020. We applied linear regression to determine whether the mean of these coefficients had converged to the true symptomatic CFR values. We then tested these coefficients against values derived in later studies as well as a large random serological study in NYC at that time. RESULTS: The age dependent symptomatic CFR values accurately predicted the percentage of the population infected as reported by two random testing studies in NYC. They also were in good agreement with later studies that estimated age specific IFR and CFR values from serological studies and more extensive data sets available later in the pandemic. CONCLUSIONS: We found that for regions with extensive testing it is possible to get early accurate symptomatic CFR coefficients. These values, in combination with an estimate of the age dependence of infection, allows symptomatic CFR values and percentage of the population that is infected to be determined in similar regions with limited testing.


Asunto(s)
COVID-19/epidemiología , Brotes de Enfermedades/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , COVID-19/mortalidad , Causas de Muerte , Niño , Preescolar , Europa (Continente)/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Israel/epidemiología , Modelos Lineales , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Mortalidad , Nueva Zelanda/epidemiología , República de Corea/epidemiología , Adulto Joven
7.
BMJ Glob Health ; 6(8)2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34373260

RESUMEN

The objectives of the study were to calculate the standardised mortality rates (SMRs) for COVID-19 in European Union/European Economic Area countries plus the UK and Switzerland and to evaluate the correlation between SMRs and selected indicators in the first versus the subsequent waves until 23 June 2021. We used indirect standardisation (using Italy as the reference) to compute SMRs and considered 16 indicators of health and social well-being, health system capacity and COVID-19 response. The highest SMRs were in Belgium, the UK and Spain in the first wave (1.20-1.84) and in Hungary, Czechia and Slovakia in the subsequent waves (2.50-2.69). Human Development Index (HDI), life expectancy, urbanisation and healthcare expenditure had positive correlations with SMR in the first wave (rho=0.30-0.46), but negative correlations (rho=-0.67 to -0.47) in the subsequent waves. Retail/recreation mobility and transit mobility were negatively correlated with SMR in the first wave, while transit mobility was inversely correlated with SMR in the subsequent waves. The first wave hit most hard countries with high HDI, high life expectancy, high urbanisation, high health expenditures and high tourism. This pattern may reflect higher early community seeding and circulation of the virus. Conversely, in the subsequent waves, this pattern was completely inversed: countries with more resources and better health status did better than eastern European countries. While major SMR differences existed across countries in the first wave, these differences largely dissipated by 23 June 2021, with few exceptions.


Asunto(s)
COVID-19 , Atención a la Salud , Europa (Continente)/epidemiología , Humanos , Italia , SARS-CoV-2
8.
Emerg Infect Dis ; 27(9): 2294-2300, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34423760

RESUMEN

Genomic analysis of a diverse collection of Clostridioides difficile ribotype 078 isolates from Ireland and 9 countries in Europe provided evidence for complex regional and international patterns of dissemination that are not restricted to humans. These isolates are associated with C. difficile colonization and clinical illness in humans and pigs.


Asunto(s)
Clostridioides difficile , Infecciones por Clostridium , Animales , Clostridioides , Clostridioides difficile/genética , Infecciones por Clostridium/epidemiología , Europa (Continente)/epidemiología , Humanos , Ribotipificación , Porcinos
9.
Epidemiol Mikrobiol Imunol ; 70(2): 110-117, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34412487

RESUMEN

AIM: To present the results of whole genome sequencing (WGS) analysis of Streptococcus pneumoniae serotype 19A and to compare them with the respective data from Europe. The vaccine serotype 19A is widely distributed in the Czech Republic. MATERIAL AND METHODS: WGS was used in this study as the most powerful available method for detailed characterization of S. pneumoniae. Nineteen Czech isolates of S. pneumoniae 19A were analysed and compared with 415 European isolates included in the PubMLST database. RESULTS: S. pneumoniae serotype 19A causes all types of pathogen - host interaction, from carriage to noninvasive and invasive pneumococcal disease (IPD). In 2010 - 2019, 3872 cases of IPD were reported within the surveillance programme in the Czech Republic, with 323 of these caused by serotype 19A. WGS data of the Czech serotype 19A isolates show a numerous and genetically related subpopulation of three sequencing types: ST-199, ST-416, and ST-3017. Within this subpopulation, the largest is the cluster of nine ST-199 isolates. High relatedness of ST-199 isolates is also confirmed by the fact that all but one isolate, 117/2019 (novel rST- -137805), share the same ribosome sequencing profile - rST-11365. Outside the above-mentioned subpopulation, there are only four isolates that form three separate genetic lines of serotype 19A. A highly similar situation is observed across European countries, where about half of all serotype 19A isolates form a genetically closely related subpopulation (ST-199, ST-416, ST-450, ST-667, ST-3017, and ST-10360) while isolates which are not part of this subpopulation represent a large number of unrelated genetic lines. CONCLUSIONS: The study has shown a mostly homogeneous population of S. pneumoniae serotype 19A to circulate in the post-vaccination era in both the Czech Republic and Europe, with some unrelated isolates located outside this population.


Asunto(s)
Streptococcus pneumoniae , República Checa/epidemiología , Europa (Continente)/epidemiología , Humanos , Serogrupo , Serotipificación , Streptococcus pneumoniae/genética , Vacunas Conjugadas , Secuenciación Completa del Genoma
11.
Pediatr Rheumatol Online J ; 19(1): 136, 2021 Aug 25.
Artículo en Inglés | MEDLINE | ID: mdl-34433477

RESUMEN

BACKGROUND: The importance of developmentally appropriate transitional care in young people with juvenile-onset rheumatic and musculoskeletal disease is well recognised. The Paediatric Rheumatology European Society (PReS) / European League Against Rheumatism (EULAR) Taskforce has developed international recommendations and standards for transitional care and a growing evidence base supports the positive benefits of such care. However, there is also evidence that universal implementation has yet to be realised. In 2020, against this background the COVID-19 pandemic arrived with significant impact on all our lives, young and old, patient, public and professional alike. The unfortunate reality of the pandemic with potential for unfavourable outcomes on healthcare provision during transition was acknowledged by the PReS working groups in a position statement to support healthcare professionals, young people and their caregivers. AIM: The aim of this review is to present the literature which provides the rationale for the recommendations in the PReS Position Statement. The following areas are specifically addressed: the prime importance of care coordination; the impact of the pandemic on the various aspects of the transition process; the importance of ensuring continuity of medication supply; the pros and cons of telemedicine with young people; ensuring meaningful involvement of young people in service development and the importance of core adolescent health practices such as routine developmental assessment psychosocial screening and appropriate parental involvement during transitional care.


Asunto(s)
COVID-19 , Enfermedades Reumáticas , Reumatología , Transición a la Atención de Adultos , Adolescente , COVID-19/epidemiología , COVID-19/prevención & control , Europa (Continente)/epidemiología , Humanos , Innovación Organizacional , Enfermedades Reumáticas/epidemiología , Enfermedades Reumáticas/terapia , Reumatología/normas , Reumatología/tendencias , SARS-CoV-2 , Nivel de Atención , Transición a la Atención de Adultos/organización & administración , Transición a la Atención de Adultos/normas , Transición a la Atención de Adultos/tendencias
12.
Eur J Endocrinol ; 185(4): 525-538, 2021 Aug 27.
Artículo en Inglés | MEDLINE | ID: mdl-34342594

RESUMEN

Objective: To report the final long-term safety and efficacy analyses of patients with acromegaly treated with pegvisomant from the ACROSTUDY. Design: Global (15 countries), multicentre, non-interventional study (2004-2017). Methods: The complete ACROSTUDY cohort comprised patients with acromegaly, who were being treated with pegvisomant (PEGV) prior to the study or at enrolment. The main endpoints were long-term safety (comorbidities, adverse events (AEs), pituitary tumour volumes, liver tests) and efficacy (IGF1 changes). Results: Patients (n = 2221) were treated with PEGV for a median of 9.3 years (range, 0-20.8 years) and followed up for a median of 7.4 years (range, 0-13.9 years). Before PEGV, 96.3% had received other acromegaly treatments (surgery/radiotherapy/medications). Before PEGV treatment, 87.2% of patients reported comorbidities. During ACROSTUDY, 5567 AEs were reported in 56.5% of patients and of these 613 were considered treatment-related (in 16.5% of patients) and led to drug withdrawal in 1.3%. Pituitary imaging showed a tumour size increase in 7.1% of patients; the majority (71.1%) reported no changes. Abnormal AST or ALT liver tests occurred in 3.2% of patients. IGF1 normalization rate improved over time, increasing from 11.4% at PEGV start to 53.7% at year 1, and reaching 75.4% at year 10 with the use of ≥30 mg PEGV/day in an increasing proportion of patients. Conclusion: This comprehensive review of the complete cohort in ACROSTUDY confirmed the overall favourable benefit-to-risk profile and high efficacy of PEGV as mono- and combination therapy in patients with an aggressive course/uncontrolled/active acromegaly requiring long-term medical therapy for control.


Asunto(s)
Acromegalia/tratamiento farmacológico , Hormona de Crecimiento Humana/análogos & derivados , Acromegalia/epidemiología , Adenoma/tratamiento farmacológico , Adenoma/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Europa (Continente)/epidemiología , Femenino , Estudios de Seguimiento , Adenoma Hipofisario Secretor de Hormona del Crecimiento/tratamiento farmacológico , Adenoma Hipofisario Secretor de Hormona del Crecimiento/epidemiología , Historia del Siglo XXI , Hormona de Crecimiento Humana/uso terapéutico , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Estados Unidos/epidemiología , Adulto Joven
13.
Euro Surveill ; 26(33)2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34414881

RESUMEN

BackgroundThe assumption that migrants acquire human immunodeficiency virus (HIV) before migration, particularly those from high prevalence areas, is common.AimWe assessed the place of HIV acquisition of migrants diagnosed in four European countries using surveillance data.MethodsUsing CD4+ T-cell count trajectories modelled to account for seroconversion bias, we estimated infection year of newly HIV-diagnosed migrants residing in the United Kingdom (UK), Belgium, Sweden and Italy with a known arrival year and CD4+ T-cell count at diagnosis. Multivariate analyses identified predictors for post-migration acquisition.ResultsBetween 2007 and 2016, migrants constituted 56% of people newly diagnosed with HIV in the UK, 62% in Belgium, 72% in Sweden and 29% in Italy. Of 23,595 migrants included, 60% were born in Africa and 70% acquired HIV heterosexually. An estimated 9,400 migrants (40%; interquartile range (IQR): 34-59) probably acquired HIV post-migration. This proportion was similar by risk group, sex and region of birth. Time since migration was a strong predictor of post-migration HIV acquisition: 91% (IQR: 87-95) among those arriving 10 or more years prior to diagnosis; 30% (IQR: 21-37) among those 1-5 years prior. Younger age at arrival was a predictor: 15-18 years (81%; IQR: 74-86), 19-25 years (53%; IQR: 45-63), 26-35 years (37%; IQR: 30-46) and 36 years and older (25%; IQR: 21-33).ConclusionsMigrants, regardless of origin, sex and exposure to HIV are at risk of acquiring HIV post-migration to Europe. Alongside accessible HIV testing, prevention activities must target migrant communities.


Asunto(s)
Infecciones por VIH , Migrantes , Recuento de Linfocito CD4 , Europa (Continente)/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Humanos , Factores de Riesgo
14.
Proc Natl Acad Sci U S A ; 118(36)2021 09 07.
Artículo en Inglés | MEDLINE | ID: mdl-34462356

RESUMEN

Drawing on past pandemics, scholars have suggested that the COVID-19 pandemic will bring about fertility decline. Evidence from actual birth data has so far been scarce. This brief report uses data on vital statistics from a selection of high-income countries, including the United States. The pandemic has been accompanied by a significant drop in crude birth rates beyond that predicted by past trends in 7 out of the 22 countries considered, with particularly strong declines in southern Europe: Italy (-9.1%), Spain (-8.4%), and Portugal (-6.6%). Substantial heterogeneities are, however, observed.


Asunto(s)
Tasa de Natalidad , Pandemias/estadística & datos numéricos , COVID-19/epidemiología , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Pandemias/economía , Crecimiento Demográfico , Embarazo , Estados Unidos/epidemiología
15.
Sci Rep ; 11(1): 16443, 2021 08 12.
Artículo en Inglés | MEDLINE | ID: mdl-34385482

RESUMEN

Comparison of COVID-19 trends in space and over time is essential to monitor the pandemic and to indirectly evaluate non-pharmacological policies aimed at reducing the burden of disease. Given the specific age- and sex- distribution of COVID-19 mortality, the underlying sex- and age-distribution of populations need to be accounted for. The aim of this paper is to present a method for monitoring trends of COVID-19 using adjusted mortality trend ratios (AMTRs). Age- and sex-mortality distribution of a reference European population (N = 14,086) was used to calculate age- and sex-specific mortality rates. These were applied to each country to calculate the expected deaths. Adjusted Mortality Trend Ratios (AMTRs) with 95% confidence intervals (C.I.) were calculated for selected European countries on a daily basis from 17th March 2020 to 29th April 2021 by dividing observed cumulative mortality, by expected mortality, times the crude mortality of the reference population. These estimated the sex- and age-adjusted mortality for COVID-19 per million population in each country. United Kingdom experienced the highest number of COVID-19 related death in Europe. Crude mortality rates were highest Hungary, Czech Republic, and Luxembourg. Accounting for the age-and sex-distribution of the underlying populations with AMTRs for each European country, four different patterns were identified: countries which experienced a two-wave pandemic, countries with almost undetectable first wave, but with either a fast or a slow increase of mortality during the second wave; countries with consistently low rates throughout the period. AMTRs were highest in Eastern European countries (Hungary, Czech Republic, Slovakia, and Poland). Our methods allow a fair comparison of mortality in space and over time. These might be of use to indirectly estimating the efficacy of non-pharmacological health policies. The authors urge the World Health Organisation, given the absence of age and sex-specific mortality data for direct standardisation, to adopt this method to estimate the comparative mortality from COVID-19 pandemic worldwide.


Asunto(s)
COVID-19/epidemiología , COVID-19/mortalidad , Distribución por Edad , Factores de Edad , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Mortalidad/tendencias , Pandemias , SARS-CoV-2/aislamiento & purificación , Distribución por Sexo , Factores Sexuales , Análisis Espacio-Temporal
16.
Artículo en Inglés | MEDLINE | ID: mdl-34360310

RESUMEN

Background: The COVID-19 pandemic is having major adverse consequences for the mental health of individuals worldwide. Alongside the direct impact of the virus on individuals, government responses to tackling its spread, such as quarantine, lockdown, and physical distancing measures, have been found to have a profound impact on mental health. This is manifested in an increased prevalence of anxiety, depression, and sleep disturbances. As older adults are more vulnerable and severely affected by the pandemic, they may be at increased psychological risk when seeking to protect themselves from COVID-19. Methods: Our study aims to quantify the association between the stringency of measures and increased feelings of sadness/depression in a sample of 31,819 Europeans and Israelis aged 65 and above. We hypothesize that more stringent measures make it more likely that individuals will report increased feelings of sadness or depression. Conclusions: We found that more stringent measures across countries in Europe and Israel affect the mental health of older individuals. The prevalence of increased feelings of sadness/depression was higher in Southern European countries, where the measures were more stringent. We therefore recommend paying particular attention to the possible effects of pandemic control measures on the mental health of older people.


Asunto(s)
COVID-19 , Pandemias , Anciano , Ansiedad , Control de Enfermedades Transmisibles , Depresión/epidemiología , Europa (Continente)/epidemiología , Gobierno , Humanos , Israel/epidemiología , Cuarentena , SARS-CoV-2
17.
Int J Public Health ; 66: 1604010, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34335145

RESUMEN

Objectives: After childcare and schools have been closed in March 2020 to prevent the spread of COVID-19, they were open again in most European countries after the summer holidays till early autumn. Aim of this study is to give an overview and to compare COVID-19 childcare and school containment policies in 19 European countries. Methods: We collected data on containment measures among delegates of the European Academy of Pediatrics (EAP), through an online, closed questionnaire in the second half of October 2020. Results: Most policy has been formulated for secondary education. In all three settings policy was most often formulated for individual hygiene, cleaning of surfaces, exclusion of sick children, ventilation, distance between children and between children and teachers. In secondary schools, policy is formulated on face masks in and outside the class. School closure, cancellation of physical education and class size reduction are measures for which the fewest countries have formulated national policies. Conclusion: We recommend to accompany the opening of children's facilities and schools by surveillance studies that further clarify questions about control measures implemented to halt COVID-19 pandemic.


Asunto(s)
COVID-19 , Guarderías Infantiles , Pandemias , Políticas , Instituciones Académicas , COVID-19/epidemiología , COVID-19/prevención & control , Niño , Europa (Continente)/epidemiología , Humanos , Pandemias/prevención & control
18.
BMJ ; 374: n1804, 2021 08 18.
Artículo en Inglés | MEDLINE | ID: mdl-34407988

RESUMEN

OBJECTIVES: To examine the association between cognitively stimulating work and subsequent risk of dementia and to identify protein pathways for this association. DESIGN: Multicohort study with three sets of analyses. SETTING: United Kingdom, Europe, and the United States. PARTICIPANTS: Three associations were examined: cognitive stimulation and dementia risk in 107 896 participants from seven population based prospective cohort studies from the IPD-Work consortium (individual participant data meta-analysis in working populations); cognitive stimulation and proteins in a random sample of 2261 participants from one cohort study; and proteins and dementia risk in 13 656 participants from two cohort studies. MAIN OUTCOME MEASURES: Cognitive stimulation was measured at baseline using standard questionnaire instruments on active versus passive jobs and at baseline and over time using a job exposure matrix indicator. 4953 proteins in plasma samples were scanned. Follow-up of incident dementia varied between 13.7 to 30.1 years depending on the cohort. People with dementia were identified through linked electronic health records and repeated clinical examinations. RESULTS: During 1.8 million person years at risk, 1143 people with dementia were recorded. The risk of dementia was found to be lower for participants with high compared with low cognitive stimulation at work (crude incidence of dementia per 10 000 person years 4.8 in the high stimulation group and 7.3 in the low stimulation group, age and sex adjusted hazard ratio 0.77, 95% confidence interval 0.65 to 0.92, heterogeneity in cohort specific estimates I2=0%, P=0.99). This association was robust to additional adjustment for education, risk factors for dementia in adulthood (smoking, heavy alcohol consumption, physical inactivity, job strain, obesity, hypertension, and prevalent diabetes at baseline), and cardiometabolic diseases (diabetes, coronary heart disease, stroke) before dementia diagnosis (fully adjusted hazard ratio 0.82, 95% confidence interval 0.68 to 0.98). The risk of dementia was also observed during the first 10 years of follow-up (hazard ratio 0.60, 95% confidence interval 0.37 to 0.95) and from year 10 onwards (0.79, 0.66 to 0.95) and replicated using a repeated job exposure matrix indicator of cognitive stimulation (hazard ratio per 1 standard deviation increase 0.77, 95% confidence interval 0.69 to 0.86). In analysis controlling for multiple testing, higher cognitive stimulation at work was associated with lower levels of proteins that inhibit central nervous system axonogenesis and synaptogenesis: slit homologue 2 (SLIT2, fully adjusted ß -0.34, P<0.001), carbohydrate sulfotransferase 12 (CHSTC, fully adjusted ß -0.33, P<0.001), and peptidyl-glycine α-amidating monooxygenase (AMD, fully adjusted ß -0.32, P<0.001). These proteins were associated with increased dementia risk, with the fully adjusted hazard ratio per 1 SD being 1.16 (95% confidence interval 1.05 to 1.28) for SLIT2, 1.13 (1.00 to 1.27) for CHSTC, and 1.04 (0.97 to 1.13) for AMD. CONCLUSIONS: The risk of dementia in old age was found to be lower in people with cognitively stimulating jobs than in those with non-stimulating jobs. The findings that cognitive stimulation is associated with lower levels of plasma proteins that potentially inhibit axonogenesis and synaptogenesis and increase the risk of dementia might provide clues to underlying biological mechanisms.


Asunto(s)
Demencia/epidemiología , Enfermedades Profesionales/epidemiología , Ocupaciones/estadística & datos numéricos , Lugar de Trabajo/psicología , Anciano , Anciano de 80 o más Años , Proteínas Sanguíneas/análisis , Demencia/sangre , Europa (Continente)/epidemiología , Femenino , Humanos , Incidencia , Masculino , Pruebas Neuropsicológicas , Enfermedades Profesionales/sangre , Enfermedades Profesionales/psicología , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Conducta Sedentaria , Reino Unido/epidemiología , Estados Unidos/epidemiología
19.
Int J Prison Health ; ahead-of-print(ahead-of-print)2021 08 21.
Artículo en Inglés | MEDLINE | ID: mdl-34410050

RESUMEN

PURPOSE: This paper aims to describe the impact of the COVID-19 containment measures on the provision of drug treatment and harm reduction services in European prisons in15 countries during the early phase of the pandemic (March -June 2020). DESIGN/METHODOLOGY/APPROACH: The paper is based on a mixed method research approach that triangulates different data sources, including the results of an on-line survey, the outcome of a focus group and four national case studies. FINDINGS: The emergence of COVID-19 led to a disruption in prison drug markets and resulted in a number of challenges for the drug services provision inside prison. Challenges for health services included the need to maintain the provision of drug-related interventions inside prison, while introducing a range of COVID-19 containment measures. To reduce contacts between people, many countries introduced measures for early release, resulted in around a 10% reduction of the prison population in Europe. Concerns were expressed around reduction of drug-related interventions, including group activities, services by external agencies, interventions in preparation for release and continuity of care. PRACTICAL IMPLICATIONS: Innovations aimed at improving drug service provision included telemedicine, better partnership between security and health staff and an approach to drug treatment more individualised. Future developments must be closely monitored. ORIGINALITY/VALUE: The paper provides a unique and timely overview of the main issues, challenges and initial adaptations implemented for drug services in European prisons in response to the COVID-19 pandemic.


Asunto(s)
COVID-19/prevención & control , Control de Enfermedades Transmisibles/métodos , Accesibilidad a los Servicios de Salud , Prisioneros , Prisiones , Trastornos Relacionados con Sustancias/terapia , Continuidad de la Atención al Paciente , Europa (Continente)/epidemiología , Reducción del Daño , Humanos , SARS-CoV-2
20.
Sleep Med Clin ; 16(3): 533-543, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34325829

RESUMEN

Sleep disturbance and sleepiness are established risk factors for driving accidents and obstructive sleep apnea (OSA) is the most prevalent medical disorder associated with excessive daytime sleepiness. Because effective treatment of OSA reduces accident risk, several jurisdictions have implemented regulations concerning the ability of patients with OSA to drive, unless effectively treated. This review provides a practical guide for clinicians who may be requested to certify a patient with OSA as fit to drive regarding the scope of the problem, the role of questionnaires and driving simulators to evaluate sleepiness, and the benefit of treatment on accident risk.


Asunto(s)
Conducción de Automóvil , Somnolencia , Accidentes de Tránsito/prevención & control , Conducción de Automóvil/legislación & jurisprudencia , Conducción de Automóvil/psicología , Trastornos de Somnolencia Excesiva/epidemiología , Europa (Continente)/epidemiología , Humanos , Factores de Riesgo , Apnea Obstructiva del Sueño/epidemiología , Apnea Obstructiva del Sueño/terapia
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