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1.
JMIR Mhealth Uhealth ; 9(4): e23989, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33792551

RESUMEN

BACKGROUND: Smoking rates are significantly higher among young people experiencing homelessness than in the general population. Despite a willingness to quit, homeless youth have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. Homeless youth generally enjoy the camaraderie and peer support that group-based programs offer, but continuous in-person support during a quit attempt can be prohibitively expensive. OBJECTIVE: This study aimed to assess the feasibility and acceptability of an automated text messaging intervention (TMI) as an adjunct to group-based cessation counseling and provision of nicotine patches to help homeless youth quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention. METHODS: Homeless youth smokers aged 18 to 25 years who were interested in quitting (n=77) were recruited from drop-in centers serving homeless youth in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches, with 52% (40/77) randomly assigned to receive 6 weeks of text messages to provide additional support for their quit attempt. Participants received text messages on their own phone rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow-up survey data as well as back-end data from the messaging platform to gauge the acceptability and feasibility of the TMI among the 40 participants who received it. RESULTS: Participants had widespread (smart)phone ownership-16.4% (36/219) were ineligible for study participation because they did not have a phone that could receive text messages. Participants experienced interruptions in their phone use (eg, 44% [16/36] changed phone numbers during the follow-up period) but reported being able to receive the majority of messages. These survey results were corroborated by back-end data (from the program used to administer the TMI) showing a message delivery rate of about 95%. Participant feedback points to the importance of carefully crafting text messages, which led to high (typically above 70%) approval of most text messaging components of the intervention. Qualitative feedback indicated that participants enjoyed the group counseling session that preceded the TMI and suggested including more such group elements into the intervention. CONCLUSIONS: The TMI was well accepted and feasible to support smoking cessation among homeless youth. Given high rates of smartphone ownership, the next generation of phone-based smoking cessation interventions for this population should consider using approaches beyond text messages and focus on finding ways to develop effective approaches to include group interaction using remote implementation. Given overall resource constraints and in particular the exigencies of the currently ongoing COVID-19 epidemic, phone-based interventions are a promising approach to support homeless youth, a population urgently in need of effective smoking cessation interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT03874585; https://clinicaltrials.gov/ct2/show/NCT03874585. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13722-020-00187-6.


Asunto(s)
Personas sin Hogar/psicología , Fumadores/psicología , Cese del Hábito de Fumar/métodos , Fumar/efectos adversos , Envío de Mensajes de Texto , Adolescente , Adulto , Femenino , Personas sin Hogar/estadística & datos numéricos , Humanos , Los Angeles/epidemiología , Masculino , Evaluación de Resultado en la Atención de Salud , Evaluación de Programas y Proyectos de Salud , Fumar/epidemiología , Apoyo Social , Adulto Joven
2.
Sci Rep ; 11(1): 6481, 2021 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-33742072

RESUMEN

The novel Coronavirus-2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020, impacting the lifestyles, economy, physical and mental health of individuals globally. This study aimed to test the model triggered by physical symptoms resembling COVID-19 infection, in which the need for health information and perceived impact of the pandemic mediated the path sequentially, leading to adverse mental health outcomes. A cross-sectional research design with chain mediation model involving 4612 participants from participating 8 countries selected via a respondent-driven sampling strategy was used. Participants completed online questionnaires on physical symptoms, the need for health information, the Impact of Event Scale-Revised (IES-R) questionnaire and Depression, Anxiety and Stress Scale (DASS-21). The results showed that Poland and the Philippines were the two countries with the highest levels of anxiety, depression and stress; conversely, Vietnam had the lowest mean scores in these areas. Chain mediation model showed the need for health information, and the perceived impact of the pandemic were sequential mediators between physical symptoms resembling COVID-19 infection (predictor) and consequent mental health status (outcome). Excessive and contradictory health information might increase the perceived impact of the pandemic. Rapid COVID-19 testing should be implemented to minimize the psychological burden associated with physical symptoms, whilst public mental health interventions could target adverse mental outcomes associated with the pandemic.


Asunto(s)
Ansiedad/diagnóstico , Depresión/diagnóstico , Estrés Psicológico/diagnóstico , Ansiedad/psicología , Asia/epidemiología , Estudios Transversales , Depresión/psicología , Europa (Continente)/epidemiología , Humanos , Salud Mental , Evaluación de Resultado en la Atención de Salud , Estrés Psicológico/psicología , Encuestas y Cuestionarios , Estados Unidos/epidemiología
3.
Medicine (Baltimore) ; 100(12): e25268, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761729

RESUMEN

INTRODUCTION: In patients with malignant distal bile duct obstruction and normal gastrointestinal anatomy, endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is indicated when endoscopic retrograde cholangiopancreatography (ERCP) fails. The ERCP drainage route passes through the tumor, whereas the EUS-CDS route does not. Therefore, EUS-CDS is expected to have a longer stent patency than ERCP. However, for first-line biliary drainage, it remains unclear whether EUS-CDS or ERCP is superior in terms of stent patency. To reduce the frequency of highly adverse events (AEs) such as bile peritonitis or stent migration following EUS-CDS, we developed an antimigration metal stent with a thin delivery system for tract dilatation. This study is designed to assess whether EUS-CDS with this novel stent is superior to ERCP with a traditional metal stent in terms of stent patency when the two techniques are used for first-line drainage of malignant distal biliary obstruction. METHODS/DESIGN: This study is a multicenter single-blinded randomized controlled trial (RCT) involving 95 patients in four tertiary centers. Patients with malignant distal biliary obstruction that is unresectable or presents a very high surgical risk and who pass the inclusion and exclusion criteria will be randomized to EUS-CDS or ERCP in a 1:1 proportion. The primary endpoint is the stent patency rate 180 days after stent insertion. Secondary outcomes include the rates of technical success, clinical success, technical success in cases not requiring fistulous-tract dilation (only EUS-CDS group), procedure-related AEs, re-intervention success, patients receiving post-drainage chemotherapy, procedure time, and overall survival time. DISCUSSION: If EUS-CDS is superior to ERCP in terms of stent patency and safety for the first-line drainage of malignant distal biliary obstruction, it is expected that the first-line drainage method will be changed from ERCP to EUS-CDS, and that interruption of chemotherapy due to stent dysfunction can be avoided. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), ID: UMIN000041343. Registered on August 6, 2020. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047201Version number: 1.2, December 7, 2020.


Asunto(s)
Neoplasias de los Conductos Biliares , Colangiopancreatografia Retrógrada Endoscópica , Coledocostomía , Colestasis , Endosonografía/métodos , Peritonitis , Complicaciones Posoperatorias , Stents , Neoplasias de los Conductos Biliares/complicaciones , Neoplasias de los Conductos Biliares/patología , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/instrumentación , Colangiopancreatografia Retrógrada Endoscópica/métodos , Coledocostomía/efectos adversos , Coledocostomía/instrumentación , Coledocostomía/métodos , Colestasis/diagnóstico por imagen , Colestasis/etiología , Colestasis/cirugía , Drenaje/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Peritonitis/etiología , Peritonitis/prevención & control , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Diseño de Prótesis , Falla de Prótesis , Cirugía Asistida por Computador/métodos
4.
Medicine (Baltimore) ; 100(12): e25274, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761730

RESUMEN

ABSTRACT: To investigate the influencing factors of fracture nonunion after intramedullary nailing for subtrochanteric fractures and to construct a risk assessment model.Based on the multicenter retrospective analysis of 251 patients, all patients were divided into modeling group and verification group. In the modeling group, postoperative fracture nonunion rate, general data, fracture-related factors, surgical reduction-related factors, mechanical and biological factors were calculated, and the influencing factors of fracture nonunion were screened by univariate analysis. Logistic regression model was used for multifactor analysis to construct the risk assessment model. Based on the logistic regression model, the risk prediction model was constructed by drawing the Nomogram diagram. Through the verification group, the influencing factors were evaluated again, and the differentiation and calibration of the model were evaluated. The calibration degree was evaluated by Hosmer-Lemeshow test, goodness of fit test, and calibration curve. The discriminant degree was evaluated by the receiver operating characteristic curve.Fracture nonunion occurred in 34 of 149 patients in the modeling group. Among the 14 potential influencing factors, univariate analysis and logistic regression analysis showed that postoperative hip varus, intramedullary nail fixation failure, and reduction of fracture with large incision were the risk factors of fracture nonunion. The medial cortex fracture was seen reduced on X-Ray was a protective factor for fracture nonunion, and a regression equation was established. Based on the logistic regression model, the Nomogram diagram is drawn. Twenty-four cases of fracture nonunion occurred in the verification group. The area under the receiver operating characteristic curve was area under curve =0.883 > 0.7, indicating that there was a moderate differentiation to evaluate the occurrence of fracture nonunion after operation. The goodness of fit test: the Hosmers-Lemeshow test (X2 = 2.921, P = .712 > .05) showed that the model had a good calibration.After intramedullary nailing of subtrochanteric fracture, hip varus, failure of intramedullary nail fixation and wide surgical dissection are the risk factors of fracture nonunion, and the postoperative reduction of medial cortex fracture is protective factor.National key research and development projects: 2016YFC0105806.


Asunto(s)
Coxa Vara , Fijación Intramedular de Fracturas , Fracturas no Consolidadas , Fracturas de Cadera/cirugía , Complicaciones Posoperatorias , Medición de Riesgo , Anciano , Clavos Ortopédicos , Coxa Vara/diagnóstico , Coxa Vara/epidemiología , Femenino , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/métodos , Fracturas no Consolidadas/diagnóstico , Fracturas no Consolidadas/epidemiología , Fracturas no Consolidadas/etiología , Fracturas de Cadera/diagnóstico , Humanos , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/epidemiología , Masculino , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Radiografía/métodos , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Insuficiencia del Tratamiento
5.
Medicine (Baltimore) ; 100(12): e25280, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761732

RESUMEN

ABSTRACT: Obesity is an inflammatory state related to vascular endothelium dysfunction. It generates a biological situation of hypercoagulability increasing the risk of thrombosis. This prothrombotic condition could be improved by bariatric surgery.The main objective was to analyze the impact of bariatric surgery on cardiovascular risk factors (CVRF) associated with changes in thrombin generation and procoagulant activity of microparticles (MP).We present a prospective longitudinal study including consecutive patients candidate for bariatric surgery. We performed 3 sequential clinical visits: at inclusion, before surgery after completing the modified fasting phase, and 6 months after surgery. We analyzed CVRF, thrombin generation, and MP activity. The data analysis was performed using a logistic regression model to determine changes over time of hemostatic parameters and body mass index (BMI). McNemar test for binary variables was used to analyze the CVRF.We included 94 patients (66 women), with an average age of 45.7 ±â€Š10.1 years. The mean BMI reduction at the end of the follow-up was 15.5 ±â€Š4.2 kg/m2. We detected a statistically significant improvement in CVRF: hypertension, diabetes mellitus, dyslipidemia, and obstructive sleep apnea, as well as a significant reduction in thrombin generation capacity and procoagulant MP activity.Massive weight loss induced by bariatric surgery improves the cardiovascular profile, associated with a reduction in the hypercoagulable status.


Asunto(s)
Cirugía Bariátrica , Enfermedades Cardiovasculares , Obesidad Mórbida , Trombina/metabolismo , Trombofilia , Cirugía Bariátrica/métodos , Cirugía Bariátrica/estadística & datos numéricos , Índice de Masa Corporal , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Estudios de Casos y Controles , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Obesidad Mórbida/sangre , Obesidad Mórbida/diagnóstico , Obesidad Mórbida/epidemiología , Obesidad Mórbida/cirugía , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos , España/epidemiología , Trombofilia/complicaciones , Trombofilia/diagnóstico , Trombofilia/prevención & control , Pérdida de Peso/fisiología
6.
N Z Med J ; 134(1531): 67-76, 2021 03 26.
Artículo en Inglés | MEDLINE | ID: mdl-33767478

RESUMEN

AIMS: To assess how well the NZ COVID Tracer QR (Quick Response) code poster is displayed by Dunedin businesses and other venues in which groups of people gather indoors, and to calculate the proportions of visitors to those venues who scan the QR code poster. METHODS: We randomly selected 10 cafes, 10 restaurants, 10 bars, five churches, and five supermarkets and visited them at their busiest times. We evaluated the display of QR code posters using a six-item assessment tool that was based on guidance provided to businesses and services by the Ministry of Health, and we counted the number of people who entered each venue during a one-hour period and the number who scanned the QR code poster. RESULTS: All six criteria for displaying QR code posters were met at half of the hospitality venues, four of five churches, and all supermarkets. Scanning proportions were low at all venues (median 10.2%), and at 12 (30%) no visitors scanned; eight of these venues were bars. CONCLUSION: This audit provides a snapshot of the display and scanning of QR code posters in a city with no managed isolation and quarantine facilities and where no COVID-19 cases have been detected for 10 months.


Asunto(s)
Trazado de Contacto , Presentación de Datos , Instalaciones Privadas y Públicas no Médicas , Carteles como Asunto , Adulto , /prevención & control , Trazado de Contacto/métodos , Trazado de Contacto/estadística & datos numéricos , Presentación de Datos/normas , Presentación de Datos/estadística & datos numéricos , Femenino , Humanos , Masculino , Auditoría Administrativa , Mercadotecnía/normas , Nueva Zelanda/epidemiología , Instalaciones Privadas y Públicas no Médicas/organización & administración , Instalaciones Privadas y Públicas no Médicas/normas , Instalaciones Privadas y Públicas no Médicas/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Salud Pública/métodos
9.
Value Health ; 24(3): 413-420, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33641776

RESUMEN

OBJECTIVES: People with neurogenic bladder and/or bowel dysfunction experience diverse challenges that can be difficult to evaluate with standardized outcome measures. Goal attainment scaling (GAS) is an individualized, patient-centric outcome measure that enables patients/caregivers to identify and track their own treatment goals. Because creating goals de novo can be cumbersome, we aimed to develop a neurogenic bladder/bowel dysfunction goal menu to facilitate goal attainment scaling uptake and use. METHODS: We conducted a workshop with 6 expert clinicians to develop an initial menu. Individual interviews with 12 people living with neurogenic bladder and/or bowel dysfunction and 2 clinician panels with 5 additional experts aided us in refining the menu. A thematic framework analysis identified emergent themes for analysis and reporting. RESULTS: Interview participants were adults (median = 36 years, range 25-58), most with spinal cord injury (75%; 9/12). Of 24 goals identified initially, 2 (8%) were not endorsed and were removed, and 3 goals were added. Most participants listed "Impact on Life" goals (eg, Exercise, Emotional Well-Being) among their 5 most important goals (58%; 35/60). Three main themes emerged: challenges posed by incontinence, limitations on everyday life, and need for personalized care. CONCLUSIONS: We developed a clinical outcome assessment tool following a multistep process of representative stakeholder engagement. This patient-centric tool consists of 25 goals specific to people living with neurogenic bladder and/or bowel dysfunction. Asking people what matters most to them can identify important constructs that clinicians might have overlooked.


Asunto(s)
Estreñimiento/psicología , Diarrea/psicología , Evaluación de Resultado en la Atención de Salud/métodos , Planificación de Atención al Paciente , Vejiga Urinaria Neurogénica/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/normas , Encuestas y Cuestionarios/normas
10.
Ann R Coll Surg Engl ; 103(4): 272-277, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33682473

RESUMEN

INTRODUCTION: Aesthetic rhinoplasty remains a challenging procedure with high expectations and narrow tolerance for errors. Considerable training is required to achieve controlled and reliable results. Use of the Piezotome is gaining popularity for performing the nasal osteotomies, a key step in rhinoplasty, where it is reported to improve precision and predictability and to keep tissue damage to a minimum. We compare the outcomes of conventional osteotomy techniques to piezosurgery in human cadavers as undertaken by surgical trainees. MATERIALS AND METHODS: Seven human cadavers were used and a total of 14 osteotomies were performed. Conventional osteotomies and piezosurgery were carried out each on one side of the cadaver. A number of fragments and a blinded assessment of the accuracy of the osteotomy compared with the preprocedure skin markings were carried out by two experienced rhinoplasty surgeons. The Mann-Whitney test for statistical analysis was used. RESULTS: The mean number of fragments was 1.57 in the piezosurgery osteotomy and 2.14 using conventional osteotomies. Four of seven piezosurgery osteotomies achieved an accuracy within 1mm. The conventional osteotomies as performed by the trainees showed a significant mismatch of more than 3mm in three of seven of cases. Accuracy within 1mm was achieved in one of seven cases. DISCUSSION: Piezosurgery offers a safe, reliable and precise method of performing lateral nasal osteotomies. This human cadaver study shows a high accuracy of osteotomy and fewer comminuted fractures using this technique compared with conventional osteotomy techniques.


Asunto(s)
Hueso Nasal/cirugía , Osteotomía/métodos , Piezocirugía/métodos , Rinoplastia/métodos , Humanos , Osteotomía/efectos adversos , Osteotomía/instrumentación , Evaluación de Resultado en la Atención de Salud , Piezocirugía/efectos adversos , Piezocirugía/instrumentación , Rinoplastia/efectos adversos , Rinoplastia/instrumentación
11.
JCO Glob Oncol ; 7: 342-352, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33656910

RESUMEN

PURPOSE: Delays and disruptions in health systems because of the COVID-19 pandemic were identified by a previous systematic review from our group. For improving the knowledge about the pandemic consequences for cancer care, this article aims to identify the effects of mitigation strategies developed to reduce the impact of such delays and disruptions. METHODS: Systematic review with a comprehensive search including formal databases, cancer and COVID-19 data sources, gray literature, and manual search. We considered clinical trials, observational longitudinal studies, cross-sectional studies, before-and-after studies, case series, and case studies. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the included studies was assessed by specific tools. The mitigation strategies identified were described in detail and their effects were summarized narratively. RESULTS: Of 6,692 references reviewed, 28 were deemed eligible, and 9 studies with low to moderate methodological quality were included. Five multiple strategies and four single strategies were reported, and the possible effects of mitigating delays and disruptions in cancer care because of COVID-19 are inconsistent. The only comparative study reported a 48.7% reduction observed in the number of outpatient visits to the hospital accompanied by a small reduction in imaging and an improvement in radiation treatments after the implementation of a multiple organizational strategy. CONCLUSION: The findings emphasize the infrequency of measuring and reporting mitigation strategies that specifically address patients' outcomes and thus a scarcity of high-quality evidence to inform program development. This review reinforces the need of adopting standardized measurement methods to monitor the impact of the mitigation strategies proposed to reduce the effects of delays and disruptions in cancer health care because of COVID-19.


Asunto(s)
/epidemiología , Instituciones Oncológicas , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Oncología Médica/tendencias , Neoplasias/terapia , Estudios Transversales , Toma de Decisiones , Humanos , Oncología Médica/organización & administración , Modelos Organizacionales , Evaluación de Resultado en la Atención de Salud , Pandemias , Tiempo de Tratamiento
12.
CMAJ Open ; 9(1): E295-E301, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33785477

RESUMEN

BACKGROUND: The quality of case reports, which are often the first reported evidence for a disease, may be negatively affected by a rush to publication early in a pandemic. We aimed to determine the completeness of reporting (COR) for case reports published on coronavirus disease 2019 (COVID-19). METHODS: We conducted a systematic search of the PubMed database for all single-patient case reports of confirmed COVID-19 published from Jan. 1 to Apr. 24, 2020. All included case reports were assessed for adherence to the CARE (Case Report) 31-item checklist, which was used to create a composite COR score. The primary outcome was the mean COR score assessed by 2 independent raters. Secondary outcomes included whether there was a change in overall COR score with certain publication factors (e.g., publication date) and whether there was a linear relation between COR and citation count and between COR scores and social media attention. RESULTS: Our search identified 196 studies that were published in 114 unique journals. We found that the overall mean COR score was 54.4%. No one case report included all of the 31 CARE checklist items. There was no significant correlation between COR with either citation count or social media attention. INTERPRETATION: We found that the overall COR for case reports on COVID-19 was poor. We suggest that journals adopt common case-reporting standards to improve reporting quality.


Asunto(s)
/epidemiología , Lista de Verificación/normas , Edición/normas , Informe de Investigación/normas , Bibliografía de Medicina , Bibliometría , /virología , Manejo de Datos , Estudios Epidemiológicos , Ética , Adhesión a Directriz , Humanos , Evaluación de Resultado en la Atención de Salud , Informe de Investigación/tendencias , /aislamiento & purificación , Medios de Comunicación Sociales/estadística & datos numéricos
13.
PLoS One ; 16(3): e0248742, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33784332

RESUMEN

BACKGROUND: In dealing with community spread of COVID-19, two active interventions have been attempted or advocated-containment, and mitigation. Given the extensive impact of COVID-19 globally, there is international interest to learn from best practices that have been shown to work in controlling community spread to inform future outbreaks. This study explores the trajectory of COVID-19 infection in Singapore had the government intervention not focused on containment, but rather on mitigation. In addition, we estimate the actual COVID-19 infection cases in Singapore, given that confirmed cases are publicly available. METHODS AND FINDINGS: We developed a COVID-19 infection model, which is a modified SIR model that differentiate between detected (diagnosed) and undetected (undiagnosed) individuals and segments total population into seven health states: susceptible (S), infected asymptomatic undiagnosed (A), infected asymptomatic diagnosed (I), infected symptomatic undiagnosed (U), infected symptomatic diagnosed (E), recovered (R), and dead (D). To account for the infection stages of the asymptomatic and symptomatic infected individuals, the asymptomatic infected individuals were further disaggregated into three infection stages: (a) latent (b) infectious and (c) non-infectious; while the symptomatic infected were disaggregated into two stages: (a) infectious and (b) non-infectious. The simulation result shows that by the end of the current epidemic cycle without considering the possibility of a second wave, under the containment intervention implemented in Singapore, the confirmed number of Singaporeans infected with COVID-19 (diagnosed asymptomatic and symptomatic cases) is projected to be 52,053 (with 95% confidence range of 49,370-54,735) representing 0.87% (0.83%-0.92%) of the total population; while the actual number of Singaporeans infected with COVID-19 (diagnosed and undiagnosed asymptomatic and symptomatic infected cases) is projected to be 86,041 (81,097-90,986), which is 1.65 times the confirmed cases and represents 1.45% (1.36%-1.53%) of the total population. A peak in infected cases is projected to have occurred on around day 125 (27/05/2020) for the confirmed infected cases and around day 115 (17/05/2020) for the actual infected cases. The number of deaths is estimated to be 37 (34-39) among those infected with COVID-19 by the end of the epidemic cycle; consequently, the perceived case fatality rate is projected to be 0.07%, while the actual case fatality rate is estimated to be 0.043%. Importantly, our simulation model results suggest that there about 65% more COVID-19 infection cases in Singapore that have not been captured in the official reported numbers which could be uncovered via a serological study. Compared to the containment intervention, a mitigation intervention would have resulted in early peak infection, and increase both the cumulative confirmed and actual infection cases and deaths. CONCLUSION: Early public health measures in the context of targeted, aggressive containment including swift and effective contact tracing and quarantine, was likely responsible for suppressing the number of COVID-19 infections in Singapore.


Asunto(s)
/epidemiología , Evaluación de Resultado en la Atención de Salud , Salud Pública , /prevención & control , Trazado de Contacto , Humanos , Modelos Estadísticos , Cuarentena , Singapur/epidemiología
14.
BMJ Open ; 11(3): e046044, 2021 03 10.
Artículo en Inglés | MEDLINE | ID: mdl-33692188

RESUMEN

OBJECTIVES: This study describes a new strategy to reduce the impact of COVID-19 on the elderly and other clinically vulnerable subjects, where general practitioners (GPs) play an active role in managing high-risk patients, reducing adverse health outcomes. DESIGN: Retrospective cohort study. SETTING: Population-based study including subjects resident in the province of Milan and Lodi. PARTICIPANTS: 127 735 residents older than 70 years, with specific chronic conditions. INTERVENTIONS: We developed a predictive algorithm for overall mortality risk based on demographic and clinical characteristics. All residents older than 70 years were classified as being at low or high risk of death from COVID-19 infection according to the algorithm. The high-risk group was assigned to their GPs for telephone triage and consultation. The high-risk cohort was divided into two groups based on GP intervention: patients who were not contacted and patients who were contacted by their GPs. OUTCOME MEASURES: Overall mortality, COVID-19 morbidity and hospitalisation. RESULTS: Patients with increased risk of death from COVID-19 were 127 735; 495 669 patients were not at high risk and were not included in the intervention. Out of the high-risk subjects, 79 110 were included but not contacted by their GPs, while 48 625 high-risk subjects were included and contacted. Overall mortality, morbidity and hospitalisation was higher in high-risk patients compared with low-risk populations. High-risk patients contacted by their GPs had a 50% risk reduction in COVID-19 mortality, and a 70% risk reduction in morbidity and hospitalisation for COVID-19 compared with non-contacted patients. CONCLUSIONS: The study showed that, during the COVID-19 outbreak, involvement of GPs and changes in care management of high-risk groups produced a significant reduction in all adverse health outcomes.


Asunto(s)
/mortalidad , Estado de Salud , Evaluación de Resultado en la Atención de Salud , Anciano , Hospitalización , Humanos , Italia/epidemiología , Morbilidad , Mortalidad , Estudios Retrospectivos
16.
Medicine (Baltimore) ; 100(8): e24844, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663106

RESUMEN

ABSTRACT: This study aimed to identify prognostic factors for severe sepsis-related in-hospital mortality using the structural equation model (SEM) analysis with statistical causality. Sepsis data from the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma study (FORECAST), a multicenter cohort study, was used. Forty seven observed variables from the database were used to construct 4 latent variables. SEM analysis was performed on these latent variables to analyze the statistical causality among these data. This study evaluated whether the variables had an effect on in-hospital mortality. Overall, 1148 patients were enrolled. The SEM analysis showed that the 72-hour physical condition was the strongest latent variable affecting mortality, followed by physical condition before treatment. Furthermore, the 72-hour physical condition and the physical condition before treatment strongly influenced the Sequential Organ Failure Assessment (SOFA) score with path coefficients of 0.954 and 0.845, respectively. The SOFA score was the strongest variable that affected mortality after the onset of severe sepsis. The score remains the most robust prognostic factor and can facilitate appropriate policy development on care.


Asunto(s)
Mortalidad Hospitalaria , Unidades de Cuidados Intensivos/estadística & datos numéricos , Sepsis/mortalidad , Adulto , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Humanos , Japón , Análisis de Clases Latentes , Modelos Logísticos , Masculino , Puntuaciones en la Disfunción de Órganos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo
17.
Mayo Clin Proc ; 96(3): 648-657, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33673916

RESUMEN

OBJECTIVE: To describe the clinical history of patients with a wide age range diagnosed with bicuspid aortic valve (BAV) and no surgical indication and to evaluate the long-term outcome of patients with BAV referred for elective surgery. PATIENTS AND METHODS: Between 2005 and 2017, 350 consecutive patients with no surgical indication (surveillance group, mean age 53±16, 71% men) and 191 with a surgical indication (surgical group, mean age 59±13, 71% men) were prospectively included. Median follow-up was 80 (32 to 115) months. RESULTS: In the surveillance group, the 5-year and 10-year survival rates were 93±1% and 89±2%, respectively, with a relative survival of patients with BAV compared with an age- and sex-matched control population of 98.7%. During follow-up, the cumulative 10-year incidence of aortic valve and aorta surgery was high; of 35±4%, the incidence of native valve infective endocarditis (IE) of 0.2% per patient-year, and no cases of aortic dissection were observed. In the surgical group, the 5-year and 10-year survival rates were 97±1% and 89±3%, respectively, with a relative survival of 99.4% compared with the general population. The incidence of IE was 0.4% per patient-year, and no cases of aortic dissection were observed. CONCLUSION: This regional cohort shows that the 10-year survival rates of patients with BAV and a wide age range, but mostly middle-aged adults, were similar to those of the general population with a very low rate of complications. Adherence to prophylactic surgical indications and younger age might have contributed to this lack of difference.


Asunto(s)
/mortalidad , Implantación de Prótesis de Válvulas Cardíacas/estadística & datos numéricos , Adulto , Anciano , Endocarditis/mortalidad , Europa (Continente) , Femenino , Insuficiencia Cardíaca/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos , Estudios Retrospectivos , Tasa de Supervivencia
18.
BMC Infect Dis ; 21(1): 245, 2021 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-33676420

RESUMEN

BACKGROUND: Based on differences in populations and prevention and control measures, the spread of new coronary pneumonia in different countries and regions also differs. This study aimed to calculate the transmissibility of coronavirus disease 2019 (COVID-19), and to evaluate the effectiveness of measures to control the disease in Jilin Province, China. METHODS: The data of reported COVID-19 cases were collected, including imported and local cases from Jilin Province as of March 14, 2019. A Susceptible-Exposed-Infectious-Asymptomatic-Recovered/Removed (SEIAR) model was developed to fit the data, and the effective reproduction number (Reff) was calculated at different stages in the province. Finally, the effectiveness of the measures was assessed. RESULTS: A total of 97 COVID-19 infections were reported in Jilin Province, among which 45 were imported infections (including one asymptomatic infection) and 52 were local infections (including three asymptomatic infections). The model fit the reported data well (R2 = 0.593, P < 0.001). The Reff of COVID-19 before and after February 1, 2020 was 1.64 and 0.05, respectively. Without the intervention taken on February 1, 2020, the predicted cases would have reached a peak of 177,011 on October 22, 2020 (284 days from the first case). The projected number of cases until the end of the outbreak (on October 9, 2021) would have been 17,129,367, with a total attack rate of 63.66%. Based on the comparison between the predicted incidence of the model and the actual incidence, the comprehensive intervention measures implemented in Jilin Province on February 1 reduced the incidence of cases by 99.99%. Therefore, according to the current measures and implementation efforts, Jilin Province can achieve good control of the virus's spread. CONCLUSIONS: COVID-19 has a moderate transmissibility in Jilin Province, China. The interventions implemented in the province had proven effective; increasing social distancing and a rapid response by the prevention and control system will help control the spread of the disease.


Asunto(s)
Número Básico de Reproducción , Control de Enfermedades Transmisibles , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , /epidemiología , /transmisión , China/epidemiología , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Control de Enfermedades Transmisibles/normas , Humanos , Incidencia , /aislamiento & purificación
20.
BMJ ; 372: n450, 2021 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-33658187

RESUMEN

OBJECTIVE: To compare effect estimates of randomised clinical trials that use routinely collected data (RCD-RCT) for outcome ascertainment with traditional trials not using routinely collected data. DESIGN: Meta-research study. DATA SOURCE: Studies included in the same meta-analysis in a Cochrane review. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Randomised clinical trials using any type of routinely collected data for outcome ascertainment, including from registries, electronic health records, and administrative databases, that were included in a meta-analysis of a Cochrane review on any clinical question and any health outcome together with traditional trials not using routinely collected data for outcome measurement. REVIEW METHODS: Effect estimates from trials using or not using routinely collected data were summarised in random effects meta-analyses. Agreement of (summary) treatment effect estimates from trials using routinely collected data and those not using such data was expressed as the ratio of odds ratios. Subgroup analyses explored effects in trials based on different types of routinely collected data. Two investigators independently assessed the quality of each data source. RESULTS: 84 RCD-RCTs and 463 traditional trials on 22 clinical questions were included. Trials using routinely collected data for outcome ascertainment showed 20% less favourable treatment effect estimates than traditional trials (ratio of odds ratios 0.80, 95% confidence interval 0.70 to 0.91, I2=14%). Results were similar across various types of outcomes (mortality outcomes: 0.92, 0.74 to 1.15, I2=12%; non-mortality outcomes: 0.71, 0.60 to 0.84, I2=8%), data sources (electronic health records: 0.81, 0.59 to 1.11, I2=28%; registries: 0.86, 0.75 to 0.99, I2=20%; administrative data: 0.84, 0.72 to 0.99, I2=0%), and data quality (high data quality: 0.82, 0.72 to 0.93, I2=0%). CONCLUSIONS: Randomised clinical trials using routinely collected data for outcome ascertainment show smaller treatment benefits than traditional trials not using routinely collected data. These differences could have implications for healthcare decision making and the application of real world evidence.


Asunto(s)
Evaluación de Resultado en la Atención de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos
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