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1.
Phys Rev Lett ; 124(6): 068301, 2020 Feb 14.
Artículo en Inglés | MEDLINE | ID: mdl-32109112

RESUMEN

Global transport and communication networks enable information, ideas, and infectious diseases to now spread at speeds far beyond what has historically been possible. To effectively monitor, design, or intervene in such epidemic-like processes, there is a need to predict the speed of a particular contagion in a particular network, and to distinguish between nodes that are more likely to become infected sooner or later during an outbreak. Here, we study these quantities using a message-passing approach to derive simple and effective predictions that are validated against epidemic simulations on a variety of real-world networks with good agreement. In addition to individualized predictions for different nodes, we find an overall sudden transition from low density to almost full network saturation as the contagion progresses in time. Our theory is developed and explained in the setting of simple contagions on treelike networks, but we are also able to show how the method extends remarkably well to complex contagions and highly clustered networks.


Asunto(s)
Enfermedades Transmisibles/epidemiología , Modelos Teóricos , Simulación por Computador , Epidemias , Métodos Epidemiológicos , Humanos , Red Social
2.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(2): 228-232, 2020 Feb 06.
Artículo en Chino | MEDLINE | ID: mdl-32074716

RESUMEN

The energy adjustment models in nutritional epidemiological studies could substantially reduce the confounding effect of total energy intake from the intake of dietary components, and it could explore the real relationship between the intake of dietary component and research outcomes. Four energy adjustment models were introduced in this article, including the standard multivariate model, multivariate nutrient residual model, energy partition model, and multivariate nutrient density model. The four energy adjustment models were applied to analyze the association between the intake of saturated fatty acids and the risk of all-cause mortality based on the data of the US National Health and Nutrition Examination Survey. The consistent results of different energy adjustment models could indicate that the four models could better control the confounding effect of total energy intake.


Asunto(s)
Ingestión de Energía , Métodos Epidemiológicos , Modelos Teóricos , Ácidos Grasos/administración & dosificación , Ácidos Grasos/efectos adversos , Humanos , Mortalidad/tendencias , Encuestas Nutricionales , Estados Unidos/epidemiología
3.
Ann R Coll Surg Engl ; 102(1): 62-66, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31891668

RESUMEN

Multifocal multicentric breast cancer has traditionally been considered a contraindication to breast conserving surgery because of concerns regarding locoregional control and risk of disease recurrence. However, the evidence supporting this practice is limited. Increasingly, many breast surgeons are advocating breast conservation in selected cases. This short narrative review summarises current evidence on the role of surgery in multifocal multicentric breast cancer and shows that when technically feasible the option of breast conservation is oncologically safe.


Asunto(s)
Neoplasias de la Mama/secundario , Mastectomía/métodos , Neoplasias de la Mama/mortalidad , Toma de Decisiones Clínicas , Métodos Epidemiológicos , Estudios de Factibilidad , Femenino , Humanos , Mastectomía/mortalidad , Mastectomía Segmentaria/métodos , Mastectomía Segmentaria/mortalidad , Pautas de la Práctica en Medicina , Resultado del Tratamiento
4.
World Neurosurg ; 135: e723-e730, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31899385

RESUMEN

OBJECTIVE: The aim of the present study was to compare the outcomes of patients with chronic subdural hematoma after undergoing burr hole craniotomy with subperiosteal or subgaleal drainage (SPGD) with those of patients who have undergone burr hole craniotomy with subdural drainage. METHODS: We searched 4 databases (PubMed, Web of Science, Embase, and Cochrane Library) for relevant reports from January 1995 to September 2019. Two reviewers recorded the major outcomes data as follows: recurrence, mortality, postoperative seizures, postoperative bleeding events, surgical infection, pneumocephalus, modified Rankin scale scores, and Glasgow outcome scale scores. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: A total of 3149 patients from 10 studies were included in our analysis. Compared with the SSD group, the SPGD group had a lower recurrence rate (OR, 0.72; 95% CI, 0.57-0.91) and a smaller risk of postoperative bleeding (OR, 0.41; 95% CI, 0.22-0.78). Also, no significant differences were found in the incidence of mortality (OR, 0.79; 95% CI, 0.54-1.18), postoperative seizures (OR, 0.74; 95% CI, 0.39-1.40), surgical infection (OR, 0.98; 95% CI, 0.55-1.76), pneumocephalus (OR, 0.58; 95% CI, 0.28-1.20), modified Rankin scale score 0-3 (OR, 1.04 at discharge; OR, 1.33 at 6 months), and Glasgow outcome scale score 4-5 (OR, 1.48; 95% CI, 0.82-2.67). CONCLUSIONS: Burr hole craniotomy with SPGD can be recommended as an effective and safe surgical therapy for patients with chronic subdural hematoma owing to its lower recurrence rate and reduced incidence of postoperative brain injuries, in addition to no increase in the rate of some postoperative complications. However, more studies are necessary for further confirmation.


Asunto(s)
Drenaje/métodos , Hematoma Subdural Crónico/cirugía , Craneotomía/efectos adversos , Craneotomía/métodos , Craneotomía/mortalidad , Drenaje/efectos adversos , Drenaje/mortalidad , Métodos Epidemiológicos , Hematoma Subdural Crónico/mortalidad , Humanos , Recurrencia , Resultado del Tratamiento
5.
World Neurosurg ; 135: e580-e587, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31870819

RESUMEN

OBJECTIVE: Inappropriate opioid use resulted in 68% of all U.S. drug overdoses in 2017-nearly 75% of all opioid deaths-costing $80 billion per year. It is imperative to understand the impact of opioid use on outcome from surgery for lower back pain disorders. METHODS: A retrospective review of lumbar spinal fusion registry data at a single center from 2015-2018 was performed. A novel algorithm was used to extract opioid utilization from the electronic health record. Number of levels fused, fusion type, and minimally invasive surgery status were collected from the registry, as were depression status, European Quality of Life 5 level score, and Oswestry Disability Index at 6 months to 1 year postoperatively. RESULTS: We included 294 patients (mean age 62 years, 48% male). Patients younger than 65 years trended toward more opioid use before surgery and significantly higher opioid use after surgery (P < 0.0001). Depression trended toward increasing opioid use after surgery (P = 0.08). Fusions of 4 or more levels were associated with overall greater opioid use after surgery (P = 0.03). Higher rate of opioid use before and after surgery is associated with worse European Quality of Life 5 level scores after surgery (P = 0.01 and P = 0.04) and worse Oswestry Disability Index scores after surgery (P = 0.006 and P = 0.002). CONCLUSIONS: This registry finds that younger age and lower functional status scores are associated with higher opioid use before surgery. Opioid use before surgery, younger age, and >4 levels of fusion are associated with higher opioid use after surgery. Overall, opioid use is associated with worse functional outcome and may serve as a marker of disease progression.


Asunto(s)
Analgésicos Opioides/efectos adversos , Dolor de la Región Lumbar/cirugía , Vértebras Lumbares/cirugía , Fusión Vertebral/estadística & datos numéricos , Evaluación de la Discapacidad , Personas con Discapacidad/estadística & datos numéricos , Métodos Epidemiológicos , Femenino , Humanos , Prescripción Inadecuada , Dolor de la Región Lumbar/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Opioides/etiología , Dolor Postoperatorio/prevención & control , Cuidados Preoperatorios
6.
World Neurosurg ; 135: e598-e609, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31870823

RESUMEN

BACKGROUND: Dual and single antiplatelet therapies are routinely used in carotid artery endarterectomy (CEA). However, the efficacy and safety of these therapies are controversial. The present study aimed to comprehensively compare the clinical outcomes between dual and single antiplatelet therapies in CEA. METHODS: This study retrieved available academic studies evaluating the complications related to antiplatelet therapy between dual and single antiplatelet therapies in CEA from the databases of ScienceDirect, the Cochrane Library, EMBASE, and PubMed. References to previous reviews and related clinical trials were manually checked to retrieve potential literature that was not included in our electronic search results. RESULTS: A total of 10 articles (1 randomized controlled trial, 9 non-randomized controlled trials) were included in the study. The overall number of patients in the dual antiplatelet group was 14,280, and the number of patients in the single antiplatelet group was 125,850. The results revealed that the single antiplatelet group had a lower incidence of 30-day death (rate difference [RD] 0.002; 95% confidence interval [CI] 0.000-0.003; P = 0.014), neck hematoma (odds ratio [OR] 2.120; 95% CI 1.431-3.142; P < 0.001), myocardial infarction (RD 0.004; 95% CI 0.001-0.007; P = 0.003), and major bleeding (RD 0.005; 95% CI 0.002-0.008; P < 0.001). Meanwhile, the single antiplatelet group was associated with a shorter operation time (weighted mean difference 4.000; 95% CI= 2.564-5.436; P < 0.001). However, there was no significant difference in the rate of postoperative transient ischemic attack (P = 0.215), stroke (P = 0.130), or length of stay (P = 0.563). CONCLUSIONS: Based on current evidence, using single antiplatelet therapy in CEA may reduce operation time and the incidences of 30-day death, neck hematoma, major bleeding, and myocardial infarction without increasing the risks of transient ischemic attack, stroke, or a longer operation time.


Asunto(s)
Endarterectomía Carotidea/efectos adversos , Ataque Isquémico Transitorio/cirugía , Inhibidores de Agregación Plaquetaria/efectos adversos , Accidente Cerebrovascular/cirugía , Anciano , Métodos Epidemiológicos , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Tempo Operativo , Resultado del Tratamiento
7.
Br J Radiol ; 93(1106): 20190781, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-31868522

RESUMEN

OBJECTIVE: Sedation for pediatric patients undergoing interventional procedures in radiology is in increasing demand. Once only anesthesiology-performed, there is a demand for sedation services to perform sedations for these procedures. However, the safety of performing long sedations by non-anesthesiologists in interventional radiology has not been reported. This pilot study aimed at describing a single center's experience and outcome with sedation. METHODS: This study reviews the sedations performed at a single center by a pediatric emergency physician who performed the sedation. The results regarding safety and satisfaction were reviewed. RESULTS: A total of 52 sedations were documented. Four cases of significant adverse events and three adverse events occurred. In all cases, the procedures were completed. None of the patients required intubation or admission following the sedation. There was high satisfaction by the interventional radiologists. CONCLUSION: This small pilot study shows that sedations for procedures in interventional radiology can be performed safely and successfully by dedicated non-anesthesiology sedation services. This may be considered as an alternative when anesthesiology service is not available. ADVANCES IN KNOWLEDGE: This small, single center pilot study examines the safety of sedation by a non-anesthesiologist for interventional radiology procedures. This may offer an additional method of performing procedures in the pediatric population while anesthesia is not readily available.


Asunto(s)
Sedación Consciente/métodos , Medicina de Emergencia/estadística & datos numéricos , Malformaciones Vasculares/cirugía , Adolescente , Anestesiólogos , Niño , Preescolar , Sedación Consciente/efectos adversos , Medicina de Emergencia/normas , Métodos Epidemiológicos , Femenino , Humanos , Lactante , Masculino , Seguridad del Paciente
8.
BJOG ; 127(1): 8-16, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31529594

RESUMEN

BACKGROUND: With expanding recreational cannabis legalisation, pregnant women and their offspring are at risk of potentially harmful consequences. OBJECTIVES: To assess the prevalence of recreational cannabis use among pregnant women, health outcomes associated with prenatal recreational cannabis use, and the potential impact of recreational cannabis legalisation on this population. SEARCH STRATEGY: Five databases and the grey literature were systematically searched (2000-2019). SELECTION CRITERIA: Human studies published in English or French reporting on the prevalence of prenatal recreational cannabis use in high-income countries. DATA COLLECTION AND ANALYSIS: Data on study characteristics, prenatal substance use, and health outcomes were extracted and qualitatively synthesised. MAIN RESULTS: Forty-one publications met our inclusion criteria. The overall prevalence of prenatal cannabis use varied substantially (min-max: 0.24-22.6%), with the greatest use in the first trimester. In the three studies with temporal data available, rates of prenatal cannabis use increased across years. Only 7/41 and 5/41 studies provided information on gestational age of exposure and frequency of use, respectively. The concomitant use of alcohol, illicit drugs, and tobacco was higher among cannabis users than nonusers. Prenatal cannabis use was associated with select neonatal, but not maternal, health outcomes. There were insufficient data to compare prenatal cannabis use between the pre- and post-legalisation periods. CONCLUSION: Cannabis use among pregnant women is prevalent and may be associated with adverse neonatal outcomes. Future studies should assess the gestational age and frequency of cannabis exposure, and usage patterns prior to and following legalisation. TWEETABLE ABSTRACT: Women who consume cannabis during pregnancy could risk predisposing their newborns to poor birth outcomes.


Asunto(s)
Uso de la Marihuana/efectos adversos , Complicaciones del Embarazo/etiología , Países Desarrollados , Métodos Epidemiológicos , Femenino , Edad Gestacional , Humanos , Renta , Recién Nacido de Bajo Peso , Cuidado Intensivo Neonatal/estadística & datos numéricos , Uso de la Marihuana/epidemiología , Uso de la Marihuana/legislación & jurisprudencia , Salud Materna , Embarazo , Complicaciones del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Efectos Tardíos de la Exposición Prenatal/etiología
9.
Eur Radiol ; 30(1): 57-65, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31372782

RESUMEN

PURPOSE: To investigate the diagnostic capability of whole-lesion (WL) histogram and texture analysis of dynamic contrast-enhanced (DCE) MRI inline-generated quantitative parametric maps using CAIPIRINHA-Dixon-TWIST-VIBE (CDTV) to differentiate malignant from benign breast lesions and breast cancer subtypes. MATERIALS AND METHODS: From February 2018 to November 2018, DCE MRI using CDTV was performed on 211 patients. The inline-generated parametric maps included Ktrans, kep, Ve, and IAUGC60. Histogram and texture features were extracted from the above parametric maps respectively based on a WL analysis. Student's t tests, one-way ANOVAs, Mann-Whitney U tests, Jonckheere-Terpstra tests, and ROC curves were used for statistical analysis. RESULTS: Compared with benign breast lesions, malignant breast lesions showed significantly higher Ktrans_median, 5th percentile, entropy, and diff-entropy, IAUGC60_median, 5th percentile, entropy, and diff-entropy, kep_mean, median, 5th percentile, entropy, and diff-entropy, and Ve_95th percentile, diff-variance, and contrast, and significantly lower kep_skewness and Ve_SD, entropy, diff-entropy, and skewness (all p ≤ 0.011). The combination of all the extracted parameters yielded an AUC of 0.85 (sensitivity 76%, specificity 86%). kep_contrast showed a significant difference among different subtypes of breast cancer (p = 0.006). kep_skewness showed a significant difference between lymph node-positive and lymph node-negative breast cancer (p = 0.007). The IAGC60_5th percentile had an AUC of 0.71 (sensitivity 50%, specificity 91%) for differentiating between high- and low-proliferation groups of breast cancer. CONCLUSIONS: The WL histogram and texture analyses of CDTV-DCE-derived parameters may give additional information for further evaluation of breast cancer. KEY POINTS: • Inline DCE mapping with CDTV is effective and time-saving. • WL histogram and texture-extracted features could distinguish breast cancer from benign lesions accurately. • kep_contrast, kep_skewness, and IAUGC60_5th percentile could predict breast cancer subtypes, lymph node metastasis, and proliferation abilities, respectively.


Asunto(s)
Neoplasias de la Mama/patología , Mama/patología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/diagnóstico , Medios de Contraste , Entropía , Métodos Epidemiológicos , Femenino , Humanos , Metástasis Linfática , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Adulto Joven
10.
Eur Radiol ; 30(1): 87-98, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31385050

RESUMEN

OBJECTIVES: To develop a radiomics model for predicting hematoma expansion in patients with intracerebral hemorrhage (ICH) and to compare its predictive performance with a conventional radiological feature-based model. METHODS: We retrospectively analyzed 251 consecutive patients with acute ICH. Two radiologists independently assessed baseline noncontrast computed tomography (NCCT) images. For each radiologist, a radiological model was constructed from radiological variables; a radiomics score model was constructed from high-dimensional quantitative features extracted from NCCT images; and a combined model was constructed using both radiological variables and radiomics score. Development of models was constructed in a primary cohort (n = 177). We then validated the results in an independent validation cohort (n = 74). The primary outcome was hematoma expansion. We compared the three models for predicting hematoma expansion. Predictive performance was assessed with the receiver operating characteristic (ROC) curve analysis. RESULTS: In the primary cohort, combined model and radiomics model showed greater AUCs than radiological model for both readers (all p < .05). In the validation cohort, combined model and radiomics model showed greater AUCs, sensitivities, and accuracies than radiological model for reader 2 (all p < .05). Combined model showed greater AUC than radiomics model for reader 1 only in the primary cohort (p = .03). Performance of three models was comparable between reader 1 and reader 2 in both cohorts (all p > .05). CONCLUSIONS: NCCT-based radiomics model showed high predictive performance and outperformed radiological model in the prediction of early hematoma expansion in ICH patients. KEY POINTS: • Radiomics model showed better performance for prediction of hematoma expansion in patients with intracerebral hemorrhage than radiological feature-based model. • Hematomas which expanded in follow-up NCCT tended to be larger in baseline volume, more irregular in shape, more heterogeneous in composition, and coarser in texture. • A radiomics model provides a convenient and objective tool for prediction of hematoma expansion that helps to define subsets of patients who would benefit from anti-expansion therapy.


Asunto(s)
Hemorragia Cerebral/patología , Hematoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Hemorragia Cerebral/diagnóstico por imagen , Métodos Epidemiológicos , Femenino , Hematoma/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos
11.
Rev Bras Epidemiol ; 22: e190064, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31826119

RESUMEN

OBJECTIVE: To investigate the prevalence of simultaneity of cardiovascular risk factors and their association with socio-demographic characteristics in older adults in Southern Brazil. METHODS: Cross-sectional study with 1.553 elderly participants of the EpiFloripa study in Florianópolis-SC. The risk factors evaluated were: Inadequate fruit and vegetable consumption, insufficient leisure-time physical activity, alcohol consumption and smoking. The construction of the outcome was performed by combining all of the factors mentioned and then categorized. Bivariate and multivariate analyzes were performed using the Poisson regression. RESULTS: It was found that 57.6% of the elderly coexist with the simultaneity of cardiovascular risk factors. The combination of inadequate fruit and vegetable consumption and insufficient leisure-time physical activity was the most prevalent. The highest prevalence observed in women and men was the insufficient leisure-time physical activity and inadequate fruit and vegetable consumption of 46.4 and 28.1%, respectively. The observed prevalence of the four factors was higher among men (2.5%), whereas for women (0.3%). Men were 11.0% more likely to accumulate risk factors compared to women. And each additional year of schooling represents 4.0% less probability of accumulating cardiovascular risk factors. CONCLUSIONS: The differences between the simultaneity of risk factors and sociodemographic aspects should be considered in the approach for older adults, both at the individual level and in the construction of public policies.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Anciano , Anciano de 80 o más Años , Alcoholismo/complicaciones , Alcoholismo/epidemiología , Brasil/epidemiología , Enfermedades Cardiovasculares/etiología , Métodos Epidemiológicos , Ejercicio , Femenino , Frutas , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Factores Sexuales , Fumar/efectos adversos , Fumar/epidemiología , Factores Socioeconómicos , Verduras
12.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 377-384, dic. 2019. graf, tab
Artículo en Español | IBECS | ID: ibc-185134

RESUMEN

Objetivo. Analizar la evolución de las características epidemiológicas de las visitas atendidas de forma consecutiva en una unidad de dolor torácico (UDT) de un servicio de urgencias hospitalario (SUH) durante un periodo de 10 años. Método. Se incluyeron todas las visitas por dolor torácico no traumático (DTNT), analizándose la evolución temporal de las características epidemiológicas, de la clasificación diagnóstica inicial (evaluación clínica inicial y electrocardiograma) y final (al alta de la UDT), y los tiempos necesarios para alcanzar las mismas. Resultados. Se incluyeron 34.552 pacientes consecutivos con una edad media 59 (DE: 13) años, el 42% mujeres. Se observó un incrementó en el número anual de visitas a la UDT (p < 0,001), menor afluencia los meses de verano (p < 0,001), y mayor los días laborables (p < 0,001) y de 8-16 horas (p < 0,001). Se comprobó que progresivamente más pacientes eran mujeres (+0,29% anual, p < 0,05), menores de 50 años (+0,92%, p < 0,001), con más factores de riesgo cardiovascular, menos antecedentes de cardiopatía isquémica y con DTNT menos sugestivo de síndrome coronario agudo (SCA). La clasificación diagnóstica inicial y final descartó SCA en un 52,2% y un 80,4% de pacientes, respectivamente, hecho que aumentó progresivamente durante el periodo evaluado (+1,86%, p < 0,001; y +0,56%, p = 0,04; respectivamente). El tiempo de clasificación inicial no se modificó, pero se incrementó el necesario para la clasificación final (p < 0,001), que resultó superior en pacientes con diagnostico final de SCA (p < 0,001). Conclusión. Se observa un mayor uso de la UDT tras su creación, causado por un incremento de pacientes con DTNT de características no típicamente coronarias, disminuyendo el porcentaje de clasificados inicial y finalmente como debidos a SCA


Objective. To analyze changes in the characteristics of consecutively treated patients attended in the chest pain unit of a hospital emergency department over a 10-year period. Methods. All patients presenting with nontraumatic chest pain (NTCP) were included. We analyzed changes over time in epidemiologic characteristics, initial diagnostic classification (on clinical and electrocardiographic evaluation), final diagnosis (on discharge), and time until these diagnoses. Results. A total of 34 552 consecutive patients with a mean (SD) age of 59 (13) years were included; 42% were women. The annual number of visits rose over time. Visits were fewer in summer and more numerous on workdays and between the hours of 8 AM and 4 PM (P<.001, both comparisons). The number of women increased over time (up 0.29% annually, P<.05) as did the number of patients under the age of 50 years (up 0.92% annually, P<.001). With time, patients had fewer cardiovascular risk factors and less often had a history of ischemic heart disease. Fewer cases of NTCP had signs suggestive of acute coronary syndrome (ACS). ACS was ruled out at the time of initial and final diagnoses in 52.2% and 80.4%, respectively, and these percentages which rose over the 10-year period by 1.86% (P<.001) and 0.56% (P=.04). Time to initial diagnosis did not change. However, time to final diagnosis did increase (P<.001), and the delay was longer in patients diagnosed with ACS (P<.001). Conclusions. The chest pain unit was more active at the end of the period, in keeping with the increase in patients with NTCP whose characteristics were not typical of coronary disease. The percentages of patients initially and finally diagnosed with ACS decreased with time


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Dolor en el Pecho/epidemiología , Servicios Médicos de Urgencia , Síndrome Coronario Agudo/epidemiología , Métodos Epidemiológicos , Atención Ambulatoria/organización & administración , Atención Ambulatoria/estadística & datos numéricos , Infarto del Miocardio sin Elevación del ST , Infarto del Miocardio con Elevación del ST , Estudios Retrospectivos , Factores de Riesgo , Análisis de Varianza
13.
Rev Soc Bras Med Trop ; 53: e20190193, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31859945

RESUMEN

INTRODUCTION: Prevalence of human immunodeficiency virus among adolescents is increasing. This study aimed to analyze this current situation in Rio de Janeiro City. METHODS: This was a retrospective longitudinal study using secondary data from the National System of Notifiable Diseases database of cases in adolescents aged 13-19 years. RESULTS: There were 885 acquired immunodeficiency syndrome cases from 1978 to 2017 and 445 human immunodeficiency virus new cases from 2014 to 2017. Over time, sexually transmitted human immunodeficiency virus/acquired immunodeficiency syndrome cases increase. CONCLUSIONS: Human immunodeficiency virus/acquired immunodeficiency syndrome epidemic in adolescents requires novel prevention policies.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Epidemias , Adolescente , Brasil/epidemiología , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Población Urbana , Adulto Joven
14.
BMC Public Health ; 19(1): 1733, 2019 Dec 26.
Artículo en Inglés | MEDLINE | ID: mdl-31878916

RESUMEN

BACKGROUND: Adherence to a traditional Mediterranean diet has been associated with lower mortality and cardiovascular disease risk. The relative importance of diet compared to other lifestyle factors and effects of dietary patterns over time remains unknown. METHODS: We used the parametric G-formula to account for time-dependent confounding, in order to assess the relative importance of diet compared to other lifestyle factors and effects of dietary patterns over time. We included healthy Melbourne Collaborative Cohort Study participants attending a visit during 1995-1999. Questionnaires assessed diet and physical activity at each of three study waves. Deaths were identified by linkage to national registries. We estimated mortality risk over approximately 14 years (1995-2011). RESULTS: Of 22,213 participants, 2163 (9.7%) died during 13.6 years median follow-up. Sustained high physical activity and adherence to a Mediterranean-style diet resulted in an estimated reduction in all-cause mortality of 1.82 per 100 people (95% confidence interval (CI): 0.03, 3.6). The population attributable fraction was 13% (95% CI: 4, 23%) for sustained high physical activity, 7% (95% CI: - 3, 17%) for sustained adherence to a Mediterranean-style diet and 18% (95% CI: 0, 36%) for their combination. CONCLUSIONS: A small reduction in mortality may be achieved by sustained elevated physical activity levels in healthy middle-aged adults, but there may be comparatively little gain from increasing adherence to a Mediterranean-style diet.


Asunto(s)
Dieta Mediterránea/estadística & datos numéricos , Ejercicio , Mortalidad/tendencias , Anciano , Australia/epidemiología , Estudios de Cohortes , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
15.
Nature ; 575(7781): 130-136, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31695207

RESUMEN

With rapidly changing ecology, urbanization, climate change, increased travel and fragile public health systems, epidemics will become more frequent, more complex and harder to prevent and contain. Here we argue that our concept of epidemics must evolve from crisis response during discrete outbreaks to an integrated cycle of preparation, response and recovery. This is an opportunity to combine knowledge and skills from all over the world-especially at-risk and affected communities. Many disciplines need to be integrated, including not only epidemiology but also social sciences, research and development, diplomacy, logistics and crisis management. This requires a new approach to training tomorrow's leaders in epidemic prevention and response.


Asunto(s)
/epidemiología , Salud Pública/tendencias , Ciencia/tendencias , Métodos Epidemiológicos , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Control de Infecciones , /microbiología , Salud Pública/historia , Ciencia/historia
16.
BMC Public Health ; 19(1): 1516, 2019 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-31718615

RESUMEN

BACKGROUND: In populations that lack vital registration systems, under-5 mortality (U5M) is commonly estimated using survey-based approaches, including indirect methods. One assumption of indirect methods is that a mother's survival and her children's survival are not correlated, but in populations affected by HIV/AIDS this assumption is violated, and thus indirect estimates are biased. Our goal was to estimate the magnitude of the bias, and to create a predictive model to correct it. METHODS: We used an individual-level, discrete time-step simulation model to measure how the bias in indirect estimates of U5M changes under various fertility rates, mortality rates, HIV/AIDS rates, and levels of antiretroviral therapy. We simulated 4480 populations in total and measured the amount of bias in U5M due to HIV/AIDS. We also developed a generalized linear model via penalized maximum likelihood to correct this bias. RESULTS: We found that indirect methods can underestimate U5M by 0-41% in populations with HIV prevalence of 0-40%. Applying our model to 2010 survey data from Malawi and Tanzania, we show that indirect methods would underestimate U5M by up to 7.7% in those countries at that time. Our best fitting model to correct bias in U5M had a root median square error of 0.0012. CONCLUSIONS: Indirect estimates of U5M can be significantly biased in populations affected by HIV/AIDS. Our predictive model allows scholars and practitioners to correct that bias using commonly measured population characteristics. Policies and programs based on indirect estimates of U5M in populations with generalized HIV epidemics may need to be reevaluated after accounting for estimation bias.


Asunto(s)
Sesgo , Mortalidad del Niño , Métodos Epidemiológicos , Infecciones por VIH/mortalidad , Mortalidad Infantil , Madres/estadística & datos numéricos , Encuestas y Cuestionarios/normas , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Adolescente , Adulto , Fármacos Anti-VIH/uso terapéutico , Tasa de Natalidad , Causas de Muerte , Preescolar , Epidemias , Femenino , VIH , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Lactante , Recién Nacido , Malaui/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Tanzanía/epidemiología , Adulto Joven
17.
Codas ; 31(5): e20190004, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31664371

RESUMEN

PURPOSE: To review the Speech-Language Pathology literature studies from the epidemiology and causality perspective. RESEARCH STRATEGIES: A national and international literature survey was carried out with searches from PubMed, SciELO and gray literature bases, conducted according to the instructions of the Cochrane Collaboration and published until January 9th, 2019. The review guiding question asks if Speech-Language Pathology uses methods in their evidence to infer causality. SELECTION CRITERIA: All studies that presented a causal epidemiological approach in speech therapy were included, as well as excluded those that did not present an appropriate methodological approach for cause and effect analysis. DATA ANALYSIS: Two authors of this study independently reviewed all citations. A priori determined form was used to extract the following data: author, year of publication, country of origin, theoretical conception, application or not of the study and central discussion addressed in the article. RESULTS: From the search performed 3842 articles were found. However, none of them investigated their outcomes from the causality point of view, not allowing cause and effect inference. CONCLUSION: There is a shortage of studies that evidence causality in Speech-Language Pathology, which may alter the effectiveness and reliable handling of diagnosis and speech-language therapy, since it is still based on association and not on cause and effect based on studies designed to that.


Asunto(s)
Trastornos del Habla/epidemiología , Trastornos del Habla/etiología , Patología del Habla y Lenguaje , Causalidad , Métodos Epidemiológicos , Humanos , Logoterapia
18.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(4): 356-357, 2019 Sep 19.
Artículo en Chino | MEDLINE | ID: mdl-31612667

RESUMEN

Spatial epidemiology is a new branch of epidemiology, and is a subject that mainly analyzes the geographical distribution and changes of population health or diseases and its related impact factors. Recently, spatial epidemiology has been extensively applied in the prevention and control of parasitic diseases in China, and delightful results have been achieved. However, the research and application of theories and methods of spatial epidemiology are still needed to protect the people's health in China.


Asunto(s)
Métodos Epidemiológicos , Enfermedades Parasitarias , China/epidemiología , Humanos , Enfermedades Parasitarias/epidemiología , Enfermedades Parasitarias/prevención & control , Investigación/tendencias
19.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(4): 368-373, 2019 Sep 25.
Artículo en Chino | MEDLINE | ID: mdl-31612670

RESUMEN

OBJECTIVE: To develop a method for designing schistosomiasis surveillance sites, so as to improve the efficiency and quality of schitsosomiasis surveillance. METHODS: By using the minimum spanning tree-based Spatial Kluster Analysis by Tree Edge Removal (SKATER) method, spatially constrained clustering was performed upon 31 historical schistosomiasis-endemic counties (districts) in Anhui Province. A surveillance site was selected from each cluster to evaluate the representativeness and surveillance efficiency of these cluster-based surveillance sites for the endemic situation of schistosomiassi in Anhui Province, and to compare the surveillance efficiency with local national schistosomiasis surveillance sites. RESULTS: There was no significant difference in the environmental factors between the cluster-based schistosomiasis surveillance sites and the whole region, showing a high homogeneity. If the same number of schistosomiasis surveillance sites was selected, there was no significant difference between the cluster-based surveillance sites and national schistosomiasis surveillance sites in the efficiency of the mean risk and long-term trend of schistosomiasis surveillance in Anhui Province; however, the cluster-based surveillance sites were superior to the national schistosomiasis surveillance sites for the prediction and estimation of the endemic situation of schistosomiasis in the unmonitored areas. CONCLUSIONS: The SKATER-based selection of schistosomiasis surveillance sites may better represent the endemic situation of schistosomiasis in Anhui Province, which may serve as an effective supplement for the conventional method of selecting schistosomiasis surveillance sites.


Asunto(s)
Métodos Epidemiológicos , Vigilancia de la Población , Esquistosomiasis , Caracoles , Animales , China/epidemiología , Análisis por Conglomerados , Humanos , Vigilancia de la Población/métodos , Schistosoma/fisiología , Esquistosomiasis/epidemiología , Esquistosomiasis/prevención & control , Caracoles/parasitología , Análisis Espacial
20.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(10): 1310-1313, 2019 Oct 10.
Artículo en Chino | MEDLINE | ID: mdl-31658536

RESUMEN

At present, traditional methods on statistics have limitations in controlling time- varying confounding. This paper introduces an analysis method, parametric g-formula, which would adjust time-varying confounding, and also exemplifies the steps of its implementation for purpose to provide a new reference for researchers to deal with long-term observational data.


Asunto(s)
Causalidad , Métodos Epidemiológicos , Estadística como Asunto
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