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1.
Cells ; 10(6)2021 05 23.
Artículo en Inglés | MEDLINE | ID: mdl-34071149

RESUMEN

The dysregulation of both the innate and adaptive responses to SARS-CoV-2 have an impact on the course of COVID-19, and play a role in the clinical outcome of the disease. Here, we performed a comprehensive analysis of peripheral blood lymphocyte subpopulations in 82 patients with COVID-19, including 31 patients with a critical course of the disease. In COVID-19 patients who required hospitalization we analyzed T cell subsets, including Treg cells, as well as TCRα/ß and γ/δ, NK cells, and B cells, during the first two weeks after admission to hospital due to the SARS-CoV-2 infection, with marked reductions in leukocytes subpopulations, especially in critically ill COVID-19 patients. We showed decreased levels of Th, Ts cells, Treg cells (both naïve and induced), TCRα/ß and γ/δ cells, as well as CD16+CD56+NK cells in ICU compared to non-ICU COVID-19 patients. We observed impaired function of T and NK cells in critically ill COVID-19 patients with extremely low levels of secreted cytokines. We found that the IL-2/INFγ ratio was the strongest indicator of a critical course of COVID-19, and was associated with fatal outcomes. Our findings showed markedly impaired innate and adaptive responses in critically ill COVID-19 patients, and suggest that the immunosuppressive state in the case of a critical course of SARS-CoV-2 infection might reflect subsequent clinical deterioration and predict a fatal outcome.


Asunto(s)
59585/inmunología , Tolerancia Inmunológica , Subgrupos Linfocitarios/inmunología , 59565/inmunología , Índice de Severidad de la Enfermedad , Inmunidad Adaptativa , Anciano , 59585/diagnóstico , 59585/mortalidad , 59585/virología , Deterioro Clínico , Enfermedad Crítica , Femenino , Mortalidad Hospitalaria , Hospitalización , Humanos , Inmunidad Innata , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Polonia/epidemiología , Estudios Prospectivos , Medición de Riesgo/métodos
2.
Sci Rep ; 11(1): 11524, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-34075155

RESUMEN

Nearly 5% of patients suffering from COVID-19 develop acute respiratory distress syndrome (ARDS). Extravascular lung water index (EVLWI) is a marker of pulmonary oedema which is associated with mortality in ARDS. In this study, we evaluate whether EVLWI is higher in patients with COVID-19 associated ARDS as compared to COVID-19 negative, ventilated patients with ARDS and whether EVLWI has the potential to monitor disease progression. EVLWI and cardiac function were monitored by transpulmonary thermodilution in 25 patients with COVID-19 ARDS subsequent to intubation and compared to a control group of 49 non-COVID-19 ARDS patients. At intubation, EVLWI was noticeably elevated and significantly higher in COVID-19 patients than in the control group (17 (11-38) vs. 11 (6-26) mL/kg; p < 0.001). High pulmonary vascular permeability index values (2.9 (1.0-5.2) versus 1.9 (1.0-5.2); p = 0.003) suggested a non-cardiogenic pulmonary oedema. By contrast, the cardiac parameters SVI, GEF and GEDVI were comparable in both cohorts. High EVLWI values were associated with viral persistence, prolonged intensive care treatment and in-hospital mortality (23.2 ± 6.7% vs. 30.3 ± 6.0%, p = 0.025). Also, EVLWI showed a significant between-subjects (r = - 0.60; p = 0.001) and within-subjects correlation (r = - 0.27; p = 0.028) to Horowitz index. Compared to non COVID-19 ARDS, COVID-19 results in markedly elevated EVLWI-values in patients with ARDS. High EVLWI reflects a non-cardiogenic pulmonary oedema in COVID-19 ARDS and could serve as parameter to monitor ARDS progression on ICU.


Asunto(s)
59585/complicaciones , Agua Pulmonar Extravascular/inmunología , Edema Pulmonar/mortalidad , Síndrome de Dificultad Respiratoria del Adulto/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , 59585/diagnóstico , 59585/inmunología , 59585/mortalidad , Permeabilidad Capilar , Progresión de la Enfermedad , Agua Pulmonar Extravascular/virología , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Pulmón/irrigación sanguínea , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/estadística & datos numéricos , Pronóstico , Edema Pulmonar/diagnóstico , Edema Pulmonar/inmunología , Edema Pulmonar/virología , Respiración Artificial , Síndrome de Dificultad Respiratoria del Adulto/diagnóstico , Síndrome de Dificultad Respiratoria del Adulto/etiología , Síndrome de Dificultad Respiratoria del Adulto/terapia , Medición de Riesgo/métodos , 59565/aislamiento & purificación , Índice de Severidad de la Enfermedad , Termodilución/métodos , Termodilución/estadística & datos numéricos , Adulto Joven
3.
Wiad Lek ; 74(5): 1196-1199, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34090289

RESUMEN

OBJECTIVE: The aim: Is the analysis of chronic kidney disease risk in patients with arterial hypertension and coexistent hyperuricemia. PATIENTS AND METHODS: Materials and methods:We observed 40 patients with arterial hypertension and coexistent hyperuricemia (I group), 35 - with arterial hypertension (II group) and 30 practically healthy people (control). The duration of hypertension was 4,3 ± 2,31 years and 4,0 ± 2,11 years (p = 0,9247) for I and II group respectively, of hyperuricemia - 4,1 ± 0,35 years for I group. Categories of albuminuria (А1, А2, А3) and glomerular filtration rate (G1, G2, G3A, G3B, G4, G5) were determined in all observed patients. Clinical, anthropometric, biochemical, immunoassay, statistical (SPSS 21, Graph Pad) methods were used. RESULTS: Results:The categories of albuminuria and glomerular filtration rate in patients from the I group demonstrated that A1G1 was confirmed in 3 persons, A1G2 - 5, A2G1 - 7, A2G2 - 20, A1G3A - 1, A1G3B - 1, A2G3A - 2, A2G3B - 1. Among patients from the II group category A1G1 was defined in 7, A1G2 - 2, A2G1 - 16, A2G2 - 10 persons. The percent of low chronic kidney disease risk was on 5,7 % higher in hypertensive persons comparable with comorbid persons. High and very high risk was confirmed in 10 % persons from I group and nobody from the ІІ group. CONCLUSION: Conclusions:Chronic kidney disease risk is increased in patients with arterial hypertension and coexistent hyperuricemia. This indicates an association between elevated uric acid levels and chronic kidney disease progression.


Asunto(s)
Hipertensión , Hiperuricemia , Insuficiencia Renal Crónica , Tasa de Filtración Glomerular , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Hiperuricemia/complicaciones , Hiperuricemia/epidemiología , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/epidemiología , Medición de Riesgo
4.
Artículo en Chino | MEDLINE | ID: mdl-34074078

RESUMEN

Objective: To understand the research status of occupational health risk assessment in recent ten years. Methods: In April 2020, the literatures related to occupational health risk assessment published by CNKI and Web of Science core collection (WoSCC) databases from 2010 to 2019 were searched, and Excel 2016 software was used to organize the literature, CiteSpace 5.6.R2 software was used for visual analysis. Results: A total of 58 Chinese literatures and 407 English literatures were included. The authors of the high frequency posts were Zhang Meibian, and Alessandro Marinaccio, and the publishing institutions were mainly the National Institute for Occupational Health and Poison Control of Chinese Center for Disease Control and Prevention and Finnish Institute Occupational Health. The Chinese journal with the most articles was Chinese Journal of Industrial Hygiene and Occupational Diseases, and the English journal was Safety Science. Chinese high-frequency keywords mainly included risk assessment, occupational health, occupational exposure. English high-frequency keywords mainly included occupational health, risk, risk factor. The prominent words in Chinese literature were occupational health, coal dust, occupational hazards, occupational health and occupational disease hazards; Risk assessment, worker, exposure, heart disease, cardiovascular disease and so on were prominent words in English literature. Conclusion: The main research keywords in the field of occupational health risk assessment at home and abroad focus on occupational health and risk assessment, but the research direction and focus are slightly different.


Asunto(s)
Bibliometría , Salud Laboral , China , Bases de Datos Factuales , Publicaciones , Medición de Riesgo
5.
Artículo en Chino | MEDLINE | ID: mdl-34074087

RESUMEN

Objective: To assess the health risks of welding fume jobs with five occupational health risk assessment methods, and to compare the advantages, disadvantages and applicability of these methods in the health risk assessment of welding fume. Methods: The International Commission for Mining and Metals (ICMM) occupational health risk assessment method, MES method, the qualitative method and comprehensive index method in GBZ/T 298-2017 "Technical Guidelines for Occupational Health Risk Assessment of Chemical Hazardous Factors in the Workplace" were used to assess the risk of welding fume exposure positions in four manufacturing enterprises in Tianjin in March, 2020. The assessment results of different methods were standardized by risk ratio (RR) . Results: After the results were standardized, the results of enterprises 1, 2 and 4 were negligible risks, enterprise 3 was medium risk in the ICMM matrix method and MES method, and the results of ICMM quantitative method for each enterprise were negligible risk, low risk, extremely high risk and low risk, respectively. The results of the qualitative assessment of the guidelines for all companies were negligible risks, and the comprehensive index method were medium risks. Conclusion: The five models are all suitable for occupational health risk assessment of welding fumes, but they all have certain shortcomings. They should be combined with qualitative and semi-quantitative assessment results for comprehensive analysis.


Asunto(s)
Contaminantes Ocupacionales del Aire , Exposición Profesional , Salud Laboral , Soldadura , Contaminantes Ocupacionales del Aire/análisis , Gases , Humanos , Exposición Profesional/análisis , Medición de Riesgo , Lugar de Trabajo
6.
Environ Monit Assess ; 193(6): 376, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-34075481

RESUMEN

This study investigated the content of Cd, Pb, Cr, and Ni in the soils of intensive vegetable growing areas of the Brahmaputra valley, North East India, to assess their status and detect any buildup of metals due to long-term and continuous application of agrochemicals and organic manures. The content of heavy metals was determined in eighty composite surface soil samples (0-20 cm) collected from eight different locations of the valley having a history of more than forty years of vegetable production. This finding is novel as no comprehensive investigation has been done till date in respect of the content of heavy metals in the intensive vegetable growing areas of Brahmaputra valley. The locations are considered free from any pollution caused by industrial effluent or urbanization processes. The investigational data showed that the content of Cd, Pb, Cr, and Ni in the soils ranged from 0.43 to 3.24, 6.00 to 22.90, 3.00 to 15.24, and 3.30 to 14.30 mg kg-1, respectively. The overall mean values of the heavy metals showed a decreasing order of Pb (14.79 mg kg-1) > Cr (8.87 mg kg-1) > Ni (8.37 mg kg-1) > Cd (1.43 mg kg-1). The findings of the study indicated significant enrichment of the metals in the surface soils over the local background values of the elements measured in the C horizon. Though the concentrations of Pb, Cr, and Ni of the soils were well below the reference levels used in different countries, Cd showed distinctly higher value with maximum enrichment level. The soils were categorized as slightly to moderately polluted based on different pollution indices. Based on the ecological risk index, soils were in the low-risk category, but in respect of Cd, most of the soils fell under the moderately risky category. Multivariate analysis suggested the predominance of lithogenic influence on the content of Pb, Ni, and Cr while Cd content bears a distinct signature of the anthropogenic source. The buildup of Cd in the studied soils is a matter of critical concern and needs proper monitoring and management strategies to avoid any potential detrimental effect on soil, crop, and human health.


Asunto(s)
Metales Pesados , Contaminantes del Suelo , China , Monitoreo del Ambiente , Humanos , India , Metales Pesados/análisis , Medición de Riesgo , Suelo , Contaminantes del Suelo/análisis , Verduras
7.
Environ Monit Assess ; 193(6): 378, 2021 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-34075483

RESUMEN

This paper presents the comprehensive evaluation of the level of accumulation of some of the most dangerous environmental pollutants (V, Co, Sn, Ni, Cr, Mn, Cd, Cu, Pb, Sb, Zn) and analyses their chemical forms in sediments of four small lakes located within Murmansk urban territory. Furthermore, the authors first studied morphology and chemical composition of industrial dust collected from the snow covering the ice of Lake Srednee. Fieldwork was carried out in April 2019. The results showed that sediments of the Murmansk urban lakes are significantly enriched in the content of the toxic metals and metalloids Cd, Pb, Sb, Zn, Cu, V, and Ni. An integrated assessment of anthropogenic impact using the pollution load index (PLI) and geoaccumulation index (Igeo) revealed a moderate to the extremely strong pollution level in recent sediment layers. The analysis of the fractions of the elements showed that they are mainly associated with stable compounds, such as primary minerals or persistent technogenic compounds (slag, matte, and dust). However, humic substances are a significant accumulative matrix for most studied elements. The share of the most mobile fractions does not exceed 30% for the vast majority of elements, even in the most polluted layers. The accumulation of the major part of pollutants can be attributed to the activities of the main industrial objects of the city (thermal power plant, coal port, transport infrastructure), and the impact of the global atmospheric transport of pollutants to the Arctic regions of Russia.


Asunto(s)
Metales Pesados , Oligoelementos , Contaminantes Químicos del Agua , Regiones Árticas , Ciudades , Monitoreo del Ambiente , Sedimentos Geológicos , Lagos , Metales Pesados/análisis , Medición de Riesgo , Federación de Rusia , Oligoelementos/análisis , Contaminantes Químicos del Agua/análisis
8.
Sensors (Basel) ; 21(9)2021 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-34062827

RESUMEN

The reproduction and simulation of workplaces, and the analysis of body postures during work processes, are parts of ergonomic risk assessments. A commercial virtual reality (VR) system offers the possibility to model complex work scenarios as virtual mock-ups and to evaluate their ergonomic designs by analyzing motion behavior while performing work processes. In this study a VR tracking sensor system (HTC Vive tracker) combined with an inverse kinematic model (Final IK) was compared with a marker-based optical motion capture system (Qualisys). Marker-based optical motion capture systems are considered the gold standard for motion analysis. Therefore, Qualisys was used as the ground truth in this study. The research question to be answered was how accurately the HTC Vive System combined with Final IK can measure joint angles used for ergonomic evaluation. Twenty-six subjects were observed simultaneously with both tracking systems while performing 20 defined movements. Sixteen joint angles were analyzed. Joint angle deviations between ±6∘ and ±42∘ were identified. These high deviations must be considered in ergonomic risk assessments when using a VR system. The results show that commercial low-budget tracking systems have the potential to map joint angles. Nevertheless, substantial weaknesses and inaccuracies in some body regions must be taken into account. Recommendations are provided to improve tracking accuracy and avoid systematic errors.


Asunto(s)
Realidad Virtual , Ergonomía , Humanos , Movimiento (Física) , Medición de Riesgo , Tecnología
9.
Medicina (Kaunas) ; 57(5)2021 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-34065022

RESUMEN

Background and Objectives: Risk management is considered an integral part of laboratory medicine to assure laboratory quality and patient safety. However, the concept of risk management is philosophical, so actually performing risk management in a clinical laboratory can be challenging. Therefore, we would like to develop a sustainable, practical system for continuous total laboratory risk management. Materials and Methods: This study was composed of two phases: the development phase in 2019 and the application phase in 2020. A concept flow diagram for the computerized risk registry and management tool (RRMT) was designed using the failure mode and effects analysis (FMEA) and the failure reporting, analysis, and corrective action system (FRACAS) methods. The failure stage was divided into six according to the testing sequence. We applied laboratory errors to this system over one year in 2020. The risk priority number (RPN) score was calculated by multiplying the severity of the failure mode, frequency (or probability) of occurrence, and detection difficulty. Results: 103 cases were reported to RRMT during one year. Among them, 32 cases (31.1%) were summarized using the FMEA method, and the remaining 71 cases (68.9%) were evaluated using the FRACAS method. There was no failure in the patient registration phase. Chemistry units accounted for the highest proportion of failure with 18 cases (17.5%), while urine test units accounted for the lowest portion of failure with two cases (1.9%). Conclusion: We developed and applied a practical computerized risk-management tool based on FMEA and FRACAS methods for the entire testing process. RRMT was useful to detect, evaluate, and report failures. This system might be a great example of a risk management system optimized for clinical laboratories.


Asunto(s)
Seguridad del Paciente , Gestión de Riesgos , Humanos , Sistema de Registros , Medición de Riesgo
10.
Sensors (Basel) ; 21(10)2021 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-34067644

RESUMEN

Falls among the elderly population cause detrimental physical, mental, financial problems and, in the worst case, death. The increasing number of people entering the higher risk age-range has increased clinicians' attention to intervene. Clinical tools, e.g., the Timed Up and Go (TUG) test, have been created for aiding clinicians in fall-risk assessment. Often simple to evaluate, these assessments are subject to a clinician's judgment. Wearable sensor data with machine learning algorithms were introduced as an alternative to precisely quantify ambulatory kinematics and predict prospective falls. However, they require a long-term evaluation of large samples of subjects' locomotion and complex feature engineering of sensor kinematics. Therefore, it is critical to build an objective fall-risk detection model that can efficiently measure biometric risk factors with minimal costs. We built and studied a sensor data-driven convolutional neural network model to predict older adults' fall-risk status with relatively high sensitivity to geriatrician's expert assessment. The sample in this study is representative of older patients with multiple co-morbidity seen in daily medical practice. Three non-intrusive wearable sensors were used to measure participants' gait kinematics during the TUG test. This data collection ensured convenient capture of various gait impairment aspects at different body locations.


Asunto(s)
Accidentes por Caídas , Equilibrio Postural , Accidentes por Caídas/prevención & control , Anciano , Fenómenos Biomecánicos , Humanos , Aprendizaje Automático , Estudios Prospectivos , Medición de Riesgo , Estudios de Tiempo y Movimiento
11.
Artículo en Inglés | MEDLINE | ID: mdl-34069419

RESUMEN

Due to airborne transmission of the coronavirus, the question arose as to how high the risk of spreading infectious particles can be while playing a wind instrument. To examine this question and to help clarify the possible risk, we analyzed 14 wind instruments, first qualitatively by making airflows visible while playing, and second quantitatively by measuring air velocity at three distances (1, 1.5, 2 m) in the direction of the instruments' bells. Measurements took place with wind instrumentalists of the Bamberg Symphony in their concert hall. Our findings highlight that while playing, no airflows escaping from any of the wind instruments-from the bell with brass instruments or from the mouthpiece, keyholes or bell with woodwinds-were measurable beyond a distance of 1.5 m, regardless of volume, pitch or what was played. With that, air velocity while playing corresponded to the usual value of 1 m/s in hall-like rooms. For air-jet woodwinds, alto flute and piccolo, significant air movements were seen close to the mouthpiece, which escaped directly into the room.


Asunto(s)
Movimientos del Aire , Humanos , Medición de Riesgo
12.
Artículo en Inglés | MEDLINE | ID: mdl-34072475

RESUMEN

Protecting worker and public health involves an understanding of multiple determinants, including exposures to biological, chemical, or physical agents or stressors in combination with other determinants including type of employment, health status, and individual behaviors. This has been illustrated during the COVID-19 pandemic by increased exposure and health risks for essential workers and those with pre-existing conditions, and mask-wearing behavior. Health risk assessment practices for environmental and occupational health typically do not incorporate multiple stressors in combination with personal risk factors. While conceptual developments in cumulative risk assessment to inform a more holistic approach to these real-life conditions have progressed, gaps remain, and practical methods and applications are rare. This scoping review characterizes existing evidence of combined stressor exposures and personal factors and risk to foster methods for occupational cumulative risk assessment. The review found examples from many workplaces, such as manufacturing, offices, and health care; exposures to chemical, physical, and psychosocial stressors combined with modifiable and unmodifiable determinants of health; and outcomes including respiratory function and disease, cancers, cardio-metabolic diseases, and hearing loss, as well as increased fertility, menstrual dysfunction and worsened mental health. To protect workers, workplace exposures and modifiable and unmodifiable characteristics should be considered in risk assessment and management. Data on combination exposures can improve assessments and risk estimates and inform protective exposure limits and management strategies.


Asunto(s)
Exposición Profesional , Salud Laboral , Humanos , Pandemias , Medición de Riesgo , Factores de Riesgo , Lugar de Trabajo
13.
Rev Med Liege ; 76(5-6): 502-506, 2021 May.
Artículo en Francés | MEDLINE | ID: mdl-34080387

RESUMEN

Breast cancer is the leading cause of neoplastic death in women around the world. In the era of personalized medicine, legitimately awaited by our patients, the future of breast cancer screening will depend on an individual-based risk assessment, making it possible to better adapt the age of onset, frequency and the type of examinations useful for this screening. This article reviews the three broad categories of highest risk factors available to establish a risk score appropriate for each patient.


Asunto(s)
Neoplasias de la Mama , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/epidemiología , Detección Precoz del Cáncer , Femenino , Humanos , Medicina de Precisión , Medición de Riesgo , Factores de Riesgo
14.
MMWR Morb Mortal Wkly Rep ; 70(22): 825-829, 2021 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-34081687

RESUMEN

End-stage renal disease (ESRD) is a condition in which kidney function has permanently declined such that renal replacement therapy* is required to sustain life (1). The mortality rate for patients with ESRD in the United States has been declining since 2001 (2). However, during the COVID-19 pandemic, ESRD patients are at high risk for COVID-19-associated morbidity and mortality, which is due, in part, to weakened immune systems and presence of multiple comorbidities (3-5). The ESRD National Coordinating Center (ESRD NCC) supports the Centers for Medicare & Medicaid Services (CMS) and the ESRD Networks†,§ through analysis of data, dissemination of best practices, and creation of educational materials. ESRD NCC analyzed deaths reported to the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb), a system that facilitates the collection of data and maintenance of information about ESRD patients on chronic dialysis or receiving a kidney transplant who are treated in Medicare-certified dialysis facilities and kidney transplant centers in the United States. Excess death estimates were obtained by comparing observed and predicted monthly numbers of deaths during February 1-August 31, 2020; predicted deaths were modeled based on data from January 1, 2016, through December 31, 2019. The analysis estimated 8.7-12.9 excess deaths per 1,000 ESRD patients, or a total of 6,953-10,316 excess deaths in a population of 798,611 ESRD patients during February 1-August 31, 2020. These findings suggest that deaths among ESRD patients during the early phase of the pandemic exceeded those that would have been expected based on previous years' data. Geographic and temporal patterns of excess mortality, including those among persons with ESRD, should be considered during planning and implementation of interventions, such as COVID-19 vaccination, infection control guidance, and patient education. These findings underscore the importance of data-driven technical assistance and further analyses of the causes and patterns of excess deaths in ESRD patients.


Asunto(s)
Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Mortalidad/tendencias , /epidemiología , Humanos , Medición de Riesgo , Estados Unidos/epidemiología
15.
Glob Health Action ; 14(1): 1918886, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-34058969

RESUMEN

Background: As a result of the Fukushima Daiichi nuclear power plant accident, many residents evacuated and were exposed to changes in their living environment and socioeconomic status, and to persistent stressors. Past studies have suggested the potential for these circumstances to contribute to long-term changes to population health.Objective: The objective of this study was to gain a better understanding of long-term health effects of evacuation, by evaluating the risk of non-communicable diseases among evacuees from Minamisoma City (one of the closest municipalities to the power plant) until 2017.Methods: The study evaluated data from annual health check-ups for residents aged 40-74 years covered by National Health Insurance (who are largely self-employed) from 2010 to 2017 administered by Minamisoma City. Diabetes, hyperlipidemia, and hypertension were defined from the results of blood sampling. Annual changes in age-adjusted prevalence were estimated by evacuation scenario. We also performed an inverse-probability weighting (IPW) analysis to adjust for baseline covariates in 2010 and estimated the differences in the risk of diabetes, hyperlipidemia, and hypertension by evacuation scenario as of the 2017 health check-up in reference to the no-evacuation group.Results: A total of 1,837 individuals were considered in this study. Regardless of evacuation scenario, there was statistical evidence suggesting an upward and a downward trend in diabetes and hypertension from 2010 to 2017, respectively, while hyperlipidemia showed no remarkable change. IPW analyses demonstrated that disease risks in 2017 did not differ significantly among people with different evacuation scenarios.Conclusions: Region-specific factors played an important role in the health effects of the evacuation. Our findings have important implications for the need of an assessment of the health effects of evacuations in more localized manner. Further research in this area will strengthen the communities' preparedness for future disasters that require mass evacuation.


Asunto(s)
Accidente Nuclear de Fukushima , Enfermedades no Transmisibles , Humanos , Enfermedades no Transmisibles/epidemiología , Plantas de Energía Nuclear , Estudios Retrospectivos , Medición de Riesgo
16.
BMJ ; 373: n1091, 2021 05 11.
Artículo en Inglés | MEDLINE | ID: mdl-33975892

RESUMEN

CLINICAL QUESTION: What are the benefits and harms of sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists when added to usual care (lifestyle interventions and/or other diabetes drugs) in adults with type 2 diabetes at different risk for cardiovascular and kidney outcomes? CURRENT PRACTICE: Clinical decisions about treatment of type 2 diabetes have been led by glycaemic control for decades. SGLT-2 inhibitors and GLP-1 receptor agonists are traditionally used in people with elevated glucose level after metformin treatment. This has changed through trials demonstrating atherosclerotic cardiovascular disease (CVD) and chronic kidney disease (CKD) benefits independent of medications' glucose-lowering potential. RECOMMENDATIONS: The guideline panel issued risk-stratified recommendations concerning the use of SGLT-2 inhibitors or GLP-1 receptor agonists in adults with type 2 diabetes• Three or fewer cardiovascular risk factors without established CVD or CKD: Weak recommendation against starting SGLT-2 inhibitors or GLP-1 receptor agonists.• More than three cardiovascular risk factors without established CVD or CKD: Weak recommendation for starting SGLT-2 inhibitors and weak against starting GLP-1 receptor agonists.• Established CVD or CKD: Weak recommendation for starting SGLT-2 inhibitors and GLP-1 receptor agonists.• Established CVD and CKD: Strong recommendation for starting SGLT-2 inhibitors and weak recommendation for starting GLP-1 receptor agonists.• For those committed to further reducing their risk for CVD and CKD outcomes: Weak recommendation for starting SGLT-2 inhibitors rather than GLP-1 receptor agonists. HOW THIS GUIDELINE WAS CREATED: An international panel including patients, clinicians, and methodologists created these recommendations following standards for trustworthy guidelines and using the GRADE approach. The panel applied an individual patient perspective. THE EVIDENCE: A linked systematic review and network meta-analysis (764 randomised trials included 421 346 participants) of benefits and harms found that SGLT-2 inhibitors and GLP-1 receptor agonists generally reduce overall death, and incidence of myocardial infarctions, and end-stage kidney disease or kidney failure (moderate to high certainty evidence). These medications exert different effects on stroke, hospitalisations for heart failure, and key adverse events in different subgroups. Absolute effects of benefit varied widely based on patients' individual risk (for example, from five fewer deaths in the lowest risk to 48 fewer deaths in the highest risk, for 1000 patients treated over five years). A prognosis review identified 14 eligible risk prediction models, one of which (RECODe) informed most baseline risk estimates in evidence summaries to underpin the risk-stratified recommendations. Concerning patients' values and preferences, the recommendations were supported by evidence from a systematic review of published literature, a patient focus group study, a practical issues summary, and a guideline panel survey. UNDERSTANDING THE RECOMMENDATION: We stratified the recommendations by the levels of risk for CVD and CKD and systematically considered the balance of benefits, harms, other considerations, and practical issues for each risk group. The strong recommendation for SGLT-2 inhibitors in patients with CVD and CKD reflects what the panel considered to be a clear benefit. For all other adults with type 2 diabetes, the weak recommendations reflect what the panel considered to be a finer balance between benefits, harms, and burdens of treatment options. Clinicians using the guideline can identify their patient's individual risk for cardiovascular and kidney outcomes using credible risk calculators such as RECODe. Interactive evidence summaries and decision aids may support well informed treatment choices, including shared decision making.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Receptor del Péptido 1 Similar al Glucagón/uso terapéutico , Transportador 2 de Sodio-Glucosa/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , Receptor del Péptido 1 Similar al Glucagón/agonistas , Humanos , Enfermedades Renales/prevención & control , Guías de Práctica Clínica como Asunto , Medición de Riesgo
17.
Vasc Health Risk Manag ; 17: 187-194, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33976549

RESUMEN

Background: Ideal cardiovascular health behaviour (CVHB) measures four ideal health behaviours (non-smoking, body mass index <85th Percentile, healthy diet, and physical activity). This study aimed to determine the prevalence, distribution, and correlates of ideal CVHB among adolescents in the Caribbean. Methods: Nationally representative cross-sectional data of 2016 or 2017 with complete CVHB measurements were analysed from 7556 school adolescents from four Caribbean countries. Results: The prevalence of 0-1 ideal metrics CVHB was 20.4%, 2 ideal metrics 48.7%, and 3-4 ideal metrics 30.8%. Only 5.0% had all 4 ideal CVHB metrics, 41.0% intermediate CVH (≥1 metric in the intermediate category and none in the poor category), and 54.0% had poor CVH (≥1 metric in poor category). In adjusted logistic regression analysis, compared to students from Dominican Republic, students from Jamaica (Adjusted Odds Ratio-AOR: 1.36, 95% confidence interval-CI: 1.01-1.85), students from Trinidad and Tobago (AOR: 1.46, 95% CI: 1.17-1.82) and male sex (AOR: 1.35, 95% CI: 1.11-1.64) were positively associated with meeting 3-4 ideal CVHB metrics. In addition, in unadjusted analysis, rarely or sometimes experiencing hunger was negatively and high peer and parent support were positively associated with meeting 3-4 ideal CVHB metrics. Conclusion: The proportion of meeting 3-4 ideal CVHB metrics was low among adolescents in four Caribbean countries. Both high-risk and school-wide intervention programmes should be implemented in aiding to improve CVHB in Caribbean countries. Several factors associated with ideal CVHB were identified, which can be targeted in school health interventions.


Asunto(s)
Conducta del Adolescente , Enfermedades Cardiovasculares/prevención & control , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Estilo de Vida Saludable , Conducta de Reducción del Riesgo , Adolescente , Factores de Edad , Índice de Masa Corporal , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Estudios Transversales , Dieta Saludable , República Dominicana/epidemiología , Ejercicio Físico , Femenino , Encuestas Epidemiológicas , 59351 , Humanos , Jamaica/epidemiología , Masculino , No Fumadores , Medición de Riesgo , Suriname/epidemiología , Trinidad y Tobago/epidemiología
18.
Vasc Health Risk Manag ; 17: 195-202, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33976550

RESUMEN

Background: This study aimed to determine the prevalence and correlates of self-reported cardiovascular diseases (SRCVDs) among adults in Ecuador. Methods: National cross-sectional survey data of 4638 persons aged 18-69 years in Ecuador were analysed. Research data were collected with an interview-administered questionnaire, physical and biochemical measurements. Results: The prevalence of SRCVDs was 8.7%, 8.5% among men and 8.9% among women. In adjusted logistic regression analysis, being Montubio (adjusted odds ratio-AOR: 1.66, 95% confidence interval-CI: 1.10-2.50), family alcohol problems (AOR: 1.78, 95% CI: 1.19-2.65), past smoking tobacco (AOR: 1.36, 95% CI: 1.02-1.81), and poor oral health status (AOR: 1.74, 95% CI: 1.19-2.54) were associated with SRCVD. In addition, in unadjusted analysis, older age, alcohol dependence, obesity, and having hypertension were associated with SRCVD. Conclusion: Almost one in ten persons aged 18-69 years had SRCVD in Ecuador. Several associated factors, including Montubio by ethnicity, family alcohol problems, past smoking, and poor oral health status, were identified, which can be targeted in public health interventions.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Estilo de Vida , Autoinforme , Adolescente , Adulto , Anciano , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Enfermedades Cardiovasculares/diagnóstico , Estudios Transversales , Ecuador/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Salud Bucal , Prevalencia , Medición de Riesgo , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiología , Factores de Tiempo , Adulto Joven
19.
Vasc Health Risk Manag ; 17: 203-210, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33981144

RESUMEN

Introduction: Hypertension is a serious medical condition that significantly increases the risks of heart, brain, kidney, and other diseases. The prevalence is highest in Africa (27%) and lowest in America (18%). Hypertension is a major reason for premature death worldwide; this is why it will become a targeted non-communicable disease by 2025. Objective: To assess the prevalence of hypertension and associated factors among adults in Debre Berhan town, Amhara region, Ethiopia. Methods: A community-based cross-sectional study was conducted among 680 participants who were selected by a systematic sampling technique. Data were checked, cleaned, and entered into Epi-data then exported to SPSS-23 for analysis. Hosmer-Lemeshow test was used to check the model fitness. Binary logistic regression analysis was used to see the association between dependent and independent variables. All variables with p <0.25 were taken into the multivariable model to minimize the possible confounders. The multi collinearity test was carried out to see the correlation between independent variables by using a variance inflation factor (VIF). The odds ratio along with 95% CI were estimated to measure the strength of association and to identify factors associated with hypertension using multivariable logistic regression. Descriptive statistics in the form of tables, figures, percent with measure of central tendency and dispersion with multivariable analysis were used to report the findings and to identify the factors associated with the outcome variable at a p<0.05. Results: Among 680 participants, the prevalence of hypertension was 27.5%. Sex, being male (AOR: 1.77, 95% CI: 1.12-2.81), alcohol consumption (AOR: 2.76: 95% CI: 1.87-4.05), physical exercise (AOR: 2.17, 95% CI: 1.28-3.71), being overweight (AOR: 1.99, 95% CI: 1.11-3.58), and family history of hypertension (AOR: 2.10, 95% CI: 1.43-3.08) were found to be significantly associated with hypertension. Conclusion and Recommendation: Prevalence of hypertension in Debre Berhan town was relatively high compared with other studies. So, it is necessary to emphasize intervention in the community for behavioral change, in order to minimize alcohol consumption and to encourage adoption of regular physical exercise, with the existing health system and partners working on hypertension.


Asunto(s)
Hipertensión/epidemiología , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Estudios Transversales , Etiopía/epidemiología , Femenino , Humanos , Hipertensión/diagnóstico , Masculino , Persona de Mediana Edad , Sobrepeso/epidemiología , Prevalencia , Medición de Riesgo , Factores de Riesgo , Conducta Sedentaria , Factores Sexuales , Adulto Joven
20.
J Environ Manage ; 292: 112749, 2021 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-34004503

RESUMEN

In the context of global climate change and increasingly severe environmental pollution, drinking water quality risk assessments to provide crucial early warnings have become essential routine work. At present, traditional water quality assessment methods are commonly used without considering the correlation among different indicators and the substantial uncertainty from multiple sources, which limit their applications. To address this issue, a copula-based Bayesian network (CBN) method was proposed in this study to concretely evaluate the water quality risk with multiple environmental risk indicators in a large drinking water reservoir in Tianjin city, China. Taking rainfall and water temperature (WT) as external environmental risk indicators and pH, ammonia nitrogen (NH3-N), total nitrogen (TN), total phosphorus (TP), and permanganate index (CODMn) as internal environmental risk indicators, the CBN model was constructed to investigate the interaction between the indicators and water quality state and assess the contingent risk. Our results showed that TN and NH3-N should be considered key risk indicators. Additionally, we performed forward and backward risk analyses to assess water quality risk during different seasons and determined the distributions of key indicators under different water quality risk grades. From a time perspective, the reservoir's water quality risk is much higher in winter and spring than in other seasons affected by winter snowfall. From a spatial perspective, the water quality risk is much higher at the reservoir's entrance than at other locations affected by water diversion. Furthermore, we found that the probability of water quality risk events may be relatively high when the TN concentration is 3.6 mg/L to 6.4 mg/L at the reservoir's entrance. The results reveal that the CBN method could be an invaluable decision-support tool for reservoir managers and scientists, which could provide an early warning of water quality degradation by only inputting monitoring data.


Asunto(s)
Contaminantes Químicos del Agua , Calidad del Agua , Teorema de Bayes , China , Monitoreo del Ambiente , Nitrógeno/análisis , Fósforo/análisis , Medición de Riesgo , Ríos , Estaciones del Año , Contaminantes Químicos del Agua/análisis
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