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1.
Braz Oral Res ; 34: e044, 2020 May 08.
Artículo en Inglés | MEDLINE | ID: mdl-32401934

RESUMEN

SARS-CoV-2 is a new virus responsible for the outbreak of the respiratory disease COVID-19, which has spread to several countries around the world, causing considerable consternation and a fear of contagions in global healthcare settings. The objective of this study is to identify, among Madrid's adult population, the impact of COVID-19 on self-perceived vulnerability, infectiousness, aversion to germs, and other behaviors in the current situation regarding dental practice. This cross-sectional observational study involves 1,008 persons randomly surveyed on the streets of Madrid, Spain between March 1 and March 8, 2020. Their perceived vulnerability to disease was measured using the perceived vulnerability to disease scale. An additional questionnaire evaluated basic sociodemographic aspects, medical history, personal hygiene behavior, willingness to go to certain places and the perception of the risk of contagion when going to a dental practice. There are significant differences by sex on the germ aversion subscale (p < 0.05) and in the risk of waiting in the waiting room (p < 0.01), tooth extraction ((p < 0.05), endodontics (p < 0.05) and fillings ((p < 0.05). Women consider the risk to be higher than men do. The risk group (over 60 and with systemic disease) has significant differences on the subscales of infectivity (p < 0.01) and germ aversion (p < 0.01). Our study shows high levels of vulnerability regarding contracting COVID-19 and avoiding dental care as perceived by the population over 60 years old and with a systemic disease.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/transmisión , Atención Odontológica/efectos adversos , Neumonía Viral/transmisión , Medición de Riesgo/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Factores de Riesgo , Autoinforme , Distribución por Sexo , Factores Socioeconómicos , España , Estadísticas no Paramétricas , Adulto Joven
2.
Medicine (Baltimore) ; 99(9): e19352, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118775

RESUMEN

Serum albumin is a marker of nutritional and frailty status. This study aimed to assess the association between serum albumin at the time of admission and the risk of acute respiratory failure (ARF) in hospitalized patientsThis cohort study, performed at a tertiary referral hospital, included all hospitalized adult patients from January 2009 to December 2013 who had serum albumin measurement and were not on mechanical ventilation within 24 hours of hospital admission. Serum albumin was stratified into 2.4, 2.5 to 2.9, 3.0 to 3.4, 3.5 to 3.9, 4.0 to 4.4, and ≥4.5 g/dL. Multivariate logistic regression analysis was performed to obtain adjusted odds ratio (OR) of risk of ARF requiring mechanical ventilation based on various admission serum albumin levels.Of 12,719 patients, ARF requiring mechanical ventilation occurred in 1128 (8.9%) during hospitalization. Hypoalbuminemia was associated with increased risk of ARF, in particular when serum albumin was ≤2.4 g/dL. Compared with serum albumin of 4.0-4.4 g/dL, serum albumin ≤2.4 g/dL at admission was associated with 2.38-time higher odds of ARF during hospitalization (OR 2.38, 95% confidence interval [CI] 1.84-3.07). In contrast, elevated serum albumin ≥4.5 g/dL was associated with lower odds of ARF (OR 0.68, 95% CI 0.48-0.97).Admission serum albumin level lower than 3.5 g/dL was associated with a higher risk of ARF requiring mechanical ventilation, whereas elevated serum albumin level at least 4.5 g/dL was associated with a lower risk of ARF. Therefore, admission albumin level at admission might be useful in the prediction of ARF during hospitalization.


Asunto(s)
Hospitalización/estadística & datos numéricos , Síndrome de Dificultad Respiratoria del Adulto/sangre , Medición de Riesgo/métodos , Albúmina Sérica/análisis , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Minnesota/epidemiología , Oportunidad Relativa , Síndrome de Dificultad Respiratoria del Adulto/epidemiología , Estudios Retrospectivos , Medición de Riesgo/normas , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo
3.
Ann Rheum Dis ; 79(3): 324-331, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31980546

RESUMEN

OBJECTIVES: To gain expert-judgement-free insight into the Gestalt of axial spondyloarthritis (axSpA), by investigating its 'latent constructs' and to test how well these latent constructs fit the Assessment of SpondyloArthritis international Society (ASAS) classification criteria. METHODS: Two independent cohorts of patients with early onset chronic back pain (SPondyloArthritis Caught Early (SPACE)) or inflammatory back pain (IBP) (DEvenir des Spondylarthopathies Indifférenciées Récentes (DESIR)) were analysed. Latent class analysis (LCA) was used to estimate the (unobserved) potential classes underlying axSpA. The best LCA model groups patients into clinically meaningful classes with best fit. Each class was labelled based on most prominent features. Percentage fulfilment of ASAS axSpA, peripheral SpA (pSpA) (ignoring IBP) or both classification criteria was calculated. Five-year data from DESIR were used to perform latent transition analysis (LTA) to examine if patients change classes over time. RESULTS: SPACE (n=465) yielded four discernible classes: 'axial' with highest likelihood of abnormal imaging and HLA-B27 positivity; 'IBP+peripheral' with 100% IBP and dominant peripheral symptoms; 'at risk' with positive family history and HLA-B27 and 'no SpA' with low likelihood for each SpA feature. LCA in DESIR (n=576) yielded similar classes, except for the 'no-SpA'. The ASAS axSpA criteria captured almost all (SPACE: 98%; DESIR: 93%) 'axial' patients, but the 'IBP+peripheral' class was only captured well by combining the axSpA and pSpA criteria (SPACE: 78%; DESIR: 89%). Only 4% of 'no SpA' patients fulfilled the axSpA criteria in SPACE. LTA suggested that 5-year transitions across classes were unlikely (11%). CONCLUSION: The Gestalt of axSpA comprises three discernible entities, only appropriately captured by combining the ASAS axSpA and pSpA classification criteria. It is questionable whether some patients with 'axSpA at risk' will ever develop axSpA.


Asunto(s)
Dolor de Espalda/diagnóstico , Dolor Crónico/diagnóstico , Medición de Riesgo/estadística & datos numéricos , Espondiloartritis/diagnóstico , Adulto , Dolor de Espalda/clasificación , Dolor Crónico/clasificación , Estudios de Cohortes , Femenino , Antígeno HLA-B27/sangre , Humanos , Análisis de Clases Latentes , Masculino , Reproducibilidad de los Resultados , Medición de Riesgo/métodos , Espondiloartritis/clasificación
4.
BMJ ; 368: l7057, 2020 01 29.
Artículo en Inglés | MEDLINE | ID: mdl-31996343

RESUMEN

OBJECTIVE: To study the impact of maternal smoking during pregnancy on fractures in offspring during different developmental stages of life. DESIGN: National register based birth cohort study with a sibling comparison design. SETTING: Sweden. PARTICIPANTS: 1 680 307 people born in Sweden between 1983 and 2000 to women who smoked (n=377 367, 22.5%) and did not smoke (n=1 302 940) in early pregnancy. Follow-up was until 31 December 2014. MAIN OUTCOME MEASURE: Fractures by attained age up to 32 years. RESULTS: During a median follow-up of 21.1 years, 377 970 fractures were observed (the overall incidence rate for fracture standardised by calendar year of birth was 11.8 per 1000 person years). The association between maternal smoking during pregnancy and risk of fracture in offspring differed by attained age. Maternal smoking was associated with a higher rate of fractures in offspring before 1 year of age in the entire cohort (birth year standardised fracture rates in those exposed and unexposed to maternal smoking were 1.59 and 1.28 per 1000 person years, respectively). After adjustment for potential confounders the hazard ratio for maternal smoking compared with no smoking was 1.27 (95% confidence interval 1.12 to 1.45). This association followed a dose dependent pattern (compared with no smoking, hazard ratios for 1-9 cigarettes/day and ≥10 cigarettes/day were 1.20 (95% confidence interval 1.03 to 1.39) and 1.41 (1.18 to 1.69), respectively) and persisted in within-sibship comparisons although with wider confidence intervals (compared with no smoking, 1.58 (1.01 to 2.46)). Maternal smoking during pregnancy was also associated with an increased fracture incidence in offspring from age 5 to 32 years in whole cohort analyses, but these associations did not follow a dose dependent gradient. In within-sibship analyses, which controls for confounding by measured and unmeasured shared familial factors, corresponding point estimates were all close to null. Maternal smoking was not associated with risk of fracture in offspring between the ages of 1 and 5 years in any of the models. CONCLUSION: Prenatal exposure to maternal smoking is associated with an increased rate of fracture during the first year of life but does not seem to have a long lasting biological influence on fractures later in childhood and up to early adulthood.


Asunto(s)
Fracturas Óseas , Mujeres Embarazadas/psicología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Fumar , Adulto , Factores de Edad , Niño , Correlación de Datos , Femenino , Fracturas Óseas/diagnóstico , Fracturas Óseas/epidemiología , Humanos , Lactante , Masculino , Embarazo , Sistema de Registros/estadística & datos numéricos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiología , Suecia/epidemiología
5.
JAMA Netw Open ; 3(1): e1919935, 2020 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-31995212

RESUMEN

Importance: Understanding suicide ideation (SI) during combat deployment can inform prevention and treatment during and after deployment. Objective: To examine associations of sociodemographic characteristics, lifetime and past-year stressors, and mental disorders with 30-day SI among a representative sample of US Army soldiers deployed in Afghanistan. Design, Setting, and Participants: In this survey study, soldiers deployed to Afghanistan completed self-administered questionnaires in July 2012. The sample was weighted to represent all 87 032 soldiers serving in Afghanistan. Prevalence of lifetime, past-year, and 30-day SI and mental disorders was determined. Logistic regression analyses examined risk factors associated with SI. Data analyses for this study were conducted between August 2018 and August 2019. Main Outcomes and Measures: Suicide ideation, lifetime and 12-month stressors, and mental disorders were assessed with questionnaires. Administrative records identified sociodemographic characteristics and suicide attempts. Results: A total of 3957 soldiers (3473 [weighted 87.5%] male; 2135 [weighted 52.6%] aged ≤29 years) completed self-administered questionnaires during their deployment in Afghanistan. Lifetime, past-year, and 30-day SI prevalence estimates were 11.7%, 3.0%, and 1.9%, respectively. Among soldiers with SI, 44.2% had major depressive disorder (MDD) and 19.3% had posttraumatic stress disorder in the past 30-day period. A series of analyses of the 23 grouped variables potentially associated with SI resulted in a final model of sex; race/ethnicity; lifetime noncombat trauma; past 12-month relationship problems, legal problems, and death or illness of a friend or family member; and MDD. In this final multivariable model, white race/ethnicity (odds ratio [OR], 3.1 [95% CI, 1.8-5.1]), lifetime noncombat trauma (OR, 2.1 [95% CI, 1.1-4.0]), and MDD (past 30 days: OR, 31.8 [95% CI, 15.0-67.7]; before past 30 days: OR, 4.9 [95% CI, 2.5-9.6]) were associated with SI. Among the 85 soldiers with past 30-day SI, from survey administration through 12 months after returning from deployment, 6% (5 participants) had a documented suicide attempt vs 0.14% (6 participants) of the 3872 soldiers without SI. Conclusions and Relevance: This study suggests that major depressive disorder and noncombat trauma are important factors in identifying SI risk during combat deployment.


Asunto(s)
Personal Militar/psicología , Trastornos por Estrés Postraumático/psicología , Ideación Suicida , Suicidio/psicología , Adaptación Psicológica , Adulto , Campaña Afgana 2001- , Factores de Edad , Femenino , Humanos , Masculino , Personal Militar/estadística & datos numéricos , Resiliencia Psicológica , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Trastornos por Estrés Postraumático/epidemiología , Suicidio/estadística & datos numéricos , Adulto Joven
6.
Cancer Invest ; 38(2): 130-138, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985314

RESUMEN

Background: Pembrolizumab as an immune checkpoint inhibitor (ICI) has emerged as an effective treatment for many cancers. It has unique immune-related adverse events (irAE) and little is known about its risk of fatal adverse events (FAEs). We conducted a meta-analysis of clinical trials to determine the incidence and risk of FAEs with pembrolizumab.Methods: A systematic search for phase I-III clinical trials of pembrolizumab was conducted using databases including PUBMED and abstracts presented at the American Society of Clinical Oncology (ASCO) conferences until October 2018. Eligible studies included prospective clinical trials of pembrolizumab with available data on FAE. Data on FAE was extracted from each study and pooled for calculations. Incidence, relative risk (RR) and 95% confidence intervals (CI) were calculated by employing fixed or random-effects models.Results: A total of 11 clinical trials with 3713 patients were included for analysis. The overall incidence of FAE with pembrolizumab was 1.2% (95% CI: 0.5-2.8%). The incidence of FAE significantly varied among different tumor types (p = .02), ranging from 0.2% in melanoma to 3.1% in breast cancer, and with its combination with chemotherapy (0.7%, 95% CI: 0.4-1.2% versus 7.0%, 95% CI: 4.9-10%; p<.01). Chemotherapy plus pembrolizumab 7.0% (95%CI: 4.9-10) as compared to pembrolizumab alone 0.7%, (95% CI: 0.4-1.2; p < .001). There was no significant difference in the risk of FAEs when pembrolizumab was compared with chemotherapy with RR = 1.24 (95% CI: 0.8-1.89; p = .31). The most common FAEs were due to infectious complication (26.5%), cardiac toxicity (14.7%) and pneumonitis (13.2%).Conclusions: The risk of FAEs with pembrolizumab may be similar to chemotherapy in cancer patients and may vary with tumor types and its combination with chemotherapy.


Asunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Antineoplásicos Inmunológicos/efectos adversos , Ensayos Clínicos como Asunto/estadística & datos numéricos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Neoplasias/tratamiento farmacológico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/diagnóstico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Humanos , Incidencia , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo
7.
PLoS One ; 15(1): e0227609, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31935238

RESUMEN

In order to quantitatively analyze the influence of different traffic conditions on highway crash risk, a method of crash risk assessment based on traffic safety state division is proposed in this paper. Firstly, the highway crash data and corresponding traffic data of upstream and downstream are extracted and processed by using the matched case-control method to exclude the influence of other factors on the model. Secondly, considering the weight of traffic volume, speed and occupancy, a multi-parameter fusion cluster method is applied to divide traffic safety state. In addition, the quantitative relationship between different traffic states and highway crash risk is analyzed by using Bayesian conditional logistic regression model. Finally, the results of case study show that different traffic safety conditions are in different crash risk levels. The highway traffic management department can improve the safety risk management level by focusing on the prevention and control of high-risk traffic safety conditions.


Asunto(s)
Accidentes de Tránsito/prevención & control , Medición de Riesgo/métodos , Accidentes de Tránsito/estadística & datos numéricos , Conducción de Automóvil/estadística & datos numéricos , Teorema de Bayes , Planificación Ambiental , Humanos , Modelos Logísticos , Medición de Riesgo/estadística & datos numéricos , Seguridad , Administración de la Seguridad/estadística & datos numéricos
8.
Dis Colon Rectum ; 63(2): 135-142, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31914110

RESUMEN

BACKGROUND: The College of American Pathologists has published guidelines for malignant colorectal polyp pathology reports that list histopathological features that are "core elements" and "optional." Lack of element reporting may result in inaccurate tumor risk stratification.This study aimed to perform a population-based assessment of pathology reporting for T1 colorectal cancers and determine the completeness of reporting for core and optional histopathological elements.This is a retrospective cohort study.This study reviews the pathology reports of endoscopically resected malignant colorectal polyps in Alberta, Canada between 2014 and 2016.Individuals aged 18 years or older with T1 colorectal polyps were selected.Histopathological elements were dichotomized into core and optional. Malignant polyps were classified as high risk or low risk for lymph node metastases and local intraluminal recurrence. Addendum reports were compared with first reports.After applying exclusion criteria, 431 polyps were analyzed. The mean age of patients was 65.5 years; 59.4% were male. Histological grade, deep margin, and lymphovascular invasion were reported in 82.4%, 86.8% and 75.6%; all 3 were reported in only 66.4%. Tumor budding (not in the 2016 guidelines) was reported in 14.4%. One hundred ninety polyps (44.1%) were high risk. Thirty-seven polyps (8.3%) had an addendum report. Following the addendum, 1 polyp was downgraded to low risk, and 9 polyps were upgraded to high risk.The main limitation of the study is its retrospective nature. The decision making surrounding treatment for T1 cancers is complex, and factors other than histopathological tumor features may have been part of treatment decisions.There is a high rate of incomplete reporting of core and optional elements for malignant colorectal polyp pathology reports in Alberta. Several variables used by colorectal surgeons for decision making, such as tumor budding and depth of submucosal invasion, are not considered core elements and are infrequently reported. A pathology review by a second pathologist often results in a change in risk stratification. See Video Abstract at http://links.lww.com/DCR/B98. PATOLOGÍA DEL PÓLIPO COLORRECTAL MALIGNO: ¿ESTAMOS OBTENIENDO INFORMACIÓN SUFICIENTE PARA TOMAR DECISIONES?: El Colegio de Patólogos Americanos publico pautas para informes de patología de pólipos colorrectales malignos que enumeran características histopatológicas como "elementos centrales" y "opcionales". La falta de información elemental puede resultar en una estratificación de riesgo tumoral imprecisa.Valoración basada en una población de los informes de patología para los cánceres colorrectales T1 y determinar la precisión de los informes en cuanto los elementos histopatológicos centrales y opcionales.Estudio de cohorte retrospectivo.Este estudio revisa los informes de patología de pólipos colorrectales malignos resecados endoscópicamente en Alberta, Canadá, entre 2014 y 2016.personas mayores de 18 años con pólipos colorrectales T1.Los elementos histopatológicos se dicotomizaron entre elementales y opcionales. Pólipos malignos se clasificaron como de alto riesgo o bajo riesgo de metástasis en los ganglios linfáticos y recurrencia intraluminal local. Los informes enmendados se compararon con los informes originales.Después de aplicar los criterios de exclusión, se analizaron 431 pólipos. La edad media fue 65.5 años, con 59.4% masculinos. El grado histológico, el margen profundo y la invasión linfovascular se informaron confirmaron en 82.4%, 86.8% y 75.6% respectivamente; las tres características se demostraron en solo 66.4%. Un patrón tumoral en ciernes se reporto en 14.4-una característica que no se usaba en las guías de 2016. Ciento noventa pólipos (44.1%) eran de alto riesgo. Treinta y siete pólipos (8.3%) requirieron de un informe enmendado. Aplicación de los nuevos criterios resulto en que 1 pólipo se redujo a bajo riesgo y 9 pólipos se actualizaron como a alto riesgo.La principal limitación del estudio es el diseño retrospectivo. La toma de decisiones en torno al tratamiento de los cánceres T1 es compleja y otros factores además de las características histopatológicas del tumor pueden haber sido parte de las decisiones terapéuticas.Hay una alta tasa de informes incompletos de elementos centrales y opcionales para informes de patología de pólipos colorrectales malignos en Alberta. Algunas variables utilizadas por los cirujanos colorrectales para la toma de decisiones, como el patrón tumoral en ciernes y la profundidad de la invasión submucosa, no se consideran elementos centrales y se informan con poca frecuencia. Una revisión de patología realizada por un segundo patólogo a menudo resulta en un cambio en la estratificación del riesgo. Consulte Video Resumen en http://links.lww.com/DCR/B98. (Traducción-Dr. Adrian E. Ortega).


Asunto(s)
Pólipos del Colon/patología , Neoplasias Colorrectales/patología , Toma de Decisiones/fisiología , Ganglios Linfáticos/patología , Adulto , Anciano , Anciano de 80 o más Años , Canadá/epidemiología , Pólipos del Colon/epidemiología , Pólipos del Colon/cirugía , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/cirugía , Endoscopía/métodos , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias/métodos , Estudios Retrospectivos , Medición de Riesgo/estadística & datos numéricos
9.
Urology ; 135: 117-123, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31568795

RESUMEN

OBJECTIVE: To elucidate the accuracy of MRI and MRI-ultrasound fusion guided targeted biopsy (TBx) on risk stratification in men who underwent subsequent radical prostatectomy (RP). MATERIALS AND METHODS: A single-center, retrospective study was performed in men at risk for prostate cancer who (n = 140) underwent TBx and RP between November 2012 and August 2018. Comparisons were made between patients clinically staged by preoperative MRI and TBx Gleason grade group (GGG) and stage after RP. Multivariable regression was performed to identify factors associated with MRI and TBx compared to RP grading, staging, and consistency with National Comprehensive Cancer Network (NCCN) risk stratification. RESULTS: There was an increase in NCCN risk stratification in 47 men (33.6%) and a decrease in 17 men (12.1%) compared to the resected prostate. GGG upgrading and downgrading occurred in 35 (25.0%) and 31 men (22.1%), respectively. Upstaging occurred in 41 men (29.3%). In adjusted analysis for age, BMI, PSA Density (PSAD), median maximal diameter of the regions of interest, and PIRADS, men with PIRADS 4 were less likely to be upgraded (OR 0.26, 95% CI 0.08-0.81, P = .020) than PIRADS 3. PSAD ≥ 0.15 ng/mL/cc was associated with upstaging (OR 3.92, 95% CI 1.60-9.62, P = .003). CONCLUSION: Accurate risk stratification is critical for disease management, mandated by the increasing use of active surveillance, partial gland ablation, and androgen deprivation therapy with radiation therapy for men with unfavorable intermediate and high-risk prostate cancer. This study confirms the need for advances in imaging and biomarker to increase the accuracy of pretreatment staging.


Asunto(s)
Imagen Multimodal/métodos , Próstata/patología , Prostatectomía , Neoplasias de la Próstata/diagnóstico , Anciano , Biopsia con Aguja Gruesa/estadística & datos numéricos , Humanos , Biopsia Guiada por Imagen/estadística & datos numéricos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Próstata/diagnóstico por imagen , Próstata/cirugía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Ultrasonografía Intervencional/métodos
10.
BJOG ; 127(3): 389-395, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31794098

RESUMEN

OBJECTIVE: Presence of lung metastases in low-risk gestational trophoblastic neoplasia (GTN) is generally considered not to influence prognosis. However, in a recent study in the Netherlands, GTN patients with lung metastases had a higher recurrence rate and more disease-specific deaths compared with patients without metastases. The aim of the present study was to validate these findings in a different country. DESIGN: Historical cohort study. SETTING: Charing Cross Hospital, United Kingdom. POPULATION: A total of 1040 low-risk GTN patients treated with methotrexate (MTX) between 2002 and 2016 were identified: 65 with lung metastases (group 1) and 975 without metastases (group 2). METHODS: Baseline characteristics, MTX resistance, survival and recurrence rates were recorded and compared between both groups. MAIN OUTCOME MEASURES: MTX resistance, recurrence rate and survival. RESULTS: The occurrence of MTX resistance and median number of MTX courses to achieve remission was significantly higher in patients with lung metastases than patients without metastases (60% versus 38.9%, P = 0.001; and nine versus six courses, P < 0.001). All choriocarcinoma patients (n = 4) with lung metastases developed MTX resistance. The recurrence rate was also higher in group I (9.2% versus 2.7%; P = 0.012). Disease-specific survival was 100% in both groups. CONCLUSIONS: The presence of lung metastases at the start of MTX therapy is associated with increased incidence of MTX resistance and recurrence in low-risk GTN without affecting overall survival, which remains 100%. However, individuals with low-risk choriocarcinoma with lung metastases are likely to become resistant to MTX and primary multi-agent chemotherapy should be considered. TWEETABLE ABSTRACT: The presence of lung metastases appears to increase the risk of recurrence in low-risk GTN, but does not affect overall cure rates and survival.


Asunto(s)
Coriocarcinoma , Resistencia a Antineoplásicos/efectos de los fármacos , Enfermedad Trofoblástica Gestacional , Neoplasias Pulmonares , Metotrexato , Adulto , Antimetabolitos Antineoplásicos/administración & dosificación , Antimetabolitos Antineoplásicos/efectos adversos , Coriocarcinoma/tratamiento farmacológico , Coriocarcinoma/patología , Estudios de Cohortes , Femenino , Enfermedad Trofoblástica Gestacional/tratamiento farmacológico , Enfermedad Trofoblástica Gestacional/patología , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/secundario , Metotrexato/administración & dosificación , Metotrexato/efectos adversos , Persona de Mediana Edad , Estadificación de Neoplasias , Países Bajos/epidemiología , Embarazo , Recurrencia , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Reino Unido/epidemiología
11.
Biochim Biophys Acta Rev Cancer ; 1873(1): 188326, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31707038

RESUMEN

Pancreatic cancer is one of the leading determinants of global cancer mortality, and its incidence is predicted to increase, to become in 2030 the second most common cause of cancer-related death. Obesity and diabetes are recognized risk factors for the development of pancreatic cancer. In the last few decades an epidemic of diabetes and obesity has been spreading worldwide, forewarning an increase in incidence of pancreatic cancer. This review considers the most recent literature, covering the multiple molecular axis linking these three pathologies, aiming to draw a more comprehensive view of pancreatic cancer for a better theragnostic stratification of the population.


Asunto(s)
Diabetes Mellitus/epidemiología , Epidemias/estadística & datos numéricos , Obesidad/epidemiología , Neoplasias Pancreáticas/epidemiología , Comorbilidad , Epidemias/prevención & control , Humanos , Incidencia , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo
12.
Int J Cancer ; 146(3): 819-828, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30980681

RESUMEN

Large, comprehensive studies of the risk for neurologic disorders among long-term survivors of noncentral nervous system (CNS) childhood cancers are lacking. Thus, the aim of our study was to assess the lifetime risk of Nordic non-CNS childhood cancer survivors for neurologic disorders. We identified 15,967 5-year survivors of non-CNS childhood cancer diagnosed in Denmark, Iceland, Finland and Sweden in 1943-2008, and 151,118 matched population comparison subjects. In-patient discharge diagnoses of neurologic disorders were used to calculate relative risks (RRs) and absolute excess risks (AERs). A neurologic disorder was diagnosed in 755 of the survivors while 370 were expected, yielding a RR of 2.0 (95% confidence interval (CI) 1.9-2.2). The highest risks were found among survivors of neuroblastoma (4.1; 95% CI 3.2-5.3) and leukemia (2.8; 95% CI 2.4-3.2). The AER decreased from 331 (278-383) excess neurologic disorders per 100,000 person-years 5-9 years after diagnosis to 82 (46-118) ≥ 20 years after diagnosis. Epilepsy was the most common diagnosis (n = 229, 1.4% of all survivors), and significantly increased risks were seen among survivors of eight out of 12 types of childhood cancer. Survivors of neuroblastoma had remarkably high risks (RR ≥ 10) for hospitalization for paralytic syndromes and hydrocephalus, while survivors of leukemia had additional high risks for dementia and encephalopathy. In conclusion, survivors of non-CNS childhood cancer are at high risk for neurologic disorders, especially within the first decade after diagnosis. Therefore, intensive follow-up to identify those who require close management is needed.


Asunto(s)
Supervivientes de Cáncer/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Enfermedades del Sistema Nervioso/epidemiología , Neoplasias del Sistema Nervioso/complicaciones , Adolescente , Adulto , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/terapia , Neoplasias del Sistema Nervioso/mortalidad , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo/estadística & datos numéricos , Países Escandinavos y Nórdicos/epidemiología , Adulto Joven
13.
Int J Cancer ; 146(3): 617-626, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30861114

RESUMEN

US guidelines recommend that most women older than 65 years cease cervical screening after two consecutive negative cotests (concurrent HPV and cytology tests) in the previous 10 years, with one in the last 5 years. However, this recommendation was based on expert opinion and modeling rather than empirical data on cancer risk. We therefore estimated the 5-year risks of cervical precancer (cervical intraepithelial neoplasia grade 3 or adenocarcinoma in situ [CIN3]) after one, two and three negative cotests among 346,760 women aged 55-64 years undergoing routine cotesting at Kaiser Permanente Northern California (2003-2015). Women with a history of excisional treatment or CIN2+ were excluded. No woman with one or more negative cotests was diagnosed with cancer during follow-up. Five-year risks of CIN3 after one, two, and three consecutive negative cotests were 0.034% (95% CI: 0.023%-0.046%), 0.041% (95% CI: 0.007%-0.076%) and 0.016% (95% CI: 0.000%-0.052%), respectively (ptrend < 0.001). These risks did not appreciably differ by a positive cotest result prior to the one, two or three negative cotest(s). Since CIN3 risks after one or more negative cotests were significantly below a proposed 0.12% CIN3+ risk threshold for a 5-year screening interval, a longer screening interval in these women is justified. However, the choice of how many negative cotests provide sufficient safety against invasive cancer over a woman's remaining life represents a value judgment based on the harms versus benefits of continued screening. Ideally, this guideline should be informed by longer-term follow-up given that exiting is a long-term decision.


Asunto(s)
Adenocarcinoma in Situ/epidemiología , Neoplasia Intraepitelial Cervical/epidemiología , Infecciones por Papillomavirus/epidemiología , Lesiones Precancerosas/epidemiología , Neoplasias del Cuello Uterino/prevención & control , Adenocarcinoma in Situ/diagnóstico , Adenocarcinoma in Situ/patología , California/epidemiología , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/patología , Cuello del Útero/patología , Detección Precoz del Cáncer/normas , Femenino , Humanos , Tamizaje Masivo/normas , Persona de Mediana Edad , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/virología , Guías de Práctica Clínica como Asunto , Lesiones Precancerosas/diagnóstico , Lesiones Precancerosas/patología , Estudios Prospectivos , Medición de Riesgo/estadística & datos numéricos , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/patología
14.
Hipertens. riesgo vasc ; 36(4): 193-198, oct.-dic. 2019. tab
Artículo en Español | IBECS | ID: ibc-188309

RESUMEN

Objetivos: Analizar la prevalencia de la hipertensión arterial (HTA), el valor de la presión arterial sistólica (PAS), el de la presión arterial diastólica (PAD) y el score de riesgo vascular de Framingham (FRS) en los sujetos con obstrucción venosa retiniana (OVR) y un grupo control. Pacientes y método: Estudio prospectivo de casos y controles (transversal) de todos los pacientes con el diagnóstico de OVR remitidos a la consulta de medicina interna, comparándolos con un grupo control. Se analizaron las variables clínicas y de laboratorio. Resultados: Se estudiaron 253 pacientes con OVR (132 varones y 121 mujeres) y 244 controles (112 varones y 132 mujeres) de edad similar (67,9±12,3 vs. 68,1±9,2 años). La prevalencia de HTA, el valor de la PAS y el de la PAD en la consulta tras la OVR fueron significativamente mayores en los pacientes con OVR que en los controles (71,5% vs. 51,2%), PAS mmHg (148±22 vs. 138±18mmHg), PAD mmHg (83±10 vs. 77±10mmHg). El diagnóstico de la HTA se realizó de novo a partir de la OVR en el 23,8% de los casos. Se encontraron diferencias significativas en el FRS entre los pacientes con OVR y los controles 11±8,3 vs. 8,25±6,3. No hubo diferencias en ninguno de los parámetros estudiados entre los pacientes con OVR periférica y central. Conclusiones: La hipertensión es muy prevalente y significativamente más frecuente en los pacientes con OVR que en los controles. El diagnóstico y tratamiento de la misma se establece frecuentemente a partir de la OVR. El FRS es mayor en los pacientes con OVR. No hay diferencias en los parámetros estudiados entre los sujetos con OVR central y periférica. Sugerimos considerar la OVR un evento vascular a la hora de definir los objetivos terapéuticosl


Objectives: To determine the prevalence of arterial hypertension (AHT), systolic blood pressure (SBP), the diastolic blood pressure (DPB), and the Framingham vascular risk score (FRS), in subjects with retinal vein occlusion (RVO), as well as in a control group. Patients and method: A prospective, cross-sectional case and control study was conducted on all patients with a diagnosis of RVO referred to the General Medicine Clinic, and comparing them with a control group. An analysis was performed on the clinical and laboratory variables. Results: A total of 253 patients with RVO were studied (132 males and 121 females) and 244 controls (112 males and 132 females) of similar age (67.9±12.3 vs. 68.1±9.2 años). The prevalence of AHT, and the SBP and DPB values in the clinic after the RVO were significantly higher in patients with RVO than in the controls (71.5% vs. 51.2%), SBP mmHg (148±22 vs. 138±18mmHg), DBP mmHg (83±10 vs. 77±10mmHg). The de novo diagnosis of AHT was made from the RVO in 23.8% of the cases. Significant differences were found in the FRS between the patients with RVO and the controls (11±8.3 vs. 8.25±6.3. There were no differences in any of the parameters studied between patients with peripheral or central RVO. Conclusions: Hypertension is very prevalent as significantly more common in patients with RVO than in controls. Its diagnosis and treatment is often established from the RVO. The FRS is greater in patients with RVO. There were no differences in any of the parameters studied between patients with peripheral or central RVO. It is suggested that RVO should be considered a vascular event when defining therapeutic objectives


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Hipertensión/epidemiología , Oclusión de la Vena Retiniana/epidemiología , Factores de Riesgo , Medición de Riesgo/estadística & datos numéricos , Hipertensión/diagnóstico , Oclusión de la Vena Retiniana/diagnóstico , Oclusión de la Vena Retiniana/terapia , Presión Sanguínea , Estudios Prospectivos , Estudios de Casos y Controles
15.
Artículo en Inglés | MEDLINE | ID: mdl-31878182

RESUMEN

The article presents an assessment of the long-term variability of storm activity in the aspect of potential threats to aircraft. The analysis of data from the period 1970-2018 was conducted for selected airports in Poland: Gdansk Lech Walesa Airport, IATA code: GDN, ICAO code: EPGD (54°22'39″N 18°27'59″E, altitude above sea level 149 m above sea level); Solidarity Szczecin- Goleniow Airport, IATA code: SZZ, ICAO code: EPSC (53°35'05″ N 14°54'08″ E, altitude above sea level 47 m above sea level); Poznan-Lawica Henryk Wieniawski Airport, IATA code: POZ, ICAO code: EPPO (52°25'16″ N 16°49'35″ E, altitude above sea level 94 m above sea level); Warsaw Chopin Airport, IATA code: WAW, ICAO code: EPWA (52°09'57″ N 20°58'02″ E, altitude above sea level 110 m above sea level); Copernicus Airport Wroclaw, IATA code: WRO, ICAO code: EPWR (51°06'10″ N 16°53'10″ E, altitude above sea level 123 m above sea level); John Paul II International Airport Kraków-Balice, IATA code: KRK, ICAO code: EPKK (50°04'40″ N 19°47'06″ E, altitude above sea level 241 m above sea level). The purpose of this paper is to assess the long-term variability of storm activity in the aspect of potential threats to air operations in Poland with the examples of six selected airports. In order to achieve the goal, an analysis of the frequency of storm phenomena in Poland was carried out both in annual and long- term terms. The analysis will allow the assessment of the geographical diversity of the distribution of storm phenomena and their variability in the years 1970-2018. The next stage of the work will be to determine the climatic conditions that exert the greatest impact on the formation of storms. The important factors include atmospheric circulation, which, over the Polish territory, is shaped by the influence of air masses from the Atlantic Ocean, the Baltic Sea and in addition, from the vast continental area. All these air masses clash over the area of Poland causing large variability in the frequency of occurrence of hazardous atmospheric phenomena. For this reason, the Polish climate is defined as a moderate warm climate with transitory features. The important factors affecting regional diversity are local conditions, such as terrain, nature of the land, and distance from water reservoirs. The thermal, humidity and aerodynamic properties of the substrate, which are components of radiation processes, determine the exchange of energy at the interface between the atmosphere and the earth, and largely determine the intensity of selected hazardous atmospheric phenomena. Each occurrence of a storm is a potentially dangerous meteorological event that threatens the environment and human activities, including all types of transport. The studied phenomenon of storms is particularly dangerous for air transport. Literature shows that storm phenomena in Poland are characterized by a large regional diversity, both during the year and over many years. The greatest threat of storm phenomena occurs in the warm period of the year-spring and summer.


Asunto(s)
Aeronaves/estadística & datos numéricos , Aeropuertos/estadística & datos numéricos , Aeropuertos/tendencias , Tormentas Ciclónicas/estadística & datos numéricos , Medición de Riesgo/estadística & datos numéricos , Medición de Riesgo/tendencias , Estaciones del Año , Predicción , Meteorología , Polonia
16.
PLoS One ; 14(12): e0226352, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31841563

RESUMEN

BACKGROUND: The effectiveness of breast cancer screening is still under debate. Our objective was to systematically review studies assessing personalized breast cancer screening strategies based on women's individual risk and to conduct a risk of bias assessment. METHODS: We followed the standard methods of The Cochrane Collaboration and PRISMA declaration and searched the MEDLINE, EMBASE and Clinical Trials databases for studies published in English. The quality of the studies was assessed using the ISPOR-AMCP-NPC Questionnaire and The Cochrane Risk of Bias Tool. Two independent reviewers screened full texts and evaluated the risk of bias. RESULTS: Out of the 1533 initially retrieved citations, we included 13 studies. Three studies were randomized controlled trials, while nine were mathematical modeling studies, and one was an observational pilot study. The trials are in the recruitment phase and have not yet reported their results. All three trials used breast density and age to define risk groups, and two of them included family history, previous biopsies, and genetic information. Among the mathematical modeling studies, the main risk factors used to define risk groups were breast density, age, family history, and previous biopsies. Six studies used genetic information to define risk groups. The most common outcome measures were the gain in quality-adjusted life years (QALY), absolute costs, and incremental cost-effectiveness ratio (ICER), while the main outcome in the observational study was the detection rate. In all models, personalized screening strategies were shown to be effective. The randomized trials were of good quality. The modeling studies showed moderate risk of bias but there was wide variability across studies. The observational study showed a low risk of bias but its utility was moderate due to its pilot design and its relatively small scale. CONCLUSIONS: There is some evidence of the effectiveness of screening personalization in terms of QUALYs and ICER from the modeling studies and the observational study. However, evidence is lacking on feasibility and acceptance by the target population. REVIEW REGISTRATION: PROSPERO: CRD42018110483.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Detección Precoz del Cáncer/métodos , Medicina de Precisión/métodos , Neoplasias de la Mama/economía , Neoplasias de la Mama/epidemiología , Análisis Costo-Beneficio , Detección Precoz del Cáncer/economía , Detección Precoz del Cáncer/estadística & datos numéricos , Femenino , Humanos , Modelos Teóricos , Estudios Observacionales como Asunto/estadística & datos numéricos , Proyectos Piloto , Medicina de Precisión/economía , Medicina de Precisión/estadística & datos numéricos , Años de Vida Ajustados por Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Medición de Riesgo/economía , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos
17.
BMJ ; 367: l6109, 2019 11 13.
Artículo en Inglés | MEDLINE | ID: mdl-31722884

RESUMEN

OBJECTIVE: To review and summarise the evidence on the prevalence of colorectal adenomas and cancers at a follow-up screening colonoscopy after negative index colonoscopy, stratified by interval between examinations and by sex. DESIGN: Systematic review and meta-analysis of all available studies. DATA SOURCES: PubMed, Web of Science, and Embase. Two investigators independently extracted characteristics and results of identified studies and performed standardised quality ratings. ELIGIBILITY CRITERIA: Studies assessing the outcome of a follow-up colonoscopy among participants at average risk for colorectal cancer with a negative previous colonoscopy (no adenomas). RESULTS: 28 studies were identified, including 22 cohort studies, five cross sectional studies, and one case-control study. Findings for an interval between colonoscopies of one to five, five to 10, and more than 10 years were reported by 17, 16, and three studies, respectively. Summary estimates of prevalences of any neoplasm were 20.7% (95% confidence interval 15.8% to 25.5%), 23.0% (18.0% to 28.0%), and 21.9% (14.9% to 29.0%) for one to five, five to 10, and more than 10 years between colonoscopies. Corresponding summary estimates of prevalences of any advanced neoplasm were 2.8% (2.0% to 3.7%), 3.2% (2.2% to 4.1%), and 7.0% (5.3% to 8.7%). Seven studies also reported findings stratified by sex. Summary estimates stratified by interval and sex were consistently higher for men than for women. CONCLUSIONS: Although detection of any neoplasms was observed in more than 20% of participants within five years of a negative screening colonoscopy, detection of advanced neoplasms within 10 years was rare. Our findings suggest that 10 year intervals for colonoscopy screening after a negative colonoscopy, as currently recommended, may be adequate, but more studies are needed to strengthen the empirical basis for pertinent recommendations and to investigate even longer intervals. STUDY REGISTRATION: Prospero CRD42019127842.


Asunto(s)
Colonoscopía/métodos , Neoplasias Colorrectales , Detección Precoz del Cáncer , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/patología , Continuidad de la Atención al Paciente/normas , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/normas , Humanos , Prevalencia , Medición de Riesgo/estadística & datos numéricos
18.
Isr Med Assoc J ; 21(10): 671-675, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31599509

RESUMEN

BACKGROUND: Recently, Israel established the first national-level adult cardiac surgery database, which was linked to the Society of Thoracic Surgeons (STS). OBJECTIVES: To validate and compare the STS predicted risk of mortality (PROM) to logistic EuroSCORE I (LESI) and EuroSCORE II (ESII) in Israeli patients undergoing cardiac surgery. METHODS: We retrospectively studied 1279 consecutive patients who underwent cardiac surgeries with a calculable PROM. Data were prospectively entered into our database and used to calculate PROM, LESI, and ESII. Scores were normalized and correlated using linear regression and Pearson's test. To examine model calibration, we plotted the total observed versus expected mortality for each score and across five risk-score subgroups. Model discrimination was assessed by measuring the area under the receiver operating curves. RESULTS: The observed 30-day operative mortality was 1.95%. The median (IQ1; IQ3) PROM, LESI, and the ESII scores were 1.45% (0.69; 3.22), 4.54% (2.28; 9.27), and 1.88% (1.18; 3.54), respectively, with observed over expected ratios of 0.63 (95% confidence interval [95%CI] 0.42-0.93), 0.59 (95%CI 0.40-0.87), and 0.24 (95%CI 0.17-0.36), respectively, (STS vs. ESII P = 0.36, STS vs. LESI P = 0.0001). There was good correlation among all scores. All models overestimated mortality. Model discrimination was high and similar for all three scores. Model calibration of the STS, PROM, and ESII were more accurate than the LESI, particularly in higher risk subgroups. CONCLUSIONS: All scores overestimated mortality. In Israeli patients, the STS, PROM, and ESII risk-scores were more reliable metrics than LESI, particularly in higher risk patients.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Gestión de Riesgos/métodos , Gestión de Riesgos/estadística & datos numéricos , Anciano , Bases de Datos Factuales , Femenino , Humanos , Israel , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Sociedades Médicas , Cirugía Torácica
19.
Artículo en Inglés | MEDLINE | ID: mdl-31581626

RESUMEN

This study compared the 1-item Strength of Urges to Drink (SUTD) scale with the 10-item Alcohol Use Disorders Identification Test (AUDIT) on (i) test-retest reliability, (ii) predictive validity, and (iii) diagnostic accuracy. Data come from 2960 participants taking part in the Alcohol Toolkit Study (ATS), a monthly population survey of adults in England. The long-term test-retest reliability of the SUTD was 'fair', but lower than that for the AUDIT (Kappaweighted 0.24 versus 0.49). Individuals with "slight/moderate" urges to drink had higher odds of reporting an attempt to cut down relative to those not experiencing urges (adjusted odds ratios (AdjORs) 1.78 95% confidence interval (CI) 1.43-2.22 and 1.54 95% CI 1.20-1.96). Drinkers reporting "moderate/slight/strong" urges to drink had mean change in consumption scores which were 0.16 (95% CI -0.31 to -0.02), 0.40 (95% CI -0.56 to -0.24) and 0.37 (95% CI -0.69 to -0.05) units lower than those reporting no urges. For all outcomes, strong associations were found with AUDIT scores. The accuracy of the SUTD for discriminating between drinkers who did and did not reduce their consumption was 'acceptable', and similar to that for the AUDIT (ROCAUC 0.6). The AUDIT had better diagnostic accuracy in predicting change in alcohol consumption. The SUTD may be an efficient dynamic measure of urges to drink for population surveys and studies assessing the impact of alcohol-reduction interventions.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Alcoholismo/epidemiología , Alcoholismo/psicología , Exactitud de los Datos , Medición de Riesgo/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
20.
Artículo en Inglés | MEDLINE | ID: mdl-31581715

RESUMEN

The study of carbon emissions is of great significance for environmental change and economic development. Gender factors is an important perspective to examine the path of carbon emissions. Based on the panel data of 30 provinces in China from 2005 to 2016, this paper selects the optimal spatial measurement model structure by using the Bayesian posterior probability model structure selection method, and studies the impact of economy on carbon emissions and the influence mechanism of gender-based "synergy effect" on carbon emissions from the National level and regional levels. The research shows that the increase of economic promotes the increase of carbon emission in this region, but it has a restraining effect on the carbon emission in the surrounding areas. Moreover, gender factors have a significant positive effect on the region at the National level and the Eastern and Northeastern regions, but not significantly in other ones, and have a significant negative impact on carbon emissions in surrounding areas. Overall, the influence intensity of economy on carbon emission increases with the increase of gender in the National level and the Eastern and Northeastern, while the influence intensity of economy of peripheral regions on carbon emission in Central Region decreases with the increase of gender factors in peripheral regions.


Asunto(s)
Dióxido de Carbono/análisis , Carbono/análisis , Desarrollo Económico/estadística & datos numéricos , Exposición a Riesgos Ambientales/estadística & datos numéricos , Medición de Riesgo/estadística & datos numéricos , Emisiones de Vehículos , Teorema de Bayes , China , Investigación Empírica , Humanos
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