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1.
Hist Philos Life Sci ; 43(1): 7, 2021 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-33439354

RESUMEN

What should the best practices be for modeling zoonotic disease risks, e.g. to anticipate the next pandemic, when background assumptions are unsettled or evolving rapidly? This challenge runs deeper than one might expect, all the way into how we model the robustness of contemporary phylogenetic inference and taxonomic classifications. Different and legitimate taxonomic assumptions can destabilize the putative objectivity of zoonotic risk assessments, thus potentially supporting inconsistent and overconfident policy decisions.


Asunto(s)
Quirópteros , Pandemias , Medición de Riesgo/métodos , Zoonosis , Animales , Quirópteros/virología , Humanos , Modelos Teóricos , Pandemias/clasificación , Filogenia , Zoonosis/epidemiología , Zoonosis/transmisión , Zoonosis/virología
2.
Int J Med Sci ; 18(3): 736-743, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33437208

RESUMEN

Background: Coronavirus disease 2019 (COVID-19) has resulted in more than 610,000 deaths worldwide since December 2019. Given the rapid deterioration of patients' condition before death, markers with efficient prognostic values are urgently required. During the treatment process, notable changes in plasma potassium levels have been observed among severely ill patients. We aimed to evaluate the association between average plasma potassium (Ka +) levels during hospitalization and 30-day mortality in patients with COVID-19. Methods: Consecutive patients with COVID-19 hospitalized in the Zhongfaxincheng branch of Tongji Hospital in Wuhan, China from February 8 to 28, 2020 were enrolled in this study. We followed patients up to 30 days after admission. Results: A total of 136 patients were included in the study. The average age was 62.1±14.6 years and 51.5% of patients were male. The median baseline potassium level was 4.3 (3.9-4.6) mmol/L and Ka + level during hospitalization was 4.4 (4.2-4.7) mmol/L; the median number of times that we measured potassium was 4 (3-5). The 30-day mortality was 19.1%. A J-shaped association was observed between Ka + and 30-day mortality. Multivariate Cox regression showed that compared with the reference group (Ka + 4.0 to <4.5 mmol/L), 30-day mortality was 1.99 (95% confidence interval [CI]=0.54-7.35, P=0.300), 1.14 (95% CI=0.39-3.32, P=0.810), and 4.14 (95% CI=1.29-13.29, P=0.017) times higher in patients with COVID-19 who had Ka + <4.0, 4.5 to <5.0, and ≥5.0 mmol/L, respectively. Conclusion: Patients with COVID-19 who had a Ka + level ≥5.0 mmol/L had a significantly increased 30-day mortality compared with those who had a Ka + level 4.0 to <4.5 mmol/L. Plasma potassium levels should be monitored routinely and maintained within appropriate ranges in patients with COVID-19.


Asunto(s)
/mortalidad , Mortalidad Hospitalaria , Potasio/sangre , Anciano , Biomarcadores/sangre , /diagnóstico , China/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo , Índice de Severidad de la Enfermedad
3.
Int J Cancer ; 148(2): 363-374, 2021 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-32683687

RESUMEN

Evidence is mounting to indicate that cancer patients may have more likelihood of having coronavirus disease 2019 (COVID-19) but lack consistency. A robust estimate is urgently needed to convey appropriate information to the society and the public, in the time of ongoing COVID-19 pandemic. We performed a systematic review and meta-analysis through a comprehensive literature search in major databases in English and Chinese, and two investigators conducted publication selection and data extraction independently. A meta-analysis was used to obtain estimates of pooled prevalence of cancer in patients with COVID-19 and determine the association of cancer with severe events, after assessment of potential heterogeneity, publication bias, and correction for the estimates when necessary. Total 38 studies comprising 7094 patients with COVID-9 were included; the pooled prevalence of cancer was estimated at 2.3% (95% confidence limit [CL] [0.018, 0.029]; P < .001) overall and 3.2% (95% CL [0.023, 0.041]; P < .001) in Hubei province; the corresponding estimates were 1.4% and 1.9% after correction for publication bias; cancer was significantly associated with the events of severe cases (odds ratio [OR] = 2.20, 95% CL [1.53, 3.17]; P < .001) and death (OR = 2.97, 95% CL [1.48, 5.96]; P = .002) in patients with COVID-19, there was no significant heterogeneity and a minimal publication bias. We conclude that cancer comorbidity is associated with the risk and severe events of COVID-19; special measures should be taken for individuals with cancer.


Asunto(s)
/prevención & control , Neoplasias/terapia , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , /epidemiología , Comorbilidad , Humanos , Neoplasias/epidemiología , Pandemias , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad
6.
J Surg Res ; 257: 189-194, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32835952

RESUMEN

BACKGROUND: Carotid artery stenosis (CAS) is the most frequently detected treatable cause of ischemic stroke. However, there are no recommendations to screen asymptomatic patients. The atherosclerotic cardiovascular disease (ASCVD) risk score estimates individuals' 10-year risk for developing cardiovascular disease. The objective of this study is to identify a relationship between the ASCVD risk score and moderate/severe CAS based on ultrasound findings. MATERIALS AND METHODS: We performed a single-institution retrospective review of patients who underwent a surveillance ultrasound for CAS between 2015 and 2018. We used Strandness velocity criteria to separate patients into two cohorts: none to mild CAS (<50%) and moderate/severe CAS (≥50%). We performed Student's t-test, multivariate analysis, and receiver operator characteristic (ROC) curve analysis to determine a relationship between the ASCVD risk score and degree of CAS. We evaluated a new risk score model based on stepwise logistic regression of significant variables on univariate analysis. RESULTS: Two thousand eight hundred and fifty-six patients with carotid ultrasounds (1623 with none to mild, 1161 with moderate, and 72 with severe disease) were included in the study. The ASCVD risk score significantly predicted moderate/severe CAS in an adjusted multivariate analysis. Each 10% increase in the ASCVD risk score corresponded to an additional 11% likelihood of moderate/severe stenosis (OR: 1.11 [1.04-1.20], P = 0.004). The ROC area under the curve for predicting moderate/severe CAS based on the ASCVD risk score was 0.59 (Youden index (J) = 0.14); the optimized ASCVD cutoff point was 28.4%. Our new atherosclerotic disease model demonstrated increased odds of moderate/severe CAS with scores greater than zero (ROC area under the curve = 0.57). CONCLUSIONS: This is the first study to demonstrate an association between atherosclerotic disease risk factors as measured by the ASCVD risk score and moderate/severe CAS. However, this tool is not sensitive or specific for using the ASCVD risk score as a screening mechanism for moderate/severe CAS.


Asunto(s)
Aterosclerosis/epidemiología , Estenosis Carotídea/epidemiología , Anciano , Anciano de 80 o más Años , Aterosclerosis/etiología , Arterias Carótidas/diagnóstico por imagen , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Curva ROC , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Ultrasonografía
7.
J Surg Res ; 257: 252-259, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32862053

RESUMEN

BACKGROUND: Emergency laparotomy (EL) is an increasingly common procedure in the elderly. Factors associated with mortality in the subpopulation of frail patients have not been thoroughly investigated. Sarcopenia has been investigated as a surrogate for frailty and poor prognosis. Our primary aim was to evaluate the association between easily measured sarcopenia parameters and 30-day postoperative mortality in elderly patients undergoing EL. Length of stay (LOS) and admission to an intensive care unit were secondary end points. METHODS: We conducted a retrospective cohort study, over a 5-year period, of patients aged 65 y and older who underwent EL at a tertiary university hospital. Sarcopenia was evaluated on admission computed tomography scan by two methods, first by psoas muscle attenuation and second by the product of perpendicular cross-sectional diameters (PCSDs). The lowest quartile of PCSDs and attenuation were defined as sarcopenic and compared with the rest of the cohort. Attenuation was stratified for the use of contrast enhancement. Multivariant logistic regression was performed to determine independent risk factors. RESULTS: During the study period, 403 patients, older than 65 y, underwent EL. Of these, 283 fit the inclusion criteria and 65 (23%) patients died within 30 d of surgery. On bivariate analysis, psoas muscle attenuation, but not PCSDs, was found to be associated with 30-day mortality (OR = 2.43, 95% CI = 1.34-4.38, P = 0.003) and longer LOS (35.7 d versus 22.2 d, Δd 13.5, 95% CI = 6.4-20.7, P < 0.001). In a multivariate analysis, psoas muscle attenuation, but not PCSDs, was an independent risk factor for 30-day postoperative mortality (OR = 2.35, 95% CI = 1.16-4.76, P = 0.017) and longer LOS (Δd = 14.4, 95% CI = 7.7-21.0, P < 0.001). Neither of the sarcopenia parameters was associated with increased admission to an intensive care unit. DISCUSSION: Psoas muscle attenuation is an independent risk factor for 30-day postoperative mortality and LOS after EL in the elderly population. This measurement can inform clinicians about the operative risk and hospital resource utilization.


Asunto(s)
Tratamiento de Urgencia/efectos adversos , Fragilidad/diagnóstico , Laparotomía/efectos adversos , Complicaciones Posoperatorias/mortalidad , Músculos Psoas/diagnóstico por imagen , Sarcopenia/diagnóstico , Anciano , Anciano de 80 o más Años , Estudios Transversales , Estudios de Factibilidad , Femenino , Fragilidad/complicaciones , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo , Sarcopenia/complicaciones , Tomografía Computarizada por Rayos X
8.
Indian J Ophthalmol ; 69(1): 140-144, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33323599

RESUMEN

Purpose: The aim of this study was to determine prevalence, symptoms frequency and associated risk factors of digital eye strain (DES) among children attending online classes during COVID-19 pandemic. Methods: The online electronic survey form was prepared on the Google app. Children/parents were asked to indicate the total duration of digital device use before and during COVID era. The symptoms of DES, its severity and frequency were recorded & measured with the Computer Vision Syndrome Questionnaire. Results: Two hundred and sixty one parents responded to the questionnaire, of these 217 were complete. Mean age of children was 13 ± 2.45 years. Mean duration of digital device used during COVID era was 3.9 ± 1.9 h which is more than pre COVID era (1.9 ± 1.1 h, P = <0.0001). 36.9% (n = 80) were using digital devices >5 h in COVID era as compared to 1.8% (n = 4) before COVID era. The most common digital device used were smartphones (n = 134, 61.7%). One hundred and eight children (49.8%) were attending online classes for >2 h per day. Prevalence of DES in our cohort is 50.23% (109/217). Of these 26.3% were mild, 12.9% moderate and 11.1% of severe grade. Most common symptoms were itching and headache (n = 117, 53.9%). Multivariate analysis revealed age >14 years (P = 0.04), male gender (P = 0.0004), smartphone use (P = 0.003), use of device >5 h (P = 0.0007) and mobile games >1 h/day (P = 0.0001) as independent risk factors for DES in children. Conclusion: There is an increased prevalence of DES among children in COVID era. Parents should be considerate about duration, type and distance of digital device use to avoid DES symptoms in children.


Asunto(s)
Astenopía/epidemiología , Pandemias , Medición de Riesgo/métodos , Teléfono Inteligente , Juegos de Video/efectos adversos , Adolescente , Astenopía/etiología , Niño , Estudios Transversales , Femenino , Humanos , India/epidemiología , Masculino , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios
9.
Bone Joint J ; 103-B(1): 65-70, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33380200

RESUMEN

AIMS: Recent improvements in surgical technique and perioperative blood management after total joint replacement (TJR) have decreased rates of transfusion. However, as many surgeons transition to outpatient TJR, obtaining routine postoperative blood tests becomes more challenging. Therefore, we sought to determine if a preoperative outpatient assessment tool that stratifies patients based on numerous medical comorbidities could predict who required postoperative haemoglobin (Hb) measurement. METHODS: We performed a prospective study of consecutive unilateral primary total knee arthroplasties (TKAs) and total hip arthroplasties (THAs) performed at a single institution. Prospectively collected data included preoperative and postoperative Hb levels, need for blood transfusion, length of hospital stay, and Outpatient Arthroplasty Risk Assessment (OARA) score. RESULTS: A total of 504 patients met inclusion criteria. Mean age at time of arthroplasty was 65.3 years (SD 10.2). Of the patients, 216 (42.9%) were THAs and 288 (57.1%) were TKAs. Six patients required a blood transfusion postoperatively (1.19%). Transfusion after surgery was associated with lower postoperative day 1 Hb (median of 8.5 (interquartile range (IQR) 7.9 to 8.6) vs 11.3 (IQR 10.4 to 12.2); p < 0.001), longer length of stay (1 day (IQR 1 to 1) vs 2 days (IQR 2 to 3); p < 0.001), higher OARA score (median of 60.0 (IQR 40 to 75) vs 5.0 (IQR 0-35); p = 0.001), and total hip arthroplasty (p < 0.001). All patients who received a transfusion had an OARA score > 34; however, this did not reach statistical significance as a screening threshold. CONCLUSION: Risk of blood transfusion after primary TJR was uncommon in our series, with an incidence of 1.19%. Transfusion was associated with OARA scores > 60. The OARA score, not American Society of Anesthesiologists grade, reliably identified patients at risk for postoperative blood transfusion. Selective Hb monitoring may result in substantial cost savings in the era of cost containment. Cite this article: Bone Joint J 2021;103-B(1):65-70.


Asunto(s)
Atención Ambulatoria , Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Transfusión Sanguínea/estadística & datos numéricos , Hemoglobinas/análisis , Complicaciones Posoperatorias/sangre , Medición de Riesgo/métodos , Anciano , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Valor Predictivo de las Pruebas , Estudios Prospectivos
10.
Anaesthesia ; 76(1): 72-81, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32592218

RESUMEN

Cardiopulmonary exercise testing is performed increasingly for cardiorespiratory fitness assessment and pre-operative risk stratification. Lower limb osteoarthritis is a common comorbidity in surgical patients, meaning traditional cycle ergometry-based cardiopulmonary exercise testing is difficult. The purpose of this study was to compare cardiopulmonary exercise testing variables and subjective responses in four different exercise modalities. In this crossover study, 15 patients with osteoarthritis scheduled for total hip or knee arthroplasty (mean (SD) age 68 (7) years; body mass index 31.4 (4.1) kg.m-2 ) completed cardiopulmonary exercise testing on a treadmill, elliptical cross-trainer, cycle and arm ergometer. Mean (SD) peak oxygen consumption was 20-30% greater on the lower limb modalities (treadmill 21.5 (4.6) (p < 0.001); elliptical cross-trainer (21.2 (4.1) (p < 0.001); and cycle ergometer (19.4 (4.2) ml.min-1 .kg-1 (p = 0.001), respectively) than on the arm ergometer (15.7 (3.7) ml.min-1 .kg-1 ). Anaerobic threshold was 25-50% greater on the lower limb modalities (treadmill 13.5 (3.1) (p < 0.001); elliptical cross-trainer 14.6 (3.0) (p < 0.001); and cycle ergometer 10.7 (2.9) (p = 0.003)) compared with the arm ergometer (8.4 (1.7) ml.min-1 .kg-1 ). The median (95%CI) difference between pre-exercise and peak-exercise pain scores was greater for tests on the treadmill (2.0 (0.0-5.0) (p = 0.001); elliptical cross-trainer (3.0 (2.0-4.0) (p = 0.001); and cycle ergometer (3.0 (1.0-5.0) (p = 0.001)), compared with the arm ergometer (0.0 (0.0-1.0) (p = 0.406)). Despite greater peak exercise pain, cardiopulmonary exercise testing modalities utilising the lower limbs affected by osteoarthritis elicited higher peak oxygen consumption and anaerobic threshold values compared with arm ergometry.


Asunto(s)
Capacidad Cardiovascular , Prueba de Esfuerzo/métodos , Osteoartritis/diagnóstico , Osteoartritis/fisiopatología , Anciano , Anciano de 80 o más Años , Umbral Anaerobio , Brazo , Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Índice de Masa Corporal , Estudios Cruzados , Ergometría/métodos , Femenino , Humanos , Extremidad Inferior , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Cuidados Preoperatorios , Medición de Riesgo/métodos
11.
Sports Health ; 13(1): 57-64, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32649842

RESUMEN

CONTEXT: Evidence concerning a systematic, comprehensive injury risk assessment in the elite swimming population is scarce. OBJECTIVE: To evaluate the quality of current literature regarding clinical assessment techniques used to evaluate the presence and/or development of pain/injury in elite swimmers and to categorize objective clinical assessment tools into relevant predictors (constructs) that should consistently be evaluated in injury risk screens of elite swimmers. DATA SOURCES: PubMed, Embase, Scopus, CINAHL, SPORTDiscus, PEDro, and the Cochrane Library Reviews were searched through September 2018. STUDY SELECTION: Studies were included for review if they assessed a correlation between clinic-based objective measures and the presence and/or development of acute or chronic pain/injury in elite swimmers. All body regions were included. Elite swimmers were defined as National Collegiate Athletic Association, collegiate, and junior-, senior-, or national-level swimmers. Only cohort and cross-sectional studies were included (both prospective and retrospective); randomized controlled trials, expert opinion, and case reports were excluded, along with studies that focused on interventions, performance, or specific swim-stroke equipment or technology. STUDY DESIGN: Systematic review and qualitative analysis. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were utilized at each phase of review by 2 reviewers; a third reviewer was utilized for tie breaking purposes. Qualitative analysis was performed using the Methodological Items for Non-Randomized Studies (MINORS) assessment tool. RESULTS: A total of 21 studies assessed the presence and/or development of injury/pain in 3 different body regions: upper extremity, lower extremity, and spine. Calculated average MINORS scores for comparative (n = 17) and noncomparative (n = 4) studies were 18.1 of 24 and 10.5 of 16, respectively. Modifiable, objectively measurable injury risk factors in elite swimmers were categorized into 4 constructs: (1) strength/endurance, (2) mobility, (3) static/dynamic posture, and (4) patient-report regardless of body region. CONCLUSION: Limited evidence exists to draw specific correlations between identified clinical objective measures and the development of pain and/or injury in elite swimmers.


Asunto(s)
Medición de Riesgo/métodos , Natación/lesiones , Humanos , Extremidad Inferior/lesiones , Extremidad Inferior/fisiopatología , Fuerza Muscular , Examen Físico , Postura , Factores de Riesgo , Autoinforme , Traumatismos Vertebrales/etiología , Traumatismos Vertebrales/fisiopatología , Extremidad Superior/lesiones , Extremidad Superior/fisiopatología
12.
J Urol ; 205(1): 241-247, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32716742

RESUMEN

PURPOSE: Resumption of elective urology cases postponed due to the COVID-19 pandemic requires a systematic approach to case prioritization, which may be based on detailed cross-specialty questionnaires, specialty specific published expert opinion or by individual (operating) surgeon review. We evaluated whether each of these systems effectively stratifies cases and for agreement between approaches in order to inform departmental policy. MATERIALS AND METHODS: We evaluated triage of elective cases postponed within our department due to the COVID-19 pandemic (March 9, 2020 to May 22, 2020) using questionnaire based surgical prioritization (American College of Surgeons Medically Necessary, Time Sensitive Procedures [MeNTS] instrument), consensus/expert opinion based surgical prioritization (based on published urological recommendations) and individual surgeon based surgical prioritization scoring (developed and managed within our department). Lower scores represented greater urgency. MeNTS scores were compared across consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores. RESULTS: A total of 204 cases were evaluated. Median MeNTS score was 50 (IQR 44, 55), and mean consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores were 2.6±0.6 and 2.2±0.8, respectively. Median MeNTS scores were 52 (46.5, 57.5), 50 (44.5, 54.5) and 48 (43.5, 54) for individual surgeon based surgical prioritization priority 1, 2 and 3 cases (p=0.129), and 55 (51.5, 57), 47.5 (42, 56) and 49 (44, 54) for consensus/expert opinion based surgical prioritization priority scores 1, 2, and 3 (p=0.002). There was none to slight agreement between consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores (Kappa 0.131, p=0.002). CONCLUSIONS: Questionnaire based, expert opinion based and individual surgeon based approaches to case prioritization result in significantly different case prioritization. Questionnaire based surgical prioritization did not meaningfully stratify urological cases, and consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization frequently disagreed. The strengths and weaknesses of each of these systems should be considered in future disaster planning scenarios.


Asunto(s)
/prevención & control , Procedimientos Quirúrgicos Electivos/normas , Enfermedades Urológicas/cirugía , Procedimientos Quirúrgicos Urológicos/normas , Urología/normas , Adulto , Anciano , /transmisión , Toma de Decisiones Clínicas , Control de Enfermedades Transmisibles/normas , Consenso , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Selección de Paciente , Medición de Riesgo/métodos , Medición de Riesgo/normas , Factores de Tiempo , Triaje/normas , Estados Unidos/epidemiología , Adulto Joven
13.
Surg Clin North Am ; 101(1): 97-107, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33212083

RESUMEN

Risk calculators are an underused tool for surgeons and trainees when determining and communicating surgical risk. We summarize some of the more common risk calculators and discuss their evolution and limitations. We also describe artificial intelligence models, which have the potential to help clinicians better understand and use risk assessment.


Asunto(s)
Inteligencia Artificial , Complicaciones Posoperatorias/epidemiología , Medición de Riesgo/métodos , Predicción , Humanos
14.
Ecotoxicol Environ Saf ; 207: 111245, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-32956896

RESUMEN

Access to safe drinking water is one of the fundamental human rights and an important part of healthy living. This study considered various land use methods, used geostatistical analysis, and triangular random model to explore nitrogen pollution and estimate its potential risk to human health for local populations in Songnen Plain of Northeast China and recognize parameter uncertainties. Nitrate concentrations in groundwater ranged from 0.01 to 523.45 mg/L, more than 72.35% of the samples exceeded Grade III threshold (20 mg/L of N) as per China's standard, and nitrate nitrogen content is greater than 20 mg/L accounted for around 60% of the research area, mainly distributed in the eastern and central high plain area. The nitrate-nitrogen content of groundwater in the town land was significantly higher than that of agricultural land, and the ammonia nitrogen content was conversely. The townland's risk value was two times that of agricultural land, considering different land use methods would avoid overestimating or underestimating regional risk value. Non-carcinogenic risks (HI) of two land use were above the safety level (i.e., HI > 1), suggesting that groundwater nitrate would have significant health effects on the age groups, and further threaten children. There was a wide range of fluctuations in the uncertainty of nitrogen concentration and model evaluation parameters; triangular random model was more sensitive to data changes, which could reduce the uncertainty. The contribution rate of nitrate-nitrogen concentration to risk was above 90%, which explained the need for random sampling to improve the evaluation results reliability. The findings in this paper will provide new insight for solving uncertainties in water safety management.


Asunto(s)
Exposición a Riesgos Ambientales/estadística & datos numéricos , Agua Subterránea/química , Nitrógeno/análisis , Contaminantes Químicos del Agua/análisis , Agricultura , Amoníaco/análisis , China , Ciudades , Contaminación Ambiental/análisis , Humanos , Nitratos/análisis , Óxidos de Nitrógeno/análisis , Reproducibilidad de los Resultados , Medición de Riesgo/métodos , Agua/análisis , Abastecimiento de Agua
15.
Front Public Health ; 8: 574915, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33330318

RESUMEN

In order to develop a novel scoring model for the prediction of coronavirus disease-19 (COVID-19) patients at high risk of severe disease, we retrospectively studied 419 patients from five hospitals in Shanghai, Hubei, and Jiangsu Provinces from January 22 to March 30, 2020. Multivariate Cox regression and orthogonal projections to latent structures discriminant analysis (OPLS-DA) were both used to identify high-risk factors for disease severity in COVID-19 patients. The prediction model was developed based on four high-risk factors. Multivariate analysis showed that comorbidity [hazard ratio (HR) 3.17, 95% confidence interval (CI) 1.96-5.11], albumin (ALB) level (HR 3.67, 95% CI 1.91-7.02), C-reactive protein (CRP) level (HR 3.16, 95% CI 1.68-5.96), and age ≥60 years (HR 2.31, 95% CI 1.43-3.73) were independent risk factors for disease severity in COVID-19 patients. OPLS-DA identified that the top five influencing parameters for COVID-19 severity were CRP, ALB, age ≥60 years, comorbidity, and lactate dehydrogenase (LDH) level. When incorporating the above four factors, the nomogram had a good concordance index of 0.86 (95% CI 0.83-0.89) and had an optimal agreement between the predictive nomogram and the actual observation with a slope of 0.95 (R 2 = 0.89) in the 7-day prediction and 0.96 (R 2 = 0.92) in the 14-day prediction after 1,000 bootstrap sampling. The area under the receiver operating characteristic curve of the COVID-19-American Association for Clinical Chemistry (AACC) model was 0.85 (95% CI 0.81-0.90). According to the probability of severity, the model divided the patients into three groups: low risk, intermediate risk, and high risk. The COVID-19-AACC model is an effective method for clinicians to screen patients at high risk of severe disease.


Asunto(s)
/epidemiología , Progresión de la Enfermedad , Pronóstico , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , China/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Curva ROC , Estudios Retrospectivos , Factores de Riesgo
16.
Am Fam Physician ; 102(12): 721-727, 2020 12 15.
Artículo en Inglés | MEDLINE | ID: mdl-33320506

RESUMEN

Approximately 1% of primary care office visits are for chest pain, and 2% to 4% of these patients will have unstable angina or myocardial infarction. Initial evaluation is based on determining whether the patient needs to be referred to a higher level of care to rule out acute coronary syndrome (ACS). A combination of age, sex, and type of chest pain can predict the likelihood of coronary artery disease as the cause of chest pain. The Marburg Heart Score and the INTERCHEST clinical decision rule can also help estimate ACS risk. Twelve-lead electrocardiography is recommended to look for ST segment changes, new-onset left bundle branch block, presence of Q waves, and new T-wave inversions. Patients with suspicion of ACS or changes on electrocardiography should be transported immediately to the emergency department. Those at low or intermediate risk of ACS can undergo exercise stress testing, coronary computed tomography angiography, or cardiac magnetic resonance imaging. In those with low suspicion for ACS, consider other diagnoses such as chest wall pain or costochondritis, gastroesophageal reflux disease, and panic disorder or anxiety states. Other less common, but important, diagnostic considerations include acute pericarditis, pneumonia, heart failure, pulmonary embolism, and acute thoracic aortic dissection.


Asunto(s)
Síndrome Coronario Agudo/diagnóstico , Infarto del Miocardio/diagnóstico , Pacientes Ambulatorios/estadística & datos numéricos , Dolor en el Pecho/etiología , Angiografía Coronaria , Electrocardiografía/métodos , Prueba de Esfuerzo/métodos , Femenino , Humanos , Masculino , Medición de Riesgo/métodos
17.
N Z Med J ; 133(1526): 12-17, 2020 12 04.
Artículo en Inglés | MEDLINE | ID: mdl-33332336

RESUMEN

AIM: This study was conducted to describe the epidemiology of thyroid eye disease (TED) in New Zealand. METHODS: One hundred and sixty-one subjects with TED seen over a 14-year period in Auckland, from a combined ophthalmology-endocrinology clinic, had data extracted from clinical notes. RESULTS: Median age at onset was 47.0±15.1 years and 77.6% were female. Crude yearly incidence of TED (per 1,000,000) was 12.6 in non-smokers and 67.3 in smokers (p<0.001).  On univariate analysis, female gender, Maori ethnicity and smoking were associated with incidence of TED. On multivariate analysis, female gender and smoking status were associated with risk of TED, and the difference in ethnicity was explained by smoking status. Maori subjects with TED were more likely to be current smokers (72.7%) compared to European (39.2%), Pacific Peoples (33.3%), Asian (8.3%) and Other (12.5%). Maori ethnicity and current smokers were associated with a higher clinical activity score at presentation (p=0.049 and p=0.027). CONCLUSION: A strong association was demonstrated with female gender and smoking status and rate of TED. Maori have increased rates of TED; however, this difference was explained by smoking. Eliminating smoking would result in at least a 28.1% reduction in TED incidence in New Zealand.


Asunto(s)
Grupos Étnicos , Oftalmopatía de Graves/etnología , Medición de Riesgo/métodos , Fumar/efectos adversos , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo
18.
N Z Med J ; 133(1526): 76-88, 2020 12 04.
Artículo en Inglés | MEDLINE | ID: mdl-33332342

RESUMEN

AIM: To estimate the number and weight of pesticides used in New Zealand agriculture that are classified as known or suspected human carcinogens. METHODS: The yearly usage of active ingredients was extracted from the most recent (2005) report on pesticide use. For each active ingredient, the carcinogenicity classification of three regulatory agencies (New Zealand Environmental Protection Authority [EPA NZ], US Environmental Protection Agency, European Chemicals Agency) was extracted. The International Agency for Research on Cancer (IARC) Monograph Programme's classifications were also considered. Total tonnes of active ingredients were calculated according to each classification. RESULTS: None of the pesticides are classified as known human carcinogens. In total, 56 active ingredients are listed as suspected carcinogens by at least one of the four agencies, including 16 high-use ingredients, representing up to 51% of the total yearly quantity. Agency-specific estimates ranged between 4-26% (148-872 tonnes) with the EPA NZ classification yielding the lowest estimate. The suspected carcinogen weight was highest for fungicides (estimates based on the three regulatory agencies ranged between 72-540 tonnes), followed by herbicides (60-200 tonnes) and insecticides (16 tonnes). CONCLUSIONS: New Zealand's use of pesticides that are suspected carcinogens is high. Efforts to increase awareness and reduce exposure need to be considered.


Asunto(s)
Carcinógenos/farmacología , Neoplasias/epidemiología , Plaguicidas/efectos adversos , Salud Pública , Medición de Riesgo/métodos , Humanos , Morbilidad/tendencias , Neoplasias/inducido químicamente , Nueva Zelanda/epidemiología
19.
Medicine (Baltimore) ; 99(51): e23779, 2020 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-33371147

RESUMEN

ABSTRACT: Pneumothorax is a life-threatening complication during acute asthma attack. However, long-term risk of pneumothorax in asthmatic children remains unknown.In this retrospective cohort study, 333,657 children were defined as asthma cohort and a 1:1 matched non-asthma cohort were generated from 2000 to 2011. At the end of 2012, the incidence of pneumothorax in asthma and non-asthma cohorts and asthma to non-asthma hazard ratios (HRs) with confidence intervals (CIs) of pneumothorax were analyzed.The incidence of pneumothorax was 1.35-fold higher in the asthma cohort than that in the non-asthma cohort. The asthma to non-asthma HRs of pneumothorax were higher in children younger than 6 years (1.76, 95% CI: 1.21-2.57) and in girls (2.27; 95% CI: 1.23-4.16). The HRs of pneumothorax were higher in asthmatic children with more asthma-related out-patient clinic visits/per year (>5 visits; HR: 2.81; 95% CI: 1.79-4.42), more emergency department visits/per year (>4 visits; HR: 1.68; 95% CI: 1.02-2.78), and longer hospitalization days due to asthma (>4 days; HR: 3.42; 95% CI: 1.52-6.94) (P < .0001, the trend test).Asthmatic children had greater risk for pneumothorax, particularly in young children and in those with severe and uncontrolled asthma.


Asunto(s)
Asma/complicaciones , Neumotórax/etiología , Medición de Riesgo/métodos , Urbanización , Adolescente , Asma/epidemiología , Asma/fisiopatología , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Masculino , Neumotórax/epidemiología , Neumotórax/fisiopatología , Estudios Retrospectivos , Medición de Riesgo/tendencias , Factores de Riesgo
20.
PLoS One ; 15(12): e0239989, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33326437

RESUMEN

Low-density lipoprotein (LDL-C) concentrations are a standard of care in the prevention of cardiovascular disease and are influenced by different factors. This study compared the LDL-C concentrations estimated by two different equations and determined their associations with inflammatory status, oxidative stress, anthropometric variables, food intake and DNA methylation levels in the LPL, ADRB3 and MTHFR genes. A cross-sectional population-based study was conducted with 236 adults (median age 37.5 years) of both sexes from the municipality of João Pessoa, Paraíba, Brazil. The LDL-C concentrations were estimated according to the Friedewald and Martin equations. LPL, ADRB3 and MTHFR gene methylation levels; malondialdehyde levels; total antioxidant capacity; ultra-sensitive C-reactive protein, alpha-1-acid glycoprotein, homocysteine, cobalamin, and folic acid levels; usual dietary intake; and epidemiological variables were also determined. For each unit increase in malondialdehyde concentration there was an increase in the LDL-C concentration from 6.25 to 10.29 mg/dL (p <0.000). Based on the Martin equation (≥70 mg/dL), there was a decrease in the DNA methylation levels in the ADRB3 gene and an increase in the DNA methylation levels in the MTHFR gene (p <0.05). There was a positive relation of homocysteine and cholesterol intake on LDL-C concentrations estimated according to the Friedewald equation and of waist circumference and age based on the two estimates. It is concluded the LDL-C concentrations estimated by the Friedewald and Martin equations were different, and the Friedewald equation values were significantly lower than those obtained by the Martin equation. MDA was the variable that was most positively associated with the estimated LDL-C levels in all multivariate models. Significant relationships were observed based on the two estimates and occurred for most variables. The methylation levels of the ADRB3 and MTHFR genes were different according to the Martin equation at low LDL-C concentrations (70 mg/dL).


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , LDL-Colesterol/sangre , Metilación de ADN , Modelos Biológicos , Estrés Oxidativo , Adulto , Brasil/epidemiología , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/genética , Estudios Transversales , Femenino , Humanos , Masculino , Malondialdehído/sangre , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Persona de Mediana Edad , Análisis Multivariante , Receptores Adrenérgicos beta 3/genética , Medición de Riesgo/métodos , Adulto Joven
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