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1.
Artículo en Ruso | MEDLINE | ID: mdl-32119206

RESUMEN

In the Kabarda-Balkar Republic during last decades, stable dynamics of increasing rates of primary breast cancer morbidity is established. The gaining rate of indicator made up to 40.7% over last 10 years. The prevalence indicator of breast cancer is characterized by high growth intensity twice higher than the national level. In the structure of malignant neoplasms morbidity, breast cancer (23.3%) takes position of leading oncologic pathology. The most of patients with breast cancer (33.0%) are in the age group of 50-59 years. However, higher oncologic alertness of medical personnel concerning young women, especially 20-29 years old is required since their percentage among patients with breast cancer is increasing. Noteworthy is the low indicator of active case finding of patients with breast cancer: only 31.8% of cases is diagnosed during prevention examinations. At the early stage of development of tumor process (stage I-II), the rate of identified patients with breast cancer is lower than in the Russian Federation. Especially low is the level of early diagnosis of the disease at stage I. The data testifies existing problems of organization of oncologic medical care in the Kabarda-Balkar Republic and indicates the need of strengthening preventive measures at the primary health care level. Their effectiveness will be assessed by the level of early diagnosis of breast cancer in women and by corresponding appropriate treatment.


Asunto(s)
Neoplasias de la Mama , Adulto , Neoplasias de la Mama/complicaciones , Femenino , Humanos , Persona de Mediana Edad , Morbilidad/tendencias , Prevalencia , Federación de Rusia/epidemiología , Adulto Joven
2.
Heart Fail Clin ; 16(1): 121-130, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31735310

RESUMEN

Understanding the role of sex- and gender-related factors, when dealing with a global growing epidemic such as heart failure, is a much needed and unmet goal for health care providers and scientists in order to design targeted strategies, aimed at improving both clinical and patient reported outcomes measures in women and men with heart failure. The present review provides an overview of the current available evidence on sex- and gender-related differences in heart failure.


Asunto(s)
Insuficiencia Cardíaca/epidemiología , Salud Global , Humanos , Morbilidad/tendencias , Distribución por Sexo , Factores Sexuales , Tasa de Supervivencia/tendencias
3.
Medicine (Baltimore) ; 98(50): e18265, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852096

RESUMEN

The purpose of this study was to investigate the association between triglyceride glucose (TyG) index and abnormal liver function both in urban and rural Chinese adult populations. The 5824 urban (Nanjing) and 20,269 rural (Hefei) Chinese adults, from random selected households provided clinical history, glucose, lipids, anthropometric, and blood pressure measurements. Liver functions were assessed using Alanine Aminotransferase (ALT). Linear regression was applied to examine the dose-response relationship between TyG index and ALT. Logistic regression was used to estimate the association between TyG index and abnormal liver and function. Cubic spline models were applied to investigate the dose-response association between TyG index and abnormal liver function. C-statistics was used to compare the discriminable capacity over triglyceride, glucose and TyG index. Linear dose-response relationship was identified between TyG index and ALT as 1.222 IU increase by 1 unit increase of TyG index (1.242 for urban population and 1.210 for rural population). The 6.0% of urban and 11.0% of rural Chinese adults were observed to have abnormal liver function. The linear association between TyG index and abnormal liver function was revealed as 2.044 (1.930 to 2.165) of odds ratio by in unit increase of TyG index (2.334 for urban population and 1.990 for rural population). Higher C-statistics was found for TyG index compared with fasting glucose and triglyceride both in Chinese urban and rural populations. This study suggested in both urban and rural Chinese adult populations, TyG index is associated with abnormal liver function. TyG index is a potential indicator to identify high-risk individuals with metabolic disorders, for example impaired liver function in Chinese population, especially in Chinese urban population.


Asunto(s)
Alanina Transaminasa/sangre , Glucemia/metabolismo , Hepatopatías/sangre , Vigilancia de la Población , Población Rural , Triglicéridos/sangre , Población Urbana , Adulto , Biomarcadores/sangre , Índice de Masa Corporal , China/epidemiología , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Hepatopatías/epidemiología , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Factores de Riesgo , Adulto Joven
4.
Artículo en Ruso | MEDLINE | ID: mdl-31884747

RESUMEN

The article presents the results of analysis of indices of total morbidity of population of the Central Federal Okrug (CFD) of the Russian Federation in 2010-2017. The significant differences in indices of total morbidity between the CFD subjects in certain ICD-10 classes were established. The indices of total morbidity of population during study period (8 years) in the Central Federal District factually didn't altered, while dynamics of indices in other subjects was characterized by multidirectionality. The gap in levels of total morbidity of population in the subjects was significant: from 115,123.6 per 100,000 of population in the Kursk Oblast to 194,404.1 per 100,000 of population in the Orel Oblast. The significant difference in rates of increase/ decrease of indices is noted. Thus, in Moscow decrease rate made up to 10%, while in the Orel Oblast morbidity increased up to 13.1%. Besides, in 2017, the Orel Region took a leadership in rate of increasing of total morbidity in such classes of diseases as infectious and parasitic diseases (39.3%), diseases of blood and blood-forming organs (49.1%), diseases of endocrine system (59,1%), diseases of nervous system (26.8%), diseases of respiratory system (28.2%), diseases of musculoskeletal system (16%), malformations (56%). It is very likely that this trend developed under influence of demographic situation in the subject due to significant increasing of percentage of people older than able-bodied age. The city of Moscow occupies leading position in decreasing of rate of prevalence of diseases and last but one place in level of total morbidity being inferior only to the Kursk Oblast. Thus, in Moscow was noted the most significant decreasing of morbidity in classes of infectious and parasitic diseases (26%) and diseases of digestive system (20.6%). The diseases of blood and blood-forming organs (235.2 per 100,000 population) and mental disorders (2353.5 per 100,000 population) were registered the less. The main contribution into trends of increasing or decreasing of indices is made by persons aged 18 years and older (74.1%).


Asunto(s)
Clasificación Internacional de Enfermedades , Morbilidad/tendencias , Moscú/epidemiología , Prevalencia , Federación de Rusia
5.
Artículo en Ruso | MEDLINE | ID: mdl-31884758

RESUMEN

On the basis of updated data from 82 subjects of the Russian Federation multivariate analysis of occupational diseases of agricultural workers was implemented. It is established that in unhealthy work conditions are characteristic for 30% of workers in the agricultural sector. In the enterprises of agriculture, the percentage of workplaces not meeting sanitary hygienic standards made up to 35%. The high etiologic pathogenic relationship between nosological form of disease and working conditions in the profession is established. Most often, the occupational pathology was developed in agricultural workers in case of conditions of physical overload (37.2%), effecting of physical factors (26.8%) and contact with infected animals (14.6%). In nosological structure of accumulated occupational diseases the first place took radiculopathy of cervical and lumbar sacral levels (23%), the second - vibration disease (15.3%), followed by brucellosis (14.6%), the fourth - neuro-sensory deafness (11.5%). The regions of the Russian Federation are characterized by pronounced heterogeneity both related to general level of registered occupational diseases and its nosological spectrum. In the whole, in Russia during 2011-2015 persistent trend of decreasing of occupational diseases morbidity of agricultural workers was marked.


Asunto(s)
Agricultura , Enfermedades Profesionales/epidemiología , Salud Laboral , Animales , Humanos , Morbilidad/tendencias , Ocupaciones , Federación de Rusia
6.
Rev Port Cardiol ; 38(8): 559-569, 2019 08.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31706732

RESUMEN

INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Portugal. Hypercholesterolemia has a causal role in atherosclerotic CVD. Guidelines recommend that cardiovascular (CV) risk reduction should be individualized and treatment goals identified. Low-density lipoprotein cholesterol (LDL-C) is the primary treatment target. METHODS: DISGEN-LIPID was a cross-sectional observational study conducted in 24 centers in Portugal in dyslipidemic patients aged ≥40 years, on lipid-lowering therapy (LLT) for at least three months and with an available lipid profile in the previous six months. RESULTS: A total of 368 patients were analyzed: 48.9% men and 51.1% women (93.9% postmenopausal), of whom 73% had a SCORE of high or very high CV risk. One quarter had a family history of premature CVD; 31% had diabetes; 26% coronary heart disease; 9.5% cerebrovascular disease; and 4.1% peripheral arterial disease. Mean baseline lipid values were total cholesterol (TC) 189 mg/dl, LDL-C 116 mg/dl, high-density lipoprotein cholesterol (HDL-C) 53.5 mg/dl, and triglycerides (TG) 135 mg/dl. Women had higher TC (p<0.001), LDL-C (non-significant) and HDL-C (p<0.001), and lower TG (p=0.002); 57% of men and 63% of women had LDL-C>100 mg/dl (p=0.28), and 58% of men and 47% of women had LDL-C>70 mg/dl (p=0.933). CONCLUSION: These observational data show that, despite their high-risk profile, more than half of patients under LLT, both men and women, did not achieve the recommended target levels for LDL-C, and a large proportion also had abnormal HDL-C and/or TG. This is a renewed opportunity to improve clinical practice in CV prevention.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Dislipidemias/sangre , Hipolipemiantes/uso terapéutico , Lípidos/sangre , Sistema de Registros , Adulto , Anciano , Biomarcadores/sangre , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Estudios Transversales , Dislipidemias/complicaciones , Dislipidemias/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Portugal/epidemiología , Estudios Retrospectivos , Tasa de Supervivencia/tendencias
7.
J Bras Pneumol ; 45(6): e20180402, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31778424

RESUMEN

OBJECTIVE: To examine the trends in overall COPD mortality, as well as trends in in-hospital morbidity and mortality due to COPD, in Brazil, and to validate predictive models. METHODS: This was a population-based study with a time-series analysis of cause-specific morbidity and mortality data for individuals ≥ 40 years of age, obtained from national health information systems for the 2000-2016 period. Morbidity and mortality rates, stratified by gender and age group, were calculated for the same period. We used regression analyses to examine the temporal trends and double exponential smoothing in our analysis of the predictive models for 2017. RESULTS: Over the study period, COPD mortality rates trended downward in Brazil. For both genders, there was a downward trend in the southern, southeastern, and central-western regions. In-hospital morbidity rates declined in all regions, more so in the south and southeast. There were significant changes in the number of hospitalizations, length of hospital stay, and hospital expenses. The predictive models for 2017 showed error rates below 9% and were therefore validated. CONCLUSIONS: In Brazil, COPD age-adjusted mortality rates have declined in regions with higher socioeconomic indices, where there has been an even sharper decrease in all in-hospital morbidity and mortality variables. In addition to factors such as better treatment adherence and reduced smoking rates, socioeconomic factors appear to be involved in controlling COPD morbidity and mortality. The predictive models estimated here might also facilitate decision making and the planning of health policies aimed at treating COPD.


Asunto(s)
Mortalidad Hospitalaria/tendencias , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Femenino , Geografía , Humanos , Tiempo de Internación/tendencias , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Distribución por Sexo , Factores Socioeconómicos , Factores de Tiempo
8.
Cardiol Clin ; 37(4): 497-503, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31587790

RESUMEN

Carcinoid heart disease is the collective term for all cardiac manifestations that develop in patients with carcinoid. The cardiac manifestations of carcinoid tumors are attributed to the paraneoplastic effects of vasoactive substances released by the malignant cells. The clinical manifestations of carcinoid heart disease include valvular destruction leading to valvular regurgitation and stenosis, right-sided heart failure, and metastatic carcinoid disease. A combination of biomarkers and cardiac imaging is used in screening and diagnosis of carcinoid heart disease in patients with carcinoid syndrome. The management of carcinoid heart disease involves medical and surgical treatment and requires a multidisciplinary approach for optimized care.


Asunto(s)
Cardiopatía Carcinoide , Diagnóstico por Imagen/normas , Manejo de la Enfermedad , Guías de Práctica Clínica como Asunto , Cardiopatía Carcinoide/diagnóstico , Cardiopatía Carcinoide/epidemiología , Cardiopatía Carcinoide/terapia , Salud Global , Humanos , Morbilidad/tendencias
9.
Sante Publique ; Vol. 31(3): 433-441, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31640331

RESUMEN

OBJECTIVES: Non-communicable diseases (NCDs) represent a major public health problem worldwide. Giving their impact on the morbidity and mortality burden, understanding their chronological trends over time is a priority for epidemiological surveillance. We aimed to determine the epidemiological specificities of NCDs and to study their chronological trends over the period 2010-2015. METHODS: We retrospectively collected data of hospitalized patients from the regional registry of morbidity and mortality in the Southern University Hospital of Tunisia during the period 2010-2015. RESULTS: We included 18,081 patients with NCDs aged ≥ 25 years. The distribution of NCDs was characterized by the predominance of cardiovascular disease (CVD) (10,346 cases, 57.2%). Chronological trends analysis of NCDs showed that NCDs remained globally stable between 2010 and 2015. The same result applied to the group of cancers, chronic respiratory diseases and diabetes mellitus. However, CVD increased significantly between 2010 and 2015 (ρ = 0.84; p = 0.036). The proportion of CVD increased significantly among men (ρ = 0.87; p = 0.019) and elderly (ρ = 0.88; p = 0.019). The hospital mortality rate of NCDs increased significantly (ρ = 0.85; p = 0.031), notably for CVDs (ρ = 0.94; p = 0.005). CONCLUSION: Chronological trends analysis revealed a significant rise in the morbidity and mortality burden of CVDs during the period 2010-2015. It is imperative, therefore, to strengthen health care for these patients and to introduce the concept of integrated NCDs prevention as an essential component of the health system.


Asunto(s)
Enfermedades no Transmisibles/epidemiología , Adulto , Anciano , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , Humanos , Masculino , Morbilidad/tendencias , Mortalidad/tendencias , Enfermedades no Transmisibles/mortalidad , Sistema de Registros , Estudios Retrospectivos , Túnez/epidemiología
10.
Heart Lung Circ ; 28(11): 1646-1654, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31631860

RESUMEN

BACKGROUND: Heart failure (HF) is associated with high morbidity and mortality, and is a major contributor to health care costs. Since the area continues to be rapidly evolving, the aim of this study was to examine 15-year trends in demographics, precipitants, symptoms and outcomes of patients hospitalised with HF, and consider the individual and societal implications. METHODS: Data were prospectively collected by Heart Failure nurses from patients enrolled in the Management of Cardiac Function program (MACARF) in Northern Sydney, Australia. Analyses of trends were performed using Mantel-Hanzel tests and one-way analysis of variance. Multivariate Cox proportional hazard models were used to determine changes in readmission and mortality rates. RESULTS: From 2001 to 2015, 5,588 patients were hospitalised with HF and enrolled in the MACARF program. Over the 15-year period, the average age of enrolled patients increased by a decade (from 74 to 84 years), with an increase in hypertension (52% to 67%), chronic kidney disease (11% to 21%), atrial fibrillation/flutter (29% to 44%), and HF with preserved ejection fraction (24% to 35%) but a decrease in ischaemic heart disease (62% to 47%). Infection and atrial arrhythmias were the two most common precipitants of admission (27% and 18% of patients in 2013-15 respectively), while acute ischaemia became less common, and "unknown" precipitant increased to 35%. While increased exertional dyspnoea and peripheral oedema remained the most common presenting symptoms, weight gain, fatigue and chest pain were less frequently identified. Medication trends included an increase in spironolactone use and a decrease in angiotensin converting enzyme inhibitors. Average length of stay reduced while 1- and 3-year mortality rates improved to 11.3% and 26.6% respectively. In contrast, readmission rates have not improved, with current 30-day and 1-year rates of 9.9% and 42.6%. CONCLUSIONS: Significant temporal changes have occurred in the characteristics and outcome of patients with HF, which pose a challenge and opportunity to improve management. Although length of stay and mortality have improved, unchanged readmission rates highlight the importance of addressing the implications of the changing nature of patients with HF.


Asunto(s)
Manejo de la Enfermedad , Predicción , Insuficiencia Cardíaca/epidemiología , Hospitalización/tendencias , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Humanos , Masculino , Morbilidad/tendencias , Estudios Prospectivos , Factores de Riesgo , Volumen Sistólico/fisiología , Tasa de Supervivencia/tendencias
11.
Acta otorrinolaringol. esp ; 70(5): 272-278, sept.-oct. 2019. graf, tab
Artículo en Español | IBECS | ID: ibc-186370

RESUMEN

Introducción y objetivos: A lo largo de las últimas décadas han aparecido una serie cambios con capacidad de modificar las características epidemiológicas de los pacientes con carcinomas escamosos de cabeza y cuello (CECC), como el incremento en las expectativas de vida, la modificación en los patrones de consumo de tabaco y alcohol, o la infección por virus del papiloma humano (HPV). El objetivo del presente estudio es analizar la existencia de modificaciones en las características epidemiológicas y clínicas de este tipo de pacientes a lo largo de un periodo de 30 años. Métodos: Estudio retrospectivo de 5.123 pacientes con CECC tratados durante el periodo 1985-2017. Se evaluó la existencia de modificaciones en los patrones de edad, sexo, consumo de tóxicos, y localización y extensión del tumor a lo largo del periodo de estudio. Para los pacientes con carcinomas de orofaringe se evaluó el estatus HPV. Resultados: A lo largo del periodo de estudio se incrementó de forma significativa el promedio de edad y el porcentaje de pacientes de sexo femenino, disminuyendo el porcentaje de pacientes con uso severo de tóxicos. A nivel del tumor, observamos una disminución en el porcentaje de pacientes con tumores de la laringe, incrementándose los pacientes con tumores iniciales cT1 y con afectación ganglionar cN2. Pudimos evidenciar un incremento progresivo en el porcentaje de pacientes con carcinomas de orofaringe HPV-positivos. Conclusiones: Durante las últimas décadas se han producido modificaciones significativas en las características epidemiológicas y clínicas de los pacientes con CECC


Introduction and objectives: The epidemiological characteristics of patients with head and neck cancer squamous cell carcinoma (HNSCC) have changed over recent years. The increase in life expectancy of the population, changed patterns of tobacco and alcohol use, and human papillomavirus infection (HPV) have brought about significant changes. The objective of the present study is to analyze the changes in the epidemiological and clinical characteristics of these patients over a 30-year period. Methods: Retrospective study of 5,123 patients with HNSCC treated over the period 1985-2017. We evaluated the existence of changes in the patterns of age, sex, tobacco and alcohol use, and location and extension of the tumours throughout the study period. HPV status was evaluated for patients with oropharyngeal carcinomas. Results: Throughout the study period there was a significant increase in the mean age at presentation and in the percentage of women, and a decrease in the percentage of patients with history of high consumption of toxic substances. We observed a decrease in the proportion of patients with laryngeal cancer, and an increase of patients with early tumours cT1 and with neck disease cN2. We detected a progressive increase in the proportion of HPV-positive oropharyngeal carcinoma patients. Conclusion: Over recent decades there have been significant changes in the epidemiological and clinical characteristics of patients with HNSCC


Asunto(s)
Humanos , Masculino , Femenino , Neoplasias de Cabeza y Cuello/epidemiología , Carcinoma de Células Escamosas de Cabeza y Cuello/epidemiología , Distribución por Edad , Consumo de Bebidas Alcohólicas/epidemiología , Hospitales Universitarios/estadística & datos numéricos , Incidencia , Morbilidad/tendencias , Infecciones por Papillomavirus/epidemiología , Sistema de Registros , Estudios Retrospectivos , Distribución por Sexo , España/epidemiología , Uso de Tabaco/epidemiología
12.
Int Health ; 11(5): 353-357, 2019 09 02.
Artículo en Inglés | MEDLINE | ID: mdl-31529113

RESUMEN

At least 800 women die each day during pregnancy or birth and more than 15 000 babies each day are stillborn or die in the first month of life. Almost all of these deaths occur in low- and middle-income countries. Many more women and babies are known to suffer morbidity as a result of pregnancy and childbirth. However, reliable estimates of the burden of physical, psychological and social morbidity and comorbidity during and after pregnancy are not available. Although there is no single intervention or 'magic bullet' that would reduce mortality and improve health, there are evidence-based care packages which are defined and agreed internationally. A functioning health system with care available and accessible for everyone at all times is required to ensure women and babies survive and thrive.


Asunto(s)
Países en Desarrollo/estadística & datos numéricos , Mortalidad Infantil/tendencias , Mortalidad Materna/tendencias , Morbilidad/tendencias , Femenino , Humanos , Lactante , Recién Nacido , Embarazo
14.
Bratisl Lek Listy ; 120(9): 690-694, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31475556

RESUMEN

AIM: Severe acute maternal morbidity (SAMM) is a state of the woman, when she nearly died, but survived. The aim of study was to find out the exact incidence of SAMM in Slovakia, establishment of functional surveillance system and improve quality of health care. MATERIALS AND METHODS: The regular annual analyses of SAMM cases in Slovakia from January 1st 2012 to December 31st 2016. Observed SAMM included: peripartum haemorrhage, peripartum hysterectomy, uterine rupture, abnormally invasive placenta, HELLP syndrome, eclampsia, sepsis, transport to intensive care unit or anaesthesiology and non-fatal amniotic fluid embolism. RESULTS: The response rate of questionnaires was 84.8 %. The overall confirmed incidence of SAMM was 6.35/1,000 births (95% CI 6.03-6.67). The most often causes of SAMM were: peripartum haemorrhage (2.1/1,000 births), transport to intensive care unit or anaesthesiology (1.46/1,000 births), peripartum hysterectomy (0.84/1,000 births) and HELLP syndrome (0.63/1,000 births). The average age of women with SAMM was 30.3 years (14-46) and average parity was 1.16 (0-15). CONCLUSION: The incidence of SAMM and especially incidence of peripartum haemorrhage and peripartum hysterectomy in Slovakia is one of the highest in Europe. To decrease incidence and improve management and outcome of patients, regular audit of SAMM is needed (Tab. 3, Fig. 2, Ref. 30).


Asunto(s)
Salud Materna/estadística & datos numéricos , Morbilidad/tendencias , Complicaciones del Embarazo/epidemiología , Adolescente , Adulto , Femenino , Hemorragia , Humanos , Histerectomía , Persona de Mediana Edad , Periodo Periparto , Placenta Accreta , Embarazo , Sepsis , Eslovaquia , Rotura Uterina , Adulto Joven
15.
Graefes Arch Clin Exp Ophthalmol ; 257(11): 2541-2545, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31489490

RESUMEN

BACKGROUND: Orbital roof fractures are a significant cause of morbidity in trauma and are associated with a spectrum of orbital and ocular injuries. This study aims to characterize orbital roof fracture patterns and quantify the rate of acute intervention as compared with non-roof involving orbital wall fractures. METHODS: This study is a retrospective analysis of 340 orbital wall fractures diagnosed by CT imaging from August 2015 to October 2016. Orbital wall fractures were categorized as roof involving (N = 50) and non-roof involving (N = 290). Comparisons were made between these two groups to indicate a statistically significant difference in mechanism of injury, subjective symptoms, CT and exam findings, and final plan of care to include acute ophthalmologic intervention at the time of consultation. RESULTS: Assault (40.7%) was the most common cause of non-roof-involving fractures while falls from height (20.0%) were associated with a higher rate of roof fractures. Roof-involving orbital wall fractures were associated with a higher prevalence of corneal abrasions (16.3%), lid lacerations (23.4%), and traumatic optic neuropathy (10.4%). A reliable subjective exam on initial ophthalmic consultation was not achieved in a larger proportion of roof fracture patients (30%). Despite this, the rate of acute intervention in this group (34%) was almost double, including lateral canthotomy and cantholysis. CONCLUSIONS: Concomitant ocular injury is common in roof-involving orbital wall fractures, and may require more urgent ophthalmologic evaluation and acute intervention. As subjective patient data is often less readily available, a high index of suspicion and thorough investigation is warranted in caring for patients with roof-involving orbital wall fractures.


Asunto(s)
Lesiones Oculares/complicaciones , Órbita/lesiones , Fracturas Orbitales/diagnóstico , Adulto , Lesiones Oculares/diagnóstico , Lesiones Oculares/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Órbita/diagnóstico por imagen , Fracturas Orbitales/complicaciones , Fracturas Orbitales/epidemiología , Estudios Retrospectivos , Centros Traumatológicos/estadística & datos numéricos , Estados Unidos/epidemiología
16.
Cardiol Young ; 29(9): 1127-1136, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31414980

RESUMEN

INTRODUCTION: Although chylothorax is an uncommon complication following paediatric cardiothoracic surgery, it has significant associated morbidities and increased in-hospital mortality, as well as results in higher costs. A lack of prospective evidence or consensus guidelines for management of chylothorax further hinders optimal management. The aim of this survey was to characterise variations in practice in the management of chylothorax and to identify areas for future research. MATERIALS AND METHODS: A descriptive, observational survey investigating conservative management practices of chylothorax was distributed internationally to health-care professionals in paediatric intensive care and cardiology units. The survey investigated five domains: the first providing general information about health-care professionals and four domains focusing on clinical practice including diet composition and duration. RESULTS: In total, sixty-four health-care professionals completed the survey, representing 38 organisations from 16 countries. The respondents were dietitians (80%), physicians (19%), and nurses (1%). In Australia and New Zealand, management was most commonly directed by physicians' preference (67%) as compared to unit protocols in Europe (67%), United States of America (67%), and Other regions (55%). Dietitians in Australia/New Zealand, United Kingdom, and Ireland followed the most restrictive diet therapy recommending <5 g long chain triglyceride fat per day (p < 0.00001). The duration of diet therapy significantly varied between regions: Australia/New Zealand: 4 weeks (36%) and 6 weeks (43%); Europe: 4 weeks (25%) and 6 weeks (57%); and North America: 4 weeks (18%) and 6 weeks (75%) (p < 0.00001). CONCLUSIONS: This survey highlights international variations in practice in the management of chylothorax, particularly with respect to treatment duration and dietary fat restriction. Future research should include a multi-centre randomised controlled trial to inform evidence-based practice and reduce morbidity, particularly poor growth.


Asunto(s)
Quilotórax/terapia , Tratamiento Conservador/métodos , Dieta con Restricción de Grasas/métodos , Manejo de la Enfermedad , Encuestas Nutricionales/métodos , Complicaciones Posoperatorias , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Niño , Preescolar , Quilotórax/epidemiología , Estudios Transversales , Salud Global , Humanos , Lactante , Morbilidad/tendencias , Guías de Práctica Clínica como Asunto , Estudios Prospectivos
17.
BMC Ophthalmol ; 19(1): 192, 2019 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-31438884

RESUMEN

BACKGROUND: A patient's perception of how their glaucoma is managed will influence both adherence to their medication and outcome measures such as quality of life. METHODS: Prospective consecutive study using a Glaucoma Patient-reported Outcome and Experience Measure (POEM) modified for an Australian ophthalmic private clinical practice setting. The Australian Glaucoma POEM consists of eight items related to the patient's understanding of the diagnosis and management, acceptability of the treatment, whether they feel their glaucoma is getting worse, interfering with their daily life and concerns regarding loss of vision as well as addressing whether they feel safe under the care of their glaucoma team and how well their care is organised. RESULTS: Two hundred and two patients (M:F 91:111) participated in the study. Mean ± standard deviation for subject age was 69 ± 13 years. Patient's overall perception of their treatment and outcome was favourable. Younger patients felt their glaucoma interfered more with their daily lives and were more worried about losing vision from glaucoma. The greater the number of medications in use, the more they felt their glaucoma was getting worse and that glaucoma interfered with their daily lives. With all other variables accounted for by the multivariate linear model, female patients more strongly agreed that they understood their glaucoma diagnosis and glaucoma management. The patients with a severe visual defect in their worse eye, reported a greater perceived understanding of their glaucoma diagnosis and management and that they felt that glaucoma had a greater interference on their daily life. They were also more concerned about losing vision from glaucoma than their fellow glaucoma patients with less severe or no visual field deficit in the worse eye. CONCLUSIONS: The modified POEM demonstrates potential to capture the concerns of a practice's glaucoma cohort with a view to enhancing the quality of glaucoma care delivered.


Asunto(s)
Glaucoma/terapia , Presión Intraocular/fisiología , Medición de Resultados Informados por el Paciente , Calidad de la Atención de Salud , Agudeza Visual , Campos Visuales/fisiología , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Glaucoma/epidemiología , Glaucoma/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Estudios Prospectivos , Calidad de Vida , Queensland/epidemiología , Encuestas y Cuestionarios , Adulto Joven
18.
Clin Cardiol ; 42(10): 908-913, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31368589

RESUMEN

BACKGROUND: Peripheral artery disease (PAD) is common, and although it is associated with cardiovascular (CV) morbidity, mortality, reduced quality of life, and increased health care burden, PAD data are relatively scarce. Elevated triglycerides (TG) are associated with and are a risk factor for PAD. HYPOTHESIS: Large administrative retrospective data may provide further insight into the relationship between hypertriglyceridemia and peripheral arterial revascularization in high-risk statin-treated patients. METHODS: This retrospective administrative claims analysis of the Optum Research Database included statin-treated patients aged ≥45 years with diabetes and/or atherosclerotic CV disease enrolled in 2010 and followed for ≥6 months. Patients with TG ≥150 mg/dL were propensity score-matched to a comparator cohort with TG <150 mg/dL and high-density lipoprotein cholesterol >40 mg/dL (n = 23 181 in each cohort). A sub-analysis was conducted in patients with TG 200-499 mg/dL and a matched comparator cohort (n = 10 990). Clustered P-values were calculated using a Cox proportional hazard model with cohort as the independent variable (α, 0.05). RESULTS: Multivariate analysis showed a 37% higher rate of peripheral arterial revascularization in the elevated-TG cohort vs the comparator cohort (hazard ratio [HR] 1.370, 95% confidence interval [CI] 1.263-1.486; P < .001). Results in the high-TG sub-cohort were similar, with a 49% higher rate of revascularization vs the comparator cohort (HR 1.489; 95% CI, 1.348-1.644; P < .001). CONCLUSIONS: This large administrative retrospective analysis of high-risk statin-treated patients showed that elevated TG (≥150 mg/dL) and high TG (200-499 mg/dL) were significant predictors of peripheral arterial revascularization; this warrants further study.


Asunto(s)
Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Hipertrigliceridemia/complicaciones , Enfermedad Arterial Periférica/etiología , Medición de Riesgo/métodos , Triglicéridos/sangre , Biomarcadores/sangre , Causas de Muerte/tendencias , Femenino , Humanos , Hipertrigliceridemia/sangre , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Enfermedad Arterial Periférica/sangre , Enfermedad Arterial Periférica/epidemiología , Puntaje de Propensión , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias , Estados Unidos/epidemiología
19.
Artículo en Ruso | MEDLINE | ID: mdl-31465670

RESUMEN

The article presents a comprehensive analysis and assessment of the state of regional characteristics of morbidity with temporary disability, disability and mortality of employees of the internal affairs bodies of Russia. The source of the data was medical statistical reports generated by the medical and sanitary units of the Ministry of Internal Affairs of Russia using lexical analysis of medical documentation.


Asunto(s)
Morbilidad/tendencias , Programas Nacionales de Salud , Personas con Discapacidad , Humanos , Federación de Rusia
20.
Public Health ; 175: 101-107, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31470235

RESUMEN

OBJECTIVES: Although the cesarean section (C-section) is known as a lifesaving procedure, it can also increase the risk of maternal mortality and morbidity. This study was conducted to achieve two objectives: (1) determination of maternal near miss (MNM) indicators and pregnancy outcomes among women with a history of C-section and (2) investigation of the women's experience of near miss events during childbirth to provide a deeper understanding of the weaknesses of care delivery process. STUDY DESIGN: The present study was conducted using a prospective cross-sectional study using the World Health Organization (organ system dysfunction-based) criteria. METHODS: All subjects were women at more than 22 weeks of gestation who gave birth in Ali ibn Abi Talib Hospital, Zahedan, Iran, and were referred to this hospital for childbirth or those within 42 days of pregnancy termination. Logistic regression was used to predict the risk factors for severe maternal outcomes (SMOs). RESULTS: Nearly 58% of all MNM cases were related to women with a history of C-section. The MNM ratio was estimated at 8.04 per 1000 live births. Moreover, the frequent causes of SMOs were reported as severe hemorrhage (58.3%), severe pre-eclampsia/eclampsia (27.8%), medical condition (8.3%), and sepsis or severe systemic infection (5.6%). Abnormally invasive placenta (61%) was the most common cause of severe hemorrhage. After adjustment for potential confounder variables, the hemoglobin level of <11 g/dl (odds ratio [OR] = 0.18, 95% confidence interval [CI] = 0.09-0.36) and place of residence (OR = 0.41, 95% CI = 0.19-0.90) remained as independent risk factors for SMOs in the final model of multivariate analysis. CONCLUSION: A risk assessment system is needed to diagnose and manage the risk factors for SMOs during prenatal care. In addition, there should be a continuous audit of the indication and number of C-sections performed across health facilities.


Asunto(s)
Cesárea/efectos adversos , Morbilidad/tendencias , Centros de Atención Terciaria , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Irán/epidemiología , Near Miss Salud/estadística & datos numéricos , Embarazo , Resultado del Embarazo/epidemiología , Estudios Prospectivos , Factores de Riesgo , Adulto Joven
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