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1.
J Am Heart Assoc ; 9(19): e017297, 2020 10 20.
Artículo en Inglés | MEDLINE | ID: mdl-32998607

RESUMEN

Background Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) may worsen the prognosis of coronavirus disease 2019, but any association could be confounded by the cardiometabolic conditions indicating ACE-I/ARB use. We therefore examined the impact of ACE-Is/ARBs on respiratory tract infection outcomes. Methods and Results This cohort study included all adult patients hospitalized with influenza or pneumonia from 2005 to 2018 in Denmark using population-based medical databases. Thirty-day mortality and risk of admission to the intensive care unit in ACE-Is/ARBs users was compared with nonusers and with users of calcium channel blockers. We used propensity scores to handle confounding and computed propensity score-weighted risks, risk differences (RDs), and risk ratios (RRs). Of 568 019 patients hospitalized with influenza or pneumonia, 100 278 were ACE-I/ARB users and 37 961 were users of calcium channel blockers. In propensity score-weighted analyses, ACE-I/ARB users had marginally lower 30-day mortality than users of calcium channel blockers (13.9% versus 14.5%; RD, -0.6%; 95% CI, -1.0 to -0.1; RR, 0.96; 95% CI, 0.93-0.99), and a lower risk of admission to the intensive care unit (8.0% versus 9.6%; RD, -1.6%; 95% CI, -2.0 to -1.2; RR, 0.83; 95% CI, 0.80-0.87). Compared with nonusers, current ACE-I/ARB users had lower mortality (RD, -2.4%; 95% CI, -2.8 to -2.0; RR, 0.85; 95% CI, 0.83-0.87), but similar risk of admission to the intensive care unit (RD, 0.4%; 95% CI, 0.0-0.7; RR, 1.04; 95% CI, 1.00-1.09). Conclusions Among patients with influenza or pneumonia, ACE-I/ARB users had no increased risk of admission to the intensive care unit and slightly reduced mortality after controlling for confounding.


Asunto(s)
Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Gripe Humana/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Neumonía/tratamiento farmacológico , Sistema Renina-Angiotensina/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Dinamarca/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Gripe Humana/epidemiología , Masculino , Oportunidad Relativa , Pandemias , Neumonía/epidemiología , Puntaje de Propensión , Estudios Retrospectivos , Tasa de Supervivencia/tendencias
2.
Comput Math Methods Med ; 2020: 1391583, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33029193

RESUMEN

Purpose: We aimed to analyze and evaluate the safety signals of ribavirin-interferon combination through data mining of the US Food and Drug Administration Adverse Event Reporting System (FAERS), so as to provide reference for the rationale use of these agents in the management of relevant toxicities emerging in patients with novel coronavirus pneumonia (COVID-19). Methods: Reports to the FAERS from 1 January 2004 to 8 March 2020 were analyzed. The proportion of report ratio (PRR), reporting odds ratio (ROR), and Bayesian confidence interval progressive neural network (BCPNN) method were used to detect the safety signals. Results: A total of 55 safety signals were detected from the top 250 adverse event reactions in 2200 reports, but 19 signals were not included in the drug labels. All the detected adverse event reactions were associated with 13 System Organ Classes (SOC), such as gastrointestinal, blood and lymph, hepatobiliary, endocrine, and various nervous systems. The most frequent adverse events were analyzed, and the results showed that females were more likely to suffer from anemia, vomiting, neutropenia, diarrhea, and insomnia. Conclusion: The ADE (adverse drug event) signal detection based on FAERS is helpful to clarify the potential adverse events related to ribavirin-interferon combination for novel coronavirus therapy; clinicians should pay attention to the adverse reactions of gastrointestinal and blood systems, closely monitor the fluctuations of the platelet count, and carry out necessary mental health interventions to avoid serious adverse events.


Asunto(s)
Infecciones por Coronavirus/tratamiento farmacológico , Interferones/efectos adversos , Neumonía Viral/tratamiento farmacológico , Ribavirina/efectos adversos , Adolescente , Adulto , Sistemas de Registro de Reacción Adversa a Medicamentos , Anciano , Algoritmos , Teorema de Bayes , Minería de Datos , Esquema de Medicación , Quimioterapia Combinada/efectos adversos , Femenino , Humanos , Interferones/administración & dosificación , Masculino , Persona de Mediana Edad , Redes Neurales de la Computación , Oportunidad Relativa , Pandemias , Seguridad del Paciente , Ribavirina/administración & dosificación , Adulto Joven
3.
BMC Infect Dis ; 20(1): 732, 2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028241

RESUMEN

BACKGROUND: Adolescent sexual debut and non-consensual sex have been linked to higher sexual risk and STI infection in adulthood among men who have sex with men (MSM) in high-income countries. This study aimed to examine adolescent and non-consensual anal sexual debut among Chinese MSM and to evaluate factors associated with adolescent sexual debut and non-consensual anal sex. METHODS: A cross-sectional study was conducted recently among Chinese men assigned male sex at birth, ≥18 years old, and who had ever engaged in anal sex with a man. Participants answered questions regarding socio-demographics, condomless sex, age at anal sexual debut with a man, and whether the first anal sex was consensual. Factors associated with an adolescent sexual debut (< 18 years old) and non-consensual sex at sexual debut were evaluated. We defined adolescent sexual debut as having anal sex with another man at 17 years old or younger, and the participants were asked whether their first male-to-male anal sex was non-consensual. RESULTS: Overall, 2031 eligible men completed the survey. The mean age of sexual debut was 20.7 (SD = 4.3) years old. 17.6% (358/2031) of men reported adolescent sexual debut, and 5.0% (101/2031) reported a non-consensual sexual debut. The adolescent sexual debut was associated with having more male sexual partners (adjusted OR 1.10, 95% CI 1.06-1.15) and condomless anal sex in the last three months (AOR = 1.71, 95% CI 1.34-2.18). MSM whose sexual debut was non-consensual were more likely to have condomless anal sex (AOR = 1.76, 95% CI 1.17-2.66), and to have reported an adolescent sexual debut (AOR = 2.72, 95% CI 1.75-4.21). CONCLUSIONS: Many Chinese MSM reported adolescent sexual debut and non-consensual sex, both of which are associated with sexual risk behaviors and drive STI transmission. These findings highlight the need for designing tailored interventions for MSM who experienced adolescent sexual debut and non-consensual sex at debut.


Asunto(s)
Homosexualidad Masculina/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Adolescente , Adulto , Grupo de Ascendencia Continental Asiática , China , Condones , Estudios Transversales , Infecciones por VIH/patología , Humanos , Masculino , Oportunidad Relativa , Asunción de Riesgos , Encuestas y Cuestionarios , Adulto Joven
4.
Medicine (Baltimore) ; 99(41): e22519, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031292

RESUMEN

BACKGOUN: Asthma and dry eye disease are common clinical diseases. Studies have shown that asthma is related to dry eye, but there is no high-quality evidence-based medical evidence. METHOD: This protocol and final study will be conducted in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols 2015 statement. We will search PubMed, EMBASE, ISI Web of Science, China National Knowledge Infrastructure for all relevant literature published from their inception up to August 1, 2020. Literature search, data extraction, and quality assessment will be carried out independently by two researchers, and a third researcher will resolve differences when necessary. The association between dry eye disease and asthma will indicate as odds ratio with 95% confidence interval and statistically analyzed using RevMan 5.3 software. If the studies included have high heterogeneity, we will conduct sensitivity analysis and subgroup analysis. RESULTS: The protocol is intended to guide a meta-analysis aimed at identifying and quantifying the association between asthma and dry eye disease.


Asunto(s)
Asma/epidemiología , Síndromes de Ojo Seco/epidemiología , Humanos , Metaanálisis como Asunto , Oportunidad Relativa , Proyectos de Investigación , Factores de Riesgo , Revisiones Sistemáticas como Asunto
5.
Medicine (Baltimore) ; 99(33): e21034, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-32871977

RESUMEN

BACKGROUND: The aim of this systematic review and meta-analysis is to assess effectiveness and safety of Chinese medicine (CM) as complementary therapy in treating coronavirus disease 2019 (COVID-19). METHODS: The following databases will be searched: PubMed, Cochrane, Embase, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, and Wanfang database from October 1, 2019 to March 1, 2020. Randomized trials and quasi-randomized or prospective controlled clinical trials of CM that reported data on COVID-19 patients will be included. Study selection, data extraction, quality assessment, and assessment of risk bias will be performed by 2 reviewers independently. Odds ratios and correlative 95% confidence intervals will be calculated to present the association between the CM and CWM using Review Manager version 5.3 when there is sufficient available data. RESULTS: The results will be disseminated through a peer-reviewed journal publication. CONCLUSION: This systematic review findings will summarize up-to-date evidence for that CM is more effective and safe as adjunctive treatment for patients with COVID-19. ETHICS AND DISSEMINATION: Ethics approval and patient consent are not required as this study is a systematic review based on published articles. PROSPERO REGISTRATION NUMBER: CRD42020185382.


Asunto(s)
Betacoronavirus , Terapias Complementarias/métodos , Infecciones por Coronavirus/terapia , Medicamentos Herbarios Chinos/uso terapéutico , Neumonía Viral/terapia , Adulto , Anciano , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/virología , Femenino , Humanos , Masculino , Medicina China Tradicional/métodos , Metaanálisis como Asunto , Persona de Mediana Edad , Oportunidad Relativa , Pandemias , Neumonía Viral/virología , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
6.
Nat Commun ; 11(1): 4592, 2020 09 14.
Artículo en Inglés | MEDLINE | ID: mdl-32929089

RESUMEN

Prediabetes is a state of glycaemic dysregulation below the diagnostic threshold of type 2 diabetes (T2D). Globally, ~352 million people have prediabetes, of which 35-50% develop full-blown diabetes within five years. T2D and its complications are costly to treat, causing considerable morbidity and early mortality. Whether prediabetes is causally related to diabetes complications is unclear. Here we report a causal inference analysis investigating the effects of prediabetes in coronary artery disease, stroke and chronic kidney disease, complemented by a systematic review of relevant observational studies. Although the observational studies suggest that prediabetes is broadly associated with diabetes complications, the causal inference analysis revealed that prediabetes is only causally related with coronary artery disease, with no evidence of causal effects on other diabetes complications. In conclusion, prediabetes likely causes coronary artery disease and its prevention is likely to be most effective if initiated prior to the onset of diabetes.


Asunto(s)
Enfermedades Cardiovasculares/complicaciones , Estado Prediabético/complicaciones , Glucemia/metabolismo , Enfermedades Cardiovasculares/genética , Intervalos de Confianza , Enfermedad de la Arteria Coronaria/complicaciones , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Ayuno/sangre , Humanos , Persona de Mediana Edad , Estudios Observacionales como Asunto , Oportunidad Relativa , Estado Prediabético/sangre , Estado Prediabético/genética , Insuficiencia Renal Crónica/complicaciones , Factores de Riesgo , Accidente Cerebrovascular/complicaciones
7.
BMC Med ; 18(1): 286, 2020 09 09.
Artículo en Inglés | MEDLINE | ID: mdl-32900372

RESUMEN

When designing a clinical trial, explicitly defining the treatment estimands of interest (that which is to be estimated) can help to clarify trial objectives and ensure the questions being addressed by the trial are clinically meaningful. There are several challenges when defining estimands. Here, we discuss a number of these in the context of trials of treatments for patients hospitalised with COVID-19 and make suggestions for how estimands should be defined for key outcomes. We suggest that treatment effects should usually be measured as differences in proportions (or risk or odds ratios) for outcomes such as death and requirement for ventilation, and differences in means for outcomes such as the number of days ventilated. We further recommend that truncation due to death should be handled differently depending on whether a patient- or resource-focused perspective is taken; for the former, a composite approach should be used, while for the latter, a while-alive approach is preferred. Finally, we suggest that discontinuation of randomised treatment should be handled from a treatment policy perspective, where non-adherence is ignored in the analysis (i.e. intention to treat).


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Ensayos Clínicos como Asunto , Infecciones por Coronavirus/tratamiento farmacológico , Hospitalización , Humanos , Oportunidad Relativa , Pandemias , Proyectos de Investigación
8.
BMJ Open ; 10(9): e040328, 2020 09 17.
Artículo en Inglés | MEDLINE | ID: mdl-32948576

RESUMEN

OBJECTIVES: To assess the public's knowledge, attitudes and practices about the novel coronavirus in Sierra Leone to inform an evidence-based communication strategy around COVID-19. DESIGN: Nationwide, cross-sectional Knowledge, Attitudes and Practices survey. SETTING: 56 randomly selected communities in all 14 districts in Sierra Leone. PARTICIPANTS: 1253 adults aged 18 years and older of which 52% were men. MAIN OUTCOME MEASURES: We calculated proportions of core indicators (awareness, knowledge, risk perception, practices). A composite variable for knowledge (based on seven variables) was created, and categorised into low (0-2 correct), medium (3-4) and high (5-7). Predictors of knowledge were analysed with multilevel ordinal regression models. Associations between information sources, knowledge and two practices (washing hands with soap and avoiding crowds) were analysed using multilevel logistic regression models. RESULTS: We found that 75% of the respondents felt at moderate or great risk of contracting coronavirus. A majority (70%) of women did not know you can survive COVID-19, compared with 61% of men. 60% of men and 54% of women had already taken action to avoid infection with the coronavirus, mostly washing hands with soap and water (87%). Radio (73%) was the most used source for COVID-19 information, followed by social media (39%). Having a medium or high level of knowledge was associated with higher odds of washing hands with soap (medium knowledge: adjusted OR (AOR) 2.1, 95% CI 1.0 to 4.4; high knowledge: AOR 4.6, 95% CI 2.1 to 10.2) and avoiding crowds (medium knowledge: AOR 2.0, 95% CI 1.1 to 3.6; high knowledge: AOR 2.3, 95% CI 1.2 to 4.3). CONCLUSIONS: This study shows that in the context of COVID-19 in Sierra Leone, there is a strong association between knowledge and practices. Because the knowledge gap differs between genders, regions, educational levels and age, it is important that messages are specifically targeted to these core audiences.


Asunto(s)
Infecciones por Coronavirus , Conocimientos, Actitudes y Práctica en Salud , Pandemias , Neumonía Viral , Adulto , Betacoronavirus , Información de Salud al Consumidor , Femenino , Desinfección de las Manos , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Radio , Sierra Leona , Medios de Comunicación Sociales , Encuestas y Cuestionarios , Adulto Joven
9.
Cochrane Database Syst Rev ; 9: CD013708, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-32870512

RESUMEN

BACKGROUND: Supplemental oxygen is frequently administered to patients with acute respiratory distress syndrome (ARDS), including ARDS secondary to viral illness such as coronavirus disease 19 (COVID-19). An up-to-date understanding of how best to target this therapy (e.g. arterial partial pressure of oxygen (PaO2) or peripheral oxygen saturation (SpO2) aim) in these patients is urgently required. OBJECTIVES: To address how oxygen therapy should be targeted in adults with ARDS (particularly ARDS secondary to COVID-19 or other respiratory viruses) and requiring mechanical ventilation in an intensive care unit, and the impact oxygen therapy has on mortality, days ventilated, days of catecholamine use, requirement for renal replacement therapy, and quality of life. SEARCH METHODS: We searched the Cochrane COVID-19 Study Register, CENTRAL, MEDLINE, and Embase from inception to 15 May 2020 for ongoing or completed randomized controlled trials (RCTs). SELECTION CRITERIA: Two review authors independently assessed all records in accordance with standard Cochrane methodology for study selection. We included RCTs comparing supplemental oxygen administration (i.e. different target PaO2 or SpO2 ranges) in adults with ARDS and receiving mechanical ventilation in an intensive care setting. We excluded studies exploring oxygen administration in patients with different underlying diagnoses or those receiving non-invasive ventilation, high-flow nasal oxygen, or oxygen via facemask. DATA COLLECTION AND ANALYSIS: One review author performed data extraction, which a second review author checked. We assessed risk of bias in included studies using the Cochrane 'Risk of bias' tool. We used the GRADE approach to judge the certainty of the evidence for the following outcomes; mortality at longest follow-up, days ventilated, days of catecholamine use, and requirement for renal replacement therapy. MAIN RESULTS: We identified one completed RCT evaluating oxygen targets in patients with ARDS receiving mechanical ventilation in an intensive care setting. The study randomized 205 mechanically ventilated patients with ARDS to either conservative (PaO2 55 to 70 mmHg, or SpO2 88% to 92%) or liberal (PaO2 90 to 105 mmHg, or SpO2 ≥ 96%) oxygen therapy for seven days. Overall risk of bias was high (due to lack of blinding, small numbers of participants, and the trial stopping prematurely), and we assessed the certainty of the evidence as very low. The available data suggested that mortality at 90 days may be higher in those participants receiving a lower oxygen target (odds ratio (OR) 1.83, 95% confidence interval (CI) 1.03 to 3.27). There was no evidence of a difference between the lower and higher target groups in mean number of days ventilated (14.0, 95% CI 10.0 to 18.0 versus 14.5, 95% CI 11.8 to 17.1); number of days of catecholamine use (8.0, 95% CI 5.5 to 10.5 versus 7.2, 95% CI 5.9 to 8.4); or participants receiving renal replacement therapy (13.7%, 95% CI 5.8% to 21.6% versus 12.0%, 95% CI 5.0% to 19.1%). Quality of life was not reported. AUTHORS' CONCLUSIONS: We are very uncertain as to whether a higher or lower oxygen target is more beneficial in patients with ARDS and receiving mechanical ventilation in an intensive care setting. We identified only one RCT with a total of 205 participants exploring this question, and rated the risk of bias as high and the certainty of the findings as very low. Further well-conducted studies are urgently needed to increase the certainty of the findings reported here. This review should be updated when more evidence is available.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Unidades de Cuidados Intensivos , Oxígeno/administración & dosificación , Neumonía Viral/complicaciones , Respiración Artificial , Síndrome de Dificultad Respiratoria del Adulto/terapia , Sesgo , Catecolaminas/uso terapéutico , Tratamiento Conservador , Humanos , Oportunidad Relativa , Pandemias , Terapia de Reemplazo Renal/estadística & datos numéricos , Respiración Artificial/estadística & datos numéricos , Síndrome de Dificultad Respiratoria del Adulto/mortalidad , Síndrome de Dificultad Respiratoria del Adulto/virología , Autoimagen , Factores de Tiempo
10.
J Korean Acad Nurs ; 50(4): 533-540, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32895340

RESUMEN

PURPOSE: This study aimed to evaluate nursing students' understanding of the prevention of COVID-19, as well as their anxiety towards the disease and their perception of their professional identity in the wake of the pandemic, in Zhengzhou, China. METHODS: A cross-sectional study was designed to investigate 474 nursing students by cluster sampling using a stratified questionnaire from February 15 to March 31, 2020. Multiple linear regression was used to identify the factors affecting professional identity. Binary and multiple logistic regression were used to identify the factors affecting anxiety. RESULTS: Responders with a high level of understanding of COVID-19 and frequent use of behavioral strategies for its prevention comprised 93.2% and 30.0% of the cohort, respectively. Professional identity was significantly associated with gender and anxiety (p < .050). The prevalence of anxiety among nursing students was 12.4%. Male (odds ratio [OR] = 2.39; 95% confidence interval [CI] = 1.26~4.52), sophomores (OR = 5.30; 95% CI = 1.61~7.45), and infrequent use of prevention measures (OR = 3.49; 95% CI = 1.16~5.19) had a significant effect on anxiety. CONCLUSION: Anxiety during the COVID-19 epidemic gives an adverse effect on the professional identity of nursing in students. Nursing education institutions need to provide psychological counseling services for nursing students, in addition to improving their teaching of COVID-19 prevention strategies.


Asunto(s)
Ansiedad/etiología , Infecciones por Coronavirus/prevención & control , Conocimiento , Pandemias/prevención & control , Neumonía Viral/prevención & control , Rol Profesional , Estudiantes de Enfermería/psicología , Ansiedad/epidemiología , Betacoronavirus/aislamiento & purificación , China/epidemiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/virología , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Oportunidad Relativa , Neumonía Viral/epidemiología , Neumonía Viral/patología , Neumonía Viral/virología , Encuestas y Cuestionarios , Adulto Joven
11.
Croat Med J ; 61(4): 309-318, 2020 Aug 31.
Artículo en Inglés | MEDLINE | ID: mdl-32881428

RESUMEN

AIM: To investigate the effect of the coronavirus 2019 (COVID-19) lockdown on lifestyle behaviors and mood changes in the Croatian general population. METHODS: During ten days of the COVID-19 lockdown in Croatia, 3027 respondents (70.3% female) from the general population completed an online, self-report questionnaire. Demographic data and data on lifestyle habits and mood changes before and during the COVID-19 lockdown were collected. RESULTS: A total of 95.64% of respondents reported to follow most or all restrictions, with female sex (P<0.001) and higher education level (P<0.001) being associated with higher restriction compliance. Women smoked an increased number of cigarettes (P<0.001). The proportion of respondents of both sexes who did not drink or drank 7 drinks per week or more increased (P<0.001). Women also reported lower frequency (P=0.001) and duration of physical exercise (P<0.001). In total, 30.7% of respondents gained weight, with female sex (OR, 2.726) and higher BMI (OR, 1.116; both P<0.001) being associated with an increased likelihood of gaining weight. Both men and women felt more frequently afraid (P<0.001), discouraged (P<0.001), and sad (P<0.001). CONCLUSION: Public health authorities should promote the adoption of healthy lifestyles in order to reduce long-term negative effects of the lockdown.


Asunto(s)
Afecto , Consumo de Bebidas Alcohólicas/epidemiología , Fumar Cigarrillos/epidemiología , Infecciones por Coronavirus/epidemiología , Ejercicio Físico , Neumonía Viral/epidemiología , Cuarentena/estadística & datos numéricos , Aumento de Peso , Adulto , Betacoronavirus , Índice de Masa Corporal , Coronavirus , Croacia/epidemiología , Estudios Transversales , Miedo , Femenino , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Pandemias , Admisión y Programación de Personal , Cuarentena/psicología , Tristeza , Encuestas y Cuestionarios
12.
Geriatr Gerontol Int ; 20(10): 951-955, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32876981

RESUMEN

AIM: Although various neutrophilic immunosenescence mechanisms have been shown, there are few clinical studies on age-related differences in leukocytosis against acute bacterial infections, including acute colonic diverticulitis. METHODS: We performed a retrospective study of 26 patients ≥65 years old and 211 patients 16-64 years old who were hospitalized for acute colonic diverticulitis at Toho University Medical Center Omori Hospital between 2010 and 2016. We compared patients' characteristics, including sex, immunocompromised status, diverticulitis site, complications, severity, previous diverticulitis, vital signs, leukocyte counts, neutrophil-to-lymphocyte ratio and serum C-reactive protein on admission. To adjust for confounding factors, we performed a logistic regression analysis. RESULTS: Univariate comparisons showed that leukocyte count (older: 10 850 [interquartile range, 9400-12 000]/mm3 vs. younger: 12 600 [interquartile range, 10 500-15 000]/mm3 , P = 0.004) and prevalence of leukocytosis (leukocytes >11 000/mm3 ) were lower in older compared with younger patients. There were significantly more female, left-sided diverticulitis and immunocompromised patients in the older compared with the younger group. Logistic regression showed that leukocyte count, prevalence of female patients, and left-sided diverticulitis were independent predictors for the older patients: Their odds ratios were 0.866 (95% confidence interval [95% CI] 0.753-0.996), 2.631 (95% CI, 1.032-6.707) and 5.810 (95% CI, 2.328-14.497), respectively. CONCLUSION: Caution should be taken when managing older patients with colonic diverticulitis because reactive leukocytosis might be poor, possibly reflecting immunosenescence. Geriatr Gerontol Int 2020; 20: 951-955.


Asunto(s)
Diverticulitis del Colon/epidemiología , Leucocitosis/epidemiología , Enfermedad Aguda , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Diverticulitis del Colon/sangre , Femenino , Humanos , Inmunosenescencia , Japón , Recuento de Leucocitos , Leucocitosis/sangre , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Adulto Joven
13.
Geriatr Gerontol Int ; 20(10): 974-979, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32881240

RESUMEN

AIM: Heart diseases and social factors are associated with physical frailty, but there are few studies of older people living in the community. Consequently, the aim of this study was to examine the association between heart diseases, social factors and physical frailty in community-dwelling older populations including the oldest-old people. METHODS: The cross-sectional study included 1882 participants of community-dwelling older and oldest-old people. The survey site assessed questionnaires on medical history, social factors, blood samples and physical examination. Physical frailty was based on slow gait speed or weak grip strength. Associations were analyzed using multiple logistic regression with adjustments for covariate factors. RESULTS: Subjects with heart disease had a higher prevalence of physical frailty than those without heart disease. After adjusting the covariate factors, heart diseases were associated with a slow gait speed (odds ratio [OR] = 1.62; 95% confidence interval [CI]: 1.13-2.32, P = 0.009). Frequency of going outdoors and direct interaction with relatives or friends were associated with a slow gait speed (OR = 0.83, 95% CI 0.75-0.91, P ≤ 0.001 and OR = 0.87, 95% CI 0.81-0.94, P < 0.001), and associated with physical frailty (OR = 0.80, 95% CI 0.72-0.89, P ≤ 0.001 and OR = 0.88, 95% CI 0.82-0.95, P = 0.002). Living alone and frequency of direct interaction with relatives or friends were associated with physical frailty in subjects with heart disease. CONCLUSIONS: Our findings indicate that in community-dwelling older people, heart diseases and social factors were associated with physical frailty. Older people with heart disease, those living alone and the frequency of direct interaction with relatives or friends were associated with physical frailty. Geriatr Gerontol Int 2020; 20: 974-979.


Asunto(s)
Anciano Frágil/estadística & datos numéricos , Fragilidad/epidemiología , Cardiopatías/epidemiología , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Evaluación Geriátrica , Humanos , Vida Independiente , Relaciones Interpersonales , Masculino , Oportunidad Relativa , Prevalencia , Apoyo Social , Encuestas y Cuestionarios , Velocidad al Caminar
14.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32900877

RESUMEN

BACKGROUND: Children born preterm are at high risk for autism spectrum disorder (ASD). However, there is still a lack of appropriate developmental markers. In this study, we aim to examine whether early mental performance trajectory is related to ASD outcome in the preterm population. METHODS: The population-based cohort included 414 very preterm survivors born between 2008 and 2014. After excluding children with severe neurosensory impairment, 319 children with available records of developmental quotients before age 2 years were enrolled. The trajectory of mental performance evaluated by using the Bayley Scales of Infant Development across 6, 12, and 24 months of age was analyzed with group-based trajectory modeling. At 5 years of age, the ASD diagnosis was established by using the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised. RESULTS: There were 29 children with ASD and 290 children without ASD. The mental performances from age 6 to 24 months could be classified into 3 trajectory patterns: low declining, high declining, and high stable, which corresponded to ASD prevalence at age 5 years of 35%, 9%, and 3%, respectively. ASD odds was 15 times higher in the low-declining group than in the high-stable group (odds ratio 15; 95% confidence interval 3.8-59; P < .001). Through the analysis of multinomial logistic regression, we found that male infants with longer exposure to oxygen therapy whose mothers had lower maternal education levels tended to follow the low-declining trajectory. CONCLUSIONS: The early-life mental trajectory patterns, by using the Bayley Scales of Infant Development, may lead to identification of vulnerable children born preterm for early ASD diagnosis and targeted intervention.


Asunto(s)
Trastorno del Espectro Autista , Desarrollo Infantil , Recien Nacido Extremadamente Prematuro , Factores de Edad , Trastorno del Espectro Autista/clasificación , Trastorno del Espectro Autista/diagnóstico , Trastorno del Espectro Autista/epidemiología , Trastorno del Espectro Autista/fisiopatología , Preescolar , Intervalos de Confianza , Diagnóstico Precoz , Escolaridad , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Oportunidad Relativa , Oxígeno/uso terapéutico , Prevalencia , Factores Sexuales
15.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32913134

RESUMEN

BACKGROUND AND OBJECTIVES: Opioid misuse and overdose remains a leading US public health concern, and many youth are first exposed to opioids via medical use. In this study, we examine school-level prevalence and correlates of medical use and misuse of prescription opioids among US 12th-grade students. METHODS: A sample of 228 507 US 12th-graders in 1079 public and private schools from 2002 to 2017 from the Monitoring the Future study was used to identify school-level prevalence and correlates associated with medical use and misuse of prescription opioids. RESULTS: The past-year prevalence of prescription opioid misuse was 7.6% and ranged from 0% to 73% across US high schools. Lifetime medical use of prescription opioids was 16.9% and ranged from 0% to 85% across US high schools. The odds of prescription opioid misuse were higher at schools with higher proportions of male students, more white students, higher rates of marijuana use, and more medical use of prescription opioids. Students attending schools with the highest rates of medical use of prescription opioids had 57% increased odds of past-year prescription opioid misuse compared with schools with no medical use (adjusted odds ratio = 1.57, 95% confidence interval = 1.35-1.83); this association was found to weaken in recent years. CONCLUSIONS: Differences exist in the prevalence of prescription opioid misuse among US high schools. The association between greater school-level medical use of prescription opioids and higher prevalence of prescription opioid misuse, although declining, indicates a key risk factor to target for prevention efforts.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Trastornos Relacionados con Opioides/epidemiología , Mal Uso de Medicamentos de Venta con Receta/estadística & datos numéricos , Adolescente , Intervalos de Confianza , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Masculino , Abuso de Marihuana/epidemiología , Oportunidad Relativa , Prevalencia , Instituciones Académicas/estadística & datos numéricos , Factores Sexuales , Estudiantes/estadística & datos numéricos , Estados Unidos/epidemiología
16.
BMC Infect Dis ; 20(1): 684, 2020 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-32948128

RESUMEN

BACKGROUND: Untreated male partners are a critical source of maternal re-infection. Contact tracing is a good way to identify infection among partners and reduce risk of mother-to-child transmission related to maternal re-infection. This study aimed to analyze the current situation and related factors of contact tracing of syphilis-seropositive pregnant women and syphilis-infection among their male partners. METHOD: Data of syphilis-seropositive pregnant women and their male partners attending clinic for syphilis-screening were obtained from the Shenzhen Program for Prevention of Congenital Syphilis. Contact tracing rate of syphilis-seropositive pregnant women and syphilis prevalence among male partners were counted, and related factors were also analyzed using a random-effects logistic regression model. RESULT: Of the 1299 syphilis-seropositive pregnant women, 74.1% (963/1299) had their male partners receiving syphilis-screening and 19.1% (184/963) of male partners were syphilis-infected. For pregnant women, being divorced (adjusted odds ratio [AOR] =0.39; 95%CI: 0.17-0.87), seeking for emergency services at their first antenatal clinics visits (AOR = 0.58; 95%CI: 0.44-0.77), reporting willingness to notify partner(AOR = 7.65; 95%CI: 4.69-12.49), multi-partners (AOR = 1.38; 95%CI:1.03-1.86) and having a history of drug abuse (AOR = 0.37; 95%CI: 0.14-1.00)were independently associated with successful contact tracing. For male partners, of minority ethnicity (AOR = 4.15; 95%CI: 1.66-10.34), age at first sex>20(AOR = 0.57; 95%CI: 0.37-0.87), reporting multi-partners (AOR = 1.60; 95%CI: 1.04-2.46), having a history of drug abuse (AOR = 4.07; 95%CI: 1.31-12.64) were independently associated with syphilis-infection. In addition, pregnant women with TRUST titer ≥1:8 (AOR = 2.81; 95%CI: 1.87-4.21), having a history of adverse pregnancy outcomes (AOR = 1.70; 95%CI: 1.14-2.53), reporting multi-partners (AOR = 0.43; 95%CI: 0.29-0.64) and reporting the current partner as the source of syphilis (AOR = 5.05; 95%CI: 2.82-9.03) were independently associated with partners' syphilis-infection. CONCLUSION: Contact tracing is feasible and effective in identifying syphilis-infected partners among syphilis-seropositive pregnant women. Contact tracing is associated with many factors such as women's marital status, services at their first antenatal clinics visit and willingness of partner notification. Partners' ethnicity, age at first sex, multi-partners and history of drug abuse as well as women's levels of TRUST titer were associated with partners' syphilis-infection.


Asunto(s)
Trazado de Contacto , Complicaciones Infecciosas del Embarazo/epidemiología , Sífilis/transmisión , Adolescente , Adulto , Instituciones de Atención Ambulatoria , China/epidemiología , Femenino , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Modelos Logísticos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Oportunidad Relativa , Embarazo , Resultado del Embarazo , Mujeres Embarazadas , Prevalencia , Parejas Sexuales , Sífilis/epidemiología , Sífilis Congénita/prevención & control , Sífilis Congénita/transmisión , Adulto Joven
17.
PLoS Med ; 17(9): e1003283, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32877401

RESUMEN

BACKGROUND: Since 2011, the protracted Syrian war has had tragic consequences on the lives of the Syrian people, threatening their stability, health, and well-being. The most vulnerable are children, who face interruption of schooling and child labor. This study explored the relationship between social capital and the physical health and emotional well-being of Syrian refugee working children in rural areas of Lebanon. METHODS AND FINDINGS: In this cross-sectional study, we surveyed 4,090 Syrian refugee children working in the Bekaa Valley of Lebanon in 2017. Children (8-18 years) gave direct testimony on their living and social environment in face-to-face interviews. Logistic regressions assessed the association of social capital and social cohesion with the health and emotional well-being of Syrian refugee working children; specifically, poor self-rated health, reporting a health problem, engaging in risky health behavior, feeling lonely, feeling optimistic, and being satisfied with life. Of the 4,090 working children in the study, 11% reported poor health, 16% reported having a health problem, and 13% were engaged in risky behaviors. The majority (67.5%) reported feeling lonely, while around 53% were optimistic and 59% were satisfied with life. The study findings suggest that positive social capital constructs were associated with better health. Lower levels of social cohesion (e.g., not spending time with friends) were significantly associated with poor self-rated health, reporting a physical health problem, and feeling more lonely ([adjusted odds ratio (AOR), 2.4; CI 1.76-3.36, p < 0.001], [AOR, 1.9; CI 1.44-2.55, p < 0.001], and [AOR, 0.5; CI 0.38-0.76, p < 0.001], respectively). Higher levels of social support (e.g., having good social relations), family social capital (e.g., discussing personal issues with parents), and neighborhood attachment (e.g., having a close friend) were all significantly associated with being more optimistic ([AOR, 1.5; CI 1.2-1.75, p < 0.001], [AOR, 1.3; CI 1.11-1.52, p < 0.001], and [AOR, 1.9; CI 1.58-2.29, p < 0.001], respectively) and more satisfied with life ([AOR, 1.3; CI 1.01-1.54, p = 0.04], [AOR, 1.2; CI 1.01-1.4, p = 0.04], and [AOR, 1.3; CI 1.08-1.6, p = 0.006], respectively). The main limitations of this study were its cross-sectional design, as well as other design issues (using self-reported health measures, using a questionnaire that was not subject to a validation study, and giving equal weighting to all the components of the health and emotional well-being indicators). CONCLUSIONS: This study highlights the association between social capital, social cohesion, and refugee working children's physical and emotional health. In spite of the poor living and working conditions that Syrian refugee children experience, having a close-knit network of family and friends was associated with better health. Interventions that consider social capital dimensions might contribute to improving the health of Syrian refugee children in informal tented settlements (ITSs).


Asunto(s)
Calidad de Vida/psicología , Refugiados/psicología , Adolescente , Niño , Trabajo Infantil , Estudios Transversales , Emociones , Femenino , Humanos , Líbano/etnología , Masculino , Oportunidad Relativa , Capital Social , Medio Social , Apoyo Social , Siria
18.
PLoS Med ; 17(9): e1003302, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32915777

RESUMEN

BACKGROUND: A number of epidemiological and genetic studies have attempted to determine whether levels of circulating lipids are associated with risks of various cancers, including breast cancer (BC). However, it remains unclear whether a causal relationship exists between lipids and BC. If alteration of lipid levels also reduced risk of BC, this could present a target for disease prevention. This study aimed to assess a potential causal relationship between genetic variants associated with plasma lipid traits (high-density lipoprotein, HDL; low-density lipoprotein, LDL; triglycerides, TGs) with risk for BC using Mendelian randomization (MR). METHODS AND FINDINGS: Data from genome-wide association studies in up to 215,551 participants from the Million Veteran Program (MVP) were used to construct genetic instruments for plasma lipid traits. The effect of these instruments on BC risk was evaluated using genetic data from the BCAC (Breast Cancer Association Consortium) based on 122,977 BC cases and 105,974 controls. Using MR, we observed that a 1-standard-deviation genetically determined increase in HDL levels is associated with an increased risk for all BCs (HDL: OR [odds ratio] = 1.08, 95% confidence interval [CI] = 1.04-1.13, P < 0.001). Multivariable MR analysis, which adjusted for the effects of LDL, TGs, body mass index (BMI), and age at menarche, corroborated this observation for HDL (OR = 1.06, 95% CI = 1.03-1.10, P = 4.9 × 10-4) and also found a relationship between LDL and BC risk (OR = 1.03, 95% CI = 1.01-1.07, P = 0.02). We did not observe a difference in these relationships when stratified by breast tumor estrogen receptor (ER) status. We repeated this analysis using genetic variants independent of the leading association at core HDL pathway genes and found that these variants were also associated with risk for BCs (OR = 1.11, 95% CI = 1.06-1.16, P = 1.5 × 10-6), including locus-specific associations at ABCA1 (ATP Binding Cassette Subfamily A Member 1), APOE-APOC1-APOC4-APOC2 (Apolipoproteins E, C1, C4, and C2), and CETP (Cholesteryl Ester Transfer Protein). In addition, we found evidence that genetic variation at the ABO locus is associated with both lipid levels and BC. Through multiple statistical approaches, we minimized and tested for the confounding effects of pleiotropy and population stratification on our analysis; however, the possible existence of residual pleiotropy and stratification remains a limitation of this study. CONCLUSIONS: We observed that genetically elevated plasma HDL and LDL levels appear to be associated with increased BC risk. Future studies are required to understand the mechanism underlying this putative causal relationship, with the goal of developing potential therapeutic strategies aimed at altering the cholesterol-mediated effect on BC risk.


Asunto(s)
Neoplasias de la Mama/genética , Lípidos/análisis , Lípidos/sangre , Adulto , Neoplasias de la Mama/metabolismo , Colesterol/análisis , Colesterol/sangre , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Femenino , Predisposición Genética a la Enfermedad/genética , Estudio de Asociación del Genoma Completo/métodos , Humanos , Masculino , Análisis de la Aleatorización Mendeliana/métodos , Persona de Mediana Edad , Oportunidad Relativa , Fenotipo , Polimorfismo de Nucleótido Simple/genética , Factores de Riesgo , Triglicéridos/sangre
19.
PLoS Med ; 17(9): e1003225, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32926731

RESUMEN

BACKGROUND: Early studies of narcolepsy after AS03-adjuvanted pandemic A/H1N12009 vaccine (Pandemrix) could not define the duration of elevated risk post-vaccination nor the risk in children aged under 5 years who may not present until much older. METHODS/FINDINGS: Clinical information and sleep test results, extracted from hospital notes at 3 large pediatric sleep centers in England between September 2017 and June 2018 for narcolepsy cases aged 4-19 years with symptom onset since January 2009, were reviewed by an expert panel to confirm the diagnosis. Vaccination histories were independently obtained from general practitioners (GPs). The odds of vaccination in narcolepsy cases compared with the age-matched English population was calculated after adjustment for clinical conditions that were indications for vaccination. GP questionnaires were returned for 242 of the 244 children with confirmed narcolepsy. Of these 5 were under 5 years, 118 were 5-11 years, and 119 were 12-19 years old at diagnosis; 39 were vaccinated with Pandemrix before onset. The odds ratio (OR) for onset at any time after vaccination was 1.94 (95% confidence interval [CI] 1.30-2.89), The elevated risk period was restricted to onsets within 12 months of vaccination (OR 6.65 [3.44-12.85]) and was highest within the first 6 months. After one year, ORs were not significantly different from 1 up to 8 years after vaccination. The ORs were similar in under five-year-olds and older ages. The estimated attributable risk was 1 in 34,500 doses. Our study is limited by including cases from only 3 sleep centers, who may differ from cases diagnosed in nonparticipating centers, and by imprecision in defining the centers' catchment population. The potential for biased recall of onset shortly after vaccination in cases aware of the association cannot be excluded. CONCLUSIONS: In this study, we found that vaccine-attributable cases have onset of narcolepsy within 12 months of Pandemrix vaccination. The attributable risk is higher than previously estimated in England because of identification of vaccine-attributable cases with late diagnoses. Absence of a compensatory drop in risk 1-8 years after vaccination suggests that Pandemrix does not trigger onsets in those in whom narcolepsy would have occurred later.


Asunto(s)
Narcolepsia/etiología , Polisorbatos/efectos adversos , Escualeno/efectos adversos , Vacunación/efectos adversos , alfa-Tocoferol/efectos adversos , Adolescente , Niño , Preescolar , Combinación de Medicamentos , Inglaterra/epidemiología , Femenino , Humanos , Subtipo H1N1 del Virus de la Influenza A/inmunología , Vacunas contra la Influenza/efectos adversos , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/epidemiología , Masculino , Narcolepsia/epidemiología , Narcolepsia/inmunología , Oportunidad Relativa , Pandemias , Factores de Riesgo , Encuestas y Cuestionarios
20.
JAMA Netw Open ; 3(9): e2021892, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-32975575

RESUMEN

Importance: Initial public health data show that Black race may be a risk factor for worse outcomes of coronavirus disease 2019 (COVID-19). Objective: To characterize the association of race with incidence and outcomes of COVID-19, while controlling for age, sex, socioeconomic status, and comorbidities. Design, Setting, and Participants: This cross-sectional study included 2595 consecutive adults tested for COVID-19 from March 12 to March 31, 2020, at Froedtert Health and Medical College of Wisconsin (Milwaukee), the largest academic system in Wisconsin, with 879 inpatient beds (of which 128 are intensive care unit beds). Exposures: Race (Black vs White, Native Hawaiian or Pacific Islander, Native American or Alaska Native, Asian, or unknown). Main Outcomes and Measures: Main outcomes included COVID-19 positivity, hospitalization, intensive care unit admission, mechanical ventilation, and death. Additional independent variables measured and tested included socioeconomic status, sex, and comorbidities. Reverse transcription polymerase chain reaction assay was used to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: A total of 2595 patients were included. The mean (SD) age was 53.8 (17.5) years, 978 (37.7%) were men, and 785 (30.2%) were African American patients. Of the 369 patients (14.2%) who tested positive for COVID-19, 170 (46.1%) were men, 148 (40.1%) were aged 60 years or older, and 218 (59.1%) were African American individuals. Positive tests were associated with Black race (odds ratio [OR], 5.37; 95% CI, 3.94-7.29; P = .001), male sex (OR, 1.55; 95% CI, 1.21-2.00; P = .001), and age 60 years or older (OR, 2.04; 95% CI, 1.53-2.73; P = .001). Zip code of residence explained 79% of the overall variance in COVID-19 positivity in the cohort (ρ = 0.79; 95% CI, 0.58-0.91). Adjusting for zip code of residence, Black race (OR, 1.85; 95% CI, 1.00-3.65; P = .04) and poverty (OR, 3.84; 95% CI, 1.20-12.30; P = .02) were associated with hospitalization. Poverty (OR, 3.58; 95% CI, 1.08-11.80; P = .04) but not Black race (OR, 1.52; 95% CI, 0.75-3.07; P = .24) was associated with intensive care unit admission. Overall, 20 (17.2%) deaths associated with COVID-19 were reported. Shortness of breath at presentation (OR, 10.67; 95% CI, 1.52-25.54; P = .02), higher body mass index (OR per unit of body mass index, 1.19; 95% CI, 1.05-1.35; P = .006), and age 60 years or older (OR, 22.79; 95% CI, 3.38-53.81; P = .001) were associated with an increased likelihood of death. Conclusions and Relevance: In this cross-sectional study of adults tested for COVID-19 in a large midwestern academic health system, COVID-19 positivity was associated with Black race. Among patients with COVID-19, both race and poverty were associated with higher risk of hospitalization, but only poverty was associated with higher risk of intensive care unit admission. These findings can be helpful in targeting mitigation strategies for racial disparities in the incidence and outcomes of COVID-19.


Asunto(s)
Afroamericanos , Infecciones por Coronavirus/etnología , Disparidades en el Estado de Salud , Hospitalización , Unidades de Cuidados Intensivos , Neumonía Viral/etnología , Adulto , Anciano , Betacoronavirus , Índice de Masa Corporal , Estudios de Cohortes , Comorbilidad , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Estudios Transversales , Disnea/epidemiología , Disnea/etiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Grupos Minoritarios , Oportunidad Relativa , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Neumonía Viral/virología , Pobreza , Respiración Artificial , Wisconsin/epidemiología
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