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1.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud | ID: lis-LISBR1.1-47123

RESUMEN

Promoção da qualificação na oficina para jornalistas sobre coronavírus oferecida pela Fundação Oswaldo Cruz em 12 de fevereiro de 2020.


Asunto(s)
Betacoronavirus , Periodismo/tendencias , Comunicación Social , Sensibilización Pública , Acceso a la Información , Educación , Coronavirus , Comunicación en Salud
2.
Bone Joint J ; 102-B(3): 293-300, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32114805

RESUMEN

AIMS: Vancouver type B periprosthetic femoral fractures (PFF) are challenging complications after total hip arthroplasty (THA), and some treatment controversies remain. The objectives of this study were: to evaluate the short-to-mid-term clinical outcomes after treatment of Vancouver type B PFF and to compare postoperative outcome in subgroups according to classifications and treatments; to report the clinical outcomes after conservative treatment; and to identify risk factors for postoperative complications in Vancouver type B PFF. METHODS: A total of 97 consecutive PPFs (49 males and 48 females) were included with a mean age of 66 years (standard deviation (SD) 14.9). Of these, 86 patients were treated with surgery and 11 were treated conservatively. All living patients had a minimum two-year follow-up. Patient demographics details, fracture healing, functional scores, and complications were assessed. Clinical outcomes between internal fixation and revisions in patients with or without a stable femoral component were compared. Conservatively treated PPFs were evaluated in terms of mortality and healing status. A logistic regression analysis was performed to identify risk factors for complications. RESULTS: In surgically treated patients, all fractures united and nine complications were identified. The mean postoperative Visual Analogue Scale (VAS) for pain was 1.5 (SD 1.3), mean Parker Mobility Score (PMS) was 6.5 (SD 2.4), and mean Harris Hip Score (HHS) was 79.4 (SD 16.2). Among type B2 and type B3 fractures, patients treated with internal fixation had significantly lower PMS (p = 0.032) and required a longer time to heal (p = 0.012). In conservatively treated patients, one-year mortality rate was 36.4% (4/11), and two patients ultimately progressed to surgery. Young age (p = 0.039) was found to be the only risk factor for complications. CONCLUSION: The overall clinical outcome among Vancouver type B PFF was satisfactory. However, treatment with internal fixation in type B2 and B3 fractures had a significantly longer time to heal and lower mobility than revision cases. Conservative treatment was associated with high rates of early mortality and, in survivors, nonunion. This probably reflects our selection bias in undertaking surgical intervention. In our whole cohort, younger patient age was a risk factor for postoperative complications in Vancouver type B PFF. Cite this article: Bone Joint J 2020;102-B(3):293-300.


Asunto(s)
Tratamiento Conservador/métodos , Fracturas del Fémur/terapia , Fijación Interna de Fracturas/métodos , Fracturas Periprotésicas/terapia , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , China/epidemiología , Femenino , Fracturas del Fémur/diagnóstico , Fracturas del Fémur/etiología , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Fracturas Periprotésicas/diagnóstico , Fracturas Periprotésicas/etiología , Estudios Retrospectivos , Tasa de Supervivencia/tendencias
3.
Bone Joint J ; 102-B(3): 360-364, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32114808

RESUMEN

AIMS: The aim of this study was to examine the recent trend in delivery of arthroscopic subacromial decompression (ASD) in Scotland and to determine if this varies by geographical location. METHODS: Scottish Morbidity Records were reviewed retrospectively between March 2014 and April 2018 to identify records for every admission to each NHS hospital. The Office of Population Censuses and Surveys (OPCS-4) surgical codes were used to identify patients undergoing primary ASD. Patients who underwent acromioclavicular joint excision (ACJE) and rotator cuff repair (RCR) were identified and grouped separately. Procedure rates were age and sex standardized against the European standard population. RESULTS: During the study period the number of ASDs fell by 649 cases (29%) from 2,217 in the first year to 1,568 in the final year. The standardized annual procedure rate fell from 41.6 (95% confidence interval (CI) 39.9 to 43.4) to 28.9 (95% CI 27.4 to 30.3) per 100,000. The greatest reduction occurred between 2017 and 2018. The number of ACJEs rose from 41 to 188 (a 3.59-fold increase). The number of RCRs fell from 655 to 560 (-15%). In the year 2017 to 2018 there were four (28.6%) Scottish NHS board areas where the ASD rate was greater than 3 standard deviations (SDs) from the national average, and two (14.3%) NHS boards where the rate was less than 3 SDs from the national average. CONCLUSION: There has been a clear decline in the rate of ASD in Scotland since 2014. Over the same period there has been an increase in the rate of ACJE. The greatest decline occurred between 2017 and 2018, corresponding to the publication of epidemiological studies demonstrating a rise in ASD, and awareness of studies which questioned the benefit of ASD. This paper demonstrates the potential impact of information from epidemiological studies, referral guidelines, and well-designed large multicentre randomized controlled trials on clinical practice. Cite this article: Bone Joint J 2020;102-B(3):360-364.


Asunto(s)
Articulación Acromioclavicular/cirugía , Artroscopía/tendencias , Descompresión Quirúrgica/tendencias , Lesiones del Manguito de los Rotadores/cirugía , Manguito de los Rotadores/cirugía , Descompresión Quirúrgica/métodos , Humanos , Incidencia , Estudios Retrospectivos , Lesiones del Manguito de los Rotadores/epidemiología , Escocia/epidemiología
4.
Bone Joint J ; 102-B(3): 285-292, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32114815

RESUMEN

AIMS: The aim of this study is to evaluate the clinical results of operative intervention for femoral metastases which were selected based on expected survival and to discuss appropriate surgical strategies. METHODS: From 2002 to 2017, 148 consecutive patients undergoing surgery for femoral metastasis were included in this study. Prognostic risk assessments were performed according to the Katagiri and revised Katagiri scoring system. In general, the low-risk group underwent resection and reconstruction with endoprosthetic replacement (EPR), while the high-risk group underwent internal fixation (IF) and radiation therapy. For the intermediate-risk group, the operative choice depended on the patient's condition, degree of bone destruction, and radio-sensitivity. Overall survival, local failure, walking ability, and systemic complications were evaluated. RESULTS: A total of 83 patients underwent EPR (low-risk, 23%; intermediate-risk, 60%; high-risk, 17%) and 65 patients underwent IF (low-risk, 0%; intermediate-risk, 32%; high-risk, 68%). The one-year survival rate was 71% for EPR and 15% for IF (p < 0.001). The one-year local failure-free survival was 93% for EPR and 67% for IF, and the two-year and five-year local failure-free survival for EPR were both 88% (p = 0.016). Although the ambulatory rate was 99% for EPR and 60% for IF, the median time to ambulation was shorter in the IF (EPR, 28 days, interquartile range (IQR) 25 to 35; IF, 23 days, IQR 18 to 28; p < 0.001) The cause of non ambulation was mainly due to progression of cancer (89%). The rate of systemic complications was comparable between the two groups (EPR, 18%; IF, 22%; p = 0.598). CONCLUSION: Selective use of EPR where survival is expected to be good offers correspondingly good long-term results. IF is less invasive with shorter treatment period, which is beneficial for patients with short-term expected survival. Prognosis is an important indicator in selecting operative procedures for femoral metastasis. Cite this article: Bone Joint J 2020;102-B(3):285-292.


Asunto(s)
Neoplasias Óseas/cirugía , Fémur , Procedimientos Ortopédicos/métodos , Complicaciones Posoperatorias/epidemiología , Anciano , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/secundario , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Factores de Tiempo
5.
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
7.
N C Med J ; 81(2): 122-125, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32132257

RESUMEN

At present, data suggests that attention-deficit/hyperactivity disorder may be more prevalent in North Carolina than other states, but whether we are properly identifying and treating cases, in childhood and adulthood, is murky. Much innovative work to this end is being done in North Carolina, but more is needed.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/terapia , Adulto , Niño , Predicción , Humanos , North Carolina/epidemiología , Prevalencia
8.
J Assoc Physicians India ; 68(3): 72-74, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32138489

RESUMEN

The fourth industrial revolution refers to a fusion of technologies which blend the physical, digital and biological worlds. It can mitigate miseries of the teeming masses. However, India faces the unique challenge. It is both the creator of enormous amount of data required for this revolution as well as largest potential market for those innovations in the coming future. This article traces the challenges and draws parallels with the past experiences. The first transformation is expected to hit healthcare sector much sooner than projected earlier. It outlines the call to action required of our thought leaders today.


Asunto(s)
Inteligencia Artificial , Investigación Biomédica , Prestación de Atención de Salud , Predicción , India
9.
Urologe A ; 59(3): 326-340, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-32125448

RESUMEN

The significance of electricity for medicine in the modern industrial age should not be underestimated. Particularly in connection with neurasthenia, electrotherapeutic approaches also experienced a boom for domestic use. Thus, electrotherapy reached urology just as it was becoming established as a medical specialty. We analyzed urological manuals and textbooks and objects in the W. P. Didusch Center for Urologic History and the Museum zur Geschichte der Urologie in Berlin to present the wide range of indications for electrotherapy in the emerging field of urology from impotence to urethral strictures and try to highlight the variability of their importance over time.


Asunto(s)
Terapia por Estimulación Eléctrica , Neurastenia/historia , Urología/historia , Berlin , Terapia por Estimulación Eléctrica/tendencias , Electricidad , Historia del Siglo XX , Humanos , Masculino , Museos , Neurastenia/terapia , Urología/tendencias
10.
Rev Med Suisse ; 16(684): 459-462, 2020 Mar 04.
Artículo en Francés | MEDLINE | ID: mdl-32134226

RESUMEN

Low-dose aspirin in primary prevention of cardiovascular disease is still debated. Recent clinical trials of aspirin vs placebo reported an unfavourable risk-benefit ratio with an increase in major bleedings without reduction on the occurrence of non-fatal cardiovascular events. These studies also highlight that current cardiovascular risk calculators overestimate cardiovascular risk, which is probably related to the improvement in the management of cardiovascular risk factors over the last decades. In accordance with European cardiovascular prevention recommendations, aspirin should not be prescribed for the primary prevention of cardiovascular disease.


Asunto(s)
Aspirina/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , Prevención Primaria/métodos , Prevención Primaria/tendencias , Aspirina/administración & dosificación , Hemorragia/inducido químicamente , Humanos , Medición de Riesgo
11.
Orthop Clin North Am ; 51(2): 219-225, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138859

RESUMEN

Global health delivery is a complex initiative requiring dedicated personnel to achieve a successful program. To be most beneficial, global health delivery should focus on cultural competence, bidirectional education, and capacity building through direct and purposeful means. The authors present the expansion of their global health delivery program in Ecuador focusing on the evolution of the program from a medical mission trip to a multilayered program that helps foster engagement, education, and learning while helping children who might not otherwise have access to care, along with future directions and potential methods to decrease the need for such initiatives in Ecuador.


Asunto(s)
Relaciones Comunidad-Institución/tendencias , Ortopedia/organización & administración , Ortopedia/tendencias , Desarrollo de Programa , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/tendencias , Ecuador , Predicción , Salud Global , Educación en Salud , Humanos , Internacionalidad
14.
Medicine (Baltimore) ; 99(12): e19490, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32195948

RESUMEN

INTRODUCTION: Contraceptive use and sexual health behavior remain a prominent public health concern in South Africa (SA). Despite many government interventions, unintended pregnancies and termination of pregnancies remain relatively high. This review aimed to map evidence on factors influencing contraceptive use and sexual behavior in SA. METHODS: We conducted a scoping review guided by Arksey and O'Malley's framework. We searched for articles from the following databases: PubMed/MEDLINE, American Doctoral Dissertations via EBSCO host, Union Catalogue of Theses and Dissertations (UCTD) and SA ePublications via SABINET Online and World Cat Dissertations, Theses via OCLC and Google Scholar. Studies published from January 1990 to March 2018 were included. We used the Population, Concept, and Context (PCC) framework and the PRISMA chart to report the screening of results. The Mixed Method Appraisal Tool (MMAT) version 11 and ACCODS tools were used to determine the quality of the included studies. RESULTS: A total of 2030 articles were identified by our search criteria for title screening. Only 21 studies met our inclusion criteria and were included in quality assessment stage. We found that knowledge of a contraceptive method, length of a relationship, sexual debut, age difference between partners availability of a contraceptive method, long waiting hours, and nurse's attitudes toward human immunodeficiency virus (HIV) positive or younger clients predict whether or not women use a contraceptive method or improve sexual behavior. CONCLUSION: There remains a necessity for improving educational programs aimed at transferring knowledge on contraceptives and sexual behavior to both women and their male counterparts, alongside the public health systems' improvements.


Asunto(s)
Conducta Anticonceptiva/tendencias , Anticoncepción/psicología , Conocimiento de la Medicación por el Paciente/estadística & datos numéricos , Conducta Sexual/psicología , Aborto Inducido/estadística & datos numéricos , Adolescente , Adulto , Conducta Anticonceptiva/estadística & datos numéricos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Tamizaje Masivo/normas , Persona de Mediana Edad , Embarazo , Embarazo no Planeado/psicología , Parejas Sexuales/psicología , Sudáfrica/epidemiología , Adulto Joven
15.
Medicine (Baltimore) ; 99(12): e19519, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32195954

RESUMEN

BACKGROUND: The purposes of this study were to examine the feasibility of using the MyotonPRO digital palpation device in measuring the passive stiffness of gastrocnemius muscle belly and Achilles tendon; to determine between-days test-retest reliability of MyotonPRO; and to evaluate the acute effect of paraffin therapy on stiffness measurements in healthy participants. METHODS: It is a randomized controlled trial. Twenty healthy participants (male, n = 10; female, n = 10; total, n = 20) were recruited to evaluate the passive stiffness of gastrocnemius muscle belly and Achilles tendon. Dominant and nondominant legs were randomly divided into an experimental side (20 cases) and a control side (20 cases). The experimental side received 20 minutes of paraffin therapy. RESULTS: The stiffness of muscle and tendon in the experimental side decreased significantly after paraffin therapy (P < .01), whereas no significant differences in stiffness measurements were found in the control side (P > .05). The passive stiffness of muscle and tendon was positively correlated with the ankle from 30° plantar flexion to10° dorsiflexion for dominant legs. Between-days test-retest reliability in stiffness measurements was high or very high (ICCs were above 0.737). CONCLUSION: Paraffin therapy induces a decrease in the passive stiffness of gastrocnemius muscle belly and Achilles tendon. Furthermore, the MyotonPRO can reliably determine stiffness measurements.


Asunto(s)
Tendón Calcáneo/efectos de los fármacos , Hidrocarburos/uso terapéutico , Tono Muscular/efectos de los fármacos , Músculo Esquelético/efectos de los fármacos , Parafina/uso terapéutico , Tendón Calcáneo/fisiopatología , Adolescente , Adulto , Articulación del Tobillo/fisiología , Femenino , Humanos , Masculino , Músculo Esquelético/fisiopatología , Modalidades de Fisioterapia/tendencias , Rango del Movimiento Articular/fisiología , Reproducibilidad de los Resultados , Adulto Joven
16.
Medicine (Baltimore) ; 99(12): e19525, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32195955

RESUMEN

BACKGROUND: To assess the arterial oxygen partial pressure (PaO2) at defined time points during preoxygenation and to compare high-flow heated humidified nasal oxygenation with standard preoxygenation using oxygen insufflation via a facemask for at least 5 minutes, before intubation during induction of general anesthesia. METHODS: This randomized, single-blinded, prospective study will be conducted in patients undergoing head and neck surgery. After standard monitoring, the artery catheter at the radial artery or dorsalis pedis artery will be placed and arterial blood gas analysis (ABGA) for baseline values will be performed simultaneously. Each group will be subjected to 1 of 2 preoxygenation methods (high-flow nasal cannula or simple facemask) for 5 minutes, and ABGA will be performed twice. After confirming intubation, we will start mechanical ventilation and check the vital signs and perform the final ABGA. DISCUSSION: This trial aims to examine the trajectory of PaO2 levels during the whole preoxygenation procedure and after intubation. We hypothesize that preoxygenation with the high-flow nasal cannula will be superior to that with the face mask. STUDY REGISTRATION: This trial was registered with the Clinical Trial Registry (NCT03896906; ClinicalTrials.gov).


Asunto(s)
Anestesia General/tendencias , Monitoreo de Gas Sanguíneo Transcutáneo/métodos , Cabeza/cirugía , Oxigenación Hiperbárica/tendencias , Cuello/cirugía , Análisis de los Gases de la Sangre , Cánula/normas , Cánula/estadística & datos numéricos , Humanos , Intubación Intratraqueal/métodos , Máscaras/normas , Máscaras/estadística & datos numéricos , Ventilación no Invasiva/instrumentación , Ventilación no Invasiva/métodos , Oxígeno/sangre , Estudios Prospectivos , Arteria Radial/cirugía , Respiración Artificial/instrumentación , Respiración Artificial/métodos , Dispositivos de Acceso Vascular/normas
17.
Medicine (Baltimore) ; 99(12): e19534, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32195956

RESUMEN

BACKGROUND: Whether or not increased hospitalizations and/or deaths due to cardiovascular disease during major football tournaments (MFTs) remains controversial. We undertook a systematic review and meta-analysis of published studies to assess the relationships of cardiovascular events and MFTs. METHODS: Observational studies reporting relationship of cardiovascular disease morbidity and mortality with MFTs during the days of games or within 2 weeks after game season were included. Relative risk ratios (RR) with 95% confidence interval (CI) were pooled and analyzed using a random/fixed-effects model. RESULTS: Nineteen cross-sectional observational studies that examined the association between MFTs and non-fetal cardiovascular events and mortality were found to be eligible from 3419 references, for inclusion in the systematic review and meta-analysis. Of the 10 studies reported hospitalizations due to non-fetal acute cardiovascular events, the pooled RR was 1.17 (95% CI 1.01-1.36). Of the 10 studies reported cardiovascular mortality the pooled RR was 1.03 (95% CI 1.00-1.05). Of the studies examining the mortality, 6 studies reported the lost or win of the national team. Pooling of four studies where their national teams lost the MFTs produced a RR for the mortality of 1.19 (95% CI: 1.09-1.30), and 4 studies of the 6 whose national teams won produced a pooled RR for cardiovascular mortality of 0.88 (0.79-0.98). CONCLUSION: This systematic review and meta-analysis showed an increased risk of hospitalization due to non-fetal acute cardiovascular events and cardiovascular mortality with watching MFTs.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Fútbol Americano/estadística & datos numéricos , Hospitalización/tendencias , Enfermedad Aguda , Enfermedades Cardiovasculares/epidemiología , Enfermedad Coronaria/epidemiología , Estudios Transversales , Muerte Súbita Cardíaca/epidemiología , Humanos , Morbilidad , Infarto del Miocardio/epidemiología , Estudios Observacionales como Asunto , Medición de Riesgo
18.
Medicine (Baltimore) ; 99(12): e19541, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32195960

RESUMEN

BACKGROUND: Knee osteoarthritis (KOA) is a common degenerative joint disorder that affects 250 million people globally. KOA can lead to disability and is often associated with cardiovascular disease, poor quality of life, and mortality. The most common treatment for KOA is non-steroidal anti-inflammatory drug administration. However, the analgesic effect is limited and often accompanied by multiple side effects. Hence, many KOA patients opt for complementary and alternative medicine. Acupuncture is one of the most popular complementary treatments with great analgesic effect and minimal side effect. Electroacupuncture (EA) and laser acupuncture (LA) have been known to reduce pain in KOA patients. However, to date, no study has assessed the benefits of combining these two therapies. METHODS: Fifty participants diagnosed with KOA, aged 50 years or older, and with consistent knee pain for more than 3 months were recruited and randomly assigned to the treatment group (EA plus LA) or control group (EA plus sham LA without laser output). All subjects in the treatment group will undergo a combined EA and LA treatment thrice a week for 4 weeks. The acupuncture will be performed on GB33, GB34, SP9, SP10, and ST36 sites. The treatment group will receive acupuncture with a transcutaneous electrical nerve stimulator at GB33, GB34, SP9, and SP10 sites and with LA at EX-LE5, ST35, and BL40 sites. The subjects in the control group will undergo the same treatment modality as the treatment group, except these subjects will not be exposed to laser output. Outcome measurements will include visual analog scale, Western Ontario McMaster Universities Osteoarthritis Index, Knee injury and osteoarthritis outcome, body composition analysis, knee range of motion, quadriceps muscle stiffness, one-leg standing with eyes open test, and the 30-s chair stand test before and after 4 weeks of intervention. OBJECTIVES: This protocol aims to investigate the combined effect of EA and LA in KOA patients.


Asunto(s)
Terapia por Acupuntura/métodos , Electroacupuntura/métodos , Terapia por Láser/métodos , Osteoartritis de la Rodilla/terapia , Estimulación Eléctrica Transcutánea del Nervio/instrumentación , Terapia por Acupuntura/tendencias , Anciano , Anciano de 80 o más Años , Terapia Combinada , Humanos , Rodilla/patología , Terapia por Luz de Baja Intensidad , Persona de Mediana Edad , Osteoartritis de la Rodilla/radioterapia , Dolor , Manejo del Dolor/métodos , Rango del Movimiento Articular/fisiología , Taiwán/epidemiología , Escala Visual Analógica
19.
Medicine (Baltimore) ; 99(12): e19575, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32195968

RESUMEN

Liver cirrhotic predisposes patients to coagulopathy and bleeding. Little is known about outcomes of acute myocardial infarction (AMI) in cirrhotic patients.Data from Taiwan National Health Insurance Research Database during 2001 to 2013 were retrieved for patients admitted with cirrhosis and AMI. We excluded patients with missing information, <20 years old, previous AMI, previous coronary intervention, and liver transplant. Patients were separated into cirrhotic and non-cirrhotic. Primary outcomes included all-cause mortality, recurrent myocardial infarction (MI), major cardiac and cerebrovascular events (MACCE: recurrent MI, revascularization, ischemic stroke, and heart failure), and liver outcomes (hepatic encephalopathy, ascites tapping, spontaneous peritonitis, and esophageal varices bleeding).A total of 3217 cirrhotic patients and 6434 non-cirrhotic patients were analyzed, with a mean follow up of 2.8 ±â€Š3.3 years. In cirrhotic patients with AMI, subsequent coronary and cerebrovascular events were lower in comparison to non-cirrhotic patients, with higher all-cause mortality observed from adverse liver related outcomes and bleeding. There were significantly lower cumulative incidence of both recurrent MI and MACCE in cirrhotic patients with AMI compared with non-cirrhotic patients with AMI (hazard ratio [HR] 0.82, confidence interval [CI] 0.71-0.94, P = .006 and HR 0.86, 95% CI 0.79-0.92, P < .001, respectively). There was significantly higher cumulative incidence of liver related outcome in cirrhotic patients with AMI compared with non-cirrhotic patients with AMI (HR 2.27, 95% CI 2.06-2.51, P < .001). And there was significantly higher all-cause mortality in cirrhotic patients with AMI compared with non-cirrhotic patients with AMI (HR 1.30, 95% CI 1.23-1.38, P < .001).In cirrhotic cohort with AMI, a decreased in coronary and cerebrovascular events were observed. However, these patients also had higher all-cause mortality due to adverse liver outcomes and bleeding.


Asunto(s)
Cirrosis Hepática/complicaciones , Cirrosis Hepática/mortalidad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/mortalidad , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/etiología , Hemorragia/etiología , Hemorragia/mortalidad , Hospitalización/tendencias , Humanos , Incidencia , Cirrosis Hepática/epidemiología , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Infarto del Miocardio/epidemiología , Taiwán/epidemiología
20.
East Mediterr Health J ; 26(2): 143-151, 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32141591

RESUMEN

Background: It is important to identify variables that influence life expectancy in order to develop strategies to improve health care systems and thereby increase life expectancy. Aims: In this study, a decision tree was built using a chi-square automatic interaction detector technique in order to identify variables influencing life expectancy at birth. Methods: Data were taken from the databases of the World Bank, World Health Organization and World Life Expectancy. Data from 166 countries for the year 2013 were extracted for 25 selected input variables related to mortality, health and the environment, child health, economy and demography in order to build the decision tree. Results: Of the 25 variables, nine had a significant influence on life expectancy: percentage of the population using improved sanitation facilities; death rates per 100 000 population for HIV/AIDS, liver disease, stroke and coronary heart disease; percentage of the urban population using improved drinking-water sources; total fertility rate (births per woman); public health expenditure (percent of government expenditure); and health expenditure per capita. Conclusions: Improving these variables may result in significant increases in life expectancy and quality of life. At the country level, appropriate strategies can be developed to improve the quality and performance of health care systems.


Asunto(s)
Árboles de Decisión , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/normas , Esperanza de Vida , Salud Pública , Tasa de Natalidad , Causas de Muerte , Demografía , Predicción , Gastos en Salud , Humanos , Mortalidad , Factores Socioeconómicos
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