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1.
Medicine (Baltimore) ; 99(5): e18919, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000401

RESUMEN

Previous studies have suggested that patients with psychotic or mental disorders are relatively pain insensitive, resulting in difficulties in the diagnosis of acute intra-abdominal diseases requiring emergency surgeries. We aimed to evaluate whether central nervous system (CNS) or mental disorders are associated with perforated appendicitis in patients with acute appendicitis.We conducted a population-based case-control study using Taiwan's National Health Insurance Research database. Patients aged >18 years who had been hospitalized with a diagnosis of acute appendicitis between 2000 and 2013 were identified. After 1:1 matching for age and sex, 2792 patients with perforated appendicitis (case group) and 2792 patients with nonperforated appendicitis (control group) were included. CNS disorders, mental disorders, pain control medication, and several comorbidities were analyzed for the odds of appendiceal perforation with 95% confidence interval (CI) using the multivariable logistic regression model.Schizophrenia and dementia were associated with a high risk of appendiceal rupture in patients with acute appendicitis, with an adjusted odds ratio of 2.01 for dementia (95% CI: 1.19-3.39, P = .009) and 4.8 for schizophrenia (95% CI: 1.62-14.19, P = .005). Other factors, such as other CNS disorders, comorbidities, and pain control medication, were not associated with the risk of perforated appendicitis.Dementia and schizophrenia are associated with perforated appendicitis in patients with acute appendicitis. This might be owing to altered pain perception, difficult symptom expression, and delayed hospitalization. Further studies are still needed to determine the underlying mechanism and confirm the causality.


Asunto(s)
Apendicitis/epidemiología , Demencia/epidemiología , Esquizofrenia/epidemiología , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Percepción del Dolor , Riesgo , Adulto Joven
4.
Anaesthesia ; 75 Suppl 1: e46-e53, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31903565

RESUMEN

The increasing age and subsequent medical complexity of patients presenting for surgery grants the opportunity to examine the processes and delivery of peri-operative care. There is a need to redesign peri-operative pathways allowing room for shared decision making and personalised, evidence-based care. In times of financial constraint, this is no easy task. However, neglecting to transform services now may lead to challenges in the sustainability of the provision of peri-operative care in the long-term. Challenges in redesigning peri-operative care pathways include identification and optimisation of those at highest peri-operative risk to inform the difficult conversations surrounding the appropriateness of surgery. The moral burden of these conversations on patient and professionals alike is increasingly recognised and managing this issue requires innovative models of collaborative, multidisciplinary and interprofessional working. To operate or not can be a challenging question to answer with a number of different perspectives to consider; not least that of the patient.


Asunto(s)
Toma de Decisiones Clínicas/métodos , Negativa al Tratamiento , Procedimientos Quirúrgicos Operativos , Anciano , Anciano de 80 o más Años , Humanos , Riesgo
5.
Anaesthesia ; 75 Suppl 1: e39-e45, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31903579

RESUMEN

Shared decision-making is central to the pre-operative consent process and accurate communication of risk is dependent on a clear understanding of numerical information by both the patient and clinician. The risk of an adverse event or complication is often described using verbal probability expressions but how these are interpreted by clinicians and patients in the pre-operative setting has not been studied. We asked patients and clinicians to assign a numerical translation (as a percentage) for seven verbal probability expressions in relation to the probability of a major peri-operative complication occurring. In total, data from 290 patients and 57 clinicians were analysed. There was a wide range in percentages assigned by patients to all verbal probability expressions. Patients assigned a wider range of percentage values to each of the verbal probability expressions and these were all significantly higher than those assigned by clinicians: median (IQR [range]) negligible risk 5% (1-15 [0-100]) vs. 0% (0-0 [0-5]); minimal risk 5% (2-10) [0-100]) vs. 1% (0-1 [0-10]); low risk 10% (3-10 [0-100]) vs. 1% (0-2) [0-10]); standard risk 20% (10-40) [0-100]) vs. 1% (1-5) [0-30]); moderate risk 33% (20-50) [0-100]) vs. 5% (3-10) [0-80]); high risk 70% (30-90 [0-100]) vs. 15% (10-40) [1-75]); and very high risk 90% (50-95 [0-100]) vs. 40% (20-50 [5-100]), respectively (p < 0.005 for all comparisons). There is considerable variation in the numerical translation of verbal probability expressions by both patients and clinicians. This suggests that verbal probability expressions should not be used in isolation as part of doctor-patient discussions regarding peri-operative risk.


Asunto(s)
Comunicación en Salud/métodos , Complicaciones Posoperatorias , Probabilidad , Femenino , Humanos , Masculino , Matemática , Persona de Mediana Edad , Riesgo
7.
J Environ Manage ; 258: 109946, 2020 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-31929044

RESUMEN

Environmental pollutants generated by waste incineration plants, such as heavy metals and dioxin, make surrounding residents very sensitive to the construction of such facilities. This sensitivity and anxiety of residents may induce group events, which further leads to the emergence of social risks. Based on risk perception theory, a total of 320 questionnaires was designed and handed out to residents neighboring to Jiangqiao Waste Incineration Plant in Shanghai, China to detect the factors affecting risk attitude toward such plants. Using ordered logit model, it is found that there are four decisive factors including impact on health, information cognitive, objective characteristics, and the attitude of the neighbors. These factors have different influence on resident risk attitudes, in which the attitude of the neighbors is of most significance, followed by the economic-geography characteristics of residents, the information cognitive has minimal impact.


Asunto(s)
Dioxinas , Eliminación de Residuos , Administración de Residuos , Actitud , China , Incineración , Riesgo
9.
Int Arch Allergy Immunol ; 181(1): 31-42, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31694023

RESUMEN

Irritable bowel syndrome (IBS) is a functional gastrointestinal disease and the most common cause of prolonged abdominal pain and bowel disturbances in the developed world. While initially thought to be functional or psychosomatic in nature, IBS is now recognized as a heterogeneous group of conditions. A subset of IBS patients and patients with allergic diseases share some characteristic inflammatory features. In fact, atopic children show an increased likelihood of developing IBS as adults. Given these findings, a subset of IBS may be suffering from allergy-related gut diseases. In this review, we present the allergy-related comorbidities of IBS, including genetic, environmental, and immunologic factors. We discuss studies demonstrating an increased sensitization of IBS patients to aeroallergens compared to food allergens. We then postulate potential pathophysiological mechanisms underlying both IBS and aeroallergens in the gut, followed by potential implications in the screening and treatment of allergies in IBS patients.


Asunto(s)
Enfermedades Gastrointestinales/inmunología , Hipersensibilidad/inmunología , Inflamación/inmunología , Síndrome del Colon Irritable/inmunología , Contaminación del Aire , Alérgenos/inmunología , Animales , Niño , Comorbilidad , Enfermedades Gastrointestinales/epidemiología , Humanos , Hipersensibilidad/epidemiología , Síndrome del Colon Irritable/epidemiología , Riesgo
10.
Eur J Endocrinol ; 182(3): 255-264, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31863690

RESUMEN

Background/objective: Data on metabolic impairments in Cushing's syndrome and GH deficiency all suggest that the relationship between cortisol and GH/IGF-I axis in obesity may have a role in the related diseases. However, studies focusing only on one of these hormones are often controversial in paediatrics. We aimed to explore the simultaneous relationship between cortisol and IGF-I with the metabolic alterations in paediatric obesity. Subjects/methods: Retrospective cross-sectional study in a tertiary care center. We recruited 876 (441 males and 435 females) overweight and obese children and adolescents. A complete clinical and biochemical evaluation including OGTT was performed. Cortisol and IGF-I SDS were divided in quartiles and then crossed to explore the reciprocal influence of high/high, low/low, and high/low levels of each one on the metabolic alterations of obesity. Results: Subjects in the higher quartiles of IGF-I-SDS and cortisol had an increased risk of hypertension, hypercholesterolemia, high levels of triglycerides, and reduced HDL cholesterol. Diversely, lower IGF-I-SDS quartiles were associated with higher blood glucose, insulin, insulin resistance, and reduced insulin sensitivity levels with the rise of cortisol quartiles. Conclusions: We observed that apart from glucose metabolism that is associated with low IGF-I and high cortisol levels, the other parameters known to be associated with increased cardiovascular risk were related to high levels of both IGF-I and cortisol, even if within normal range. Cortisol and IGF-I play a complex role in the comorbidities of obesity, and the evaluation of both variables could clarify some of the discordant results.


Asunto(s)
Hidrocortisona/sangre , Factor I del Crecimiento Similar a la Insulina/análisis , Obesidad/metabolismo , Sobrepeso/metabolismo , Adolescente , Glucemia/metabolismo , Niño , Colesterol/sangre , Estudios Transversales , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Hiperlipidemias/sangre , Hiperlipidemias/epidemiología , Hipertensión/sangre , Hipertensión/epidemiología , Resistencia a la Insulina , Masculino , Estudios Retrospectivos , Riesgo , Triglicéridos/sangre
11.
Int J Cancer ; 146(2): 329-340, 2020 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-30838637

RESUMEN

Gastrointestinal cancer patterns are distinct among populations. Our study aims to compare the incidence and risk of gastrointestinal cancers between Chinese American and non-Hispanic whites in Los Angeles, CA, USA, to those of people indigenous to Shanghai to elucidate the changing patterns of gastrointestinal cancers. Cancer incidence data from 1988 to 2012 were extracted from the Cancer Incidence in Five Continents plus database. The age standardized incidence and estimated annual percentage change were calculated to estimate the temporal trends of gastrointestinal cancers. Traditional Poisson regression models and three-factor constrained Poisson regression models were applied to compare the gastrointestinal cancer risk across populations. The incidences of oesophageal, stomach, liver and gall bladder cancers were higher among indigenous Chinese residents of Shanghai than among the other two populations in Los Angeles. While the incidences of colorectal and pancreatic cancer were higher among non-Hispanic whites, Chinese American immigrants were considered to be at an intermediate level for most gastrointestinal cancers. The gender-specific gastrointestinal cancer disparities across populations, especially between Shanghai Chinese and non-Hispanic US whites, were significant regardless of age, period or cohort scale. However, the regional differences in gastrointestinal cancer rates decreased over time. Most gastrointestinal cancer patterns in Chinese American immigrants were more aligned to those of their new country of residence than to those of their original country. The disparities in gastrointestinal cancers across populations indicate that environmental factors might play a key role in cancer genesis. Shift in environmental exposures may result in significant changes in gastrointestinal cancer incidence.


Asunto(s)
Neoplasias Gastrointestinales/epidemiología , Anciano , Americanos Asiáticos , Grupo de Ascendencia Continental Asiática , Emigrantes e Inmigrantes , Grupo de Ascendencia Continental Europea , Femenino , Humanos , Incidencia , Los Angeles/epidemiología , Masculino , Riesgo
12.
Int J Cancer ; 146(2): 553-565, 2020 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-31173338

RESUMEN

Tumors are complex networks of constantly interacting elements: tumor cells, stromal cells, immune and stem cells, blood/lympathic vessels, nerve fibers and extracellular matrix components. These elements can influence their microenvironment through mechanical and physical signals to promote tumor cell growth. To get a better understanding of tumor biology, cooperation between multidisciplinary fields is needed. Diverse mathematic computations and algorithms have been designed to find prognostic targets and enhance diagnostic assessment. In this work, we use computational digital tools to study the topology of vitronectin, a glycoprotein of the extracellular matrix. Vitronectin is linked to angiogenesis and migration, two processes closely related to tumor cell spread. Here, we investigate whether the distribution of this molecule in the tumor stroma may confer mechanical properties affecting neuroblastoma aggressiveness. Combining image analysis and graph theory, we analyze different topological features that capture the organizational cues of vitronectin in histopathological images taken from human samples. We find that the Euler number and the branching of territorial vitronectin, two topological features, could allow for a more precise pretreatment risk stratification to guide treatment strategies in neuroblastoma patients. A large amount of recently synthesized VN would create migration tracks, pinpointed by both topological features, for malignant neuroblasts, so that dramatic change in the extracellular matrix would increase tumor aggressiveness and worsen patient outcomes.


Asunto(s)
Neuroblastoma/etiología , Neuroblastoma/genética , Vitronectina/genética , Algoritmos , Proliferación Celular/genética , Matriz Extracelular/genética , Matriz Extracelular/patología , Humanos , Neovascularización Patológica/genética , Neovascularización Patológica/patología , Neuroblastoma/patología , Pronóstico , Riesgo , Células del Estroma/patología , Microambiente Tumoral/genética
13.
Int J Cancer ; 146(3): 739-748, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30963577

RESUMEN

Glioma incidence is highest in non-Hispanic Whites, and to date, glioma genome-wide association studies (GWAS) to date have only included European ancestry (EA) populations. African Americans and Hispanics in the US have varying proportions of EA, African (AA) and Native American ancestries (NAA). It is unknown if identified GWAS loci or increased EA is associated with increased glioma risk. We assessed whether EA was associated with glioma in African Americans and Hispanics. Data were obtained for 832 cases and 675 controls from the Glioma International Case-Control Study and GliomaSE Case-Control Study previously estimated to have <80% EA, or self-identify as non-White. We estimated global and local ancestry using fastStructure and RFMix, respectively, using 1,000 genomes project reference populations. Within groups with ≥40% AA (AFR≥0.4 ), and ≥15% NAA (AMR≥0.15 ), genome-wide association between local EA and glioma was evaluated using logistic regression conditioned on global EA for all gliomas. We identified two regions (7q21.11, p = 6.36 × 10-4 ; 11p11.12, p = 7.0 × 10-4 ) associated with increased EA, and one associated with decreased EA (20p12.13, p = 0.0026) in AFR≥0.4 . In addition, we identified a peak at rs1620291 (p = 4.36 × 10-6 ) in 7q21.3. Among AMR≥0.15 , we found an association between increased EA in one region (12q24.21, p = 8.38 × 10-4 ), and decreased EA in two regions (8q24.21, p = 0. 0010; 20q13.33, p = 6.36 × 10-4 ). No other significant associations were identified. This analysis identified an association between glioma and two regions previously identified in EA populations (8q24.21, 20q13.33) and four novel regions (7q21.11, 11p11.12, 12q24.21 and 20p12.13). The identifications of novel association with EA suggest regions to target for future genetic association studies.


Asunto(s)
Afroamericanos/genética , Predisposición Genética a la Enfermedad/genética , Glioma/etiología , Glioma/genética , Estudios de Casos y Controles , Grupo de Ascendencia Continental Europea/genética , Femenino , Estudios de Asociación Genética/métodos , Sitios Genéticos/genética , Estudio de Asociación del Genoma Completo/métodos , Genotipo , Hispanoamericanos , Humanos , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple/genética , Riesgo
14.
Disasters ; 44(1): 103-124, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31231821

RESUMEN

Urban planning can serve to minimise the effects of a tsunami and enhance community resilience. This study explores to what extent urban planning has addressed tsunami resilience in four villages on Chile's South Pacific coast, each of which was struck by tsunamis in 1960, 2010, and 2015. Through a detailed policy review and semi-structured interviews with residents, this paper analyses whether tsunami mitigation policies were incorporated into regional and local planning tools. It finds that although the government proposed relocation to tsunami-safe areas after the tsunami of 1960, urban development continued mainly in tsunami inundation zones-in the context of weak local planning frameworks and in the absence of community participation. In only one of the four case studies did participatory planning bring about the relocation of an entire village to a safe location. This paper concludes that incorporating participatory risk zone planning into urban planning enhances tsunami resilience.


Asunto(s)
Planificación de Ciudades/organización & administración , Participación de la Comunidad/psicología , Planificación en Desastres/organización & administración , Resiliencia Psicológica , Tsunamis , Chile , Humanos , Riesgo
15.
Rev. Soc. Cardiol. Estado de São Paulo ; 29(3): 249-254, Jul. 2019. TABELA, GRÁFICO
Artículo en Portugués | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1048058

RESUMEN

Nesta breve análise crítica, discutiremos três estudos com potencial de alterar a prática clínica e as principais diretrizes internacionais no que tange à doença valvar. O estudo PARTNER III foi um estudo que randomizou 1000 pacientes de baixo risco cirúrgico entre troca valvar trans cateter e cirurgia convencional, com superioridade da técnica trans cateter em um desfecho primário combinado de mortalidade de todas as causas, acidente vascular cerebral (AVC) e ré hospitalização em doze meses de seguimento (8,5% vs. 15,1%, p = 0,001). Já o estudo Evolua Ló Risk randomizou 1468 pacientes entre as duas técnicas, com um desfecho primário de mortalidade ou AVC incapacitante ao final de dois anos de seguimento que atingiu não-inferioridade na comparação Bayesiana (5,3% trans cateter vs. 6,7% cirurgia). Finalmente, discutimos também o estudo COAPT, no qual 614 pacientes foram randomizados entre o dispositivo edge-to-edge MitraClip e o tratamento clínico da insuficiência mitral secundária. Nesses pacientes selecionados, a taxa anualizada de hospitalizações por insuficiência cardíaca foi de 35,8% por paciente-ano no grupo MitraClip, comparado com 67,9% no grupo controle (HR 0,53, IC 95% 0,4-0,7).Nas novas diretrizes, pode-se razoavelmente esperar uma indicação I para a troca valvar trans cateter em pacientes de baixo risco e uma indicação para a técnica edge-to-edge em pacientes com características semelhantes aos do COAPT. Esses procedimentos devem ser considerados no contexto do Heart Team para que sejam atingidos os melhores resultados.(AU)


Asunto(s)
Estenosis de la Válvula Aórtica , Insuficiencia de la Válvula Mitral , Riesgo
16.
Adv Gerontol ; 32(4): 581-591, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31800187

RESUMEN

In the present review, the main attention is focused on the problem of polymorbidity and age-related conditions in elderly patients with CAD who need myocardial revascularization. In addition to a high risk of mortality, elderly patients with polymorbidity are characterized reduced functional activity, cognitive impairment, low quality of life and frequent seeking medical help. There is evidence of the presence of common mechanisms that affect the aging process and the development of a number of associated diseases associated with age. Accordingly, the study of polymorbidity will allow us to develop strategies for the prevention it and understand the aging process and significantly reduce the risks of surgical intervention. In this regard, there is a necessity for research aimed at studying the causal relationship between coronary artery disease and polymorbidity in elderly patients with an additional assessment of functional and cognitive status for the development of specific prognostic tools and treatment strategies.


Asunto(s)
Enfermedad de la Arteria Coronaria , Revascularización Miocárdica , Anciano , Disfunción Cognitiva/complicaciones , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/cirugía , Humanos , Revascularización Miocárdica/mortalidad , Revascularización Miocárdica/estadística & datos numéricos , Calidad de Vida , Riesgo
17.
Environ Health Prev Med ; 24(1): 74, 2019 Dec 07.
Artículo en Inglés | MEDLINE | ID: mdl-31812162

RESUMEN

BACKGROUND: There have been inconsistent findings reported on maternal passive smoking during pregnancy and child risk of ADHD. In this study, ADHD symptoms at pre-school age children in association with prenatal passive and active tobacco smoke exposure determined by maternal plasma cotinine levels in the third trimester were investigated. METHODS: This was a follow-up study of the birth cohort: the Hokkaido Study on Environment and Children's Health. Children whose parents answered Strengths and Difficulties Questionnaire (SDQ) to identify child ADHD symptoms (hyperactivity/inattention and conduct problems) and total difficulties at age 5 years with available maternal plasma cotinine level at the third trimester were included (n = 3216). Cotinine levels were categorized into 4 groups; ≦ 0.21 ng/ml (non-smoker), 0.22-0.51 ng/ml (low-passive smoker), 0.52-11.48 ng/ml (high-passive smoker), and ≧ 11.49 ng/ml (active smoker). RESULTS: Maternal cotinine levels of active smokers were significantly associated with an increased risk of total difficulties (OR = 1.67) and maternal low- and high-passive smoking also increased the risk (OR = 1.11, 1.25, respectively) without statistical significance. Similarly, maternal cotinine levels of active smokers were associated with an increased risk of hyperactivity/inattention (OR = 1.49). Maternal low- and high-passive smoking and active smoking increased the risk of hyperactivity/inattention (OR = 1.45, 1.43, and OR = 1.59, respectively) only in boys. CONCLUSION: Our findings suggested that maternal active smoking during pregnancy may contribute to the increased risk of child total difficulties and hyperactivity/inattention at pre-school age. Pregnant women should be encouraged to quit smoking and avoid exposure to tobacco smoke.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/etiología , Exposición Materna/efectos adversos , Efectos Tardíos de la Exposición Prenatal/etiología , Fumar Tabaco/efectos adversos , Adulto , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Preescolar , Cotinina/sangre , Femenino , Estudios de Seguimiento , Humanos , Japón/epidemiología , Masculino , Madres , Embarazo , Tercer Trimestre del Embarazo , Efectos Tardíos de la Exposición Prenatal/epidemiología , Riesgo , Factores Sexuales , Fumar Tabaco/epidemiología
18.
Environ Health Prev Med ; 24(1): 71, 2019 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-31787072

RESUMEN

BACKGROUND: Maintenance of instrumental activities of daily living (IADL) and social role (SR) is crucial to keep independent life because the decline in SR and IADL was a significant predictor of dependence in basic ADL in later. The independent effect of physical and cultural leisure activities and their effect modification on the IADL remains unknown. METHODS: We prospectively observed 3241 elderly with intact IADL at baseline for 5 years. Higher level functional capacity such as IADL and SR was assessed using the Tokyo Metropolitan Institute of Gerontology Index of competence (TMIG index). RESULTS: The mean age of the participants was 72.3 years (standard deviation 5.1), and 46.9% were male, and 90.9% of them received a follow-up assessment. Of the participants, 10.4% developed an IADL decline. Engagement in leisure physical activity was associated with a significantly lower risk of IADL decline (adjusted risk ratio, 0.73; 95% confidence interval [CI], 0.60 to 0.89), and cultural leisure activity was also associated with lower risk of IADL decline (adjusted risk ratio, 0.77; 95% CI, 0.63 to 0.95) independent of potential confounders. We also found significant and positive interaction between physical and cultural leisure activities at risk for IADL decline (P = 0.024) and SR decline (P = 0.004). CONCLUSIONS: We found an independent association of physical and cultural leisure activities with a lower risk for functional decline in IADL and SR with positive interaction. Combined engagement in physical and cultural activities may effectively prevent from IADL decline and SR decline.


Asunto(s)
Actividades Cotidianas , Actividades Recreativas , Anciano , Anciano de 80 o más Años , Femenino , Evaluación Geriátrica/estadística & datos numéricos , Humanos , Vida Independiente/estadística & datos numéricos , Japón , Actividades Recreativas/clasificación , Masculino , Oportunidad Relativa , Estudios Prospectivos , Riesgo , Habilidades Sociales
20.
Artículo en Japonés | MEDLINE | ID: mdl-31875633

RESUMEN

OBJECTIVES: In this multicity study, we aimed to elucidate the city-specific factors affecting the association of high ambient temperature with ambulance dispatches due to acute illnesses. METHODS: We used the data of ambulance dispatches in 27 cities in Japan with more than 500,000 population excluding Tokyo, from May to September from 2012 to 2015. We included patients 20 years and older (≥20 years) and stratified them into three age groups (20-59, 60-79, and ≥80 years). We explored the city-specific pattern of the daily relative temperature (in temperature percentiles) and the risk of ambulance dispatches for each age group using a distributed lag nonlinear model and estimated the city-specific relative risks of ambulance dispatches at the 95/99 percentile temperature compared with the 77.6 percentile temperature defined as the reference temperature (Tref). Then, the estimates were combined by performing meta-analyses for each age group. We also applied meta-regression models to explore whether the city-specific characteristics modified the association of temperature with ambulance dispatches. RESULTS: The relative risks of the 95th percentile with respect to Tref were 1.14 (95% confidence interval (CI): 1.12, 1.16), 1.16 (95% CI: 1.13, 1.20), 1.13 (95% CI: 1.10, 1.16), and 1.13 (95% CI: 1.00, 1.16), for all-age (≥20) and age-stratified groups (20-59, 60-79, and ≥80 years), respectively. We observed a higher relative risk for the ≥20 years age group in the cities with higher proportions of single-elderly, single-mother, and single-father households. We also found that the relative risk for the 20-59 years age group was higher in the cities with a higher proportion of blue-collar workers. CONCLUSIONS: The present study provides insights into city-specific characteristics modifying heat-related health effects.


Asunto(s)
Ambulancias/estadística & datos numéricos , Salud Urbana , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Cambio Climático , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Riesgo , Adulto Joven
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