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1.
Environ Health Prev Med ; 26(1): 74, 2021 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-34273955

RESUMEN

BACKGROUND: Ambient fine particle (PM2.5) pollution is an important public health problem in China. Short-term ambient PM2.5 exposure is associated with increased mortality of respiratory diseases. However, few evidence was available on the effect of exposure to ambient PM2.5 on the years of life lost (YLL) from respiratory diseases in the elderly. Furthermore, birth season which is frequently applied as a proxy for environmental exposure in early life may influence the health outcome in the later life. Nevertheless, the modification effect of birth season on the relationship of PM2.5 exposure and respiratory health need to be explored. METHODS: A time-stratified case-crossover design was used to analyze YLL from respiratory diseases in the elderly related to ambient PM2.5 exposure between 2013 and 2016 in Ningbo, China. The modification effect of birth season was explored by subgroup comparisons between different birth seasons. RESULTS: Each 10 µg/m3 increase in daily ambient PM2.5 was associated with an increment of 1.61 (95% CI 0.12, 3.10) years in YLL from respiratory diseases in the elderly population. Individuals who were born in winter had significantly higher YLL from respiratory diseases associated with ambient PM2.5 exposure than those who were born in other seasons. CONCLUSIONS: Birth season which reflects the early-life PM2.5 exposure level that may influence the lung development has a potential effect on the disease burden of respiratory diseases related to ambient PM2.5 exposure in later life. The results would provide theoretical basis to protect vulnerable population defined by birth season when exploring the adverse effects of ambient PM2.5 in the respiratory health.


Asunto(s)
Contaminantes Atmosféricos/efectos adversos , Exposición a Riesgos Ambientales/efectos adversos , Esperanza de Vida , Material Particulado/efectos adversos , Trastornos Respiratorios/etiología , Anciano , Anciano de 80 o más Años , Contaminantes Atmosféricos/análisis , Causas de Muerte , China/epidemiología , Estudios Cruzados , Exposición a Riesgos Ambientales/análisis , Humanos , Material Particulado/análisis , Trastornos Respiratorios/mortalidad , Estaciones del Año
2.
Sci Rep ; 11(1): 15315, 2021 07 28.
Artículo en Inglés | MEDLINE | ID: mdl-34321526

RESUMEN

Cardiorespiratory fitness (CRF) is associated with mortality and cardiovascular disease, but assessing CRF in the population is challenging. Here we develop and validate a novel framework to estimate CRF (as maximal oxygen consumption, VO2max) from heart rate response to low-risk personalised exercise tests. We apply the method to examine associations between CRF and health outcomes in the UK Biobank study, one of the world's largest and most inclusive studies of CRF, showing that risk of all-cause mortality is 8% lower (95%CI 5-11%, 2670 deaths among 79,981 participants) and cardiovascular mortality is 9% lower (95%CI 4-14%, 854 deaths) per 1-metabolic equivalent difference in CRF. Associations obtained with the novel validated CRF estimation method are stronger than those obtained using previous methodology, suggesting previous methods may have underestimated the importance of fitness for human health.


Asunto(s)
Capacidad Cardiovascular , Prueba de Esfuerzo/métodos , Causas de Muerte , Femenino , Cardiopatías/mortalidad , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Obesidad/epidemiología , Consumo de Oxígeno , Modelos de Riesgos Proporcionales , Trastornos Respiratorios/mortalidad
3.
Respir Res ; 22(1): 37, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33546658

RESUMEN

BACKGROUND: Comorbidities play a key role in severe disease outcomes in COVID-19 patients. However, the literature on preexisting respiratory diseases and COVID-19, accounting for other possible confounders, is limited. The primary objective of this study was to determine the association between preexisting respiratory diseases and severe disease outcomes among COVID-19 patients. Secondary aim was to investigate any correlation between smoking and clinical outcomes in COVID-19 patients. METHODS:  This is a multihospital retrospective cohort study on 1871 adult patients between March 10, 2020, and June 30, 2020, with laboratory confirmed COVID-19 diagnosis. The main outcomes of the study were severe disease outcomes i.e. mortality, need for mechanical ventilation, and intensive care unit (ICU) admission. During statistical analysis, possible confounders such as age, sex, race, BMI, and comorbidities including, hypertension, coronary artery disease, congestive heart failure, diabetes, any history of cancer and prior liver disease, chronic kidney disease, end-stage renal disease on dialysis, hyperlipidemia and history of prior stroke, were accounted for. RESULTS:  A total of 1871 patients (mean (SD) age, 64.11 (16) years; 965(51.6%) males; 1494 (79.9%) African Americans; 809 (43.2%) with ≥ 3 comorbidities) were included in the study. During their stay at the hospital, 613 patients (32.8%) died, 489 (26.1%) needed mechanical ventilation, and 592 (31.6%) required ICU admission. In fully adjusted models, patients with preexisting respiratory diseases had significantly higher mortality (adjusted Odds ratio (aOR), 1.36; 95% CI, 1.08-1.72; p = 0.01), higher rate of ICU admission (aOR, 1.34; 95% CI, 1.07-1.68; p = 0.009) and increased need for mechanical ventilation (aOR, 1.36; 95% CI, 1.07-1.72; p = 0.01). Additionally, patients with a history of smoking had significantly higher need for ICU admission (aOR, 1.25; 95% CI, 1.01-1.55; p = 0.03) in fully adjusted models. CONCLUSION:  Preexisting respiratory diseases are an important predictor for mortality and severe disease outcomes, in COVID-19 patients. These results can help facilitate efficient resource allocation for critical care services.


Asunto(s)
Afroamericanos , COVID-19/mortalidad , COVID-19/terapia , Trastornos Respiratorios/mortalidad , Trastornos Respiratorios/terapia , Anciano , COVID-19/diagnóstico , Estudios de Cohortes , Femenino , Mortalidad Hospitalaria/tendencias , Hospitalización/tendencias , Humanos , Masculino , Persona de Mediana Edad , Cobertura de Afecciones Preexistentes , Trastornos Respiratorios/diagnóstico , Respiración Artificial/mortalidad , Respiración Artificial/tendencias , Estudios Retrospectivos , Resultado del Tratamiento
4.
Am J Clin Dermatol ; 22(1): 89-99, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33237496

RESUMEN

Ophthalmic timolol solution is increasingly being repurposed as a topical therapeutic for a variety of dermatologic diseases, including pyogenic granulomas, infantile hemangiomas, and chronic wounds. There are no published guidelines or protocols for use in these indications in adults, and the dermatologic community may not be familiar with adverse events that have been extensively documented relating to its ophthalmic use. We review the evidence available relating to adverse events to topical timolol use to evaluate its safety in dermatologic applications and to alert clinicians to screening and monitoring that is needed when repurposing this drug for dermatologic use. The majority of serious adverse events associated with ophthalmic timolol were reported in the first 7 years of use, between 1978 and 1985, of which most common were cardiovascular and respiratory events, but also included 32 deaths. The available evidence suggests that ophthalmic timolol safety profiling may have been incomplete prior to widespread use. Recent clinical trials for dermatologic indications have focused on documenting efficacy and have not had rigorous monitoring for potential adverse events. Topical timolol may be safe and effective for the treatment of various dermatologic conditions in patients whose medical histories have been carefully reviewed for evidence of pre-existing cardiac or pulmonary disease and are monitored for potential adverse events. Despite the wide use of timolol in ophthalmologic practice, safe dermatologic repurposing requires recognition of the potential for facilitated systemic absorption though the skin and appreciation of its history of adverse events.


Asunto(s)
Antagonistas Adrenérgicos beta/efectos adversos , Enfermedades Cardiovasculares/inducido químicamente , Reposicionamiento de Medicamentos/historia , Hemangioma/tratamiento farmacológico , Trastornos Respiratorios/mortalidad , Timolol/efectos adversos , Absorción Fisiológica , Administración Cutánea , Antagonistas Adrenérgicos beta/administración & dosificación , Antagonistas Adrenérgicos beta/historia , Enfermedades Cardiovasculares/mortalidad , Historia del Siglo XX , Humanos , Soluciones Oftálmicas/administración & dosificación , Soluciones Oftálmicas/efectos adversos , Soluciones Oftálmicas/historia , Trastornos Respiratorios/inducido químicamente , Piel/metabolismo , Timolol/administración & dosificación , Timolol/historia
6.
Can J Diabetes ; 45(6): 524-530, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33339741

RESUMEN

OBJECTIVES: Patients with diabetes are potentially at higher risk of mortality due to coronavirus disease-2019 (COVID-19). In this study, we aimed to compare the outcomes and severity of pulmonary involvement in COVID-19 patients with and without diabetes. METHODS: In this cohort study, we recruited patients with diabetes who were hospitalized due to COVID-19 during the period from February 2020 to May 2020. Hospitalized individuals without diabetes were enrolled as control subjects. All patients were followed for 90 days and clinical findings and patients' outcomes were reported. RESULTS: Over a period of 4 months, 127 patients with diabetes and 127 individuals without diabetes with a diagnosis of COVID-19 were recruited. Their mean age was 65.70±12.51 years. Mortality was higher in the group with diabetes (22.8% vs 15.0%; p=0.109), although not significantly. More severe pulmonary involvement (p=0.015), extended hospital stay (p<0.001) and greater need for invasive ventilation (p=0.029) were reported in this population. Stepwise logistic regression revealed that diabetes was not independently associated with mortality (p=0.092). Older age (odds ratio [OR], 1.054; p=0.003), aggravated pulmonary involvement on admission (OR, 1.149; p=0.001), presence of comorbidities (OR, 1.290; p=0.020) and hypothyroidism (OR, 6.576; p=0.021) were associated with mortality. Diabetic foot infection had a strong positive correlation with mortality (OR, 49.819; p=0.016), whereas insulin therapy had a negative correlation (OR, 0.242; p=0.045). CONCLUSIONS: The mortality rate due to COVID-19 did not differ significantly between patients with or without diabetes. Older age, macrovascular complications and presence of comorbidities could increase mortality in people with diabetes. Insulin therapy during hospitalization could attenuate the detrimental effects of hyperglycemia and improve prognosis of patients with COVID-19 and diabetes.


Asunto(s)
COVID-19/mortalidad , Diabetes Mellitus Tipo 2/mortalidad , Hospitalización/tendencias , Trastornos Respiratorios/mortalidad , Índice de Severidad de la Enfermedad , Adulto , Anciano , COVID-19/diagnóstico por imagen , COVID-19/terapia , Estudios de Cohortes , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Diabetes Mellitus Tipo 2/terapia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Trastornos Respiratorios/diagnóstico por imagen , Trastornos Respiratorios/terapia
7.
PLoS One ; 15(10): e0240494, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33045034

RESUMEN

BACKGROUND: Non-communicable diseases (NCDs) have received political attention and commitment, yet surveillance is needed to measure progress and set priorities. Building on global estimates suggesting that Peru is not on target to meet the Sustainable Development Goal 3.4, we estimated the contribution of various NCDs to the change in unconditional probability of dying from NCDs in 25 regions in Peru. METHODS: Using national death registries and census data, we estimated the unconditional probability of dying between ages 30 and 69 from any and from each of the following NCDs: cardiovascular, cancer, diabetes, chronic respiratory diseases and chronic kidney disease. We estimated the contribution of each NCD to the change in the unconditional probability of dying from any of these NCDs between 2006 and 2016. RESULTS: The overall unconditional probability of dying improved for men (21.4%) and women (23.3%). Cancer accounted for 10.9% in men and 13.7% in women of the overall reduction; cardiovascular diseases also contributed substantially: 11.3% in men) and 9.8% in women. Consistently in men and women and across regions, diabetes moved in the opposite direction of the overall reduction in the unconditional probability of dying from any selected NCD. Diabetes contributed a rise in the unconditional probability of 3.6% in men and 2.1% in women. CONCLUSIONS: Although the unconditional probability of dying from any selected NCD has decreased, diabetes would prevent Peru from meeting international targets. Policies are needed to prevent diabetes and to strengthen healthcare to avoid diabetes-related complications and delay mortality.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus/prevención & control , Mortalidad/tendencias , Neoplasias/prevención & control , Insuficiencia Renal Crónica/prevención & control , Trastornos Respiratorios/prevención & control , Desarrollo Sostenible , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , Diabetes Mellitus/epidemiología , Diabetes Mellitus/mortalidad , Femenino , Humanos , Esperanza de Vida , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Neoplasias/mortalidad , Perú/epidemiología , Pronóstico , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/mortalidad , Trastornos Respiratorios/epidemiología , Trastornos Respiratorios/mortalidad , Tasa de Supervivencia
8.
PLoS One ; 15(9): e0239055, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32966334

RESUMEN

BACKGROUND: Chronic obstructive pulmonary disease (COPD) and asthma exacerbations are associated with ill health, increased mortality, and health care costs. However, there is limited evidence regarding mortality and its predictors among patients treated for COPD and asthma exacerbations in low-income nations, particularly in Ethiopia. METHODS: A-6 month prospective observational study was conducted from April 20-September 20, 2019. Data were collected on socio-demographic, baseline clinical characteristics and outcomes of asthma and COPD exacerbations. Data were entered into Epi-Data version 4.02.01 for cleaning and exported to STATA 14.0 for analysis. Kaplan-Meier (Log-rank test) was used to compare the baseline survival experience of the study participants and Cox proportional hazard regression analysis was conducted to determine the predictors of mortality. Adjusted hazard ratios (AHRs) with two-sided p-value <0.05 were considered statistically significant. RESULTS: A total of 130 patients (60% males) were included. The median (interquartile range (IQR)) age of the study participants was 59(50-70) years. The median (IQR) survival time to death was 17.5 (10-26) days. The total proportion of in-hospital mortality was 10.78% (14/130), and the incidence rate of mortality was 2.56 per 1000 person-years. The duration of oxygen therapy ≥16hours/day (AHR = 6.330, 95% CI [1.092-36.679], and old age (AHR = 1.066, 95% CI [1.0001-1.136] were the independent predictors of in-hospital mortality. CONCLUSION: In this study, the in-hospital mortality rate was very high. Moreover, prolonged oxygen therapy (≥16hours/day) and old age were independently associated with in-hospital mortality. Therefore, special attention should be given to recipients of prolonged oxygen therapy and the elderly during hospital stay.


Asunto(s)
Asma/mortalidad , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Anciano , Progresión de la Enfermedad , Etiopía/epidemiología , Femenino , Mortalidad Hospitalaria , Hospitales , Humanos , Estimación de Kaplan-Meier , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Trastornos Respiratorios/mortalidad , Factores de Riesgo , Brote de los Síntomas
9.
Am J Ind Med ; 63(10): 851-858, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32687235

RESUMEN

BACKGROUND: Working in the mining industry increases the risk of chronic diseases and mortality. We investigated overall and cause-specific mortality rates among workers employed in the mining sector in the United States. METHODS: We pooled 29 years of National Health Interview Survey (NHIS) public-use data from 1986 to 2014, with mortality follow-up until 31 December 2015. We grouped respondents into the mining and nonmining sectors based on the responses given at the time of the NHIS interview. We compared the overall and cause-specific mortality rates using standardized mortality ratios (SMR) and 95% confidence interval (CI) adjusted for the competing cause of death. RESULTS: From 1986 to 2014, an estimated 14 million deaths were recorded among subjects eligible for mortality follow-up. Of these, an estimated 50,000 deaths occurred among those working in the mining sector. A significantly higher overall mortality (SMR = 1.26, 95% CI: 1.17-1.36), and mortality from heart diseases (adjusted SMR = 1.56, 95% CI: 1.31-1.83), cancer (adjusted SMR = 1.30, 95% CI: 1.14-1.48) and unintentional injuries (adjusted SMR = 1.41, 95%CI: 1.03-1.85) were observed among those employed in the mining sector. When the analyses were restricted to men, only the SMRs for heart disease and cancer remained statistically significant. No elevated SMR for deaths from chronic lower respiratory disease was observed in the study. CONCLUSION: Workers employed in the mining sector have a significantly increased total death rate and death rates from heart disease, cancer, and unintentional injuries.


Asunto(s)
Minería , Mortalidad/tendencias , Enfermedades Profesionales/mortalidad , Salud Laboral/tendencias , Adolescente , Adulto , Causas de Muerte , Femenino , Cardiopatías/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Traumatismos Ocupacionales/mortalidad , Trastornos Respiratorios/mortalidad , Estados Unidos/epidemiología , Adulto Joven
10.
Epilepsy Res ; 166: 106411, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32679488

RESUMEN

BACKGROUND: Non-trauma fracture (NTFx), an indicator of skeletal fragility, is a risk factor for mortality among adults with epilepsy. NTFx may elicit its effect on mortality through development of respiratory disease (RD) and cardiovascular disease (CVD). Therefore, the objective was to determine if NTFx increases risk for RD and CVD, and if incident RD and CVD mediates the association between NTFx and mortality for adults with epilepsy. METHODS: Data were gathered from Optum Clinformatics® Data Mart years 2011-2016 for this retrospective cohort study. Diagnosis codes identified adults (≥18 years) with epilepsy, NTFx, RD (pneumonia, chronic obstructive pulmonary disease, interstitial/pleura disease), CVD (ischemic heart disease, heart failure, cerebrovascular disease), and baseline comorbidities. Crude incidence rate (IR) and crude IR ratio (IRR and 95 % confidence intervals [CI]) was estimated for mortality and incidence of RD and CVD for up to 2 years of follow up. Cox regression estimated hazard ratios (HR and 95 % CI) for each outcome, comparing adults with vs. without NTFx after adjusting for sociodemographics and baseline comorbidities. Separate mediation analyses estimated the extent that incident RD and CVD mediated the association between NTFx and mortality. RESULTS: Adults with epilepsy with vs. without NTFx had a higher crude incidence of mortality (IRR = 2.42; 95 %CI = 2.24-2.60) and each RD and CVD measure (IRR = 1.60-2.02). After adjustments, the HR remained elevated for mortality (HR = 1.66; 95 %CI = 1.54-1.79) and each RD and CVD measure (HR = 1.18-1.61). Incident pneumonia and interstitial/pleura disease mediated 9.82 % and 7.51 %, respectively, of the association between NTFx and mortality. CONCLUSIONS: In a relatively short follow up of 2 years, NTFx was a robust risk factor for mortality, RD, and CVD among adults with epilepsy, and post-NTFx incidence of RD mediated a portion of the association between NTFx and mortality.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Epilepsia/mortalidad , Fracturas Óseas/mortalidad , Trastornos Respiratorios/mortalidad , Adolescente , Adulto , Anciano , Enfermedades Cardiovasculares/diagnóstico , Estudios de Cohortes , Epilepsia/diagnóstico , Femenino , Fracturas Óseas/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Trastornos Respiratorios/diagnóstico , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
11.
Environ Monit Assess ; 192(7): 412, 2020 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-32495152

RESUMEN

Green space and its spatial formation are important elements of public welfare in urban environments and green ecosystems in big cities largely contribute to the mental and physical health of citizens. Tehran is Iran's biggest and most polluted city and air pollution in this city causes loss of human lives due to respiratory diseases. The effect of green area has been less studied in former researches in Tehran, and the reducing effects of green landscape on the mortality of respiratory diseases have not yet been evaluated. To measure the effects of green area landscape patterns (fragmentation, area-edge, shape, and aggregation) on public health, the current study evaluated the pathways and effects of green space on air pollution and the mortality of respiratory diseases using structural equation modeling approach and the partial least squares method. The results of the study indicated green space has a significant mitigating effect on air pollution and mortality of respiratory diseases and also air pollution has a meaningful increasing effect on mortality due to respiratory diseases in Tehran. The most important latent variable in green space is class area that indicates more area of green space is correlated with less mortality of respiratory diseases. The most important indicator of air pollution was the PM2.5 that needs to be considered and controlled by urban policymakers. Accordingly, maximizing the green area and its cohesion and minimizing fragmentation and green patch edge can contribute to a reduction in air pollution and consequently lower mortality of citizens.


Asunto(s)
Monitoreo del Ambiente , Modelos Teóricos , Material Particulado , Trastornos Respiratorios , Ciudades/estadística & datos numéricos , Ecosistema , Monitoreo del Ambiente/métodos , Humanos , Irán , Material Particulado/análisis , Material Particulado/toxicidad , Trastornos Respiratorios/inducido químicamente , Trastornos Respiratorios/mortalidad
12.
Am J Ind Med ; 63(7): 577-588, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32378753

RESUMEN

BACKGROUND: Previous analyses of mortality were conducted in a large cohort of ethylene oxide (EtO) exposed workers employed at 13 sterilization facilities throughout the U.S. and followed from the start of operation through 1998. Statistically significant elevated mortality was reported from hematopoietic cancer in men and breast cancer in women compared to the general population. Possible healthy worker survivor bias was not addressed. METHODS: To examine survivor bias in this cohort, employment termination was analyzed with statistical models stratified on sex and race that included age, employment duration, and cumulative EtO exposure. To reduce survivor bias employment duration was included in Poisson regression model specifications for estimating standardized mortality ratios for several cancer outcomes. RESULTS: Strong statistically significant effects of unlagged cumulative EtO exposure were observed on rate of employment termination, indicating potential healthy worker survivor effect bias. Adjustment for employment duration in analyses of mortality resulted in statistically significant and stronger associations between cumulative EtO exposure and lung cancer, female breast cancer and hematopoietic cancer. There was a striking reduction in nonmalignant respiratory disease mortality risk with increasing employment duration with a further (nonsignificant) reduction with cumulative EtO, suggesting that EtO itself is driving termination of workers with respiratory morbidity even though the average EtO exposures in this population were generally far below odor and acute irritancy thresholds. CONCLUSIONS: Important survivor bias was present in this EtO cohort and may be present in many occupational settings involving irritant exposures.


Asunto(s)
Empleo/estadística & datos numéricos , Óxido de Etileno/análisis , Modelos Estadísticos , Enfermedades Profesionales/mortalidad , Exposición Profesional/estadística & datos numéricos , Adulto , Anciano , Sesgo , Neoplasias de la Mama/etiología , Neoplasias de la Mama/mortalidad , Causas de Muerte , Estudios de Cohortes , Óxido de Etileno/toxicidad , Femenino , Efecto del Trabajador Sano , Neoplasias Hematológicas/etiología , Neoplasias Hematológicas/mortalidad , Humanos , Neoplasias Pulmonares/etiología , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/etiología , Exposición Profesional/efectos adversos , Exposición Profesional/análisis , Trastornos Respiratorios/etiología , Trastornos Respiratorios/mortalidad , Factores de Tiempo , Estados Unidos
13.
Nat Commun ; 11(1): 2457, 2020 05 20.
Artículo en Inglés | MEDLINE | ID: mdl-32433517

RESUMEN

A growing number of epidemiological studies have recently assessed temporal variations in vulnerability and/or mortality attributable to hot and cold temperatures. However, the eventual changes in the seasonal distribution of temperature-attributable mortality remain unexplored. Here, we analyse countrywide daily time-series of temperature and mortality counts from respiratory diseases by sex, age group and province of residence during the period 1980-2016 in Spain. We show the complete reversal of the seasonality of temperature-attributable mortality, with a significant shift of the maximum monthly incidence from winter to summer, and the minimum monthly incidence from early and late summer to winter. The reversal in the seasonal distribution of the attributable deaths is not driven by the observed warming in both winter and summer temperatures, but rather by the very large decrease in the risk of death due to cold temperatures and the relatively much smaller reduction due to hot temperatures. We conclude that the projected decrease in the number of moderate and extreme cold days due to climate warming will not contribute to a further reduction of cold-attributable respiratory deaths.


Asunto(s)
Cambio Climático , Clima , Trastornos Respiratorios/mortalidad , Estaciones del Año , Temperatura , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Trastornos Respiratorios/diagnóstico , Trastornos Respiratorios/epidemiología , España/epidemiología , Tasa de Supervivencia , Adulto Joven
14.
Spinal Cord ; 58(9): 970-979, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32286529

RESUMEN

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: We studied complications during early rehabilitation and their relation to length of stay (LOS) in the hospital as well as to survival in people with traumatic spinal cord injury (TSCI). SETTING: All specialized hospitals of Saint Petersburg. METHODS: We analysed all charts of patients admitted with acute TSCI to the city hospitals, 2012-2016. Patient characteristics, complications, time and cause of death, and LOS were recorded. Mean values with standard deviations and t-tests were used. We analysed mortality rate using the Kaplan-Meier method and calculated relative risks (RRs). RESULTS: A total of 311 patients with TSCI were included. Complications occurred in 34% of patients; most were respiratory complications and pressure ulcers. Complications occurred more often in those with concomitant traumatic brain injury (TBI) (RR = 1.4, 95% CI: 1.2-1.8). All complications prolonged LOS (median, 11 days) and increased mortality in the acute phase (p < 0.001). In the early phase, 15% died, with a median time to death of 13 days. Respiratory complications markedly increased the death rate (RR = 18, 95% CI: 15-22). Mortality rate correlated also with age, TSCI severity and level, and concomitant TBI. Alcohol/drug consumption before TSCI increased the likelihood for complications (RR = 1.7, 95% CI: 1.3-2.1) and mortality (RR = 2.2, 95% CI: 1.6-3.1). CONCLUSION: Focus on prevention as well as early and optimal treatment of complications, together with no or low alcohol/drug consumption may reduce mortality in the early phase after TSCI and at the same time shorten LOS.


Asunto(s)
Lesiones Traumáticas del Encéfalo , Tiempo de Internación , Úlcera por Presión , Trastornos Respiratorios , Traumatismos de la Médula Espinal , Enfermedad Aguda , Adolescente , Adulto , Anciano , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/mortalidad , Lesiones Traumáticas del Encéfalo/rehabilitación , Comorbilidad , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Úlcera por Presión/etiología , Úlcera por Presión/mortalidad , Trastornos Respiratorios/etiología , Trastornos Respiratorios/mortalidad , Estudios Retrospectivos , Federación de Rusia/epidemiología , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/mortalidad , Traumatismos de la Médula Espinal/rehabilitación , Adulto Joven
15.
Br J Haematol ; 190(4): 583-587, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32157682

RESUMEN

For patients with untreated hepatic veno-occlusive disease (VOD)/sinusoidal obstruction syndrome (SOS) with multi-organ dysfunction (MOD), mortality is >80%. We conducted a pooled analysis of three studies that assessed Day 100 survival in relationship to MOD severity, with dialysis and/or ventilator dependence representing the most severe organ dysfunction. All patients in the analysis were diagnosed using Baltimore criteria/biopsy. This analysis of patients with VOD/SOS and MOD after haematopoietic cell transplantation (HCT; n = 651) demonstrated higher Day 100 survival rates amongst defibrotide-treated patients with VOD/SOS with less versus more severe forms of MOD. Even patients with severe forms of MOD post-HCT benefitted from defibrotide.


Asunto(s)
Fibrinolíticos/uso terapéutico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Enfermedad Veno-Oclusiva Hepática/tratamiento farmacológico , Polidesoxirribonucleótidos/uso terapéutico , Diálisis Renal , Respiración Artificial , Acondicionamiento Pretrasplante/efectos adversos , Lesión Renal Aguda/etiología , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/terapia , Adolescente , Adulto , Anciano , Niño , Preescolar , Ensayos Clínicos Fase II como Asunto/estadística & datos numéricos , Ensayos Clínicos Fase III como Asunto/estadística & datos numéricos , Intervalos de Confianza , Femenino , Fibrinolíticos/efectos adversos , Hemorragia/inducido químicamente , Enfermedad Veno-Oclusiva Hepática/etiología , Enfermedad Veno-Oclusiva Hepática/mortalidad , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Insuficiencia Multiorgánica/tratamiento farmacológico , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/mortalidad , Oportunidad Relativa , Polidesoxirribonucleótidos/efectos adversos , Trastornos Respiratorios/etiología , Trastornos Respiratorios/mortalidad , Trastornos Respiratorios/terapia , Estudios Retrospectivos , Adulto Joven
16.
Biomedica ; 40(1): 137-152, 2020 03 01.
Artículo en Inglés, Español | MEDLINE | ID: mdl-32220170

RESUMEN

Introduction: The World Health Organization (WHO) points out that 3 million deaths per year caused by cardiopulmonary diseases are related to exposure to air pollution. Objective: To estimate areas of concentration of PM2.5 in Bogotá according to the WHO Air Quality Guidelines (AQG) for cardiopulmonary diseases during the period 2014-2015. Materials and methods: We conducted an ecological study with geostatistical techniques. We calculated the PM2.5 averages for six hour-periods distributed throughout the day in four time slots, which were classified according to daily and annual WHO AQG. Results: The locality of Kennedy presented the highest concentrations of PM2.5 in all time slots. The values registered in this area classified within the daily and annual AQG showed that the locality would present an increase of 1.2% and 9% in cardiopulmonary mortality in the short and long term, respectively. Conclusion: The time slots from 0:00 to 6:00 h y from 12:00 to 18:00 h met the annual AQG value of 10 µg/m3 in a part of the eastern zone of the city; in the rest of the city, in these same time slots, intermediate objectives 2 and 3 were met, which means increases by 9% and 3% in the cardiopulmonary mortality according to the AQG, respectively.


Asunto(s)
Contaminación del Aire , Material Particulado/análisis , Salud Urbana , Ciudades , Colombia , Guías como Asunto , Cardiopatías/etiología , Cardiopatías/mortalidad , Humanos , Conceptos Meteorológicos , Tamaño de la Partícula , Material Particulado/efectos adversos , Trastornos Respiratorios/etiología , Trastornos Respiratorios/mortalidad , Riesgo , Organización Mundial de la Salud
17.
Acta Oncol ; 59(6): 628-635, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32202189

RESUMEN

Purpose: To examine the feasibility of automatic data extraction from clinical radiation therapy (RT) databases at four hospitals to investigate the impact of mean lung dose (MLD) and age on the risk of early respiratory-related death and early overall death for patients treated with RT for non-small-cell lung cancer (NSCLC).Material and methods: We included adult patients with NSCLC receiving curatively intended RT between 2002 and 2017 at four hospitals. A script was developed to automatically extract RT-related data. The cause of death for patients deceased within 180 days of the start of RT was retrospectively assessed. Using logistic regression, the risks of respiratory-related death and of overall death within 90 and 180 days were investigated using MLD and age as variables.Results: Altogether, 1785 patients were included in the analysis of early overall mortality and 1655 of early respiratory-related mortality. The respiratory-related mortalities within 90 and 180 days were 0.9% (15/1655) and 3.6% (60/1655). The overall mortalities within 90 and 180 days were 2.5% (45/1785) and 10.6% (190/1785). Higher MLD and older age were associated with an increased risk of respiratory-related death within 180 days and overall death within 90 and 180 days (all p<.05). For example, the risk of respiratory-related death within 180 days and their 95% confidence interval for patients aged 65 and 75 years with MLDs of 20 Gy was according to our logistic model 3.8% (2.6-5.0%) and 7.7% (5.5-10%), respectively.Conclusions: Automatic data extraction was successfully used to pool data from four hospitals. MLD and age were associated with the risk of respiratory-related death within 180 days of the start of RT and with overall death within 90 and 180 days. A model quantifying the risk of respiratory-related death within 180 days was formulated.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/radioterapia , Trastornos Respiratorios/mortalidad , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Causas de Muerte , Quimioradioterapia/métodos , Recolección de Datos/métodos , Bases de Datos Factuales , Relación Dosis-Respuesta en la Radiación , Estudios de Factibilidad , Femenino , Humanos , Modelos Logísticos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Neumonitis por Radiación/mortalidad , Radioterapia Conformacional/efectos adversos , Radioterapia Conformacional/métodos , Estudios Retrospectivos , Distribución por Sexo , Análisis de Supervivencia , Factores de Tiempo
18.
Artículo en Inglés | MEDLINE | ID: mdl-31551607

RESUMEN

AIM: The aim of this study was to reduce the severe respiratory complications of esophageal cancer surgery often leading to death. METHODS: Two groups of patients operated on for esophageal cancer were evaluated in this retrospective analysis. The first group was operated between 2006-2011, prior to the implementation of preoperative microbiological examination while the second group had surgery between 2012-2017 after implementation of this examination. RESULTS: In total, 260 patients, 220 males and 40 females underwent esophagectomy. Between 2006-2011, 113 (87.6%) males and 16 (12.4%) females and between 2012-2017, esophagectomy was performed in 107 (81.7%) males and 24 (18.3%) females. In the first cohort, 10 patients died due to respiratory complications. The 30-day mortality was 6.9% and 90-day was 9.3%. In the second cohort, 4 patients died from respiratory complications. The 30-day mortality was 1.5% and 90-day mortality was 3.1%. With regard to the incidence of respiratory complications (P=0.014), these occurred more frequently in patients with sputum collection, however, severe respiratory complications were more often observed in patients without sputum collection. Significantly fewer patients died (P=0.036) in the group with sputum collection. The incidence of respiratory complications was very significantly higher in the patients who died (P<0.0001). CONCLUSION: The incidence of severe respiratory complications (causing death) may be reduced by identifying clinically silent respiratory tract infections.


Asunto(s)
Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Complicaciones Posoperatorias/etiología , Trastornos Respiratorios/etiología , Trastornos Respiratorios/mortalidad , Sistema Respiratorio/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/métodos , Trastornos Respiratorios/microbiología , Factores de Riesgo
19.
Am J Epidemiol ; 189(2): 116-119, 2020 02 28.
Artículo en Inglés | MEDLINE | ID: mdl-31566673

RESUMEN

There is limited suggestive evidence of relationships between public transport strikes and either increased air pollution or worse population health. In this study we aimed to assess whether public transport strikes were associated with increases in health events (overall, cardiovascular and respiratory mortality, and cardiovascular and respiratory hospitalizations). We also explored whether air pollution mediated those associations. We used data from the city of Barcelona (Spain) for the period 2005-2016 on strikes, health events, and ambient air pollution (nitrogen dioxide, nitrogen monoxide, particulate matter (PM) with an aerodynamic diameter ≤10 µm, PM with an aerodynamic diameter ≤2.5µm, PM with an aerodynamic diameter ≤1µm, number of particles with a diameter greater than 5 nm per cm3 (particle number concentration), and black carbon). We used linear and quasi-Poisson regression models to explore the associations between air pollution and public transport strikes and between public transport strikes and health outcomes. We also investigated potential causal mediation by air pollution. Overall, this study suggested that public transport strikes are associated with increased overall mortality, respiratory mortality, and respiratory hospitalizations. However, our findings suggest that such increases are not mediated by the increase in air pollution. Our results indicate the need to further investigate these relationships and potential mechanisms.


Asunto(s)
Contaminación del Aire/análisis , Hospitalización/estadística & datos numéricos , Huelga de Empleados/estadística & datos numéricos , Contaminación por Tráfico Vehicular/análisis , Transportes , Adulto , Anciano , Contaminantes Atmosféricos/análisis , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Ciudades , Exposición a Riesgos Ambientales/análisis , Monitoreo del Ambiente , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Distribución de Poisson , Trastornos Respiratorios/etiología , Trastornos Respiratorios/mortalidad , España/epidemiología
20.
BMC Public Health ; 19(1): 1484, 2019 Nov 08.
Artículo en Inglés | MEDLINE | ID: mdl-31703658

RESUMEN

BACKGROUND: Previous studies have associated elevated mortality risk in central Appalachia with coal-mining activities, but few have explored how different non-coal factors influence the association within each county. Consequently, there is a knowledge gap in identifying effective ways to address health disparities in coal-mining counties. To specifically address this knowledge gap, this study estimated the effect of living in a coal-mining county on non-malignant respiratory diseases (NMRD) mortality, and defined this as "coal-county effect." We also investigated what factors may accentuate or attenuate the coal-county effect. METHODS: An ecological epidemiology protocol was designed to observe the characteristics of three populations and to identify the effects of coal-mining on community health. Records for seven coal-mining counties (n = 19,692) were obtained with approvals from the Virginia Department of Health Office of Vital Statistics for the years 2005 to 2012. Also requested were records from three adjacent coal counties (n = 10,425) to provide a geographic comparison. For a baseline comparison, records were requested for eleven tobacco-producing counties (n = 27,800). We analyzed the association of 57,917 individual mortality records in Virginia with coal-mining county residency, county-level socioeconomic status, health access, behavioral risk factors, and coal production. The development of a two-level hierarchical model allowed the coal-county effect to vary by county-level characteristics. Wald tests detected sets of significant factors explaining the variation of impacts across counties. Furthermore, to illustrate how the model estimations help explain health disparities, two coal-mining county case studies were presented. RESULTS: The main result revealed that coal-mining county residency increased the probability of dying from NMRD. The coal-county effect was accentuated by surface coal mining, high smoking rates, decreasing health insurance coverage, and a shortage of doctors. In Virginia coal-mining regions, the average coal-county effect increased by 147% (p-value< 0.01) when one doctor per 1000 left, and the effect increased by 68% (p-value< 0.01) with a 1% reduction of health insurance rates, holding other factors fixed. CONCLUSIONS: This study showed a high mortality risk of NMRD associated with residents living in Virginia coal-mining counties. Our results also revealed the critical role of health access in reducing health disparities related to coal exposure.


Asunto(s)
Minas de Carbón/estadística & datos numéricos , Enfermedades Profesionales/mortalidad , Trastornos Respiratorios/mortalidad , Adulto , Región de los Apalaches/epidemiología , Carbón Mineral , Estudios Transversales , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/etiología , Trastornos Respiratorios/etiología , Factores de Riesgo , Fumar/efectos adversos , Clase Social , Adulto Joven
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