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1.
CMAJ Open ; 10(3): E599-E609, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35790229

RESUMO

BACKGROUND: Early in the COVID-19 pandemic, the South Asian community in the Greater Toronto Area (GTA) was identified as having risk factors for exposure and specific barriers to accessing testing and reliable health information, rendering them particularly vulnerable to SARS-CoV-2 infection. We sought to investigate the burden of SARS-CoV-2 infection among South Asian people in the GTA, and to characterize the demographic characteristics, risk perceptions and trusted sources of health information in this group. METHODS: We conducted a cross-sectional analysis from the baseline assessment of participants in a prospective cohort study. Participants from the GTA were enrolled from Apr. 14 to July 28, 2021. Seropositivity for antispike and antinucleocapsid antibodies was determined from dried blood spots, and estimates of seropositivity were age and sex standardized to the South Asian population in Ontario. Demographic characteristics, risk perceptions and sources of COVID-19 information were collected via questionnaire and reported descriptively. RESULTS: Among the 916 South Asian participants enrolled (mean age 41 yr), the age- and sex-standardized seropositivity was 23.6% (95% confidence interval 20.8%-26.4%). Of the 693 respondents to the questionnaire, 228 (32.9%) identified as essential workers, and 125 (19.1%) reported living in a multigenerational household. A total of 288 (49.4%) perceived that they were at high COVID-19 risk owing to their geographic location, and 149 (34.3%) owing to their type of employment. The top 3 most trusted sources of information related to COVID-19 included health care providers and public health, traditional media sources and social media. INTERPRETATION: By the third wave of the COVID-19 pandemic, about one-quarter of a sample of South Asian individuals in Ontario had serologic evidence of prior SARS-CoV-2 infection. Insight into factors that put certain populations at risk can help future pandemic planning and disease control efforts.


Assuntos
COVID-19 , Adulto , COVID-19/epidemiologia , Estudos Transversais , Humanos , Ontário/epidemiologia , Pandemias , Estudos Prospectivos , Fatores de Risco , SARS-CoV-2
2.
JAMA Cardiol ; 7(8): 796-807, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35704349

RESUMO

Importance: High amounts of sitting time are associated with increased risks of cardiovascular disease (CVD) and mortality in high-income countries, but it is unknown whether risks also increase in low- and middle-income countries. Objective: To investigate the association of sitting time with mortality and major CVD in countries at different economic levels using data from the Prospective Urban Rural Epidemiology study. Design, Setting, and Participants: This population-based cohort study included participants aged 35 to 70 years recruited from January 1, 2003, and followed up until August 31, 2021, in 21 high-income, middle-income, and low-income countries with a median follow-up of 11.1 years. Exposures: Daily sitting time measured using the International Physical Activity Questionnaire. Main Outcomes and Measures: The composite of all-cause mortality and major CVD (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). Results: Of 105 677 participants, 61 925 (58.6%) were women, and the mean (SD) age was 50.4 (9.6) years. During a median follow-up of 11.1 (IQR, 8.6-12.2) years, 6233 deaths and 5696 major cardiovascular events (2349 myocardial infarctions, 2966 strokes, 671 heart failure, and 1792 cardiovascular deaths) were documented. Compared with the reference group (<4 hours per day of sitting), higher sitting time (≥8 hours per day) was associated with an increased risk of the composite outcome (hazard ratio [HR], 1.19; 95% CI, 1.11-1.28; Pfor trend < .001), all-cause mortality (HR, 1.20; 95% CI, 1.10-1.31; Pfor trend < .001), and major CVD (HR, 1.21; 95% CI, 1.10-1.34; Pfor trend < .001). When stratified by country income levels, the association of sitting time with the composite outcome was stronger in low-income and lower-middle-income countries (≥8 hours per day: HR, 1.29; 95% CI, 1.16-1.44) compared with high-income and upper-middle-income countries (HR, 1.08; 95% CI, 0.98-1.19; P for interaction = .02). Compared with those who reported sitting time less than 4 hours per day and high physical activity level, participants who sat for 8 or more hours per day experienced a 17% to 50% higher associated risk of the composite outcome across physical activity levels; and the risk was attenuated along with increased physical activity levels. Conclusions and Relevance: High amounts of sitting time were associated with increased risk of all-cause mortality and CVD in economically diverse settings, especially in low-income and lower-middle-income countries. Reducing sedentary time along with increasing physical activity might be an important strategy for easing the global burden of premature deaths and CVD.


Assuntos
Insuficiência Cardíaca , Infarto do Miocárdio , Acidente Vascular Cerebral , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Prospectivos , Comportamento Sedentário , Acidente Vascular Cerebral/epidemiologia
3.
N Engl J Med ; 386(21): 1986-1997, 2022 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-35363452

RESUMO

BACKGROUND: Perioperative bleeding is common in patients undergoing noncardiac surgery. Tranexamic acid is an antifibrinolytic drug that may safely decrease such bleeding. METHODS: We conducted a trial involving patients undergoing noncardiac surgery. Patients were randomly assigned to receive tranexamic acid (1-g intravenous bolus) or placebo at the start and end of surgery (reported here) and, with the use of a partial factorial design, a hypotension-avoidance or hypertension-avoidance strategy (not reported here). The primary efficacy outcome was life-threatening bleeding, major bleeding, or bleeding into a critical organ (composite bleeding outcome) at 30 days. The primary safety outcome was myocardial injury after noncardiac surgery, nonhemorrhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism (composite cardiovascular outcome) at 30 days. To establish the noninferiority of tranexamic acid to placebo for the composite cardiovascular outcome, the upper boundary of the one-sided 97.5% confidence interval for the hazard ratio had to be below 1.125, and the one-sided P value had to be less than 0.025. RESULTS: A total of 9535 patients underwent randomization. A composite bleeding outcome event occurred in 433 of 4757 patients (9.1%) in the tranexamic acid group and in 561 of 4778 patients (11.7%) in the placebo group (hazard ratio, 0.76; 95% confidence interval [CI], 0.67 to 0.87; absolute difference, -2.6 percentage points; 95% CI, -3.8 to -1.4; two-sided P<0.001 for superiority). A composite cardiovascular outcome event occurred in 649 of 4581 patients (14.2%) in the tranexamic acid group and in 639 of 4601 patients (13.9%) in the placebo group (hazard ratio, 1.02; 95% CI, 0.92 to 1.14; upper boundary of the one-sided 97.5% CI, 1.14; absolute difference, 0.3 percentage points; 95% CI, -1.1 to 1.7; one-sided P = 0.04 for noninferiority). CONCLUSIONS: Among patients undergoing noncardiac surgery, the incidence of the composite bleeding outcome was significantly lower with tranexamic acid than with placebo. Although the between-group difference in the composite cardiovascular outcome was small, the noninferiority of tranexamic acid was not established. (Funded by the Canadian Institutes of Health Research and others; POISE-3 ClinicalTrials.gov number, NCT03505723.).


Assuntos
Antifibrinolíticos , Ácido Tranexâmico , Antifibrinolíticos/efeitos adversos , Antifibrinolíticos/uso terapêutico , Canadá , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Procedimentos Cirúrgicos Operatórios , Trombose/induzido quimicamente , Trombose/tratamento farmacológico , Ácido Tranexâmico/efeitos adversos , Ácido Tranexâmico/uso terapêutico
4.
N Engl J Med ; 386(9): 827-836, 2022 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-35235725

RESUMO

BACKGROUND: Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to ≥70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations. METHODS: We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex). RESULTS: Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit. CONCLUSIONS: The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury. (Funded by the Canadian Institutes of Health Research and others; VISION Cardiac Surgery ClinicalTrials.gov number, NCT01842568.).


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Infarto do Miocárdio/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Troponina I/sangue , Idoso , Valva Aórtica/cirurgia , Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/mortalidade , Ponte de Artéria Coronária/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Valores de Referência
5.
Res Synth Methods ; 13(3): 381-388, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35278030

RESUMO

Overlap of primary studies among systematic reviews (SRs) is one of the main methodological challenges when conducting overviews. If not assessed properly, overlapped primary studies may mislead findings, since they may have a major influence either in qualitative analyses or in statistical weight. Moreover, overlapping SRs may represent the existence of duplicated efforts. Matrices of evidence and the calculation of the overall corrected covered area (CCA) are appropriate methods to address this issue, but they seem to be not comprehensive enough. In this article we present Graphical Representation of Overlap for OVErviews (GROOVE), an easy-to-use tool for overview authors. Starting from a matrix of evidence, GROOVE provides the number of included primary studies and SRs included in the matrix; the absolute number of overlapped and non-overlapped primary studies; and an overall CCA assessment. The tool also provides a detailed CCA assessment for each possible pair of SRs (or "nodes"), with a graphical and easy-to-read representation of these results. Additionally, it includes an advanced optional usage, incorporating structural missingness in the matrix. In this article, we show the details about how to use GROOVE, what results it achieves and how the tool obtains these results. GROOVE is intended to improve the overlap assessment by making it easier, faster, and more friendly for both authors and readers. The tool is freely available at http://doi.org/10.17605/OSF.IO/U2MS4 and https://es.cochrane.org/es/groovetool.


Assuntos
Medicina Baseada em Evidências , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
6.
BMC Med ; 20(1): 71, 2022 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-35172840

RESUMO

BACKGROUND: Patients with disorders of gut-brain interaction (DGBI) report meal intake to be associated with symptoms. DGBI patients with meal-related symptoms may have more severe symptoms overall and worse health outcomes, but this subgroup has not been well characterized. We aimed to describe the global prevalence of meal-related abdominal pain and characterize this subgroup. METHODS: The data analyzed originated from the Internet survey component of the population-based Rome Foundation Global Epidemiology Study, completed in 26 countries (n = 54,127). Adult subjects were asked whether they had abdominal pain and how often this was meal-related. Respondents were categorized into "no," "occasional," and "frequent" meal-related abdominal pain groups based on 0%, 10-40%, and ≥50% of the pain episodes being meal-related, respectively. DGBI diagnoses, frequency of other GI symptoms, psychological distress, non-GI somatic symptoms, quality of life, and healthcare utilization were compared between groups. Mixed linear and ordinal regression was used to assess independent associations between psychological distress, non-GI somatic symptoms, quality of life, other GI symptoms, and meal-related abdominal pain. RESULTS: Overall, 51.9% of the respondents reported abdominal pain in the last 3 months, and 11.0% belonged to the group with frequent meal-related abdominal pain, which included more females and younger subjects. DGBI diagnoses were more common in subjects with frequent meal-related abdominal pain, and the frequency of several GI symptoms was associated with having more frequent meal-related abdominal pain. Having meal-related abdominal pain more frequently was also associated with more severe psychological distress, non-GI somatic symptoms, and a poorer quality of life. The group with frequent meal-related abdominal pain also more often consulted a doctor for bowel problems compared to the other groups of meal-related abdominal pain. CONCLUSION: Reporting frequent meal-related abdominal pain is common across the globe and associated with other GI and non-GI somatic symptoms, psychological distress, healthcare utilization, and a poorer quality of life. Individuals who frequently experience meal-related abdominal pain also more frequently fulfill the diagnostic criteria for DGBI. Assessing meal-related symptoms in all DGBI patients could be of major importance to improve and individualize symptom management.


Assuntos
Gastroenteropatias , Síndrome do Intestino Irritável , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Adulto , Feminino , Gastroenteropatias/epidemiologia , Humanos , Prevalência , Qualidade de Vida , Inquéritos e Questionários
8.
Neurogastroenterol Motil ; 34(8): e14323, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35072332

RESUMO

BACKGROUND: Data for Israel from the Rome Foundation Global Epidemiology Study on the disorders of gut-brain interaction (DGBI) were used to assess the national prevalence of all 22 DGBI, the percentage of respondents meeting diagnostic criteria for at least one DGBI, and the impact on burden of disease in Israel. METHODS: The survey was conducted through the Internet with multiple built-in quality-assurance techniques and included the Rome IV diagnostic questionnaire and an in-depth supplemental questionnaire. KEY RESULTS: 2012 Israeli participants completed the survey nationwide: mean age 44.6 ± 16.4 years, 50% females. The national distribution was very close to the latest Israeli census. 36.4% (95% CI 34.3, 38.4) met diagnostic criteria for at least one DGBI, with 4.4% for any esophageal disorder, 6.5% for any gastroduodenal disorder, 30.8% for any bowel disorder, and 5.3% for any anorectal disorder. The rates were higher for women. Having any DGBI was associated negatively with psychosocial variables (including quality of life, somatization, and concern about digestive problems), and healthcare utilization (including doctor visits, use of medications, and abdominal surgeries). CONCLUSIONS & INFERENCES: The results of this study provide the first in-depth assessment of the prevalence and burden of Rome IV DGBI in Israel and facilitate comparisons with other countries. As 36.4% of the 2,012 participants met diagnostic criteria for at least one DGBI, and 23.5% of those met criteria for more than one DGBI, the burden of DGBI in Israel is high, indicating a need to focus on research and training for patient care.


Assuntos
Síndrome do Intestino Irritável , Qualidade de Vida , Adulto , Encéfalo , Feminino , Humanos , Síndrome do Intestino Irritável/diagnóstico , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Cidade de Roma , Inquéritos e Questionários
9.
Clin Gastroenterol Hepatol ; 20(5): e945-e956, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34052391

RESUMO

BACKGROUND AND AIMS: Conditions such as irritable bowel syndrome (IBS), functional dyspepsia, and functional constipation are among the prevalent gastrointestinal (GI) disorders classified as disorders of gut-brain interaction (DGBI), which can adversely affect the lives of sufferers. This study aimed to assess the degree and consequences of overlapping DGBI in a large population-based global scale. METHODS: Internet survey data from 54,127 adults (49.1% women) in 26 countries were analyzed by 4 GI anatomic regions (esophageal, gastroduodenal, bowel, and anorectal). The number of DGBI-affected GI regions was assessed, including associations with sex, age, disease severity, quality of life, psychosocial variables, and health care utilization. RESULTS: A total of 40.3% of surveyed individuals met Rome IV criteria for a DGBI. The percentages with 1-4 DGBI-affected GI regions were 68.3%, 22.3%, 7.1%, and 2.3%, respectively. The IBS symptom severity score increased significantly from 1 (207.6) to 4 (291.6) regions, as did non-GI symptom reporting (somatization), anxiety and depression, concerns and embarrassment about bowel function, doctor visits, medications, and abdominal surgeries (all P < .0001). Quality of life decreased with increasing number of DGBI regions (P < .0001). In a logistic mixed model, non-GI symptoms (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.08-1.10), being very vs not concerned (OR, 2.55; 95% CI, 2.27-2.90), being very vs not embarrassed about bowel function (OR, 1.20; 95% CI, 1.08-1.33), and mean number of doctor visits (OR, 1.23; 95% CI, 1.115-1.32) were most strongly associated with number of DGBI regions. CONCLUSIONS: DGBI in multiple anatomic GI regions is associated with increased psychological comorbidity, health care utilization, and IBS severity. Physician awareness of overlap could improve quality of care, prevent unnecessary interventions, and yield more positive health outcomes.


Assuntos
Gastroenteropatias , Síndrome do Intestino Irritável , Adulto , Encéfalo , Feminino , Gastroenteropatias/diagnóstico , Gastroenteropatias/epidemiologia , Humanos , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/epidemiologia , Masculino , Qualidade de Vida , Cidade de Roma , Índice de Gravidade de Doença , Inquéritos e Questionários
10.
Gastroenterology ; 162(3): 731-742.e9, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34774539

RESUMO

BACKGROUND & AIMS: Rumination syndrome is a Disorder of Gut-Brain Interaction (DGBI) of unknown etiology. We aimed to assess its global prevalence and potential associations with other medical conditions. METHODS: Data were collected via the Internet in 26 countries. Subjects were evenly distributed by country, sex, and age groups and were invited for a "health survey" using the Rome IV diagnostic questionnaire and a supplementary questionnaire addressing factors potentially associated with DGBI. RESULTS: In all, 54,127 subjects completed the survey (51% male; mean age, 44.3 years). The overall prevalence of rumination syndrome was 3.1% (95% confidence interval [CI], 3.0-3.3%). It was highest in Brazil (5.5% CI, 4.5-6.5) and lowest in Singapore (1.7% CI, 1.1-2.2). The mean age of people with rumination syndrome was 44.5 years (standard deviation, 15.6) and it was more common in females (54.5% vs 45.5%). Factors independently associated with rumination syndrome were depression (odds ratio [OR], 1.46), anxiety (OR, 1.8), body mass index (OR, 1.04), and female sex (OR, 1.19). Subjects with multiple DGBI were at increased risk of having rumination syndrome, with the highest risk in subjects with 4 gastrointestinal regions with DGBI (OR, 15.9 compared with none). Quality of life (QoL) was lower in subjects with rumination syndrome compared with the rest of the cohort (PROMIS-10 score: physical QoL mean 12.9 vs 14.5; mental QoL mean 12.0 vs 13.6). CONCLUSIONS: The prevalence of rumination syndrome is higher than reported in most previous population studies and is likely underdiagnosed in clinical practice. Awareness of rumination syndrome should be raised among clinicians to improve care for these patients.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Refluxo Gastroesofágico/epidemiologia , Síndrome da Ruminação/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Recursos em Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Fatores Sexuais , Adulto Jovem
11.
Int J Inj Contr Saf Promot ; : 1-13, 2021 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-34719336

RESUMO

The relative roles of school context and individual student factors are of special interest to educators in measuring academic performance. Little is known about the effect of school violence on a student's academic performance and well-being. The aims of this study were to examine the effects of three types of school violence (direct violence, discrimination, and cyberbullying) on students' academic performance in standardized tests of mathematics, reading and history, and to identify individual student factors that contribute to reducing the negative effect of exposure to violence at school. We used 10th grade Chilean student data from the representative cross-sectional test of the Education Quality Measurement System (SIMCE in Spanish) from 2015. Multilevel linear models, adjusted for gender, incorporated other school and environmental contextual factors, as well as individual student factors. The results show that school violence in its three forms had a negative effect on academic performance. Student self-efficacy, educational expectations and satisfaction with interpersonal relations with their teachers, were important in reducing the negative effect of exposure to violence. The implications for the school are discussed.

12.
J Phys Act Health ; 18(11): 1412-1418, 2021 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-34662854

RESUMO

BACKGROUND: Although low levels of physical activity have slightly decreased globally, the need to reverse the physical inactivity remains urgent. One approach has been the installation of outdoor gyms (OGs). METHOD: A natural experiment arose from the installation of OGs in different neighborhoods of the city of Temuco, Chile. Baseline measurements were collected between 2006 and 2017 in a cohort of adults participating in the Prospective Urban & Rural Epidemiology study. Physical activity was assessed with the short version of the International Physical Activity Questionnaire, and time-varying covariates was assessed every 3 years. The multistage hierarchical, nested sampling process and the follow-up assessments led to data correlated at different levels, thus the authors analyzed the data using a logistic multilevel model. RESULT: 2463 urban adults from 16 neighborhoods, with an average age of 51.7 (9.8) years (67% female), were included. Having an adequate number of OGs improved the odds of complying with the World Health Organization's recommendations (adjusted odds ratio = 4.64, 3.95-5.45). In addition, being male (odds ratio = 1.53, 1.32-1.77) and under the age of 60 years (odds ratio = 0.83, 0.71-0.97) were associated with being physically active. CONCLUSION: The presence of more OGs can have a positive impact on physical activity recommendations.


Assuntos
Exercício Físico , Características de Residência , Adulto , Chile , Cidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
13.
BMJ ; 374: n2209, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-34593374

RESUMO

OBJECTIVE: To determine if virtual care with remote automated monitoring (RAM) technology versus standard care increases days alive at home among adults discharged after non-elective surgery during the covid-19 pandemic. DESIGN: Multicentre randomised controlled trial. SETTING: 8 acute care hospitals in Canada. PARTICIPANTS: 905 adults (≥40 years) who resided in areas with mobile phone coverage and were to be discharged from hospital after non-elective surgery were randomised either to virtual care and RAM (n=451) or to standard care (n=454). 903 participants (99.8%) completed the 31 day follow-up. INTERVENTION: Participants in the experimental group received a tablet computer and RAM technology that measured blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, and body weight. For 30 days the participants took daily biophysical measurements and photographs of their wound and interacted with nurses virtually. Participants in the standard care group received post-hospital discharge management according to the centre's usual care. Patients, healthcare providers, and data collectors were aware of patients' group allocations. Outcome adjudicators were blinded to group allocation. MAIN OUTCOME MEASURES: The primary outcome was days alive at home during 31 days of follow-up. The 12 secondary outcomes included acute hospital care, detection and correction of drug errors, and pain at 7, 15, and 30 days after randomisation. RESULTS: All 905 participants (mean age 63.1 years) were analysed in the groups to which they were randomised. Days alive at home during 31 days of follow-up were 29.7 in the virtual care group and 29.5 in the standard care group: relative risk 1.01 (95% confidence interval 0.99 to 1.02); absolute difference 0.2% (95% confidence interval -0.5% to 0.9%). 99 participants (22.0%) in the virtual care group and 124 (27.3%) in the standard care group required acute hospital care: relative risk 0.80 (0.64 to 1.01); absolute difference 5.3% (-0.3% to 10.9%). More participants in the virtual care group than standard care group had a drug error detected (134 (29.7%) v 25 (5.5%); absolute difference 24.2%, 19.5% to 28.9%) and a drug error corrected (absolute difference 24.4%, 19.9% to 28.9%). Fewer participants in the virtual care group than standard care group reported pain at 7, 15, and 30 days after randomisation: absolute differences 13.9% (7.4% to 20.4%), 11.9% (5.1% to 18.7%), and 9.6% (2.9% to 16.3%), respectively. Beneficial effects proved substantially larger in centres with a higher rate of care escalation. CONCLUSION: Virtual care with RAM shows promise in improving outcomes important to patients and to optimal health system function. TRIAL REGISTRATION: ClinicalTrials.gov NCT04344665.


Assuntos
Assistência ao Convalescente/métodos , Monitorização Ambulatorial/métodos , Procedimentos Cirúrgicos Operatórios/enfermagem , Telemedicina/métodos , Idoso , COVID-19/epidemiologia , Canadá/epidemiologia , Feminino , Humanos , Masculino , Erros de Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Pandemias , Alta do Paciente , Período Pós-Operatório , Procedimentos Cirúrgicos Operatórios/mortalidade
14.
Lancet ; 398(10306): 1133-1146, 2021 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-34469765

RESUMO

BACKGROUND: In randomised controlled trials, fixed-dose combination treatments (or polypills) have been shown to reduce a composite of cardiovascular disease outcomes in primary prevention. However, whether or not aspirin should be included, effects on specific outcomes, and effects in key subgroups are unknown. METHODS: We did an individual participant data meta-analysis of large randomised controlled trials (each with ≥1000 participants and ≥2 years of follow-up) of a fixed-dose combination treatment strategy versus control in a primary cardiovascular disease prevention population. We included trials that evaluated a fixed-dose combination strategy of at least two blood pressure lowering agents plus a statin (with or without aspirin), compared with a control strategy (either placebo or usual care). The primary outcome was time to first occurrence of a composite of cardiovascular death, myocardial infarction, stroke, or arterial revascularisation. Additional outcomes included individual cardiovascular outcomes and death from any cause. Outcomes were also evaluated in groups stratified by the inclusion of aspirin in the fixed-dose treatment strategy, and effect sizes were estimated in prespecified subgroups based on risk factors. Kaplan-Meier survival curves and Cox proportional hazard regression models were used to compare strategies. FINDINGS: Three large randomised trials were included in the analysis (TIPS-3, HOPE-3, and PolyIran), with a total of 18 162 participants. Mean age was 63·0 years (SD 7·1), and 9038 (49·8%) participants were female. Estimated 10-year cardiovascular disease risk for the population was 17·7% (8·7). During a median follow-up of 5 years, the primary outcome occurred in 276 (3·0%) participants in the fixed-dose combination strategy group compared with 445 (4·9%) in the control group (hazard ratio 0·62, 95% CI 0·53-0·73, p<0·0001). Reductions were also observed for the separate components of the primary outcome: myocardial infarction (0·52, 0·38-0·70), revascularisation (0·54, 0·36-0·80), stroke (0·59, 0·45-0·78), and cardiovascular death (0·65, 0·52-0·81). Significant reductions in the primary outcome and its components were observed in the analyses of fixed-dose combination strategies with and without aspirin, with greater reductions for strategies including aspirin. Treatment effects were similar at different lipid and blood pressure levels, and in the presence or absence of diabetes, smoking, or obesity. Gastrointestinal bleeding was uncommon but slightly more frequent in the fixed-dose combination strategy with aspirin group versus control (19 [0·4%] vs 11 [0·2%], p=0·15). The frequencies of haemorrhagic stroke (10 [0·2%] vs 15 [0·3%]), fatal bleeding (two [<0·1%] vs four [0·1%]), and peptic ulcer disease (32 [0·7%] vs 34 [0·8%]) were low and did not differ significantly between groups. Dizziness was more common with fixed-dose combination treatment (1060 [11·7%] vs 834 [9·2%], p<0·0001). INTERPRETATION: Fixed-dose combination treatment strategies substantially reduce cardiovascular disease, myocardial infarction, stroke, revascularisation, and cardiovascular death in primary cardiovascular disease prevention. These benefits are consistent irrespective of cardiometabolic risk factors. FUNDING: Population Health Research Institute.


Assuntos
Aspirina/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Quimioterapia Combinada , Metanálise como Assunto , Inibidores da Agregação Plaquetária/uso terapêutico , Prevenção Primária , Pressão Sanguínea/efeitos dos fármacos , Feminino , Hemorragia Gastrointestinal/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/epidemiologia
15.
Rev Panam Salud Publica ; 45: e108, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34484314

RESUMO

OBJECTIVE: To describe the role of statistical literacy and proper risk communication in communication strategies related to COVID-19 vaccination. METHODS: A scoping review was carried out in January 2021, with the keywords "statistical literacy," "risk communication," "health communication," and "pandemic," in the Pan American Health Organization Virtual Health Library, PubMed, Web of Science, EBSCO, and Google Scholar databases. No filters were applied for dates, language, or publication type. RESULTS: Of the 87 articles identified, four met the inclusion criteria. Four main messages were recognized that relate statistical literacy and risk communication: 1) risk communication and statistical literacy level affect individual and collective decision-making; 2) communication of uncertainty should include what is known and not known with regard to statistics and risks; 3) the use of graphics and visuals is key to appropriately informing the population; and 4) different formats should be used to improve communication, always adjusted to the population's statistical literacy level. CONCLUSIONS: Statistical literacy plays a key role in communicating risks related to health in general and COVID-19 vaccination in particular. In health emergencies, proper communication of risk and associated uncertainty should be clear, transparent, and timely.


OBJETIVO: Descrever o papel da literacia estatística e da comunicação correta de riscos nas estratégias de comunicação relacionadas à vacinação contra a COVID-19. MÉTODOS: Em janeiro de 2021, foi realizada uma revisão de escopo com as palavras-chave "statistical literacy", "risk communication", "health communication" e "pandemic" nos bancos de dados da Biblioteca Virtual em Saúde da Organização Pan-Americana da Saúde, PubMed, Web of Science, EBSCO e Google Scholar. Não foi aplicado filtro de data, idioma ou tipo de publicação. RESULTADOS: Dos 87 artigos identificados, quatro atenderam aos critérios de inclusão. Foram reconhecidas quatro mensagens principais relacionadas à literacia estatística e à comunicação de risco: 1) a comunicação de risco e o nível de literacia estatística afetam a tomada de decisão individual e coletiva; 2) a comunicação da incerteza deve incluir o que é conhecido e desconhecido sobre estatísticas e riscos; 3) o uso de gráficos e visualizações é fundamental para informar adequadamente a população; e 4) devem ser usados diferentes formatos para melhorar a comunicação, sempre ajustados ao nível de literacia estatística da população. CONCLUSÕES: A literacia estatística desempenha um papel fundamental na comunicação dos riscos relacionados à saúde em geral e à vacinação contra a COVID-19 em particular. Em situações de emergência de saúde, a comunicação correta do risco e da incerteza a ele associada deve ser clara, transparente e oportuna.

16.
J Am Heart Assoc ; 10(18): e017735, 2021 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-34514842

RESUMO

Background Heart failure (HF) is a common complication to atrial fibrillation (AF), leading to rehospitalization and death. Early identification of patients with AF at risk for HF might improve outcomes. We aimed to derive a score to predict 1-year risk of new-onset HF after an emergency department (ED) visit with AF. Methods and Results The RE-LY AF (Randomized Evaluation of Long-Term Anticoagulant Therapy) registry enrolled patients with AF presenting to an ED in 47 countries, and followed them for a year. The end point was HF hospitalization and/or HF death. Among 15 400 ED patients, 9765 had no prior HF (mean age, 64.9±14.9 years). Within 1 year, new-onset HF developed in 6.8% of patients, of whom 21% died of HF. Independent predictors of HF included left ventricular hypertrophy (odds ratio [OR], 1.47; 95% CI, 1.19-1.82), valvular heart disease (OR, 1.55; 95% CI, 1.18-2.04), smoking (OR, 1.42; 95% CI, 1.12-1.78), height (OR, 0.93; 95% CI, 0.90-0.95 per 3 cm), age (OR, 1.11; 95% CI, 1.07-1.15 per 5 years), rheumatic heart disease (OR, 1.77, 95% CI, 1.24-2.51), prior myocardial infarction (OR, 1.85; 95% CI, 1.45-2.36), remaining in AF at ED discharge (OR, 1.86; 95% CI, 1.46-2.36), and diabetes (OR, 1.33; 95% CI, 1.09-1.64). A continuous risk prediction score (LVS-HARMED [left ventricular, valvular heart disease, smoking or other tobacco use, height, age, rheumatic heart disease, myocardial infarction, emergency department discharge rhythm, and diabetes]) had good discrimination (C statistic, 0.735; 95% CI, 0.716-0.755). Validation was conducted internally using bootstrapping (optimism-corrected C statistic, 0.705) and externally (C statistic, 0.699). The 1-year incidence of HF hospitalization and/or HF death across quartile groups of the score was 1.1%, 4.5%, 6.9%, and 14.4%, respectively. LVS-HARMED also predicted incident stroke (C statistic, 0.753; 95% CI, 0.728-0.778). Conclusions The LVS-HARMED score predicts new-onset HF after an ED visit for AF. Preventative strategies should be considered in patients with high LVS-HARMED HF risk.


Assuntos
Fibrilação Atrial , Diabetes Mellitus , Insuficiência Cardíaca , Doenças das Valvas Cardíacas , Infarto do Miocárdio , Cardiopatia Reumática , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Pré-Escolar , Serviço Hospitalar de Emergência , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Humanos , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco
18.
Int J Inj Contr Saf Promot ; 28(3): 290-300, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34346284
19.
Artigo em Espanhol | PAHO-IRIS | ID: phr-54651

RESUMO

[RESUMEN]. Objetivo. Describir el papel que desempeñan la alfabetización estadística y la correcta comunicación de riesgo en las estrategias de comunicación relacionadas con la vacunación contra la COVID-19. Métodos. Se realizó una revisión de alcance en enero del 2021, con las palabras clave “ statistical literacy ”, “ risk communication”, “health communication ” y “ pandemic ” en las bases de datos de la Biblioteca Virtual en Salud de la Organización Panamericana de la Salud, PubMed, Web of Science, EBSCO y Google Académico. No se aplicaron filtros para fechas, idioma o tipos de publicación. Resultados. De los 87 artículos identificados, cuatro cumplieron con los criterios de inclusión. Se recono-cieron cuatro mensajes principales que relacionan la alfabetización estadística y la comunicación de riesgo: 1) la comunicación de riesgo y el nivel de alfabetización estadística afectan a la toma de decisión individual y colectiva, 2) la comunicación de la incertidumbre debe incluir lo que se sabe y no se sabe respecto a las estadísticas y los riesgos, 3) el uso de gráficos y visualizaciones es clave para informar apropiadamente a la población y 4) deben utilizarse diferentes formatos para mejorar la comunicación, siempre ajustados al nivel de alfabetización estadística de la población. Conclusiones. La alfabetización estadística desempeña un papel clave en la comunicación de los riesgos relacionados con la salud en general y la vacunación contra la COVID-19 en particular. En situaciones de emergencia sanitaria, la correcta comunicación de riesgo y de la incertidumbre asociada debe ser clara, transparente y oportuna.


[ABSTRACT]. Objective. To describe the role of statistical literacy and proper risk communication in communication strate-gies related to COVID-19 vaccination.Methods. A scoping review was carried out in January 2021, with the keywords “statistical literacy,” “risk com-munication,” “health communication,” and “pandemic,” in the Pan American Health Organization Virtual Health Library, PubMed, Web of Science, EBSCO, and Google Scholar databases. No filters were applied for dates, language, or publication type.Results. Of the 87 articles identified, four met the inclusion criteria. Four main messages were recognized that relate statistical literacy and risk communication: 1) risk communication and statistical literacy level affect indi-vidual and collective decision-making; 2) communication of uncertainty should include what is known and not known with regard to statistics and risks; 3) the use of graphics and visuals is key to appropriately informing the population; and 4) different formats should be used to improve communication, always adjusted to the population’s statistical literacy level.Conclusions. Statistical literacy plays a key role in communicating risks related to health in general and COVID-19 vaccination in particular. In health emergencies, proper communication of risk and associated uncertainty should be clear, transparent, and timely.


[RESUMO]. Objetivo. Descrever o papel da literacia estatística e da comunicação correta de riscos nas estratégias de comunicação relacionadas à vacinação contra a COVID-19.Métodos. Em janeiro de 2021, foi realizada uma revisão de escopo com as palavras-chave “statistical lite-racy”, “risk communication”, “health communication” e “pandemic” nos bancos de dados da Biblioteca Virtual em Saúde da Organização Pan-Americana da Saúde, PubMed, Web of Science, EBSCO e Google Scholar. Não foi aplicado filtro de data, idioma ou tipo de publicação.Resultados. Dos 87 artigos identificados, quatro atenderam aos critérios de inclusão. Foram reconhecidas quatro mensagens principais relacionadas à literacia estatística e à comunicação de risco: 1) a comunicação de risco e o nível de literacia estatística afetam a tomada de decisão individual e coletiva; 2) a comunicação da incerteza deve incluir o que é conhecido e desconhecido sobre estatísticas e riscos; 3) o uso de gráficos e visualizações é fundamental para informar adequadamente a população; e 4) devem ser usados diferentes formatos para melhorar a comunicação, sempre ajustados ao nível de literacia estatística da população.Conclusões. A literacia estatística desempenha um papel fundamental na comunicação dos riscos relaciona-dos à saúde em geral e à vacinação contra a COVID-19 em particular. Em situações de emergência de saúde, a comunicação correta do risco e da incerteza a ele associada deve ser clara, transparente e oportuna.


Assuntos
Comunicação em Saúde , Risco , Infecções por Coronavirus , Vacinas , Letramento em Saúde , Estatística , Comunicação em Saúde , Risco , Infecções por Coronavirus , Vacinas , Letramento em Saúde , Estatística , Comunicação em Saúde , Risco , Infecções por Coronavirus , Vacinas , Letramento em Saúde , Estatística
20.
Cochrane Database Syst Rev ; 7: CD013433, 2021 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-34286511

RESUMO

BACKGROUND: Stem cell therapy (SCT) has been proposed as an alternative treatment for dilated cardiomyopathy (DCM), nonetheless its effectiveness remains debatable. OBJECTIVES: To assess the effectiveness and safety of SCT in adults with non-ischaemic DCM. SEARCH METHODS: We searched CENTRAL in the Cochrane Library, MEDLINE, and Embase for relevant trials in November 2020. We also searched two clinical trials registers in May 2020. SELECTION CRITERIA: Eligible studies were randomized controlled trials (RCT) comparing stem/progenitor cells with no cells in adults with non-ischaemic DCM. We included co-interventions such as the administration of stem cell mobilizing agents. Studies were classified and analysed into three categories according to the comparison intervention, which consisted of no intervention/placebo, cell mobilization with cytokines, or a different mode of SCT. The first two comparisons (no cells in the control group) served to assess the efficacy of SCT while the third (different mode of SCT) served to complement the review with information about safety and other information of potential utility for a better understanding of the effects of SCT. DATA COLLECTION AND ANALYSIS: Two review authors independently screened all references for eligibility, assessed trial quality, and extracted data. We undertook a quantitative evaluation of data using random-effects meta-analyses. We evaluated heterogeneity using the I² statistic. We could not explore potential effect modifiers through subgroup analyses as they were deemed uninformative due to the scarce number of trials available. We assessed the certainty of the evidence using the GRADE approach. We created summary of findings tables using GRADEpro GDT. We focused our summary of findings on all-cause mortality, safety, health-related quality of life (HRQoL), performance status, and major adverse cardiovascular events. MAIN RESULTS: We included 13 RCTs involving 762 participants (452 cell therapy and 310 controls). Only one study was at low risk of bias in all domains. There were many shortcomings in the publications that did not allow a precise assessment of the risk of bias in many domains. Due to the nature of the intervention, the main source of potential bias was lack of blinding of participants (performance bias). Frequently, the format of the continuous data available was not ideal for use in the meta-analysis and forced us to seek strategies for transforming data in a usable format. We are uncertain whether SCT reduces all-cause mortality in people with DCM compared to no intervention/placebo (mean follow-up 12 months) (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.54 to 1.31; I² = 0%; studies = 7, participants = 361; very low-certainty evidence). We are uncertain whether SCT increases the risk of procedural complications associated with cells injection in people with DCM (data could not be pooled; studies = 7; participants = 361; very low-certainty evidence). We are uncertain whether SCT improves HRQoL (standardized mean difference (SMD) 0.62, 95% CI 0.01 to 1.23; I² = 72%; studies = 5, participants = 272; very low-certainty evidence) and functional capacity (6-minute walk test) (mean difference (MD) 70.12 m, 95% CI -5.28 to 145.51; I² = 87%; studies = 5, participants = 230; very low-certainty evidence). SCT may result in a slight functional class (New York Heart Association) improvement (data could not be pooled; studies = 6, participants = 398; low-certainty evidence). None of the included studies reported major adverse cardiovascular events as defined in our protocol. SCT may not increase the risk of ventricular arrhythmia (data could not be pooled; studies = 8, participants = 504; low-certainty evidence). When comparing SCT to cell mobilization with granulocyte-colony stimulating factor (G-CSF), we are uncertain whether SCT reduces all-cause mortality (RR 0.46, 95% CI 0.16 to 1.31; I² = 39%; studies = 3, participants = 195; very low-certainty evidence). We are uncertain whether SCT increases the risk of procedural complications associated with cells injection (studies = 1, participants = 60; very low-certainty evidence). SCT may not improve HRQoL (MD 4.61 points, 95% CI -5.62 to 14.83; studies = 1, participants = 22; low-certainty evidence). SCT may improve functional capacity (6-minute walk test) (MD 140.14 m, 95% CI 119.51 to 160.77; I² = 0%; studies = 2, participants = 155; low-certainty evidence). None of the included studies reported MACE as defined in our protocol or ventricular arrhythmia. The most commonly reported outcomes across studies were based on physiological measures of cardiac function where there were some beneficial effects suggesting potential benefits of SCT in people with non-ischaemic DCM. However, it is unclear if this intermediate effects translates into clinical benefits for these patients. With regard to specific aspects related to the modality of cell therapy and its delivery, uncertainties remain as subgroup analyses could not be performed as planned, making it necessary to wait for the publication of several studies that are currently in progress before any firm conclusion can be reached. AUTHORS' CONCLUSIONS: We are uncertain whether SCT in people with DCM reduces the risk of all-cause mortality and procedural complications, improves HRQoL, and performance status (exercise capacity). SCT may improve functional class (NYHA), compared to usual care (no cells). Similarly, when compared to G-CSF, we are also uncertain whether SCT in people with DCM reduces the risk of all-cause mortality although some studies within this comparison observed a favourable effect that should be interpreted with caution. SCT may not improve HRQoL but may improve to some extent performance status (exercise capacity). Very low-quality evidence reflects uncertainty regarding procedural complications. These suggested beneficial effects of SCT, although uncertain due to the very low certainty of the evidence, are accompanied by favourable effects on some physiological measures of cardiac function. Presently, the most effective mode of administration of SCT and the population that could benefit the most is unclear. Therefore, it seems reasonable that use of SCT in people with DCM is limited to clinical research settings. Results of ongoing studies are likely to modify these conclusions.


Assuntos
Cardiomiopatia Dilatada/terapia , Transplante de Células-Tronco , Arritmias Cardíacas/epidemiologia , Viés , Cardiomiopatia Dilatada/mortalidade , Causas de Morte , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Humanos , Placebos/uso terapêutico , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Transplante de Células-Tronco/efeitos adversos , Transplante de Células-Tronco/mortalidade , Teste de Caminhada , Conduta Expectante
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