Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 86
Filtrar
1.
BMJ Open ; 12(2): e060387, 2022 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-35140165

RESUMO

OBJECTIVE: To synthesise evidence on the primary healthcare system's readiness for preventing and managing non-communicable diseases (NCDs). DESIGN: Systematic review. DATA SOURCES: Ovid MEDLINE, EMBASE, CINAHL, PsycINFO and Scopus were searched from 1 January 1984 to 30 July 2021, with hand-searching references and expert advice. ELIGIBILITY CRITERIA: Any English-language health research with evidence of readiness/preparedness of the health system at the primary healthcare level in the context of four major NCDs: diabetes mellitus, cancer, chronic respiratory diseases (CRDs) and cardiovascular diseases (CVDs). DATA EXTRACTION AND SYNTHESIS: Two authors independently extracted data and assessed the bias. The full-text selected articles were then assessed using the Mixed Methods Appraisal Tool. Health system readiness was descriptively and thematically synthesised in line with the health system dynamics framework. RESULTS: Out of 7843 records, 23 papers were included in this review (15 quantitative, 3 qualitative and 5 mixed-method studies). The findings showed that existing literature predominantly examined health system readiness from the supply-side perspective as embedded in the WHO's health system framework. However, at the primary healthcare level, these components are insufficiently prepared for NCDs. Among NCDs, higher levels of readiness were reported for diabetes mellitus and hypertension in comparison to CRDs (asthma, chronic obstructive pulmonary disease), CVDs and cancer. There has been a dearth of research on the demand-side perspective, which is an essential component of a health system and must be addressed in the future research. CONCLUSION: The supply-side components at the primary healthcare level are inadequately ready to address the growing NCD burden. Improving supply-side factors, with a particular focus on CRDs, CVDs and cancer, and improving understanding of the demand-side components of the health system's readiness, may help to prevent and manage NCDs at the primary healthcare level.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus , Doenças não Transmissíveis , Transtornos Respiratórios , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/prevenção & controle , Programas Governamentais , Humanos , Doenças não Transmissíveis/prevenção & controle , Atenção Primária à Saúde
2.
J Public Health Policy ; 43(1): 89-108, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35042964

RESUMO

The diabetes burden is rapidly accelerating in India, particularly since the 2000s. We explore the burden and contribution of modifiable risk factors in diabetes among reproductive women across geographic regions of India. The study uses data from the National Family Health Survey in India 2015-2016, Census of India 2011, and World Population Prospects 2015. We computed Population Attributable Fractions and the number of total and estimated avoidable diabetic cases across regions. The prevalence of diabetic cases in India were 24.4 per 1000 women, varying across geographic regions. Diabetes affected around 8.2 million women (15-49 years) in India. Overweight (PAF = 19.5%) and obesity (PAF = 18.3%) contributed to the diabetes burden; if mitigated optimally, these can reduce diabetic cases by 2.8 million in India. Controlling diabetes should be region specific for maximum impact. Extending chronic disease screening during maternal and child health consultations might help decelerate the growing menace of diabetes in the country.


Assuntos
Diabetes Mellitus , Criança , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Sobrepeso/epidemiologia , Prevalência , Fatores de Risco
3.
BMC Public Health ; 22(1): 198, 2022 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-35093064

RESUMO

BACKGROUND: Hypertension and type 2 diabetes are associated with each other, and their coexistence is linked to diabetes-related complications such as stroke, coronary artery disease, kidney disease, retinopathy and diabetic foot. This study aimed to determine the prevalence, awareness and control of hypertension and factors associated with hypertension among people with type 2 diabetes mellitus (T2DM) in Bangladesh. METHODS: A cross-sectional and retrospective study was conducted in 2017, and data from 1252 adults with T2DM were collected from six hospitals that specialise in diabetes care. These hospitals provide primary, secondary and tertiary healthcare and cover the rural and urban populations of Bangladesh. Cross-sectional data were collected from patients via face-to-face interviews, and retrospective data were collected from patients' past medical records (medical passport), locally known as the patients' guidebook or record book. The associations between hypertension and its related factors were examined using the bootstrapping method with multiple logistic regression to adjust for potential confounders. RESULTS: The mean age of participants was 55.14 (± 12.51) years. Hypertension was found to be present among 67.2% of participants, and 95.8% were aware that they had it. Of these, 79.5% attained the blood pressure control. The mean duration of diabetes was 10.86 (± 7.73) years. The variables that were found to be related to hypertension include an age of above 60 years, physical inactivity, being overweight or obese, a longer duration of diabetes and chronic kidney disease. CONCLUSION: The prevalence of hypertension as well as its awareness and control were very high among people with known type 2 diabetes. As there is a strong relationship between hypertension and diabetes, patients with diabetes should have their blood pressure regularly monitored to prevent major diabetes-related complications.


Assuntos
Complicações do Diabetes , Diabetes Mellitus Tipo 2 , Hipertensão , Adulto , Idoso , Bangladesh/epidemiologia , Estudos Transversais , Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Hospitais , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco
4.
Intern Med J ; 52(5): 724-739, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35066970

RESUMO

BACKGROUND: Observational data during the pandemic have demonstrated mixed associations between frailty and mortality. AIM: To examine associations between frailty and short-term mortality in patients hospitalised with coronavirus disease 2019 (COVID-19). METHODS: In this systematic review and meta-analysis, we searched PubMed, Embase and the COVID-19 living systematic review from 1 December 2019 to 15 July 2021. Studies reporting mortality and frailty scores in hospitalised patients with COVID-19 (age ≥18 years) were included. Data on patient demographics, short-term mortality (in hospital or within 30 days), intensive care unit (ICU) admission and need for invasive mechanical ventilation (IMV) were extracted. The quality of studies was assessed using the Newcastle-Ottawa Scale. RESULTS: Twenty-five studies reporting 34 628 patients were included. Overall, 26.2% (n = 9061) died. Patients who died were older (76.7 ± 9.6 vs 69.2 ± 13.4), more likely male (risk ratio (RR) = 1.08; 95% confidence interval (CI): 1.06-1.11) and had more comorbidities. Fifty-eight percent of patients were frail. Adjusting for age, there was no difference in short-term mortality between frail and non-frail patients (RR = 1.04; 95% CI: 0.84-1.28). The non-frail patients were commonly admitted to ICU (27.2% (4256/15639) vs 29.1% (3567/12274); P = 0.011) and had a higher mortality risk (RR = 1.63; 95% CI: 1.30-2.03) than frail patients. Among patients receiving IMV, there was no difference in mortality between frail and non-frail (RR = 1.62; 95% CI 0.93-2.77). CONCLUSION: This systematic review did not demonstrate an independent association between frailty status and short-term mortality in patients with COVID-19. Patients with frailty were less commonly admitted to ICU and non-frail patients were more likely to receive IMV and had higher mortality risk. This finding may be related to allocation decisions for patients with frailty amidst the pandemic.


Assuntos
COVID-19 , Fragilidade , Adolescente , Idoso , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pandemias
5.
Br J Anaesth ; 128(2): 258-271, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34924178

RESUMO

BACKGROUND: Preoperative frailty may be a strong predictor of adverse postoperative outcomes. We investigated the association between frailty and clinical outcomes in surgical patients admitted to the ICU. METHODS: PubMed, Embase, and Ovid MEDLINE were searched for relevant articles. We included full-text original English articles that used any frailty measure, reporting results of surgical adult patients (≥18 yr old) admitted to ICUs with mortality as the main outcome. Data on mortality, duration of mechanical ventilation, ICU and hospital length of stay, and discharge destination were extracted. The quality of included studies and risk of bias were assessed using the Newcastle Ottawa Scale. Data were synthesised according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. RESULTS: Thirteen observational studies met inclusion criteria. In total, 58 757 patients were included; 22 793 (39.4%) were frail. Frailty was associated with an increased risk of short-term (risk ratio [RR]=2.66; 95% confidence interval [CI]: 1.99-3.56) and long-term mortality (RR=2.66; 95% CI: 1.32-5.37). Frail patients had longer ICU length of stay (mean difference [MD]=1.5 days; 95% CI: 0.8-2.2) and hospital length of stay (MD=3.9 days; 95% CI: 1.4-6.5). Duration of mechanical ventilation was longer in frail patients (MD=22 h; 95% CI: 1.7-42.3) and they were more likely to be discharged to a healthcare facility (RR=2.34; 95% CI: 1.36-4.01). CONCLUSION: Patients with frailty requiring postoperative ICU admission for elective and non-elective surgeries had increased risk of mortality, lengthier admissions, and increased likelihood of non-home discharge. Preoperative frailty assessments and risk stratification are essential in patient and clinician planning, and critical care resource utilisation. CLINICAL TRIAL REGISTRATION: PROSPERO CRD42020210121.


Assuntos
Fragilidade/complicações , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Adulto , Cuidados Críticos , Fragilidade/epidemiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Período Pré-Operatório , Respiração Artificial/estatística & dados numéricos
6.
BMJ Open ; 11(9): e051961, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493524

RESUMO

INTRODUCTION: The burden of non-communicable diseases (NCDs) is rapidly increasing in Bangladesh. Currently, it contributes to 67% of annual deaths, and accounts for approximately 64% of the disease burden. Since 70% of the Bangladeshi population residing in the rural area rely on the primary healthcare system, assessment of its capacity is crucial for guiding public health decisions to prevent and manage NCDs. This protocol is designed to recognise and assess the Bangladeshi health system's readiness for NCDs at the primary level. METHODS AND ANALYSIS: The study will use a mixed-method design. Numerical data will be collected using households and health facilities surveys, while qualitative data will be collected by interviewing healthcare providers, policy planners, health administrators and community members. The WHO's Service Availability and Readiness Assessment (SARA) methodology and Package of Essential Non-communicable (PEN) Disease Interventions for Primary Healthcare reference manuals will be used to assess the readiness of the primary healthcare facilities for NCD services. Furthermore, Health System Dynamics Framework will be used to examine health system factors. Using the supportive items outlined in the WHO PEN package, and indicators proposed in WHO SARA methodology, a composite score will be created to analyse facility-level data. Two independent samples t-test, analysis of variance and χ2 test methods will be used for bivariate analysis, and multiple regression analysis will be used for multivariable analysis. Complementarily, the thematic analysis approach will be used to analyse qualitative data. ETHICS AND DISSEMINATION: The project has been approved by the Monash University Human Research Ethics Committee (Project ID: 27112), and Bangladesh Medical Research Council (Ref: BMRC/NREC/2019-2022/270). The research findings will be shared through research articles, conference proceedings or in other scientific media. The reports or publications will not have any information that can be used to identify any of the study participants.


Assuntos
Doenças não Transmissíveis , Bangladesh , Atenção à Saúde , Instalações de Saúde , Humanos , Doenças não Transmissíveis/prevenção & controle , Atenção Primária à Saúde
7.
Diabetes Metab Syndr ; 15(5): 102255, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34479101

RESUMO

AIMS: This study aimed to explore the health-related quality of life and the various demographics and clinical characteristics associated with it among people with type 2 diabetes mellitus in Bangladesh. METHODS: A total of 1253 participants with type 2 diabetes were recruited from a cross-sectional and retrospective study conducted in Bangladesh in 2017. Participants were recruited from six rural and urban diabetes hospitals. The health-related quality of life of the participants was assessed using the validated EuroQol-5D-5L scale and EuroQol-VAS score. Information was collected via face-to-face interviews and existing medical records. Data was analysed using univariate and multivariable regression analyses with bootstrap resampling. RESULTS: The average health-related quality of life was 0.64 (±0.20) for EQ-5D-5L score and 61.69 (±34.98) for EQ-VAS score. Old age, low income, low education level, residing in an urban area, longer duration of diabetes, being physically inactive, the presence of macro- and/or micro-vascular complications, impaired cognitive function, being depressed and having anxiety were related to poor health-related quality of life. CONCLUSION: The health-related quality of life among people with type 2 diabetes in Bangladesh is low, and various socio-demographic and psychological factors and diabetes-related complications are associated with it. This finding will help reform treatments and enforce lifestyle modifications to ensure that the burden of diabetes on people's quality of life is minimal.


Assuntos
Ansiedade/epidemiologia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Nível de Saúde , Qualidade de Vida , Adulto , Ansiedade/psicologia , Bangladesh/epidemiologia , Glicemia/análise , Estudos Transversais , Complicações do Diabetes/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores Socioeconômicos , Inquéritos e Questionários
8.
BMJ Open ; 11(9): e051447, 2021 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521674

RESUMO

OBJECTIVE: To assess the knowledge, attitude and practice (KAP) of the global general population regarding COVID-19. DESIGN: Systematic review and meta-analysis. METHODS: MEDLINE, Embase, CINAHL and PsycINFO were used to identify articles published between 1 January and 30 June 2021 assessing KAP regarding COVID-19 in the global general population. The quality of eligible studies was assessed. Random effects model was used to obtain the pooled proportion of each component of KAP of COVID-19. Heterogeneity (I2) was tested, and subgroup and correlation analyses were performed. RESULTS: Out of 3099 records, 84 studies from 45 countries across all continents assessing 215 731 participants' COVID-19 KAP were included in this study. The estimated overall correct answers for knowledge, good attitude and good practice in this review were 75% (95% CI 72% to 77%), 74% (95% CI 71% to 77%) and 70% (95% CI 66% to 74%), respectively. Low-income countries, men, people aged below 30 years and people with 12 years of education or less had the lowest practice scores. Practice scores were below 60% in Africa and Europe/Oceania. Overall heterogeneity was high (I2 ≥98%), and publication bias was present (Egger's regression test, p<0.01). A positive significant correlation between knowledge and practice (r=0.314, p=0.006), and attitude and practice (r=0.348, p=0.004) was observed. CONCLUSIONS: This study's findings call for community-based awareness programmes to provide a simple, clear and understandable message to reinforce knowledge especially regarding efficacy of the preventive measures in low and lower middle-income countries, and in Africa and Europe/Oceania, which will translate into good practice. Targeted intervention for men, people with low education, unemployed people and people aged below 30 years should be recommended. As most of the included studies were online surveys, underprivileged and remote rural people may have been missed out. Additional studies are needed to cover heterogeneous populations. PROSPERO REGISTRATION NUMBER: CRD42020203476.


Assuntos
COVID-19 , Idoso , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Conhecimento , Masculino , SARS-CoV-2 , Inquéritos e Questionários
9.
Crit Care Med ; 49(10): e1001-e1014, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33927120

RESUMO

OBJECTIVES: Several studies have reported prone positioning of nonintubated patients with coronavirus diseases 2019-related hypoxemic respiratory failure. This systematic review and meta-analysis evaluated the impact of prone positioning on oxygenation and clinical outcomes. DESIGN AND SETTING: We searched PubMed, Embase, and the coronavirus diseases 2019 living systematic review from December 1, 2019, to November 9, 2020. SUBJECTS AND INTERVENTION: Studies reporting prone positioning in hypoxemic, nonintubated adult patients with coronavirus diseases 2019 were included. MEASUREMENTS AND MAIN RESULTS: Data on prone positioning location (ICU vs non-ICU), prone positioning dose (total minutes/d), frequency (sessions/d), respiratory supports during prone positioning, relative changes in oxygenation variables (peripheral oxygen saturation, Pao2, and ratio of Pao2 to the Fio2), respiratory rate pre and post prone positioning, intubation rate, and mortality were extracted. Twenty-five observational studies reporting prone positioning in 758 patients were included. There was substantial heterogeneity in prone positioning location, dose and frequency, and respiratory supports provided. Significant improvements were seen in ratio of Pao2 to the Fio2 (mean difference, 39; 95% CI, 25-54), Pao2 (mean difference, 20 mm Hg; 95% CI, 14-25), and peripheral oxygen saturation (mean difference, 4.74%; 95% CI, 3-6%). Respiratory rate decreased post prone positioning (mean difference, -3.2 breaths/min; 95% CI, -4.6 to -1.9). Intubation and mortality rates were 24% (95% CI, 17-32%) and 13% (95% CI, 6-19%), respectively. There was no difference in intubation rate in those receiving prone positioning within and outside ICU (32% [69/214] vs 33% [107/320]; p = 0.84). No major adverse events were recorded in small subset of studies that reported them. CONCLUSIONS: Despite the significant variability in frequency and duration of prone positioning and respiratory supports applied, prone positioning was associated with improvement in oxygenation variables without any reported serious adverse events. The results are limited by a lack of controls and adjustments for confounders. Whether this improvement in oxygenation results in meaningful patient-centered outcomes such as reduced intubation or mortality rates requires testing in well-designed randomized clinical trials.


Assuntos
COVID-19/complicações , COVID-19/fisiopatologia , Decúbito Ventral/fisiologia , COVID-19/mortalidade , Humanos , Posicionamento do Paciente , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia
10.
Crit Care Med ; 49(6): 901-911, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33710030

RESUMO

OBJECTIVES: To investigate the incidence, characteristics, and outcomes of in-hospital cardiac arrest in patients with coronavirus disease 2019 and to describe the characteristics and outcomes for patients with in-hospital cardiac arrest within the ICU, compared with non-ICU patients with in-hospital cardiac arrest. Finally, we evaluated outcomes stratified by age. DATA SOURCES: A systematic review of PubMed, EMBASE, and preprint websites was conducted between January 1, 2020, and December 10, 2020. Prospective Register of Systematic Reviews identification: CRD42020203369. STUDY SELECTION: Studies reporting on consecutive in-hospital cardiac arrest with a resuscitation attempt among patients with coronavirus disease 2019. DATA EXTRACTION: Two authors independently performed study selection and data extraction. Study quality was assessed with the Newcastle-Ottawa Scale. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews guidelines. Discrepancies were resolved by consensus or through an independent third reviewer. DATA SYNTHESIS: Eight studies reporting on 847 in-hospital cardiac arrest were included. In-hospital cardiac arrest incidence varied between 1.5% and 5.8% among hospitalized patients and 8.0-11.4% among patients in ICU. In-hospital cardiac arrest occurred more commonly in older male patients. Most initial rhythms were nonshockable (83.9%, [asystole = 36.4% and pulseless electrical activity = 47.6%]). Return of spontaneous circulation occurred in 33.3%, with a 91.7% in-hospital mortality. In-hospital cardiac arrest events in ICU had higher incidence of return of spontaneous circulation (36.6% vs 18.7%; p < 0.001) and relatively lower mortality (88.7% vs 98.1%; p < 0.001) compared with in-hospital cardiac arrest in non-ICU locations. Patients greater than or equal to 60 years old had significantly higher in-hospital mortality than those less than 60 years (93.1% vs 87.9%; p = 0.019). CONCLUSIONS: Approximately, one in 20 patients hospitalized with coronavirus disease 2019 received resuscitation for an in-hospital cardiac arrest. Hospital survival after in-hospital cardiac arrest within the ICU was higher than non-ICU locations and seems comparable with prepandemic survival for nonshockable rhythms. Although the data provide guidance surrounding prognosis after in-hospital cardiac arrest, it should be interpreted cautiously given the paucity of information surrounding treatment limitations and resource constraints during the pandemic. Further research is into actual causative mechanisms is needed.


Assuntos
COVID-19/mortalidade , COVID-19/terapia , Parada Cardíaca/mortalidade , Parada Cardíaca/terapia , Mortalidade Hospitalar , Resultado do Tratamento , Causas de Morte , Humanos , Incidência
11.
J Med Virol ; 93(6): 3564-3571, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33386771

RESUMO

Acute gastroenteritis (AGE) is one of the most common diseases in children, and it continues to be a significant cause of morbidity and mortality worldwide. Norovirus is one of the major enteropathogens associated with both sporadic diarrhea and outbreaks of gastroenteritis. This study aims to investigate genotype diversity and molecular epidemiology of norovirus in Bangladesh. A total of 466 fecal specimens were collected from January 2014 to January 2019 from children below 5 years old with AGE in Bangladesh. All samples were analyzed by reverse transcriptase polymerase chain reaction to detect norovirus, and sequence analysis was conducted if found positive. Norovirus was detected in 5.1% (24 of 466) fecal specimens. Norovirus genotype GII.7 was predominant (62.5%, 15 of 24), followed by GII.3 (37.5%, 9 of 24). Coinfection between rotavirus and norovirus was found in 7 of 24 positive cases. Diarrhea (93.7%) and dehydration (89%) were the most common symptoms in children with AGE. About 80% of the positive cases were detected in children aged under 24 months. One seasonal peak (87.5% infection) was detected in the winter. This study suggests that norovirus continues to be one of the major etiologies of children AGE in Bangladesh. This study will provide a guideline to assess the burden of norovirus infection in Bangladesh, which will assist to combat against AGE.


Assuntos
Infecções por Caliciviridae/epidemiologia , Fezes/virologia , Gastroenterite/epidemiologia , Variação Genética , Genótipo , Norovirus/genética , Bangladesh/epidemiologia , Infecções por Caliciviridae/virologia , Pré-Escolar , Feminino , Gastroenterite/virologia , Humanos , Lactente , Masculino , Norovirus/classificação , Filogenia , Prevalência , RNA Viral/genética , Rotavirus/genética , Infecções por Rotavirus/epidemiologia , Estações do Ano , Análise de Sequência de DNA
12.
Workplace Health Saf ; 69(1): 22-31, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32689923

RESUMO

Background: Few studies have reported associations between occupational exposure to tannery chemicals with breathing difficulty and skin diseases and none have been conducted in Bangladesh. The aim of this study was to investigate the associations of health complaints with types of work and length of employment among tannery workers in Bangladesh, where occupational health and safety regulations are less restricted compared with the developed world. Methods: One hundred sixty-seven (n = 167) workers from 10 tanneries were interviewed using a questionnaire adapted from the European Community Respiratory Health Survey (ECRHS) and the Tasmanian Longitudinal Health Study (TAHS) to collect information on occupational exposures and health outcomes. Workers' length of employment was examined, as well as their areas of work including beamhouse, wet finishing, dry finishing, and miscellaneous. Univariate and multivariate logistic regressions were performed to investigate potential associations while controlling for confounders. Results: Length of employment was positively associated with breathing difficulty (odds ratio [OR]: 1.32, 95% confidence interval [CI]:1.07-1.64). Workers involved in the wet finishing (OR: 11.75, 95% CI: 2.12-65.10) and dry finishing (OR: 13.38, 95% CI: 1.00-181.70) had higher odds of breathing difficulty; while, working in the beamhouse was associated with an increased risk of developing skin diseases (OR: 4.36, 95% CI: 1.10-17.32). Conclusion/Application to Practice: Length of employment and types of work were associated with increased risk of health complaints, including breathing difficulty and skin disease among tannery workers. Stronger regulations with regular enforcement, regular health surveillance, and worker and employer education are necessary for reducing these exposures and improving the health outcomes of the tannery workers.


Assuntos
Exposição Ocupacional/efeitos adversos , Doenças Respiratórias/epidemiologia , Dermatopatias/epidemiologia , Curtume , Adulto , Bangladesh/epidemiologia , Feminino , Humanos , Icterícia/epidemiologia , Masculino , Doenças Profissionais/epidemiologia , Traumatismos Ocupacionais/epidemiologia , Inquéritos e Questionários
13.
Am J Respir Crit Care Med ; 203(1): 54-66, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33119402

RESUMO

Rationale: Initial reports of case fatality rates (CFRs) among adults with coronavirus disease (COVID-19) receiving invasive mechanical ventilation (IMV) are highly variable.Objectives: To examine the CFR of patients with COVID-19 receiving IMV.Methods: Two authors independently searched PubMed, Embase, medRxiv, bioRxiv, the COVID-19 living systematic review, and national registry databases. The primary outcome was the "reported CFR" for patients with confirmed COVID-19 requiring IMV. "Definitive hospital CFR" for patients with outcomes at hospital discharge was also investigated. Finally, CFR was analyzed by patient age, geographic region, and study quality on the basis of the Newcastle-Ottawa Scale.Measurements and Results: Sixty-nine studies were included, describing 57,420 adult patients with COVID-19 who received IMV. Overall reported CFR was estimated as 45% (95% confidence interval [CI], 39-52%). Fifty-four of 69 studies stated whether hospital outcomes were available but provided a definitive hospital outcome on only 13,120 (22.8%) of the total IMV patient population. Among studies in which age-stratified CFR was available, pooled CFR estimates ranged from 47.9% (95% CI, 46.4-49.4%) in younger patients (age ≤40 yr) to 84.4% (95% CI, 83.3-85.4%) in older patients (age >80 yr). CFR was also higher in early COVID-19 epicenters. Overall heterogeneity is high (I2 >90%), with nonsignificant Egger's regression test suggesting no publication bias.Conclusions: Almost half of patients with COVID-19 receiving IMV died based on the reported CFR, but variable CFR reporting methods resulted in a wide range of CFRs between studies. The reported CFR was higher in older patients and in early pandemic epicenters, which may be influenced by limited ICU resources. Reporting of definitive outcomes on all patients would facilitate comparisons between studies.Systematic review registered with PROSPERO (CRD42020186997).


Assuntos
Pandemias , Respiração Artificial/métodos , COVID-19/mortalidade , COVID-19/terapia , Saúde Global , Humanos , SARS-CoV-2 , Taxa de Sobrevida/tendências
14.
Resuscitation ; 157: 248-258, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33137418

RESUMO

BACKGROUND: The impact of COVID-19 on pre-hospital and hospital services and hence on the prevalence and outcomes of out-of-hospital cardiac arrests (OHCA) remain unclear. The review aimed to evaluate the influence of the COVID-19 pandemic on the incidence, process, and outcomes of OHCA. METHODS: A systematic review of PubMed, EMBASE, and pre-print websites was performed. Studies reporting comparative data on OHCA within the same jurisdiction, before and during the COVID-19 pandemic were included. Study quality was assessed based on the Newcastle-Ottawa Scale. RESULTS: Ten studies reporting data from 35,379 OHCA events were included. There was a 120% increase in OHCA events since the pandemic. Time from OHCA to ambulance arrival was longer during the pandemic (p = 0.036). While mortality (OR = 0.67, 95%-CI 0.49-0.91) and supraglottic airway use (OR = 0.36, 95%-CI 0.27-0.46) was higher during the pandemic, automated external defibrillator use (OR = 1.78 95%-CI 1.06-2.98), return of spontaneous circulation (OR = 1.63, 95%CI 1.18-2.26) and intubation (OR = 1.87, 95%-CI 1.12--3.13) was more common before the pandemic. More patients survived to hospital admission (OR = 1.75, 95%-CI 1.42-2.17) and discharge (OR = 1.65, 95%-CI 1.28-2.12) before the pandemic. Bystander CPR (OR = 1.18, 95%-CI 0.95-1.46), unwitnessed OHCA (OR = 0.84, 95%-CI 0.66-1.07), paramedic-resuscitation attempts (OR = 1.19 95%-CI 1.00-1.42) and mechanical CPR device use (OR = 1.57 95%-CI 0.55-4.55) did not defer significantly. CONCLUSIONS: The incidence and mortality following OHCA was higher during the COVID-19 pandemic. There were significant variations in resuscitation practices during the pandemic. Research to define optimal processes of pre-hospital care during a pandemic is urgently required. REVIEW REGISTRATION: PROSPERO (CRD42020203371).


Assuntos
COVID-19/epidemiologia , Reanimação Cardiopulmonar/métodos , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar/epidemiologia , Pandemias , Sistema de Registros , COVID-19/complicações , Saúde Global , Humanos , Incidência , Parada Cardíaca Extra-Hospitalar/etiologia , Parada Cardíaca Extra-Hospitalar/terapia , SARS-CoV-2
15.
PLoS One ; 15(10): e0239409, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33021981

RESUMO

INTRODUCTION: Anemia is a common problem in children particularly in developing countries and taking steps to tackle it is one of the major public health challenges for Nepal. The objective of this study is to investigate the prevalence of individual, household and community level determinants of childhood anemia in Nepal. METHODS: Data was taken from a nationally representative sample of 1,942 Nepalese children aged from 6-59 months. The Chi-square test was used to determine the bivariate relationship between the selected variables and childhood anemia and a multilevel logistic regression model with a random intercept at household and community level was used to identify important determinants of this kind of anemia. RESULTS: The results showed that 52.6% (95% CI: 49.8%-55.4%) of the children were anemic while 26.6% (95% CI: 24.0%-29.3%) of them were moderate to severe. The prevalence of overall anemia was higher among children aged less than 11 months as well as in underweight children, children of underweight, anemic and uneducated mothers and those in the terrain ecological regions. Multivariable analysis showed that children aged less than 11 months, who were underweight and had anemic mothers were more likely to have moderate or severe anemia. Children in the hilly ecological region were less likely to have it compared to mountain and terrain ecological regions. Children in middle-class families and children of mothers who completed secondary education were more likely to have anemia. CONCLUSION: Nepal is facing a serious public health problem due to the high prevalence of childhood anemia. This adverse situation occurs due to socio-demographic and geographical factors such as age, malnutrition status, mother's anemia status, socio-economic status and regional variations. Prevention of childhood anemia should be given top priority in Nepal and should be considered as a major public health intervention.


Assuntos
Anemia/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Prevalência , Fatores de Risco , Adulto Jovem
16.
BMJ Open ; 10(9): e036086, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907898

RESUMO

OBJECTIVE: The purpose of this paper is to perform a systematic review and meta-analysis in order to summarise the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh. DESIGN: Systematic review and meta-analysis. PARTICIPANTS: General population of Bangladesh. DATA SOURCES: PubMed, Medline, Embase, Bangladesh Journals Online, Science Direct, Scopus, Cochrane Library and Web of Science were used to search for studies, published between 1st of January 1995 and 31st of August 2019, on the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh. Only articles published in the English language articles were considered. Two authors independently selected studies. The quality of the articles was also assessed. RESULTS: Out of 996 potentially relevant studies, 26 population-based studies, which together involved a total of 80 775 individuals, were included in the meta-analysis. The pooled prevalence of diabetes in the general population was 7.8% (95% CI: 6.4-9.3). In a sample of 56 452 individuals, the pooled prevalence of pre-diabetes was 10.1% (95% CI: 6.7-14.0; 17 studies). The univariable meta-regression analyses showed that the prevalence of diabetes is associated with the factors: the year of study, age of patients and presence of hypertension. The prevalence of diabetes was significantly higher in urban areas compared with rural areas, while there was no significant gender difference. CONCLUSIONS: This meta-analysis suggests a relatively high prevalence of pre-diabetes and diabetes in Bangladesh, with a significant difference between rural and urban areas. The main factors of diabetes include urbanisation, increasing age, hypertension and time period. Further research is needed to identify strategies for early detecting, prevention and treatment of people with diabetes in the population. PROSPERO REGISTRATION NUMBER: CRD42019148205.


Assuntos
Diabetes Mellitus , Hipertensão , Estado Pré-Diabético , Bangladesh/epidemiologia , Diabetes Mellitus/epidemiologia , Humanos , Estado Pré-Diabético/epidemiologia , Prevalência
17.
BMJ Glob Health ; 5(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32532757

RESUMO

AIMS: To estimate the impact of type 2 diabetes in terms of mortality, years of life lost (YLL) and productivity-adjusted life years (PALY) lost in Bangladesh. METHODS: A life table model was constructed to estimate the productivity of the Bangladeshi population of current working age (20-59 years) with diabetes. Follow-up to 60 years (retirement age) was simulated. The life table analysis was then repeated assuming that the cohort did not have diabetes, with subsequent improvement in productivity. Differences in the results of the two analyses reflected the impact of diabetes on health and productivity. Demographic and the prevalence of diabetes data were sourced from the International Diabetes Foundation estimates for 2017 and mortality data were based on the 2017 Global Burden of Disease study. Relative risk and productivity indices were based on an Indian and Bangladeshi study, respectively. The cost of each PALY was assumed to be equivalent to gross domestic product (GDP) per equivalent full-time worker (US$8763). Future costs and years of life, and PALYs lived were discounted at an annual rate of 3%. RESULTS: Assuming a follow-up of this population (aged 20-59 years) until age 60 years or death, an estimated 813 807 excess deaths, loss of 4.0 million life years (5.5%) and 9.2 million PALYs (20.4%) were attributable to having diabetes. This was equivalent to 0.7 YLL, and 1.6 PALYs lost per person. The loss in PALYs equated to a total of US$97.4 billion lost (US$16 987 per person) in GDP. The results of the scenario analysis showed that the estimation was robust. CONCLUSION: In Bangladesh, the impact of diabetes on productivity loss and the broader economy looms large, and poses a substantial risk to the country's future prosperity. This highlights the critical importance of health strategies aimed at the control of diabetes.


Assuntos
Diabetes Mellitus Tipo 2 , Adulto , Bangladesh/epidemiologia , Efeitos Psicossociais da Doença , Eficiência , Humanos , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Adulto Jovem
18.
PLoS One ; 15(5): e0232931, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32407423

RESUMO

BACKGROUND: Hepatitis C virus (HCV) infection is one of the most common bloodborne viral infections reported in Pakistan. Frequent dialysis treatment of hemodialysis patients exposes them to a high risk of HCV infection. The main purpose of this paper is to quantify the prevalence of HCV in hemodialysis patients through a systematic review and meta-analysis. METHODS: We systematically searched PubMed, Medline, EMBASE, Pakistani Journals Online and Web of Science to identify studies published between 1 January 1995 and 30 October 2019, reporting on the prevalence of HCV infection in hemodialysis patients. Meta-analysis was performed using a random-effects model to obtain pooled estimates. A funnel plot was used in conjunction with Egger's regression test for asymmetry and to assess publication bias. Meta-regression and subgroup analyses were used to identify potential sources of heterogeneity among the included studies. This review was registered on PROSPERO (registration number CRD42019159345). RESULTS: Out of 248 potential studies, 19 studies involving 3446 hemodialysis patients were included in the meta-analysis. The pooled prevalence of HCV in hemodialysis patients in Pakistan was 32.33% (95% CI: 25.73-39.30; I2 = 94.3%, p < 0.01). The subgroup analysis showed that the prevalence of HCV among hemodialysis patients in Punjab was significantly higher (37.52%; 95% CI: 26.66-49.03; I2 = 94.5, p < 0.01) than 34.42% (95% CI: 14.95-57.05; I2 = 91.3%, p < 0.01) in Baluchistan, 27.11% (95% CI: 15.81-40.12; I2 = 94.5, p < 0.01) in Sindh and 22.61% (95% CI: 17.45-28.2; I2 = 78.6, p < 0.0117) in Khyber Pukhtoonkhuwa. CONCLUSIONS: In this study, we found a high prevalence (32.33%) of HCV infection in hemodialysis patients in Pakistan. Clinically, hemodialysis patients require more attention and resources than the general population. Preventive interventions are urgently needed to decrease the high risk of HCV infection in hemodialysis patients in Pakistan.


Assuntos
Hepacivirus/isolamento & purificação , Hepatite C/epidemiologia , Diálise Renal/estatística & dados numéricos , Hepatite C/virologia , Humanos , Paquistão/epidemiologia , Prevalência , Diálise Renal/efeitos adversos , Fatores de Risco
19.
Pediatr Infect Dis J ; 39(7): 580-585, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32187137

RESUMO

BACKGROUND: Diarrheal disease is one of the leading causes of childhood morbidity and mortality in the 21st century in developing countries. Mainly infants and young children develop diarrheal diseases. This study aims to determine the incidence of diarrheal pathogens in children in Bangladesh. METHODS: During 2014 to 2019, 387 fecal specimens were collected from children with diarrhea in Bangladesh. Bacterial pathogens were detected by conventional bacteriologic, biochemical and molecular sequence analysis methods. DNA virus and RNA virus (diarrheal viruses) were detected using polymerase chain reaction and reverse transcriptase polymerase chain reaction, respectively and confirmed by molecular sequence analysis. RESULTS: Bacterial infections were detected in 39.27% (152 of 387) of the stool samples. Escherichia coli was the most prevalent (17.3%) followed by Vibrio cholerae (13.5%), Salmonella spp. (4.9%) and Shigella spp. (3.6%). From 387 fecal specimens tested, 42.4% (164 of 387) were positive for viral infections. Rotavirus was the most prevalent (26.3%), followed by adenovirus (5.7%), norovirus (5.4%) and human bocavirus (4.9%). Dual infection between rotavirus and E. coli accounted for the largest portion of coinfection (48%). Diarrhea (77%) and abdominal pain (65%) were most common followed by vomiting (63%), fever (43%) and dehydration (39%). E. coli and V. cholerae were most resistant against ciprofloxacin (62.7%) and tetracycline (88.5%). qnrA and sul4 resistance genes were isolated from these pathogens. CONCLUSIONS: Data from this study underline the high incidence of diarrheal pathogens and presence of antibiotics resistance genes in a pediatric population in Bangladesh.


Assuntos
Infecções Bacterianas/epidemiologia , Gastroenterite/epidemiologia , Viroses/epidemiologia , Doença Aguda/epidemiologia , Bactérias/classificação , Bactérias/isolamento & purificação , Bangladesh/epidemiologia , Criança , Pré-Escolar , Coinfecção/epidemiologia , Coinfecção/microbiologia , Coinfecção/virologia , Vírus de DNA/classificação , Vírus de DNA/isolamento & purificação , Fezes/virologia , Feminino , Gastroenterite/microbiologia , Gastroenterite/virologia , Humanos , Lactente , Masculino , Filogenia , Vírus de RNA/classificação , Vírus de RNA/isolamento & purificação , Estudos Retrospectivos
20.
Curr Med Res Opin ; 36(3): 419-426, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31870180

RESUMO

Background: In routine clinical practice, the implantation of a drug-eluting stent (DES) versus a bare metal stent (BMS) for percutaneous coronary intervention (PCI) has been guided by criteria for appropriate use. The cost-effectiveness (CE) of adopting these guidelines, however, is not clear, and was investigated from the perspective of the Australian healthcare payer.Methods and results: Baseline and 12-month follow-up data of 12,710 PCI patients enrolled in the Melbourne Interventional Group (MIG) registry between 2004 and 2011 were analysed. Costs inputs were derived from a clinical costing database and published sources. Propensity-score-matching was performed for DES and BMS groups within sub-groups. Incremental cost-effectiveness ratios (ICERs) were evaluated for all patients, and sub-groups of patients with '0', 1, 2, or ≥3 indications for a DES. The incremental cost per target vessel revascularization avoided for the overall population was $24,683, and for patients with 0, 1, and 2 indications for a DES was $44,635, $33,335, and $23,788, respectively. However, for those with >3 indications, DES compared with BMS was associated with cost savings. At willingness to pay thresholds of $45,000-$75,000, the probability of cost-effectiveness of DES for the overall cohort was 71-91%, '0' indications, 49-67%, 1 indication, 56-82%, 2 indications, 70-90%, and ≥3 indications, 97-99%.Conclusions: The cost-effectiveness of DES compared with BMS increased with increasing risk profile of patients from those who had 1, 2, to ≥3 indications for a DES. When compared with BMS, DES was least cost effective among patients with '0' indications for a DES. Based on these results, selective use of DES implantation is supported. These findings may be useful for evidence-based clinical decision-making.


Assuntos
Stents Farmacológicos , Intervenção Coronária Percutânea/métodos , Stents , Idoso , Idoso de 80 Anos ou mais , Austrália , Análise Custo-Benefício , Stents Farmacológicos/economia , Feminino , Humanos , Masculino , Intervenção Coronária Percutânea/economia , Pontuação de Propensão , Stents/economia , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...