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1.
Infect Control Hosp Epidemiol ; : 1-7, 2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-34607624

RESUMO

OBJECTIVE: To estimate population-based rates and to describe clinical characteristics of hospital-acquired (HA) influenza. DESIGN: Cross-sectional study. SETTING: US Influenza Hospitalization Surveillance Network (FluSurv-NET) during 2011-2012 through 2018-2019 seasons. METHODS: Patients were identified through provider-initiated or facility-based testing. HA influenza was defined as a positive influenza test date and respiratory symptom onset >3 days after admission. Patients with positive test date >3 days after admission but missing respiratory symptom onset date were classified as possible HA influenza. RESULTS: Among 94,158 influenza-associated hospitalizations, 353 (0.4%) had HA influenza. The overall adjusted rate of HA influenza was 0.4 per 100,000 persons. Among HA influenza cases, 50.7% were 65 years of age or older, and 52.0% of children and 95.7% of adults had underlying conditions; 44.9% overall had received influenza vaccine prior to hospitalization. Overall, 34.5% of HA cases received ICU care during hospitalization, 19.8% required mechanical ventilation, and 6.7% died. After including possible HA cases, prevalence among all influenza-associated hospitalizations increased to 1.3% and the adjusted rate increased to 1.5 per 100,000 persons. CONCLUSIONS: Over 8 seasons, rates of HA influenza were low but were likely underestimated because testing was not systematic. A high proportion of patients with HA influenza were unvaccinated and had severe outcomes. Annual influenza vaccination and implementation of robust hospital infection control measures may help to prevent HA influenza and its impacts on patient outcomes and the healthcare system.

2.
Clin Ther ; 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34509304

RESUMO

PURPOSE: Cyproheptadine, an antihistamine and antiserotonergic agent, is an appetite stimulant that is efficacious in promoting weight gain in children and adults with poor appetite. Despite numerous studies showing that cyproheptadine achieved positive outcomes, studies documenting its effectiveness on appetite are limited. This study evaluated the efficacy and tolerability of cyproheptadine in adults with poor appetite in South Korea. METHODS: Patients aged 19 to 64 years with poor appetite were randomly assigned to receive either cyproheptadine or placebo for 8 weeks. The primary end point was the difference between the groups in change in appetite, as measured by the Korean version of the Edmonton Symptom Assessment System from the beginning to the end of the study period. The secondary end points included effects on weight, anthropometrics, body composition, Simplified Nutritional Appetite Questionnaire-measured appetite, and toxicities. A total of 375 patients were randomly assigned to the two groups (189 cyproheptadine, 186 placebo). FINDINGS: The cyproheptadine group experienced a mean (SD) change in appetite score of -2.42 (0.12) compared with -2.03 (0.13) in the placebo arm, representing a statistically significant appetite gain in the cyproheptadine group (difference, +0.38 [0.18]; 95% CI, -0.73 to -0.04; P = 0.0307). Patients in the cyproheptadine group experienced significant increases in weight and body mass index. The most common adverse event was somnolence, as predicted. Cyproheptadine was well tolerated, with one serious adverse event (colitis) which was classified as a moderate adverse effect unlikely to be related to the study drug. IMPLICATIONS: We present the largest randomized, double-blind, placebo-controlled clinical trial of cyproheptadine versus placebo in healthy adults with poor appetite using the lowest effective dosage of cyproheptadine. Cyproheptadine is a safe treatment option in patients with poor appetite. Our findings provide important information for the use of cyproheptadine to ameliorate poor appetite in adults. Further randomized studies focused on the effect of cyproheptadine in older populations are needed.

3.
PLoS One ; 16(9): e0257622, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34559838

RESUMO

OBJECTIVES: Some studies suggested more COVID-19-associated hospitalizations among racial and ethnic minorities. To inform public health practice, the COVID-19-associated Hospitalization Surveillance Network (COVID-NET) quantified associations between race/ethnicity, census tract socioeconomic indicators, and COVID-19-associated hospitalization rates. METHODS: Using data from COVID-NET population-based surveillance reported during March 1-April 30, 2020 along with socioeconomic and denominator data from the US Census Bureau, we calculated COVID-19-associated hospitalization rates by racial/ethnic and census tract-level socioeconomic strata. RESULTS: Among 16,000 COVID-19-associated hospitalizations, 34.8% occurred among non-Hispanic White (White) persons, 36.3% among non-Hispanic Black (Black) persons, and 18.2% among Hispanic or Latino (Hispanic) persons. Age-adjusted COVID-19-associated hospitalization rate were 151.6 (95% Confidence Interval (CI): 147.1-156.1) in census tracts with >15.2%-83.2% of persons living below the federal poverty level (high-poverty census tracts) and 75.5 (95% CI: 72.9-78.1) in census tracts with 0%-4.9% of persons living below the federal poverty level (low-poverty census tracts). Among White, Black, and Hispanic persons living in high-poverty census tracts, age-adjusted hospitalization rates were 120.3 (95% CI: 112.3-128.2), 252.2 (95% CI: 241.4-263.0), and 341.1 (95% CI: 317.3-365.0), respectively, compared with 58.2 (95% CI: 55.4-61.1), 304.0 (95%: 282.4-325.6), and 540.3 (95% CI: 477.0-603.6), respectively, in low-poverty census tracts. CONCLUSIONS: Overall, COVID-19-associated hospitalization rates were highest in high-poverty census tracts, but rates among Black and Hispanic persons were high regardless of poverty level. Public health practitioners must ensure mitigation measures and vaccination campaigns address needs of racial/ethnic minority groups and people living in high-poverty census tracts.


Assuntos
COVID-19 , Grupos Étnicos , Disparidades nos Níveis de Saúde , Hospitalização , Grupos Minoritários , SARS-CoV-2 , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
4.
Health Qual Life Outcomes ; 19(1): 217, 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521426

RESUMO

BACKGROUND: Health-related quality of life (HRQOL) is an important concept to consider both individuals' ability to manage their daily lives and health status across the lifespan. Despite this variable's importance, there is a lack of clarification on the factors associated with HRQOL, especially for military women. The aim of this study was to examine factors associated with HRQOL of military women in the Republic of Korea (ROK) Army. METHODS: This cross-sectional study included 196 participants who were currently within their 5-year service period. HRQOL was measured by the Korean version of the Short-Form 36 Health Survey Questionnaire version 2.0 (SF-36v2), and depression was assessed using the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Differences in HRQOL according to general and occupational factors were analyzed using the independent t-test and analysis of variance (ANOVA). Multiple linear regression analysis was performed to identify factors associated with the HRQOL of women serving as military junior officers. RESULTS: The mean score for the physical component summary (PCS) of SF-36v2 was 56.0 ± 5.8, and that for the mental component summary (MCS) of SF-36v2 was 47.2 ± 10.0. For depression, the mean score was 5.4 ± 5.2, whereas 19.4% of the participants scored more than 10 out of 27 points, which means moderate to severe. No variables showed statistically significant relationships with the PCS. However, military women showed a lower score for MCS when they were officers (adjusted ß = - 3.52; 95% CI = - 5.47, - 1.58), had higher perceived stress (adjusted ß = - 0.62, 95% CI = - 0.83, - 0.41), and a higher score for depression (adjusted ß = - 0.86, 95% CI = - 1.10, - 0.63). CONCLUSIONS: Although depression levels were not severe, it was a significant factor of HRQOL. Stress and depression were found to be significant factors associated with the MCS in military women. Therefore, to improve their HRQOL, the ROK Army should provide early screening, intervention, and management program for high-risk military women. In addition, an appropriate organizational atmosphere within the military must be created to promote such programs.


Assuntos
Depressão/psicologia , Militares/psicologia , Estresse Ocupacional/psicologia , Qualidade de Vida/psicologia , Estresse Fisiológico , Adulto , Estudos Transversais , Feminino , Humanos , República da Coreia , Inquéritos e Questionários
5.
MMWR Morb Mortal Wkly Rep ; 70(36): 1255-1260, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34499627

RESUMO

Although COVID-19-associated hospitalizations and deaths have occurred more frequently in adults,† COVID-19 can also lead to severe outcomes in children and adolescents (1,2). Schools are opening for in-person learning, and many prekindergarten children are returning to early care and education programs during a time when the number of COVID-19 cases caused by the highly transmissible B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, is increasing.§ Therefore, it is important to monitor indicators of severe COVID-19 among children and adolescents. This analysis uses Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET)¶ data to describe COVID-19-associated hospitalizations among U.S. children and adolescents aged 0-17 years. During March 1, 2020-August 14, 2021, the cumulative incidence of COVID-19-associated hospitalizations was 49.7 per 100,000 children and adolescents. The weekly COVID-19-associated hospitalization rate per 100,000 children and adolescents during the week ending August 14, 2021 (1.4) was nearly five times the rate during the week ending June 26, 2021 (0.3); among children aged 0-4 years, the weekly hospitalization rate during the week ending August 14, 2021, was nearly 10 times that during the week ending June 26, 2021.** During June 20-July 31, 2021, the hospitalization rate among unvaccinated adolescents (aged 12-17 years) was 10.1 times higher than that among fully vaccinated adolescents. Among all hospitalized children and adolescents with COVID-19, the proportions with indicators of severe disease (such as intensive care unit [ICU] admission) after the Delta variant became predominant (June 20-July 31, 2021) were similar to those earlier in the pandemic (March 1, 2020-June 19, 2021). Implementation of preventive measures to reduce transmission and severe outcomes in children is critical, including vaccination of eligible persons, universal mask wearing in schools, recommended mask wearing by persons aged ≥2 years in other indoor public spaces and child care centers,†† and quarantining as recommended after exposure to persons with COVID-19.§§.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Adolescente , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , Vacinação/estatística & dados numéricos
6.
Pediatrics ; 148(4)2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34470815

RESUMO

BACKGROUND: Antiviral treatment is recommended for hospitalized patients with suspected and confirmed influenza, but evidence is limited among children. We evaluated the effect of antiviral treatment on hospital length of stay (LOS) among children hospitalized with influenza. METHODS: We included children <18 years hospitalized with laboratory-confirmed influenza in the US Influenza Hospitalization Surveillance Network. We collected data for 2 cohorts: 1 with underlying medical conditions not admitted to the ICU (n = 309, 2012-2013) and an ICU cohort (including children with and without underlying conditions; n = 299, 2010-2011 to 2012-2013). We used a Cox model with antiviral receipt as a time-dependent variable to estimate hazard of discharge and a Kaplan-Meier survival analysis to determine LOS. RESULTS: Compared with those not receiving antiviral agents, LOS was shorter for those treated ≤2 days after illness onset in both the medical conditions (adjusted hazard ratio: 1.37, P = .02) and ICU (adjusted hazard ratio: 1.46, P = .007) cohorts, corresponding to 37% and 46% increases in daily discharge probability, respectively. Treatment ≥3 days after illness onset had no significant effect in either cohort. In the medical conditions cohort, median LOS was 3 days for those not treated versus 2 days for those treated ≤2 days after symptom onset (P = .005). CONCLUSIONS: Early antiviral treatment was associated with significantly shorter hospitalizations in children with laboratory-confirmed influenza and high-risk medical conditions or children treated in the ICU. These results support Centers for Disease Control and Prevention recommendations for prompt empiric antiviral treatment in hospitalized patients with suspected or confirmed influenza.

7.
JAMA Netw Open ; 4(8): e2121880, 2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34427679

RESUMO

Importance: Racial and ethnic minority groups, such as Black, Hispanic, American Indian or Alaska Native, and Asian or Pacific Islander persons, often experience higher rates of severe influenza disease. Objective: To describe rates of influenza-associated hospitalization, intensive care unit (ICU) admission, and in-hospital death by race and ethnicity over 10 influenza seasons. Design, Setting, and Participants: This cross-sectional study used data from the Influenza-Associated Hospitalization Surveillance Network (FluSurv-NET), which conducts population-based surveillance for laboratory-confirmed influenza-associated hospitalizations in selected counties, representing approximately 9% of the US population. Influenza hospitalizations from the 2009 to 2010 season to the 2018 to 2019 season were analyzed. Data were analyzed from October 2020 to July 2021. Main Outcomes and Measures: The main outcomes were age-adjusted and age-stratified rates of influenza-associated hospitalization, ICU admission, and in-hospital death by race and ethnicity overall and by influenza season. Results: Among 113 352 persons with an influenza-associated hospitalization (34 436 persons [32.0%] aged ≥75 years; 61 009 [53.8%] women), 70 225 persons (62.3%) were non-Hispanic White (White), 24 850 persons (21.6%) were non-Hispanic Black (Black), 11 903 persons (10.3%) were Hispanic, 5517 persons (5.1%) were non-Hispanic Asian or Pacific Islander, and 857 persons (0.7%) were non-Hispanic American Indian or Alaska Native. Among persons aged younger than 75 years and compared with White persons of the same ages, Black persons were more likely to be hospitalized (eg, age 50-64 years: rate ratio [RR], 2.50 95% CI, 2.43-2.57) and to be admitted to an ICU (eg, age 50-64 years: RR, 2.09; 95% CI, 1.96-2.23). Among persons aged younger than 50 years and compared with White persons of the same ages, American Indian or Alaska Native persons were more likely to be hospitalized (eg, age 18-49 years: RR, 1.72; 95% CI, 1.51-1.96) and to be admitted to an ICU (eg, age 18-49 years: RR, 1.84; 95% CI, 1.40-2.42). Among children aged 4 years or younger and compared with White children, hospitalization rates were higher in Black children (RR, 2.21; 95% CI, 2.10-2.33), Hispanic children (RR, 1.87; 95% CI, 1.77-1.97), American Indian or Alaska Native children (RR, 3.00; 95% CI, 2.55-3.53), and Asian or Pacific Islander children (RR, 1.26; 95% CI, 1.16-1.38), as were rates of ICU admission (Black children: RR, 2.74; 95% CI, 2.43-3.09; Hispanic children: RR, 1.96; 95% CI, 1.73-2.23; American Indian and Alaska Native children: RR, 3.51; 95% CI, 2.45-5.05). In this age group and compared with White children, in-hospital death rates were higher among Hispanic children (RR, 2.98; 95% CI, 1.23-7.19), Black children (RR, 3.39; 95% CI, 1.40-8.18), and Asian or Pacific Islander children (RR, 4.35; 95% CI, 1.55-12.22). Few differences were observed in rates of severe influenza-associated outcomes by race and ethnicity among adults aged 75 years or older. For example, in this age group, compared with White adults, hospitalization rates were slightly higher only among Black adults (RR, 1.05; 95% CI 1.02-1.09). Overall, Black persons had the highest age-adjusted hospitalization rate (68.8 [95% CI, 68.0-69.7] hospitalizations per 100 000 population) and ICU admission rate (11.6 [95% CI, 11.2-11.9] admissions per 100 000 population). Conclusions and Relevance: This cross-sectional study found racial and ethnic disparities in rates of severe influenza-associated disease. These data identified subgroups for whom improvements in influenza prevention efforts could be targeted.

8.
Health Serv Res ; 2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34378205

RESUMO

OBJECTIVE: To (1) characterize change in type of insurance coverage among childhood cancer survivors from diagnosis to survivorship and (2) examine whether insurance change is associated with cancer-related follow-up care utilization. DATA SOURCES: Participants in this study were derived from the Project Forward study, a population-based, observational study of childhood cancer survivors in Los Angeles County that used California Cancer Registry data to identify participants. STUDY DESIGN: Multivariable logistic regression models incorporating survey nonresponse weights estimated the change in the marginal predicted probabilities of insurance change and survivorship care, adjusting for demographic, socioeconomic, and clinical covariates and clustering by treating hospital. DATA COLLECTION/EXTRACTION METHODS: Study participants were diagnosed with cancer who were younger than age 20 years while living in Los Angeles County from 1996 to 2010 and were older than the age 18 years at the time of survey participation, from 2015 to 2017 (N = 1106). PRINCIPAL FINDINGS: Most participants were 18-26 years of age, male, diagnosed before 2004, Hispanic/Latino race/ethnicity, single, without children, highly educated, not employed full time, and lived with their parents at survey. Almost half (N = 529) of participants experienced insurance change from diagnosis to survivorship. Insurance change was associated with insurance coverage at diagnosis, as those who were uninsured were most likely to experience change and gain coverage during survivorship (by 51 percentage points [ppt], standard error [SE] of 0.05). Survivors who experienced any change had decreased probability of reporting a recent cancer-related follow-up care visit, a disparity that was magnified for those who lost insurance coverage (-5 ppt, SE 0.02 for those who gained coverage; -15 ppt, SE 0.04 for those who lost coverage). CONCLUSIONS: Insurance coverage change was associated with lower cancer-related follow-up care utilization. Indeed, survivors who experienced any insurance coverage change had decreased probability of having a cancer-related follow-up care visit, and this was magnified for those who lost their insurance coverage.

9.
Acute Crit Care ; 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34380189

RESUMO

Background: Acute kidney injury (AKI) is a major complication after cardiac surgery and significantly affects postoperative mortality and morbidity. This study was conducted to evaluate the association between target pump flow to achieve adequate oxygen delivery (DO2) and postoperative renal function after aortic valve replacement. Methods: From January 2017 to May 2020, 281 patients (male:female, 160:121; mean age, 68±11 years) who underwent aortic valve replacement were retrospectively reviewed. Target pump flow was calculated based on DO2 level of 280 mL/min/m2. The primary endpoint was postoperative renal dysfunction, defined as the ratio of postoperative peak creatinine level to preoperative value. The ratio of the lowest actual pump flow to the ideal target pump flow, other hemodynamic variables related with cardiopulmonary bypass, intraoperative transfusion, and preoperative characteristics were analyzed to identify factors associated with the primary endpoint using a multivariable linear regression model. Results: Preoperative and peak postoperative creatinine levels were 0.94±0.33 mg/dl and 1.15±0.56 mg/dl, respectively (ratio, 1.22±0.33). The ideal target pump flow was 4.70±0.59 L/min, whereas the lowest actual pump flow was 3.77±0.47 L/min (ratio, 0.81±0.13). The multivariable model showed that the ratio of the lowest pump flow to target pump flow (ß±standard error, -0.405±0.162, P=0.013), as well as sex, stroke history, emergency, and transfusion of red blood cells were associated with the primary endpoint. Conclusion: : Low actual nadir pump flow compared to the ideal target pump flow based on DO2 is associated with the risk of AKI after aortic valve replacement.

10.
MMWR Morb Mortal Wkly Rep ; 70(32): 1088-1093, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34383730

RESUMO

Clinical trials of COVID-19 vaccines currently authorized for emergency use in the United States (Pfizer-BioNTech, Moderna, and Janssen [Johnson & Johnson]) indicate that these vaccines have high efficacy against symptomatic disease, including moderate to severe illness (1-3). In addition to clinical trials, real-world assessments of COVID-19 vaccine effectiveness are critical in guiding vaccine policy and building vaccine confidence, particularly among populations at higher risk for more severe illness from COVID-19, including older adults. To determine the real-world effectiveness of the three currently authorized COVID-19 vaccines among persons aged ≥65 years during February 1-April 30, 2021, data on 7,280 patients from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) were analyzed with vaccination coverage data from state immunization information systems (IISs) for the COVID-NET catchment area (approximately 4.8 million persons). Among adults aged 65-74 years, effectiveness of full vaccination in preventing COVID-19-associated hospitalization was 96% (95% confidence interval [CI] = 94%-98%) for Pfizer-BioNTech, 96% (95% CI = 95%-98%) for Moderna, and 84% (95% CI = 64%-93%) for Janssen vaccine products. Effectiveness of full vaccination in preventing COVID-19-associated hospitalization among adults aged ≥75 years was 91% (95% CI = 87%-94%) for Pfizer-BioNTech, 96% (95% CI = 93%-98%) for Moderna, and 85% (95% CI = 72%-92%) for Janssen vaccine products. COVID-19 vaccines currently authorized in the United States are highly effective in preventing COVID-19-associated hospitalizations in older adults. In light of real-world data demonstrating high effectiveness of COVID-19 vaccines among older adults, efforts to increase vaccination coverage in this age group are critical to reducing the risk for COVID-19-related hospitalization.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Hospitalização/estatística & dados numéricos , Idoso , COVID-19/epidemiologia , Humanos , Estados Unidos/epidemiologia , Vacinas Sintéticas
11.
Nurs Open ; 8(6): 2996-3005, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34342177

RESUMO

AIM: This study aimed to evaluate the correlations among anti-Müllerian hormone levels, body mass index and lipid profile in female nurses of reproductive age. DESIGN: This is a descriptive cross-sectional study that used data from the Korea Nurses' Health Study, based on Nurses' Health Study 3 in the United States. METHODS: Participants included 448 female nurses of reproductive age. They provided details about their work experience, shift work, body mass index and history of polycystic ovary syndrome. Serum anti-Müllerian hormone levels and lipid profile were measured using blood samples. Statistical analysis included quantile regression analysis using STATA 13.0. Data were collected between November 2016 and March 2017 from Module 5 of the Korean Nurses' Health Study. RESULTS: Approximately 12% of the participants were underweight, and roughly one-tenth were either overweight or obese. Although linear regression showed no relationship between anti-Müllerian hormone levels and body mass index, quantile regression showed that body mass index, total cholesterol levels and low-density lipoprotein levels were negatively correlated with anti-Müllerian hormone levels at the lower tails of the dependent variable. Meanwhile, high-density lipoprotein levels were positively correlated with anti-Müllerian hormone at the higher percentiles of anti-Müllerian hormone levels. CONCLUSION: These findings suggest the possibility that changes in the lipid profile may influence anti-Müllerian hormone levels in women with diminished ovarian function, rather than obesity itself.

12.
Ann Intern Med ; 174(10): 1409-1419, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34370517

RESUMO

BACKGROUND: The COVID-19 pandemic has caused substantial morbidity and mortality. OBJECTIVE: To describe monthly clinical trends among adults hospitalized with COVID-19. DESIGN: Pooled cross-sectional study. SETTING: 99 counties in 14 states participating in the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET). PATIENTS: U.S. adults (aged ≥18 years) hospitalized with laboratory-confirmed COVID-19 during 1 March to 31 December 2020. MEASUREMENTS: Monthly hospitalizations, intensive care unit (ICU) admissions, and in-hospital death rates per 100 000 persons in the population; monthly trends in weighted percentages of interventions, including ICU admission, mechanical ventilation, and vasopressor use, among an age- and site-stratified random sample of hospitalized case patients. RESULTS: Among 116 743 hospitalized adults with COVID-19, the median age was 62 years, 50.7% were male, and 40.8% were non-Hispanic White. Monthly rates of hospitalization (105.3 per 100 000 persons), ICU admission (20.2 per 100 000 persons), and death (11.7 per 100 000 persons) peaked during December 2020. Rates of all 3 outcomes were highest among adults aged 65 years or older, males, and Hispanic or non-Hispanic Black persons. Among 18 508 sampled hospitalized adults, use of remdesivir and systemic corticosteroids increased from 1.7% and 18.9%, respectively, in March to 53.8% and 74.2%, respectively, in December. Frequency of ICU admission, mechanical ventilation, and vasopressor use decreased from March (37.8%, 27.8%, and 22.7%, respectively) to December (20.5%, 12.3%, and 12.8%, respectively); use of noninvasive respiratory support increased from March to December. LIMITATION: COVID-NET covers approximately 10% of the U.S. population; findings may not be generalizable to the entire country. CONCLUSION: Rates of COVID-19-associated hospitalization, ICU admission, and death were highest in December 2020, corresponding with the third peak of the U.S. pandemic. The frequency of intensive interventions for management of hospitalized patients decreased over time. These data provide a longitudinal assessment of clinical trends among adults hospitalized with COVID-19 before widespread implementation of COVID-19 vaccines. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention.

13.
Health Qual Life Outcomes ; 19(1): 179, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34247645

RESUMO

BACKGROUND: Fatigability has recently emerged in oncology as a concept that anchors patients' perceptions of fatigue to defined activities of specified duration and intensity. This study aimed to examine the psychometric properties of the Korean version of the Pittsburgh Fatigability Scale (K-PFS) for women with breast cancer. METHODS: This cross-sectional study involved 196 women with breast cancer recruited from a tertiary hospital in Seoul, Korea. Reliability was evaluated using Cronbach's alpha, and confirmatory factor analysis was conducted to examine the factor structure of the K-PFS. Four goodness-of-fit values were evaluated: (1) the comparative fit index (CFI), (2) the Tucker-Lewis index (TLI), (3) the root mean square error of approximation (RMSEA), and (4) the standardized root mean square residual (SRMR). RESULTS: Of the 196 survivors, 71.1% had greater physical fatigability (K-PFS Physical score ≥ 15) and 52.6% had greater mental fatigability (K-PFS Mental score ≥ 13). The Cronbach's alpha coefficient for the total K-PFS scale was 0.926, and the coefficients for the physical and mental fatigability domains were 0.870 and 0.864, respectively. In the confirmatory factor analysis for physical fatigability, the SRMR value (0.076) supported goodness of fit, but other model fit statistics did not (CFI = 0.888, TLI = 0.826, and RMSEA = 0.224). For mental fatigability, although three goodness-of-fit values were acceptable (CFI = 0.948, TLI = 0.919, and SRMR = 0.057), the RMSEA value (0.149) did not indicate good model fit. However, each item coefficient was statistically significant (> 0.5), and the K-PFS was therefore found to be valid from a theoretical perspective. CONCLUSION: This study provides meaningful information on the reliability and validity of the K-PFS instrument, which was developed to meet an important need in the context of breast cancer survivors. Additional research should examine its test-retest reliability and construct validity with performance measures.


Assuntos
Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Fadiga/psicologia , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Neoplasias da Mama/complicações , Estudos Transversais , Análise Fatorial , Fadiga/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Reprodutibilidade dos Testes , República da Coreia
14.
BMC Cancer ; 21(1): 855, 2021 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-34311713

RESUMO

BACKGROUND: Fatigue is one of the most common and burdensome symptoms experienced by cancer patients. In interventions intended to reduce fatigue in such patients, fatigability, or perception of fatigue contextualized to activities of fixed intensity and duration, may also be measured. This study investigated the effects of a 15-month intervention on fatigue and fatigability in breast cancer survivors (BCS); explored the fatigue-fatigability relationship; and evaluated the impacts of fatigue and fatigability on anxiety, depression, sleep disturbance, and endocrine symptoms. METHODS: A randomized controlled trial design was applied to an exercise program called BLESS (Better Life after cancer, Energy, Strength, and Support). The intervention included this 12-week exercise program and four follow-up contacts intended to promote exercise adherence over the following year. Participants were women aged 20 to 69 who had been diagnosed with stage I, II, or III breast cancer; had completed active treatment; and had moderate or higher fatigue. At the completion of the intervention, the survey responses of 40 BCS were evaluated using the chi-square test and multiple regression analysis. The Korean versions of the Revised Piper Fatigue Scale and Pittsburgh Fatigability Scale were used to measure fatigue and fatigability, respectively. RESULTS: There was no significant difference in fatigue or fatigability between the experimental and control groups at intervention completion. However, the control group showed a stronger association than the experimental group between fatigue and physical fatigability. In the control group, fatigue and fatigability were significantly associated with anxiety, depression, sleep disturbance, and endocrine symptoms. In the experimental group, only the cognitive/mood fatigue score and depression were significantly associated. Only endocrine symptoms influenced mental fatigability (B = - 0.185, P < 0.05), and only depression influenced cognitive/mood fatigue (B = 1.469, P < 0.05). CONCLUSIONS: Fatigue and fatigability showed different correlations with cancer-related symptoms after the exercise intervention. Future assessments of fatigability in intervention studies will allow measurement of the spectrum of patients' abilities to overcome fatigue at various physical activity levels while capturing different aspects of cancer-related symptoms. TRIAL REGISTRATION: This study was retrospectively registered on Clinical Research Information Service ( KCT0005763 ; date of registration: 31/12/2020).


Assuntos
Ansiedade/epidemiologia , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Sobreviventes de Câncer , Depressão/epidemiologia , Fadiga/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Sobreviventes de Câncer/psicologia , Depressão/etiologia , Exercício Físico , Fadiga/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , República da Coreia , Transtornos do Sono-Vigília/etiologia , Avaliação de Sintomas
15.
Aging (Albany NY) ; 13(12): 15898-15916, 2021 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-34148030

RESUMO

We aimed to evaluate the feasibility of multidomain intervention (MI) tailored to the Korean context. In an outcome assessor-blinded, randomized controlled trial, participants without dementia and with one or more modifiable dementia risk factors, aged 60-79 years, were randomly assigned to the facility-based MI (FMI; n=51), the home-based MI (HMI; n=51), or the control group receiving general health advice (n=50). The 24-week intervention comprised vascular risk management, cognitive training, social activity, physical exercise, nutrition guidance, and motivational enhancement. The FMI participants performed all intervention programs at a facility three times a week. The HMI participants performed some programs at a facility once every 1-2 weeks and performed others at home. The primary outcome was feasibility measured through retention, adherence, and at least no differences from the control group in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). In the FMI and HMI groups, the retention rates were 88.2% and 96.1%, and adherence to the intervention was 94.5% and 96.8%, respectively. The RBANS total scale index score improved significantly in the FMI (5.46 ± 7.50, P = 0.004) and HMI (5.50 ± 8.14, P = 0.004) groups compared to the control group (-0.74 ± 11.51). The FMI and HMI are feasible and there are indicators of efficacy.


Assuntos
Cognição/fisiologia , Dieta , Exercício Físico/fisiologia , Instalações de Saúde , Motivação , Gestão de Riscos , Idoso , Biomarcadores/sangue , Determinação de Ponto Final , Estudos de Viabilidade , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Cooperação do Paciente
16.
JMIR Res Protoc ; 10(6): e26264, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34114954

RESUMO

BACKGROUND: In hereditary breast and ovarian cancer (HBOC), family communication of genetic test results is essential for cascade genetic screening, that is, identifying and testing blood relatives of known mutation carriers to determine whether they also carry the pathogenic variant, and to propose preventive and clinical management options. However, up to 50% of blood relatives are unaware of relevant genetic information, suggesting that potential benefits of genetic testing are not communicated effectively within family networks. Technology can facilitate communication and genetic education within HBOC families. OBJECTIVE: The aims of this study are to develop the K-CASCADE (Korean-Cancer Predisposition Cascade Genetic Testing) cohort in Korea by expanding an infrastructure developed by the CASCADE (Cancer Predisposition Cascade Genetic Testing) Consortium in Switzerland; develop a digital health intervention to support the communication of cancer predisposition for Swiss and Korean HBOC families, based on linguistic and cultural adaptation of the Family Gene Toolkit; evaluate its efficacy on primary (family communication of genetic results and cascade testing) and secondary (psychological distress, genetic literacy, active coping, and decision making) outcomes; and explore its translatability using the reach, effectiveness, adoption, implementation, and maintenance framework. METHODS: The digital health intervention will be available in French, German, Italian, Korean, and English and can be accessed via the web, mobile phone, or tablet (ie, device-agnostic). K-CASCADE cohort of Korean HBOC mutation carriers and relatives will be based on the CASCADE infrastructure. Narrative data collected through individual interviews or mini focus groups from 20 to 24 HBOC family members per linguistic region and 6-10 health care providers involved in genetic services will identify the local cultures and context, and inform the content of the tailored messages. The efficacy of the digital health intervention against a comparison website will be assessed in a randomized trial with 104 HBOC mutation carriers (52 in each study arm). The translatability of the digital health intervention will be assessed using survey data collected from HBOC families and health care providers. RESULTS: Funding was received in October 2019. It is projected that data collection will be completed by January 2023 and results will be published in fall 2023. CONCLUSIONS: This study addresses the continuum of translational research, from developing an international research infrastructure and adapting an existing digital health intervention to testing its efficacy in a randomized controlled trial and exploring its translatability using an established framework. Adapting existing interventions, rather than developing new ones, takes advantage of previous valid experiences without duplicating efforts. Culturally sensitive web-based interventions that enhance family communication and understanding of genetic cancer risk are timely. This collaboration creates a research infrastructure between Switzerland and Korea that can be scaled up to cover other hereditary cancer syndromes. TRIAL REGISTRATION: ClinicalTrials.gov NCT04214210; https://clinicaltrials.gov/ct2/show/NCT04214210 and CRiS KCT0005643; https://cris.nih.go.kr/cris/. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/26264.

17.
J Nurs Manag ; 29(7): 2102-2114, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33894028

RESUMO

AIM: To examine the factors affecting actual turnover among nurses working in hospitals using the Brewer-Kovner synthesis model. BACKGROUND: To increase retention of nurses, it is important to understand factors contributing to actual turnover among nurses. METHODS: A longitudinal study design was utilized with 2,633 of 20,613 eligible female hospital nurses who participated in Korea Nurses' Health Study. We created two age groups: a younger group (20-35 years) and an older group (36-49 years). Multivariate logistic regression was used to identify the factors influencing turnover by age group. RESULTS: Pregnancy and childbirth increased young nurses' turnover. When we excluded intent to leave, depression and burnout were significant factors affecting young nurses' turnover. Salary and hospital size were factors predicting nurse turnover among nurses older than 36 years. CONCLUSIONS: It is essential to develop prevention strategies of female nurse turnover based on the age group in Korea. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers and health care institutes need to develop new managerial and policy strategies to reduce nurse turnover in each age group.


Assuntos
Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem no Hospital , Adulto , Estudos Transversais , Feminino , Hospitais , Humanos , Satisfação no Emprego , Estudos Longitudinais , Reorganização de Recursos Humanos , República da Coreia , Inquéritos e Questionários , Adulto Jovem
18.
Healthcare (Basel) ; 9(2)2021 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-33668525

RESUMO

Nurses often experience work-related physical and mental fatigue. This study sought to identify the levels of physical and mental fatigue present among Korean female nurses and discern factors influencing their onset. This cross-sectional study analyzed data from the Korea Nurses' Health Study (KNHS). A total of 14,839 hospital nurses were assessed by hierarchical regression analysis. The mean scores of physical and mental fatigue were 12.57 and 5.79 points, respectively. After adjusting for confounding variables, the work department had a significant influence on both physical and mental fatigue, that is, nurses working in special care units experienced greater degrees of both physical and mental fatigue than those working in general units. Nurse fatigue is an important consideration to monitor to ensure nurses' continued wellbeing as well as good patient safety levels. Therefore, it is necessary to establish a strategy to mitigate nursing fatigue while considering the characteristics of specific departments. In nursing practice, the introduction of a counseling program and guarantee of rest time that can alleviate the mental and physical fatigue of nurses working in special care units should be considered.

19.
Cancer Nurs ; 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33654008

RESUMO

BACKGROUND: The worldwide spread of the coronavirus disease 2019 (COVID-19) has impacted the treatment of cancer patients. Treatment changes can negatively affect patients' prognosis and may be psychologically burdensome. OBJECTIVE: The aim of this study was to explore whether COVID-19-related treatment changes (delays, cancellations, changes) influenced fear of cancer recurrence, anxiety, and depression in breast cancer patients. METHODS: A convenience sample (n = 154) of patients who were diagnosed with breast cancer no longer than 2 years ago was obtained from an online community and social network site. The survey content included COVID-19-related treatment experiences and psychological status. The data were analyzed using descriptive statistics, χ2 test, independent t test, and analysis of variance. RESULTS: Twenty-nine patients (18.8%) had experienced COVID-19-related treatment changes, and changes of the treatment plan had a significant correlation with depression (t = 2.000, P = .047). Fear of cancer recurrence was high (mean score, 84.31 ± 24.23). Fifteen percent had moderate to severe levels of anxiety, and 24.7% had moderate to severe levels of depression. Narrative reports also identified COVID-19-related unforeseen costs. CONCLUSION: In the midst of the COVID-19 pandemic, breast cancer patients experienced treatment changes, and changes in treatment plans were significantly associated with depression. Fear of recurrence, anxiety, and depression were found at high levels. IMPLICATIONS FOR PRACTICE: Oncology nurses should assess the psychological status of cancer patients in the early survivorship phase who appear to be especially vulnerable during the COVID-19 pandemic. Oncology nurses can also monitor whether patients are receiving timely supportive care to alleviate fears and anxiety and assess financial needs for COVID-19-related costs.

20.
Hum Resour Health ; 19(1): 19, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33588873

RESUMO

BACKGROUND: The Western Pacific region constitutes one-quarter of the world's population and has diverse health needs. While dialogue on and promotion of advanced practice nurses are ongoing, this study investigated the current responsibilities of nurses in advanced roles, future healthcare needs, and the implications of these components for nurses' professional development within the Western Pacific region. METHODS: This study employed three phases, a descriptive survey on the current status of nurses in advanced roles in the Western Pacific region, followed by a Delphi survey, and exploratory interviews. A total of 55 national experts with clinical, academic, and/or government-related backgrounds from 18 countries participated from December 2017 - December 2018. The descriptive survey via email to identify the status of nurses in advanced roles and a working definition was developed. This formed the basis for the Delphi survey, which identified key barriers and challenges for enhancing the development of nurses in advanced roles within the country (round 1) and for the region (rounds 2 and 3). Lastly, semi-structured individual interviews were conducted to identify strategies for establishing nurses in advanced roles to improve equitable access to healthcare. RESULTS: Thirty-seven roles and characteristics were identified and categorized for nurses performing advanced roles. Emergency care, critical care, elderly health, child health, and rural/remote communities were identified as fields with particular need for nurses in advanced roles in the Western Pacific region. Providing effective services, influencing government leadership, and advocating for health system sustainability were deemed necessary to improve equitable healthcare access. We found that nurses in advanced roles are not limited to clinical tasks within the hospital but are poised for active participation in primary healthcare, education/teaching, professional leadership, quality management, and research. CONCLUSIONS: Demand for nurses in advanced roles is high in the Western Pacific region and 15 items were identified across five core strategic areas to enhance development of nurses in advanced roles. Governmental-level recommendations include establishing legislative protection, improving systems for remuneration, strengthening supportive channels, and conducting national needs assessments.

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