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1.
Monaldi Arch Chest Dis ; 90(4)2020 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-33305554

RESUMO

Coronavirus Disease-2019 (COVID-19) is the worst worldwide pandemic with more than 12,000,000 cases and 560,000 deaths until 14th July 2020. Men were more infected by COVID-19 than women, and male subjects with underlying conditions, including diabetes, hypertension, and cardiovascular diseases developed a severe form of the affection, with increased mortality rate. Many factors can contribute to the disparity in disease outcomes, such as hormone-specific reaction and activity of X-linked genes, which modulate the innate and adaptive immune response to virus infection. Until now, only the Remdesivir was approved by FDA (Food Drug Administration) for COVID-19 treatment, although several clinical trials are ongoing worldwide also on other drugs. In this review, we analyzed published studies on several drugs (chloroquine or hydroxychloroquine, remdesivir, favipiravir, lopinavir-ritonavir in combination, tocilizumab, plasma, and immunoglobulins) with some efficacy to COVID-19 in humans, and evaluated if there were a gender analysis of the available data. In our opinion, it is essential to report data about COVID-19 disaggregated by sex, age, and race, because the knowledge of gender differences is fundamental to identify effective and customized treatments to reduce hospitalizations, admissions to intensive care units, and mortality.

2.
Monaldi Arch Chest Dis ; 90(2)2020 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-32449614

RESUMO

In December 2019 a novel coronavirus emerged in Wuhan, China causing many cases of severe pneumonia. World Health Organization (WHO) named this disease Coronavirus Disease 2019 (COVID-19). The infection has rapidly spread across China to many other countries, and on March 12, 2020 the WHO declared pandemic outbreak of COVID-19. As of May 16, 2020, COVID-19 has been diagnosed in more than 4,490,000 patients, associated to 305,976 deaths worldwide; in Italy 224,760 COVID-19 cases have been reported with 31,763 deaths. The main routes of transmission are respiratory droplets and direct contact with infected people, so numerous prevention strategies are employed to mitigate the spread of disease, including social distancing and isolation. The aim of this narrative review is to underline gender differences in epidemiology, etiopathogenesis, risk factors, clinical presentation, diagnosis, prognosis and mortality of patients infected with SARS-CoV-2. Currently data on the sex indicators for admitted or deceased patients are only available, but there is no analysis about other gender indicators. The data considered in our study are the only currently available in the literature, but it is appropriate to implement a specific analysis with all gender indicators to identify appropriate strategies. Moreover, the evaluation of a health service efficiency is a key element to define gender outcomes. Knowing the gender differences in COVID-19 outbreak would be a fundamental tool to understand the effects of a health emergency on individuals and communities as well as to carry out effective and equitable policies, public health measures and targeted solutions.


Assuntos
Betacoronavirus/fisiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Animais , Betacoronavirus/genética , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Humanos , Imunidade Inata , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Prevalência , Prognóstico , Fatores de Risco , Serina Endopeptidases/metabolismo , Fatores Sexuais , Ligação Viral
3.
Monaldi Arch Chest Dis ; 89(2)2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31122005

RESUMO

The aim of this study is to evaluate, in patients hospitalized for COPD exacerbation, how educational level, marital status and sex (social gender indicators) affect the prognosis (main effects) and how interact with each other in affecting prognosis (effect modification). Data for all patients discharged with a principal diagnosis of COPD with exacerbation (ICD-9 491.21) by Apulian facilities between 2013 and 2017 were retrieved from the National Hospital Discharge Register Database. A multivariable multi-stratified frailty cox proportional-hazard regression with interaction terms was fitted in order to assess the effect of sex, educational level and marital status on the time-to-event for home discharge through the estimation of hazard ratios. Adjusting for several hospitalization characteristics and for healthcare facilities, low educational level (<8 years of schooling) seems to be a risk factor in both sexes and in all marital status categories (HR 0.92, 95%CI 0.87-0.97, p=0.0020). Female sex seems to be a risk factor only in married patients (HR 0.83, 95%CI 0.78-0.88, p<0.0001). Marital status different from married seems to be a risk factor only in male patients, in particular single patients (HR 0.82, 95%CI 0.74-0.92, p=0.0009), separated or divorced patients (HR 0.71, 95%CI 0.58-0.86, p=0.0005) and widowed patients (HR 0.87, 95%CI 0.80-0.95, p=0.0018). Differently from findings about protective effect of education, the evidence of different effects of sex among civil statuses and of different effect of civil status among sexes is supposed to be a proxy for social gender health and healthcare inequalities.


Assuntos
Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Escolaridade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Estado Civil , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/terapia , Estudos Retrospectivos , Fatores Sexuais , Exacerbação dos Sintomas
4.
Clin Respir J ; 12(3): 1150-1159, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28466511

RESUMO

INTRODUCTION: Smoking is the major risk factor for cancer and several respiratory diseases. Quitting smoking at any point of life may increase the effectiveness of treatments and improve prognosis of patients with any pulmonary disease, including lung cancer. However, few institutions in Europe offer to patients adequate counseling for smoking cessation. OBJECTIVES: Aim of this study was to investigate the level of counseling for smoking cessation offered by healthcare professionals to patients and their appreciation towards the intervention itself. METHODS: Between January 2013 and February 2016, 490 patients, diagnosed with a respiratory diseases, were prospectively evaluated with an anonymous survey developed by WALCE (Women Against Lung Cancer in Europe). RESULTS: The majority of patients enrolled (76%) declared to have stopped smoking after the diagnosis of a respiratory disease, 17% to smoke less, 7% to continue smoking. Patients who reported to have never received any counseling for smoking cessation were 38%. Almost 73% of the other patients reported a positive judgment about the quality of healthcare's intervention. Despite these favorable considerations, 83% of patients have disclosed they simply quit smoking overnight without help, 5% have used electronic cigarettes, 5% nicotine replacement treatments, 4% dedicated books, 3% have attended a referral clinic. CONCLUSIONS: Considering all the smoking-related side effects, greater efforts should be made in order to better support patients in smoking cessation. Smoking should be considered as a real physical disorder and similar surveys should be encouraged with the aim to fight the 'stigma' of smoking that still exists among patients.


Assuntos
Aconselhamento/métodos , Doenças Respiratórias/epidemiologia , Prevenção do Hábito de Fumar/métodos , Fumar/efeitos adversos , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Prognóstico , Doenças Respiratórias/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia , Abandono do Hábito de Fumar/métodos , Adulto Jovem
5.
Multidiscip Respir Med ; 6(5): 299-304, 2011 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-22958809

RESUMO

BACKGROUND AND AIMS: Chronic obstructive pulmonary disease (COPD) is currently the 5th cause of morbidity and mortality in the developed world and represents a substantial economic and social burden. The aim of this study is to report on hospital admissions and related costs of hospital treatment for COPD in the Puglia Region of Italy in the years 2005-2007. MATERIALS AND METHODS: Patients were selected who were hospitalized between 01/01/2005 and 31/12/2007 with ICD-9-CM code: 490.xx: bronchitis not specified as acute or chronic; 491.xx: chronic bronchitis; 492.xx: emphysema; 493.xx: asthma; 494.xx: bronchiectasis; 496.xx: chronic airway obstruction not elsewhere classified; 518.81: acute respiratory failure as principal or secondary diagnosis. RESULTS: In the period 2005-2007, there were 73,721 hospital admissions for COPD registered in Puglia (25,690 in 2005; 24,153 in 2006 and 23,878 in 2007) of which 34.3% were women, with no significant variation in the three years. There appears to be a negative trend in hospitalisations in Puglia for chronic bronchitis with ratios decreasing from 359.4 per 100,000 population in 2005 to 307.9 per 100,000 in 2007. The overall cost of COPD for Apulian hospital trusts was €272,293,182.85 over the 3-year period. CONCLUSIONS: Analysis of the data for hospital care, its costs and performance may be an important indicator of the efficacy of community care. In particular, the lack of reduction in admissions for COPD should lead decision makers to question both the appropriateness and quality of the care given.

6.
Respir Med ; 103(6): 866-72, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19200705

RESUMO

INTRODUCTION: Spirometry may reveal pre-clinical abnormal airway function in asymptomatic subjects and allow a better definition of severity in clinically diagnosed asthma and COPD. The hypothesis of this study was that telespirometry might increase the diagnostic accuracy of asthma and COPD. METHODS: In the Italian "Alliance" study, 638 general practitioners (GPs) were trained to perform telespirometry and were asked to enroll the following categories of subjects: (a) current or ex-smokers without respiratory symptoms; (b) subjects with respiratory symptoms but without a pre-existing diagnosis of asthma or COPD; (c) subjects with a pre-existing clinical diagnosis of asthma; and (d) subjects with a pre-existing clinical diagnosis of COPD. Subjects completed a case report form (CRF) and performed telespirometry in the GP's office. Traces were sent by telephone to a Telespirometry Central Office, where they were interpreted by a pulmonary specialist, according to appropriately defined criteria. The results were returned in real time to the GP. RESULTS: Overall, 9312 subjects were recruited and 7262 (78%) performed an acceptable telespirometric examination and the CRF. In the asymptomatic group, 340/1437 (24%) of the telespirometries were abnormal (147 with moderate-to-severe airway obstruction, i.e. FEV(1) <80% of predicted). Among symptomatic subjects, 1433/3725 (38%) had abnormal telespirometries (682 with moderate-to-severe obstruction). Of the asthmatic subjects, 336/1285 (26%) had moderate-to-severe airway obstruction, while telespirometry was normal in 184/815 (23%) of the COPD group. CONCLUSION: Telespirometry, performed in a GP's office, can aid the diagnosis of obstructive airway diseases and could help GPs to better manage airway obstruction.


Assuntos
Medicina de Família e Comunidade/métodos , Pneumopatias Obstrutivas/diagnóstico , Consulta Remota , Fumar/efeitos adversos , Adulto , Idoso , Medicina de Família e Comunidade/educação , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Índice de Gravidade de Doença , Espirometria/métodos
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