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2.
Adv Exp Med Biol ; 1154: 279-319, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31297766

RESUMO

This chapter analyses the taxonomic position of Dicrocoeliidae family and several of its genus and species. The biology of the major species causing veterinary diseases such Dicrocoelium dendriticum, Dicrocoelium hospes, Dicrocoelium chinensis, Eurytrema pancreaticum and Platynosomum fastosum, has been reviewed. All these species have an indirect life cycle, involving two intermediate hosts (molluscs as first and ants, grasshoppers and lizards as second). Dicrocoelium dendriticum is a very widespread hepatic trematode in the ruminants of many countries in Europe, Asia, North Africa and North America, even affecting humans. Dicrocoelium hospes is widely distributed in the savanna areas of Africa south of the Sahara, whilst D. chinensis has mainly been found in ruminants in East Asia and some European countries (probably imported from Asia). Eurytrema pancreaticum is a common parasite whose adults live in ruminant bile ducts, gall bladder, pancreatic ducts and intestines in Europe, Madagascar, Asia and South America. Adult P. fastosum live in the liver, gall bladder and pancreas of birds and mammals in Europe, Africa, Asia, North, Central and South America. Information about the epidemiology, pathology, clinical aspect, diagnosis, treatment, control, prevention and economic impact mainly of Dicrocoeliosis produced by D. dendriticum, as well as of Eurytrematodosis and Platynosomiosis, has been included.


Assuntos
Dicrocoeliidae , Infecções por Trematódeos , África/epidemiologia , Animais , Ásia/epidemiologia , Dicrocoeliidae/classificação , Europa (Continente)/epidemiologia , Humanos , América do Norte/epidemiologia , América do Sul/epidemiologia , Infecções por Trematódeos/diagnóstico , Infecções por Trematódeos/epidemiologia , Infecções por Trematódeos/parasitologia , Infecções por Trematódeos/prevenção & controle
3.
BMC Public Health ; 19(1): 670, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146721

RESUMO

As the overdose crisis in North America continues to deepen, public health leaders find themselves responding to sensational media stories, many of which carry forms and themes that mark them as urban legends.This article analyzes one set of media accounts - stories of misuse of naloxone, an opioid overdose antidote distributed to people who use drugs - through the lens of social science scholarship on urban legends. We suggest that these stories have met a public need to feel a sense of safety in uncertain times, but function to reinforce societal views of people who use drugs as undeserving of support and resources.Our field has a duty to speak out in favour of evidence-based programs that support the health of people who use drugs, but the optimal communication strategies are not always clear. Drawing attention to the functions and consequences of urban legends can help frame public health communication in a way that responds to needs without reinforcing prejudices, with application beyond naloxone to the other urban legends that continue to emerge in response to this crisis.


Assuntos
Analgésicos Opioides/toxicidade , Meios de Comunicação , Overdose de Drogas/tratamento farmacológico , Naloxona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Overdose de Drogas/epidemiologia , Comunicação em Saúde , Humanos , América do Norte/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Papel Profissional , Saúde Pública
4.
Vet Parasitol ; 269: 42-52, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31079827

RESUMO

Toxoplasmosis, caused by the protozoan parasite Toxoplasma gondii, is an important disease with worldwide distribution. Infection can occur from ingesting raw or undercooked infected meat, and among food animal species, pork is known to be one of the main sources of meat-borne infection. Here, we present results of the first systematic review and meta-analysis on the global T. gondii seroprevalence in pigs. PubMed/MEDLINE, Scopus, and EMBASE databases were comprehensively searched for relevant studies published between January 1, 1990 and October 25, 2018. We used a random effects model to calculate pooled seroprevalence estimates with 95% confidence intervals (CI) and analyzed data from five continents. We also conducted subgroup and meta-regression analyses to evaluate the effects of geographical and climate variables on pooled seroprevalence rates. Among 1542 publications identified, 148 studies containing 150 datasets were included in the meta-analysis, and comprised 148,092 pigs from 47 countries. The pooled global T. gondii seroprevalence in pigs was estimated to be 19% (95%CI, 17-22%; 23,696/148,092), with the lowest seroprevalence in Europe (13%; 10-15%) and highest seroprevalence in Africa (25%; 17-34%) and North America (25%; 19-33%). The seropositivity rates in Asia and South America regions were (21%, 16-26%) and (23%; 17-30%), respectively. A significantly higher T. gondii seroprevalence was associated with higher mean annual temperature and lower geographical latitude. The presence of cats on farms was identified as a potential risk factor for T. gondii seropositivity (OR, 1.41; 95%CI, 1.00-2.02). Our findings highlight the importance of pigs as a possible source of human T. gondii infections.


Assuntos
Anticorpos Antiprotozoários/sangue , Carne Vermelha/parasitologia , Doenças dos Suínos/epidemiologia , Toxoplasma/imunologia , Toxoplasmose Animal/epidemiologia , Toxoplasmose/epidemiologia , África/epidemiologia , Animais , Ásia/epidemiologia , Europa (Continente)/epidemiologia , Saúde Global , Humanos , América do Norte/epidemiologia , Fatores de Risco , Estudos Soroepidemiológicos , América do Sul/epidemiologia , Suínos , Doenças dos Suínos/parasitologia , Temperatura Ambiente , Toxoplasmose/parasitologia , Toxoplasmose Animal/parasitologia , Zoonoses
5.
Sci Total Environ ; 683: 489-497, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31141750

RESUMO

BACKGROUND: The growing concern with environmental related impacts on mortality and morbidity means that the conceptual framework of environment-health-economic policy nexus is salient in the global debate on air pollution. OBJECTIVES: With time series data spanning 2000-2016, this study explored the proximate determinants of ambient air pollution, mortality, and life expectancy in North America, Europe & Central Asia, and East Asia & Pacific regions. METHODS: The study applied historical data on urban population, total pollution, energy consumption, GDP per capita, life expectancy, mortality rate and industrial PM2.5 emissions to develop six parsimonious models using the generalized least squares (GLS) random-effects model estimation with first-order autoregressive [AR(1)] disturbance across 54 countries. RESULTS: An increase in income level by 1% declined mortality rate by 0.01% and increased longevity by ~0.02% (95% Confidence Interval [CI]) in the long-run. An increase in industrial PM2.5 emissions per capita by 1% decreased life expectancy by 0.004% and mortality rate by 0.02% (95% CI). Intensification of energy consumption and its related services by 1% were found to increase industrial PM2.5 emissions by 0.42-0.45% (95% CI). An inversed-U shaped curve between PM2.5 emissions per capita and income levels was found at a turning point of US$ 48,061. The validity of an environmental Kuznets curve hypothesis between ambient air pollution and urbanization was confirmed, while a rapid increase in population had a significant positive impact on ambient air pollution. CONCLUSION: Ambient air pollution contributes significantly in reducing life expectancy and increasing mortality. However, sustained economic development, along with energy efficiency, and sustainable urban settlement planning and management are potential options for reducing ambient air pollution while improving quality of life and environmental sustainability.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Mortalidade/tendências , Material Particulado/análise , Ásia/epidemiologia , Austrália/epidemiologia , Europa (Continente)/epidemiologia , Extremo Oriente/epidemiologia , Expectativa de Vida , América do Norte/epidemiologia , Qualidade de Vida
6.
Parasite ; 26: 22, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30963996

RESUMO

Due to the rarity of human cases and the nonspecific clinical symptoms of dioctophymiasis, Dioctophyma renale infection is not well recognized and is easily neglected or misdiagnosed. Recently, we diagnosed a human case of dioctophymiasis accompanied by renal cancer. To enhance the understanding of human dioctophymiasis, this case is presented here, and a retrospective study of this disease was conducted based on relevant papers screened from PubMed and three Chinese databases. In the end, 32 papers describing 37 human cases of dioctophymiasis were assessed. These cases were distributed in ten countries of Asia, Europe, North America and Oceania, with the highest number in China (n = 22). The majority of the cases occurred in adults (91.9%, 34/37) and involved the kidneys (83.8%, 31/37). Ectopic parasitism mainly occurred in subcutaneous tissue (83.3%, 5/6). A proportion of 45.9% (17/37) of individuals had a history of eating raw or undercooked fish or frogs. The main clinical manifestations of human dioctophymiasis were loin pain (59.5%) and hematuria (59.5%). All the cases were diagnosed based on the morphological characteristics of eggs or adults in urine or tissue sections. Currently, there is no strictly defined therapeutic approach. This is the first retrospective analysis of human cases of dioctophymiasis. These review data will deepen our understanding of dioctophymiasis and help avoid misdiagnosis in clinical practice.


Assuntos
Infecções por Enoplida/complicações , Infecções por Enoplida/diagnóstico , Neoplasias Renais/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Ásia/epidemiologia , Criança , China/epidemiologia , Dioctophymatoidea/isolamento & purificação , Ectoparasitoses/epidemiologia , Infecções por Enoplida/urina , Europa (Continente)/epidemiologia , Feminino , Peixes/parasitologia , Humanos , Rim/parasitologia , Rim/patologia , Neoplasias Renais/diagnóstico , Neoplasias Renais/parasitologia , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Alimentos Crus/parasitologia , Estudos Retrospectivos , Fatores Sexuais , Adulto Jovem
7.
Fertil Steril ; 111(6): 1201-1210.e1, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30987736

RESUMO

OBJECTIVE: To prospectively evaluate the association between female sleep patterns, shift work, and fecundability. DESIGN: Web-based preconception cohort study, Pregnancy Study Online (PRESTO). SETTING: Not applicable. PATIENT(S): North American Women aged 21-45 years attempting pregnancy. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): At baseline, self-reported average sleep duration per 24-hour period in the previous month, the frequency of trouble sleeping within the last 2 weeks (as measured by the Major Depression Inventory), and shift work patterns. Pregnancy status determined by follow-up questionnaires completed every 8 weeks for up to 12 months or until conception. RESULT(S): The analyses were restricted to 6,873 women attempting pregnancy for ≤6 months at enrollment from June 2013 through September 2018. We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs), adjusting for potential confounders. Relative to 8 hours of sleep per day, FRs for <6, 6, 7, and ≥9 hours of sleep/day were 0.89 (95% CI, 0.75-1.06), 0.95 (95% CI, 0.86-1.04), 0.99 (95% CI, 0.92-1.06), and 0.96 (95% CI, 0.84-1.10), respectively. Compared with no trouble sleeping, FRs for trouble sleeping <50% of the time or trouble sleeping >50% of the time were 0.93 (95% CI, 0.88-1.00) and 0.87 (95% CI, 0.79-0.95), respectively. The results were slightly stronger among women with higher depressive symptoms and perceived stress levels. There was no association between shift work and fecundability. CONCLUSION(S): Trouble sleeping at night was associated with modestly reduced fecundability. A weaker inverse association was observed between shorter sleep duration and fecundability.


Assuntos
Fertilidade , Infertilidade Feminina/fisiopatologia , Admissão e Escalonamento de Pessoal , Privação do Sono/fisiopatologia , Transtornos do Sono do Ritmo Circadiano/fisiopatologia , Sono , Tempo para Engravidar , Adulto , Feminino , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/epidemiologia , Pessoa de Meia-Idade , América do Norte/epidemiologia , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Privação do Sono/diagnóstico , Privação do Sono/epidemiologia , Transtornos do Sono do Ritmo Circadiano/diagnóstico , Transtornos do Sono do Ritmo Circadiano/epidemiologia , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
8.
Vet Clin North Am Small Anim Pract ; 49(4): 687-702, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30961995

RESUMO

"In North America, with the exceptions of Bartonella henselae and Cytauxzoon felis, feline vector-borne diseases (FVBDs) have been minimally studied in domestic cats. Cats can be infected with many of the same vector-borne pathogens that infect dogs. Nonspecific clinical signs linked to FVBDs and low prevalence of certain vector-borne pathogens contribute to a limited awareness of FVBDs in sick cats. As clinicians become informed about FVBDs and as vector-borne disease diagnostics are routinely applied to evaluate sick cats, we will gain a stronger understanding of vector-borne pathogens in cats. This article focuses on recent findings related to FVBDs."


Assuntos
Vetores Artrópodes/microbiologia , Doenças do Gato/transmissão , Animais , Vetores Artrópodes/parasitologia , Doenças do Gato/epidemiologia , Doenças do Gato/microbiologia , Doenças do Gato/parasitologia , Gatos , América do Norte/epidemiologia
9.
Methods Mol Biol ; 1969: 205-215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30877679

RESUMO

Meningococcal Antigen Typing System (MATS) is the combination of a sandwich ELISA (Enzyme Linked Immunosorbent Assay) developed to estimate the level of expression and immunoreactivity of the antigen components (fHbp, NHBA, and NadA) of the 4CMenB vaccine (Bexsero, GSK Vaccines) in circulating, serogroup B meningococcal (MenB) strains, with the molecular typing of PorA, the main antigenic component in the outer membrane vesicles (OMV). MATS has been proven to be a good surrogate of the accepted correlate of protection for meningococcus (hSBA), thus providing a quick, conservative and reproducible method to assess vaccine coverage. The method has been successfully transferred and standardized in several public health laboratories across Europe, North America, and Australia and used to screen thousands of isolates all over the world. Here we describe the sandwich ELISA method applied to assess the expression and cross-reactivity of fHbp, NHBA, and NadA in MenB isolates.


Assuntos
Antígenos de Bactérias/análise , Ensaio de Imunoadsorção Enzimática/métodos , Infecções Meningocócicas/prevenção & controle , Vacinas Meningocócicas/imunologia , Neisseria meningitidis Sorogrupo B/imunologia , Antígenos de Bactérias/imunologia , Austrália/epidemiologia , Reações Cruzadas , Europa (Continente)/epidemiologia , Humanos , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/imunologia , Infecções Meningocócicas/microbiologia , Vacinas Meningocócicas/administração & dosagem , América do Norte/epidemiologia , Vacinação
10.
Artigo em Inglês | MEDLINE | ID: mdl-30889810

RESUMO

Epidemiological studies consistently show an association between wildfire-related smoke exposure and adverse respiratory health. We conducted a systematic review of evidence in published literature pertaining to heterogeneity of respiratory effects from this exposure in North America. We calculated the within-study ratio of relative risks (RRR) and 95% confidence intervals (CI) to examine heterogeneity of effect by population subgroup, and then summarized the RRRs using meta-analysis. We found evidence of a greater effect of wildfire smoke on respiratory health among females relative to males for asthma (RRR: 1.035, 95% CI: 1.013, 1.057) and chronic obstructive pulmonary disease (RRR: 1.018, 95% CI: 1.003, 1.032). There was evidence of a lower relative risk for all respiratory outcomes among youth compared to adults (RRR: 0.976, 95% CI: 0.963, 0.989). We also found wildfire smoke effects stratified by income, race, education, health behaviors, access to care, housing occupancy, geographic region, and urban/rural status. However, data were insufficient to quantitatively evaluate effect modification by these characteristics. While we found evidence that certain demographic subgroups of the population are more susceptible to respiratory health outcomes from wildfire smoke, it is unclear whether this information can be used to inform policy aimed to reduce health impact of wildfires.


Assuntos
Exposição Ambiental/efeitos adversos , Doenças Respiratórias/etiologia , Fumaça/efeitos adversos , Incêndios Florestais , Feminino , Humanos , Masculino , América do Norte/epidemiologia , Doenças Respiratórias/epidemiologia , Risco , População Rural , Fatores Sexuais
11.
Drug Alcohol Depend ; 197: 168-182, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30831429

RESUMO

BACKGROUND: Opioid use disorder is a major health concern in North America. Currently, buprenorphine is one of the most common pharmacological interventions used to treat opioid use disorder. Despite increasing prevalence of opioid use disorder among females, little is known about sex considerations in relation to treatment with buprenorphine. METHODS: CINAHL, PsycINFO, EMBASE, PubMed/MEDLINE and Cochrane Central were searched for randomized controlled trials examining buprenorphine maintenance versus other medication-assisted treatment, placebo, or withdrawal management to determine if there were any sex differences in treatment outcomes reported. RESULTS: This review included 25 studies and found that only 52% included information related to sex differences in treatment outcomes or discussed any sex considerations in their studies. Of the 6,466 patients represented by these studies, only 26% were female. Of the studies conducting sex-specific analyses, seven studies examined treatment retention, five examined opioid use, two examined other substance use and one examined sexual risk behaviours. However, due to mixed findings, small sample sizes, and inability to conduct meta-analyses, no conclusive statements can be made about sex differences in these outcomes. None of the studies described sex differences in quality of life, legal involvement or mental and physical health. CONCLUSIONS: Low numbers of females have been included in randomized controlled trials examining buprenorphine compared to males. While sex differences in treatment outcomes were identified in this review, further research is needed in order to add to these findings. Future studies should include greater numbers of female participants and conduct sex-specific analyses.


Assuntos
Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Caracteres Sexuais , Ensaios Clínicos como Assunto/métodos , Feminino , Humanos , Masculino , Metadona/uso terapêutico , América do Norte/epidemiologia , Tratamento de Substituição de Opiáceos/psicologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Qualidade de Vida/psicologia , Resultado do Tratamento
12.
Virulence ; 10(1): 222-233, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30898028

RESUMO

The genus Coccidioides consists of two species: C. immitis and C. posadasii. Prior to 2000, all disease was thought to be caused by a single species, C. immitis. The organism grows in arid to semiarid alkaline soils throughout western North America and into Central and South America. Regions in the United States, with highest prevalence of disease, include California, Arizona, and Texas. The Mexican states of Baja California, Coahuila, Sonora, and Neuvo Leon currently have the highest skin test positive results. Central America contains isolated endemic areas in Guatemala and Honduras. South America has isolated regions of high endemicity including areas of Colombia, Venezuela, Argentina, Paraguay, and Brazil. Although approximately 15,000 cases per year are reported in the United States, actual disease burden is estimated to be in the hundreds of thousands, as only California and Arizona have dedicated public health outreach, and report and track disease reliably. In this review, we survey genomics, epidemiology, ecology, and summarize aspects of disease, diagnosis, prevention, and treatment.


Assuntos
Coccidioides/patogenicidade , Coccidioidomicose/epidemiologia , Clima Desértico , Animais , América Central/epidemiologia , Coccidioides/genética , Coccidioides/isolamento & purificação , Coccidioidomicose/diagnóstico , Coccidioidomicose/tratamento farmacológico , Ecologia , Genômica , Humanos , América do Norte/epidemiologia , América do Sul/epidemiologia
13.
Viruses ; 11(2)2019 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-30791586

RESUMO

Bats are a unique group of mammals of the order Chiroptera. They are highly diversified and are the group of mammals with the second largest number of species. Such highly diversified cell types and receptors facilitate them to be potential hosts of a large variety of viruses. Bats are the only group of mammals capable of sustained flight, which enables them to disseminate the viruses they harbor and enhance the chance of interspecies transmission. This article aims at reviewing the various aspects of the global epidemiology of bat coronaviruses (CoVs). Before the SARS epidemic, bats were not known to be hosts for CoVs. In the last 15 years, bats have been found to be hosts of >30 CoVs with complete genomes sequenced, and many more if those without genome sequences are included. Among the four CoV genera, only alphaCoVs and betaCoVs have been found in bats. As a whole, both alphaCoVs and betaCoVs have been detected from bats in Asia, Europe, Africa, North and South America and Australasia; but alphaCoVs seem to be more widespread than betaCoVs, and their detection rate is also higher. For betaCoVs, only those from subgenera Sarbecovirus, Merbecovirus, Nobecovirus and Hibecovirus have been detected in bats. Most notably, horseshoe bats are the reservoir of SARS-CoV, and several betaCoVs from subgenus Merbecovirus are closely related to MERS-CoV. In addition to the interactions among various bat species themselves, bat⁻animal and bat⁻human interactions, such as the presence of live bats in wildlife wet markets and restaurants in Southern China, are important for interspecies transmission of CoVs and may lead to devastating global outbreaks.


Assuntos
Quirópteros/virologia , Infecções por Coronavirus/veterinária , Coronavirus/genética , Reservatórios de Doenças/virologia , Evolução Molecular , África/epidemiologia , Animais , Ásia/epidemiologia , Australásia/epidemiologia , China/epidemiologia , Coronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Europa (Continente)/epidemiologia , Genoma Viral , Saúde Global , Humanos , América do Norte/epidemiologia , Filogenia , Filogeografia , América do Sul/epidemiologia
14.
PLoS Med ; 16(2): e1002744, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30742624

RESUMO

BACKGROUND: Maternal obesity and excessive gestational weight gain may have persistent effects on offspring fat development. However, it remains unclear whether these effects differ by severity of obesity, and whether these effects are restricted to the extremes of maternal body mass index (BMI) and gestational weight gain. We aimed to assess the separate and combined associations of maternal BMI and gestational weight gain with the risk of overweight/obesity throughout childhood, and their population impact. METHODS AND FINDINGS: We conducted an individual participant data meta-analysis of data from 162,129 mothers and their children from 37 pregnancy and birth cohort studies from Europe, North America, and Australia. We assessed the individual and combined associations of maternal pre-pregnancy BMI and gestational weight gain, both in clinical categories and across their full ranges, with the risks of overweight/obesity in early (2.0-5.0 years), mid (5.0-10.0 years) and late childhood (10.0-18.0 years), using multilevel binary logistic regression models with a random intercept at cohort level adjusted for maternal sociodemographic and lifestyle-related characteristics. We observed that higher maternal pre-pregnancy BMI and gestational weight gain both in clinical categories and across their full ranges were associated with higher risks of childhood overweight/obesity, with the strongest effects in late childhood (odds ratios [ORs] for overweight/obesity in early, mid, and late childhood, respectively: OR 1.66 [95% CI: 1.56, 1.78], OR 1.91 [95% CI: 1.85, 1.98], and OR 2.28 [95% CI: 2.08, 2.50] for maternal overweight; OR 2.43 [95% CI: 2.24, 2.64], OR 3.12 [95% CI: 2.98, 3.27], and OR 4.47 [95% CI: 3.99, 5.23] for maternal obesity; and OR 1.39 [95% CI: 1.30, 1.49], OR 1.55 [95% CI: 1.49, 1.60], and OR 1.72 [95% CI: 1.56, 1.91] for excessive gestational weight gain). The proportions of childhood overweight/obesity prevalence attributable to maternal overweight, maternal obesity, and excessive gestational weight gain ranged from 10.2% to 21.6%. Relative to the effect of maternal BMI, excessive gestational weight gain only slightly increased the risk of childhood overweight/obesity within each clinical BMI category (p-values for interactions of maternal BMI with gestational weight gain: p = 0.038, p < 0.001, and p = 0.637 in early, mid, and late childhood, respectively). Limitations of this study include the self-report of maternal BMI and gestational weight gain for some of the cohorts, and the potential of residual confounding. Also, as this study only included participants from Europe, North America, and Australia, results need to be interpreted with caution with respect to other populations. CONCLUSIONS: In this study, higher maternal pre-pregnancy BMI and gestational weight gain were associated with an increased risk of childhood overweight/obesity, with the strongest effects at later ages. The additional effect of gestational weight gain in women who are overweight or obese before pregnancy is small. Given the large population impact, future intervention trials aiming to reduce the prevalence of childhood overweight and obesity should focus on maternal weight status before pregnancy, in addition to weight gain during pregnancy.


Assuntos
Índice de Massa Corporal , Análise de Dados , Ganho de Peso na Gestação/fisiologia , Obesidade Pediátrica/epidemiologia , Austrália/epidemiologia , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Humanos , América do Norte/epidemiologia , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Obesidade Pediátrica/diagnóstico , Gravidez , Fatores de Risco
15.
BMC Musculoskelet Disord ; 20(1): 80, 2019 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-30764793

RESUMO

BACKGROUND: Hypophosphatasia (HPP) is a rare, systemic disease caused by mutation(s) within the ALPL gene encoding tissue-nonspecific alkaline phosphatase (ALP). HPP has a heterogeneous presentation, which coupled with its rarity, often leads to missed/delayed diagnosis and an incomplete understanding of its natural history. To better understand the epidemiology and clinical course of HPP, including timing of diagnosis after first reported manifestation, we present baseline data for patients enrolled in the Global HPP Registry. METHODS: Data were analyzed from patients with an HPP diagnosis confirmed by low serum ALP activity and/or an ALPL pathogenic variant, regardless of prior or current treatment, according to age at enrollment (children: < 18 y; adult: ≥18 y). All analyses were descriptive. RESULTS: Of 269 patients from 11 countries enrolled January 2015-September 2017, 121 (45.0%) were children and 148 (55.0%) were adults. The majority of children and adults were female (61.2 and 73.0%, respectively) and white (57.7 and 90.0%, respectively). Children had a median (min, max) age at earliest reported HPP manifestation of 7.2 months (- 2.3 mo, 16.0 y), which was > 12 months before diagnosis at age 20.4 months (- 0.2 mo, 16.0 y). In adults, the earliest reported manifestation occurred at a median (min, max) age of 37.6 years (0.2 y, 75.2 y), which preceded age at diagnosis (47.5 years [0.2 y, 75.2 y]) by ~ 10 years. Premature loss of deciduous teeth (48.2%, age ≥ 6 mo), bone deformity (32.5%), and failure to thrive (26.7%) were most commonly reported in the HPP-related disease history of children. Pain (74.5%), orthopedic procedures and therapies (44.6%), and recurrent and poorly healing fractures (36.5%) were most commonly reported in the HPP-related disease history of adults. CONCLUSIONS: The Global HPP Registry represents the largest observational study of patients with HPP, capturing real world data. This analysis shows that diagnostic delay is common, reflecting limited awareness of HPP, and that HPP is associated with systemic manifestations across all ages. Many patients diagnosed in adulthood had HPP manifestations in childhood, highlighting the importance of taking thorough medical histories to ensure timely diagnosis. TRIAL REGISTRATION: Clinicaltrials.gov : NCT02306720 , December 2014; ENCePP.eu: EUPAS13526 , May 2016 (retrospectively registered).


Assuntos
Diagnóstico Tardio , Hipofosfatasia/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Fosfatase Alcalina/genética , Criança , Pré-Escolar , Europa (Continente)/epidemiologia , Feminino , Predisposição Genética para Doença , Humanos , Hipofosfatasia/tratamento farmacológico , Hipofosfatasia/epidemiologia , Hipofosfatasia/genética , Lactente , Japão/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Mutação , América do Norte/epidemiologia , Fenótipo , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Sistema de Registros , Fatores de Tempo , Adulto Jovem
16.
Can J Cardiol ; 35(2): 199-207, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30760427

RESUMO

BACKGROUND: Several clinical and procedural factors determine outcomes after transcatheter aortic valve replacement (TAVR), but data are scarce on the impact of post-TAVR discharge disposition on long-term outcomes. We sought to analyse whether discharge location after TAVR is associated with 1-year outcomes in women undergoing contemporary TAVR. METHODS: The Women's INternational Transcatheter Aortic Valve Implantation (WIN-TAVI) registry is the first all-female TAVR registry to study the safety and performance of contemporary TAVR in women (n = 1019). Information on discharge location was available in 817 patients (80.2%). We compared women discharged home vs those discharged to another location (nursing home, rehabilitation, or other hospital). One-year outcomes were adjusted using multivariable Cox regression methods with discharge home as the reference group. RESULTS: Of the study subjects, 75.2% (n = 614) were discharged home and 24.8% (n = 203) to another location. Women discharged to other locations were older with a greater prevalence of severe lung disease requiring home oxygen and renal failure on dialysis but were less frequently considered frail or at high surgical risk compared with women discharged home. After multivariable adjustment, non-home discharge was associated with greater hazard for 1-year Valve Academic Research Consortium 2 efficacy (21.3% vs 10.8%, hazards ratio [HR] 1.9, 95% confidence interval [CI] 1.2-2.9) and safety endpoints (31.5% vs 15.2%, HR 2.1, 95% CI 1.5-3.0), cardiovascular death (12.7% vs 5.5%, HR 2.0, 95% CI 1.1-3.6), and stroke (6.5% vs 0.8%, HR 8.5, 95% CI 2.9-25.6). CONCLUSIONS: In women undergoing contemporary TAVR, discharge disposition significantly affects 1-year risk of outcomes even after adjustment for recorded baseline differences. This might suggest the necessity of considering additional factors beyond comorbidities in the TAVR decision-making process.


Assuntos
Estenose da Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Alta do Paciente/tendências , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Medição de Risco/métodos , Substituição da Valva Aórtica Transcateter/métodos , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , América do Norte/epidemiologia , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
BJOG ; 126(8): 984-995, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30786138

RESUMO

OBJECTIVE: To assess the separate and combined associations of maternal pre-pregnancy body mass index (BMI) and gestational weight gain with the risks of pregnancy complications and their population impact. DESIGN: Individual participant data meta-analysis of 39 cohorts. SETTING: Europe, North America, and Oceania. POPULATION: 265 270 births. METHODS: Information on maternal pre-pregnancy BMI, gestational weight gain, and pregnancy complications was obtained. Multilevel binary logistic regression models were used. MAIN OUTCOME MEASURES: Gestational hypertension, pre-eclampsia, gestational diabetes, preterm birth, small and large for gestational age at birth. RESULTS: Higher maternal pre-pregnancy BMI and gestational weight gain were, across their full ranges, associated with higher risks of gestational hypertensive disorders, gestational diabetes, and large for gestational age at birth. Preterm birth risk was higher at lower and higher BMI and weight gain. Compared with normal weight mothers with medium gestational weight gain, obese mothers with high gestational weight gain had the highest risk of any pregnancy complication (odds ratio 2.51, 95% CI 2.31- 2.74). We estimated that 23.9% of any pregnancy complication was attributable to maternal overweight/obesity and 31.6% of large for gestational age infants was attributable to excessive gestational weight gain. CONCLUSIONS: Maternal pre-pregnancy BMI and gestational weight gain are, across their full ranges, associated with risks of pregnancy complications. Obese mothers with high gestational weight gain are at the highest risk of pregnancy complications. Promoting a healthy pre-pregnancy BMI and gestational weight gain may reduce the burden of pregnancy complications and ultimately the risk of maternal and neonatal morbidity. TWEETABLE ABSTRACT: Promoting a healthy body mass index and gestational weight gain might reduce the population burden of pregnancy complications.


Assuntos
Índice de Massa Corporal , Ganho de Peso na Gestação/fisiologia , Sobrepeso/complicações , Complicações na Gravidez/etiologia , Adulto , Austrália/epidemiologia , Peso ao Nascer , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , América do Norte/epidemiologia , Razão de Chances , Gravidez , Complicações na Gravidez/epidemiologia , Fatores de Risco
18.
Drugs Aging ; 36(4): 387-393, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30737759

RESUMO

INTRODUCTION: Angiotensin-converting enzyme inhibitors (ACEI) may have several pleiotropic effects, but the literature regarding a possible relationship between ACEI use and frailty is limited. We investigated whether ACEI use is associated with lower risk of frailty in a cohort of North American individuals. METHODS: Data from the Osteoarthritis Initiative, a cohort study with 8 years of follow-up including community-dwelling adults with knee osteoarthritis or at high risk for this condition, were analyzed. ACEI use was defined through self-reported information and confirmed by a trained interviewer. Frailty was defined using the Study of Osteoporotic Fracture (SOF) index as the presence of at least two of the following criteria: (1) weight loss ≥ 5% between baseline and any subsequent follow-up visit; (2) inability to do five chair stands; and (3) low energy level according to the SOF definition. A multivariable Poisson regression analysis was used to assess the association between ACEI use at baseline and incident frailty. The data were reported as relative risks (RRs) with their 95% confidence intervals (CIs). RESULTS: The final sample consisted of 4295 adults (mean age 61.2 years, females 58.1%). At baseline, 551 participants (12.8%) used ACEI. After adjusting for 15 potential confounders, the use of ACEI was associated with a lower risk of frailty (RR 0.72; 95% CI 0.53-0.99). The adjustment for the propensity score substantially confirmed these findings (RR 0.75; 95% CI 0.54-0.996). CONCLUSION: ACEI use may be associated with a reduced risk of frailty in individuals with/at risk of knee osteoarthritis, suggesting a potential role for ACI in the prevention of frailty.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Fragilidade/epidemiologia , Idoso , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Estudos de Coortes , Feminino , Fragilidade/prevenção & controle , Humanos , Vida Independente , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Osteoartrite do Joelho/tratamento farmacológico , Osteoartrite do Joelho/fisiopatologia , Pontuação de Propensão , Risco , Autorrelato , Perda de Peso
19.
BMC Infect Dis ; 19(1): 117, 2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30727970

RESUMO

BACKGROUND: In the spring of 1918, the "War to End All Wars", which would ultimately claim more than 37 million lives, had entered into its final year and would change the global political and economic landscape forever. At the same time, a new global threat was emerging and would become one of the most devastating global health crises in recorded history. MAIN TEXT: The 1918 H1N1 pandemic virus spread across Europe, North America, and Asia over a 12-month period resulting in an estimated 500 million infections and 50-100 million deaths worldwide, of which ~ 50% of these occurred within the fall of 1918 (Emerg Infect Dis 12:15-22, 2006, Bull Hist Med 76:105-115, 2002). However, the molecular factors that contributed to the emergence of, and subsequent public health catastrophe associated with, the 1918 pandemic virus remained largely unknown until 2005, when the characterization of the reconstructed pandemic virus was announced heralding a new era of advanced molecular investigations (Science 310:77-80, 2005). In the century following the emergence of the 1918 pandemic virus we have landed on the Moon, developed the electronic computer (and a global internet), and have eradicated smallpox. In contrast, we have a largely remedial knowledge and understanding of one of the greatest scourges in recorded history. CONCLUSION: Here, we reflect on the 1918 influenza pandemic, including its emergence and subsequent rapid global spread. In addition, we discuss the pathophysiology associated with the 1918 virus and its predilection for the young and healthy, the rise of influenza therapeutic research following the pandemic, and, finally, our level of preparedness for future pandemics.


Assuntos
Antivirais/farmacologia , Vírus da Influenza A Subtipo H1N1/patogenicidade , Influenza Humana/epidemiologia , Influenza Humana/etiologia , Ásia/epidemiologia , Surtos de Doenças , Europa (Continente)/epidemiologia , Saúde Global , História do Século XX , Humanos , Vacinas contra Influenza/farmacologia , Influenza Humana/história , América do Norte/epidemiologia , Saúde Pública
20.
J Cardiovasc Comput Tomogr ; 13(2): 99-104, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30745132

RESUMO

INTRODUCTION: Non-statin therapy (NST) is used as second-line treatment when statin monotherapy is inadequate or poorly tolerated. OBJECTIVE: To determine the association of NST with plaque composition, alone or in combination with statins, in patients undergoing coronary computed tomography angiography (coronary CTA). METHODS: From the multicenter CONFIRM registry, we analyzed individuals who underwent coronary CTA with known lipid-lowering therapy status and without prior coronary artery disease at baseline. We created a propensity score for being on NST, followed by stepwise multivariate linear regression, adjusting for the propensity score as well as risk factors, to determine the association between NST and the number of coronary artery segments with each plaque type (non-calcified (NCP), partially calcified (PCP) or calcified (CP)) and segment stenosis score (SSS). RESULTS: Of the 27,125 subjects in CONFIRM, 4,945 met the inclusion criteria; 371 (7.5%) took NST. At baseline, patients on NST had more prevalent risk factors and were more likely to be on concomitant cardiac medications. After multivariate and propensity score adjustment, NST was not associated with plaque composition: NCP (0.07 increase, 95% CI: -0.05, 0.20; p = 0.26), PCP (0.10 increase, 95% CI: -0.10, 0.31; p = 0.33), CP (0.18 increase, 95% CI: -0.10, 0.46; p = 0.21) or SSS (0.45 increase, 95% CI: -0.02,0.93; p = 0.06). The absence of an effect of NST on plaque type was not modified by statin use (p for interaction > 0.05 for all). CONCLUSION: In this cross-sectional study, non-statin therapy was not associated with differences in plaque composition as assessed by coronary CTA.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Dislipidemias/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Lipídeos/sangue , Placa Aterosclerótica , Idoso , Ásia/epidemiologia , Biomarcadores/sangue , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/prevenção & controle , Estenose Coronária/epidemiologia , Estenose Coronária/patologia , Estenose Coronária/prevenção & controle , Vasos Coronários/patologia , Estudos Transversais , Quimioterapia Combinada , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Valor Preditivo dos Testes , Prevalência , Sistema de Registros , Fatores de Risco
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