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1.
Prev Chronic Dis ; 17: E124, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-33034555

RESUMO

Miami-Dade County zip code-level (N = 91 zip codes) coronavirus disease 2019 (COVID-19) cases (N = 89,556 as of July 21, 2020) reported from the Florida Department of Health were used to estimate rates of COVID-19 per 1,000 population at the census block group level (N = 1,594 study block groups). To identify associations between rates of COVID-19 infections and multidimensional indexes of social determinants of health (SDOH) across Miami-Dade County, Florida, I applied a global model (ordinary least squares) and a local regression model (geographically weighted regression). Findings indicated that a social disadvantage index positively affected COVID-19 infection rates, whereas a socioeconomic status and opportunity index and a convergence of vulnerability index had an inverse but significant connection to COVID-19 infection rates over the study area. Rates of COVID-19 infections were localized to specific geographic areas and ranged from 0 to 60.75 per 1,000 population per square mile.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Classe Social , Determinantes Sociais da Saúde , Florida/epidemiologia , Humanos , Pandemias , Análise de Regressão , Fatores de Risco , Fatores Socioeconômicos
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 793-797, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018105

RESUMO

At present, the vast majority of human subjects with neurological disease are still diagnosed through in-person assessments and qualitative analysis of patient data. In this paper, we propose to use Topological Data Analysis (TDA) together with machine learning tools to automate the process of Parkinson's disease classification and severity assessment. An automated, stable, and accurate method to evaluate Parkinson's would be significant in streamlining diagnoses of patients and providing families more time for corrective measures. We propose a methodology which incorporates TDA into analyzing Parkinson's disease postural shifts data through the representation of persistence images. Studying the topology of a system has proven to be invariant to small changes in data and has been shown to perform well in discrimination tasks. The contributions of the paper are twofold. We propose a method to 1) classify healthy patients from those afflicted by disease and 2) diagnose the severity of disease. We explore the use of the proposed method in an application involving a Parkinson's disease dataset comprised of healthy-elderly, healthy-young and Parkinson's disease patients. Our code is available at https://github.com/itsmeafra/Sublevel-Set-TDA.


Assuntos
Doença de Parkinson , Idoso , Humanos , Aprendizado de Máquina , Análise de Regressão
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3011-3014, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018639

RESUMO

The estimation of the visual stimulus-based reaction time (RT) using subtle and complex information from the brain signals is still a challenge, as the behavioral response during perceptual decision making varies inordinately across trials. Several investigations have tried to formulate the estimation based on electroencephalogram (EEG) signals. However, these studies are subject-specific and limited to regression-based analysis. In this paper, for the first time to our knowledge, a generalized model is introduced to estimate RT using single-trial EEG features for a simple visual reaction task, considering both regression and classification-based approaches. With the regression-based approach, we could predict RT with a root mean square error of 111.2 ms and a correlation coefficient of 0.74. A binary and a 3-class classifier model were trained, based on the magnitude of RT, for the classification approach. Accuracy of 79% and 72% were achieved for the binary and the 3-class classification, respectively. Limiting our study to only high and low RT groups, the model classified the two groups with an accuracy of 95%. Relevant EEG channels were evaluated to localize the part of the brain significantly responsible for RT estimation, followed by the isolation of important features.Clinical relevance- Electroencephalogram (EEG) signals can be used in Brain-computer interfaces (BCIs), enabling people with neuromuscular disorders like brainstem stroke, amyotrophic lateral sclerosis, and spinal cord injury to communicate with assistive devices. However, advancements regarding EEG signal analysis and interpretation are far from adequate, and this study is a step forward.


Assuntos
Interfaces Cérebro-Computador , Eletroencefalografia , Encéfalo , Tempo de Reação , Análise de Regressão
4.
Nat Commun ; 11(1): 4968, 2020 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-33009413

RESUMO

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread to become a worldwide emergency. Early identification of patients at risk of progression may facilitate more individually aligned treatment plans and optimized utilization of medical resource. Here we conducted a multicenter retrospective study involving patients with moderate COVID-19 pneumonia to investigate the utility of chest computed tomography (CT) and clinical characteristics to risk-stratify the patients. Our results show that CT severity score is associated with inflammatory levels and that older age, higher neutrophil-to-lymphocyte ratio (NLR), and CT severity score on admission are independent risk factors for short-term progression. The nomogram based on these risk factors shows good calibration and discrimination in the derivation and validation cohorts. These findings have implications for predicting the progression risk of COVID-19 pneumonia patients at the time of admission. CT examination may help risk-stratification and guide the timing of admission.


Assuntos
Infecções por Coronavirus/diagnóstico , Progressão da Doença , Pneumonia Viral/diagnóstico , Pneumonia , Tomografia Computadorizada por Raios X/métodos , Adulto , Betacoronavirus , China , Técnicas de Laboratório Clínico , Coinfecção , Infecções por Coronavirus/patologia , Infecções por Coronavirus/fisiopatologia , Feminino , Hospitalização , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Pandemias , Pneumonia Viral/patologia , Pneumonia Viral/fisiopatologia , Análise de Regressão , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
5.
Prog Orthod ; 21(1): 38, 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-33043408

RESUMO

BACKGROUND AND AIM: Determination of skeletal maturity and bone age from cervical vertebrae has been well documented. Most methods described use subjective evaluation of morphological characteristics of cervical vertebrae and may be prone to variability and error. A few objective methods have also been developed, specific for certain populations and genders. The aim of this study was to establish and validate an objective method to determine cervical vertebral bone age from lateral cephalometric radiographs, for Asian South Indian patients of both genders. METHODS: Ninety boys and 90 girls between 9 and 15 years of age were recruited, and their lateral cephalograms were taken. Using measurements made from the third and fourth cervical vertebrae, a formula to determine cervical vertebral bone age was derived using stepwise regression analysis. To validate the formula, a separate sample of 30 boys and 30 girls was chosen, and hand-wrist radiographs and lateral cephalograms were obtained. Cervical vertebral bone age (CVBA) was determined by applying the formula derived. Bone age was also calculated using the Tanner-Whitehouse 3 method. The bone ages determined by both methods were compared to each other and chronological age, using one-way ANOVA, Tukey's post hoc analysis, and Pearson's correlation coefficient. RESULTS: The formulae derived in the current study to determine CVBA differed for both genders. No statistically significant difference was found between CVBA, bone age derived by the Tanner-Whitehouse 3 method, and chronological age for both boys (p value = 0.425) and girls (p value = 0.995). A moderate to strong positive correlation was found between CVBA, bone age, and chronological age. CONCLUSION: The formulae derived in this study were validated and are reliable for objectively determining cervical vertebral bone age and skeletal maturation from lateral cephalograms for Asian South Indian patients of both genders.


Assuntos
Determinação da Idade pelo Esqueleto , Vértebras Cervicais , Adolescente , Cefalometria , Vértebras Cervicais/diagnóstico por imagem , Criança , Feminino , Humanos , Masculino , Análise de Regressão , Reprodutibilidade dos Testes
6.
An. psicol ; 36(2): 210-219, mayo 2020. tab
Artigo em Inglês | IBECS | ID: ibc-192057

RESUMO

Sexting is a recent phenomenon in which people send and receive photos, videos and/or text messages of sexual nature via smartphones or similar devices. Similar to other developed countries, it is becoming an increasingly popular practice among teenagers in Spain. Provided it has appeared very recently, scarce research has focused on examining in-depth factors involved in its initiation and maintenance. Therefore, the two main aims of this study were to determine its prevalence and to analyse the explanatory variables of the sexting behaviours. The sample consisted of 784 Spanish adolescents (52% boys and 48% girls) between 12 and 18 years of age (M = 14.44; SD = 1.61). The results showed that 24.4% have practised sexting at some time, with an average of 2.32 people (SD = 2.70). The regression analysis revealed that positive attitudes towards sexting, level of impulsivity, age, being male and having a partner are variables that predict engagement in sexting. These results are very important for designing and implementing preventive strategies that emphasise the responsible use of ICTs and social networks


El sexting es un fenómeno que consiste en el envío y la recepción de fotos, videos y/o mensajes de texto de naturaleza sexual a través de smartphones. Como en todos los demás países desarrollados, se está convirtiendo en una práctica cada vez más popular entre los adolescentes de España. Al tratarse de un fenómeno muy reciente todavía no existen muchos trabajos que hayan estudiado con profundidad su entidad y sus factores implicados. Por tanto, los dos objetivos de este estudio fueron determinar la prevalencia y analizar las variables explicativas del inicio y del mantenimiento de las conductas de sexting. La muestra estuvo formada por 784 adolescentes españoles (52% chicos y 48% chicas) con edades comprendidas entre los 12 y los 18 años (M = 14.44; DT = 1.61). Los resultados indican que el 24.4% ha practicado sexting en alguna ocasión, realizando esta conducta con una media de 2.32 personas (DT = 2.70). El análisis de regresión reveló que las actitudes positivas hacia el sexting, el nivel de impulsividad, la edad, ser hombre y el mantener una relación de pareja son variables que predicen la práctica del sexting. Estos resultados son muy importantes en la elaboración e implementación de estrategias preventivas que enfaticen el uso responsable de las TICS y las redes sociales


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Parceiros Sexuais , Envio de Mensagens de Texto , Comportamento Sexual/psicologia , Atitude , Motivação , Psicometria/instrumentação , Análise de Regressão , Escalas de Graduação Psiquiátrica/normas , Inquéritos e Questionários , Comportamento do Adolescente/psicologia
7.
An. psicol ; 36(2): 242-246, mayo 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192060

RESUMO

El objetivo de la investigación fue estudiar los hábitos de sueño y la salud psicológica de profesionales del sector sanitario, así como analizar las relaciones entre ambas variables. La muestra contó con 511 trabajadores de hospitales públicos de la Comunidad de Madrid. La salud psicológica fue evaluada con el Cuestionario GHQ-28; los hábitos de sueño a través del Cuestionario CHAS, además, se recogieron datos sociodemográficos como edad, sexo, puesto de trabajo, categoría profesional. Los resultados mostraron diferencias estadísticamente significativas en síntomas somáticos, salud psicológica y estabilidad en hábitos de sueño. Los análisis de regresión indicaron que calidad del sueño y somnolencia diurna son las variables más relacionadas con las dimensiones de salud, especialmente con la ansiedad/insomnio y síntomas somáticos. Estos los resultados ponen de manifiesto las diferencias entre hábitos de sueño y salud percibida en personal de enfermería y facultativos. En conclusión, la población sanitaria presenta mayor prevalencia en malestar psicológico, peor calidad de sueño e inestabilidad en las horas de sueño. Deterioro del sueño, somnolencia y síntomas somáticos son más frecuentes en personal de enfermería que en el resto de profesionales sanitarios


The aim was to study the sleep habits and the psychological health of professionals in the health sector, as well as to analyze the relationships between both variables. The sample consisted of 511 workers from public hospitals in the Community of Madrid. Psychological health was evaluated using the GHQ-28 Questionnaire; and sleep habits with the CHAS Questionnaire. In addition, sociodemographic data were collected, such as age, sex, job position, professional category. The results showed statistically significant differences in somatic symptoms, psychological health and stability in sleep habits. Regression analysis indicated that sleep quality and daytime sleepiness are the variables most related to health dimensions, especially with anxiety/insomnia and somatic symptoms. These results reveal the differences between sleep habits and perceived health in nursing staff and physicians. Finally, the health workers present a higher prevalence of psychological distress, and poor sleep quality and instability in sleep hours. Sleep impairment, somnolence and somatic symptoms are more frequent in nursing staff than in other health professionals


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Higiene do Sono/fisiologia , Pessoal de Saúde/psicologia , Saúde Mental , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/psicologia , Inquéritos e Questionários , Análise de Regressão , Recursos Humanos de Enfermagem/psicologia , Recursos Humanos de Enfermagem/estatística & dados numéricos
8.
An. psicol ; 36(2): 283-294, mayo 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-192065

RESUMO

Identificar factores instruccionales específicos relacionados con progresos en comprensión lectora es esencial para optimizar el aprendizaje y orientar la intervención, especialmente en contextos de desventaja socio-cultural o dificultades de aprendizaje. Este estudio pretende identificar patrones instruccionales de mediación eficaces en la explicación del progreso en comprensión. Se grabaron, transcribieron y analizaron sistemáticamente 82 sesiones-clase, y se registraron pautas de mediación relativas a diferentes procesos lectores. Los patrones de mediación fueron analizados mediante codificación y categorización del contenido con el programa Maxqdea-7. Fueron consideradas 19 categorías, que aglutinaron 178 unidades de información significativas (pautas/conductas de mediación). La muestra estuvo compuesta por 21 docentes y 821 estudiantes de tercero a octavo grado de Educación Básica de escuelas públicas de Chile ubicadas en contextos de-privados socialmente. El progreso lector se midió con la prueba estandarizada CL-PT, aplicada al principio y al final del curso escolar. Los resultados permitieron identificar pautas específicas de mediación significativas en la explicación del progreso, especialmente el patrón M_17 (Mediación del uso de estrategias para la activación e integración de conocimientos previos) explicaba el 26% de la varianza (r = .55, p < .01; R2ajustado = .26, F (1, 19) = 8.19, p = .01). Se discuten las implicaciones educativas de estos resultados


Identifying specific instructional factors related to progress in reading comprehension is essential to optimize learning and guide intervention, especially in contexts of sociocultural disadvantage or learning difficulties. This study aims to identify effective mediational instructional patterns in the explanation of progress in reading comprehension. Teaching guidelines were systematically recorded in relation to different reading processes. Eighty-two sessions were recorded, transcribed and analyzed by coding and categorizing the content of the sessions through the Maxqdea-7 program. Nineteen categories were considered, which comprised 178 significant units of information (mediation guidelines). The sample consisted of 21 teachers and 821 students from third to the eighth grade of public schools of Chile located in deprived contexts. Reading progress was measured with the standardized CL-PT test, which was applied at the beginning and end of the school year. The results have allowed identifying mediation patterns with a significant relevance in the explanation of reading progress, especially the pattern M_P17 (Mediation of the use of strategies for the activation and integration of previous knowledge) managed to explain 26% of the variance in the progress (r = .55, p < .01; R2adjusted = .26, F(1, 19) = 8.19, p = .01). The educational implications of these results are discussed


Assuntos
Humanos , Masculino , Feminino , Criança , Compreensão , Populações Vulneráveis , Leitura , Aprendizagem , Docentes/normas , Desempenho Acadêmico/psicologia , Estudantes/psicologia , Metacognição/fisiologia , Estudos Transversais , 25783 , Recursos Audiovisuais/normas , Ajustamento Social , Análise de Regressão , Desempenho Acadêmico/normas
9.
Infect Dis Poverty ; 9(1): 124, 2020 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-32867851

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) was confirmed in Brazil in February 2020. Since then, the disease has spread throughout the country, reaching the poorest areas. This study analyzes the relationship between COVID-19 and the population's living conditions. We aimed to identify social determinants related to the incidence, mortality, and case fatality rate of COVID-19 in Brazil, in 2020. METHODS: This is an ecological study evaluating the relationship between COVID-19 incidence, mortality, and case fatality rates and 49 social indicators of human development and social vulnerability. For the analysis, bivariate spatial correlation and multivariate and spatial regression models (spatial lag model and spatial error models) were used, considering a 95% confidence interval and a significance level of 5%. RESULTS: A total of 44.8% of municipalities registered confirmed cases of COVID-19 and 14.7% had deaths. We observed that 56.2% of municipalities with confirmed cases had very low human development (COVID-19 incidence rate: 59.00/100 000; mortality rate: 36.75/1 000 000), and 52.8% had very high vulnerability (COVID-19 incidence rate: 41.68/100 000; mortality rate: 27.46/1 000 000). The regression model showed 17 indicators associated with transmission of COVID-19 in Brazil. CONCLUSIONS: Although COVID-19 first arrived in the most developed and least vulnerable municipalities in Brazil, it has already reached locations that are farther from large urban centers, whose populations are exposed to a context of intense social vulnerability. Based on these findings, it is necessary to adopt measures that take local social aspects into account in order to contain the pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Determinantes Sociais da Saúde , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Intervalos de Confiança , Infecções por Coronavirus/mortalidade , Educação , Emprego , Humanos , Incidência , Renda , Longevidade , Análise Multivariada , Pandemias , Pneumonia Viral/mortalidade , Pobreza , Análise de Regressão , Saneamento , Esgotos , Condições Sociais , Análise Espacial , Abastecimento de Água/normas , Adulto Jovem
10.
PLoS One ; 15(9): e0239385, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32966315

RESUMO

Following its initial appearance in December 2019, coronavirus disease 2019 (COVID-19) quickly spread around the globe. Here, we evaluated the role of climate (temperature and precipitation), region-specific COVID-19 susceptibility (BCG vaccination factors, malaria incidence, and percentage of the population aged over 65 years), and human mobility (relative amounts of international visitors) in shaping the geographical patterns of COVID-19 case numbers across 1,020 countries/regions, and examined the sequential shift that occurred from December 2019 to June 30, 2020 in multiple drivers of the cumulative number of COVID-19 cases. Our regression model adequately explains the cumulative COVID-19 case numbers (per 1 million population). As the COVID-19 spread progressed, the explanatory power (R2) of the model increased, reaching > 70% in April 2020. Climate, host mobility, and host susceptibility to COVID-19 largely explained the variance among COVID-19 case numbers across locations; the relative importance of host mobility and that of host susceptibility to COVID-19 were both greater than that of climate. Notably, the relative importance of these factors changed over time; the number of days from outbreak onset drove COVID-19 spread in the early stage, then human mobility accelerated the pandemic, and lastly climate (temperature) propelled the phase following disease expansion. Our findings demonstrate that the COVID-19 pandemic is deterministically driven by climate suitability, cross-border human mobility, and region-specific COVID-19 susceptibility. The identification of these multiple drivers of the COVID-19 outbreak trajectory, based on mapping the spread of COVID-19, will contribute to a better understanding of the COVID-19 disease transmission risk and inform long-term preventative measures against this disease.


Assuntos
Betacoronavirus , Infecções por Coronavirus/transmissão , Pneumonia Viral/transmissão , Análise de Regressão , Clima , Doenças Transmissíveis Importadas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/etiologia , Suscetibilidade a Doenças , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Doença Relacionada a Viagens
11.
Nat Commun ; 11(1): 4809, 2020 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-32968055

RESUMO

Kinase inhibitors (KIs) represent an important class of anti-cancer drugs. Although cardiotoxicity is a serious adverse event associated with several KIs, the reasons remain poorly understood, and its prediction remains challenging. We obtain transcriptional profiles of human heart-derived primary cardiomyocyte like cell lines treated with a panel of 26 FDA-approved KIs and classify their effects on subcellular pathways and processes. Individual cardiotoxicity patient reports for these KIs, obtained from the FDA Adverse Event Reporting System, are used to compute relative risk scores. These are then combined with the cell line-derived transcriptomic datasets through elastic net regression analysis to identify a gene signature that can predict risk of cardiotoxicity. We also identify relationships between cardiotoxicity risk and structural/binding profiles of individual KIs. We conclude that acute transcriptomic changes in cell-based assays combined with drug substructures are predictive of KI-induced cardiotoxicity risk, and that they can be informative for future drug discovery.


Assuntos
Cardiotoxicidade/genética , Cardiotoxicidade/metabolismo , Perfilação da Expressão Gênica/métodos , Inibidores de Proteínas Quinases/efeitos adversos , Inibidores de Proteínas Quinases/farmacologia , Transcriptoma , Antineoplásicos/farmacologia , Cardiotoxicidade/tratamento farmacológico , Linhagem Celular , Relação Dose-Resposta a Droga , Aprovação de Drogas , Feminino , Expressão Gênica/efeitos dos fármacos , Humanos , Masculino , Miócitos Cardíacos/efeitos dos fármacos , Análise de Regressão , Medição de Risco , Fatores de Risco , Alinhamento de Sequência , Estados Unidos , United States Food and Drug Administration
12.
Medicine (Baltimore) ; 99(37): e22194, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925794

RESUMO

DNA methylation is an important epigenetic regulatory mechanism in esophageal carcinoma (EC) and is associated with genomic instability and carcinogenesis. In the present study, we aimed to identify tumor biomarkers for predicting prognosis of EC patients.We downloaded mRNA expression profiles and DNA methylation profiles associated with EC from the Gene Expression Omnibus database. Differentially expressed and differentially methylated genes between tumor tissues and adjacent normal tissue samples were identified. Functional enrichment analyses were performed, followed by the construction of protein-protein interaction networks. Data were validated based on methylation profiles from The Cancer Genome Atlas. Candidate genes were further verified according to survival analysis and Cox regression analysis.We uncovered multiple genes with differential expression or methylation in tumor samples compared with normal samples. After taking the intersection of 3 differential gene sets, we obtained a total of 232 overlapping genes. Functional enrichment analysis revealed that these genes are related to pathways such as "glutathione metabolism," "p53 signaling pathway," and "focal adhesion." Furthermore, 8 hub genes with inversed expression and methylation correlation were identified as candidate genes. The abnormal expression levels of MSN, PELI1, and MTHFD2 were correlated with overall survival times in EC patients (P < .05). Only MTHFD2 was significantly associated with a pathologic stage according to univariate analysis (P = .037) and multivariate analysis (P = .043).Our study identified several novel EC biomarkers with prognostic value by integrated analysis of transcriptomic data and methylation profiles. MTHFD2 could serve as an independent biomarker for predicting prognosis and pathological stages of EC.


Assuntos
Aminoidrolases/biossíntese , Neoplasias Esofágicas/genética , Neoplasias Esofágicas/patologia , Metilenotetra-Hidrofolato Desidrogenase (NADP)/biossíntese , Enzimas Multifuncionais/biossíntese , Biomarcadores Tumorais , Metilação de DNA , Bases de Dados Genéticas , Perfilação da Expressão Gênica , Genes Neoplásicos/fisiologia , Humanos , Prognóstico , Mapas de Interação de Proteínas , RNA Mensageiro , Análise de Regressão , Análise de Sobrevida
13.
PLoS One ; 15(9): e0239252, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941512

RESUMO

Until treatment and vaccine for coronavirus disease-2019 (COVID-19) becomes widely available, other methods of reducing infection rates should be explored. This study used a retrospective, observational analysis of deidentified tests performed at a national clinical laboratory to determine if circulating 25-hydroxyvitamin D (25(OH)D) levels are associated with severe acute respiratory disease coronavirus 2 (SARS-CoV-2) positivity rates. Over 190,000 patients from all 50 states with SARS-CoV-2 results performed mid-March through mid-June, 2020 and matching 25(OH)D results from the preceding 12 months were included. Residential zip code data was required to match with US Census data and perform analyses of race/ethnicity proportions and latitude. A total of 191,779 patients were included (median age, 54 years [interquartile range 40.4-64.7]; 68% female. The SARS-CoV-2 positivity rate was 9.3% (95% C.I. 9.2-9.5%) and the mean seasonally adjusted 25(OH)D was 31.7 (SD 11.7). The SARS-CoV-2 positivity rate was higher in the 39,190 patients with "deficient" 25(OH)D values (<20 ng/mL) (12.5%, 95% C.I. 12.2-12.8%) than in the 27,870 patients with "adequate" values (30-34 ng/mL) (8.1%, 95% C.I. 7.8-8.4%) and the 12,321 patients with values ≥55 ng/mL (5.9%, 95% C.I. 5.5-6.4%). The association between 25(OH)D levels and SARS-CoV-2 positivity was best fitted by the weighted second-order polynomial regression, which indicated strong correlation in the total population (R2 = 0.96) and in analyses stratified by all studied demographic factors. The association between lower SARS-CoV-2 positivity rates and higher circulating 25(OH)D levels remained significant in a multivariable logistic model adjusting for all included demographic factors (adjusted odds ratio 0.984 per ng/mL increment, 95% C.I. 0.983-0.986; p<0.001). SARS-CoV-2 positivity is strongly and inversely associated with circulating 25(OH)D levels, a relationship that persists across latitudes, races/ethnicities, both sexes, and age ranges. Our findings provide impetus to explore the role of vitamin D supplementation in reducing the risk for SARS-CoV-2 infection and COVID-19 disease.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/sangue , Pandemias , Pneumonia Viral/sangue , RNA Viral/sangue , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Adulto , Comorbidade , Grupos de Populações Continentais , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Grupos Étnicos , Feminino , Geografia Médica , Saúde Global , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Amplificação de Ácido Nucleico , Razão de Chances , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Análise de Regressão , Estudos Retrospectivos , Estações do Ano , Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia
14.
Eur Rev Med Pharmacol Sci ; 24(17): 9172-9181, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32965011

RESUMO

OBJECTIVE: Our objective was to find an association between exposure of a population to Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and mortality rate due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) across different countries worldwide. MATERIALS AND METHODS: To find the relationship between exposure to MERS-CoV and mortality rate due to SARS-CoV-2, we collected and analyzed data of three possible factors that may have resulted in an exposure of a population to MERS-CoV: (1) the number of Middle East Respiratory Syndrome (MERS) cases reported among 16 countries since 2012; (2) data of MERS-CoV seroprevalence in camels across 23 countries, as working with camels increase risk of exposure to MERS-CoV; (3) data of travel history of people from 51 countries to Saudi Arabia was collected on the assumption that travel to a country where MERS is endemic, such as, Saudi Arabia, could also lead to exposure to MERS-CoV. RESULTS: We found a significantly lower number of Coronavirus disease 2019 (COVID-19) deaths per million (deaths/M) of a population in countries that are likely to be exposed to MERS-CoV than otherwise (t-stat=3.686, p<0.01). In addition, the number of COVID-19 deaths/M of a population was significantly lower in countries that reported a higher seroprevalence of MERS-CoV in camels than otherwise (t-stat=4.5077, p<0.01). Regression analysis showed that increased travelling history to Saudi Arabia is likely to be associated with a lower mortality rate due to COVID-19. CONCLUSIONS: This study provides empirical evidence that a population that was at an increased risk of exposure to MERS-CoV had a significantly lower mortality rate due to SARS-CoV-2, which might be due to cross-protective immunity against SARS-CoV-2 in that population because of an earlier exposure to MERS-CoV.


Assuntos
Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Prevalência , Análise de Regressão , Estudos Soroepidemiológicos , Taxa de Sobrevida
15.
Eur Rev Med Pharmacol Sci ; 24(17): 9216-9225, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32965017

RESUMO

OBJECTIVE: The weather allied conditions have an impact on air, water, soil, food, ecosystem, feelings, behaviors, and pattern of health and disease. The present study aims to investigate the impact of heat and humidity on the daily basis incidence and mortality due to COVID-19 pandemic in European countries. MATERIALS AND METHODS: We selected 10 European countries, Russia, United Kingdom, Spain, Italy, Germany, Turkey, France, Belgium, Netherlands and Belarus. This region has a relatively low temperature and high humidity, and has homogenous European ethnicity with almost similar socioeconomic culture and health care system. The data on COVID-19 pandemic including daily new cases and new deaths were recorded from World Health Organization (WHO). The information on daily temperature and humidity was obtained from world climate web "Time and Date". The daily cases, deaths, temperature and humidity were recorded from the date of appearance of first case of "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)" in the European region, from Jan 27, 2020 to July 17, 2020. RESULTS: In 10 European countries, (Russia, United Kingdom, Spain, Italy, Germany, Turkey, France, Belgium, Netherlands and Belarus), the daily basis mean temperature from Jan 27, 2020 to July 17, 2020 was 17.07±0.18°C, and humidity was 54.78±0.47%. The overall results revealed a significant inverse correlation between humidity and the number of cases (r= -0.134, p<0.001) and deaths (r= -0.126, p<0.001). Moreover, an increase in temperature was linked with an increase in the number of cases (r=0.062, p=0.013) and deaths (r=0.118, p<0.001). The regression analysis results further revealed that with an increase of 1% humidity the number of cases (ß = -15.90, p<0.001) and deaths (ß=-1.56, p<0.001) reduced significantly. Whereas, with an increase of 1°C in temperature the number of cases (ß = 20.65, p<0.001) and deaths (ß = 3.71, p<0.001) increased significantly. CONCLUSIONS: Increase in relative humidity was associated with a decrease in the number of daily cases and deaths, however, a rise in temperature was allied with an upsurge in the number of daily cases and daily deaths due to COVID-19 pandemic in European countries. The study findings on weather events and COVID-19 pandemic have an impact at European regional levels to project the incidence and mortality trends with regional weather events to enhance public health readiness and assist in planning to fight against this pandemic situation.


Assuntos
Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Europa (Continente)/epidemiologia , Humanos , Umidade , Incidência , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Análise de Regressão , Taxa de Sobrevida , Temperatura
16.
Infez Med ; 28(3): 295-301, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32920564

RESUMO

Most studies evaluating chest computed tomography (CT) features in coronavirus disease 2019 (COVID-19) have been small-sized and have presented varied findings. We aim to systematically review these studies and to conduct a meta-analysis of their results to provide a well-powered assessment of chest CT findings in patients with COVID-19. PubMed and EMBASE databases were systematically searched to identify published studies that evaluated chest CT findings in COVID-19 patients. Data regarding study characteristics and CT findings, including distribution of lesions, the lobe of lung involved, lesion densities, and radiological patterns, were extracted. Arcsine transformed proportions from individual studies were pooled using a random-effects model to derive pooled proportions (PPs) and 95% confidence intervals (CIs). A total of fifty-four studies (n=2693 confirmed COVID-19 patients) were included in the final review. Prevalence of different CT findings varied across studies; however, the most common findings were bilateral pulmonary involvement (PP: 74.1% [68.4%, 79.5%]; I2 = 85.76%), ground glass opacification (PP: 64.6% [57.6%, 71.4%]; I2 = 91.52%), involvement of the left lower lobe (PP: 71.2% [58.9%, 82.1%]; I2 = 90.91%), and subpleural distribution of lesions (PP: 57.2% [39.0%, 74.3%]; I2 = 93.08%). Multivariate meta-regression revealed a positive association between prevalence of air bronchograms and average age of the population (p=0.013). Bilateral ground glass opacification, a subpleural distribution of lesions, and involvement of the left lower lobe were the most notable chest CT findings in COVID-19 patients.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Intervalos de Confiança , Infecções por Coronavirus/diagnóstico , Feminino , Hospitalização , Humanos , Masculino , Registros Médicos/estatística & dados numéricos , Pandemias , Radiografia Torácica/métodos , Análise de Regressão , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
17.
N Engl J Med ; 383(15): 1436-1446, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-32970396

RESUMO

BACKGROUND: Patients with chronic kidney disease have a high risk of adverse kidney and cardiovascular outcomes. The effect of dapagliflozin in patients with chronic kidney disease, with or without type 2 diabetes, is not known. METHODS: We randomly assigned 4304 participants with an estimated glomerular filtration rate (GFR) of 25 to 75 ml per minute per 1.73 m2 of body-surface area and a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of 200 to 5000 to receive dapagliflozin (10 mg once daily) or placebo. The primary outcome was a composite of a sustained decline in the estimated GFR of at least 50%, end-stage kidney disease, or death from renal or cardiovascular causes. RESULTS: The independent data monitoring committee recommended stopping the trial because of efficacy. Over a median of 2.4 years, a primary outcome event occurred in 197 of 2152 participants (9.2%) in the dapagliflozin group and 312 of 2152 participants (14.5%) in the placebo group (hazard ratio, 0.61; 95% confidence interval [CI], 0.51 to 0.72; P<0.001; number needed to treat to prevent one primary outcome event, 19 [95% CI, 15 to 27]). The hazard ratio for the composite of a sustained decline in the estimated GFR of at least 50%, end-stage kidney disease, or death from renal causes was 0.56 (95% CI, 0.45 to 0.68; P<0.001), and the hazard ratio for the composite of death from cardiovascular causes or hospitalization for heart failure was 0.71 (95% CI, 0.55 to 0.92; P = 0.009). Death occurred in 101 participants (4.7%) in the dapagliflozin group and 146 participants (6.8%) in the placebo group (hazard ratio, 0.69; 95% CI, 0.53 to 0.88; P = 0.004). The effects of dapagliflozin were similar in participants with type 2 diabetes and in those without type 2 diabetes. The known safety profile of dapagliflozin was confirmed. CONCLUSIONS: Among patients with chronic kidney disease, regardless of the presence or absence of diabetes, the risk of a composite of a sustained decline in the estimated GFR of at least 50%, end-stage kidney disease, or death from renal or cardiovascular causes was significantly lower with dapagliflozin than with placebo. (Funded by AstraZeneca; DAPA-CKD ClinicalTrials.gov number, NCT03036150.).


Assuntos
Compostos Benzidrílicos/uso terapêutico , Taxa de Filtração Glomerular/efeitos dos fármacos , Glucosídeos/uso terapêutico , Insuficiência Renal Crônica/tratamento farmacológico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Idoso , Compostos Benzidrílicos/efeitos adversos , Compostos Benzidrílicos/farmacologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Nefropatias Diabéticas/tratamento farmacológico , Feminino , Glucosídeos/efeitos adversos , Glucosídeos/farmacologia , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Insuficiência Renal Crônica/complicações , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia
18.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32900876

RESUMO

BACKGROUND: State mandates have required insurance companies to provide coverage for autism-related child health care services; however, it has not been determined if insurance mandates have improved the supply of child health care providers. We investigate the effect of state insurance mandates on the supply of child psychiatrists, pediatricians, and board-certified behavioral analysts (BCBAs). METHODS: We used data from the National Conference of State Legislatures and Health Resources and Services Administration's Area Health Resource Files to examine child psychiatrists, pediatricians, and BCBAs in all 50 states from 2003 to 2017. Fixed-effects regression models compared change in workforce density before versus one year after mandate implementation and the effect of mandate generosity across 44 US states implementing mandates between 2003 and 2017. RESULTS: From 2003 to 2017, child psychiatrists increased from 7.40 to 10.03 per 100 000 children, pediatricians from 62.35 to 68.86, and BCBAs from 1.34 to 29.88. Mandate introduction was associated with an additional increase of 0.77 BCBAs per 100 000 children (95% confidence interval [CI]: 0.18 to 1.42) one year after mandate enactment. Mandate introduction was also associated with a more modest increase among child psychiatrists (95% CI: 0.10 to 0.91) and was not associated with the prevalence of pediatricians (95% CI: -0.76 to 1.13). We also found evidence that more generous mandate benefits were associated with larger effects on workforce supply. CONCLUSIONS: State insurance mandates were associated with an ∼16% increase in BCBAs from 2003 to 2017, but the association with child psychiatrists was smaller and nonsignificant among pediatricians. In these findings, it is suggested that policies are needed that specifically address workforce constraints in the provision of services for children with autism spectrum disorder.


Assuntos
Transtorno do Espectro Autista/terapia , Psiquiatria Infantil/estatística & dados numéricos , Cobertura do Seguro/legislação & jurisprudência , Pediatras/provisão & distribução , Psicologia da Criança/estatística & dados numéricos , Criança , Intervalos de Confiança , Estudos Transversais , Regulamentação Governamental , Humanos , Análise de Regressão , Estudos Retrospectivos , Estados Unidos , Recursos Humanos/estatística & dados numéricos
19.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32948657

RESUMO

OBJECTIVES: To determine the natural history of pediatric hypertension. METHODS: We conducted a 72-month retrospective cohort study among 165 primary care sites. Blood pressure measurements from two consecutive 36 month periods were compared. RESULTS: Among 398 079 primary care pediatric patients ages 3 to 18, 89 347 had ≥3 blood pressure levels recorded during a 36-month period, and 43 825 children had ≥3 blood pressure levels for 2 consecutive 36-month periods. Among these 43 825 children, 4.3% (1881) met criteria for hypertension (3.5% [1515] stage 1, 0.8% [366] stage 2) and 4.9% (2144) met criteria for elevated blood pressure in the first 36 months. During the second 36 months, 50% (933) of hypertensive patients had no abnormal blood pressure levels, 22% (406) had elevated blood pressure levels or <3 hypertensive blood pressure levels, and 29% (542) had ≥3 hypertensive blood pressure levels. Of 2144 patients with elevated blood pressure in the first 36 months, 70% (1492) had no abnormal blood pressure levels, 18% (378) had persistent elevated blood pressure levels, and 13% (274) developed hypertension in the second 36-months. Among the 7775 patients with abnormal blood pressure levels in the first 36-months, only 52% (4025) had ≥3 blood pressure levels recorded during the second 36-months. CONCLUSIONS: In a primary care cohort, most children initially meeting criteria for hypertension or elevated blood pressure had subsequent normal blood pressure levels or did not receive recommended follow-up measurements. These results highlight the need for more nuanced initial blood pressure assessment and systems to promote follow-up of abnormal results.


Assuntos
Determinação da Pressão Arterial/estatística & dados numéricos , Hipertensão/diagnóstico , Adolescente , Fatores Etários , Estatura , Criança , Pré-Escolar , Intervalos de Confiança , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Valores de Referência , Análise de Regressão , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo
20.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32968030

RESUMO

OBJECTIVES: Adolescents often display heterogenous trajectories of alcohol use. Initiation and escalation of drinking may be important predictors of later harms, including alcohol use disorder (AUD). Previous conceptualizations of these trajectories lacked adjustment for known confounders of adolescent drinking, which we aimed to address by modeling dynamic changes in drinking throughout adolescence while adjusting for covariates. METHODS: Survey data from a longitudinal cohort of Australian adolescents (n = 1813) were used to model latent class alcohol use trajectories over 5 annual follow-ups (mean age = 13.9 until 17.8 years). Regression models were used to determine whether child, parent, and peer factors at baseline (mean age = 12.9 years) predicted trajectory membership and whether trajectories predicted self-reported symptoms of AUD at the final follow-up (mean age = 18.8 years). RESULTS: We identified 4 classes: abstaining (n = 352); late-onset moderate drinking (n = 503); early-onset moderate drinking (n = 663); and early-onset heavy drinking (n = 295). Having more alcohol-specific household rules reduced risk of early-onset heavy drinking compared with late-onset moderate drinking (relative risk ratio: 0.31; 99.5% confidence interval [CI]: 0.11-0.83), whereas having more substance-using peers increased this risk (relative risk ratio: 3.43; 99.5% CI: 2.10-5.62). Early-onset heavy drinking increased odds of meeting criteria for AUD in early adulthood (odds ratio: 7.68; 99.5% CI: 2.41-24.47). CONCLUSIONS: Our study provides evidence that parenting factors and peer influences in early adolescence should be considered to reduce risk of later alcohol-related harm. Early initiation and heavy alcohol use throughout adolescence are associated with increased risk of alcohol-related harm compared with recommended maximum levels of consumption (late-onset, moderate drinking).


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/etiologia , Consumo de Álcool por Menores/psicologia , Adolescente , Fatores Etários , Alcoolismo/diagnóstico , Austrália/epidemiologia , Intervalos de Confiança , Feminino , Humanos , Estudos Longitudinais , Masculino , Poder Familiar , Pais , Grupo Associado , Análise de Regressão , Fatores de Risco , Fatores Sexuais , Adulto Jovem
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