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1.
Cancer Radiother ; 24(6-7): 762-767, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32873486

RESUMO

Health data financed by the French national solidarity system constitute a common heritage. Such data should be exploited to optimize care while complying with ethics and fundamental rights of citizens. The creation of the Health Data Hub (HDH) was allowed by the 24 July 2019 Law on the organization and transformation of the French health system. Its objective is to enable authorized innovative project leaders to access non-nominative data via a state-of-the-art secure technological platform. It appears to be one of the strong points of the French Artificial Intelligence strategy. This structure is a public interest group which associates 56 stakeholders, mostly from the public authorities. It implements, in partnership with the National Health Insurance Fund, the major strategic orientations relating to the National Health Data System set by the French State and the Ministry of Solidarity and Health. The Health Data Hub allows cross-reference of consolidated databases with SNDS data. Several use cases are under construction. The creation of relational databases in radiation oncology is also possible through specific strategies to get pseudonymized data from the various radiotherapy software programs upstream of the Health Data Hub.


Assuntos
Bases de Dados Factuais , Oncologia , Neoplasias/radioterapia , Radioterapia (Especialidade) , França , Humanos
2.
Hist Psychol ; 23(3): 230-231, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32940505

RESUMO

Replies to comments by I. Gravier (see record 2020-68859-002), R. A. Blackwell and M. J. Rossano (see record 2020-68859-003), and D. L. Smail (see record 2020-68859-004) on the article by Henley (see record 2020-68859-001). That each of the commentators acknowledged the significance of the Neolithic for psychology was welcome, as were their alternative views on how such prehistoric events potentially fit with our discipline's history. As new scholarship continues to emerge related to Göbekli Tepe demonstrating radical changes in how Neolithic humans understood themselves, each other, and the world around them, Henley contends that this is significant for our chronicle of the nature of not just "psychology in history" but also deserves "space" within the history of psychology. To reiterate the last line from Smail's reply-"Now all we have to do is persuade the historians". (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Pessoal de Saúde , Bases de Dados Factuais , Humanos
4.
S Afr Med J ; 110(8): 802-806, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880310

RESUMO

BACKGROUND: There is a paucity of research on homicidal strangulation by gender. OBJECTIVES: A sex-disaggregated and comparative research approach was used to investigate individual-level risk factors for female and male homicidal strangulation in Johannesburg, South Africa (2001 - 2010). METHODS: Data were drawn from the National Injury Mortality Surveillance System. Logistic regressions were used to examine associations between each of the independent variables and homicidal strangulation in females and males relative to all other female and male homicides, respectively. RESULTS: The risk of fatal strangulation was high for both females and males aged ≥60 years, but markedly high only for male children and adolescents. Temporal risk for females was undifferentiated for day of the week, and the risk for males was high during weekdays. Females were more likely to be strangled in public places, and males in private locations. CONCLUSIONS: The study underlines the importance of disaggregating homicide by external cause and gender.


Assuntos
Asfixia/mortalidade , Homicídio/estatística & dados numéricos , Lesões do Pescoço/mortalidade , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Grupos de Populações Continentais/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estações do Ano , Distribuição por Sexo , África do Sul/epidemiologia , Adulto Jovem
5.
S Afr Med J ; 110(7): 652-656, 2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32880342

RESUMO

BACKGROUND: Ingestion of foreign bodies remains a frequent reason for presentation to paediatric emergency departments worldwide. Among the variety of objects ingested, button batteries are particularly harmful owing to their electrochemical properties, which can cause extensive injuries if not diagnosed and treated rapidly. International trends show an increasing incidence of button battery ingestion, leading to concern that this pattern may be occurring in South Africa. Limited local data on paediatric foreign body ingestion have been published. OBJECTIVES: To assess battery ingestion rates in a tertiary paediatric hospital. We hypothesised that the incidence has increased, in keeping with international trends. Secondary objectives included describing admission rates, requirements for anaesthesia and surgery, and promoting awareness of the problems associated with battery ingestion. METHODS: We performed a retrospective, descriptive analysis of the Red Cross War Memorial Children's Hospital trauma database, including all children under 13 years of age seen between 1 January 2010 and 31 December 2015 with suspected ingestion of a foreign body. The ward admissions database was then examined to find additional cases in which children were admitted directly. After exclusion of duplicate records, cases were classified by type of foreign body, management, requirement for admission, anaesthesia and surgery. Descriptive statistics were used to analyse the data in comparison with previous studies published from this database. RESULTS: Patient age and gender patterns matched the literature, with a peak incidence in children under 2 years of age. Over the 6-year period, 180 patients presented with food foreign bodies, whereas 497 objects were classified as non-food. After exclusion of misdiagnosed cases, the remaining 462 objects were dominated by coins (44.2%). Batteries were the causative agent in 4.8% (22/462). Although the subtypes of batteries were not reliably recorded, button batteries accounted for at least 64% (14/22). Most children who ingested batteries presented early, but more required admission, anaesthesia and surgery than children who ingested other forms of foreign body. CONCLUSIONS: The study demonstrated that the local incidence of button battery ingestion may be increasing, although data are still limited.Admission, anaesthesia and surgery rates for batteries were higher in this cohort than for all other foreign bodies. As button batteries can mimic coins, with much more dire consequences on ingestion, our ability to expedite diagnosis and management hinges on a high index of suspicion. It is imperative to increase awareness among healthcare workers and parents.


Assuntos
Fontes de Energia Elétrica/estatística & dados numéricos , Corpos Estranhos/epidemiologia , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Bases de Dados Factuais , Fontes de Energia Elétrica/efeitos adversos , Corpos Estranhos/cirurgia , Humanos , Incidência , Lactente , Recém-Nascido , Estudos Retrospectivos , África do Sul/epidemiologia , Centros de Atenção Terciária
6.
Int J Mol Med ; 46(4): 1266-1273, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32945352

RESUMO

The outbreak of the 2019 coronavirus disease (named, COVID­19), caused by the novel SARS­CoV­2 virus, represents a worldwide severe threat to public health. It is of the utmost importance to characterize the immune responses against the SARS­CoV­2 and the mechanisms of hyperinflammation, in order to design better therapeutic strategies for COVID­19. In the present study, a transcriptomic analysis was performed to profile the immune signatures in lung and the bronchoalveolar lavage fluid samples from COVID­19 patients and controls. Our data concordantly revealed increased humoral responses to infection. The elucidation of the host responses to SARS­CoV­2 infection may further improve our understanding of COVID­19 pathogenesis and suggest better therapeutic strategies.


Assuntos
Linfócitos B/imunologia , Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Ativação Linfocitária , Pneumonia Viral/imunologia , Transcriptoma , Linfócitos B/metabolismo , Betacoronavirus/fisiologia , Líquido da Lavagem Broncoalveolar , Infecções por Coronavirus/genética , Bases de Dados Factuais , Feminino , Regulação da Expressão Gênica , Redes Reguladoras de Genes , Interações Hospedeiro-Patógeno , Humanos , Pulmão/imunologia , Pulmão/metabolismo , Masculino , Pandemias , Pneumonia Viral/genética
7.
PLoS One ; 15(9): e0239026, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936811

RESUMO

The Government of India in-network with the state governments has implemented the epidemic curtailment strategies inclusive of case-isolation, quarantine and lockdown in response to ongoing novel coronavirus (COVID-19) outbreak. In this manuscript, we attempt to estimate the impact of these steps across ten selected Indian states using crowd-sourced data. The trajectory of the outbreak was parameterized by the reproduction number (R0), doubling time, and growth rate. These parameters were estimated at two time-periods after the enforcement of the lockdown on 24th March 2020, i.e. 15 days into lockdown and 30 days into lockdown. The authors used a crowd sourced database which is available in the public domain. After preparing the data for analysis, R0 was estimated using maximum likelihood (ML) method which is based on the expectation minimum algorithm where the distribution probability of secondary cases is maximized using the serial interval discretization. The doubling time and growth rate were estimated by the natural log transformation of the exponential growth equation. The overall analysis shows decreasing trends in time-varying reproduction numbers (R(t)) and growth rate (with a few exceptions) and increasing trends in doubling time. The curtailment strategies employed by the Indian government seem to be effective in reducing the transmission parameters of the COVID-19 epidemic. The estimated R(t) are still above the threshold of 1, and the resultant absolute case numbers show an increase with time. Future curtailment and mitigation strategies thus may take into account these findings while formulating further course of action.


Assuntos
Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Número Básico de Reprodução , Betacoronavirus/fisiologia , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Crowdsourcing , Bases de Dados Factuais , Geografia Médica , Órgãos Governamentais , Política de Saúde , Humanos , Incidência , Índia/epidemiologia , Modelos Biológicos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Quarentena
8.
BMJ ; 370: m3342, 2020 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-32967856

RESUMO

OBJECTIVE: To compare the risk of cardiovascular events between sodium glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors among people with type 2 diabetes in a real world context of clinical practice. DESIGN: Multi-database retrospective cohort study using a prevalent new user design with subsequent meta-analysis. SETTING: Canadian Network for Observational Drug Effect Studies (CNODES), with administrative healthcare databases from seven Canadian provinces and the United Kingdom, 2013-18. POPULATION: 209 867 new users of a SGLT2 inhibitor matched to 209 867 users of a DPP-4 inhibitor on time conditional propensity score and followed for a mean of 0.9 years. MAIN OUTCOME MEASURES: The primary outcome was major adverse cardiovascular events (MACE, a composite of myocardial infarction, ischaemic stroke, or cardiovascular death). Secondary outcomes were the individual components of MACE, heart failure, and all cause mortality. Cox proportional hazards models were used to estimate site specific adjusted hazards ratios and 95% confidence intervals, comparing use of SGLT2 inhibitors with use of DPP-4 inhibitors in an as treated approach. Site specific results were pooled using random effects meta-analysis. RESULTS: Compared with DPP-4 inhibitors, SGLT2 inhibitors were associated with decreased risks of MACE (incidence rate per 1000 person years: 11.4 v 16.5; hazard ratio 0.76, 95% confidence interval 0.69 to 0.84), myocardial infarction (5.1 v 6.4; 0.82, 0.70 to 0.96), cardiovascular death (3.9 v 7.7; 0.60, 0.54 to 0.67), heart failure (3.1 v 7.7; 0.43, 0.37 to 0.51), and all cause mortality (8.7 v 17.3; 0.60, 0.54 to 0.67). SGLT2 inhibitors had more modest benefits for ischaemic stroke (2.6 v 3.5; 0.85, 0.72 to 1.01). Similar benefits for MACE were observed with canagliflozin (0.79, 0.66 to 0.94), dapagliflozin (0.73, 0.63 to 0.85), and empagliflozin (0.77, 0.68 to 0.87). CONCLUSIONS: In this large observational study conducted in a real world clinical practice context, the short term use of SGLT2 inhibitors was associated with a decreased risk of cardiovascular events compared with the use of DPP-4 inhibitors. TRIAL REGISTRATION: ClinicalTrials.gov NCT03939624.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Bases de Dados Factuais , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Reino Unido , Adulto Jovem
9.
Nat Commun ; 11(1): 4704, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943637

RESUMO

Many public health responses and modeled scenarios for COVID-19 outbreaks caused by SARS-CoV-2 assume that infection results in an immune response that protects individuals from future infections or illness for some amount of time. The presence or absence of protective immunity due to infection or vaccination (when available) will affect future transmission and illness severity. Here, we review the scientific literature on antibody immunity to coronaviruses, including SARS-CoV-2 as well as the related SARS-CoV, MERS-CoV and endemic human coronaviruses (HCoVs). We reviewed 2,452 abstracts and identified 491 manuscripts relevant to 5 areas of focus: 1) antibody kinetics, 2) correlates of protection, 3) immunopathogenesis, 4) antigenic diversity and cross-reactivity, and 5) population seroprevalence. While further studies of SARS-CoV-2 are necessary to determine immune responses, evidence from other coronaviruses can provide clues and guide future research.


Assuntos
Anticorpos Antivirais/imunologia , Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Pneumonia Viral/imunologia , Infecções por Coronavirus/terapia , Reações Cruzadas , Bases de Dados Factuais , Humanos , Imunização Passiva , Isotipos de Imunoglobulinas/imunologia , Coronavírus da Síndrome Respiratória do Oriente Médio/imunologia , Pandemias , Pneumonia Viral/terapia , Estudos Soroepidemiológicos
10.
Phys Biol ; 17(6): 065001, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32959788

RESUMO

Epidemiological models usually contain a set of parameters that must be adjusted based on available observations. Once a model has been calibrated, it can be used as a forecasting tool to make predictions and to evaluate contingency plans. It is customary to employ only point estimators of model parameters for such predictions. However, some models may fit the same data reasonably well for a broad range of parameter values, and this flexibility means that predictions stemming from them will vary widely, depending on the particular values employed within the range that gives a good fit. When data are poor or incomplete, model uncertainty widens further. A way to circumvent this problem is to use Bayesian statistics to incorporate observations and use the full range of parameter estimates contained in the posterior distribution to adjust for uncertainties in model predictions. Specifically, given an epidemiological model and a probability distribution for observations, we use the posterior distribution of model parameters to generate all possible epidemic curves, whose information is encapsulated in posterior predictive distributions. From these, one can extract the worst-case scenario and study the impact of implementing contingency plans according to this assessment. We apply this approach to the evolution of COVID-19 in Mexico City and assess whether contingency plans are being successful and whether the epidemiological curve has flattened.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Epidemias , Pneumonia Viral/epidemiologia , Teorema de Bayes , Infecções por Coronavirus/mortalidade , Bases de Dados Factuais , Epidemias/estatística & dados numéricos , Humanos , Conceitos Matemáticos , México/epidemiologia , Modelos Biológicos , Modelos Estatísticos , Pandemias , Pneumonia Viral/mortalidade , Probabilidade , Fatores de Tempo , Incerteza
11.
Phys Biol ; 17(6): 065005, 2020 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-32966241

RESUMO

Error analysis and data visualization of positive COVID-19 cases in 27 countries have been performed up to August 8, 2020. This survey generally observes a progression from early exponential growth transitioning to an intermediate power-law growth phase, as recently suggested by Ziff and Ziff. The occurrence of logistic growth after the power-law phase with lockdowns or social distancing may be described as an effect of avoidance. A visualization of the power-law growth exponent over short time windows is qualitatively similar to the Bhatia visualization for pandemic progression. Visualizations like these can indicate the onset of second waves and may influence social policy.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , China/epidemiologia , Infecções por Coronavirus/transmissão , Bases de Dados Factuais , Progressão da Doença , Humanos , Análise dos Mínimos Quadrados , Modelos Lineares , Modelos Logísticos , Conceitos Matemáticos , Modelos Biológicos , Pandemias/estatística & dados numéricos , Pneumonia Viral/transmissão , Fatores de Tempo
12.
AIDS ; 34(12): 1765-1770, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32889852

RESUMO

OBJECTIVE: A new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) emerged in China during late 2019 and resulted in the coronavirus disease 2019 (COVID-19) pandemic which peaked in France in March-April 2020. Immunodeficiency, precariousness and promiscuity could increase the risk of COVID-19 in HIV-infected patients and in preexposure prophylaxis (PrEP) users. No epidemiological data are available in these two populations. We report COVID-19 attack rate in HIV-infected patients and in PrEP users in the Rhône department, France, and compared it with the general population. DESIGN: Retrospective analysis of a laboratory database. METHODS: COVID-19 testing strategy in France was centered on symptomatic infections, hospitalized patients and symptomatic healthcare workers while most asymptomatic cases were not confirmed. SARS-CoV-2 positivity rate on PCR assays and COVID-19 attack rate were determined in HIV-infected patients and in PrEP users. COVID-19 attack rate in the general population was estimated from health authorities' database and demographic data. A corrected attack rate taking into account the laboratory representativeness was calculated. RESULTS: From March to April 2020, 24 860 samples from 19 113 patients (HIV-infected 77, PrEP users 27, others 19 009) were assessed for SARS-CoV-2 PCR assay. The positivity rate appeared similar in HIV-infected patients (15.6%), in PrEP users (14.8%) and in other patients (19.1%). The crude/corrected COVID-19 attack rate appeared similar in HIV-infected patients (0.31/0.38%) and in PrEP users (0.38/0.42%), and of the same order as the estimated attack rate in the general population (0.24%). CONCLUSION: The risk of symptomatic COVID-19 in France appeared similar in HIV-infected patients and in PrEP users compared with the general population.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por HIV/complicações , Pneumonia Viral/epidemiologia , Profilaxia Pré-Exposição , Adulto , Idoso , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Bases de Dados Factuais , Feminino , França/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pandemias , Estudos Retrospectivos , Fatores de Risco
13.
Medicine (Baltimore) ; 99(36): e21688, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899000

RESUMO

In this study, the National Health Insurance Research Database of Taiwan was used to examine the recurrence and death risk for stage 0 colorectal cancer patients. We examined stage 0 colorectal cancer patients to identify factors causing recurrence and death.This is a retrospective study, and stage 0 colorectal cancer patients that are registered in the Taiwan Cancer Registry of the Health Promotion Administration in 2007 to 2012 were included. The database was linked to the National Health Insurance Research Database, and subjects were followed up until the end of 2016. The mean follow-up period was 69 months. Bivariate analysis methods (log-rank test) and Cox proportional hazards model were used to evaluate the risk of recurrence and death and demographic characteristics, economic factors, environmental factors, health factors, treatment and hospitals, and absence/presence of postoperative tests were used to examine related risk factors.Our study showed that the 5-year recurrence rate and 5-year mortality rate for stage 0 colorectal cancer are 1.68% and 0.6%, respectively. For stage 0 colorectal cancer, age (61-74 years) is the only factor affecting recurrence in patients (hazard ratio (HR) = 2.44; 95% CI: 1.41-4.22), while age >75 years (HR = 4.35; 95% CI: 1.14-16.68) and Charlson Comorbidity Index >4 points (HR = 7.20, 95% CI: 2.60-19.94) can increase the risk of death. In contrast, patients who underwent one (HR = 0.27, 95% CI: 0.10-0.71) and two or more colonoscopies (HR = 0.26, 95% CI: 0.10-0.70) within 2 years after surgery can reduce the risk of death from stage 0 colorectal cancer. In addition, the risk of recurrence is higher in patients who underwent colonoscopic polypectomy (HR = 2.07, 95% CI: 0.98-4.33) and patients with rectal cancer (HR = 2.74, 95% CI: 0.96-7.83), but these differences are not statistically significant (P > .05).From this study, we can see that age and comorbidity index increase the risk of recurrence and death for stage 0 colorectal cancer, while postoperative colonoscopy can decrease the risk of death.


Assuntos
Neoplasias Colorretais/mortalidade , Recidiva Local de Neoplasia/mortalidade , Fatores Etários , Idoso , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/cirurgia , Bases de Dados Factuais , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
14.
Medicine (Baltimore) ; 99(36): e21982, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899041

RESUMO

In the past 30 years, dengue has undergone dramatic changes in China every year. This study explores the epidemiological trend of dengue in China during this period to identify high-risk seasons, regions, ages, susceptible populations, and provide information for dengue prevention and control activities.Dengue data from 1990 to 2019 were derived from the Public Health Science Data Center, Web of Science, China National Knowledge Infrastructure, PubMed, and Centers for Disease Control and Prevention of the corresponding province. GraphPad Prism 7 was conducted to generate disease evolution maps, occupational heat maps, and monthly heat maps of dengue cases and deaths in mainland China and Guangdong Province. Excel 2016 was used to create a cyclone map of age and gender distribution. Powerpoint 2016 was performed to create geographic maps.From 1990 to 2019, the annual number of dengue cases showed an increasing trend and reaching a peak in 2014, with 46,864 dengue cases (incidence rate: 3.4582/100,000), mainly contributed by Guangdong Province (45,189 cases, accounting for 96.43%). Dengue pandemics occurred every 4 to 6 years. The prevalence of dengue fever was Autumn, which was generally prevalent from June to December and reached its peak from September to November. The provinces reporting dengue cases each year have expanded from the southeastern coastal region to the southwest, central, northeast, and northwest regions, and the provinces with a high incidence were Guangdong, Guangxi, Yunnan, Fujian, and Zhejiang. People aged 25 to 44 years were more susceptible to dengue virus infection. And most of them were male patients. Dengue mainly occurs in the following groups: students, business service staffs, workers, farmers, retired staffs, housewives, and the unemployed. Four provinces reported deaths from dengue, namely Guangdong Province, Zhejiang Province, Henan Province, and Hunan Province.The dengue fever epidemic occurred every 4 to 6 years, mostly in autumn. The endemic areas were Guangdong, Guangxi, Yunnan, Fujian, and Zhejiang provinces. People aged 25 to 44 years, men, students, business service staffs, workers, farmers, retired staffs, housewives, and the unemployed were more susceptible to dengue fever. These findings help to develop targeted public health prevention and control measures.


Assuntos
Dengue/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Bases de Dados Factuais , Feminino , Geografia Médica , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem
15.
PLoS One ; 15(9): e0238904, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32913365

RESUMO

The population-level case-fatality rate (CFR) associated with COVID-19 varies substantially, both across countries at any given time and within countries over time. We analyze the contribution of two key determinants of the variation in the observed CFR: the age-structure of diagnosed infection cases and age-specific case-fatality rates. We use data on diagnosed COVID-19 cases and death counts attributable to COVID-19 by age for China, Germany, Italy, South Korea, Spain, the United States, and New York City. We calculate the CFR for each population at the latest data point and also for Italy, Germany, Spain, and New York City over time. We use demographic decomposition to break the difference between CFRs into unique contributions arising from the age-structure of confirmed cases and the age-specific case-fatality. In late June 2020, CFRs varied from 2.2% in South Korea to 14.0% in Italy. The age-structure of detected cases often explains more than two-thirds of cross-country variation in the CFR. In Italy, the CFR increased from 4.2% to 14.0% between March 9 and June 30, 2020, and more than 90% of the change was due to increasing age-specific case-fatality rates. The importance of the age-structure of confirmed cases likely reflects several factors, including different testing regimes and differences in transmission trajectories; while increasing age-specific case-fatality rates in Italy could indicate other factors, such as the worsening health outcomes of those infected with COVID-19. Our findings lend support to recommendations for data to be disaggregated by age, and potentially other variables, to facilitate a better understanding of population-level differences in CFRs. They also show the need for well-designed seroprevalence studies to ascertain the extent to which differences in testing regimes drive differences in the age-structure of detected cases.


Assuntos
Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Fatores Etários , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Bases de Dados Factuais , Humanos , Pandemias , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Taxa de Sobrevida/tendências
16.
Medicine (Baltimore) ; 99(37): e21896, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925724

RESUMO

This study aimed to determine the differences in antibiotic usage patterns in the treatment of acute pyelonephritis according to hospital type and region in Korea.The claims database of the Health Insurance Review and Assessment Service in Korea was used to select patients with the International Classification of Diseases, Tenth Revision code N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, neither acute nor chronic) as the primary discharge diagnosis in 2010-2014. Usage of each class of antibiotics was expressed as the defined daily dose (DDD)/event.The average antibiotic usage per inpatient event was 11.3 DDD. The average antibiotic usage was the highest among patients admitted to tertiary hospitals (13.8 DDD), followed by those admitted to secondary hospitals (11.5 DDD), clinics (10.0 DDD), and primary hospitals (9.8 DDD). According to the geographic analyses, third-generation cephalosporins were highly prescribed in some southern regions; fluoroquinolones and aminoglycosides were highly prescribed in some centrally located regions of the Korean peninsula. The hotspots for carbapenem usage included Seoul and Gyeonggi province cluster and Busan cluster: these regions include the capital city and the second biggest city in Korea, respectively.In conclusion, the antibiotic usage patterns for acute pyelonephritis in Korea differ according to the hospital type and region.


Assuntos
Antibacterianos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Pielonefrite/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Aminoglicosídeos/uso terapêutico , Cefalosporinas/uso terapêutico , Bases de Dados Factuais , Feminino , Fluoroquinolonas/uso terapêutico , Geografia , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
17.
Value Health ; 23(9): 1191-1199, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940237

RESUMO

OBJECTIVES: Hospital comparisons to improve quality of care require valid and reliable quality indicators. We aimed to test the validity and reliability of 6 breast cancer indicators by quantifying the influence of case-mix and random variation. METHODS: The nationwide population-based database included 79 690 patients with breast cancer from 91 Dutch hospitals between 2011 and 2016. The indicator-scores calculated were: (1) irradical breast-conserving surgery (BCS) for invasive disease, (2) irradical BCS for ductal carcinoma-in-situ, (3) breast contour-preserving treatment, (4) magnetic resonance imaging (MRI) before neo-adjuvant chemotherapy, (5) radiotherapy for locally advanced disease, and (6) surgery within 5 weeks from diagnosis. Case-mix and random variation adjustments were performed by multivariable fixed and random effect logistic regression models. Rankability quantified the between-hospital variation, representing unexplained differences that might be the result of the level of quality of care, as low (<50%), moderate (50%-75%), or high (>75%). RESULTS: All of the indicators showed between-hospital variation with wide (interquartile) ranges. Case-mix adjustment reduced variation in indicators 1 and 3 to 5. Random variation adjustment (further) reduced the variation for all indicators. Case-mix and random variation adjustments influenced the indicator-scores of individual hospitals and their ranking. Rankability was poor for indicator 1, 2, and 5, and moderate for 3, 4, and 6. CONCLUSIONS: The 6 indicators lacked validity and/or reliability to a certain extent. Although measuring quality indicators may stimulate quality improvement in general, comparisons and judgments of individual hospital performance should be made with caution if based on indicators that have not been tested or adjusted for validity and reliability, especially in benchmarking.


Assuntos
Neoplasias da Mama/terapia , Hospitais/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Benchmarking , Neoplasias da Mama/epidemiologia , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Masculino , Países Baixos/epidemiologia , Melhoria de Qualidade , Reprodutibilidade dos Testes
18.
Am Surg ; 86(7): 856-864, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32916073

RESUMO

BACKGROUND: Older data indicate that less patients undergo surgery for complicated peptic ulcer disease (PUD). We evaluated contemporary trends in the surgical management and outcomes of patients with complicated PUD. METHODS: The National Inpatient Sample (2005-2014) was queried for patients with complicated PUD (hemorrhage, perforation, or obstruction). Trend analyses were used to evaluate changes in management and outcomes. RESULTS: There were 1 570 696 admissions for complicated PUD during the study period. Majority (87.0%) presented with hemorrhage, 10.6% presented with perforation, and 2.4% had an obstruction. The average age was 67 years. Overall, admissions with complicated PUD decreased from 180 054 in 2005 to 150 335 in 2014. The proportion of patients managed operatively decreased from 2.5% to 1.9% in the hemorrhage group, 75.0% to 67.4% in the perforation group, and 26.0% to 20.2% in the obstruction group (all P-trend < .05). Overall, among patients managed operatively, the use of acid-reducing procedures decreased from 25.9% to 13.9%, mortality decreased from 11.9% to 9.4% (both P-trend < .001), while complications remained stable (10.4% to 10.3%, P-trend = .830). CONCLUSIONS: There are fewer admissions with complicated PUD and more patients are treated nonoperatively. Despite subtle improvements, significant proportions of patients still die from complicated PUD indicating the need for improved preoperative optimization and postoperative care among these patients.


Assuntos
Úlcera Péptica/complicações , Úlcera Péptica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Bases de Dados Factuais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Úlcera Péptica/mortalidade , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos
19.
Sensors (Basel) ; 20(18)2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-32937867

RESUMO

The rapid worldwide spread of Coronavirus Disease 2019 (COVID-19) has resulted in a global pandemic. Correct facemask wearing is valuable for infectious disease control, but the effectiveness of facemasks has been diminished, mostly due to improper wearing. However, there have not been any published reports on the automatic identification of facemask-wearing conditions. In this study, we develop a new facemask-wearing condition identification method by combining image super-resolution and classification networks (SRCNet), which quantifies a three-category classification problem based on unconstrained 2D facial images. The proposed algorithm contains four main steps: Image pre-processing, facial detection and cropping, image super-resolution, and facemask-wearing condition identification. Our method was trained and evaluated on the public dataset Medical Masks Dataset containing 3835 images with 671 images of no facemask-wearing, 134 images of incorrect facemask-wearing, and 3030 images of correct facemask-wearing. Finally, the proposed SRCNet achieved 98.70% accuracy and outperformed traditional end-to-end image classification methods using deep learning without image super-resolution by over 1.5% in kappa. Our findings indicate that the proposed SRCNet can achieve high-accuracy identification of facemask-wearing conditions, thus having potential applications in epidemic prevention involving COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Máscaras , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Algoritmos , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Bases de Dados Factuais , Aprendizado Profundo , Face , Humanos , Processamento de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/estatística & dados numéricos , Máscaras/classificação , Máscaras/estatística & dados numéricos , Redes Neurais de Computação , Pneumonia Viral/epidemiologia
20.
PLoS Med ; 17(8): e1003291, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32866147

RESUMO

BACKGROUND: Nearly 100,000 people underwent total hip replacement (THR) in the United Kingdom in 2018, and most can expect it to last at least 25 years. However, some THRs fail and require revision surgery, which results in worse outcomes for the patient and is costly to the health service. Variation in the survival of THR implants has been observed between units and reducing this unwarranted variation is one focus of the "Getting it Right First Time" (GIRFT) program in the UK. We aimed to investigate whether the statistically improved implant survival of THRs in a high-performing unit is associated with the implants used or other factors at that unit, such as surgical skill. METHODS AND FINDINGS: We analyzed a national, mandatory, prospective, cohort study (National Joint Registry for England, Wales, Northern Ireland and the Isle of Man [NJR]) of all THRs performed in England and Wales. We included the 664,761 patients with records in the NJR who have received a stemmed primary THR between 1 April 2003 and 31 December 2017 in one of 461 hospitals, with osteoarthritis as the only indication. The exposure was the unit (hospital) in which the THR was implanted. We compared survival of THRs implanted in the "exemplar" unit with THRs implanted anywhere else in the registry. The outcome was revision surgery of any part of the THR construct for any reason. Net failure was calculated using Kaplan-Meier estimates, and adjusted analyses employed flexible parametric survival analysis. The mean age of patients contributing to our analyses was 69.9 years (SD 10.1), and 61.1% were female. Crude analyses including all THRs demonstrated better implant survival at the exemplar unit with an all-cause construct failure of 1.7% (95% CI 1.3-2.3) compared with 2.9% (95% CI 2.8-3.0) in the rest of the country after 13.9 years (log-rank test P < 0.001). The same was seen in analyses adjusted for age, sex, and American Society of Anesthesiology (ASA) score (difference in restricted mean survival time 0.12 years [95% CI 0.07-0.16; P < 0.001]). Adjusted analyses restricted to the same implants as the exemplar unit show no demonstrable difference in restricted mean survival time between groups after 13.9 years (P = 0.34). A limitation is that this study is observational and conclusions regarding causality cannot be inferred. Our outcome is revision surgery, and although important, we recognize it is not the only marker of success of a THR. CONCLUSIONS: Our results suggest that the "better than expected" implant survival results of this exemplar center are associated with implant choice. The survival results may be replicated by adopting key treatment decisions, such as implant selection. These decisions are easier to replicate than technical skills or system factors.


Assuntos
Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/tendências , Bases de Dados Factuais/tendências , Falha de Prótese/tendências , Sistema de Registros , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/normas , Estudos de Coortes , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Irlanda do Norte/epidemiologia , Estudos Prospectivos , Reino Unido/epidemiologia , País de Gales/epidemiologia
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