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1.
BMJ ; 373: n379, 2021 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-33846159

RESUMO

Atrial fibrillation is a common chronic disease seen in primary care offices, emergency departments, inpatient hospital services, and many subspecialty practices. Atrial fibrillation care is complicated and multifaceted, and, at various points, clinicians may see it as a consequence and cause of multi-morbidity, as a silent driver of stroke risk, as a bellwether of an acute medical illness, or as a primary rhythm disturbance that requires targeted treatment. Primary care physicians in particular must navigate these priorities, perspectives, and resources to meet the needs of individual patients. This includes judicious use of diagnostic testing, thoughtful use of novel therapeutic agents and procedures, and providing access to subspecialty expertise. This review explores the epidemiology, screening, and risk assessment of atrial fibrillation, as well as management of its symptoms (rate and various rhythm control options) and stroke risk (anticoagulation and other treatments), and offers a model for the integration of the components of atrial fibrillation care.


Assuntos
Fibrilação Atrial/diagnóstico , Programas de Rastreamento/normas , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Acidente Vascular Cerebral/prevenção & controle , Antiarrítmicos/administração & dosagem , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Cateterismo Cardíaco , Eletrocardiografia , Carga Global da Doença , Estilo de Vida Saudável , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Humanos , Incidência , Programas de Rastreamento/métodos , Prevalência , Atenção Primária à Saúde/métodos , Medição de Risco/métodos , Fatores de Risco , Acidente Vascular Cerebral/etiologia
2.
Arq Gastroenterol ; 58(1): 100-106, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33909787

RESUMO

BACKGROUND: In the world, around 450,000 new cases of esophageal cancer are diagnosed each year. OBJECTIVE: To evaluate the trend of esophageal cancer mortality rates in Brazil between 1990-2017. METHODS: A time series study using data on mortality from esophageal cancer in residents ≥30 years in Brazil from 1990 to 2017. Data was estimated by the Global Burden of Disease (GBD) study and analyzed according to sex, age group and federal unit of Brazil. The standardized rates according to age were calculated by the direct method using the standard GBD world population. Annual average percentage change and 95% confidence interval (95% CI) were calculated for mortality by Joinpoint regression. RESULTS: The age-standardized mortality rate in males was 20.6 in 1990 and 17.6/100,000 in 2017, increasing according to age, being 62.4 (1990) and 54.7 (2017) for ≥70 years. In women, the age-standardized mortality rate was 5.9 in 1990 and 4.2/100,000 in 2017. There was a reduction in mortality rates in all age groups and both sexes with great variation among the states. CONCLUSION: Despite the high mortality rates for esophageal cancer in Brazil, the trend was decreasing, but with regional differences. Mortality was around four times higher in men.


Assuntos
Neoplasias Esofágicas , Carga Global da Doença , Idoso , Brasil/epidemiologia , Feminino , Humanos , Masculino
3.
Artigo em Inglês | MEDLINE | ID: mdl-33806629

RESUMO

The HIV/AIDS incidence rates have decreased in African countries although the rates are still high in Sub-Saharan Africa. Our study aimed to examine the long-term trend of the overall HIV/AIDS incidence rates in four countries of the central region of Africa, using data from the Global Burden of Diseases (GBD) 2019 study. The Age-Period-Cohort statistical model analysis was used to measure the trends of HIV/AIDS incidence rates in each of the four countries. HIV/AIDS incidence rates decreased slowly in Cameroon (CAM), Chad, and Central African Republic (CAR), but considerably in the Democratic Republic of the Congo (DRC) from 1990-2019. HIV/AIDS incidence rates in the four countries were at their peaks in the age group of 25-29 years. According to the age relative risks, individuals aged between 15 and 49 years old are at high risk of HIV/AIDS incidence in the four countries. The period and cohort relative risks have decreased in all four countries. Although CAM recorded an increase of 59.6% in the period relative risks (RRs) between 1990 and 1999, HIV/AIDS incidence has decreased dramatically in all four countries, especially after 2000. The decrease of the period RRs (relative risk) by nearly 20.6-folds and the decrease of the cohort RRs from 147.65 to almost 0.0034 in the DRC made it the country with the most significant decrease of the period and cohort RRs compared to the rest. HIV/AIDS incidence rates are decreasing in each of the four countries. Our study findings could provide solid ground for policymakers to promptly decrease HIV/AIDS incidence by strengthening the prevention policies to eliminate the public health threat of HIV/AIDS by 2030 as one of the targets of the Sustainable Development Goals (SDGs).


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adolescente , Adulto , África ao Sul do Saara/epidemiologia , Camarões , Carga Global da Doença , Infecções por HIV/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Adulto Jovem
4.
Open Heart ; 8(1)2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33883228

RESUMO

OBJECTIVE: Adults with congenital heart disease (ACHD) may be at a higher risk of a fatal outcome in case of COVID-19. Current risk stratification among these patients relies on personal experience and extrapolation from patients with acquired heart disease. We aimed to provide an expert view on risk stratification while awaiting results from observational studies. METHODS: This study was an initiative of the EPOCH (European Collaboration for Prospective Outcome Research in Congenital Heart disease). Among nine European countries (Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain and Switzerland), 24 experts from 23 tertiary ACHD centres participated in the survey. ACHD experts were asked to identify ACHD-specific COVID-19 risk factors from a list of potential outcome predictors and to estimate the risk of adverse COVID-19 outcomes in seven commonly seen patient scenarios. RESULTS: 82% of participants did not consider all ACHD patients at risk of COVID-19 related complications. There was a consensus on pulmonary arterial hypertension, Fontan physiology and cyanotic heart disease as risk factors for adverse outcomes. Among different ACHD scenarios, a patient with Eisenmenger syndrome was considered to be at the highest risk. There was a marked variability in risk estimation among the other potential outcome predictors and ACHD scenarios. CONCLUSIONS: Pulmonary arterial hypertension, Fontan palliation and cyanotic heart disease were widely considered as risk factors for poor outcome in COVID-19. However, there was a marked disparity in risk estimation for other clinical scenarios. We are in urgent need of outcome studies in ACHD suffering from COVID-19.


Assuntos
Complexo de Eisenmenger/epidemiologia , Técnica de Fontan/estatística & dados numéricos , Cardiopatias Congênitas , Hipertensão Arterial Pulmonar/epidemiologia , Medição de Risco/métodos , /diagnóstico , Europa (Continente)/epidemiologia , Carga Global da Doença , Cardiopatias Congênitas/classificação , Cardiopatias Congênitas/epidemiologia , Humanos , Avaliação de Resultados em Cuidados de Saúde/métodos , Prognóstico , Fatores de Risco , Sociedades Médicas , Inquéritos e Questionários
7.
Psychiatry Res ; 299: 113855, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33721788

RESUMO

The COVID-19 pandemic has caused unprecedented isolation and mental health effects; few studies have characterized this in sexual and gender (SGM) minority young people, a particularly vulnerable population. This cross-sectional study sought to analyze the mental health outcomes of SGM young people (18-30 years) during the early stages of the pandemic in the United States (April 13-June 18, 2020) and to explore how factors related to SGM identity impact mental health, such as lifetime discrimination, family support, and pre-existing mental health conditions. An online survey collected socio-demographic information and assessed for both mental health (depression (PHQ-8), anxiety (GAD-7), PTSD (PCL-C)) and COVID-19-related outcomes (COVID-19-related worries and COVID-19-related grief). Out of 981 participants, 320 (32.6%) identified as SGM. SGM had significantly higher levels of depression and PTSD symptoms as well as COVID-19-related worries and grief than non-SGM, even after controlling for family support, lifetime discrimination, and pre-existing mental health diagnoses. These findings suggest that not only has the COVID-19 pandemic disproportionately impacted SGM mental health, but that minority stress factors cannot fully explain this impact. Thus, clinicians and societal stakeholders (schools, employers, policymakers) must think beyond traditional minority stress factors (family support, discrimination) and pre-pandemic disparities to support this vulnerable population as the pandemic progresses.


Assuntos
/psicologia , Carga Global da Doença , Saúde Mental/estatística & dados numéricos , Fatores Sexuais , Comportamento Sexual/psicologia , Minorias Sexuais e de Gênero/psicologia , Adolescente , Ansiedade/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pandemias , Questionário de Saúde do Paciente , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
8.
Lancet ; 397(10283): 1505-1518, 2021 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-33773612

RESUMO

Migraine is a highly disabling neurological disorder that directly affects more than 1 billion individuals worldwide. Available treatment options differ between countries and include acute, preventive, and non-pharmacological therapies. Because of major progress in the understanding of migraine pathogenesis, novel mechanism-based medications have emerged and expanded the armamentarium of treatments. We provide a comprehensive overview of the current standard of care that will enable informed clinical management. First, we discuss the efficacy, tolerability, and safety profile of various pharmacological therapies for acute and preventive treatment of migraine. Second, we review the current knowledge on non-pharmacological therapies, such as neuromodulation and biobehavioural approaches, which can be used for a multidisciplinary approach to clinical management. Third, we emphasise that any effective treatment strategy starts with building a therapeutic plan tailored to individual clinical characteristics, preferences, and needs. Finally, we explore the outlook of emerging mechanism-based treatments that could address unmet challenges in clinical management of migraine.


Assuntos
Carga Global da Doença , Transtornos de Enxaqueca/epidemiologia , Feminino , Humanos , Masculino , Transtornos de Enxaqueca/terapia , Prevalência , Atenção Primária à Saúde/métodos
9.
Lancet Psychiatry ; 8(4): 320-328, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33675688

RESUMO

BACKGROUND: Anorexia nervosa and bulimia nervosa are the only eating disorders included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, yet binge-eating disorder and other specified feeding or eating disorder (OSFED) are more prevalent. This study sought to estimate the prevalence and burden of binge-eating disorder and OSFED globally and present a case for their inclusion in GBD. METHODS: We sourced studies from the GBD 2019 anorexia nervosa and bulimia nervosa epidemiological databases, two systematic reviews that included studies with epidemiological estimates of binge-eating disorder and OSFED, and experts in the field. Studies, published between Jan 1, 1998, and March 1, 2019, were included if they reported non-zero prevalence of two or more eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder, or OSFED) and diagnosed cases according to DSM-IV or DSM-5. The proportions of total eating disorder cases that met diagnostic criteria for each individual eating disorder were estimated via network meta-regression and simulation using studies reporting eating disorder prevalence. The global cases unrepresented in GBD 2019 were estimated using the proportions from the simulation and the GBD 2019 eating disorder prevalence. Disability weights for binge-eating disorder and OSFED were then estimated along with disability-adjusted life-years (DALYs). Estimates are presented with 95% uncertainty intervals (UIs). FINDINGS: 54 studies, of which 36 were from high-income countries, were included in the analysis. The number of global eating disorder cases in 2019 that were unrepresented in GBD 2019 was 41·9 million (95% UI 27·9-59·0), and consisted of 17·3 million (11·3-24·9) people with binge-eating disorder and 24·6 million (14·7-39·7) people with OSFED (vs 13·6 million [10·2-17·5] people with eating disorders in GBD 2019). Together, binge-eating disorder and OSFED caused 3·7 million (95% UI 2·0-6·5) DALYs globally, bringing the total eating disorder DALYs to 6·6 million (3·8-10·6) in 2019. INTERPRETATION: Binge-eating disorder and OSFED accounted for the majority of eating disorder cases and DALYs globally. These findings warrant the inclusion of binge-eating disorder and OSFED in future iterations of GBD, which will bring the burden experienced by people living with these disorders to the attention of policy makers with the means to target this burden. FUNDING: Queensland Health, Australian National Health and Medical Research Council, and Bill & Melinda Gates Foundation.


Assuntos
Transtorno da Compulsão Alimentar/epidemiologia , Carga Global da Doença , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Masculino , Prevalência , Anos de Vida Ajustados por Qualidade de Vida
14.
Biomed Environ Sci ; 34(2): 101-109, 2021 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-33685568

RESUMO

Objective: To assess the association of socioeconomic status with the burden of cataract blindness in terms of year lived with disability (YLD) rates and to determine whether ultraviolet radiation (UVR) levels modify the effect of socioeconomic status on this health burden. Methods: National and subnational age-standardized YLD rates associated with cataract-related blindness were derived from the Global Burden of Disease (GBD) study 2017. The human development index (HDI) from the Human Development Report was used as a measure of socioeconomic status. Estimated ground-level UVR exposure was obtained from the Ozone Monitoring Instrument (OMI) dataset of the National Aeronautics and Space Administration (NASA). Results: Across 185 countries, socioeconomic status was inversely associated with the burden of cataract blindness. Countries with a very high HDI had an 84% lower age-standardized YLD rate [95% confidence interval ( CI): 60%-93%, P < 0.001] than countries with a low HDI; for high-HDI countries, the proportion was 76% (95% CI: 53%-88%, P < 0.001), and for medium-HDI countries, the proportion was 48% (95% CI: 15%-68%, P = 0.010; P for trend < 0.001). The interaction analysis showed that UVR exposure played an interactive role in the association between socioeconomic status and cataract blindness burden ( P value for interaction = 0.047). Conclusion: Long-term high-UVR exposure amplifies the association of poor socioeconomic status with the burden of cataract-related blindness. The findings emphasize the need for strengthening UVR exposure protection interventions in developing countries with high-UVR exposure.


Assuntos
Cegueira/epidemiologia , Catarata/epidemiologia , Carga Global da Doença , Raios Ultravioleta/efeitos adversos , Cegueira/etiologia , Catarata/etiologia , Feminino , Carga Global da Doença/estatística & dados numéricos , Humanos , Masculino , Anos de Vida Ajustados por Qualidade de Vida , Classe Social , Fatores Socioeconômicos
15.
Sci Total Environ ; 775: 145839, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-33631580

RESUMO

Exposure to household air pollution from solid fuels (HAP) is associated with stroke. However, few studies have assessed stroke burden attributable to HAP globally and made comparisons across countries. We aimed to estimate the spatiotemporal trends in stroke burden and mortality attributable to household air pollution from solid fuels (HAP) in 204 countries and territories from 1990 to 2019. Data on stroke burden and mortality attributable to HAP from 1990 to 2019 were obtained from Global Burden of Disease Study 2019. We estimated the numbers and age-standardized rates (ASRs) of stroke disability-adjusted life years (DALYs) and mortality (ASDR and ASMR) by sex, age, and subtype, at global, regional, and national levels. Estimated annual percentage change (EAPC) was calculated to evaluate the temporal trends in ASDR and ASMR from 1990 to 2019. In 2019, globally, 14.7 million DALYs and 0.6 million deaths were caused by stroke attributable to HAP. The corresponding ASDR and ASMR increased with age, were highest in males and for intracerebral hemorrhage, with highest ASRs in the low sociodemographic index (SDI) regions and Solomon Islands, and varied greatly at the national level. From 1990 to 2019, the corresponding EAPCs in ASDR and ASMR were -4.00 (95% confidence interval [CI]: -4.21 to -3.80) and -4.12 (95% CI: -4.37 to -3.87), respectively. Stroke burden attributable to HAP decreased in all age groups. Females had a lower decreasing trend in ASDR and ASMR, compared with males. The decline was more significant for subarachnoid hemorrhage, while proportions of ischemic stroke in the numbers of stroke burden increased worldwide and in all SDI regions. Although most of countries and territories were in a decreasing trend in ASRs over the past three decades, Zimbabwe and Philippines showed an undesirable increased trend. Stroke burden attributable to HAP is still pronounced in males, old-age populations, low-income countries, and for intracerebral hemorrhage. Despite its decreasing spatiotemporal trends in most countries, continued efforts on HAP control are needed to reduce related stroke burden, especially in those countries with increased trends.


Assuntos
Poluição do Ar , Acidente Vascular Cerebral , Feminino , Carga Global da Doença , Humanos , Masculino , Melanesia , Filipinas , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Zimbábue
17.
JAMA Netw Open ; 4(2): e2037530, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33599775

RESUMO

Importance: Occupational exposure to carcinogens has been shown to pose a serious disease burden at the global, regional, and national levels. Based on epidemiologic studies and clinical observations, working environment appears to have important effects on the occurrence of human malignant tumors; however, to date, no systematic articles have been published that specifically investigated cancer burden due to occupational exposure in an individual and collective manner. Objective: To estimate the degree of exposure and evaluate the cancer burden attributable to occupational carcinogens (OCs) individually and collectively by sex, age, year, and location. Design, Setting, and Participants: Cross-sectional study including data on 195 countries from the Global Burden of Diseases, Injuries, and Risk Factors Study from January 1, 1990, to December 31, 2017. Data were analyzed from June 24, 2020, to July 20, 2020. Exposures: Thirteen OCs (ie, arsenic, asbestos, benzene, beryllium, cadmium, chromium, diesel engine exhaust, formaldehyde, nickel, polycyclic aromatic hydrocarbons, silica, sulfuric acid, and trichloroethylene). Main Outcomes and Measures: The degree and change patterns of exposure as well as the attributable cancer burden, including deaths and disability-adjusted life years (DALYs), by sex, age, year, and location for 13 OCs. The calculation of the population-attributable fraction was based on past exposure in the population and relative risks. Results: Based on the GBD 2017 study, 13 OCs attributable to 7 cancer types were included. Most summary exposure values for the 13 OCs, particularly those of diesel engine exhaust (35.6% increase; 95% uncertainty interval [UI], 32.4%-38.5%) and trichloroethylene (30.3% increase; 95% UI, 27.3%-33.5%), increased from 1990 to 2017. Only exposure to asbestos decreased by 13.8% (95% UI, -26.7% to 2.2%). In 2017, 319 000 (95% UI, 256 000-382 000) cancer deaths and 6.42 million (95% UI, 5.15 million to 7.76 million) DALYs were associated with OCs combined, accounting for 61.0% (95% UI, 59.6%-62.4%) of the total cancer deaths and 48.3% (46.3% to 50.2%) of the DALYs. Among the 13 OCs, the 3 leading risk factors for cancer burden were asbestos (71.8%), silica (15.4%), and diesel engine exhaust (5.6%). For most OCs, the attributed cancer outcome was tracheal, bronchial, and lung cancer, which accounted for 89.0% of attributable cancer deaths. China (61 644 cancer deaths), the US (42 848), and Japan (20 748) accounted for the largest number of attributable cancer deaths in 2017; for DALYs, China (1.47 million), the US (0.71 million), and India (0.37 million) were the 3 leading countries. Conclusions and Relevance: Results of this study suggest that although OC exposure levels have decreased, the overall cancer burden is continuously increasing.


Assuntos
Carcinógenos , Carga Global da Doença , Neoplasias/mortalidade , Exposição Ocupacional/estatística & dados numéricos , Anos de Vida Ajustados por Qualidade de Vida , Adolescente , Adulto , Idoso , Arsênico , Asbestos , Benzeno , Berílio , Cádmio , China/epidemiologia , Cromo , Estudos Transversais , Feminino , Formaldeído , Humanos , Índia/epidemiologia , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Níquel , Hidrocarbonetos Policíclicos Aromáticos , Dióxido de Silício , Ácidos Sulfúricos , Tricloroetileno , Estados Unidos/epidemiologia , Emissões de Veículos , Adulto Jovem
19.
Nutrients ; 13(2)2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33573027

RESUMO

The associations among early childhood caries (ECC), socioeconomic status, and sugar consumption are of the utmost importance, due to their potential policy implications. The purpose of this study was to identify trends in ECC burden in children under 5 years old among European Union (EU) member states over time and to evaluate the relationship with its risk factors. Global Burden of Disease 2019 data were analyzed to estimate the burden of ECC over time, specifically incidence, prevalence, and years lived with disability (YLDs) for children under 5 years old. Four ecological variables with a potential effect on YLDs for ECC were used to investigate the association between 2014 and 2017. The YLDs rate was consistently higher among Eastern EU countries over time. Univariate models showed a positive significant association between at-risk-of-poverty rate and YLDs rate, while GDP per capita and urbanization were inversely associated with YLDs rate. In the multivariate analysis, sugar consumption, GDP per capita and urbanization showed significant association with YLDs rate. After stratification by region, association remained significant only in the Eastern EU countries between GDP, urbanization, and YLDs rate, while sugar consumption and at-risk-of-poverty rate had no significant impact on YLDs rates. This study found increasing ECC burden in the EU. The complexity of the problem indicates the need for innovative and personalized policy approaches to tackle the disease.


Assuntos
Cárie Dentária/epidemiologia , União Europeia/estatística & dados numéricos , Carga Global da Doença/tendências , Saúde Global/tendências , Saúde Bucal/tendências , Pré-Escolar , Cárie Dentária/etiologia , Suscetibilidade à Cárie Dentária , Dieta/efeitos adversos , Dieta/estatística & dados numéricos , Açúcares da Dieta/efeitos adversos , Açúcares da Dieta/análise , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Produto Interno Bruto , Humanos , Incidência , Masculino , Análise Multivariada , Pobreza/estatística & dados numéricos , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Urbanização/tendências
20.
Lancet Glob Health ; 9(4): e489-e551, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33607016
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