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1.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(8): 1231-1236, 2020 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-32867428

RESUMO

Genetic variation is used as instrumental variable to investigate the causal relationship between exposure and outcome, which can avoid issues of confounding and reserve causation regarding Mendelian randomization studies. However, the instrumental variables in Mendelian randomization studies must satisfy three core assumptions-the relevance assumption, the independence assumption, and the exclusion restriction assumption. In addition to the plausibility of core assumptions, the application of Mendelian randomization studies in causal inference is also subject to other limitations. Findings from the Mendelian randomization studies should be interpreted in the context of existing evidence from other sources. In this article we provide an overview of the assumptions, limitations, and interpretation on causal inference that related to Mendelian randomization studies that can be applied in studies of the same kind.


Assuntos
Causalidade , Análise da Randomização Mendeliana , Variação Genética , Humanos
2.
Medicine (Baltimore) ; 99(33): e21703, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872044

RESUMO

Studies have shown that peptic ulcer disease (PUD) increases the risk of dementia via the mechanism of systemic inflammation. We examined the association between PUD and the risk of dementia using a population-based national sample cohort from South Korea.Using the national cohort study from the Korean National Health Insurance Service, we extracted data for patients with dementia (n = 11,434) and for 1:4 matched control participants (n = 45,736) and then analyzed the previous histories of PUD from 2002 to 2013 using conditional logistic regression analyses. The controls were matched to the patients according to age, sex, income, region of residence, and past medical history. Subgroup analyses were performed based on age and sex.There was no statistically significant difference in the incidence of PUD between the dementia and control groups (18.0% vs 17.4%, P = .107). The adjusted odds ratio (OR) for PUD was 0.92 (95% confidence interval [CI] = 0.88-0.97, P = .002). In the subgroup analysis based on age, the adjusted ORs for PUD were 0.93 (95% CI = 0.88-0.99) in the <80-year-old group and 0.90 (95% CI = 0.82-1.00) in the ≥80-year-old group (each P < .05). In the subgroup analysis based on sex, the adjusted ORs for PUD were 0.89 (95% CI = 0.81-0.97; P < .05) in men and 0.94 (95% CI = 0.89-1.00; P = .06) in women.PUD does not increase the risk of dementia at any age or in either sex after adjusting for age and the history of hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, stroke, and depression.


Assuntos
Doença de Alzheimer/epidemiologia , Úlcera Péptica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Causalidade , Bases de Dados Factuais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Medição de Risco
4.
Maturitas ; 140: 24-26, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32972631

RESUMO

Using Hill's methodology for exploring causality, we aimed to determine in early May 2020 whether evidence supports vitamin D as a biological determinant of COVID-19 outcomes. Vitamin D is a secosteroid hormone theoretically able to reduce COVID-19 risk through regulation of (i) the renin-angiotensin system, (ii) cellular innate and adaptive immunity, and (iii) physical barriers. Inverse associations were found between 25-hydroxyvitamin D concentrations and COVID-19 incidence and mortality. Randomized controlled trials testing vitamin D supplementation in the treatment of COVID-19 are in progress. Positive results in such studies would encourage the use of vitamin D supplements as an adjuvant treatment in COVID-19.


Assuntos
Infecções por Coronavirus/sangue , Pneumonia Viral/sangue , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Betacoronavirus , Causalidade , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Suplementos Nutricionais , Humanos , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Prognóstico , Vitamina D/sangue , Vitamina D/uso terapêutico , Deficiência de Vitamina D/epidemiologia , Vitaminas/uso terapêutico
5.
Lancet Glob Health ; 8(10): e1316-e1325, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32971054

RESUMO

BACKGROUND: Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection (LRTI) in children. Early-life RSV LRTI might affect long-term health but there are few data from low-income and middle-income countries. We investigated the epidemiology and effect of early-life RSV LRTI on lung health in a South African birth cohort. METHODS: We conducted the Drakenstein Child Health Study (DCHS), an ongoing birth cohort longitudinal study in the Western Cape province, South Africa. We enrolled pregnant women aged 18 years or older during their second trimester of pregnancy at two public health clinics. We followed up study children from birth to 2 years. The primary outcome of the study was LRTI and RSV LRTI. LRTI and wheezing episodes were identified through active surveillance; respiratory samples were tested for RSV and other pathogens. Wheezing was longitudinally identified by caregiver report and ascertainment at health facilities. Lung function was measured from 6 weeks to 2 years. We analysed the associations between RSV LRTI and subsequent LRTI, wheezing, and lung function using generalised estimating equations and mixed-effects linear regression. FINDINGS: We enrolled 1137 mothers between March 5, 2012, and March 31, 2015. Among their 1143 infants, accruing 2093 child-years of follow-up, there were 851 cases of LRTI (incidence 0·41 episodes per child-year, 95% CI 0·38-0·43). Admission to hospital owing to LRTI occurred in 169 (20%) cases (incidence 0·08 episodes per child-year, 0·07-0·09), with a case-fatality ratio of 0·5%. RSV was detected in 164 (21%) of 785 LRTI events with a specimen available for qPCR, an incidence of 0·08 episodes per child-year (0·07-0·09); highest at age 0-6 months (0·15 episodes per child-year, 0·12-0·19). Children with a first RSV LRTI were three times as likely to develop recurrent LRTI compared with those with non-RSV LRTI (0·32 [0·22-0·48] vs 0·10 [0·07- 0·16] episodes per child-year; p<0·0001), particularly following hospitalised RSV LRTI. RSV LRTI and hospitalisation for all-cause LRTI were independently associated with recurrent wheezing (adjusted incident rate ratio 1·41, 95% CI 1·25-1·59, for RSV LRTI and 1·48, 1·30-1·68, for hospitalisation). LRTI or recurrent LRTI was associated with impaired lung function, but a similar outcome was observed following RSV LRTI or non-RSV LRTI. All-cause LRTI was associated with an average 3% higher respiratory rate (95% CI 0·01-0·06; p=0·013) and lower compliance (-0·1, -0·18 to 0·02) at 2 years compared with no LRTI. Recurrent LRTI was associated with further increased respiratory rate (0·01, 0·001-0·02), resistance (0·77 hPa s L-1, 0·07-1·47), and lower compliance (-0·6 mL hPa-1, -0·09 to -0·02) with each additional event. INTERPRETATION: RSV LRTI was common in young infants and associated with recurrent LRTI, particularly after hospitalised RSV. Hospitalisation for all-cause LRTI, especially for RSV-LRTI, was associated with recurrent wheezing. Impairments in lung function followed LRTI or recurrent episodes, but were not specific to RSV. New preventive strategies for RSV might have an effect on long-term lung health. FUNDING: Bill & Melinda Gates Foundation; South African Medical Research Council; National Research Foundation South Africa; National Institutes of Health, Human Heredity and Health in Africa; Wellcome Trust.


Assuntos
Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções Respiratórias/epidemiologia , Causalidade , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , África do Sul/epidemiologia
7.
Med Clin North Am ; 104(5): 791-806, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773046

RESUMO

A large body of research has addressed the assessment and management of fall risk among community-dwelling older adults. Persons with dementia are at higher risk for falls and fall-related injuries, yet less is known about effective strategies for reducing falls and injuries among those with dementia. Falls and dementia are regularly considered to be discrete conditions and are often managed separately. Increasing evidence shows that these conditions frequently co-occur, and one may precede the other. This article explores the relationship between falls and dementia, including the importance of rehabilitation strategies for reducing fall risk in these individuals.


Assuntos
Acidentes por Quedas , Demência , Avaliação Geriátrica/métodos , Medição de Risco/métodos , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Idoso , Causalidade , Demência/diagnóstico , Demência/epidemiologia , Humanos , Vida Independente/psicologia , Atenção Primária à Saúde/métodos
8.
Med Clin North Am ; 104(5): 843-854, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773049

RESUMO

Older adults experience greater emotional well-being in late life. However, older adults may be vulnerable to certain physiologic risk factors, including less physiologic resilience to prolonged stress. Depression and anxiety can be difficult to diagnose in late life owing to differences in self-reported symptoms from younger adults and unclear distinctions between normative and non-normative emotional experiences. We discuss age differences in the presentations of depression and anxiety, and normative and non-normative late life developmental trajectories around bereavement and grief, social isolation and loneliness, and thoughts of death and suicide. We provide recommendations for clinicians for assessing and diagnosing older adults.


Assuntos
Ansiedade , Depressão , Saúde Mental , Tristeza/psicologia , Isolamento Social/psicologia , Idoso , Ansiedade/diagnóstico , Ansiedade/prevenção & controle , Ansiedade/psicologia , Causalidade , Depressão/diagnóstico , Depressão/prevenção & controle , Depressão/psicologia , Avaliação Geriátrica , Humanos , Apoio Social , Ideação Suicida
10.
Crit Care ; 24(1): 485, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32758295

RESUMO

BACKGROUND: While obesity confers an increased risk of death in the general population, numerous studies have reported an association between obesity and improved survival among critically ill patients. This contrary finding has been referred to as the obesity paradox. In this retrospective study, two causal inference approaches were used to address whether the survival of non-obese critically ill patients would have been improved if they had been obese. METHODS: The study cohort comprised 6557 adult critically ill patients hospitalized at the Intensive Care Unit of the Ghent University Hospital between 2015 and 2017. Obesity was defined as a body mass index of ≥ 30 kg/m2. Two causal inference approaches were used to estimate the average effect of obesity in the non-obese (AON): a traditional approach that used regression adjustment for confounding and that assumed missingness completely at random and a robust approach that used machine learning within the targeted maximum likelihood estimation framework along with multiple imputation of missing values under the assumption of missingness at random. 1754 (26.8%) patients were discarded in the traditional approach because of at least one missing value for obesity status or confounders. RESULTS: Obesity was present in 18.9% of patients. The in-hospital mortality was 14.6% in non-obese patients and 13.5% in obese patients. The raw marginal risk difference for in-hospital mortality between obese and non-obese patients was - 1.06% (95% confidence interval (CI) - 3.23 to 1.11%, P = 0.337). The traditional approach resulted in an AON of - 2.48% (95% CI - 4.80 to - 0.15%, P = 0.037), whereas the robust approach yielded an AON of - 0.59% (95% CI - 2.77 to 1.60%, P = 0.599). CONCLUSIONS: A causal inference approach that is robust to residual confounding bias due to model misspecification and selection bias due to missing (at random) data mitigates the obesity paradox observed in critically ill patients, whereas a traditional approach results in even more paradoxical findings. The robust approach does not provide evidence that the survival of non-obese critically ill patients would have been improved if they had been obese.


Assuntos
Estado Terminal/mortalidade , Estado Terminal/terapia , Obesidade/epidemiologia , Idoso , Causalidade , Feminino , Mortalidade Hospitalar/tendências , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
11.
PLoS One ; 15(8): e0236278, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32841247

RESUMO

Rabies is a lethal viral disease and dogs are the major disease reservoir in the Philippines. Spatio-temporal variations in environmental factors are known to affect disease dynamics. Some rabies-affected countries considered investigating the role of weather components in driving rabies cases and it has helped them to strategize their control efforts. In this study, cointegration analysis was conducted between the monthly reported rabies cases and the weather components, such as temperature and precipitation, to verify the effect of weather components on rabies incidence in Davao City, Philippines. With the Engle-Granger cointegration tests, we found that rabies cases are cointegrated into each of the weather components. It was further validated, using the Granger causality test, that each weather component predicts the rabies cases and not vice versa. Moreover, we performed the Johansen cointegration test to show that the weather components simultaneously affect the number of rabies cases, which allowed us to estimate a vector-error correction model for rabies incidence as a function of temperature and precipitation. Our analyses showed that canine rabies in Davao City was weather-sensitive, which implies that rabies incidence could be projected using established long-run relationship among reported rabies cases, temperature, and precipitation. This study also provides empirical evidence that can guide local health officials in formulating preventive strategies for rabies control and eradication based on weather patterns.


Assuntos
Reservatórios de Doenças/virologia , Cães/virologia , Monitorização de Parâmetros Ecológicos/estatística & dados numéricos , Raiva/epidemiologia , Tempo (Meteorologia) , Animais , Causalidade , Cidades/estatística & dados numéricos , Conjuntos de Dados como Assunto , Previsões/métodos , Humanos , Incidência , Modelos Estatísticos , Filipinas/epidemiologia , Raiva/prevenção & controle , Raiva/virologia , Vírus da Raiva , Análise Espaço-Temporal
12.
Epidemiology ; 31(6): 836-843, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32841988

RESUMO

Testing of symptomatic persons for infection with severe acute respiratory syndrome coronavirus-2 is occurring worldwide. We propose two types of case-control studies that can be carried out jointly in test settings for symptomatic persons. The first, the test-negative case-control design (TND) is the easiest to implement; it only requires collecting information about potential risk factors for Coronavirus Disease 2019 (COVID-19) from the tested symptomatic persons. The second, standard case-control studies with population controls, requires the collection of data on one or more population controls for each person who is tested in the test facilities, so that test-positives and test-negatives can each be compared with population controls. The TND will detect differences in risk factors between symptomatic persons who have COVID-19 (test-positives) and those who have other respiratory infections (test-negatives). However, risk factors with effect sizes of equal magnitude for both COVID-19 and other respiratory infections will not be identified by the TND. Therefore, we discuss how to add population controls to compare with the test-positives and the test-negatives, yielding two additional case-control studies. We describe two options for population control groups: one composed of accompanying persons to the test facilities, the other drawn from existing country-wide healthcare databases. We also describe other possibilities for population controls. Combining the TND with population controls yields a triangulation approach that distinguishes between exposures that are risk factors for both COVID-19 and other respiratory infections, and exposures that are risk factors for just COVID-19. This combined design can be applied to future epidemics, but also to study causes of nonepidemic disease.


Assuntos
Estudos de Casos e Controles , Grupos Controle , Infecções por Coronavirus/epidemiologia , Projetos de Pesquisa Epidemiológica , Pneumonia Viral/epidemiologia , Betacoronavirus , Causalidade , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Infecções Respiratórias/epidemiologia , Fatores de Risco
13.
Caracas; Observatorio Nacional de Ciencia, Tecnología e Innovación; ago. 2020. 57-78 p. ilus.(Observador del Conocimiento. Revista Especializada de Gestión Social del Conocimiento, 5, 3).
Monografia em Espanhol | LILACS, LIVECS | ID: biblio-1120131

RESUMO

El objetivo principal de este trabajo es describir los principales aspectos biológicos, epidemiológicos y clínicos,con especial énfasis en la fisiopatología, ocasionado por el SARS-CoV-2.El Coronavirus 2 del Síndrome Agudo Respiratorio Severo,es un orthocoronavirinae, del grupoI V, pertenecientes al género betacoronavirus,que causa la actual enfermedad pandémica definida por la Organización Mundial de la Salud (OMS)(2020), como COVID-19.Esta es considerada por los expertos mundiales como una infección viral emergente. Su origenes veterinario y su transmisión zoonótica, a partir de virus que tienen como reservorios a murciélagos y como hospedador intermediario al pangolín, desde el cual se infiere que pudo adaptarse al ser humano, para transmitirse de persona a persona,mediante gotitas respiratorias y secreciones nasales contaminadas con partículas altamente infecciosas. No se descarta la transmisión fecal-oral. La enfermedad posee un periodo de incubación de 2 a 14 días (promedio:5,2 días) y hasta ahora las medidas de prevención y control más eficientes son la cuarentena social obligatoria, el uso de tapabocas, lavado de manos con agua y jabón por al menos 20 segundos,o con productos en gel con alcohol al 70%, mantener una distancia mínima entre las personas de 2 metros. Lo aprendido de los otros dos betacoronavirus humanos relacionados, causantes de las epidemias previas: SARS-CoVen 2002-2003 y el MERSen 2012 ,permiten encarar de mejor forma la actual pandemia(AU)


The main objective of this work is to describe the main biological, epidemiological and clinical aspects, with special emphasis on pathophysiology, caused by SARS-CoV-2. Coronavirus 2 of Severe Acute Respiratory Syndrome is a member of group IV orthocoronavirinae, belonging to the betacoronavirus genus, which causes the current pandemic disease defined by the World Health Organization as COVID-19. This is considered by world experts as an emerging viral infection. Its origin is veterinary and its zoonotic transmission, from viruses that have bats as reservoirs to pangolin an as an intermediate host, from which it is inferred that it could have adapted to the human being, transmitted from person to person by means of respiratory droplets, and highly infectious contaminated nasal secretions Fecal-oral transmission is not ruled out. The disease has an incubation period of 2 to 14 days (5.2 days in mean), and until now the most efficient prevention and control measures are the obligatory social quarantine, the use of face masks, hand washing with soap and water for at least 20 seconds, or with products in gel with 70 alcohol, keeping a minimum distance between people of 2 meters. What has been learned from the other two related human betacoronaviruses that caused the previous epidemics: SARS-CoV in 2002-2003 and MERS in 2012, allow us to better face the current pandemic(AU)


Assuntos
Humanos , Vírus , Desinfecção das Mãos , Causalidade , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa , Secreções Corporais , Síndrome Respiratória Aguda Grave , Pandemias
14.
Crit Care Med ; 48(8): e657-e665, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32697506

RESUMO

OBJECTIVES: Coronavirus disease 2019 has emerged as a major global health threat with a great number of deaths in China. We aimed to assess the association between Acute Physiology and Chronic Health Evaluation II score and hospital mortality in patients with coronavirus disease 2019, and to compare the predictive ability of Acute Physiology and Chronic Health Evaluation II score, with Sequential Organ Failure Assessment score and Confusion, Urea, Respiratory rate, Blood pressure, Age 65 (CURB65) score. DESIGN: Retrospective observational cohort. SETTING: Tongji Hospital in Wuhan, China. SUBJECTS: Confirmed patients with coronavirus disease 2019 hospitalized in the ICU of Tongji hospital from January 10, 2020, to February 10, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 178 potentially eligible patients with symptoms of coronavirus disease 2019, 23 patients (12.92%) were diagnosed as suspected cases, and one patient (0.56%) suffered from cardiac arrest immediately after admission. Ultimately, 154 patients were enrolled in the analysis and 52 patients (33.77%) died. Mean Acute Physiology and Chronic Health Evaluation II score (23.23 ± 6.05) was much higher in deaths compared with the mean Acute Physiology and Chronic Health Evaluation II score of 10.87 ± 4.40 in survivors (p < 0.001). Acute Physiology and Chronic Health Evaluation II score was independently associated with hospital mortality (adjusted hazard ratio, 1.07; 95% CI, 1.01-1.13). In predicting hospital mortality, Acute Physiology and Chronic Health Evaluation II score demonstrated better discriminative ability (area under the curve, 0.966; 95% CI, 0.942-0.990) than Sequential Organ Failure Assessment score (area under the curve, 0.867; 95% CI, 0.808-0.926) and CURB65 score (area under the curve, 0.844; 95% CI, 0.784-0.905). Based on the cut-off value of 17, Acute Physiology and Chronic Health Evaluation II score could predict the death of patients with coronavirus disease 2019 with a sensitivity of 96.15% and a specificity of 86.27%. Kaplan-Meier analysis showed that the survivor probability of patients with coronavirus disease 2019 with Acute Physiology and Chronic Health Evaluation II score less than 17 was notably higher than that of patients with Acute Physiology and Chronic Health Evaluation II score greater than or equal to 17 (p < 0.001). CONCLUSIONS: Acute Physiology and Chronic Health Evaluation II score was an effective clinical tool to predict hospital mortality in patients with coronavirus disease 2019 compared with Sequential Organ Failure Assessment score and CURB65 score. Acute Physiology and Chronic Health Evaluation II score greater than or equal to 17 serves as an early warning indicator of death and may provide guidance to make further clinical decisions.


Assuntos
Causas de Morte , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Mortalidade Hospitalar , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/mortalidade , APACHE , Adulto , Idoso , Causalidade , China/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Urbanos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Pandemias , Pneumonia Viral/terapia , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Curva ROC , Estudos Retrospectivos , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/terapia , Sobreviventes/estatística & dados numéricos
15.
PLoS One ; 15(7): e0234659, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614834

RESUMO

BACKGROUND: The relationship between poor oral health conditions and cognitive decline is unclear. OBJECTIVE: To examine the association between oral health and cognition in humans and rats. METHODS: In humans: a cross-sectional study was conducted. Cognitive levels were evaluated by the Mini Mental State Examination (MMSE); oral conditions were reflected by the number of missing index teeth, bleeding on probing, and probing pocket depth (PD). In rats: a ligature-induced (Lig) periodontitis model and Aß25-35-induced model of Alzheimer's disease (AD) were established; tumor necrosis factor-α (TNF-α), interleukin 1 (IL-1), interleukin 6 (IL-6), and C-reactive protein levels in the hippocampus and cerebral cortex were detected. RESULTS: MMSE scores for the number of missing index teeth ≥ 7 group were significantly lower than those in the ≤ 6 group. A negative relationship (correlation coefficient ρ = -0.310, P = 0.002) was observed between MMSE scores and number of missing index teeth. More missing index teeth and lower education levels were independent risk factors for cognitive decline. A negative relationship (correlation coefficient ρ = -0.214, P = 0.031) was observed between MMSE scores and average PD. TNF-α and IL-6 levels in the hippocampus of the Lig+AD group were significantly higher than those of the AD group. IL-1 and IL-6 levels in the cerebral cortex of the Lig+AD group were significantly higher than those of the AD group. CONCLUSION: Poor oral health conditions including more missing index teeth and higher average PD may be risk factors for cognitive decline. Periodontitis may increase inflammatory cytokines in rat models of AD.


Assuntos
Transtornos Cognitivos/etiologia , Saúde Bucal , Periodontite/complicações , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/etiologia , Peptídeos beta-Amiloides/toxicidade , Animais , Proteína C-Reativa/análise , Causalidade , Córtex Cerebral/química , China/epidemiologia , Transtornos Cognitivos/epidemiologia , Comorbidade , Estudos Transversais , Índice CPO , Modelos Animais de Doenças , Feminino , Hipocampo/química , Humanos , Interleucina-1/análise , Masculino , Aprendizagem em Labirinto , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Fragmentos de Peptídeos/toxicidade , Índice Periodontal , Periodontite/epidemiologia , Periodontite/etiologia , Periodontite/fisiopatologia , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Fatores de Risco , Fator de Necrose Tumoral alfa/análise
16.
Nat Commun ; 11(1): 3673, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32699250

RESUMO

Causal reasoning can shed new light on the major challenges in machine learning for medical imaging: scarcity of high-quality annotated data and mismatch between the development dataset and the target environment. A causal perspective on these issues allows decisions about data collection, annotation, preprocessing, and learning strategies to be made and scrutinized more transparently, while providing a detailed categorisation of potential biases and mitigation techniques. Along with worked clinical examples, we highlight the importance of establishing the causal relationship between images and their annotations, and offer step-by-step recommendations for future studies.


Assuntos
Diagnóstico por Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Aprendizado de Máquina , Causalidade , Humanos
18.
J Affect Disord ; 274: 405-410, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32663970

RESUMO

BACKGROUND: Since the outbreak of 2019 new coronavirus (COVID-19) pneumonia, healthcare workers (HCW) have suffered psychological stress. The present study is to examine the prevalence of stress, anxiety and depression of HCW in China during the COVID-19 epidemic, and to determine the risk factors predicting psychological morbidities that can be used as psychological intervention targets. METHODS: A cross-sectional survey was conducted to investigate the psychological levels of HCW in multiple centers in China. The prevalence of stress, anxiety and depression were determined by using Perceived Stress Scale (PSS-14) and Hospital Anxiety / Depression scale (HAD). Psychology related factors were evaluated and correlation between job title and contact history was analyzed. RESULTS: We received 958 of effective responses, 73.6% of which were from Wuhan and 67.2% were female participants. 55.1% of respondents had psychological stress that is higher than that of HCW during SARS. 54.2% and 58% of participants had symptoms of anxiety and depression. Stress levels of HCW were different in job titles and years of work experience. Anxiety and depression levels were different between different gender, job titles, degrees of protective measures and levels of contact history. Gender, intermediate title, protective measures and contact history were the independent risk factors for anxiety. Protective measures and contact history were the independent risk factors for depression. CONCLUSIONS: The COVID-19 epidemic has induced stress levels for HCW, and high percentages of HCW have anxiety and depression. The situation of HCW is worrying and intervention service is urgent.


Assuntos
Transtornos de Ansiedade/epidemiologia , Atitude do Pessoal de Saúde , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transtorno Depressivo/epidemiologia , Pessoal de Saúde/psicologia , Pneumonia Viral/epidemiologia , Estresse Psicológico/epidemiologia , Adulto , Transtornos de Ansiedade/psicologia , Causalidade , China/epidemiologia , Comorbidade , Infecções por Coronavirus/psicologia , Estudos Transversais , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/psicologia , Prevalência , Fatores de Risco , Estresse Psicológico/psicologia , Inquéritos e Questionários , Adulto Jovem
19.
J Affect Disord ; 274: 576-582, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32663990

RESUMO

BACKGROUND: COVID-19 is fast-spreading and potentially fatal, introducing home quarantine, social distancing, and increased internet usage globally. We investigated COVID-19 anxiety, general anxiety and depression symptoms, and their impact on problematic smartphone use (PSU) severity METHODS: Participants were 908 residents of a large Eastern Chinese city, surveyed from late-February to mid-March, 2020. We administered online measures including the Depression Anxiety Stress Scale-21, Smartphone Addiction Scale-Short Version, and items querying COVID-19-related news exposure and threat of death. Additionally, participants rated anxiety using the Generalized Anxiety Disorder Scale-7 with reference to COVID-19. RESULTS: COVID-19 anxiety correlated with severity of PSU, depression and anxiety. Using established cut-off scores, 12% of participants were identified with at least moderate depression, and 24% with moderate anxiety. Using structural equation modeling, COVID-19 anxiety related to PSU severity, mediating relations between general anxiety and PSU severity. However, controlling PSU for general anxiety and depression severity, COVID-19 anxiety no longer predicted PSU severity. LIMITATIONS: Limitations include the cross-sectional research design and reliance on data from only one country. CONCLUSIONS: Results are discussed in context of the I-PACE model of excessive internet use. While COVID-19 anxiety is likely a global anxiety-provoking event, other everyday worries and anxiety are additionally clinically important in driving excessive internet use.


Assuntos
Transtornos de Ansiedade/epidemiologia , Comportamento Aditivo/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Smartphone/estatística & dados numéricos , Adulto , Transtornos de Ansiedade/psicologia , Comportamento Aditivo/psicologia , Causalidade , China/epidemiologia , Comorbidade , Infecções por Coronavirus/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/psicologia , Índice de Gravidade de Doença , Inquéritos e Questionários
20.
Swiss Med Wkly ; 150: w20316, 2020 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-32668007

RESUMO

AIMS OF THE STUDY: To describe admission characteristics, risk factors and outcomes of patients with coronavirus disease 2019 (COVID-19) hospitalised in a tertiary care hospital in Switzerland during the early phase of the pandemic. METHODS: This retrospective cohort study included adult patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection confirmed by polymerase chain reaction (PCR) testing and hospitalised at the cantonal hospital Aarau (Switzerland) between 26 February 2020 and 30 April 2020. Our primary endpoint was severe COVID-19 progression defined as a composite of transfer to the intensive care unit (ICU) and in-hospital mortality. RESULTS: A total of 99 patients (median age 67 years [interquartile range 56–76], 37% females) were included and 35% developed severe COVID-19 progression (24% needed ICU treatment, 19% died). Patients had a high burden of comorbidities with a median Charlson comorbidity index of 3 points and a high prevalence of hypertension (57%), chronic kidney disease (28%) and obesity (27%). Baseline characteristics with the highest prognostic value for the primary endpoint by means of area under the receiver operating characteristic curve were male gender (0.63) and initial laboratory values including shock markers (lactate on ambient air 0.67; lactate with O2 supply 0.70), markers of inflammation (C-reactive protein 0.72, procalcitonin 0.80) and markers of compromised oxygenation (pO2 0.75 on ambient air), whereas age and comorbidities provided little prognostic information. CONCLUSION: This analysis provides insights into the first consecutively hospitalised patients with confirmed COVID-19 at a Swiss tertiary care hospital during the initial period of the pandemic. Markers of disease progression such as inflammatory markers, markers for shock and impaired respiratory function provided the most prognostic information regarding severe COVID-19 progression in our sample.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Idoso , Causalidade , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Progressão da Doença , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Inflamação/sangue , Masculino , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco , Suíça/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos
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