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1.
Trials ; 25(1): 429, 2024 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-38951929

RESUMO

BACKGROUND: Randomised trials are essential to reliably assess medical interventions. Nevertheless, interpretation of such studies, particularly when considering absolute effects, is enhanced by understanding how the trial population may differ from the populations it aims to represent. METHODS: We compared baseline characteristics and mortality of RECOVERY participants recruited in England (n = 38,510) with a reference population hospitalised with COVID-19 in England (n = 346,271) from March 2020 to November 2021. We used linked hospitalisation and mortality data for both cohorts to extract demographics, comorbidity/frailty scores, and crude and age- and sex-adjusted 28-day all-cause mortality. RESULTS: Demographics of RECOVERY participants were broadly similar to the reference population, but RECOVERY participants were younger (mean age [standard deviation]: RECOVERY 62.6 [15.3] vs reference 65.7 [18.5] years) and less frequently female (37% vs 45%). Comorbidity and frailty scores were lower in RECOVERY, but differences were attenuated after age stratification. Age- and sex-adjusted 28-day mortality declined over time but was similar between cohorts across the study period (RECOVERY 23.7% [95% confidence interval: 23.3-24.1%]; vs reference 24.8% [24.6-25.0%]), except during the first pandemic wave in the UK (March-May 2020) when adjusted mortality was lower in RECOVERY. CONCLUSIONS: Adjusted 28-day mortality in RECOVERY was similar to a nationwide reference population of patients admitted with COVID-19 in England during the same period but varied substantially over time in both cohorts. Therefore, the absolute effect estimates from RECOVERY were broadly applicable to the target population at the time but should be interpreted in the light of current mortality estimates. TRIAL REGISTRATION: ISRCTN50189673- Feb. 04, 2020, NCT04381936- May 11, 2020.


Assuntos
COVID-19 , Hospitalização , Humanos , COVID-19/mortalidade , COVID-19/epidemiologia , Masculino , Inglaterra/epidemiologia , Feminino , Pessoa de Meia-Idade , Idoso , Hospitalização/estatística & dados numéricos , Idoso de 80 Anos ou mais , SARS-CoV-2 , Comorbidade , Adulto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fragilidade/epidemiologia , Fragilidade/diagnóstico , Fragilidade/mortalidade
2.
Health Expect ; 27(4): e14126, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38952213

RESUMO

INTRODUCTION: The impact of multiple health conditions on bowel cancer screening is currently unknown. We explored the impact of multiple health conditions on bowel cancer screening perceptions, experience and clinical management decisions following a positive stool test. METHODS: Semi-structured qualitative interviews were conducted remotely with Bowel Screening Wales staff (n = 16) stratified by regional location and role and with screening participants (n = 19) stratified by age, gender and comorbidity. Interview topics were guided by the Common-Sense Model. RESULTS: Screening participants, regardless of comorbidity status, placed great emphasis on the importance of early detection of cancer and completing the bowel screening process. Screening staff emphasised comorbidities in the clinical decision-making process; however, screening participants had low awareness of the impact that comorbidities can have on bowel screening. Participants describe how the presence of multiple health conditions can mask potential bowel symptoms and influence beliefs about follow-up. CONCLUSION: Bowel screening staff try to individualise the service to meet participant needs. The potential mismatch in screening staff and participant awareness and expectations of the bowel screening and diagnostic process needs to be addressed. Clearer and more regular communication with screening participants could support the screening process, particularly for those with significant coexisting health conditions or facing time delays. The possible masking effects and misattribution of symptoms because of comorbidities highlight an opportunity for education and raising awareness for screening participants and a potential area of focus for discussions in clinical consultations and staff training. PATIENT AND PUBLIC CONTRIBUTION: Project funding included costs for patients and public contributors to be compensated for their contributions to the project, in line with current standards. A patient and public contributor was involved in the design of the study, including protocol development, and the interpretation of key findings and implications for patients, which are subsequently reflected within the manuscript.


Assuntos
Neoplasias Colorretais , Comorbidade , Detecção Precoce de Câncer , Entrevistas como Assunto , Pesquisa Qualitativa , Humanos , Feminino , Masculino , Detecção Precoce de Câncer/psicologia , Pessoa de Meia-Idade , Idoso , Neoplasias Colorretais/diagnóstico , Programas de Rastreamento , País de Gales , Adulto
3.
J Clin Psychiatry ; 85(3)2024 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-38959495

RESUMO

Objective: Borderline personality disorder (BPD) and eating disorders (EDs) both cause significant distress and co-occur at rates higher than expected, signifying potential overlapping regulatory mechanisms between both disorders. More specifically, both disorders involve emotion regulation deficits, suggesting they may share specific maladaptive regulatory components. The present study sought to examine the predictive role of emotion dysregulation within the comorbidity between EDs and BPD.Methods: A sample of psychiatric outpatients (N = 872) collected from a longitudinal study spanning the mid-1990s to 2015 completed the Structured Clinical Interview for DSM-IV for Axis I Disorders as well as a measure of emotion regulation strategies, the Difficulties in Emotion Regulation Scale, in order to assess overall functioning.Results: In a regression analysis, BPD was significantly predicted by emotion regulation deficits and was strongly related to categories of emotion dysregulation. EDs were not significantly predicted by emotion regulation deficits but did predict BPD diagnoses (B = -0.14, P < .001). Overall, BPD demonstrated strong relationships to emotion regulation deficits.Conclusions: Results indicate that targeted treatment focusing on emotion regulation deficits may be particularly indicated with co-occurring BPD and ED diagnoses.


Assuntos
Transtorno da Personalidade Borderline , Comorbidade , Regulação Emocional , Transtornos da Alimentação e da Ingestão de Alimentos , Humanos , Transtorno da Personalidade Borderline/psicologia , Transtorno da Personalidade Borderline/epidemiologia , Feminino , Adulto , Masculino , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Estudos Longitudinais , Pessoa de Meia-Idade , Adulto Jovem , Adolescente
4.
PLoS One ; 19(7): e0306131, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38954717

RESUMO

INTRODUCTION: A number of seroprevalence studies in Zambia document the extent of spread of acute SARS-CoV-2 infection, yet knowledge gaps still exist on symptoms and conditions that continue or develop after acute COVID-19 (long COVID). This is an important gap given the estimated prevalence of long COVID in other African countries. We assessed factors associated with long COVID at the initial visit to a post-acute COVID-19 (PAC-19) clinic and longitudinally among a cohort of patients with ≥2 review visits. METHODS: We implemented a cross-sectional and longitudinal analysis of PAC-19 clinic patients from Aug-2020 to Jan-2023. The study outcome was long COVID; defined as the presence of new, relapsing, or persistent COVID-19 symptoms that interfere with the ability to function at home or work. Explanatory variables were demographic and clinical characteristics of patients which included sex, age group, presence of new onset medical conditions, presence of pre-existing comorbidities, vaccination status and acute COVID-19 episode details. We fitted logistic and mixed effects regression models to assess for associated factors and considered statistical significance at p<0.05. RESULTS: Out of a total 1,359 PAC-19 clinic patients in the cross-sectional analysis, 548 (40.3%) patients with ≥2 PAC-19 clinic visits were in the longitudinal analysis. Patients' median age was 53 (interquartile range [IQR]: 41-63) years, 919 (67.6%) were hospitalized for acute COVID-19, and of whom 686 (74.6%) had severe acute COVID-19. Overall, 377 (27.7%) PAC-19 clinic patients had long COVID. Patients with hospital length of stay ≥15 days (adjusted odds ratio [aOR]: 5.37; 95% confidence interval [95% CI]: 2.99-10.0), severe acute COVID-19 (aOR: 3.22; 95% CI: 1.68-6.73), and comorbidities (aOR:1.50; 95% CI: 1.02-2.21) had significantly higher chance of long COVID. Longitudinally, long COVID prevalence significantly (p<0.001) declined from 75.4% at the initial PAC-19 visit to 26.0% by the final visit. The median follow-up time was 7 (IQR: 4-12) weeks. CONCLUSION: Factors associated with long COVID in Zambia were consistent both cross-sectionally at the initial visit to PAC-19 clinics and longitudinally across subsequent review visits. This highlights the importance of ongoing monitoring and tailored interventions for patients with comorbidities and severe COVID-19 to mitigate the long-term impacts of COVID-19.


Assuntos
COVID-19 , SARS-CoV-2 , Humanos , Zâmbia/epidemiologia , COVID-19/epidemiologia , Masculino , Feminino , Estudos Transversais , Estudos Longitudinais , Adulto , Pessoa de Meia-Idade , SARS-CoV-2/isolamento & purificação , Síndrome de COVID-19 Pós-Aguda , Idoso , Adulto Jovem , Adolescente , Comorbidade , Fatores de Risco , Prevalência
5.
BMC Psychiatry ; 24(1): 482, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38956492

RESUMO

BACKGROUND: Hypertension, sleep disorders, and depression represent notable public health issues, and their interconnected nature has long been acknowledged. The objective of this study is to explore the interplay between sleep disorders and depression in the context of hypertension. METHODS: This cross-sectional study involved 42,143 participants aged 18 and above from the NHANES database across seven survey cycles between 2005 and 2018. After excluding those with missing data on depression, sleep disorders, and hypertension, as well as incomplete main variables, 33,383 participants remained. We used weighted logistic regression to examine the relationship between sleep disorders, depression, and hypertension. Additionally, we assessed the interaction between sleep disorders and depression on hypertension using both multiplicative and additive approaches to quantify their combined effect. RESULTS: Compared to individuals without sleep disorders, those with sleep disorders have an increased risk of hypertension (OR = 1.51, 95% CI: 1.37-1.67). Furthermore, individuals with depression experience a significantly higher risk of hypertension compared to those with sleep disorders alone (OR = 2.34, 95% CI: 1.95-2.80). Our study reveals a positive interaction between sleep disorders and depression in relation to hypertension risk (OR = 1.07, 95% CI: 1.02-1.13). In addition, we observed the quantitative additive interaction indicators (RERI = 0.73, 95% CI: 0.56 ~ 0.92; API = 0.31, 95% CI: 0.11 ~ 0.46; SI = 2.19, 95% CI: 1.08-3.46) influencing hypertension risk. Furthermore, our research also identified that individuals with less than 7 h of sleep, a sleep latency period between 5 and 30 min, or a latency period exceeding 30 min experience a significantly increased risk of hypertension. CONCLUSIONS: Our research uncovered separate links between sleep disorders, depression, and hypertension prevalence. Moreover, we identified an interaction between depression and sleep disorders in hypertension prevalence. Enhancing mental well-being and tackling sleep disorders could help prevent and manage hypertension. Yet, more investigation is required to establish causation and clarify mechanisms.


Assuntos
Depressão , Hipertensão , Transtornos do Sono-Vigília , Humanos , Hipertensão/epidemiologia , Estudos Transversais , Masculino , Feminino , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/complicações , Pessoa de Meia-Idade , Adulto , Depressão/epidemiologia , Depressão/complicações , Adulto Jovem , Idoso , Comorbidade , Inquéritos Nutricionais , Adolescente , Fatores de Risco
6.
BMC Endocr Disord ; 24(1): 102, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38956584

RESUMO

BACKGROUND: Lipodystrophy is characterized by progressive loss of adipose tissue and consequential metabolic abnormalities. With new treatments emerging for lipodystrophy, there is a growing need to understand the prevalence of specific comorbidities that may be commonly associated with lipodystrophy to contextualize the natural history of lipodystrophy without any disease modifying therapy. OBJECTIVE: To examine the risk of specific clinical characteristics in people living with lipodystrophy (LD) in 2018-2019 compared with the general US population, among the commercially insured US population. METHODS: A retrospective cohort study was conducted using the 2018-2019 Clinformatics® Data Mart database. An adult LD cohort (age ≥ 18 years) with at least ≥ 1 inpatient or ≥ 2 outpatient LD diagnoses was created. The LD cohort included non-HIV-associated LD (non-HIV-LD) and HIV-associated LD (HIV-LD) subgroups and compared against age- and sex-matched control groups with a 1:4 ratio from the general population with neither an LD or an HIV diagnosis using odds ratios (ORs) with 95% confidence intervals. RESULTS: We identified 546 individuals with non-HIV-LD (mean age, 60.3 ± 14.9 years; female, 67.6%) and 334 individuals with HIV-LD (mean age, 59.2 ± 8.3 years; female, 15.0%) in 2018-2019. Compared with the general population, individuals with non-HIV-LD had higher risks (odds ratio [95% confidence interval]) for hyperlipidemia (3.32 [2.71-4.09]), hypertension (3.58 [2.89-4.44]), diabetes mellitus (4.72 [3.85-5.79]), kidney disease (2.78 [2.19-3.53]), liver fibrosis or cirrhosis (4.06 [1.66-9.95]), cancer (2.20 [1.59-3.01]), and serious infections resulting in hospitalization (3.00 [2.19-4.10]). Compared with individuals with HIV, those with HIV-LD have higher odds of hypertension (1.47 [1.13-1.92]), hyperlipidemia (2.46 [1.86-3.28]), and diabetes (1.37 [1.04-1.79]). CONCLUSIONS: LD imposes a substantial burden on affected individuals due to a high prevalence of metabolic comorbidities and other complications as compared with the general non-LD population. Future longitudinal follow-up studies investigating the causality between LD and observed comorbidities are warranted.


Assuntos
Lipodistrofia , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Prevalência , Adulto , Estados Unidos/epidemiologia , Lipodistrofia/epidemiologia , Bases de Dados Factuais , Idoso , Comorbidade , Infecções por HIV/epidemiologia , Infecções por HIV/complicações , Adulto Jovem , Seguimentos
7.
Georgian Med News ; (349): 60-67, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38963203

RESUMO

In Georgia, the number of confirmed cases of Coronavirus were 1,85,5289. Among them, 17 132 patients died. Information on risk factors for mortality is insufficient. The purpose of our research is to evaluate clinical features of heavy patients with severe COVID and determine prognostic factors of outcome. Factors associated with critical COVID-19 included older age and certain chronic medical conditions. The clinical material of 250 chronically ill COVID-19 patients admitted to the intensive care unit was retrospectively studied. We divided the patients into two groups. The dead and the survivors. Demographic data, comorbidities, chronic diseases, results of ultrasound, cardiography, computed tomography and laboratory characteristics were studied. In patients with chronic diseases, in the intensive care unit during COVID-19, the relative chance of survival decreases: CRP3 - OR=0.98(95% CI:0.97-0.99Hydrothorax- OR=0.24(95% CI:0.06-0.95); Sepsis/Septic shock - OR=0.07(95% CI:0.01-0.39); WBC - OR=0.86(95% CI:0.74-0.99); Mechanical lung ventilation - OR=0.01(95% CI:0.00-0.05)); increase survival relative chance- pO2 - OR=1.03(95% CI:1.0-1.06). Predictors of mortality in patients with chronic diseases: coagulation characteristics, inflammatory markers, sepsis, and artificial lung ventilation. Risk factors for covid-19 mortality need to be studied to increase pandemic preparedness.


Assuntos
COVID-19 , Humanos , COVID-19/mortalidade , COVID-19/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , SARS-CoV-2 , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , República da Geórgia/epidemiologia , Comorbidade , Prognóstico , Adulto , Mortalidade Hospitalar , Idoso de 80 Anos ou mais
8.
Br J Community Nurs ; 29(7): 321-325, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38963276

RESUMO

Many people living with dementia will also have multimorbidity comprising several other intercurrent, long-term and comorbid conditions. This article examines the relationship between such conditions in the context of dementia, giving an overview of the literature, including prevalence and some of the common conditions that can coexist with dementia. The theory and evidence-base will be tied together using a case study approach, to illustrate the complexity of managing comorbid conditions and multimorbidity alongside dementia, and explore some of the approaches that can be used by community nurses to support the overall health of people living with dementia that they work with.


Assuntos
Comorbidade , Demência , Multimorbidade , Humanos , Demência/epidemiologia , Demência/enfermagem , Idoso , Enfermagem em Saúde Comunitária , Prevalência , Feminino
9.
Eur J Psychotraumatol ; 15(1): 2367815, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38957149

RESUMO

Background: Comorbidity between posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) is surrounded by diagnostic controversy and although various effective treatments exist, dropout and nonresponse are high.Objective: By estimating the network structure of comorbid PTSD and BPD symptoms, the current study illustrates how the network perspective offers tools to tackle these challenges.Method: The sample comprised of 154 patients with a PTSD diagnosis and BPD symptoms, assessed by clinician-administered interviews. A regularised partial correlation network was estimated using the GLASSO algorithm in R. Central symptoms and bridge symptoms were identified. The reliability and accuracy of network parameters were determined through bootstrapping analyses.Results: PTSD and BPD symptoms largely clustered into separate communities. Intrusive memories, physiological cue reactivity and loss of interest were the most central symptoms, whereas amnesia and suicidal behaviour were least central.Conclusions: Present findings suggest that PTSD and BPD are two distinct, albeit weakly connected disorders. Treatment of the most central symptoms could lead to an overall deactivation of the network, while isolated symptoms would need more specific attention during therapy. Further experimental, longitudinal research is needed to confirm these hypotheses.Trial registration: ClinicalTrials.gov identifier: NCT03833453.


A network analysis of PTSD and BPD symptoms.PTSD and BPD symptoms largely clustered into separate communities.Intrusive memories, loss of interest and physiological cue reactivity seem valuable treatment targets.


Assuntos
Transtorno da Personalidade Borderline , Transtornos de Estresse Pós-Traumáticos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno da Personalidade Borderline/epidemiologia , Comorbidade , Reprodutibilidade dos Testes , Transtornos de Estresse Pós-Traumáticos/epidemiologia
10.
Age Ageing ; 53(7)2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38965032

RESUMO

INTRODUCTION: Delirium and multiple long-term conditions (MLTC) share numerous risk factors and have been shown individually to be associated with adverse outcomes following hospitalisation. However, the extent to which these common ageing syndromes have been studied together is unknown. This scoping review aims to summarise our knowledge to date on the interrelationship between MLTC and delirium. METHODS: Searches including terms for delirium and MLTC in adult human participants were performed in PubMed, EMBASE, Medline, Psycinfo and CINAHL. Descriptive analysis was used to summarise findings, structured according to Synthesis Without Meta-analysis reporting guidelines. RESULTS: After removing duplicates, 5256 abstracts were screened for eligibility, with 313 full-texts sought along with 17 additional full-texts from references in review articles. In total, 140 met inclusion criteria and were included in the final review. Much of the literature explored MLTC as a risk factor for delirium (n = 125). Fewer studies explored the impact of MLTC on delirium presentation (n = 5), duration (n = 3) or outcomes (n = 6) and no studies explored how MLTC impacts the treatment of delirium or whether having delirium increases risk of developing MLTC. The most frequently used measures of MLTC and delirium were the Charlson Comorbidity Index (n = 98/140) and Confusion Assessment Method (n = 81/140), respectively. CONCLUSION: Existing literature largely evaluates MLTC as a risk factor for delirium. Major knowledge gaps identified include the impact of MLTC on delirium treatment and the effect of delirium on MLTC trajectories. Current research in this field is limited by significant heterogeneity in defining both MLTC and delirium.


Assuntos
Delírio , Adulto , Feminino , Humanos , Masculino , Envelhecimento/psicologia , Doença Crônica , Comorbidade , Delírio/diagnóstico , Delírio/epidemiologia , Delírio/terapia , Delírio/psicologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais
11.
Int J Chron Obstruct Pulmon Dis ; 19: 1447-1456, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38948908

RESUMO

Purpose: Chronic obstructive pulmonary disease (COPD) and metabolic syndrome (MetS) are among the most prevalent conditions that might predispose individuals to life-threatening events. We aimed to examine their associations with cardiovascular (CV) events and mortality using a large-scale population dataset from the National Health Information Database in Korea. Patients and Methods: This population-based cohort study enrolled adults aged ≥40 years who had undergone more than two health examinations between 2009 and 2011. They were divided into four groups based on the presence of COPD and MetS. Analysis of the outcomes and CV events or deaths was performed from 2014 to 2019. We compared CV event incidence and mortality rates using a multivariate Cox proportional hazards model and Kaplan-Meier curves. Results: Totally, 5,101,810 individuals were included, among whom 3,738,458 (73.3%) had neither COPD nor MetS, 1,193,014 (23.4%) had only MetS, 125,976 (2.5%) had only COPD, and 44,362 (0.9%) had both. The risk of CV events was significantly higher in individuals with both COPD and MetS than in those with either COPD or MetS alone (HRs: 2.4 vs 1.6 and 1.8, respectively; all P <0.001). Similarly, among those with both COPD and MetS, all-cause and CV mortality risks were also elevated (HRs, 2.9 and 3.0, respectively) compared to the risks in those with either COPD (HRs, 2.6 and 2.1, respectively) or MetS (HRs, 1.7 and 2.1, respectively; all P <0.001). Conclusion: The comorbidity of MetS in patients with COPD increases the incidence of CV events and all-cause and cardiovascular mortality rates.


Assuntos
Doenças Cardiovasculares , Bases de Dados Factuais , Síndrome Metabólica , Doença Pulmonar Obstrutiva Crônica , Humanos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/mortalidade , Síndrome Metabólica/diagnóstico , Masculino , Feminino , República da Coreia/epidemiologia , Pessoa de Meia-Idade , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Idoso , Incidência , Medição de Risco , Adulto , Fatores de Tempo , Modelos de Riscos Proporcionais , Prognóstico , Fatores de Risco , Fatores de Risco de Doenças Cardíacas , Comorbidade
12.
Oncol Nurs Forum ; 51(4): E4-E24, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38950088

RESUMO

OBJECTIVES: To identify subgroups of patients with distinct cough occurrence profiles and evaluate for differences among these subgroups. SAMPLE & SETTING: Outpatients receiving chemotherapy (N = 1,338) completed questionnaires six times over two chemotherapy cycles. METHODS & VARIABLES: Occurrence of cough was assessed using the Memorial Symptom Assessment Scale. Latent class analysis was used to identify subgroups with distinct cough occurrence profiles. Parametric and nonparametric tests were used to evaluate for differences. RESULTS: Four distinct cough profiles were identified (None, Decreasing, Increasing, and High). Risk factors associated with membership in the High class included lower annual household income; history of smoking; self-reported diagnoses of lung disease, heart disease, and back pain; and having lung cancer. IMPLICATIONS FOR NURSING: Clinicians need to assess all patients with cancer for cough and provide targeted interventions.


Assuntos
Comorbidade , Tosse , Neoplasias , Fumar , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Fumar/epidemiologia , Adulto , Neoplasias/tratamento farmacológico , Inquéritos e Questionários , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Fatores de Risco , Renda/estatística & dados numéricos , Cardiopatias/induzido quimicamente , Cardiopatias/epidemiologia , Pneumopatias/epidemiologia , Pneumopatias/induzido quimicamente , Neoplasias Pulmonares/tratamento farmacológico , Efeitos Psicossociais da Doença , Carga de Sintomas
13.
Front Public Health ; 12: 1414768, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38983261

RESUMO

Background: Some occupational and environmental exposures could increase the risk of chronic obstructive pulmonary disease (COPD) and hypertension in various work and living environments. However, the effect of exposure to multiple exogenous harmful substances on COPD and hypertension co-morbidities remains unclear. Methods: Participants were selected from eight hospitals in five provinces in China using a multistage cluster sampling procedure. Participants' demographic, exposure, and disease information were collected through questionnaires, spirometry, and blood pressure examinations. Demographic data were used as matching factors, and 1:1 matching between the exposed and non-exposed groups was performed by employing propensity score matching (PSM) to minimize the influence on the results. A one-way chi-squared analysis and multifactorial logistic regression were used to analyze the association between the exposure to exogenous harmful substances (metals and their compound dust, inorganic mineral dust, organic chemicals, and livestock by-products) and the co-morbidity of COPD and hypertension. Results: There were 6,610 eligible participants in the final analysis, of whom 2,045 (30.9%) were exposed to exogenous harmful substances. The prevalence of co-morbidities of COPD and hypertension (6.0%) in the exposure group was higher than their prevalence in the total population (4.6%). After PSM, exogenous harmful substance exposure was found to be a risk factor for the co-morbidity of COPD and hypertension [odds ratio (OR) = 1.347, 95% confidence interval (CI): 1.011-1.794], which was not statistically significant before PSM (OR = 1.094, 95% CI: 0.852-1.405). Meanwhile, the results of different outcomes showed that the association between hypertension and exogenous harmful substance exposure was not statistically significant (OR = 0.965, 95% CI: 0.846-1.101). Smoking (OR = 4.702, 95% CI: 3.321-6.656), history of a respiratory disease during childhood (OR = 2.830, 95% CI: 1.600-5.006), and history of respiratory symptoms (OR = 1.897, 95% CI: 1.331-2.704) were also identified as risk factors for the co-morbidity of COPD and hypertension. Conclusion: The distribution of exogenous harmful substance exposure varies in the population, and the prevalence of co-morbidities is generally higher in susceptible populations. Exposure to exogenous harmful substances was found to be a key risk factor after adjusting for demographic confounders.


Assuntos
Comorbidade , Exposição Ambiental , Hipertensão , Doença Pulmonar Obstrutiva Crônica , Humanos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Hipertensão/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , China/epidemiologia , Fatores de Risco , Exposição Ambiental/efeitos adversos , Exposição Ambiental/estatística & dados numéricos , Pontuação de Propensão , Adulto , Prevalência , Inquéritos e Questionários , Idoso , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/estatística & dados numéricos
14.
Int J Chron Obstruct Pulmon Dis ; 19: 1579-1589, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38983577

RESUMO

Purpose: Pulmonary rehabilitation (PR) is a type of multidisciplinary care strongly recommended after severe exacerbation of chronic obstructive pulmonary disease (COPD). Recently, a national French study reported a very low rate of PR uptake (8.6%); however, important clinical data were missing. Here, we aimed to identify the main factors associated with insufficient PR uptake after hospitalisation for COPD exacerbation. Patients and Methods: This multicentre retrospective study included patients hospitalised with COPD exacerbation between 1 January 2017 and 31 December 2018, as identified by both coding and a detailed review of medical records. PR was defined as inpatient care in a specialised centre or unit within 90 days of discharge. Multivariate logistic regression was used to identify associations between PR uptake and patient characteristics, such as comorbidities, non-invasive ventilation (NIV), inhaled treatment, and forced expiratory volume in 1 second (FEV1). Results: Among the 325 patients admitted for severe COPD exacerbation, 92 (28.3%) underwent PR within 90 days of discharge. In univariate analysis, relative to those who underwent PR, patients without PR had significantly more comorbidities, were less often treated with triple bronchodilator therapy or NIV, and had a higher FEV1. In multivariate analysis, variables independently associated with the lack of PR uptake were the presence of comorbidities (adjusted odds ratio (aOR) = 1.28 [1.10-1.53], p = 0.003) and a higher FEV1 (aOR = 1.04 [1.02-1.06], p < 0.001). There was no significant correlation between PR uptake and departmental PR centre capacity (notably, some departments had no PR facilities). Conclusion: These data highlight the lack of PR in the early stages of COPD. Collaboration among all healthcare providers involved in patient management is crucial for improved PR uptake.


Pulmonary rehabilitation (PR) is multidisciplinary care strongly recommended after severe exacerbation of chronic obstructive pulmonary disease (COPD); however, referral remains very low in France. We have shown, in three French centres, that early-stage COPD and associated comorbidities are the main factors contributing to insufficient PR after hospitalisation for exacerbation. Collaboration among all healthcare providers involved in patient management is crucial to improve PR uptake in the years ahead because physical medicine and rehabilitation professionals play key roles in the promotion and early initiation of PR programs.


Assuntos
Progressão da Doença , Doença Pulmonar Obstrutiva Crônica , Índice de Gravidade de Doença , Humanos , Doença Pulmonar Obstrutiva Crônica/reabilitação , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Masculino , Estudos Retrospectivos , Feminino , Idoso , França/epidemiologia , Pessoa de Meia-Idade , Fatores de Tempo , Volume Expiratório Forçado , Pulmão/fisiopatologia , Resultado do Tratamento , Fatores de Risco , Ventilação não Invasiva/estatística & dados numéricos , Broncodilatadores/uso terapêutico , Comorbidade , Idoso de 80 Anos ou mais , Recuperação de Função Fisiológica
15.
J Headache Pain ; 25(1): 109, 2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38965463

RESUMO

BACKGROUND: Management of patients with migraine who have concomitant medication overuse (MO) or medication overuse headache (MOH) is a major problem in clinical practice. Detoxification of acute analgesics before or during initiation of prophylactic therapy has long been recommended although this concept has recently been questioned. Additionally, relapse after detoxification is a common problem. This real-world study analyses the initial and sustained effectiveness of prophylactic migraine therapy with CGRP (receptor) antibodies without prior detoxification in patients with comorbid MO or MOH for up to one year. METHODS: A retrospective real-world analysis was performed on 291 patients (episodic migraine (EM) with MO (EM-MO; n = 35), EM without MO (EM-noMO; n = 77), chronic migraine (CM) with MOH (CM-MOH; n = 109), CM without MOH (CM-noMOH; n = 70). All patients began treatment with either erenumab (n = 173), fremanezumab (n = 70) or galcanezumab (n = 48) without prior detoxification. Data were available for up to 12 months of treatment. Responder rates for monthly headache days (MHD), monthly migraine days (MMD) and monthly acute medication intake (AMD) were analysed. RESULTS: All groups showed a significant reduction in MHD, MMD and AMD at the last observed time point compared to baseline. In patients with CM and MOH, 60.6% (66/109) no longer fulfilled the definition of MO or MOH and a further 13.8% (15/109) had only EM-MO. In the EM cohort, 89% (31/35) of MO patients lost their MO during therapy. MHD and AMD 30% responder rates were comparable for CM-MOH and CM-noMOH (MHD: CM-MOH: 56.0% vs. CM-noMOH: 41.4%, p = 0.058, AMD: CM-MOH: 66.1% vs. CM-noMOH: 52.9%, p = 0.077). MMD responder rate did not differ significantly (after Bonferroni adjustment) (CM-MOH: 62.4% vs. CM-noMOH: 47.1%, p = 0.045, α = 0.017). After successful initiation of therapy, 15.4% of the initial CM-MOH patients relapsed and met the criterion for CM-MOH at the end of follow-up. There were no antibody specific differences in response to therapy. CONCLUSIONS: Our data confirms the effectiveness of CGRP antibody treatment in migraine patients with additional MOH or MO in a real-world setting. Low relapse rates after initial successful therapy support an early start of CGRP antibody treatment in patients with MOH or MO. TRIAL REGISTRATION: No registration, retrospective analysis.


Assuntos
Transtornos da Cefaleia Secundários , Transtornos de Enxaqueca , Humanos , Transtornos de Enxaqueca/tratamento farmacológico , Feminino , Masculino , Transtornos da Cefaleia Secundários/tratamento farmacológico , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/administração & dosagem , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/efeitos adversos , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/uso terapêutico , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Comorbidade , Resultado do Tratamento
17.
Sci Rep ; 14(1): 15563, 2024 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-38971866

RESUMO

Influenza viruses are responsible for a high number of infections and hospitalizations every year. In this study, we aimed to identify clinical and host-specific factors that influence the duration of hospitalization and the progression to acute respiratory failure (ARF) in influenza. We performed an analysis of data from a prospective active influenza surveillance study that was conducted over five seasons (2018/19 to 2022/23). A total of 1402 patients with influenza were included in the analysis, the majority of which (64.5%) were children (under 18 years), and 9.1% were elderly. At least one chronic condition was present in 29.2% of patients, and 9.9% of patients developed ARF. The median hospital stay was 4 days (IQR: 3, 6 days). The most important predictors of prolonged hospital stay and development of ARF were extremes of age (infants and elderly), presence of chronic diseases, particularly the cumulus of at least 3 chronic diseases, and late presentation to hospital. Among the chronic diseases, chronic obstructive pulmonary disease, cardiovascular disease, cancer, diabetes, obesity, and chronic kidney disease were strongly associated with a longer duration of hospitalization and occurrence of ARF. In this context, interventions aimed at chronic disease management, promoting influenza vaccination, and improving awareness and access to health services may contribute to reducing the impact of influenza not only in Romania but globally. In addition, continued monitoring of the circulation of influenza viruses is essential to limit their spread among vulnerable populations.


Assuntos
Comorbidade , Hospitalização , Influenza Humana , Tempo de Internação , Insuficiência Respiratória , Humanos , Influenza Humana/epidemiologia , Influenza Humana/complicações , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adolescente , Adulto , Criança , Pré-Escolar , Hospitalização/estatística & dados numéricos , Lactente , Adulto Jovem , Insuficiência Respiratória/epidemiologia , Estudos Prospectivos , Fatores Etários , Doença Aguda , Idoso de 80 Anos ou mais , Fatores de Risco
18.
PLoS One ; 19(7): e0296139, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38968193

RESUMO

BACKGROUND: Chronic inflammation may increase susceptibility to pneumonia. RESEARCH QUESTION: To explore associations between clinical comorbidities, serum protein immunoassays, and long-term pneumonia risk. METHODS: Framingham Heart Study Offspring Cohort participants ≥65 years were linked to their Centers for Medicare Services claims data. Clinical data and 88 serum protein immunoassays were evaluated for associations with 10-year incident pneumonia risk using Fine-Gray models for competing risks of death and least absolute shrinkage and selection operators for covariate selection. RESULTS: We identified 1,370 participants with immunoassays and linkage to Medicare data. During 10 years of follow up, 428 (31%) participants had a pneumonia diagnosis. Chronic pulmonary disease [subdistribution hazard ratio (SHR) 1.87; 95% confidence interval (CI), 1.33-2.61], current smoking (SHR 1.79, CI 1.31-2.45), heart failure (SHR 1.74, CI 1.10-2.74), atrial fibrillation/flutter (SHR 1.43, CI 1.06-1.93), diabetes (SHR 1.36, CI 1.05-1.75), hospitalization within one year (SHR 1.34, CI 1.09-1.65), and age (SHR 1.06 per year, CI 1.04-1.08) were associated with pneumonia. Three baseline serum protein measurements were associated with pneumonia risk independent of measured clinical factors: growth differentiation factor 15 (SHR 1.32; CI 1.02-1.69), C-reactive protein (SHR 1.16, CI 1.06-1.27) and matrix metallopeptidase 8 (SHR 1.14, CI 1.01-1.30). Addition of C-reactive protein to the clinical model improved prediction (Akaike information criterion 4950 from 4960; C-statistic of 0.64 from 0.62). CONCLUSIONS: Clinical comorbidities and serum immunoassays were predictive of pneumonia risk. C-reactive protein, a routinely-available measure of inflammation, modestly improved pneumonia risk prediction over clinical factors. Our findings support the hypothesis that prior inflammation may increase the risk of pneumonia.


Assuntos
Biomarcadores , Pneumonia , Humanos , Feminino , Pneumonia/sangue , Pneumonia/epidemiologia , Masculino , Biomarcadores/sangue , Idoso , Fatores de Risco , Proteínas Sanguíneas/análise , Estudos de Coortes , Idoso de 80 Anos ou mais , Estados Unidos/epidemiologia , Comorbidade
19.
J Korean Med Sci ; 39(26): e199, 2024 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-38978486

RESUMO

BACKGROUND: The relationship between aspirin usage and the risk of colorectal cancer (CRC) among individuals with both hypertension (HTN) and diabetes mellitus (DM) remains unclear. This study aims to explore the impact of aspirin use on the site-specific CRC risk in patients with metabolic comorbidity. METHODS: A case-control study was conducted among 1,331 CRC patients and 2,771 controls recruited from the Nation Cancer Center in Korea. Multinomial logistic regression analyses were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between aspirin use, metabolic disease status, and site-specific CRC risk. RESULTS: Among the 4,102 participants, 1,191 individuals had neither HTN nor DM, 2,044 were diagnosed with HTN, 203 with DM, and 664 presented with HTN and DM comorbidity. An increasing number of HTN and DM was associated with an increased risk of overall CRC (HTN or DM: OR, 1.70; 95% CI, 1.39-2.07; HTN and DM: OR, 8.43; 95% CI, 6.37-11.16), while aspirin use was associated with a decreased risk of overall CRC (OR, 0.31; 95% CI, 0.21-0.46). These results remained consistent across anatomical sites. Among individuals with HTN and DM comorbidity, aspirin use notably associated with lower risk of overall CRC (OR, 0.39; 95% CI, 0.21-0.72), proximal colon (OR, 0.32; 95% CI, 0.13-0.71) and rectal cancer (OR, 0.27; 95% CI, 0.08-0.97), but not distal colon cancer (OR, 0.58; 95% CI, 0.27-1.24). CONCLUSION: This study showed that aspirin use is negatively associated with overall and site-specific CRC, even among individuals with HTN and DM comorbidity.


Assuntos
Aspirina , Neoplasias Colorretais , Comorbidade , Hipertensão , Humanos , Aspirina/uso terapêutico , Masculino , Feminino , Pessoa de Meia-Idade , Estudos de Casos e Controles , Neoplasias Colorretais/epidemiologia , Idoso , Razão de Chances , Hipertensão/epidemiologia , Hipertensão/complicações , Fatores de Risco , Modelos Logísticos , Diabetes Mellitus/epidemiologia , República da Coreia/epidemiologia , Adulto
20.
J Am Heart Assoc ; 13(14): e032589, 2024 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-38979832

RESUMO

BACKGROUND: To study the age-adjusted Charlson comorbidity index (ACCI) scale, which is a comprehensive quantification of multimorbidity coexistence, for the assessment of the risk of acute myocardial infarction death in elderly people. METHODS AND RESULTS: A total of 502 older patients with acute myocardial infarction were studied at Qilu Hospital from September 2017 to March 2022. They were categorized on the basis of ACCI into low (≤5), intermediate (6, 7), and high (≥8) risk groups. Hospitalization duration was observed, with death as the end point. least absolute shrinkage and selection operator regression was used to screen variables, 10-fold cross-validation was performed to validate the screened variables, a Cox regression nomogram predicting the risk of patient death was prepared, hazard ratio with 95% CI was calculated, a nomogram calibration curve was constructed, and a receiver operating characteristic curve, decision curve analysis, and a clinical impact curve were established. From 62 potential factors in a least absolute shrinkage and selection operator regression, 12 were selected via 10-fold cross-validation. Retain variables with significant statistical differences in the Cox regression. A nomogram of the risk of death from acute infarction was constructed, and risk factors included ventricular tachycardia/fibrillation, atrial fibrillation, nicorandil, angiotensin-converting enzyme inhibitors/angiotensin-converting enzyme inhibitors, ß blockers, and ACCI score, carbon dioxide combining power, and blood calcium concentration. CONCLUSIONS: The ACCI score effectively assesses multimorbidity in the older patients. As ACCI rises, the death risk from acute myocardial infarction grows. The study's nomogram is valid and clinically applicable.


Assuntos
Mortalidade Hospitalar , Infarto do Miocárdio , Nomogramas , Humanos , Masculino , Idoso , Feminino , Medição de Risco/métodos , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/diagnóstico , Idoso de 80 Anos ou mais , Fatores de Risco , Fatores Etários , Estudos Retrospectivos , Comorbidade , Prognóstico , China/epidemiologia , Valor Preditivo dos Testes
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