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1.
Epidemiol Psychiatr Sci ; 29: e84, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31915099

RESUMO

AIMS: Although immune-mediated inflammatory diseases (IMID) are associated with multiple mental health conditions, there is a paucity of literature assessing personality disorders (PDs) in these populations. We aimed to estimate and compare the incidence of any PD in IMID and matched cohorts over time, and identify sociodemographic characteristics associated with the incidence of PD. METHODS: We used population-based administrative data from Manitoba, Canada to identify persons with incident inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA) using validated case definitions. Unaffected controls were matched 5:1 on sex, age and region of residence. PDs were identified using hospitalisation or physician claims. We used unadjusted and covariate-adjusted negative binomial regression to compare the incidence of PDs between the IMID and matched cohorts. RESULTS: We identified 19 572 incident cases of IMID (IBD n = 6,119, MS n = 3,514, RA n = 10 206) and 97 727 matches overall. After covariate adjustment, the IMID cohort had an increased incidence of PDs (incidence rate ratio [IRR] 1.72; 95%CI: 1.47-2.01) as compared to the matched cohort, which remained consistent over time. The incidence of PDs was similarly elevated in IBD (IRR 2.19; 95%CI: 1.69-2.84), MS (IRR 1.79; 95%CI: 1.29-2.50) and RA (IRR 1.61; 95%CI: 1.29-1.99). Lower socioeconomic status and urban residence were associated with an increased incidence of PDs, whereas mid to older adulthood (age 45-64) was associated with overall decreased incidence. In a restricted sample with 5 years of data before and after IMID diagnosis, the incidence of PDs was also elevated before IMID diagnosis among all IMID groups relative to matched controls. CONCLUSIONS: IMID are associated with an increased incidence of PDs both before and after an IMID diagnosis. These results support the relevance of shared risk factors in the co-occurrence of PDs and IMID conditions.


Assuntos
Artrite Reumatoide/epidemiologia , Doenças do Sistema Imunitário/complicações , Inflamação/complicações , Doenças Inflamatórias Intestinais/epidemiologia , Esclerose Múltipla/epidemiologia , Transtornos da Personalidade/epidemiologia , Adolescente , Adulto , Canadá/epidemiologia , Estudos de Coortes , Comorbidade/tendências , Feminino , Humanos , Doenças do Sistema Imunitário/epidemiologia , Incidência , Inflamação/epidemiologia , Masculino , Manitoba/epidemiologia , Pessoa de Meia-Idade , Transtornos da Personalidade/psicologia , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
3.
Niger Postgrad Med J ; 26(4): 211-215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621660

RESUMO

Introduction: Recent evidence suggests that rates of drug use and abuse in Nigeria exceed the global average. There is a strong treatment demand for psychoactive drug use disorders in Nigeria; however, it is not known whether available treatment facilities are attending to the array of treatment needs. This audit compares the pattern of presentations at a tertiary facility with a community-based survey. Methods: A review of cases (n = 212) seen at a regional drug treatment facility over a 4-year period, using local data retrieved from the Nigerian Epidemiological Network of Drug Use (NENDU) and comparison with data from the recently published national drug use survey. Results: Nine out of ten clients seen were male (93.4%). About half (49.5%) of the clients used psychoactive substances for the first time between ages 10 and 19 years. Cannabis was the primary drug of use overall and also among males, while females were more likely to present with opiate abuse. Over half had a co-occurring physical or mental disorder, and a minority had received testing for hepatitis C in the past 12 months. Conclusion: Although patterns of drug abuse presentations were consistent with findings from a national community-based survey, there was an under-representation of females in treatment. Implications for policy development and practice are discussed.


Assuntos
/efeitos adversos , Transtornos Mentais/epidemiologia , Pacientes/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Adulto , Distribuição por Idade , Alcoolismo/epidemiologia , Alcoolismo/reabilitação , Criança , Comorbidade/tendências , Estudos Transversais , Feminino , Hospitais Psiquiátricos , Humanos , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Masculino , Abuso de Maconha/epidemiologia , Transtornos Mentais/reabilitação , Pessoa de Meia-Idade , Nigéria/epidemiologia , Pacientes/psicologia , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários , Adulto Jovem
4.
Drugs Aging ; 36(11): 1027-1034, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31485926

RESUMO

OBJECTIVE: Our objective was to investigate associations between proton pump inhibitor (PPIs) use and infection-related hospitalizations among residents of long-term care facilities (LTCFs). METHODS: This was a case-control study of residents aged ≥ 65 years admitted to hospital between July 2013 and June 2015. Residents admitted for infections (cases) and falls or fall-related injuries (controls) were matched for age (± 2 years), sex, and index date of admission (± 6 months). Conditional logistic regression was used to estimate crude and adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between PPI use and infection-related hospitalizations. Analyses were adjusted for age, sex, polypharmacy, diabetes, heart failure, chronic obstructive pulmonary disease, myocardial infarction, cerebrovascular accident, and concomitant use of cancer and immunosuppressant medications. Subgroup analyses were performed for high- and low/moderate-intensity PPIs and for respiratory and non-respiratory infections. Logistic regression was used to compare the odds of infection-related hospitalizations among users of high- and low/moderate-intensity PPIs. RESULTS: Overall, 181 cases were matched to 354 controls. Preadmission PPI use was associated with infection-related hospitalizations (aOR 1.66; 95% CI 1.11-2.48). In subgroup analyses, the association was apparent only for respiratory infections (aOR 2.26; 95% CI 1.37-3.73) and high-intensity PPIs (aOR 1.93; 95% CI 1.23-3.04). However, the risk of infection-related hospitalization was not significantly higher among users of high- versus low/moderate-intensity PPIs (aOR 1.25; 95% CI 0.74-2.13). CONCLUSION: Residents who use PPIs may be at increased risk of infection-related hospitalizations, particularly respiratory infections. Study findings provide further support for initiatives to minimize unnecessary PPI use in the LTCF setting.


Assuntos
Hospitalização/estatística & dados numéricos , Assistência de Longa Duração , Inibidores da Bomba de Prótons/efeitos adversos , Adulto , Idoso , Estudos de Casos e Controles , Comorbidade/tendências , Feminino , Humanos , Modelos Logísticos , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Polimedicação , Inibidores da Bomba de Prótons/administração & dosagem , Inibidores da Bomba de Prótons/uso terapêutico , Vitória/epidemiologia
5.
Prensa méd. argent ; 105(6): 361-369, Jul 2019. graf, tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1023787

RESUMO

Influenza is a respiratory disease ocasionated by influenza virus A and B. Is a disease with high morbi-mortality world-wide. Influenza produces an acute febrile respiratory illness with cough, headache and myalgias for 3-4 days, with simptoms that may persist for as long as 2 weeks. There are three types of influenza virsuses: A, B and C, of whom the type a has a higher ability to originate pandemias and is subclassified according to their surface antigens: hemaglutinine (H) and neuraminidase (N). Of the capacity of mutation that has the influenza virus and the consequent expression of different proteins, can modify its virulence. The transmission route is through direct contact with secretetory repirations. The transmission route is through direct contact with secretetory repirations. The incubation period is scant, between 12-72 hs. The aim of this study was to compare the clinical characteristics demographicals and evolutive of pediatric patients hospitalized because by Influenze A: subtypes H1N1 (pdm2009) and H3N2. An observative study was performed, retrospective, using data of hospitalizations of children during the years 2016 and 2017 with influenza A confirmed by laboratory. The study also, aimed to evaluate if the viral subtype constitutes a factor of risk, independent for complicated hospitalization (admission to intensive care and/or development of complications) in hospitalized children. The results obtained in the study are detailed in the paper. In conclusion, both viral subtypes affected mainly to children with risk factors. The viral subtype H1N1 was related with higher severety in hospitalized children. is of most importance to perform preventive works, specially in vulnerable groups, offering a good cover of immunizations. The clinical parameters arae commented (AU)


Assuntos
Humanos , Criança , Comorbidade/tendências , Fatores Epidemiológicos , Análise Estatística , Estudos Retrospectivos , Estudos de Coortes , Tamanho da Amostra , Seleção de Pacientes , Vírus da Influenza A Subtipo H1N1/patogenicidade , Vírus da Influenza A Subtipo H3N2/patogenicidade , Influenza Aviária/complicações , Fatores de Risco
6.
Eur J Clin Microbiol Infect Dis ; 38(9): 1701-1708, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31187308

RESUMO

The true burden of sepsis is largely unknown. Conventional underlying cause of death (UCoD) statistics largely underestimates sepsis-related mortality. This study aims to analyze all the conditions mentioned in the death certificates (multiple causes of death-MCoD) to estimate the nationwide burden of sepsis-related mortality in Italy, to investigate time trends and main comorbidities in sepsis-related deaths. All death certificates mentioning sepsis from 2003 to 2015 were analyzed. Age-standardized mortality rates were calculated for sepsis as both UCoD and MCoD, by gender and broad age groups. The ratio of the age-standardized proportions of any mention of sepsis in the presence/absence of associated chronic diseases (ASPR) was computed. The number of certificates reporting sepsis increased from 18,939 in 2003 to 49,010 in 2015 (from 3 to 8% of all deaths). The increase in sepsis mortality rates was larger for UCoD (males, + 200%; females, + 175%) than for MCoD-based figures (+ 100%; + 90%); MCoD rates remained noticeably higher than UCoD rates (2015, 87.3 per 100,000 vs. 16.3 for males; 54.9 vs. 11.8 for females). The largest increase was observed among the very elderly. The association between sepsis and chronic diseases was stronger for subjects aged less than 75 years. The increased awareness within the medical community in addition to the growing susceptible elderly population and the spread of antimicrobial resistance could have contributed to the sepsis-related mortality increase. MCoD statistics could help in recognizing sepsis not only as a clinical challenge, but also as a major public health issue.


Assuntos
Comorbidade/tendências , Sepse/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Adulto Jovem
7.
J Med Internet Res ; 21(5): e12996, 2019 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-31148545

RESUMO

BACKGROUND: Individuals living with long-term physical health conditions frequently experience co-occurring mental health problems. This comorbidity has a significant impact on an individual's levels of emotional distress, health outcomes, and associated health care utilization. As health care services struggle to meet demand and care increasingly moves to the community, digital tools are being promoted to support patients to self-manage their health. One such technology is the autonomous virtual agent (chatbot, conversational agent), which uses artificial intelligence (AI) to process the user's written or spoken natural language and then to select or construct the corresponding appropriate responses. OBJECTIVE: This study aimed to co-design the content, functionality, and interface modalities of an autonomous virtual agent to support self-management for patients with an exemplar long-term condition (LTC; chronic pulmonary obstructive disease [COPD]) and then to assess the acceptability and system content. METHODS: We conducted 2 co-design workshops and a proof-of-concept implementation of an autonomous virtual agent with natural language processing capabilities. This implementation formed the basis for video-based scenario testing of acceptability with adults with a diagnosis of COPD and health professionals involved in their care. RESULTS: Adults (n=6) with a diagnosis of COPD and health professionals (n=5) specified 4 priority self-management scenarios for which they would like to receive support: at the time of diagnosis (information provision), during acute exacerbations (crisis support), during periods of low mood (emotional support), and for general self-management (motivation). From the scenario testing, 12 additional adults with COPD felt the system to be both acceptable and engaging, particularly with regard to internet-of-things capabilities. They felt the system would be particularly useful for individuals living alone. CONCLUSIONS: Patients did not explicitly separate mental and physical health needs, although the content they developed for the virtual agent had a clear psychological approach. Supported self-management delivered via an autonomous virtual agent was acceptable to the participants. A co-design process has allowed the research team to identify key design principles, content, and functionality to underpin an autonomous agent for delivering self-management support to older adults living with COPD and potentially other LTCs.


Assuntos
Comorbidade/tendências , Saúde Mental/tendências , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Apoio Social , Terapia de Exposição à Realidade Virtual/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/mortalidade
8.
Medicina (Kaunas) ; 55(5)2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31108992

RESUMO

Background: In recent years, patterns of the use of psychotropic drugs vary with increasing rates of psychiatric presentation and diagnosis in children and adolescents. Purpose: In this study, we aimed to investigate distributions of current psychiatric symptoms and diagnosis, patterns of the use of psychotropic drugs, and differences according to age and gender in patients presented to a child and adolescent outpatient clinic. Methods: All patients aged between 0 and 18 years presenting to a child and adolescent psychiatry outpatient clinic between November 1, 2017 and November 1, 2018 were included in the study. Files of all patients were examined in detail, and patients' demographic characteristics, symptoms, psychiatric diagnoses established according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), psychotropic drugs initiated, and side effect profiles were recorded. Psychiatric symptoms and diagnostic features of the patients were determined, and the differences were investigated according to gender. Clinical characteristics were compared between diagnosed and undiagnosed patients, and between patients with and without drug initiation. Results: Of the 2066 patients, 1298 (62.8%) were male and the mean age was 10.14 ± 4.42 years. The most common symptoms were hyperactivity (23.8%) and inattention (21.6%) in males, inattention (15.1%) and irritability (14.2%) in females, and 79% of the patients received one or more psychiatric diagnoses. The most common psychiatric diagnoses in both genders were attention-deficit hyperactivity disorder (ADHD), specific learning disorder (SLD), and conduct disorder, respectively. Of the patients who received a psychiatric diagnosis, 61.8% were using psychotropic drugs, with the majority of them (71.3%) receiving monotherapy. The most frequently initiated drugs included psychostimulants, antipsychotics, and antidepressants, with 28.7% of the drug user patients receiving multiple drug therapy. Conclusion: Our study indicates that rate of presentation to child and adolescent psychiatry outpatient clinics is increasing, and rates of diagnosis and initiation of psychiatry drugs are high among the presented children. The prevalence of ADHD shows an increase in males and females in our country, and psychiatric polypharmacy has reached significant rates.


Assuntos
Comorbidade/tendências , Transtornos Mentais/tratamento farmacológico , Psicotrópicos/uso terapêutico , Adolescente , Antidepressivos/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Turquia/epidemiologia
9.
Monaldi Arch Chest Dis ; 89(1)2019 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-30985096

RESUMO

Among the older patients' cohort, the aetiology of heart failure is peculiar and differs in many ways from the younger one, both in its epidemiology, diagnostic work-up and clinical presentation. Focusing on this population, we could assume that heart failure is a real geriatric syndrome, characterized by several features, which coexist with other comorbidities and require specific and targeted cares. It is therefore necessary to examine the global burden of heart failure and the patient's history rather than the causal cardiomyopathy - frequently more than one in the elderly - facing with the condition, bearing in mind the quality of life even before its duration.


Assuntos
Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Qualidade de Vida/psicologia , Idoso , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Comorbidade/tendências , Efeitos Psicossociais da Doença , Feminino , Geriatria , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Polimedicação , Prevalência , Fatores de Risco , Síndrome
10.
Monaldi Arch Chest Dis ; 89(1)2019 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-30985097

RESUMO

Despite improvements in treatments, the prognosis of heart failure remains poor. Elderly patients with heart failure are burdened with multiple co-morbidities and polypharmacy. Multidisciplinary disease-management programs are recommended as standard care for patients at high risk of hospitalization. Cardiac rehabilitation is defined a coordinated multidimensional intervention that integrates the basic elements in multidisciplinary management programs with a continuing program of physical activity and exercise training. Cardiac rehabilitation services can be provided on an inpatient or outpatient basis according to the clinical characteristics and severity of the disease. Data support the usefulness of inpatient cardiac rehabilitation interventions soon after hospitalization for acute decompensated heart failure as a "transition care service" to overcome the particularly high risk "vulnerable" phase. Although in the elderly, physical activity is conditioned by the general clinical conditions, the presence of comorbidities and frailty, several data underscore the importance of improving exercise capacity in the elderly vulnerable patient.


Assuntos
Reabilitação Cardíaca/métodos , Idoso Fragilizado/estatística & dados numéricos , Insuficiência Cardíaca/reabilitação , Idoso , Idoso de 80 Anos ou mais , Reabilitação Cardíaca/estatística & dados numéricos , Comorbidade/tendências , Prática Clínica Baseada em Evidências/métodos , Terapia por Exercício/métodos , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Polimedicação , Prevalência , Recuperação de Função Fisiológica/fisiologia , Índice de Gravidade de Doença , Resultado do Tratamento , Teste de Caminhada/métodos , Teste de Caminhada/estatística & dados numéricos
11.
Health Psychol ; 38(9): 822-830, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31021125

RESUMO

OBJECTIVE: Exercise is effective in producing a wide range of beneficial health outcomes. To ensure safe and effective exercise, guidance has been developed for seemingly healthy people and for people with a single disease. Unfortunately, similar guidance is not yet available for people with comorbidity in addition to the index disease or for people with multimorbidity. However, researchers have recently started to explore the application of exercise in people with comorbidity or multimorbidity, and these innovative applications of exercise have produced encouraging results: Exercise was shown to be safe and effective. The objective of the present article is to identify the underlying principles of exercise in people with comorbidity or multimorbidity. METHOD: We perform a narrative review of applications of exercise in people with comorbidity or multimorbidity. RESULTS: Principles of exercise in people with comorbidity or multimorbidity appear to include (a) a rigorous assessment of health status, (b) the adaptation of exercise to comorbidity or multimorbidity, (c) the application and integration of behavior change techniques into the exercise plan, and (d) clinical reasoning to support the application of exercise by health professionals. CONCLUSIONS: We posit that these 4 principles provide a framework for the successful development of exercise guidance for people with comorbidity or multimorbidity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Comorbidade/tendências , Exercício/psicologia , Multimorbidade/tendências , Doença Crônica , Feminino , Nível de Saúde , Humanos , Masculino
12.
Am J Gastroenterol ; 114(6): 984-994, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31008735

RESUMO

OBJECTIVES: The literature related to eosinophilic gastritis (EG), gastroenteritis (EGE), and colitis (EC) is limited. We aimed to characterize rates of diagnosis, clinical features, and initial treatments for patients with EG, EGE, and EC. METHODS: In this retrospective study, data were collected from 6 centers in the Consortium of Eosinophilic Gastrointestinal Researchers from 2005 to 2016. We analyzed demographics, time trends in diagnosis, medical history, presenting symptoms, disease overlap, and initial treatment patterns/responses. RESULTS: Of 373 subjects (317 children and 56 adults), 38% had EG, 33% EGE, and 29% EC. Rates of diagnosis of all diseases increased over time. There was no male predominance, and the majority of subjects had atopy. Presenting symptoms were similar between diseases with nausea/vomiting and abdominal pain, the most common. One hundred fifty-four subjects (41%) had eosinophilic inflammation outside of their primary disease location with the esophagus the second most common gastrointestinal (GI) segment involved. Multisite inflammation was more common in children than in adults (68% vs 37%; P < 0.001). Initial treatment patterns varied highly between centers. One hundred-nine subjects (29%) had follow-up within 6 months, and the majority had clinical, endoscopic, and histologic improvements. CONCLUSIONS: In this cohort, EG, EGE, and EC were diagnosed more frequently over time, and inflammation of GI segments outside the primary disease site co-occurrence of atopy was common with a lack of male predominance. Symptoms were similar between diseases, and initial treatment strategies were highly variable. Future investigation should assess the cause of the increased prevalence of eosinophilic GI disorders and prospectively assess outcomes to establish treatment algorithms.


Assuntos
Anti-Inflamatórios/uso terapêutico , Colite/epidemiologia , Enterite/epidemiologia , Eosinofilia/epidemiologia , Eosinófilos/patologia , Gastrite/epidemiologia , Gastroenterite/epidemiologia , Fármacos Gastrointestinais/uso terapêutico , Mucosa Intestinal/patologia , Adolescente , Adulto , Criança , Pré-Escolar , Colite/diagnóstico , Colite/tratamento farmacológico , Comorbidade/tendências , Enterite/diagnóstico , Enterite/tratamento farmacológico , Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Feminino , Seguimentos , Previsões , Gastrite/diagnóstico , Gastrite/tratamento farmacológico , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
13.
Medicina (Kaunas) ; 55(4)2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30987061

RESUMO

Background and objectives: Cardiovascular (CV) disease is a major cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD). Patients with COPD have increased arterial stiffness, which may predict future CV risk. However, the development of arterial stiffness in COPD has not yet been studied prospectively. The Assessment of Risk in Chronic Airways Disease Evaluation (ARCADE) is a longitudinal study of CV risk and other comorbidities in COPD. The aims of this analysis were to explore factors associated with aortic pulse wave velocity (aPWV) at baseline and to describe the progression of aPWV in patients with COPD and comparators over two years. Materials and methods: At baseline, 520 patients with COPD (confirmed by spirometry) and 150 comparators free from respiratory disease were assessed for body composition, blood pressure, aPWV, noninvasive measures of cardiac output, inflammatory biomarkers, and exercise capacity. This was repeated after two years, and mortality cases and causes were also recorded. Results: At baseline, aPWV was greater in COPD patients 9.8 (95% confidence interval (CI) 9.7-10.0) versus comparators 8.7 (8.5-9.1) m/s (p < 0.01) after adjustments for age, mean arterial pressure (MAP), and heart rate. Mean blood pressure was 98 ± 11 in COPD patients and 95 ± 10 mmHg in comparators at baseline (p = 0.004). After two years, 301 patients and 105 comparators were fully reassessed. The mean (95% CI) aPWV increased similarly in patients 0.44 (0.25-0.63) and comparators 0.46 (0.23-0.69) m/s, without a change in blood pressure. At the two-year follow-up, there were 29 (6%) deaths in COPD patients, with the majority due to respiratory causes, with an overall dropout of 43% of patients with COPD and 30% of comparators. Conclusions: This was the first large longitudinal study of CV risk in COPD patients, and we confirmed greater aPWV in COPD patients than comparators after adjustments for confounding factors. After two years, patients and comparators had a similar increase of almost 0.5 m/s aPWV.


Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Comorbidade/tendências , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Análise de Onda de Pulso , Idoso , Análise de Variância , Pressão Sanguínea , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Progressão da Doença , Feminino , Seguimentos , Frequência Cardíaca , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Risco , Estatísticas não Paramétricas , Rigidez Vascular , País de Gales/epidemiologia
14.
J Rehabil Med ; 51(5): 369-375, 2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-30964543

RESUMO

OBJECTIVE: To examine how factors associated with infection, organ failure, poor wound healing, or indices of chronic vascular disease are associated with unplanned transfers and functional gains in a population of dysvascular amputees during inpatient rehabilitation. DESIGN: Cross-sectional. SETTING: Inpatient rehabilitation unit at an academic medical centre. PATIENTS: A total of 118 patients with new, dysvascular, lower-extremity, amputation participating in inpatient rehabilitation. METHODS: Logistic regression and indices of change (minimal detectable change; MDC90), standardized response mean and effect size were used to examine the risks of unplanned transfer and functional change. MAIN OUTCOME MEASUREMENTS: Rate of unplanned transfers from rehabilitation, and Functional Independence Measure (FIM). RESULTS: Out of the total of 118 patients 19 had unplanned transfers due to medical complications. Age, creatinine, haemoglobin, white blood cell count, haemodialysis, wound vacuum device use, intravenous antibiotic use, or previous amputations were not independently associated with unplanned transfers, motor FIM change or efficiency. The MDC90 for motor FIM was 17.84, with 21.2% of patients exceeding this value; standardized response mean and effect size were large (1.03 and 1.39, respectively). CONCLUSION: This study suggests that the presence of comorbidities in a population of dysvascular amputees participating in inpatient rehabilitation did not increase the risk of unplanned transfers or affect FIM gains.


Assuntos
Amputação/métodos , Comorbidade/tendências , Alta do Paciente/tendências , Estudos Transversais , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Int J Cardiol ; 285: 140-146, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-30879938

RESUMO

BACKGROUND: Global commitments to reduce cardiovascular disease (CVD) burden by 2025 will require data on CVDs from lower income countries. This study aimed to estimate the prevalence of angina, and its association with hypertension, diabetes, and depression, in six low- and middle-income countries (LMICs). METHODS: Data from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 from China, Ghana, India, Mexico, Russia and South Africa were utilized. Multivariable logistic regression methods were used to examine the factors associated with angina. RESULTS: A total of 31,443 respondents aged 50 years and over were included in these analyses. The prevalence of angina was highest in Russia (39%), lowest in China (8%), and consistently higher in women than men. Angina was comorbid with chronic conditions and depression but patterns varied across countries. Depression was negatively associated with angina among older adults in Ghana but was positively associated with angina in all other countries. Hypertension was associated with increased odds of angina among older adults in China (OR 1.9; 95% CI 1.59-2.25), India (OR 1.4; 95% CI 1.14-1.78) and Russia (OR 3.7; 95% CI 2.33-6.00). Diabetes was associated with higher odds of angina in China (OR 1.6; 95% CI 1.15-2.15), Russia (OR 2.5; 95% CI 1.57-3.87), and South Africa (OR 4.1; 95% CI 2.49-6.88). CONCLUSIONS: CVD is a significant contributor to disease burden in LMICs. Angina was often co-morbid with other conditions, therefore compelling health systems to develop longer-term integrated care systems to address co- and multi-morbidity.


Assuntos
Angina Pectoris/epidemiologia , Depressão/epidemiologia , Adolescente , Adulto , China/epidemiologia , Comorbidade/tendências , Estudos Transversais , Países em Desenvolvimento , Feminino , Gana/epidemiologia , Humanos , Renda , Índia/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Pobreza , Fatores de Risco , Federação Russa/epidemiologia , Fatores Socioeconômicos , África do Sul/epidemiologia , Adulto Jovem
16.
Cardiol Clin ; 37(2): 131-138, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30926014

RESUMO

Atrial fibrillation and heart failure (HF) frequently coexist and are associated with a significant increase in morbidity and mortality. Despite the shared common risk factors atrial fibrillation and HF subtypes exacerbate each other. This review provides an overview of the pathophysiologic relationship between atrial fibrillation and the two most common types of heart failure syndromes: HF with reduced ejection fraction and HF with preserved ejection fraction.


Assuntos
Fibrilação Atrial/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca/fisiologia , Volume Sistólico/fisiologia , Fibrilação Atrial/epidemiologia , Comorbidade/tendências , Saúde Global , Insuficiência Cardíaca/epidemiologia , Humanos , Prognóstico , Fatores de Risco
17.
Cardiol Clin ; 37(2): 139-146, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30926015

RESUMO

Atrial fibrillation (AF) and heart failure (HF) both significantly affect morbidity and mortality and also account for high symptom burden and impaired health-related quality of life (hrQoL). Several well-designed and broadly implemented patient-reported outcome instruments are available for both AF and HF and can easily measure hrQoL in each disease process. A better understanding of the diverse phenotypes of AF and HF, as well as the heterogeneous treatment effects of disease-specific interventions, is necessary to further disentangle the complex relationship between symptoms of AF and HF.


Assuntos
Fibrilação Atrial/diagnóstico , Lista de Checagem , Nível de Saúde , Insuficiência Cardíaca/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Fibrilação Atrial/epidemiologia , Comorbidade/tendências , Saúde Global , Insuficiência Cardíaca/epidemiologia , Humanos , Fatores de Risco
19.
Neuro Endocrinol Lett ; 39(7): 489-495, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30860680

RESUMO

INTRODUCTION: The clinical characteristics of subacute thyroiditis (SAT) has been changing in recent years. There are more and more patients with painless SAT, and more cases of SAT with elevated levels of anti-thyroid antibodies were reported. The aim of the study was to evaluate the clinical characteristics of SAT patients with special regard to the differences between the previously described and currently observed features of the disease. MATERIAL AND METHODS: Clinical and laboratory data were retrospectively reviewed for 64 patients with confirmed SAT. RESULTS: Mean age of the patients was 42.67 years. The male to female ratio was 1:7. Neck or ear pain was reported by 93.75% of patients, while fever occurred in 65.63% of patients. The aTPO and aTg levels were increased in 15.5% and 33.3% of patients, respectively. TRAb level was increased in 6% of patients. Transient microhaematuria was present in 63% of analyzed cases. No statistically significant differences in clinical characteristics or laboratory results were found between the groups with- and without neck/ear pain, with- and without elevated TRAb, and with- and without elevated aTPO and/or aTg. CONCLUSION: In our study, several new features of current SAT course, different from what we used to know about the disease, were reported. Higher frequency of painless SAT than it was ever described, was observed. Moreover, in as much as one third of the patients aTPO and/or aTg were present, and in 6% of SAT cases the coexistence of TRAb was demonstrated. Transient microhaematuria was typical for the acute SAT phase.


Assuntos
Febre/epidemiologia , Hematúria/epidemiologia , Dor/epidemiologia , Tireoidite Subaguda/epidemiologia , Adulto , Idoso , Anticorpos/imunologia , Comorbidade/tendências , Feminino , Humanos , Iodeto Peroxidase/imunologia , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , Receptores da Tireotropina/imunologia , Estudos Retrospectivos , Tireoglobulina/imunologia , Adulto Jovem
20.
PLoS One ; 14(2): e0211230, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30726277

RESUMO

PURPOSE: We analyzed temporal trends, demographic and clinical characteristics and hospital mortality rates of postoperative pneumonia among type 2 diabetes mellitus (T2DM) patients in Spain from 2001 to 2015. We also compared the incidence, comorbidities and mortality between patients with and without T2DM suffering from postoperative pneumonia. Finally, we analyzed the factors involved in the prediction of in-hospital mortality among patients suffering postoperative pneumonia. METHODS: We used the Spanish National Hospital Discharge Database for the period 2001-2015. We analyzed patients aged 40 years or over who had been hospitalized for a surgical procedure and suffered pneumonia or ventilator-associated pneumonia during their hospital admission. We compared patients with and without T2DM. The main outcome measures were the type of surgical procedure, the presence of a comorbidity, the type of isolated pathogens, admission to the emergency room (ER) and in-hospital mortality (IHM). RESULTS: We selected 117,665 hospitalized patients who suffered postoperative pneumonia (16.9% with T2DM). After multivariable adjustment, T2DM patients had a 21% higher incidence of postoperative pneumonia than nondiabetic patients (IRR 1.21, 95% CI 1.03-1.42). The IHM was approximately 31% in both groups. Predictors of IHM included age, the presence of comorbidities, treatment with a pleural drainage tube, dialysis, blood transfusion, mechanical ventilation and admission to the ER. From 2001 to 2015, the IHM decreased significantly in both populations. Suffering from T2DM was not a predictor of IHM (OR 0.99, 95% CI 0.96-1.03) in our investigation. CONCLUSIONS: T2DM patients have a higher incidence of postoperative pneumonia than those without this disease. The IHM decreased from 2001 to 2015, regardless of T2DM status. T2DM did not predict a higher IHM after suffering from postoperative pneumonia.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Mortalidade Hospitalar , Pneumonia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade/tendências , Diabetes Mellitus Tipo 2/complicações , Serviço Hospitalar de Emergência , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Alta do Paciente/estatística & dados numéricos , Pneumonia/mortalidade , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/mortalidade , Complicações Pós-Operatórias/mortalidade , Espanha/epidemiologia
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