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1.
J Am Heart Assoc ; 9(19): e017297, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-32998607

RESUMO

Background Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) may worsen the prognosis of coronavirus disease 2019, but any association could be confounded by the cardiometabolic conditions indicating ACE-I/ARB use. We therefore examined the impact of ACE-Is/ARBs on respiratory tract infection outcomes. Methods and Results This cohort study included all adult patients hospitalized with influenza or pneumonia from 2005 to 2018 in Denmark using population-based medical databases. Thirty-day mortality and risk of admission to the intensive care unit in ACE-Is/ARBs users was compared with nonusers and with users of calcium channel blockers. We used propensity scores to handle confounding and computed propensity score-weighted risks, risk differences (RDs), and risk ratios (RRs). Of 568 019 patients hospitalized with influenza or pneumonia, 100 278 were ACE-I/ARB users and 37 961 were users of calcium channel blockers. In propensity score-weighted analyses, ACE-I/ARB users had marginally lower 30-day mortality than users of calcium channel blockers (13.9% versus 14.5%; RD, -0.6%; 95% CI, -1.0 to -0.1; RR, 0.96; 95% CI, 0.93-0.99), and a lower risk of admission to the intensive care unit (8.0% versus 9.6%; RD, -1.6%; 95% CI, -2.0 to -1.2; RR, 0.83; 95% CI, 0.80-0.87). Compared with nonusers, current ACE-I/ARB users had lower mortality (RD, -2.4%; 95% CI, -2.8 to -2.0; RR, 0.85; 95% CI, 0.83-0.87), but similar risk of admission to the intensive care unit (RD, 0.4%; 95% CI, 0.0-0.7; RR, 1.04; 95% CI, 1.00-1.09). Conclusions Among patients with influenza or pneumonia, ACE-I/ARB users had no increased risk of admission to the intensive care unit and slightly reduced mortality after controlling for confounding.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Influenza Humana/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Pneumonia/tratamento farmacológico , Sistema Renina-Angiotensina/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Influenza Humana/epidemiologia , Masculino , Razão de Chances , Pandemias , Pneumonia/epidemiologia , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida/tendências
2.
JAMA ; 324(14): 1419-1428, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-33048155

RESUMO

Importance: Coagulopathy may deter physicians from performing a lumbar puncture. Objective: To determine the risk of spinal hematoma after lumbar puncture in patients with and without coagulopathy. Design, Setting, and Participants: Danish nationwide, population-based cohort study using medical registries to identify persons who underwent lumbar puncture and had cerebrospinal fluid analysis (January 1, 2008-December 31, 2018; followed up through October 30, 2019). Coagulopathy was defined as platelets lower than 150 × 109/L, international normalized ratio (INR) greater than 1.4, or activated partial thromboplastin time (APTT) longer than 39 seconds. Exposures: Coagulopathy at the time of lumbar puncture. Main Outcomes and Measures: Thirty-day risk of spinal hematoma. Risks were provided as numbers and percentages with 95% CIs. Secondary analyses included risks of traumatic lumbar puncture (>300 × 106 erythrocytes/L after excluding patients diagnosed with subarachnoid hemorrhage). Adjusted hazard rate ratios (HRs) were computed using Cox regression models. Results: A total of 83 711 individual lumbar punctures were identified among 64 730 persons (51% female; median age, 43 years [interquartile range, 22-62 years]) at the time of the procedure. Thrombocytopenia was present in 7875 patients (9%), high INR levels in 1393 (2%), and prolonged APTT in 2604 (3%). Follow-up was complete for more than 99% of the study participants. Overall, spinal hematoma occurred within 30 days for 99 of 49 526 patients (0.20%; 95% CI, 0.16%-0.24%) without coagulopathy vs 24 of 10 371 patients (0.23%; 95% CI, 0.15%-0.34%) with coagulopathy. Independent risk factors for spinal hematoma were male sex (adjusted hazard ratio [HR], 1.72; 95% CI, 1.15-2.56), those aged 41 through 60 years (adjusted HR, 1.96; 95% CI, 1.01-3.81) and those aged 61 through 80 years (adjusted HR, 2.20; 95% CI, 1.12-4.33). Risks did not increase significantly according to overall severity of coagulopathy, in subgroup analyses of severity of coagulopathy by pediatric specialty or medical indication (infection, neurological condition, and hematological malignancy), nor by cumulative number of procedures. Traumatic lumbar punctures occurred more frequently among patients with INR levels of 1.5 to 2.0 (36.8%; 95% CI, 33.3%-40.4%), 2.1 to 2.5 (43.7%; 95% CI, 35.8%-51.8%), and 2.6 to 3.0 (41.9% 95% CI 30.5-53.9) vs those with normal INR (28.2%; 95% CI, 27.7%-28.75%). Traumatic spinal tap occurred more often in patients with an APTT of 40 to 60 seconds (26.3%; 95% CI, 24.2%-28.5%) vs those with normal APTT (21.3%; 95% CI, 20.6%-21.9%) yielding a risk difference of 5.1% (95% CI, 2.9%-7.2%). Conclusions and Relevance: In this Danish cohort study, risk of spinal hematoma following lumbar puncture was 0.20% among patients without coagulopathy and 0.23% among those with coagulopathy. Although these findings may inform decision-making about lumbar puncture by describing rates in this sample, the observed rates may reflect bias due to physicians selecting relatively low-risk patients for lumbar puncture.


Assuntos
Transtornos da Coagulação Sanguínea/complicações , Hematoma/etiologia , Doenças da Coluna Vertebral/etiologia , Punção Espinal/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos da Coagulação Sanguínea/sangue , Líquido Cefalorraquidiano/química , Criança , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Modelos de Riscos Proporcionais , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Punção Espinal/estatística & dados numéricos , Trombocitopenia/epidemiologia , Fatores de Tempo , Adulto Jovem
3.
BMJ ; 370: m2930, 2020 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-32878745

RESUMO

OBJECTIVE: To evaluate the association between quadrivalent human papillomavirus vaccination and syndromes with autonomic dysfunction, such as chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome. DESIGN: Population-based self-controlled case series. SETTING: Information on human papillomavirus vaccinations and selected syndromes with autonomic dysfunction (chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome) identified using ICD-10 (international classification of diseases, revision 10) diagnostic codes from Danish nationwide registers. PARTICIPANTS: 869 patients with autonomic dysfunction syndromes from a cohort of 1 375 737 Danish born female participants aged 10 to 44 years during 2007-16. MAIN OUTCOME MEASURES: Self-controlled case series rate ratios (95% confidence intervals) of the composite outcome of chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome, adjusted for age and season, comparing female participants vaccinated and unvaccinated with the quadrivalent human papillomavirus vaccine. Chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome were also considered separately in secondary analyses. RESULTS: During 10 581 902 person years of follow-up, 869 female participants with syndromes of autonomic dysfunction (136 with chronic fatigue syndrome, 535 with complex regional pain syndrome, and 198 with postural orthostatic tachycardia syndrome) were identified. Quadrivalent human papillomavirus vaccination did not statistically significantly increase the rate of a composite outcome of all syndromes with autonomic dysfunction in a 365 day risk period following vaccination (rate ratio 0.99, 95% confidence interval 0.74 to 1.32) or the rate of any individual syndrome in the risk period (chronic fatigue syndrome (0.38, 0.13 to 1.09), complex regional pain syndrome (1.31, 0.91 to 1.90), or postural orthostatic tachycardia syndrome (0.86, 0.48 to 1.54)). CONCLUSIONS: When vaccination is introduced, adverse events could occur in close temporal relation to the vaccine purely by chance. These results do not support a causal association between quadrivalent human papillomavirus vaccination and chronic fatigue syndrome, complex regional pain syndrome, or postural orthostatic tachycardia syndrome, either individually or as a composite outcome. An increased risk of up to 32% cannot be formally excluded, but the statistical power of the study suggests that a larger increase in the rate of any syndrome associated with vaccination is unlikely.


Assuntos
Vacinas contra Papillomavirus/efeitos adversos , Disautonomias Primárias/epidemiologia , Disautonomias Primárias/etiologia , Vacinação/efeitos adversos , Adolescente , Adulto , Sistema Nervoso Autônomo/fisiopatologia , Estudos de Casos e Controles , Criança , Estudos de Coortes , Síndromes da Dor Regional Complexa/diagnóstico , Síndromes da Dor Regional Complexa/epidemiologia , Síndromes da Dor Regional Complexa/etiologia , Dinamarca/epidemiologia , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/epidemiologia , Síndrome de Fadiga Crônica/etiologia , Feminino , Humanos , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Síndrome da Taquicardia Postural Ortostática/epidemiologia , Síndrome da Taquicardia Postural Ortostática/etiologia , Disautonomias Primárias/diagnóstico , Adulto Jovem
4.
PLoS One ; 15(9): e0238203, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881877

RESUMO

BACKGROUND: Chronic hepatitis C (CHC) can be eliminated as a public health threat by meeting the WHO targets: 90% of patients diagnosed and 80% treated by 2030. To achieve and monitor progress towards elimination, an updated estimate of the size of the CHC population is needed, but Denmark has no complete national CHC register. By combining existing registers in 2007, we estimated the population living with CHC to be 16,888 (0.38% of the adult population). AIM: To estimate the population living with diagnosed and undiagnosed CHC in Denmark on 31 December 2016. Among additional aims were to estimate the proportion of patients attending specialised clinical care. METHODS: People with diagnosed CHC were identified from four national registers. The total diagnosed population was estimated by capture-recapture analysis. The undiagnosed population was estimated by comparing the register data with data from two cross-sectional surveys. RESULTS: The population living with diagnosed CHC in Denmark was 7,581 persons (95%CI: 7,416-12,661) of which 6,116 (81%) were identified in the four registers. The estimated undiagnosed fraction was 24%, so the total CHC infected population was 9,975 corresponding to 0.21% of the adult population (95%CI: 9,758-16,659; 0.21%-0.36%). Only 48% of diagnosed patients had received specialised clinical care. CONCLUSION: CHC prevalence in Denmark is declining and 76% of patients have been diagnosed. Linking diagnosed patients to care and increasing efforts to test people with former or current drug use will be necessary to achieve CHC elimination.


Assuntos
Hepatite C Crônica/epidemiologia , Adulto , Estudos Transversais , Bases de Dados Factuais , Dinamarca/epidemiologia , Feminino , Hepatite C Crônica/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros
5.
BMJ Open ; 10(9): e039082, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938602

RESUMO

OBJECTIVE: To identify what motivates medical students to join a pandemic emergency healthcare workforce. DESIGN: Cross-sectional study. SETTING: Aalborg University, Denmark. PARTICIPANTS: All medical students. MAIN OUTCOME MEASURES: Motivational points as perceived by the students to be important. Demographic characteristics and 11 motivational domains scored on a Visual Analog Scale from 0 (low) to 100 (high) responding to the question: 'To what degree are the following statements important for you to join a national emergency preparedness workforce?' The questionnaire was developed by an expert panel in a process of four iterations. RESULTS: A total of 486 students of 688 (70.6%) completed the survey within 7 days in March 2020. 80% had decided to join the pandemic emergency healthcare workforce. Ranked median scores for motivational statements in each domain were: care, 100; learn, 90; pride, 83; team, 77; needed, 75; safety, 75; supervision, 75; job, 73; duty, 66; salary, 62; historic, 50. Supervision (p<0.001), salary (p<0.001) and duty (p=0.001) were given increasing priority with advancing study years. Interestingly, students added that support by the university and clarification of study plans were priorities. CONCLUSIONS: Results guide decision-makers and colleagues on how to motivate or reinforce medical students in joining the pandemic emergency healthcare workforce. Importantly, students emphasised protection for themselves.


Assuntos
Atitude do Pessoal de Saúde , Infecções por Coronavirus/epidemiologia , Mão de Obra em Saúde , Motivação , Pneumonia Viral/epidemiologia , Estudantes de Medicina/psicologia , Voluntários/psicologia , Adulto , Betacoronavirus , Comportamento de Escolha , Estudos Transversais , Dinamarca/epidemiologia , Educação Médica , Feminino , Humanos , Masculino , Pandemias , Salários e Benefícios , Inquéritos e Questionários , Adulto Jovem
6.
J Med Internet Res ; 22(9): e19992, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32877352

RESUMO

BACKGROUND: In the absence of a vaccine or effective treatment for COVID-19, countries have adopted nonpharmaceutical interventions (NPIs) such as social distancing and full lockdown. An objective and quantitative means of passively monitoring the impact and response of these interventions at a local level is needed. OBJECTIVE: We aim to explore the utility of the recently developed open-source mobile health platform Remote Assessment of Disease and Relapse (RADAR)-base as a toolbox to rapidly test the effect and response to NPIs intended to limit the spread of COVID-19. METHODS: We analyzed data extracted from smartphone and wearable devices, and managed by the RADAR-base from 1062 participants recruited in Italy, Spain, Denmark, the United Kingdom, and the Netherlands. We derived nine features on a daily basis including time spent at home, maximum distance travelled from home, the maximum number of Bluetooth-enabled nearby devices (as a proxy for physical distancing), step count, average heart rate, sleep duration, bedtime, phone unlock duration, and social app use duration. We performed Kruskal-Wallis tests followed by post hoc Dunn tests to assess differences in these features among baseline, prelockdown, and during lockdown periods. We also studied behavioral differences by age, gender, BMI, and educational background. RESULTS: We were able to quantify expected changes in time spent at home, distance travelled, and the number of nearby Bluetooth-enabled devices between prelockdown and during lockdown periods (P<.001 for all five countries). We saw reduced sociality as measured through mobility features and increased virtual sociality through phone use. People were more active on their phones (P<.001 for Italy, Spain, and the United Kingdom), spending more time using social media apps (P<.001 for Italy, Spain, the United Kingdom, and the Netherlands), particularly around major news events. Furthermore, participants had a lower heart rate (P<.001 for Italy and Spain; P=.02 for Denmark), went to bed later (P<.001 for Italy, Spain, the United Kingdom, and the Netherlands), and slept more (P<.001 for Italy, Spain, and the United Kingdom). We also found that young people had longer homestay than older people during the lockdown and fewer daily steps. Although there was no significant difference between the high and low BMI groups in time spent at home, the low BMI group walked more. CONCLUSIONS: RADAR-base, a freely deployable data collection platform leveraging data from wearables and mobile technologies, can be used to rapidly quantify and provide a holistic view of behavioral changes in response to public health interventions as a result of infectious outbreaks such as COVID-19. RADAR-base may be a viable approach to implementing an early warning system for passively assessing the local compliance to interventions in epidemics and pandemics, and could help countries ease out of lockdown.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Coleta de Dados , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Smartphone , Isolamento Social , Telemedicina , Dispositivos Eletrônicos Vestíveis , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Dinamarca/epidemiologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Monitorização Fisiológica , Países Baixos/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Mídias Sociais , Espanha/epidemiologia , Reino Unido/epidemiologia , Adulto Jovem
7.
PLoS One ; 15(8): e0235781, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760096

RESUMO

BACKGROUND: An association between education and dementia is well-established but it is unclear whether education is associated with dementia after accounting for early life cognitive ability and whether there is a joint effect, such that the risk associated with one of the exposures depends on the value of the other. We examined separate and joint associations of adolescent cognitive ability and educational attainment with risk of dementia among Danish men born between 1939 and 1959. METHODS: Men (N = 477,421) from the Danish Conscription Database were followed for dementia from the age 60 for up to 17 years via patient and prescription registry linkages. Exposure measures included cognitive ability assessed at the conscript board examination around age 18 and highest educational level (low: 0-10 year, medium: 10-13 years, high: ≥13 years) at age 30 from registry records. Associations with dementia diagnosis were estimated in Cox proportional hazards models adjusted for birth year and age at conscript board examination. Interaction was assessed on the multiplicative scale by including a product term between the two exposure measures and on the additive scale by calculating relative excess risk due to interaction (RERI) between different levels of the exposure measures. RESULTS: Compared to men in the high education group hazard ratio [HR] for men in the medium and low group were 1.21 (95% confidence interval [CI]: 1.13, 1.30) and 1.34 (95% CI: 1.24, 1.45), respectively when not adjusting for cognitive ability. Additional adjustment for cognitive ability attenuated the magnitude of the associations, but they remained significant (education medium: HR = 1.10, 95% CI: 1.02, 1.19 and education low: HR = 1.12, 95% CI: 1.02, 1.22). A 10% higher cognitive ability score was associated with a 3.8% lower hazard of dementia (HR = 0.962; 95% CI: 0.957, 0.967), and the magnitude of the association only changed marginally after adjustment for education. Men in the low education group with relatively low cognitive ability were identified as a high-risk subgroup for dementia. The increased risk associated with exposure to both risk factors did, however, not significantly depart from the sum of risk experienced by men only exposed to one of the risk factors (estimates of RERI were not significantly different from 0) and no significant evidence of either additive or multiplicative interactions was found. CONCLUSIONS: In conclusion, the results suggest that education and cognitive ability protect against the risk of dementia independently of one another and that increases in educational attainment may at least partially offset dementia risk due to low cognitive ability.


Assuntos
Desenvolvimento do Adolescente/fisiologia , Cognição/fisiologia , Demência/epidemiologia , Escolaridade , Adolescente , Idoso , Demência/fisiopatologia , Dinamarca/epidemiologia , Seguimentos , Humanos , Testes de Inteligência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros/estatística & dados numéricos , Medição de Risco , Fatores de Risco
9.
Dan Med J ; 67(8)2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32741438

RESUMO

INTRODUCTION: Chemosensory loss is a common symptom of coronavirus disease 2019 (COVID-19) and has been associated with a milder clinical course in younger patients. Whereas several studies have confirmed this association, knowledge about the improvement and recovery of olfactory and gustatory loss is lacking. The aim of this study was to investigate the temporal dynamics of improvement and recovery from sudden olfactory and gustatory loss in patients with confirmed and suspected COVID-19. METHODS: Subjective chemosensory function, symptoms of COVID-19, COVID-19 tests results, demographics and medical history were collected through a questionnaire. RESULTS: Among the 109 study participants, 95 had a combined olfactory and gustatory loss, five participants had isolated olfactory loss and nine participants has isolated taste loss. The mean age of participants was 39.4 years and 25% of participants were under the age of 30 years. Young age was not associated with a higher recovery rate. After a mean time of > 30 days since the chemosensory loss, participants reported relatively low recovery and improvement rates. For participants with olfactory loss, only 44% had fully recovered, whereas 28% had not yet experienced any improvement of symptoms. After gustatory loss, 50% had fully recovered, whereas 20% had not yet experienced any improvement. Olfactory and gustatory deficits were predominantly quantitative and mainly included complete loss of both olfactory and gustatory function. CONCLUSIONS: Chemosensory loss was frequent in young individuals and persisted beyond a month after symptom onset, often without any improvement during this time. FUNDING: The author wishes to acknowledge research salary funding from Arla Foods (Viby, Denmark) and the Central Region Denmark. The sponsors had no say, roles or responsibilities in relation to the study, including (but not limited to) the study design, data collection, management and analysis. TRIAL REGISTRATION: not relevant.


Assuntos
Ageusia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Transtornos do Olfato , Pandemias , Pneumonia Viral , Adulto , Ageusia/diagnóstico , Ageusia/etiologia , Ageusia/reabilitação , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Dinamarca/epidemiologia , Autoavaliação Diagnóstica , Feminino , Humanos , Masculino , Transtornos do Olfato/diagnóstico , Transtornos do Olfato/etiologia , Transtornos do Olfato/reabilitação , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Recuperação de Função Fisiológica , Inquéritos e Questionários , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
10.
Dan Med J ; 67(7)2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32734880

RESUMO

INTRODUCTION: The health authorities have recommended that face-to-face consultations be substituted by telephone consultations to reduce the risk of virus transmission in out-patient clinics during the coronavirus disease 2019 (COVID-19) pandemic. The aim of the present study was to assess the frequency of such telephone consultations and families' evaluations of them in a paediatric outpatient clinic during the initial weeks of the COVID-19 pandemic lockdown. METHODS: During the period from 16 March to 23 April 2020, telephone consultations substituting face-to-face consultations in children and adolescents from 0 to 19 years of age were prospectively recorded. In subsequent telephone interviews, families were asked about their views on the telephone consultation. RESULTS: During the observation period, the clinic had 499 scheduled face-to-face appointments and 112 (22.4%) substitute telephone consultations. A total of 103 families participated in a telephone interview representing 87 (84.5%) children with atopic diseases and 16 (15.5%) with other conditions. A total of 100 (97.0%) of the families agreed or strongly agreed that they felt good about being offered a substitute telephone consultation; 14 (13.6%) said that a telephone consultation was not the best option, whereas 89 (80.4%) would not have preferred a face-to-face consultation; 98 (95.1%) felt that the telephone consultation was useful to them. CONCLUSIONS: A minority of planned face-to-face consultations was substituted by telephone consultations during the COVID-19 pandemic lockdown. Families were satisfied with substitute telephone consultations. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Consulta Remota , Telefone , Adolescente , Betacoronavirus , Criança , Pré-Escolar , Dinamarca/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Adulto Jovem
11.
Lancet ; 396(10249): 489-497, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32798491

RESUMO

BACKGROUND: Childhood is a sensitive period with rapid brain development and physiological growth, and adverse events in childhood might interfere with these processes and have long-lasting effects on health. In this study, we aimed to describe trajectories of adverse childhood experiences and relate these to overall and cause-specific mortality in early adult life. METHODS: For this population-based cohort study, we used unselected annually updated data from Danish nationwide registers covering more than 1 million children born between 1980 and 1998. We distinguished between three different dimensions of childhood adversities: poverty and material deprivation, loss or threat of loss within the family, and aspects of family dynamics such as maternal separation. We used a group-based multi-trajectory clustering model to define the different trajectories of children aged between 0 and 16 years. We assessed the associations between these trajectories and mortality rates between 16 and 34 years of age using a Cox proportional hazards model and an Aalen hazards difference model. FINDINGS: Between Jan 1, 1980 and Dec 31, 2015, 2 223 927 children were included in the Danish Life Course cohort. We excluded 1 064 864 children born after 1998, 50 274 children who emigrated before their 16th birthday, and 11 161 children who died before their 16th birthday, resulting in a final sample of 1 097 628 children. We identified five distinct trajectories of childhood adversities. Compared with children with a low adversity trajectory, those who had early-life material deprivation (hazard ratio 1·38, 95% CI 1·27-1·51), persistent deprivation (1·77, 1·62-1·93), or loss or threat of loss (1·80, 1·61-2·00) had a moderately higher risk of premature mortality. A small proportion of children (36 081 [3%]) had multiple adversities within all dimensions and throughout the entire childhood. This group had a 4·54 times higher all-cause mortality risk (95% CI 4·07-5·06) than that of children with a low adversity trajectory, corresponding to 10·30 (95% CI 9·03-11·60) additional deaths per 10 000 person-years. Accidents, suicides, and cancer were the most common causes of death in this high adversity population. INTERPRETATION: Almost half of Danish children in our study experienced some degree of adversity, and this was associated with a moderately higher risk of mortality in adulthood. Among these, a small group of children had multiple adversities across social, health, and family-related dimensions. This group had a markedly higher mortality risk in early adulthood than that of other children, which requires public health attention. FUNDING: None.


Assuntos
Características da Família , Privação Materna , Mortalidade , Pobreza , Adolescente , Adulto , Causas de Morte , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Modelos de Riscos Proporcionais , Sistema de Registros , Adulto Jovem
12.
Dan Med J ; 67(9)2020 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-32800063

RESUMO

INTRODUCTION: The aim of this study was to describe the clinical symptoms, including affection of sense of smell and taste, among participants in a party held in Copenhagen after which many participants reported symptoms compatible with coronavirus disease 2019 (COVID-19). METHODS: A 37-item questionnaire was sent electronically to all 95 participants seven weeks after the party. The questionnaire included questions about the type, timing and duration of COVID-19 symptoms. RESULTS: In total, 65 of 95 (68%) participants responded, among whom 51/65 (78%) had symptoms compatible with COVID-19; 53% (27/51) had affection of their sense of smell and taste; 70% (19/27) reported a total loss of taste. These symptoms continued for 1-3 weeks for 78% and 3-6 weeks for 22% (6/27). Interestingly, 11/27 (41%) reported that they had not fully regained their sense of taste and 3/27(11%) were still very affected by this symptom. Moreover, 44% of the respondents who had lost their sense of taste perceived this symptom as moderate to severe. Eighty-one percent (22/27) reported a total loss of smell. This symptom continued for 1-3 and > 3 weeks in 74% and 26%, respectively. At the time of the investigation, 48% had not fully regained their sense of smell and 7% were still very affected. More than half of the respondents who lost their sense of smell perceived this symptom as moderate to severe. CONCLUSIONS: Many patients with clinically diagnosed COVID-19 report an affected sense of smell and taste. The duration of these symptoms currently remains unknown. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Transtornos do Olfato/etiologia , Pneumonia Viral/complicações , Olfato/fisiologia , Paladar/fisiologia , Infecções por Coronavirus/epidemiologia , Dinamarca/epidemiologia , Feminino , Humanos , Incidência , Masculino , Transtornos do Olfato/diagnóstico , Transtornos do Olfato/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Inquéritos e Questionários
13.
Dan Med J ; 67(9)2020 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-32800064

RESUMO

INTRODUCTION: Childhood irritant contact dermatitis (ICD) is the most common cause for developing chronic hand eczema as an adult. The COVID-19 reopening in Denmark included regulations introducing frequent hand washing. The aim of the present study was to evaluate if frequent hand washing increases the incidence of ICD in children. METHODS: We conducted an observational study in Denmark during the reopening of schools and daycare facilities for children aged 0-12 years (April 22nd to May 1st 2020). A questionnaire was sent out to parents in four municipalities consisting of 20 questions about frequency of hand washing, use of hand sanitiser, symptoms of ICD, atopic dermatitis, allergy and predispositions. RESULTS: The study included 6,273 children. In children without any prior symptoms of dermatitis, 42.4% experienced ICD (dry, red and itchy skin) due to increased hand hygiene. Schoolchildren had a 1.5 times greater relative risk of developing ICD than preschool children. Frequency of hand washing was a strong risk factor, whereas this was not the case for alcohol-based hand sanitiser. Hand washing 7-10 times/day and >10 times/day increased the relative risk by 1.83 and 2.23 times, respectively. CONCLUSIONS: A higher frequency of hand washing during the COVID-19 reopening increased the incidence of ICD in children. Hand hygiene is essential in our fight against novel coronavirus, but prophylactic initiatives are important to reduce the possible long-term consequences of ICD in children. FUNDING: none TRIAL REGISTRATION: Clinicaltrials.gov (NCT04375410).


Assuntos
Anti-Infecciosos Locais/efeitos adversos , Betacoronavirus , Infecções por Coronavirus/complicações , Dermatite Irritante/etiologia , Pneumonia Viral/complicações , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Dinamarca/epidemiologia , Dermatite Irritante/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pandemias , Pneumonia Viral/epidemiologia
14.
Dan Med J ; 67(9)2020 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-32800066

RESUMO

INTRODUCTION: We explored transmission of the coronavirus disease 2019 (COVID-19) in severely ill patients and analysed the relationship between co-morbidity and mortality or the need for intensive care unit (ICU) care. METHODS: Clinical data, treatment and outcome were analysed in this retrospective study of 101 consecutive patients with COVID-19 admitted to a regional Danish hospital from 2 March 2020, based on data from electronic medical records. RESULTS: The mean age was 71.8 years, 33% were never smokers and 82% had one or more predefined chronic diseases. In-hospital mortality was 30%, and 20% of the patients were offered ICU care. In ICU patients, we found a male preponderance (88% versus 44%, p = 0.006), but death (50% versus 25%, p = 0.053) and other pre-defined co-morbidities did not differ significantly from non-ICU patients. The source of infection was unknown in 74% of patients, related to endemic travel in 10%, hospital acquired in 6% and related to close acquaintances in 11%. COVID-19-related symptoms were initially observed from February 21 (week 8 and week 9) in the first three patients who had no known source of infection. We found that 7% of cases had an increased risk of in-hospital transmission, based on a 7-16 days delay in coronavirus testing. CONCLUSIONS: The frequency of co-morbidity in hospital-admitted COVID-19 patients and the correlation to death and ICU attendance were analysed. In all, 74% of the infection cases were of unknown source during the first weeks of the epidemic, which points to considerable community transmission and possibly pre- or asymptomatic transmission, also several weeks before 21 February 2020. FUNDING: none. TRIAL REGISTRATION: not relevant after correspondence with the Ethics Committee of Region Zealand. Furthermore, permission was granted from The Danish Data Protection Agency, Region Zealand (REG-070-2020).


Assuntos
Betacoronavirus , Infecções por Coronavirus/transmissão , Hospitalização/tendências , Pneumonia Viral/transmissão , Idoso , Infecções por Coronavirus/epidemiologia , Dinamarca/epidemiologia , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Morbidade/tendências , Pandemias , Pneumonia Viral/epidemiologia , Estudos Retrospectivos
15.
Dan Med J ; 67(9)2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32800070

RESUMO

INTRODUCTION: Due to the coronavirus disease 2019 (COVID-19) exposure in Denmark, first-line referral centres were established to handle all patients suspected of COVID-19 or other upper respiratory tract infection. Here we report the first experiences from a first-line referral centre from Amager-Hvidovre Hospital, situated on the outskirts of Copenhagen. METHODS: A retrospective quality assessment was performed with collection of symptom patterns and COVID-19 status. RESULTS: During the first 24 days, a total of 3,551 patients were referred for assessment of symptoms of upper respiratory tract infection and COVID-19. A total of 2,048 patients were assessed as having mild symptoms and referred for COVID-19 testing alone, whereas 337 patients were assessed clinically by a physician. Thirty-seven were positive for COVID-19 infection, 286 were negative. The most common symptoms reported were fever, coughing and dyspnoea. Fever was an independent predictor of COVID-19 infection (odds ratio (OR) = 2.25 (95% confidence interval (CI): 1.08-5.04); p = 0.037); whereas sore throat was not (OR = 0.40 (95% CI: 0.15-0.92); p = 0.045). Only a small number of patients reported loss of taste or anosmia. In total, 113 patients were admitted to hospital, the majority of patients were discharged within 24 hours with mild symptoms of upper respiratory tract infections. Three of the COVID-19-positive patients developed a severe infection and two had a fatal outcome. CONCLUSIONS: The present study is the first to report the experiences and symptom patterns of a COVID-19 first-line referral centre with efficient triage of patients in need of hospitalisation. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Encaminhamento e Consulta , Adulto , Infecções por Coronavirus/diagnóstico , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Estudos Retrospectivos , Índice de Gravidade de Doença
16.
Dan Med J ; 67(9)2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32800073

RESUMO

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is an ongoing pandemic associated with significant morbidity and mortality worldwide. Limited data are available describing the clinical presentation and outcomes of hospitalised COVID-19 patients in Europe. METHODS: This was a single-centre retrospective chart review of all patients with COVID-19 admitted to the North Zealand Hospital in Denmark between 1 March and 4 May 2020. Main outcomes include major therapeutic interventions during hospitalisation, such as invasive mechanical ventilation, as well as death. RESULTS: A total of 115 patients were included, including four infants. The median age of adults was 68 years and 40% were female. At admission, 55 (50%) patients had a fever, 29 (26%) had a respiratory rate exceeding 24 breaths/minute, and 78 (70%) received supplemental oxygen. The prevalence of co-infection was 13%. Twenty patients (18%) (median age: 64 years; 15% female) were treated in the intensive care unit. Twelve (10.4%) received invasive mechanical ventilation and three (2.6%) renal replacement therapy. Nine patients (8%) developed pulmonary embolism. Sixteen patients (14%) died. Among patients requiring mechanical ventilation (n = 12), seven (6.1%) were discharged alive, four (3.4%) died and one (0.9%) was still hospitalised. CONCLUSION: In this cohort of hospitalised COVID-19 patients, mortality was lower than in other Danish and European case series. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Hospitalização/tendências , Unidades de Terapia Intensiva/estatística & dados numéricos , Pandemias , Pneumonia Viral/terapia , Adulto , Idoso , Infecções por Coronavirus/epidemiologia , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Prevalência , Estudos Retrospectivos
18.
PLoS One ; 15(8): e0237375, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780781

RESUMO

BACKGROUND: Multimorbidity is an increasing public health concern and is associated with a range of further adverse outcomes. Identification of disease patterns as well as characteristics of populations affected by multimorbidity is important for prevention strategies to identify those at risk. AIM: The aim of the study was to identify and describe demographic characteristics of multimorbidity classes in three age groups (16-44 years, 45-64 years, and 65+ years). METHODS: Based on register information on 47 chronic diseases and conditions, we used latent class analysis to identify multimorbidity classes in a random sample of the Danish population (n = 470,794). Information on sociodemographic characteristics (age, sex, region of origin, educational level, employment status, and marital status) was obtained from registers and linked to the study population. Age- and sex-adjusted multinomial logistic regression models were used to examine associations between multimorbidity classes and sociodemographic characteristics. RESULTS: We identified seven classes among individuals in the age groups 45-64 years and 65+ years and five classes in the age group 16-44 years. Overall, the classes were similar in the three age groups, but varied in size, i.e. the class 'No or few diseases' was larger in the younger age group. The class 'Many diseases' (a class with both somatic diseases and mental illnesses) was only seen in individuals aged 45-64 years and 65+ years. There were social inequalities in odds of belonging to the multimorbidity classes compared to the healthier class. These social inequalities varied but were especially strong in the classes named 'Many diseases' and 'Mental illness, epilepsy'. CONCLUSION: The results of the study suggest that there are social inequalities in multimorbidity but that these inequalities are not universal to all types of multimorbidity. This supports that multimorbidity is diverse and should be prevented and treated accordingly.


Assuntos
Doença Crônica/epidemiologia , Multimorbidade , Sistema de Registros/estatística & dados numéricos , Adolescente , Adulto , Idoso , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
19.
BMJ ; 370: m2791, 2020 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-32816747

RESUMO

OBJECTIVE: To identify risk factors (air pollution and family related) for the onset of asthma and persistent wheezing in children. DESIGN: Nationwide case-control study. SETTING: Denmark. PARTICIPANTS: All Danish children born from 1997 to 2014 and followed for asthma onset and persistent wheezing from age 1 year to 15 years. MAIN OUTCOME MEASURE: Onset of asthma and persistent wheezing. RESULTS: A higher incidence of asthma was found in children of parents with asthma (adjusted hazard ratio 2.29 (95% confidence interval 2.22 to 2.35) and mothers who smoked during pregnancy (1.20, 1.18 to 1.22), whereas a lower incidence was found in children of parents with high educational attainment (0.72, 0.69 to 0.75) and high incomes (0.85, 0.81 to 0.89). Exposure to particulate matter ≤2.5 µm (PM2.5) and ≤10 µm (PM10) and nitrate was associated with an increased risk of asthma and persistent wheezing, with hazard ratios per 5 µg/m3 increase in pollutant concentrations 1.05 (1.03 to 1.07) for PM2.5, 1.04 (1.02 to 1.06) for PM10, and 1.04 (1.03 to 1.04) for nitrogen dioxide. Only the positive association of PM2.5 with asthma and persistent wheezing remained robust across the different models and in sensitivity analyses. CONCLUSIONS: The findings of this study suggest that children exposed to higher levels of PM2.5 are more likely to develop asthma and persistent wheezing than children who are not exposed. Other risk factors associated with these outcomes were parental asthma, parental education, and maternal smoking during pregnancy.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Asma/epidemiologia , Material Particulado/efeitos adversos , Sons Respiratórios , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Dinamarca/epidemiologia , Escolaridade , Feminino , Humanos , Incidência , Lactente , Masculino , Nitratos/efeitos adversos , Dióxido de Nitrogênio/efeitos adversos , Fatores de Risco , Fumar/efeitos adversos
20.
Epidemiol Psychiatr Sci ; 29: e149, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32744212

RESUMO

AIMS: Widowed people have increased mortality compared to married people of the same age. Although most widowed people are of older age, few studies include the oldest old. As life expectancy is increasing, knowledge of widowhood into older age is needed. This study aimed to examine mortality and widowhood in older age by comparing mortality in widowed and married people by sex, age, time since spousal loss and cause of death. METHODS: A Danish register-based matched cohort study of 10% of widowed persons ⩾65 years in the years 2000-2009. For each randomly drawn widowed person, five married persons were matched on sex and age. Mortality rate ratios (MRR) were calculated using Poisson regression, and stratified according to sex and 5-year age intervals. MRRs were furthermore calculated by time since spousal loss and by specific cause of death. RESULTS: The study included 82 130 persons contributing with 642 914.8 person-years. The overall MRR between widowed and married persons with up to 16 years of follow-up was 1.25 (95% CI 1.23-1.28). At age ⩾95 years for men, and ⩾90 years for women, no differences in mortality rates were seen between widowed and married persons. Mortality in widowed persons was increased for most specific causes of death, with the highest MRR from external causes (MRR 1.53 [1.35-1.74]) and endocrine diseases (MRR 1.51 [1.34-1.70]). CONCLUSIONS: Widowhood was associated with increased mortality in older age for both men and women until age ⩾95 and ⩾90 years, respectively. Increased mortality was observed for almost all causes of death.


Assuntos
Luto , Casamento , Viuvez/psicologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Pesar , Humanos , Masculino , Mortalidade
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