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1.
Rev Lat Am Enfermagem ; 28: e3335, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33027400

RESUMO

OBJECTIVE: to assess the effect of a breastfeeding educational intervention on the counseling provided to postpartum women. METHOD: this is a randomized controlled trial including 104 postpartum women (intervention group = 52 and control group = 52) from a private hospital, whose educational intervention was based on the pragmatic theory and on the use of a soft-hard technology called Breastfeeding Educational Kit (Kit Educativo para Aleitamento Materno, KEAM). Women were followed-up for up to 60 days after childbirth. Chi-Squared Test, Fischer's Exact Test, and Generalized Estimating Equation were used, with a significance level of 5% (p-value <0.05). The analyses were performed using the Statistical Package for the Social Sciences, version 24. RESULTS: the postpartum women in the intervention group had fewer breastfeeding difficulties and a higher percentage of exclusive breastfeeding at all time points compared with those in the control group. CONCLUSION: the educational intervention based on active methodologies and stimulating instructional resources was effective in developing greater practical mastery among postpartum women with regard to adherence and maintenance of exclusive breastfeeding. Registry REBEC RBR - 8p9v7v.


Assuntos
Aleitamento Materno , Período Pós-Parto , Distribuição de Qui-Quadrado , Parto Obstétrico , Feminino , Humanos , Parto , Gravidez
2.
PLoS One ; 15(9): e0238491, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936804

RESUMO

As the most visible face of health expertise to the general public, health agencies have played a central role in alerting the public to the emerging COVID-19 threat, providing guidance for protective action, motivating compliance with health directives, and combating misinformation. Social media platforms such as Twitter have been a critical tool in this process, providing a communication channel that allows both rapid dissemination of messages to the public at large and individual-level engagement. Message dissemination and amplification is a necessary precursor to reaching audiences, both online and off, as well as inspiring action. Therefore, it is valuable for organizational risk communication to identify strategies and practices that may lead to increased message passing among online users. In this research, we examine message features shown in prior disasters to increase or decrease message retransmission under imminent threat conditions to develop models of official risk communicators' messages shared online from February 1, 2020-April 30, 2020. We develop a lexicon of keywords associated with risk communication about the pandemic response, then use automated coding to identify message content and message structural features. We conduct chi-square analyses and negative binomial regression modeling to identify the strategies used by official risk communicators that respectively increase and decrease message retransmission. Findings show systematic changes in message strategies over time and identify key features that affect message passing, both positively and negatively. These results have the potential to aid in message design strategies as the pandemic continues, or in similar future events.


Assuntos
Betacoronavirus , Doenças Transmissíveis Emergentes , Comunicação , Infecções por Coronavirus , Disseminação de Informação/métodos , Pandemias , Pneumonia Viral , Mídias Sociais , Distribuição de Qui-Quadrado , Emergências , Serviços Médicos de Emergência/organização & administração , Órgãos Governamentais , Humanos , Internet , Meios de Comunicação de Massa , Modelos Estatísticos , Modelos Teóricos , Administração em Saúde Pública , Gestão da Segurança , Mídias Sociais/estatística & dados numéricos
3.
Med Sci Monit ; 26: e925591, 2020 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-32917849

RESUMO

BACKGROUND Beginning in the 2020 spring semester, due to the COVID-19 pandemic, all school-age children in China were homeschooled via live/recorded broadcasts, online group communication, and software-based homework submission. This study assessed the effects of and proper preparation for this educational approach. MATERIAL AND METHODS The homeschooling behaviors and feelings of school-age children were assessed with 2010 online surveys obtained separately from students, parents, and teachers of grades 1-9 in 15 Chinese provinces. Answers were compared among low- (grades 1-3), middle- (grades 4-6), and high- (grades 7-9) grade groups. The chi-square test was used to identify significant differences between groups. RESULTS We found that 76% of the respondents thought the homeschooling style was acceptable. However, teachers were concerned that students' interest, focus, and academic performance would decline. Sixty-nine percent of the parents reported their children had more than 3 hours of daily screen time, and 82% of students had less than 2 hours of daily outdoor activity. Ninety-five percent of the parents were concerned about their children's eyesight. Additionally, 17.6% of the students were suspected to have emotional or behavioral problems according to the parent-rated Strengths and Difficulties Questionnaire (SDQ) results. The Self-Rating Anxiety Scale (SAS) results of parents and teachers showed higher levels of anxiety than usual. CONCLUSIONS Students should continue the going-to-school rhythm at home to cope with changes caused by the COVID-19 pandemic. Integrated grade-specific approaches are needed. Because long screen time and insufficient outdoor activities can severely affect children's eyesight, appropriate eye-protection measures should be implemented.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Educação a Distância , Pandemias , Pais/psicologia , Pneumonia Viral/psicologia , Professores Escolares/psicologia , Estudantes/psicologia , Adolescente , Adulto , Distribuição de Qui-Quadrado , Criança , Transtornos do Comportamento Infantil/etiologia , Emoções , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Psicologia da Criança , Quarentena/psicologia , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários , Transtornos da Visão/etiologia
4.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32753371

RESUMO

BACKGROUND AND OBJECTIVES: Although clinical settings are increasingly screening for social determinants of health, essential questions about optimal screening remain. We aimed to assess primary care contexts of individuals choosing not to answer questions about health-related social needs and to compare screening question response with subsequent use of resource information. METHODS: We compared caregiver responses to an electronic survey administered during a child's emergency department visit and through telephone follow-up 2 weeks later by responses to questions about health-related social needs (no social needs endorsed, ≥1 endorsed, none endorsed but ≥1 question not answered). RESULTS: Of 146 respondents, 42 (29%) endorsed ≥1 health-related social need. Additionally, 19 (13%) endorsed no social needs but did not answer ≥1 question. Compared with those denying all social needs and those endorsing ≥1 social need, respondents who did not answer social needs screening questions reported longer duration since their child's last primary care visit, lower perceptions of primary care, and less social support. For the 61 respondents participating in the 2-week follow-up survey, reported use of a community resource packet was 37% among those who had reported a social need, 26% among those who had denied all social needs, and 0% among those who had not answered ≥1 social needs questions. CONCLUSIONS: Clinicians and systems implementing screening for health-related social risks should plan for individuals who choose not to respond to specific items and may also wish to consider strategies that do not rely on screening and disclosure, particularly in communities known to have high prevalence of social needs.


Assuntos
Acesso à Informação , Cuidadores/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Adulto , Cuidadores/psicologia , Distribuição de Qui-Quadrado , Pré-Escolar , Feminino , Seguimentos , Abastecimento de Alimentos/estatística & dados numéricos , Recursos em Saúde/organização & administração , Humanos , Comportamento de Busca de Informação , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Apoio Social , Transportes/estatística & dados numéricos , Adulto Jovem
5.
Rev. Asoc. Odontol. Argent ; 108(2): 52-56, mayo-ago. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1121121

RESUMO

Objetivo: Evaluar radiográficamente 162 tratamientos endodónticos realizados ex vivo en premolares inferiores y superiores humanos mediante el empleo del sistema ProTaper Next por parte de alumnos de grado de una cátedra de endodoncia de una universidad argentina. Materiales y métodos: Se evaluaron 162 tratamientos endodónticos realizados ex vivo durante los años 2017, 2018 y 2019 (54 por cohorte) en premolares inferiores y superiores humanos por alumnos de grado de la cátedra de Endodoncia I de la Escuela de Odontología de la Universidad del Salvador / Asociación Odontológica Argentina. Para la instrumentación fue empleado el sistema ProTaper Next. La muestra se tomó de forma aleatoria. En un programa de presentación de computadora se incluyeron las radiografías periapicales pre- y posoperatoria para su evaluación. Un evaluador externo analizó las imágenes radiográficas de los tratamientos y los categorizó como correctos o incorrectos teniendo en cuenta tres requisitos excluyentes: la conformación de la preparación quirúrgica, el límite apical y la homogeneidad de la obturación. Para el análisis estadístico, se utilizó la frecuencia relativa (intervalo de confianza 95%) y la prueba de chi-cuadrado. Resultados: La evaluación radiográfica de los tratamientos endodónticos realizados mostró un número considerable de tratamientos correctos. Los resultados para cada cohorte (años 2017, 2018 y 2019) fueron del 96,3% (87,2- 99,5%), el 94,4% (84,6-98,8%) y el 98,2% (90,1-99,9%) respectivamente. El porcentaje global de tratamientos correctos fue del 96,3% (92,1-98,6%). La diferencia entre las cohortes no fue estadísticamente significativa (P>0,05). Conclusión: El empleo del sistema ProTaper Next por parte de estudiantes de grado evaluados mostró resultados radiográficamente satisfactorios en la instrumentación ex vivo de conductos radiculares de premolares inferiores y superiores humanos (AU)


Aim: To evaluate radiographically, 162 endodontic treatments performed ex vivo by three cohorts of students from a school of dentistry in Argentina, using ProTaper Next rotatory system in mandibular and maxillary human premolars. Materials and methods: 162 mandibular and maxillary human premolars received endodontic treatment by undergraduate students from the Department of Endodontics I of the School of Dentistry USAL/AOA. The treatments were performed ex vivo during the academic years 2017, 2018 and 2019 (54 teeth were chosen for each cohort) using the rotatory system ProTaper Next. The samples were taken randomly. Pre and postoperative radiographs were included in a computer presentation program for its evaluation. An external examiner analysed the radiographic images by the shape of the preparation, the apical limit, and the homogeneity of the obturation, considering the treatments well obturated (correct) or ill obturated (incorrect). To be considered correct the case had to meet all the requirements. The statistic calculations used in this study were: relative frequency (confidence interval 95%) and the chi-square test. Results: The radiographic evaluation showed a considerable number of endodontic treatments correctly done using ProTaper Next system. The percentages for each cohort were 96.3% (87.2-99.5%), 94.4% (84.6-98.8%) y 98.2% (90.1-99.9%) for years 2017, 2018 y 2019 respectively. Global percentage of correctly endodontic treatments was 96.3% (92.1-98.6%). The difference between the cohorts was not statistically significant (P>0.05). Conclusion: The use of ProTaper Next by the dental students evaluated showed satisfactory results in the ex vivo instrumentation of mandibular and maxillary human premolar root canals (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Tratamento do Canal Radicular/estatística & dados numéricos , Estudantes de Odontologia , Equipamentos Odontológicos de Alta Rotação , Preparo de Canal Radicular/instrumentação , Educação Pré-Odontológica/métodos , Avaliação Educacional , Argentina , Faculdades de Odontologia , Dente Pré-Molar , Distribuição de Qui-Quadrado , Análise Estatística , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(32): e21548, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769893

RESUMO

Novel coronavirus disease (COVID-19) emerged in Wuhan in December 2019, has spread in many countries affected people globally. In response to the economic requirement of the nation and meet the need of patient's, a momentous event was going back to work step by step as fighting against COVID-19. Safety in clinical work is of priority as elective surgery in the department of surgery progressing. We used checklists based on our experiences on COVID-19 control and reality of clinical work from February to March in the West China Hospital, involving events of screening patient, chaperonage, and healthcare workers. Checklist summarized the actual clinical nursing work and management practices, hope to provide a reference for the order of surgery during the epidemic prevention and control, and standardize the clinical nursing work of surgery during pandemic.


Assuntos
Lista de Checagem/métodos , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Controle de Infecções/organização & administração , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Procedimentos Cirúrgicos Vasculares/organização & administração , Distribuição de Qui-Quadrado , China , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Corpo Clínico Hospitalar , Saúde do Trabalhador , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Centro Cirúrgico Hospitalar/organização & administração
7.
Medicine (Baltimore) ; 99(32): e21575, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769903

RESUMO

BACKGROUND: Recent studies showed that Macrophage migration inhibitory factor (MIF) is overexpressed and closely associated with prognosis in cancer patients. The present study was systematically evaluated the prognostic significance of MIF expression in cancer patients. METHODS: PubMed, Cochrane library and Scopus were searched for eligible studies up to January 2020. Pooled hazard ratio with confidence interval (CI) was determined to assess the relationship between MIF expression and survival in cancer patients. RESULTS: A total of 8 studies comprising 847 cancer patients were included in this meta-analysis. For overall survival, the pooled hazard ratio was 2.23 (95% CI 1.67-2.99, P < .001). For disease-free survival, the pooled hazard ratio was 2.24 (95% CI 1.69-2.96, P < .001). The results suggested that high expression of MIF was significantly related to poor overall survival and disease-free survival in cancer patients. CONCLUSION: MIF expression could be a valuable prognostic factor in cancer patients.


Assuntos
Fatores Inibidores da Migração de Macrófagos/análise , Neoplasias/sangue , Prognóstico , Distribuição de Qui-Quadrado , Expressão Gênica/fisiologia , Humanos , Oxirredutases Intramoleculares/análise , Oxirredutases Intramoleculares/sangue , Oxirredutases Intramoleculares/fisiologia , Fatores Inibidores da Migração de Macrófagos/sangue , Fatores Inibidores da Migração de Macrófagos/fisiologia , Neoplasias/fisiopatologia
8.
Medicine (Baltimore) ; 99(32): e21649, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769935

RESUMO

BACKGROUND: An increasing number of studies in recent years have identified mean platelet volume (MPV) as a predictive marker for neonatal sepsis. However, most of these studies focused on single regions, and therefore, the findings remain inconclusive. We, in this study, aimed to evaluate the potential of MPV as a biological indicator of neonatal sepsis through a systematic review and meta-analysis. METHODS: We searched PubMed, the Cochrane Library, Embase, and WanFang database for articles on MPV and neonatal sepsis, published from January 1, 1990 to December 31, 2018. We included 11 studies on 932 neonates with sepsis in this meta-analysis. RESULTS: The overall meta-analysis showed that MPV was significantly higher in patients with neonatal sepsis compared with healthy controls. Subgroup analysis revealed that the type of diagnostic criteria, analyzer, analyte, and controls used in the studies affected the difference in MPV between patients and healthy controls. CONCLUSION: MPV was significantly higher in the neonatal sepsis group compared to the control group. Therefore, in clinical practice, MPV could be used as an indicator for the early diagnosis of neonatal sepsis.


Assuntos
Volume Plaquetário Médio/métodos , Sepse Neonatal/diagnóstico , Prognóstico , Biomarcadores/análise , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Humanos , Recém-Nascido , Volume Plaquetário Médio/normas , Sepse Neonatal/sangue , Valor Preditivo dos Testes
9.
Artigo em Inglês | MEDLINE | ID: mdl-32806775

RESUMO

In South Korea, 4.5% patients of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were readmitted to hospitals after discharge. However, there is insufficient research on risk factors for readmission and management of patients after discharge is poor. In this study, 7590 confirmed coronavirus disease (COVID-19) patients were defined as a target for analysis using nationwide medical claims data. The demographic characteristics, underlying diseases, and the use of medical resources were used to examine the association with readmission through the chi-square test and then logistic regression analysis was performed to analyze factors affecting readmission. Of the 7590 subjects analyzed, 328 patients were readmitted. The readmission rates of men, older age and patients with medical benefits showed a high risk of readmission. The Charlson Comorbidity Index score was also related to COVID-19 readmission. Concerning requiring medical attention, there was a higher risk of readmission for the patients with chest radiographs, computed tomography scans taken and lopinavir/ritonavir at the time of their first admission. Considering the risk factors presented in this study, classifying patients with a high risk of readmission and managing patients before and after discharge based on priority can make patient management and medical resource utilization more efficient. This study also indicates the importance of lifestyle management after discharge.


Assuntos
Infecções por Coronavirus/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Betacoronavirus , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Comorbidade , Coronavirus , Feminino , Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Humanos , Lactente , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , República da Coreia/epidemiologia , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
10.
Respir Res ; 21(1): 163, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600344

RESUMO

OBJECTIVE: This study investigated the influence of Coronavirus Disease 2019 (COVID-19) on lung function in early convalescence phase. METHODS: A retrospective study of COVID-19 patients at the Fifth Affiliated Hospital of Sun Yat-sen University were conducted, with serial assessments including lung volumes (TLC), spirometry (FVC, FEV1), lung diffusing capacity for carbon monoxide (DLCO),respiratory muscle strength, 6-min walking distance (6MWD) and high resolution CT being collected at 30 days after discharged. RESULTS: Fifty-seven patients completed the serial assessments. There were 40 non-severe cases and 17 severe cases. Thirty-one patients (54.3%) had abnormal CT findings. Abnormalities were detected in the pulmonary function tests in 43 (75.4%) of the patients. Six (10.5%), 5(8.7%), 25(43.8%) 7(12.3%), and 30 (52.6%) patients had FVC, FEV1, FEV1/FVC ratio, TLC, and DLCO values less than 80% of predicted values, respectively. 28 (49.1%) and 13 (22.8%) patients had PImax and PEmax values less than 80% of the corresponding predicted values. Compared with non-severe cases, severe patients showed higher incidence of DLCO impairment (75.6%vs42.5%, p = 0.019), higher lung total severity score (TSS) and R20, and significantly lower percentage of predicted TLC and 6MWD. No significant correlation between TSS and pulmonary function parameters was found during follow-up visit. CONCLUSION: Impaired diffusing-capacity, lower respiratory muscle strength, and lung imaging abnormalities were detected in more than half of the COVID-19 patients in early convalescence phase. Compared with non-severe cases, severe patients had a higher incidence of DLCO impairment and encountered more TLC decrease and 6MWD decline.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Músculos Respiratórios/fisiopatologia , Síndrome Respiratória Aguda Grave/diagnóstico , Adulto , Idoso , Distribuição de Qui-Quadrado , China/epidemiologia , Estudos de Coortes , Convalescença , Teste de Esforço , Feminino , Seguimentos , Volume Expiratório Forçado , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Força Muscular , Pandemias , Alta do Paciente , Radiografia Torácica/métodos , Testes de Função Respiratória , Estudos Retrospectivos , Medição de Risco , Síndrome Respiratória Aguda Grave/epidemiologia , Espirometria/métodos , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X/métodos , Capacidade Vital/fisiologia
11.
Medicine (Baltimore) ; 99(29): e21133, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702866

RESUMO

The aim of the study is to discuss the risk factor of right heart failure (RHF) especially the association of iron deficiency with RHF in Tibetan children who live in high altitude area. In this retrospective study, we collected the data of Tibetan children from January 2011 to December 2018 in our hospital. The patients included in the study had the following data: age, gender, ferritin, echocardiography, hemoglobin, C-reaction protein, and altitude of residence. According to whether RHF was diagnosed, the patients were divided into RHF group and non-RHF group. Totally 133 patients were included with 59 in RHF group and 74 in non-RHF group. In single factor analysis, age (P = .008), altitude of residence (P < .001), ferritin (P < .001), and pulmonary arterial systolic pressure (P < .001) showed significant difference between the 2 groups. Binary logistic regression was performed to further identify the association of the clinical factors with RHF. Higher pulmonary arterial systolic pressure (odds ratio: 29.303, 95% confidence interval: 5.249-163.589, P < .001) and lower ferritin level (odds ratio: 5.849, 95% confidence interval: 1.585-21.593, P = .008) were independent risk factors associated with RHF. In receiver-operating characteristic curve, the optimal cutoff value of ferritin level was 14.6 µg/L with the sensitivity of 81.4% and specificity of 89.2%. As continuous variable, the correlation between ferritin and RHF was not certain (P = .281). Due to the possibility that iron deficiency be a risk factor of RHF in Tibetan children, prevention and treatment of iron deficiency might be a potential way in reducing the incidence of RHF in this high altitude area.


Assuntos
Altitude , Anemia Ferropriva/complicações , Insuficiência Cardíaca/etiologia , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/fisiopatologia , Proteína C-Reativa/análise , Distribuição de Qui-Quadrado , Ecocardiografia/métodos , Ecocardiografia/estatística & dados numéricos , Feminino , Ferritinas/análise , Ferritinas/sangue , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Hemoglobinas/análise , Humanos , Lactente , Modelos Logísticos , Masculino , Estudos Retrospectivos , Tibet/epidemiologia , Disfunção Ventricular Direita/sangue , Disfunção Ventricular Direita/epidemiologia , Disfunção Ventricular Direita/etiologia
12.
Medicine (Baltimore) ; 99(29): e21179, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702877

RESUMO

Nowadays most of the hepatitis B virus (HBV) infected population are adults, among which hepatitis B e antigen (HBeAg) negative infection occupied the largest proportion of HBV infection in China. HBeAg-negative patients are heterogeneous, and the corresponding interventions are different. Therefore, it is worth researching the infection characteristics of HBeAg-negative patients to help guide the interventions.A total of 11,738 treatment-naïve HBeAg-negative adult patients were randomly selected, and their demographic and medical history information were collected. The liver biochemistry, and HBV infection biomarkers including hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), HBeAg, hepatitis B e antibody (anti-HBe), hepatitis B core antibody (anti-HBc), and hepatitis B virus deoxyribonucleic acid (HBV-DNA) levels were tested. The infection characteristics and their influencing factors were explored.Sixty percent of the patients presented HBV-DNA-positive, of which 31.2% had HBV-DNA level higher than 2000 IU/mL, and 16.5% had HBV-DNA level higher than 20,000 IU/mL. HBV-DNA levels tended to increase along with the increasing of age, and the male patients had significant higher HBV-DNA levels than the female patients. Twenty-four percent of the patients had abnormal transaminase. The male patients were more vulnerable to abnormal transaminase (30.0%) than the female patients (18.4%). Fifty-five percent patients with HBV-DNA ≥20,000 IU/mL presented abnormal alanine aminotransferase (ALT) or aspartate transaminase (AST), which was significantly higher than that of patients with HBV-DNA levels below 20,000 IU/mL (19.0-21.7%). Multivariate logistic regression analyses revealed that the male patients and the patients with higher viral load had higher risk of having abnormal liver function.A considerable number of HBeAg-negative patients were virological active and had liver damage. It is necessary and urgent to carry out regular active interventions for the chronic HBV-infected patients.


Assuntos
Antígenos E da Hepatite B/análise , Vírus da Hepatite B/classificação , Hepatite B/virologia , Adulto , Idoso , Distribuição de Qui-Quadrado , China , Feminino , Hepatite B/sangue , Antígenos E da Hepatite B/sangue , Vírus da Hepatite B/patogenicidade , Humanos , Fígado/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Testes Sorológicos
13.
BMC Infect Dis ; 20(1): 477, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631257

RESUMO

BACKGROUND: The probability of hospitalization in patients suffering from community-acquired pneumonia (CAP) with an underlying comorbidity, such as a cardiac pathology, is 73-fold higher than that in CAP patients without a comorbidity. Although previous studies have investigated patients with cardiac events and pneumonia, they have not studied the burden of disease in depth at the population level. The objective of this study is to provide population-level data on patients ≥60 years old who were hospitalized with pneumonia with comorbid cardiovascular disease (CVD) in Spain over a period of 19 years (1997-2015). METHODS: This is a retrospective study based on a minimum basic data set (MBDS). The following variables were collected: age, sex, re-admission (yes/no), hospital stay (days), and other diagnoses. Hospitalization rate (per 100,000 inhabitants), mortality rate (per 100,000 inhabitants), and lethality rate (%) were obtained, and the 95% confidence interval of each rate was calculated. Analyses were stratified by age (categorized into 4-year intervals), sex, and year of admission. Differences were assessed for significance with the chi-squared test for proportions and the Poisson model for rates. Logistic regression was run with in-hospital survival as the dependent variable and sex, age, year of admission, and re-admission (yes/no) as the independent variables. The level of significance was p < 0.005. RESULTS: The total number of patients ≥60 years old hospitalized for pneumonia with comorbid CVD was 99,346. The rates of hospitalization, mortality, and lethality increased significantly with age over the 19 years. Men had higher rates of hospitalization and mortality. The probability of a patient with CAP and CVD dying was correlated with male sex, older age, hospital re-admission, and having been hospitalized earlier in the study period. CONCLUSIONS: Community-acquired pneumonia with comorbid cardiovascular disease continues to be a major cause of hospitalization in Spain, especially in the elderly population, making it necessary to develop more preventive strategies for this group of patients.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/mortalidade , Hospitalização , Pneumonia/epidemiologia , Pneumonia/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Comorbidade , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Estudos Retrospectivos , Fatores Sexuais , Espanha/epidemiologia
14.
Ann Surg ; 272(2): 199-205, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675481

RESUMO

OBJECTIVE: The aim of this retrospective study was to compare portal vein embolization (PVE) and radiologica simultaneous portohepatic vein embolization (RASPE) for future liver remnant (FLR) growth in terms of feasibility, safety, and efficacy. SUMMARY OF BACKGROUND DATA: After portal vein embolization (PVE), 15% of patients remain ineligible for hepatic resection due to insufficient hypertrophy of the FLR. RASPE has been proposed to induce FLR growth. MATERIALS AND METHODS: Between 2016 and 2018, 73 patients were included in the study. RASPE was proposed for patients with a ratio of FLR to total liver volume (FLR/TLV) of <25% (RASPE group). This group was compared to patients who underwent PVE for a FLR/TLV <30% (PVE group). Patients in the 2 groups were matched for age, sex, type of tumor, and number of chemotherapy treatments. FLR was assessed by computed tomography before and 4 weeks after the procedure. RESULTS: The technical success rate in both groups was 100%. Morbidity post-embolization, and the time between embolization and surgery were similar between the groups. In the PVE group, the FLR/TLV ratio before embolization was 31.03% (range: 18.33%-38.95%) versus 22.91% (range: 16.55-32.15) in the RASPE group (P < 0.0001). Four weeks after the procedure, the liver volume increased by 28.98% (range: 9.31%-61.23%) in the PVE group and by 61.18% (range: 23.18%-201.56%) in the RASPE group (P < 0.0001). Seven patients in the PVE group, but none in the RASPE group, had postoperative liver failure (P = 0.012). CONCLUSIONS: RASPE can be considered as "radiological associating liver partition and portal vein ligation for staged hepatectomy." RASPE induced safe and profound growth of the FLR and was more efficient than PVE. RASPE also allowed for extended hepatectomy with less risk of post-operative liver failure.


Assuntos
Embolização Terapêutica/métodos , Hepatectomia/métodos , Hepatomegalia/prevenção & controle , Neoplasias Hepáticas/cirurgia , Veia Porta/cirurgia , Cirurgia Assistida por Computador/métodos , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Intervalo Livre de Doença , Feminino , França , Hepatectomia/mortalidade , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
15.
Ann Surg ; 272(2): 241-247, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675536

RESUMO

OBJECTIVE: To determine whether absorbable or nonabsorbable mesh repair of large hiatus hernias is followed by less recurrences at late follow-up compared to sutured repair. SUMMARY OF BACKGROUND DATA: Radiological recurrences have been reported in up to 30% of patients after repair of large hiatus hernias, and mesh repair has been proposed as a solution. Earlier trials have revealed mixed outcomes and early outcomes from a trial reported previously revealed no short-term advantages for mesh repair. METHODS: Multicentre prospective double-blind randomized controlled trial of 3 methods of hiatus hernia repair; sutures versus absorbable mesh versus nonabsorbable mesh. Primary outcome - hernia recurrence assessed by barium meal X-ray and endoscopy at 3-4 years. Secondary outcomes - clinical symptom scores at 2, 3, and 5 years. RESULTS: 126 patients were enrolled - 43 sutures, 41 absorbable mesh, and 42 nonabsorbable mesh. Clinical outcomes were obtained at 5 years in 89.9%, and objective follow-up was obtained in 72.3%. A recurrent hernia (any size) was identified in 39.3% after suture repair, 56.7% - absorbable mesh, and 42.9% - nonabsorbable mesh (P = 0.371). Clinical outcomes were similar at 5 years, except chest pain, diarrhea, and bloat symptoms which were more common after repair with absorbable mesh. CONCLUSIONS: No advantages were demonstrated for mesh repair at up to 5 years follow-up, and symptom outcomes were worse after repair with absorbable mesh. The longer-term results from this trial do not support mesh repair for large hiatus hernias.


Assuntos
Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Telas Cirúrgicas/efeitos adversos , Técnicas de Sutura , Implantes Absorvíveis , Adulto , Análise de Variância , Austrália , Distribuição de Qui-Quadrado , Método Duplo-Cego , Feminino , Seguimentos , Hérnia Hiatal/diagnóstico por imagem , Herniorrafia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Reoperação/métodos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Cicatrização/fisiologia
16.
Ann Surg ; 272(2): 248-252, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675537

RESUMO

BACKGROUND: There is limited evidence for the use of postoperative antibiotics for simple appendicitis (SA) in children. Our aim was to conduct a prospective double-blinded randomized controlled trial to investigate this after a laparoscopic appendicectomy. METHODS: Following ethical approval, children (≤16 years) undergoing appendicectomy were recruited at a single institution. Patients were randomized intraoperatively to receive either 2 postoperative intravenous doses of placebo or antibiotics (Abx). All patients received a dose of Abx at induction of anesthesia. Primary outcome was the incidence of postoperative wound infection (WI), and secondary outcome was the incidence of intra-abdominal abscess formation. Data are reported as number of cases (%), median (range), relative risk, and analyzed using Mann Whitney U test, Chi-square test, as appropriate, a P-value ≤0.05 was considered significant. RESULTS: A total of 304 patients were randomized. Sixty-one were subsequently excluded due to protocol violations or recruitment errors; therefore, 243 were included in the final analysis. One hundred twenty-two patients received placebo and 121 Intravenous Abx. There was no difference between the sex (50F/72 M vs 47F/74 M, P = 0.8), median age (12.4 vs 12.2 years, P = 0.5), and postoperative length of stay in a hospital (27.2 vs 25.6 hours, P = 0.7). There was also no difference in the preoperative blood results. A total of 9 WIs occurred: 8/122 (6.6%) placebo versus 1/121 (0.8%) Abx, P = 0.01 [relative risk for WI 7.9 (95% confidence interval: 1.0-62.4)]. There were no intra-abdominal abscess in either groups. CONCLUSIONS: This prospective randomized double blinded randomized controlled trial has revealed a significant decrease in WI rates by giving 2 postoperative intravenous doses of Abx, suggesting postoperative Abx are of benefit in SA.


Assuntos
Antibacterianos/administração & dosagem , Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Cicatrização/efeitos dos fármacos , Apendicectomia/efeitos adversos , Apendicite/diagnóstico , Austrália , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Método Duplo-Cego , Esquema de Medicação , Feminino , Seguimentos , Humanos , Injeções Intravenosas , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Estudos Prospectivos , Medição de Risco , Estatísticas não Paramétricas , Resultado do Tratamento , Cicatrização/fisiologia
17.
PLoS One ; 15(7): e0233761, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32702026

RESUMO

In decision-making situations individuals rarely have complete information available to select the best option and often show decisional randomness, i.e. given the same amount of knowledge individuals choose different options at different times. Dysfunctional processes resulting in altered decisional randomness can be considered a target process for psychiatric disorders, yet these processes remain poorly understood. Advances in computational modeling of decision-making offer a potential explanation for decisional randomness by positing that decisions are implemented in the brain through accumulation of noisy evidence, causing a generally less preferred option to be chosen at times by chance. One such model, the linear ballistic accumulator (LBA), assumes that individuals accumulate information for each option independently over time and that the first option to reach a threshold will be selected. To investigate the mechanisms of decisional randomness, we applied the LBA to a decision-making task in which risk and expected value (EV) were explicitly signaled prior to making a choice, and estimated separate drift rates for each of the four task stimuli (representing high and low EV and high and low risk). We then used the fitted LBA parameters to predict subject response rates on held-out trials for each of the 6 possible stimulus pairs. We found that choices predicted by LBA were correlated with actual choices across subjects for all stimulus pairs. Taken together, these findings suggest that sequential sampling models can account for decisional randomness on an explicit probabilistic task, which may have implications for understanding decision-making in healthy individuals and in psychiatric populations.


Assuntos
Biologia Computacional/métodos , Tomada de Decisões/fisiologia , Modelos Neurológicos , Modelos Psicológicos , Probabilidade , Assunção de Riscos , Processos Estocásticos , Adolescente , Distribuição de Qui-Quadrado , Comportamento de Escolha , Retroalimentação Psicológica , Feminino , Jogo de Azar , Jogos Experimentais , Humanos , Masculino , Modelos Econômicos , Satisfação Pessoal , Valores Sociais , Estatísticas não Paramétricas , Adulto Jovem
18.
J Am Soc Nephrol ; 31(7): 1398-1408, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32482688

RESUMO

BACKGROUND: Health care-associated infections during previous coronavirus epidemics involving severe acute respiratory syndrome and Middle East respiratory syndrome resulted from human-to-human transmission in hemodialysis (HD) facilities. The effect of a strategy of HD with cohort isolation-separate dialysis sessions for close contacts of patients with confirmed coronavirus disease 2019 (COVID-19)-on the prevention of secondary transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in HD units is unknown. METHODS: Our multicenter cohort study of an HD with cohort isolation strategy enrolled close contacts of patients with confirmed COVID-19, including patients on HD and health care workers in HD units. Close contacts had been identified by epidemiologic investigation and tested negative on an immediate screening test for SARS-CoV-2. RESULTS: As of March 14, 11 patients on HD and 7 health care workers from 11 HD centers were diagnosed as having COVID-19. The immediate screening test was performed in 306 people, and among them, 302 close contacts with negative test results were enrolled. HD with cohort isolation was performed among all close contacts for a median of 14 days in seven centers. During cohort isolation, nine patients showed symptoms but tested negative for SARS-CoV-2. Two health care workers in the HD units (0.66% of the total group) were diagnosed at the termination test for SARS-CoV-2. CONCLUSIONS: The transmission of COVID-19 can be controlled without closure of HD centers by implementing preemptive activities, including early detection with rapid testing, cohort isolation, collaboration between institutions, and continuous monitoring of infection. Our strategy and experience may provide helpful guidance for circumstances involving the rapid spread of infectious diseases such as COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Transmissão de Doença Infecciosa/prevenção & controle , Falência Renal Crônica/terapia , Isolamento de Pacientes/organização & administração , Pneumonia Viral/epidemiologia , Diálise Renal/métodos , Adulto , Distribuição de Qui-Quadrado , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Incidência , Controle de Infecções/organização & administração , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Saúde do Trabalhador , Pandemias , Segurança do Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Avaliação de Programas e Projetos de Saúde , Diálise Renal/estatística & dados numéricos , República da Coreia/epidemiologia , Estudos Retrospectivos , Medição de Risco , Prevenção Secundária/organização & administração , Estatísticas não Paramétricas , Taxa de Sobrevida
19.
Medicine (Baltimore) ; 99(26): e20830, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590771

RESUMO

To identify the clinical risk factors and investigate the efficacy of a classification model based on the identified factors for predicting 2-year recurrence after ischemic stroke.From June 2017 to January 2019, 358 patients with first-ever ischemic stroke were enrolled and followed up in Shenzhen Traditional Chinese Medicine Hospital. Demographic and clinical characteristics were recorded by trained medical staff. The outcome was defined as recurrence within 2 years. A multivariate logistic regression model with risk factors and their interaction effects was established and evaluated.The mean (standard deviation) age of the participants was 61.6 (12.1) years, and 101 (28.2%) of the 358 patients were female. The common comorbidities included hypertension (286 patients, 79.9%), diabetes (148 patients, 41.3%), and hyperlipidemia (149 patients, 41.6%). The 2-year recurrence rate was 30.7%. Of the 23 potential risk factors, 10 were significantly different between recurrent and non-recurrent subjects in the univariate analysis. A multivariate logistic regression model was developed based on 10 risk factors. The significant variables include diabetes mellitus, smoking status, peripheral artery disease, hypercoagulable state, depression, 24 h minimum systolic blood pressure, 24 h maximum diastolic blood pressure, age, family history of stroke, NIHSS score status. The area under the receiver operating characteristic curve (ROC) was 0.78 (95% confidence interval: 0.726-0.829) with a sensitivity of 0.61 and a specificity of 0.81, indicating a potential predictive ability.Ten risk factors were identified, and an effective classification model was built. This may aid clinicians in identifying high-risk patients who would benefit most from intensive follow-up and aggressive risk factor reduction.The clinical trial registration number: ChiCTR1800019647.


Assuntos
Isquemia Encefálica/classificação , Recidiva , Acidente Vascular Cerebral/classificação , Idoso , Isquemia Encefálica/epidemiologia , Distribuição de Qui-Quadrado , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Curva ROC , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo
20.
Medicine (Baltimore) ; 99(26): e20836, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590774

RESUMO

INTRODUCTION: Postoperative pulmonary complications (PPCs) are common and associated with increased morbidity, mortality, and medical cost. They are gaining increasing concerns among patients receiving neurological surgery. Chronic obstructive pulmonary disease (COPD) affect a large section of whole population and is also one of the risk factors of PPCs in the perioperative setting. Ipratropium bromide is the inhalation solution for the treatment of COPD. Studies showed the perioperative nebulization of ipratropium bromide could increase the lung function and decrease the incidence of postoperative pneumonia in COPD patients underwent thoracic surgery. The purpose of this study is to investigate the effect of perioperative nebulization of ipratropium bromide on PPCs in COPD patients underwent neurosurgical surgery. METHODS AND ANALYSIS: This study is a multicenter retrospective study in China. Patients who meet the inclusion/exclusion criteria are selected from 7 neurosurgical centers in China. According to whether ipratropium bromide is used in perioperative period, the patients are divided into exposure group and control group. The primary outcome is the incidence of postoperative pneumonia. Secondary outcomes are unplanned intubation, postoperative mechanical ventilation ≥ 48 hours, respiratory failure, atelectasis, death, and length of stay. ETHICS AND DISSEMINATION: This study was approved by the ethics committee (EC) of the School of Public Health, Fudan University, Shanghai, China. Waived by the ethics committee, no written consent form was obtained since we used the registry data. The study results will be communicated via publication. TRIAL REGISTRATION NUMBER: ChiCTR1900022552.


Assuntos
Craniotomia/efeitos adversos , Dispneia/tratamento farmacológico , Ipratrópio/normas , Complicações Pós-Operatórias/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Broncodilatadores/normas , Broncodilatadores/uso terapêutico , Distribuição de Qui-Quadrado , China/epidemiologia , Craniotomia/métodos , Feminino , Humanos , Ipratrópio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos
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